reglab/statecodes huggingface dataset:
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 580 - THIRD-PARTY NOTICE OF CANCELLATION › Section 031-580-6 - Limitations on Cancellation; Right to Reinstatement

Current through 2024-29, July 17, 2024
A.
Individual and group coverage
1.
				Within 90 days after cancellation of a contract for nonpayment of premium, the
				insured, any person authorized to act on behalf of the insured, or any
				dependent of the insured covered under the contract may request reinstatement
				of the contract on the basis that the insured suffered from cognitive
				impairment or functional incapacity at the time of contract
				cancellation.
2. The insurer may
				request a medical demonstration that the insured suffered from cognitive
				impairment or functional incapacity at the time of cancellation of the
				contract. If the demonstration is waived, or substantiates the existence of
				cognitive impairment or functional incapacity at the time of cancellation to
				the satisfaction of the insurer, the contract shall be reinstated. The medical
				demonstration may be at the expense of the insured.
3. The reinstated contract shall be issued
				without any evidence of insurability.
4. The reinstated contract shall cover loss
				occurring from the date of contract cancellation. There shall be no gaps in
				coverage. Coverage shall be at the level provided immediately before the
				cancellation.
5. Premium shall be
				paid from the date of the last premium payment at the rate which would have
				been in effect had the contract remained in force. Payment shall be made within
				15 days after request by the insurer. If the premium is not paid as required,
				the insurer has no obligation to reinstate the policy. If the policy is not
				reinstated, the insurer is not responsible for claims incurred after the date
				of cancellation.
6. The insured
				also has the right to reinstatement of the prior contract, subject to the
				conditions and procedures set forth in Paragraphs 1 through 5 of this
				Subsection, in the event of cancellation for any other lapse or default on the
				part of the insured, provided that the default is cured promptly and an
				adequate causal connection is made between the default and the insured's
				cognitive impairment or functional incapacity.
7. All policies and certificates subject to
				this Rule issued on or after January 1, 2013 shall include notice of the right
				to seek reinstatement after cancellation, if loss of coverage is attributable
				to the contract holder's affliction with cognitive impairment or functional
				incapacity. This requirement may be satisfied through an endorsement to the
				contract or by including the notice of reinstatement right in an application
				that is incorporated into the contract.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 580 - THIRD-PARTY NOTICE OF CANCELLATION › Section 031-580-7 - Administrative Rights

Current through 2024-29, July 17, 2024
A. If a request for
				reinstatement of coverage because of cognitive impairment or functional
				incapacity is denied, notice of denial shall be provided to the insured and to
				the person making the request, if different. The notice of denial shall include
				notification of the 30 day period following receipt of the notice during which
				a hearing before the Superintendent may be requested.
B. Any hearing shall be for the purpose of
				determining whether a violation of this Rule or the Maine Insurance Code has
				occurred.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 580 - THIRD-PARTY NOTICE OF CANCELLATION › Section 031-580-8 - Transition

Current through 2024-29, July 17, 2024
A. Within 60 days after the effective date of
				any amendment to this Rule, every insurer shall file with the Superintendent
				any new forms or contract provisions, and all revisions to existing forms or
				contracts, which it will be using as a result of the amendment.
B. If the forms will be part of an
				application or contract, the requirements of
				24-A M.R.S.A.
				§2412 and any other applicable form
				filing requirements must be satisfied.
C. Every insurer required to file forms with
				the Superintendent pursuant to Subsection A of this Section shall send all
				applicable forms and amended contract provisions to existing individual and
				group contract holders within 60 days after the first billing date after the
				form or contract provision has been approved by the Superintendent. Sufficient
				copies of the form or contract provision to permit distribution to covered
				insureds shall be provided to group contract holders when the contract holder
				retains information concerning insureds. At the request of the insurer, the
				Superintendent may waive the 60-day deadline for notice to existing insureds
				upon a determination that the revised forms are determined to be substantially
				similar to the forms previously provided to those insureds.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 580 - THIRD-PARTY NOTICE OF CANCELLATION › Section 031-580-9 - Severability

