Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 280 - GROUP HEALTH CONTRACTS CONVERSION RULE › Section 031-280-3 - Similar benefits

Current through 2024-29, July 17, 2024
Conversion policies providing benefits set forth in this
				  section will be deemed to be providing benefits similar to those provided by
				  the group policy from which conversion is being made.
A. Insurers other than non-profit hospital,
				medical, and health care service organizations.
(1) Hospital Surgical Expense Benefits. If
				the group insurance policy from which conversion is made insures the employee
				or member, with or without dependent coverage, for basic hospital and/or
				surgical expense insurance; the covered individuals, pursuant to Title
				 24-A M.R.S.A.,
				Section2809-A, shall be entitled to obtain a
				converted policy, or at the insurer's option, a group certificate providing, at
				the individual's option, coverage on an expense incurred basis under any one of
				the plans meeting the following requirements:
PLAN A
(a) hospital
				room and board daily expense benefits in a dollar amount approximating or equal
				to the average semi-private rate charged in metropolitan areas of this State,
				for a period of seventy days per hospital confinement,
(b) miscellaneous hospital expense benefits
				in the amount of ten times the room and board daily expense benefits, per
				hospital confinement, and
(c)
				surgical expense benefits according to a surgical schedule consistent with
				those customarily offered by the insurer under group or individual health
				insurance policies and providing a maximum of eight hundred dollars, or
PLAN B
(a) hospital
				room and board daily expense benefits in a dollar amount equal to 75 percent of
				the dollar amount determined in Plan A, for a duration of seventy days per
				hospital confinement,
(b)
				miscellaneous hospital expense benefits in the amount of ten times the hospital
				room and board daily expense benefits, per hospital confinement, and
(c) surgical expense benefits according to a
				surgical schedule consistent with those customarily offered by the insurer
				under group or individual health insurance policies and providing a maximum
				benefit of six hundred dollars.
PLAN C
(a) hospital
				room and board daily expense benefits in a dollar amount equal to 50 percent of
				the dollar amount determined for Plan A, for a duration of seventy days per
				hospital confinement,
(b)
				miscellaneous hospital benefits in the amount of ten times the hospital room
				and board daily expense benefit, per hospital confinement, and
(c) surgical expense benefits according to a
				surgical schedule consistent with those customarily offered by the insurer
				under group or individual health insurance policies and providing a maximum
				benefit of four hundred dollars.
The dollar amount in Plan A, Subsection a, as of the
				  effective date of this Rule is $200. This amount may be redetermined by the
				  Superintendent from time to time, as to converted policies issued subsequent to
				  such redetermination, but not more often than once in three years. The dollar
				  amounts in Plans A, B and C shall be rounded upward to the nearest multiple of
				  ten dollars ($10).
For the purpose of determining the hospital room and board
				  daily expense benefits and the miscellaneous hospital expense benefits under
				  Plans A, B, and C, the policy or certificate may define recurrent hospital
				  confinements resulting from the same cause to be one continuous period of
				  confinement if the confinements are separated by a period of less than 90 days.
				  If recurrent hospital confinements do not result from the same cause or are
				  separated by a period of 90 days or more, the subsequent confinement shall be
				  considered to be a separate confinement for the purpose of determining the
				  benefits payable under the policy or certificate.