reglab/statecodes huggingface dataset:
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 310 - VARIABLE ANNUITY RULE › Article IX - Reports to Policyholders › Section 031-310-IX-2 - Report of contractholder's accumulation units credited to such contracts

Current through 2024-29, July 17, 2024
Any insurer issuing individual variable annuity contracts
					 in this state shall mail to the contractholder in the case of an annuity
					 contract under which annuity payments have not yet commenced, a statement
					 reporting the number of accumulation units credited to such contract, the
					 dollar value of a unit, and the value of the contractholder's account; a
					 similar report shall be given to persisting contractholders at least once in
					 each contract year after the first at his last address known to the insurer.
					 Those reports to persisting contractholders shall reflect values not less
					 current in time than four months previous to the date of mailing.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 310 - VARIABLE ANNUITY RULE › Article X - Foreign Companies

Current through 2024-29, July 17, 2024
If the law or regulation in the place of domicile of a
				  foreign company provides a degree of protection to the policyholders and the
				  public which is substantially similar to that provided by these regulations,
				  the Superintendent to the extent deemed appropriate by him or her may consider
				  compliance with such law or regulation as compliance with this rule.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 310 - VARIABLE ANNUITY RULE › Article XI - Authorization of Agents for the Sale of Variable Annuities › Section 031-310-XI-1 - Qualification to sell variable annuities

Current through 2024-29, July 17, 2024
No person may sell or offer for sale in this state any
					 variable annuity contract unless such person is a variable annuity agent and
					 has filed with the Superintendent, in a form satisfactory to the
					 Superintendent, evidence that such person holds appropriate license or
					 authorization which may be required for the solicitation or sale of variable
					 annuity contracts.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 310 - VARIABLE ANNUITY RULE › Article XI - Authorization of Agents for the Sale of Variable Annuities › Section 031-310-XI-2 - Reports of disciplinary actions

Current through 2024-29, July 17, 2024
Any person authorized in this state under applicable law to
					 sell or offer to sell variable annuities shall immediately report to the
					 Bureau:
a. any suspension or
				  revocation of his or her agent's license in any other state or territory of the
				  United States;
b. the imposition of
				  any disciplinary sanction, including suspension or expulsion from membership,
				  suspension, or revocation of or denial of registration, imposed upon him by any
				  national securities exchange, or national securities association, or any
				  federal, state, or territorial agency with jurisdiction over securities or
				  variable annuities; and
c. any
				  judgment or injunction entered against him or her on the basis of conduct
				  deemed to have involved fraud, deceit, misrepresentation, or violation of any
				  insurance or securities law or regulation.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 310 - VARIABLE ANNUITY RULE › Article XI - Authorization of Agents for the Sale of Variable Annuities › Section 031-310-XI-3 - Refusal to qualify agent to sell variable annuities or suspension, revocation, or nonrenewal of authority

Current through 2024-29, July 17, 2024
The Superintendent may reject any application or refuse to
					 renew or initiate proceedings to suspend or revoke any agent's authority to
					 sell or offer to sell variable annuities for cause including that which would
					 bar such applicant or such agent from being licensed to sell other such
					 insurance contracts in this state.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 310 - VARIABLE ANNUITY RULE › Article XII - Separability

Current through 2024-29, July 17, 2024
If any provision of this rule or the application thereof to
				  any person or circumstance is for any reason held to be invalid, the remainder
				  of the rule and the application of such provision to other persons or
				  circumstances shall not be affected thereby.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 320 - MINIMUM STANDARDS FOR ALCOHOLISM AND DRUG DEPENDENCY BENEFITS › Section 031-320-1 - AUTHORITY

Current through 2024-29, July 17, 2024
This rule is promulgated by the Superintendent pursuant to
				  Title
				  24 M.R.S.A.,
				  Sections2325-A and
				  2329
				  and Title
				   24-A M.R.S.A.,
				  Sections212,
				  2842,
				  2843
				  and
				  4234-A.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 320 - MINIMUM STANDARDS FOR ALCOHOLISM AND DRUG DEPENDENCY BENEFITS › Section 031-320-2 - Purpose

Current through 2024-29, July 17, 2024
The purpose of this Rule is to clarify the requirements of
				  Title
				  24 M.R.S.A.,
				  Sections2325-A and
				  2329
				  and Title
				  
				  24-A M.R.S.A., Sections2842,
				  2843
				  and
				  4234-A,
				  by establishing standards to assure equitable health care for the treatment of
				  alcoholism and drug dependency.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 320 - MINIMUM STANDARDS FOR ALCOHOLISM AND DRUG DEPENDENCY BENEFITS › Section 031-320-3 - Scope

Current through 2024-29, July 17, 2024
This rule applies to all policies subject to Title
				   24 M.R.S.A.,
				  Sections2325-A and
				  2329,
				  and Title
				  