Current through 2024-29, July 17, 2024
If any section, term, or provision of this Rule shall be
				  deemed invalid for any reason, any remaining section, provision, or definition
				  shall remain in full force and effect.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 580 - THIRD-PARTY NOTICE OF CANCELLATION › Section 031-580-10 - Effective Date

Current through 2024-29, July 17, 2024
This Rule shall be effective January 1, 1991. The 1996
				  Amendments shall be effective December 1, 1996. The 2012 Amendments shall be
				  effective November 3, 2012, except that any required changes to contract forms
				  shall apply to policies, contracts, and certificates executed, delivered or
				  issued for delivery, continued, or renewed in this State on or after January 1,
				  2013.
The 2014 Amendments shall be effective _____ , 2014.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 585 - LIFE INSURANCE THIRD-PARTY NOTICE OF CANCELLATION; RIGHTS OF REINSTATEMENT FOR INDIVIDUALS AFFLICTED WITH COGNITIVE IMPAIRMENT OR FUNCTIONAL INCAPACITY › Section 031-585-1 - Authority

Current through 2024-29, July 17, 2024
This Rule is adopted by the Superintendent pursuant to
				   24-A M.R.S.A.
				  §§212 and
				  2556.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 585 - LIFE INSURANCE THIRD-PARTY NOTICE OF CANCELLATION; RIGHTS OF REINSTATEMENT FOR INDIVIDUALS AFFLICTED WITH COGNITIVE IMPAIRMENT OR FUNCTIONAL INCAPACITY › Section 031-585-2 - Purpose

Current through 2024-29, July 17, 2024
The purpose of this Rule is twofold. First, the Rule's
				  third-party notice provisions allow a policyholder to establish in advance a
				  line of communication that will increase the likelihood that adequate notice is
				  given if an insurer intends to terminate coverage for nonpayment of premiums.
				  Second, the Rule establishes conditions and procedures to reduce the danger
				  that persons suffering from cognitive impairment or functional incapacity will
				  lose life insurance coverage because of their condition.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 585 - LIFE INSURANCE THIRD-PARTY NOTICE OF CANCELLATION; RIGHTS OF REINSTATEMENT FOR INDIVIDUALS AFFLICTED WITH COGNITIVE IMPAIRMENT OR FUNCTIONAL INCAPACITY › Section 031-585-3 - Scope

Current through 2024-29, July 17, 2024
This Rule applies to all individual life insurance policies
				  and riders delivered, issued for delivery, continued, or renewed in the State
				  of Maine.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 585 - LIFE INSURANCE THIRD-PARTY NOTICE OF CANCELLATION; RIGHTS OF REINSTATEMENT FOR INDIVIDUALS AFFLICTED WITH COGNITIVE IMPAIRMENT OR FUNCTIONAL INCAPACITY › Section 031-585-4 - Requirement for Notification Prior to Cancellation

Current through 2024-29, July 17, 2024
An individual life insurance policy that has been in force
				  for at least one year may not be terminated for nonpayment of premium, unless
				  at least 21 days prior to the expiration of the policy's grace period, the
				  insurer has mailed a notice of cancellation to the policyholder and any third
				  party designated by the policyholder by name and address in writing. The notice
				  shall state the reason(s) for cancellation and the date that coverage is to
				  terminate. If the policy is subject to cancellation for nonpayment of premium,
				  the notice shall include the amount of unpaid premium and the date by which
				  premium must be paid to avoid policy cancellation.
At its option, an insurer may provide other notification
				  regarding termination of coverage or other rights to the policyholder and any
				  designated third party. The notice shall include an explanation of the reason
				  for termination and the time and method by which termination may be avoided. If
				  the reason for termination is beyond the policyholder's control, the notice
				  shall so state. This optional notification is in addition to, not a substitute
				  for, other requirements of law or contract.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 585 - LIFE INSURANCE THIRD-PARTY NOTICE OF CANCELLATION; RIGHTS OF REINSTATEMENT FOR INDIVIDUALS AFFLICTED WITH COGNITIVE IMPAIRMENT OR FUNCTIONAL INCAPACITY › Section 031-585-5 - Provision for Notification to Third Parties