				  24-A M.R.S.A., Sections2842 and
				  2843.
				  Pursuant to those sections, this rule does not apply to employee group
				  insurance policies issued to employers with 20 or fewer employees insured under
				  the group policy. This rule does apply to other types of groups, such as
				  association groups, regardless of size. This rule does not apply to health
				  maintenance organizations.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 320 - MINIMUM STANDARDS FOR ALCOHOLISM AND DRUG DEPENDENCY BENEFITS › Section 031-320-4 - Definitions

Current through 2024-29, July 17, 2024
For purposes of this Rule, the following terms have the
				  following meaning:
A. "Usual Charge"
				means the most consistent charge by a provider for a given service.
B. "Customary Charge" means a charge within
				the range of usual charges for a given service billed by most providers with
				similar training and experience taking into consideration the geographic area
				in which the services are provided and significant regional variations in the
				cost of services.
C. "Reasonable
				Charge" means a charge that is not more than the usual and customary
				charge.
D. "Allowable Charge" means
				the amount which would be payable for services of a preferred provider under a
				preferred provider arrangement prior to the application of any deductible or
				coinsurance.
E. "Residential
				Treatment" means those services defined by Title 24, Section 2329, subsection
				2, paragraph B, or Title
				
				24-A M.R.S.A., Section2842, subsection
				2,
				paragraph B, whether billed by the facility or by a physician or other
				professional.
F. "Non-residential
				Day Treatment" means a program of outpatient care involving visits of more than
				two hours but less than 24 hours per day, at least three days per
				week.
G. "Substance Abuse" means
				the illnesses of alcoholism and drug dependency as those terms are used in
				2329, and 2842 Section .
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 320 - MINIMUM STANDARDS FOR ALCOHOLISM AND DRUG DEPENDENCY BENEFITS › Section 031-320-5 - Policies subject to parity requirements

Current through 2024-29, July 17, 2024
A.
				Pursuant to Title
				24 M.R.S.A.,
				Section2325-A(5-C) and Title
				 24-A M.R.S.A.,
				Section2843(5-C), all group
				contracts subject to this Rule, except to the extent they cover employees of
				employers with 20 or fewer employees, must provide the same level of benefits
				for the treatment of substance abuse-related disorders as for treatment of
				physical illnesses.
B. With respect
				to residential treatment, the benefit level must be at least the greater of:
(1) The same level of benefits, if any,
				provided for residential treatment of physical illnesses; or
(2) Benefits meeting the following
				requirements:
a. Annual Maximum. The policy
				must provide residential treatment benefits for substance abuse of at least 30
				days per calendar year or, if less, the total number of inpatient days allowed
				by the policy for all illnesses.
b.
				Coinsurance. The minimum level of benefits provided for residential treatment
				for substance abuse must be at least 90 percent of the charges or, if less, the
				percentage applicable to inpatient benefits.
c. Maximum Lifetime Residential Benefits. The
				policy may contain a lifetime maximum limit on the number of covered days for
				residential treatment of substance abuse of not less than 60 days.
This subsection applies only to residential treatment as
				  defined by
				  
				  24-A M.R.S.A.
				  Section2842(2)(B) that does
				  not also meet the definition of "inpatient services" in
				   24-A M.R.S.A.
				  Section2843(3)(B). Inpatient
				  services must be covered at the same benefit level as for physical
				  illnesses.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 320 - MINIMUM STANDARDS FOR ALCOHOLISM AND DRUG DEPENDENCY BENEFITS › Section 031-320-6 - Minimum benefits for policies not subject to parity requirements

Current through 2024-29, July 17, 2024
This section applies only to policies that are subject to
				  this rule but are not subject to the parity requirements of Title
				   24-A M.R.S.A.,
				  Section2843(5-C). Most
				  policies subject to this rule will be subject to the parity requirements and
				  not to this section. The exception is group policies other than employee
				  groups, such as association groups, to the extent they cover employees of
				  employers with 20 or fewer employees. Except as provided by Section
				  7, any policy subject to this section
				  will be deemed to be in compliance with the requirements of Title
				  
				  24-A M.R.S.A., Section2842 if it provides, at
				  a minimum, the following benefits for a covered person suffering from substance
				  abuse:
A. Residential Treatment and
				Non-residential Day Treatment.
(1) Annual
				Maximum. The policy must provide residential treatment benefits for substance
				abuse of at least 30 days per calendar year. However, in no case need the total
				number of inpatient days allowed by the policy for all illnesses be exceeded.
				Two days of non-residential day treatment shall be counted as one day of
				residential treatment.
(2)
				Coinsurance. The minimum level of benefits provided for substance abuse must be
				at least the lesser of 90 percent of the charges or the level of benefits
				provided for any other illness. The coinsurance provision, if any, shall be
				administered uniformly regardless of whether services are rendered in a
				hospital or other residential or non-residential facility.
(3) Maximum Lifetime Residential Benefits.
				The policy may contain a lifetime maximum limit on the number of covered days
				for residential treatment of substance abuse of not less than 60 days. Two days
				of non-residential treatment shall be counted as one day of residential
				treatment. Services for each admission shall be according to a treatment
				plan.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 320 - MINIMUM STANDARDS FOR ALCOHOLISM AND DRUG DEPENDENCY BENEFITS › Section 031-320-7 - Major medical policy

Current through 2024-29, July 17, 2024
This section applies only to policies that are subject to
				  this rule but are not subject to the parity requirements of Title
				   24-A M.R.S.A.,
				  Section2843(5-C). Most
				  policies subject to this rule will be subject to the parity requirements and
				  not to this section. The exception is group policies other than employee
				  groups, such as association groups, to the extent they cover employees of
				  employers with 20 or fewer employees. Any supplemental major medical Policy
				  subject to this section will be deemed to be in compliance with the
				  requirements of Title
				  
				  24-A M.R.S.A., Section2842 if it provides, at
				  a minimum, the benefits provided under Section
				  5 above less an amount equal to the
				  covered charges used to determine the benefit provided by any base coverage
				  provided the same group, by an insurer or non-profit and/or hospital medical
				  services organization. Although a supplemental major medical policy must
				  contain the minimum required benefits, it is the intent of the Rule that a
				  person covered under both base coverage and a supplemental major medical policy
				  not be entitled to "stack" the substance abuse benefits of the two policies.
				  The two policies combined need not provide, in the aggregate, more than the
				  minimum required benefits.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 320 - MINIMUM STANDARDS FOR ALCOHOLISM AND DRUG DEPENDENCY BENEFITS › Section 031-320-8 - Non-profit hospital or medical service corporation

Current through 2024-29, July 17, 2024
This section applies only to contracts that are subject to
				  this rule but are not subject to the parity requirements of Title
				   24 M.R.S.A.,
				  Section2325-A(5-C). Most
				  contracts subject to this rule will be subject to the parity requirements and
				  not to this section. The exception is group contracts other than employee
				  groups, such as association groups, to the extent they cover employees of
				  employers with 20 or fewer employees. For purposes of this Rule, group
				  contracts issued jointly by a nonprofit hospital service corporation and a
				  nonprofit medical service corporation will be considered as one
				  contract.
Any group contract subject to this section will be deemed to
				  be in compliance with
				  
				  24M.R.S.A. Section2329, if it provides, at a
				  minimum, the following benefits for a covered person suffering from substance
				  abuse:
A. Residential Treatment and
				Non-residential Day Treatment.
(1) Annual
				Maximum. The contract must provide residential treatment benefits for substance
				abuse of at least 30 days per calendar year. However, in no case need the total
				number of inpatient days allowed by the contract for all illnesses be exceeded.
				Two days of non-residential day treatment shall be counted as one day of
				residential treatment.
(2)
				Coinsurance. The minimum level of benefits provided for substance abuse must be
				at least the lesser of 90 percent of the charges or the level of benefits
				provided for any other illness. The coinsurance provision, if any, shall be
				administered uniformly regardless of whether services are rendered in a
				hospital or other residential or non-residential facility.
(3) Maximum Lifetime Residential Benefits.
				The contract may contain a lifetime maximum limit on the number of covered days
				for residential treatment of substance abuse of not less than 60 days. Two days
				of non-residential treatment shall be counted as one day of residential
				treatment. Services for each admission shall be according to a treatment
				plan.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 320 - MINIMUM STANDARDS FOR ALCOHOLISM AND DRUG DEPENDENCY BENEFITS › Section 031-320-9 - Coordination with Medicare

Current through 2024-29, July 17, 2024
Any policy or contract subject to this Rule may limit or
				  exclude benefits for substance abuse treatment services to the extent benefits
				  would otherwise duplicate and be secondary to benefits provided by the United
				  States Health Insurance for by the Aged Act, Title XVIII of the Social Security
				  Amendments of 1965, Public Law 89-97 as amended (Medicare). To the extent
				  Medicare may provide benefits for substance abuse less than the minimum
				  required by this Rule, contracts and policies other than Medicare supplement
				  policies subject to Title 24-A M.R.S.A., Chapter 67, must cover the difference
				  between Medicare and minimum required benefits.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 320 - MINIMUM STANDARDS FOR ALCOHOLISM AND DRUG DEPENDENCY BENEFITS › Section 031-320-10 - Effective date

Current through 2024-29, July 17, 2024
The provisions of this Rule are effective June 1, 1984. The
				  1993 amendments to this Rule apply to policies and certificates executed,
				  delivered, issued for delivery, or renewed on or after July 15, 1993. The 2004
				  amendments to this rule are effective March 1, 2004.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 330 - MINIMUM STANDARDS FOR MENTAL ILLNESS BENEFITS - REVISED › Section 031-330-1 - AUTHORITY

Current through 2024-29, July 17, 2024
This Rule is promulgated by the Superintendent pursuant to
				  24 M.R.S.A. §
										2325-A, 24-A M.R.S.A. § 284324-A
				  M.R.S.A. § 4234-A, and
				   24-A M.R.S.A.
				  §212.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 330 - MINIMUM STANDARDS FOR MENTAL ILLNESS BENEFITS - REVISED › Section 031-330-2 - Purpose