Current through 2024-29, July 17, 2024
A.
				All policies subject to this Rule shall include notice of the right:
1. To receive notification pursuant to
				Section
				4 of the Rule;
2. To designate a third party to receive
				notification pursuant to Section
				4 of the Rule; and
3. To change a third-party
				designation.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 585 - LIFE INSURANCE THIRD-PARTY NOTICE OF CANCELLATION; RIGHTS OF REINSTATEMENT FOR INDIVIDUALS AFFLICTED WITH COGNITIVE IMPAIRMENT OR FUNCTIONAL INCAPACITY › Section 031-585-6 - Limitations on Loss of Coverage and Right to Reinstatement for Persons with Cognitive Impairment or Functional Incapacity

Current through 2024-29, July 17, 2024
A.
				All policies subject to this Rule shall include notice of the right to seek
				reinstatement after cancellation, termination, or lapse, if loss of coverage is
				attributable to the policyholder's affliction with cognitive impairment or
				functional incapacity.
B. Within 90
				days after cancellation, termination, or lapse of coverage, the policyholder,
				any person authorized to act on behalf of the policyholder, or any dependent of
				the policyholder covered under the policy may request reinstatement of the
				policy on the basis that loss of coverage was a result of the policyholder's
				cognitive impairment or functional incapacity at the time of cancellation,
				termination, or lapse.
C. If a
				policyholder, any person authorized to act on behalf of the policyholder, or
				any dependent of the policyholder covered under the policy requests
				reinstatement of coverage pursuant to this Section, an insurer may request a
				medical demonstration that the policyholder suffered from cognitive impairment
				or functional incapacity at the time of cancellation, termination, or lapse. If
				the insurer waives its right to request a medical demonstration or a medical
				demonstration substantiates that loss of coverage was the result of the
				existence of cognitive impairment or functional incapacity at the relevant
				time, the policy shall be reinstated. The medical demonstration may be at the
				expense of the policyholder.
D. A
				policy reinstated pursuant to this Section must cover any loss or claim
				occurring from the date of the termination, cancellation, or lapse, and shall
				be issued without any evidence of insurability.
E. Premium for policy reinstatement pursuant
				to this Section shall be paid from the date of the last premium payment at the
				rate which would have been in effect had the policy remained in force. Payment
				shall be made within 15 days after request by the insurer.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 585 - LIFE INSURANCE THIRD-PARTY NOTICE OF CANCELLATION; RIGHTS OF REINSTATEMENT FOR INDIVIDUALS AFFLICTED WITH COGNITIVE IMPAIRMENT OR FUNCTIONAL INCAPACITY › Section 031-585-7 - Administrative Appeal Rights

Current through 2024-29, July 17, 2024
If a request for reinstatement of coverage pursuant to this
				  Rule is denied, notice of denial shall be provided to the policyholder, to any
				  third party designated pursuant to Section
				  5 of this Rule, and to the person
				  making the request, if different. The notice of denial shall include
				  notification of a 30-day period following receipt of the notice during which a
				  hearing before the Superintendent may be requested.
Any hearing before the Superintendent shall be for the
				  purposes of determining whether a violation of this Rule or the Maine Insurance
				  Code has occurred and whether policy reinstatement is
				  required.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 585 - LIFE INSURANCE THIRD-PARTY NOTICE OF CANCELLATION; RIGHTS OF REINSTATEMENT FOR INDIVIDUALS AFFLICTED WITH COGNITIVE IMPAIRMENT OR FUNCTIONAL INCAPACITY › Section 031-585-8 - Transition