Current through 2024-29, July 17, 2024
The purpose of this Rule is to clarify the requirements of
				  24 M.R.S.A. §
										2325-A, 24-A M.R.S.A. § 284324-A and
				  M.R.S.A. § 4234-A by establishing standards to assure equitable health
				  care for the treatment of mental illness or nervous
				  conditions.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 330 - MINIMUM STANDARDS FOR MENTAL ILLNESS BENEFITS - REVISED › Section 031-330-3 - Scope

Current through 2024-29, July 17, 2024
This Rule applies to all policies subject to
				  24 M.R.S.A. §
										2325-A, 24-A M.R.S.A. § 24-AM.R.S.A.
				  § 2843 and 24-A M.R.S.A. § 4234-A. Pursuant to those sections, this
				  rule does not apply to employee group insurance policies issued to employers
				  with 20 or fewer employees insured under the group policy. This rule does apply
				  to other types of groups, such as association groups, and to all group HMO
				  contracts, regardless of size. Nothing in this Rule requires benefit levels or
				  maximum lifetime or annual benefits for treatment of mental illness that exceed
				  the highest benefit levels payable for other covered illnesses and
				  diseases.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 330 - MINIMUM STANDARDS FOR MENTAL ILLNESS BENEFITS - REVISED › Section 031-330-4 - Definitions

Current through 2024-29, July 17, 2024
For purposes of this Rule, the following terms shall have the
				  following meanings:
A. "Usual Charge"
				means the most consistent charge by a provider for a given service.
B. "Customary Charge" means a charge within
				the range of usual charges for a given service billed by most providers with
				similar training and experience taking into consideration the geographic area
				in which the services are provided and significant regional variations in the
				cost of services.
C. "Reasonable
				Charge" means a charge that is not more than the usual and customary
				charge.
D. "Allowable Charge" means
				the amount which would be payable for services of a preferred provider under a
				preferred provider arrangement prior to the application of any deductible or
				coinsurance.
E. "Inpatient
				Services" means those services defined by 24 § 2325-A,
				 24-A M.R.S.A.
				§2843, subsection
				3,
				paragraph B, or
				 24-A M.R.S.A.
				§4234-A, subsection
				5,
				paragraph A, whether billed by the facility or by a physician or other
				professional.
F. "Large Employer"
				means an employer who employed an average of at least 51 employees, including
				part-time employees, on business days during the preceding calendar year and
				who employs at least two employees on the first day of the plan year.
G. "Home Health Care Services" means those
				services rendered by a licensed provider of mental health services to provide
				medically necessary health care to a person suffering from a mental illness in
				the person's place of residence if:
1.
				Hospitalization or confinement in a residential treatment facility would
				otherwise have been required if home health care services were not
				provided;
2. Hospitalization or
				confinement in a residential treatment facility is not required as an
				antecedent to the provision of home health care services; and
3. The services are prescribed in writing by
				a licensed allopathic or osteopathic physician or a licensed psychologist who
				is trained and has received a doctorate in psychology specializing in the
				evaluation and treatment of mental illness.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 330 - MINIMUM STANDARDS FOR MENTAL ILLNESS BENEFITS - REVISED › Section 031-330-5 - Minimum Benefits

Current through 2024-29, July 17, 2024
Treatment for the mental illnesses listed in
				   24-A M.R.S.A.
				  §2843(5-C) must be
				  covered at the same level of benefits as for treatment of physical illnesses
				  ("parity"). Most mental illnesses fall into this category. The standards set
				  forth in this section apply to other "unlisted" mental illnesses and to all
				  mental illnesses under policies and certificates that are subject to this rule
				  but exempt from the parity requirement. Policies subject to this rule but
				  exempt from the parity requirement are group policies other than employee
				  groups, such as association groups, to the extent they cover employees of
				  employers with 20 or fewer employees. With respect to these unlisted conditions
				  and exempt policies and certificates, and except as provided by Section
				  6, any policy subject to this Rule
				  will be deemed to be in compliance with the requirements of
				   24-A M.R.S.A.
				  §2843 if it provides, at a minimum, the
				  following benefits for a covered person suffering from a mental illness or
				  nervous condition:
A. Inpatient and
				Day Treatment Care.
1. Annual Minimum. The
				policy must provide inpatient benefits for mental illness of at least 30 days
				per calendar year. However in no case need the total number of inpatient days
				allowed by the policy for all illnesses be exceeded. For purposes of this
				paragraph, two days of day treatment will be considered equivalent to one day
				of inpatient care.
2. Coinsurance.
				The minimum level of benefits provided for mental illness must be at least the
				lesser of 80% of the charges or the highest level of benefits provided for
				other covered illnesses.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 330 - MINIMUM STANDARDS FOR MENTAL ILLNESS BENEFITS - REVISED › Section 031-330-6 - Supplemental Major Medical Policy

Current through 2024-29, July 17, 2024
Any supplemental major medical policy subject to this Rule
				  will be deemed to be in compliance with the requirements of
				   24-A M.R.S.A.
				  §2843, if it provides, at a minimum, the
				  benefits provided under Section
				  5 above less an amount equal to the
				  covered charges used to determine the benefit provided by any base coverage
				  provided the same group by an insurer or nonprofit hospital and/or medical
				  service organization. Although a supplemental major medical policy must contain
				  the minimum required benefits, it is the intent of the Rule that a person
				  covered under both base coverage and a supplemental major medical policy not be
				  entitled to "stack" the mental illness benefits of the two policies. The two
				  policies combined need not provide, in the aggregate, more than the minimum
				  required benefits.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 330 - MINIMUM STANDARDS FOR MENTAL ILLNESS BENEFITS - REVISED › Section 031-330-7 - Nonprofit Hospital or Medical Service Corporation

Current through 2024-29, July 17, 2024
For purposes of this Rule group contracts issued jointly by a
				  nonprofit hospital service corporation and a nonprofit medical service
				  corporation will be considered as one contract.
Treatment for the mental illnesses listed in
				   24 M.R.S.A.
				  §2325-A(5-C) must be
				  covered at the same level of benefits as for treatment of physical illnesses
				  ("parity"). Most mental illnesses fall into this category. The standards set
				  forth in this section apply to other "unlisted" mental illnesses and to all
				  mental illnesses under contracts and certificates that are subject to this rule
				  but exempt from the parity requirement. Contracts subject to this rule but
				  exempt from the parity requirement are group contracts other than employee
				  groups, such as association groups, to the extent they cover employees of
				  employers with 20 or fewer employees. With respect to these unlisted conditions
				  and exempt contracts and certificates, any group contract subject to this Rule
				  will be deemed to be in compliance with
				   24 M.R.S.A.
				  §2325-A, if it provides, at a minimum,
				  the following benefits for a covered person suffering from mental illness or
				  nervous condition:
A. Inpatient and
				Day Treatment Care.
1. Annual Maximum. The
				contract must provide inpatient benefits for mental illness of at least 30 days
				per calendar year. However in no case need the total number of inpatient days
				allowed by the contract for all illnesses be exceeded. For purposes of this
				paragraph, two days of day treatment will be considered equivalent to one day
				of inpatient care.
2. Coinsurance.
				The minimum level of benefits provided for mental illness must be at least the
				lesser of 80% of the charges or the highest level of benefits provided for
				other covered illnesses.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 330 - MINIMUM STANDARDS FOR MENTAL ILLNESS BENEFITS - REVISED › Section 031-330-8 - Health Maintenance Organizations

Current through 2024-29, July 17, 2024
Treatment for certain mental illnesses listed in
				   24-A M.R.S.A.
				  §4234-A(6) must be
				  covered at the same level of benefits as for treatment of physical illnesses
				  ("parity"). Most mental illnesses fall into this category. The standards set
				  forth in this section apply to other "unlisted" mental illnesses and to all
				  mental illnesses under contracts and certificates that are subject to this rule
				  but exempt from the parity requirement. Contracts subject to this rule but
				  exempt from the parity requirement are group contracts to the extent they cover
				  employees of employers with 20 or fewer employees. With respect to these
				  unlisted conditions and exempt contracts and certificates, any group contract
				  subject to this Rule will be deemed to be in compliance with
				   24-A M.R.S.A.
				  §4234-A, if it provides, at a minimum,
				  benefit levels described in Section
				  5 or
				  7, or the following benefits for a
				  covered person suffering from mental illness or nervous condition:
A. Inpatient and Day Treatment Care. The
				contract must provide inpatient treatment up to a maximum of 30 days in a
				calendar year subject to the same copayment that applies for other illnesses.
				Two days of day treatment will be considered one day of inpatient treatment.
				Day treatment is subject to a copayment of no more than 50% of the copayment
				applicable to inpatient treatment and may be applied only once per course of
				treatment.
B. Outpatient Care. The
				contract must provide outpatient services up to a maximum benefit of $1,500 in
				a calendar year and subject to a copayment of $10 per visit or the copayment
				applicable to other illnesses. In the large group market, the contract must
				contain no annual maximum except as permitted by Section
				11.
C. Home Health Care Services. The contract
				must provide home health care services up to a maximum benefit of $1,500 in a
				calendar year and subject to a copayment of $10 per visit or the copayment
				applicable to other illnesses. In the large group market, the contract must
				contain no annual maximum except as permitted by Section
				11.
D. Maximum Lifetime Benefit. Except for
				coverage applicable to a large employer, the contract may contain a separate
				maximum lifetime benefit for mental illness if the maximum benefit is at least
				$50,000 except the contract total maximum benefit, if any, need not be
				exceeded. The maximum applies to benefits actually paid, net of any applicable
				discount. Coverage applicable to large employers may only contain a lifetime
				maximum to the extent permitted by Section
				11.
E. Point-of Service-Plans. For a
				point-of-service plan, the standards in subsections A through D apply to the
				in-network benefit level.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 330 - MINIMUM STANDARDS FOR MENTAL ILLNESS BENEFITS - REVISED › Section 031-330-9 - Managed Care