Current through 2024-29, July 17, 2024
A. Within 60 days after the effective date of
				any amendment to this Rule, every insurer shall file with the Superintendent
				any new forms or policy provisions and all revisions to existing forms or
				policies to be used as a result of the amendment.
B. If the forms submitted pursuant to
				Subsection A will be part of an application or policy, the requirements of
				 24-A M.R.S.A.
				§2412 and any other applicable
				form-filing requirement must be satisfied.
C. Every insurer shall send approved forms
				and amended policy provisions to existing individual policyholders within 120
				days after the first billing date subsequent to the Superintendent's approval
				of the forms or policy provisions.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 585 - LIFE INSURANCE THIRD-PARTY NOTICE OF CANCELLATION; RIGHTS OF REINSTATEMENT FOR INDIVIDUALS AFFLICTED WITH COGNITIVE IMPAIRMENT OR FUNCTIONAL INCAPACITY › Section 031-585-9 - Severability

Current through 2024-29, July 17, 2024
If any section, term, or provision of this Rule shall be
				  deemed invalid for any reason, any remaining section, provision, or definition
				  shall remain in full force and effect.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 585 - LIFE INSURANCE THIRD-PARTY NOTICE OF CANCELLATION; RIGHTS OF REINSTATEMENT FOR INDIVIDUALS AFFLICTED WITH COGNITIVE IMPAIRMENT OR FUNCTIONAL INCAPACITY › Section 031-585-10 - Effective Date

Current through 2024-29, July 17, 2024
This Rule shall be effective October 28, 2008 (filing
				  2008-496). The 2012 amendments shall be effective November 3, 2012 (filing
				  2012-302).
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 590 - DEFINITION OF TOTAL DISABILITY FOR PURPOSES OF EXTENSION OF BENEFITS › Section 031-590-1 - Purpose

Current through 2024-29, July 17, 2024
The purpose of this rule is to define the term "total
				  disability" for purposes of the extension of benefits required by Title
				  
				  24 M.R.S.A. §2348 and Title
				   24-A M.R.S.A.
				  §2849-A.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 590 - DEFINITION OF TOTAL DISABILITY FOR PURPOSES OF EXTENSION OF BENEFITS › Section 031-590-2 - Authority

Current through 2024-29, July 17, 2024
This rule is promulgated pursuant to the authority vested in
				  the Superintendent of Insurance under Title
				  
				  24 M.R.S.A. §2348 and Title
				   24-A M.R.S.A.
				  §§212 and
				  2849-A.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 590 - DEFINITION OF TOTAL DISABILITY FOR PURPOSES OF EXTENSION OF BENEFITS › Section 031-590-3 - Applicability and scope

Current through 2024-29, July 17, 2024
This rule shall apply to all group contracts and policies
				  which are subject to the requirements of Title
				  
				  24 M.R.S.A. §2348 and Title
				   24-A M.R.S.A.
				  §2849-A.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 590 - DEFINITION OF TOTAL DISABILITY FOR PURPOSES OF EXTENSION OF BENEFITS › Section 031-590-4 - Definition

Current through 2024-29, July 17, 2024
For purposes of determining eligibility for extension of
				  benefits, "total disability" shall be defined no more restrictively
				  than:
A. in the case of an insured who
				was gainfully employed prior to disability, "the inability to engage in any
				gainful occupation for which he or she is reasonably suited by training,
				education, and experience;" or
B.
				in the case of an insured who was not gainfully employed prior to disability,
				"the inability to engage in most normal activities of a person of like age in
				good health."
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 590 - DEFINITION OF TOTAL DISABILITY FOR PURPOSES OF EXTENSION OF BENEFITS › Section 031-590-5 - Transition

Current through 2024-29, July 17, 2024
Any insurer subject to this rule that does not have approved
				  forms which comply with this rule may continue to issue previously approved
				  forms until complying forms are approved, providing the following conditions
				  are met:
A. The previously approved
				forms must be in compliance with Title
				
				24 M.R.S.A. §2348 or Title
				 24-A M.R.S.A.
				§2849-A; and
B. Complying forms must be filed on or before
				July 1, 1991.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 590 - DEFINITION OF TOTAL DISABILITY FOR PURPOSES OF EXTENSION OF BENEFITS › Section 031-590-6 - Effective date

Current through 2024-29, July 17, 2024
This rule shall be effective July 1, 1991.
History. -- Effective. 7-1-91.
History. -- Statutory Authority.--
				  
				  24 M.R.S.A. §2348;
				   24-A M.R.S.A.
				  §§212 and 2849A.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 600 - SCREENING MAMMOGRAMS › Section 031-600-1 - Authority

Current through 2024-29, July 17, 2024
This Rule is promulgated by the Superintendent pursuant to
				  Title
				  24 M.R.S.A.
				  §2320-A, and Title
				   24-A M.R.S.A.
				  §§212,
				  2745-A,
				  2837-A, and
				  §
									4237-A.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 600 - SCREENING MAMMOGRAMS › Section 031-600-2 - 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.
				  §2320-A and Title
				   24-A M.R.S.A.
				  §§2745-A,
				  2837-A, and
				  §
									4237-A by
				  establishing standards to assure equitable coverage for screening
				  mammograms.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 600 - SCREENING MAMMOGRAMS › Section 031-600-3 - Scope

Current through 2024-29, July 17, 2024
This rule applies to all policies, as defined herein, that
				  cover radiologic procedures and are executed, delivered, issued for delivery,
				  continued, or renewed in this State on or after March 1, 1991, except
				  Standardized Medicare supplement policies issued pursuant to Title 24-A
				  M.R.S.A. Chapter 67, and those policies designed to cover only specific
				  diseases, accidental injury, or dental procedures. The extraterritorial scope
				  of this Rule includes all certificates delivered or issued for delivery in
				  Maine pursuant to out-of-state group policies or contracts.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 600 - SCREENING MAMMOGRAMS › Section 031-600-4 - Definitions

Current through 2024-29, July 17, 2024
For the purposes of this Rule, the following terms have the
				  following meanings:
A. "Screening
				Mammogram" means a radiologic procedure that is provided to an asymptomatic
				woman for the purpose of early detection of breast cancer and that consists of
				2 radiographic views per breast. A screening mammogram also includes an
				additional radiological procedure recommended by a provider when the results of
				an initial radiological procedure are not definitive.
B. "Insurer" includes a nonprofit health care
				or medical services plan.
C.
				"Policy" includes any individual or group insurance policy or contract of
				coverage issued by an insurer or Health Maintenance Organization, and any
				certificate under a group policy.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 600 - SCREENING MAMMOGRAMS › Section 031-600-5 - Policy benefits

Current through 2024-29, July 17, 2024
Each policy shall provide for screening mammograms performed
				  at least once a year for women of age 40 or over in accordance with the
				  following standards:
A. Policies other
				than Medicare supplement policies shall provide at least the same level of
				benefits for screening mammograms as the highest level of coverage provided for
				other radiological procedures. For the purposes of this Rule, Medicare Risk or
				Cost Contracts are not considered Medicare supplement policies.
B. Standardized Medicare supplement policies
				shall provide coverage in accordance with Bureau of Insurance Rule 275. Other
				Medicare Supplement policies shall provide coverage for screening mammograms on
				the following basis:
1. The policy must pay a
				minimum of 80 percent of the Medicare approved amount for screening mammograms.
				This level of coverage may be reduced if Medicare coverage combined with
				coverage required by this Rule would exceed the Medicare approved amount. For
				purposes of this rule, Medicare approved amount means the amount which Medicare
				recognizes as reasonable, without reduction for coinsurance. A screening
				mammogram must be covered as required by this rule even if it is not covered by
				Medicare.
2. If the policy covers
				physician charges in excess of the Medicare approved amount, it must also cover
				charges for screening mammograms in excess of the Medicare approved amount on
				the same basis.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 600 - SCREENING MAMMOGRAMS › Section 031-600-6 - Deductibles