Current through 2024-29, July 17, 2024
When a preferred provider arrangement is used, benefits for
				  services of a non-preferred provider may not reduce benefits below the minimums
				  set forth in this rule. If a point-of-service option is provided as part of an
				  HMO plan, benefit levels may be lower than the mandated levels only for the
				  self-referred services. No penalties under a utilization review program may
				  reduce benefits below the minimums set forth in this rule.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 330 - MINIMUM STANDARDS FOR MENTAL ILLNESS BENEFITS - REVISED › Section 031-330-10 - Coordination With Medicare

Current through 2024-29, July 17, 2024
Any policy or contract subject to this Rule may limit or
				  exclude benefits for mental illness treatment to the extent benefits would
				  otherwise duplicate and be secondary to benefits provided by the United States
				  Health Insurance for the Aged Act, Title XVIII of the Social Security
				  Amendments of 1965, Public Law 89-97 as amended (Medicare). To the extent
				  Medicare may provide benefits for mental illness less than the minimum required
				  by this Rule, policies and contracts other than Medicare supplement policies
				  subject to 24-A M.R.S.A., Chapter 67, must cover the difference between
				  Medicare and minimum required benefits.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 330 - MINIMUM STANDARDS FOR MENTAL ILLNESS BENEFITS - REVISED › Section 031-330-11 - Federal Parity Requirements

Current through 2024-29, July 17, 2024
This section applies to all policies identified in section
				  3 to the extent they cover large
				  employers and are issued or renewed on or after January 1, 1998. This section
				  applies only to conditions other than those listed in
				   24-A M.R.S.A.
				  §2843(5-C).
A. Annual Maximums for Unlisted Conditions.
1. If the policy contains no annual dollar
				maximum for other illnesses, it shall contain no annual dollar maximum for
				mental illness, but may include annual maximum numbers of visits if the maximum
				is not less than the following:
a. For
				outpatient care, 40 visits; and
b.
				For home health care services, 40 visits.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 330 - MINIMUM STANDARDS FOR MENTAL ILLNESS BENEFITS - REVISED › Section 031-330-12 - Effective Date

Current through 2024-29, July 17, 2024
The provisions of this Rule are effective June 1, 1984. The
				  1993 amendments to this Rule apply to policies and certificates executed,
				  delivered, issued for delivery, or renewed on or after July 15, 1993. The 1996
				  amendments to this Rule apply to policies and certificates executed, delivered,
				  issued for delivery, or renewed on or after July 9, 1996. The 1997 amendments
				  to this rule are effective December 1, 1997. The 2001 amendments to this rule
				  are effective August 20, 2001. The 2004 amendments to this rule are effective
				  March 1, 2004.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 340 - MORTALITY TABLES FOR DETERMINING MINIMUM RESERVES AND NONFORFEITURE BENEFITS › Article I - Authority

Current through 2024-29, July 17, 2024
This rule is promulgated by the Superintendent pursuant to
				  Title
				  24-A M.R.S.A.
				  Sections212,
				  953 and
				  2532-A.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 340 - MORTALITY TABLES FOR DETERMINING MINIMUM RESERVES AND NONFORFEITURE BENEFITS › Article II - Scope

Current through 2024-29, July 17, 2024
This rule applies to all policies subject to Title
				   24-A M.R.S.A.
				  Sections951 to
				  958-A and
				  Sections
				  2528 to
				  2534.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 340 - MORTALITY TABLES FOR DETERMINING MINIMUM RESERVES AND NONFORFEITURE BENEFITS › Article III - Procedure for Use of Same Minimum Nonforfeiture Standards for Men and Women Insured Under 1980 CSO and 1980 CET Mortality Tables › Section 031-340-III-1 - Preamble

Current through 2024-29, July 17, 2024
The U.S. Supreme Court in its decision in Arizona Governing
					 Committee v. Norris makes it illegal for an employer to make contributions
					 after August 1, 1983 to a defined contribution pension plan if the benefits
					 derived from those contributions differ by sex. Although there is some
					 uncertainty as to the breadth of the Supreme Court's decision, it would seem to
					 require that after August 1, 1983, employer pension plans may need to be funded
					 by life insurance products that have identical nonforfeiture values for men and
					 women. Since the 1980 CSO and 1980 CET Mortality Tables contain mortality rates
					 that vary by both age and sex, it is very difficult if not impossible for
					 companies to determine actual nonforfeiture values that are identical for men
					 and women and also satisfy a sex-differentiated minimum standard. For this
					 reason, this rule permits the same minimum nonforfeiture standards for men and
					 women insureds under the 1980 CSO and 1980 CET Mortality Tables.
A few background comments may be helpful in understanding
					 the intent of this Article.
(1) No
				  attempt was made to define which policies and situations are covered by the
				  Norris decision and which are not. The breadth of the Norris decision is
				  unclear and may ultimately have to be resolved by further court decisions or
				  Federal Legislation.
(2) Insurers
				  are given flexibility to use either
(a) The
				  existing tables with mortality rates that vary by age and sex, or
(b) Tables of mortality rates which are a
				  blend of the male and female mortality rates.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 340 - MORTALITY TABLES FOR DETERMINING MINIMUM RESERVES AND NONFORFEITURE BENEFITS › Article III - Procedure for Use of Same Minimum Nonforfeiture Standards for Men and Women Insured Under 1980 CSO and 1980 CET Mortality Tables › Section 031-340-III-2 - Purpose