Current through 2024-29, July 17, 2024
No separate policy deductible for screening mammograms may be
				  required. Screening mammograms may be subject to existing policy deductibles.
				  Expenses for screening mammograms may be used to satisfy policy deductibles the
				  same as expenses for any other illness.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 600 - SCREENING MAMMOGRAMS › Section 031-600-7 - Coordination of benefits

Current through 2024-29, July 17, 2024
Screening mammograms may be subject to coordination of
				  benefits provisions. Benefits provided for screening mammograms need not exceed
				  the actual charge.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 600 - SCREENING MAMMOGRAMS › Section 031-600-8 - Reporting

Current through 2024-29, July 17, 2024
A. Each insurer subject to this Rule shall
				file annually, by April 30, a report of claims for screening mammography in
				Maine for the previous year on a form prescribed by the
				Superintendent
B. Each insurer is
				additionally required to keep records which contain all information needed to
				complete the form. This form shall be copied by each insurer and kept on
				file.
C. Penalty. Any insurer
				failing to file this report is subject to a fine of up to $2,000 as specified
				in Title
				 24-A M.R.S.A.
				§12-A.
D. Health Maintenance Organizations are not
				required to comply with this Section.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 600 - SCREENING MAMMOGRAMS › Section 031-600-9 - Separability

Current through 2024-29, July 17, 2024
If any provision of this Rule or any 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 600 - SCREENING MAMMOGRAMS › Section 031-600-10 - Effective date

Current through 2024-29, July 17, 2024
The provisions of this Rule shall be applicable August 1,
				  1991. The effective date of the 1998 revisions shall be January 1, 1999. The
				  effective date of the 2007 revisions shall be January 1, 2008.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 630 - RURAL MEDICAL ACCESS PROGRAM › Section 031-630-1 - Purpose

Current through 2024-29, July 17, 2024
The purpose of this Rule is to establish the assessment and
				  premium assistance procedures for the Rural Medical Access Program ("Program")
				  and to establish standards or procedures to implement the Program. The
				  assessment procedures are intended to result in collections that are adequate
				  for the Program to fulfill its statutory purpose.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 630 - RURAL MEDICAL ACCESS PROGRAM › Section 031-630-2 - Authority

Current through 2024-29, July 17, 2024
This Rule is promulgated pursuant to
				   24-A M.R.S.A.
				  §§212,
				  229(1),
				  6305,
				  and
				  6311.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 630 - RURAL MEDICAL ACCESS PROGRAM › Section 031-630-3 - Definitions

Current through 2024-29, July 17, 2024
1. "Insurer" is defined as in
				24-A M.R.S.A.
				§6303(1).
2. "Program fund balance" is defined as in
				24-A M.R.S.A.
				§6305(3).
3.  "Self-insured" is defined as in
				24-A M.R.S.A.
				§6303(3). In
				particular, the term includes a physician, hospital, or physician's employer
				obtaining coverage from an unauthorized insurer (other than pursuant to the
				surplus lines law) or a risk retention group. It also includes a physician,
				hospital, or physician's employer that has not obtained insurance coverage. A
				policyholder may be insured in part and self-insured in part, as provided in
				Subsections
				4(3) and
				4 () of this Rule.
4. "Superintendent" means the Superintendent
				of Insurance.
5. "Practices
				medicine" or "practicing medicine" is defined as in
				32 M.R.S.A.
				§3270, whether or not the physician
				receives compensation.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 630 - RURAL MEDICAL ACCESS PROGRAM › Section 031-630-5 - Reporting, transfers