Current through 2024-29, July 17, 2024
The purpose of this Article is to permit individual life
					 insurance policies to provide the same cash values and paid-up nonforfeiture
					 benefits to both men and women. No change in minimum valuation standards is
					 implied by this rule.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 340 - MORTALITY TABLES FOR DETERMINING MINIMUM RESERVES AND NONFORFEITURE BENEFITS › Article III - Procedure for Use of Same Minimum Nonforfeiture Standards for Men and Women Insured Under 1980 CSO and 1980 CET Mortality Tables › Section 031-340-III-3 - Definitions

Current through 2024-29, July 17, 2024
A. As used in this Article, "1980 CSO Table,
				  with or without Ten-Year Select Mortality Factor" means that mortality table,
				  consisting of separate rates of mortality for male and female lives, developed
				  by the Society of Actuaries Committee to Recommend New Mortality Tables for
				  Valuation of Standard Individual Ordinary Life Insurance, incorporated in the
				  1980 NAIC Amendments to the Model Standard Valuation Law and Standard
				  Nonforfeiture Law for Life Insurance, and referred to in those models as the
				  Commissioners 1980 Standard Ordinary Mortality Table, with or without Ten-Year
				  Select Mortality Factors.
B. As
				  used in this Article, "1980 CSO Table (M), with or without Ten-Year Select
				  Mortality Factors" means that mortality table consisting of the rates of
				  mortality for male lives from the 1980 CSO Table, with or without Ten-Year
				  Select Mortality Factor.
C. As used
				  in this Article, "1980 CSO Table (F), with or without Ten-Year Select Mortality
				  Factors" means that mortality table consisting of the rates of mortality for
				  female lives from the 1980 CSO Table, with or without Ten-Year Select Mortality
				  Factors.
D. As used in this
				  Article, "1980 CET Table" means that mortalitytable consisting of separate
				  rates of mortality for male and female lives, developed by the Society of
				  Actuaries Committee to Recommend New Mortality Tables for Valuation of Standard
				  Individual Ordinary Life Insurance, incorporated in the 1980 NAIC Amendments to
				  the Model Standard Valuation Law and Standard Nonforfeiture Law for Life
				  Insurance, and referred to in those models as the Commissioners 1980 Extended
				  Term Insurance Table.
E. As used in
				  this Article, "1980 CET Table (M)" means that mortality table consisting of the
				  rates of mortality for male lives from the 1980 CET Table.
F. As used in this Article, "1980 CET Table
				  (F)" means that mortality table consisting of the rates of mortality for female
				  lives from the 1980 CET Table.
G.
				  As used in this Rule, "1980 CSO and 1980 CET Smoker and Nonsmoker Mortality
				  Tables" mean the mortality tables with separate rates of mortality for smokers
				  and nonsmokers derived from the 1980 CSO and 1980 CET Mortality Tables by the
				  Society of Actuaries Task Force on Smoker/Nonsmoker Mortality and adopted by
				  the NAIC in December 1983.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 340 - MORTALITY TABLES FOR DETERMINING MINIMUM RESERVES AND NONFORFEITURE BENEFITS › Article III - Procedure for Use of Same Minimum Nonforfeiture Standards for Men and Women Insured Under 1980 CSO and 1980 CET Mortality Tables › Section 031-340-III-4 - Rule

Current through 2024-29, July 17, 2024
For any policy of insurance on the life of either a male
					 or female insured delivered or issued for delivery in this state after the
					 operative date of Title
					 
					 24-A M.R.S.A. Section2532-A for that policy
					 form, (i) a mortality table which is a blend as defined below, of the 1980 CSO
					 Table (M) and the 1980 CSO Table (F) with or without Ten-Year Select Mortality
					 Factors may at the option of the company be substituted for the 1980 CSO Table,
					 with or without Ten-Year Select Mortality Factors, and (ii) a mortality table
					 which is of the same blend as used in (i) but applied to form a blend of the
					 1980 CET Table (M) and the 1980 CET Table (F) may at the option of the company
					 be substituted for the 1980 CET Table for use in determining minimum cash
					 surrender values and amounts of paid-up nonforfeiture benefits.
The following blends, as adopted by the National
					 Association of Insurance Commissioners in December, 1983, and later corrected,
					 will be acceptable:
A. 100% Male 0%
				  for tables to be designated as the "1980 CSO-A" and "1980 CET-A"
				  tables.
B. 80% Male 20% Female for
				  tables to be designated as the "1980 CSO-B" and "1980 CET-B" tables.
C. 60% Male 40% Female for tables to be
				  designated as the "1980 CSO-C" and "1980 CET-C" tables.
D. 50% Male 50% Female for tables to be
				  designated as the "1980 CSO-D" and "1980 CET-D" tables.
E. 40% Male 60% Female for tables to be
				  designated as the "1980 CSO-E" and "1980 CET-E" tables.
F. 20% Male 80% Female for tables to be
				  designated as the "1980 CSO-F" and "1980 CET-F" tables.
G. 0% Male 100% Female for tables to be
				  designated as the "1980 CSO-G" and "1980 CET-G" tables.
Tables A and G are not to be used with respect to policies
					 issued on or after January 1, 1985 except where the proportion of persons
					 insured is anticipated to be 90 percent or more of one sex or the other or
					 except for certain policies converted from group insurance. Such group
					 conversions issued on or after January 1, 1986 must use Mortality Tables based
					 on the blend of lives by sex expected for such policies if such group
					 conversions are considered as extensions of the Norris decision. This
					 consideration has not been clearly defined by court or legislative action in
					 all jurisdictions.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 340 - MORTALITY TABLES FOR DETERMINING MINIMUM RESERVES AND NONFORFEITURE BENEFITS › Article III - Procedure for Use of Same Minimum Nonforfeiture Standards for Men and Women Insured Under 1980 CSO and 1980 CET Mortality Tables › Section 031-340-III-5 - Unfair discrimination