Current through 2024-29, July 17, 2024
1. Each insurer
				shall report annually, on or before September 1, the assessments collected on
				policies issued between July 1 of the prior year and June 30 of the current
				year. The report shall contain the name of each physician, hospital, or
				physician's employer, the physician's Maine license number, the policy number,
				the policy effective date, and the assessment collected or credited. This
				detailed report shall be made available in an electronic format acceptable to
				the Superintendent. The insurer shall also report in aggregate, on a quarterly
				basis, funds collected, interest earnings, disbursements, and a net balance.
				The quarterly statements are due at the Bureau within 30 days of the end of
				each calendar quarter.
2. If an
				insurer reports or projects a negative fund balance or if the Superintendent
				finds that transfers of funds are desirable to effectively administer the
				Program, the Superintendent may order intercompany transfers among
				insurers.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 630 - RURAL MEDICAL ACCESS PROGRAM › Section 031-630-6 - Premium assistance

Current through 2024-29, July 17, 2024
1. The
				Superintendent shall apply the standards of prioritization adopted by the
				Commissioner of Human Services to determine the physicians who shall receive
				premium assistance.
2. No premium
				assistance shall be authorized to a physician not found eligible by the
				Department of Human Services or who owes premiums to any insurer for any policy
				year prior to the year for which assistance is sought.
3. For each physician eligible for
				assistance, the Superintendent shall calculate the difference between the
				medical malpractice premium with and without obstetrical care coverage. For
				purposes of this calculation, the Superintendent shall use the policy with an
				effective date occurring in the eligibility period, without regard for any
				subsequent cancellations and endorsements. The assistance per physician shall
				be adjusted to comply with the $5,000 minimum and $15,000 maximum established
				in
				24-A M.R.S.A.
				§6308(2).
4. In determining the difference between the
				physician's medical malpractice insurance premium with obstetrical care
				coverage and without obstetrical care coverage, the Superintendent shall
				consider the following:
(A) The services
				performed and the applicable insurance rating classification during the Program
				eligibility period.
(B) The
				services performed other than obstetrical care and the applicable insurance
				rating classification without obstetrical care during the Program eligibility
				period.
(C) The rates and rating
				rules of the physician's insurer or principal writer during the period for
				which assistance is sought.
(D) If
				necessary, the services performed and the applicable insurance rating
				classification immediately preceding eligibility for Program
				assistance.
(E) For physicians
				newly entering practice, and if necessary for other applicants, the training
				and certification of that physician immediately prior to eligibility for
				Program assistance.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 630 - RURAL MEDICAL ACCESS PROGRAM › Section 031-630-7 - Appeals

Current through 2024-29, July 17, 2024
A physician, hospital, or physician's employer aggrieved by
				  the imposition of an assessment may request a hearing before the
				  Superintendent. A request for hearing shall be made not more than 30 days from
				  the date the applicant knew or reasonably should have known of the action
				  causing the grievance, shall be in writing, and shall state the reason or
				  reasons for the grievance and the requested relief.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 630 - RURAL MEDICAL ACCESS PROGRAM › Section 031-630-8 - Severability

Current through 2024-29, July 17, 2024
If any section or provision of this Rule is adjudged invalid
				  for any reason, the judgment shall not impair or invalidate any other section
				  or provision of the Rule, and the remaining sections or provisions shall remain
				  in full force and effect.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 630 - RURAL MEDICAL ACCESS PROGRAM › Section 031-630-9 - Effective date

Current through 2024-29, July 17, 2024
The effective date of this Rule is January 29, 1992. The
				  effective date of the 2008 amendments to this Rule is August 10, 2008. The 2014
				  amendments are effective May 5, 2014.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 705 - CORPORATE GOVERNANCE ANNUAL DISCLOSURE › Section 031-705-1 - Authority and Purpose

Current through 2024-29, July 17, 2024
The Superintendent of Insurance adopts this Rule pursuant to
				   24-A M.R.S.
				  §§212 and
				  423-G(6),
				  to set forth the required contents and filing procedures for the Corporate
				  Governance Annual Disclosure (CGAD).
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 705 - CORPORATE GOVERNANCE ANNUAL DISCLOSURE › Section 031-705-2 - Definitions