Current through 2024-29, July 17, 2024
It shall not be a violation of Title
					 
					 24-A M.R.S.A. Section2159, for an insurer to
					 issue the same kind of policy of life insurance on both a sex distinct and sex
					 neutral basis.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 340 - MORTALITY TABLES FOR DETERMINING MINIMUM RESERVES AND NONFORFEITURE BENEFITS › Article III - Procedure for Use of Same Minimum Nonforfeiture Standards for Men and Women Insured Under 1980 CSO and 1980 CET Mortality Tables › Section 031-340-III-6 - Effective date

Current through 2024-29, July 17, 2024
The effective date of this Article as amended is January 1,
					 2015.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 340 - MORTALITY TABLES FOR DETERMINING MINIMUM RESERVES AND NONFORFEITURE BENEFITS › Article IV - Smoker/Nonsmoker Mortality Table › Section 031-340-IV-1 - Purpose

Current through 2024-29, July 17, 2024
The purpose of this Article is to permit the use of
					 mortality tables that reflect differences in mortality between smokers and
					 nonsmokers in determining minimum reserve liabilities and minimum cash
					 surrender values and amounts of paid-up nonforfeiture benefits for plans of
					 insurance with separate premium rates for smokers and nonsmokers.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 340 - MORTALITY TABLES FOR DETERMINING MINIMUM RESERVES AND NONFORFEITURE BENEFITS › Article IV - Smoker/Nonsmoker Mortality Table › Section 031-340-IV-2 - Definitions

Current through 2024-29, July 17, 2024
A. As used in this Article, "1980 CSO Table,
				  with or without Ten-Year Select Mortality Factor" means that mortality table,
				  consisting of separate rates of mortality for male and female lives, developed
				  by the Society of Actuaries Committee to Recommend New Mortality Tables for
				  Valuation of Standard Individual Ordinary Life Insurance, incorporated in the
				  1980 NAIC Amendments to the Model Standard Valuation Law and Standard
				  Nonforfeiture Law for Life Insurance, and referred to in those models as the
				  Commissioners 1980 Standard Ordinary Mortality Table, with or without Ten-Year
				  Select Mortality Factors. The same select factors will be used for both smokers
				  and nonsmokers tables.
B. As used
				  in this Article, "1980 CET Table"means that mortality table consisting of
				  separate rates of mortality for male and female lives, developed by the Society
				  of Actuaries Committee to Recommend New Mortality Tables for Valuation of
				  Standard Individual Ordinary Life Insurance, incorporated in the 1980 NAIC
				  Amendments to the Model Standard Valuation Law and Standard Nonforfeiture Law
				  for Life Insurance, and referred to in those models as the Commissioners 1980
				  Extended Term Insurance Table.
C.
				  As used in this Article, "1958 CSO Table" means that mortality table developed
				  by the Society of Actuaries Special Committee on New Mortality Tables,
				  incorporated in the NAIC Model Standard Nonforfeiture Law for Life Insurance,
				  and referred to in that model as the Commissioners 1958 Standard Ordinary
				  Mortality Table.
D. As used in
				  this Article, "1958 CET Table" means that mortality table developed by the
				  Society of Actuaries Special Committee on New Mortality Tables, incorporated in
				  the NAIC Model Standard Nonforfeiture Law for Life Insurance, and referred to
				  in that model as the Commissioners 1958 Extended Term Insurance
				  Table.
E. As used in this Article,
				  the phrase "smoker and nonsmoker mortality tables" refers to the mortality
				  tables with separate rates of mortality for smokers and nonsmokers derived from
				  the tables defined in A through D of this section which were developed by the
				  Society of Actuaries Task Force on Smoker/Nonsmoker Mortality and the
				  California Insurance Department staff and adopted by the National Association
				  of Insurance Commissioners in December, 1983.
F. As used in this Article, the phrase "the
				  composite mortality tables" refers to the mortality tables defined in A through
				  D of this section as they were originally published with rates of mortality
				  that do not distinguish between smokers and nonsmokers.