Current through 2024-29, July 17, 2024
1. "Domestic insurance carrier" means an
				insurance company, health maintenance organization, fraternal benefit society,
				nonprofit hospital or medical service organization, or nonprofit health plan
				domiciled in this State.
2. "Filing
				entity" means a domestic insurance carrier filing a CGAD or a parent entity
				filing a group-level CGAD on behalf of a domestic insurance carrier.
3. "Insurance group" means the insurance
				carriers and affiliates included within a domestic insurance carrier's
				insurance holding company system as defined in section 222, subsection 2,
				paragraph C.
4. "Intermediate
				holding company" means an entity, other than the ultimate controlling person,
				which exercises control over the management of an insurance group or
				intermediate insurance group.
5.
				"Intermediate insurance group" means a unit within an insurance group
				comprising some, but not all, of the insurance carriers within the group, which
				the group's lead state regulator has found to be operationally autonomous and
				has authorized to file a CGAD separately from other legal entities and
				intermediate insurance groups within the group.
6. "Senior management" means all corporate
				officers responsible for reporting information to the Board of Directors
				("Board") at regular intervals or determining the information to be provided to
				shareholders or regulators. Senior management is presumed to include, without
				limitation, any executive with a "C-level" title such as Chief Executive
				Officer ("CEO"), Chief Financial Officer ("CFO"), Chief Operations Officer
				("COO"), Chief Procurement Officer ("CPO"), Chief Legal Officer ("CLO"), Chief
				Information Officer ("CIO"), Chief Technology Officer ("CTO"), Chief Revenue
				Officer ("CRO"), or Chief Visionary Officer ("CVO").
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 705 - CORPORATE GOVERNANCE ANNUAL DISCLOSURE › Section 031-705-3 - Filing Procedures

Current through 2024-29, July 17, 2024
1. Annually, no
				later than June 1, each domestic insurance carrier shall file a CGAD in
				accordance with
				24-A M.R.S.
				§423-G(2)(A).
A. Except as provided in Paragraph B, the
				CGAD shall be filed with the Superintendent in compliance with the provisions
				of this Section and shall contain all information required by Section 4 of this
				Rule. If a group-level CGAD is filed with the Superintendent, the filing entity
				shall also provide a copy of the CGAD on request to the chief insurance
				regulator of the domiciliary state of any insurance carrier within the
				group.
B. If the CGAD is prepared
				at the group level, this State is not the group's lead state, and the
				Superintendent has determined that the lead state has corporate governance
				disclosure laws substantially similar to
				24-A M.R.S.
				§423-G and this Rule, a CGAD filed with
				the lead state in compliance with its legal requirements is deemed to comply
				with this Rule, as long as the carrier, or the filing entity acting on the
				carrier's behalf, provides a copy to the Superintendent on request.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 705 - CORPORATE GOVERNANCE ANNUAL DISCLOSURE › Section 031-705-4 - Contents of Corporate Governance Annual Disclosure

Current through 2024-29, July 17, 2024
1.
				The filing entity shall be as descriptive as possible in completing the CGAD,
				with inclusion of attachments or example documents that are used in the
				governance process, since these may provide a means to demonstrate the
				strengths of their governance framework and practices. For purposes of this
				section, governance of the filing entity includes governance at any higher
				level within the holding company system that exercises direct or indirect
				operational control over the filing entity.
2. The CGAD shall describe the filing
				entity's corporate governance framework and structure, including consideration
				of the following:
A. The Board and the
				committees that are ultimately responsible for overseeing the domestic
				insurance carrier and the level(s) at which that oversight occurs
				(
e.g.,
ultimate control level, intermediate holding company,
				legal entity). The filing entity shall describe and discuss the rationale for
				the current Board size and structure;
B. The duties of the Board and each of its
				significant committees and how they are governed (
e.g.,
bylaws, charters, informal mandates), and how the Board's leadership is
				structured, including a discussion of the roles of Chief Executive Officer
				(CEO) and Chair of the Board within the organization; and
C. If the filing entity is not the domestic
				insurance carrier, the relationship between the filing entity's Board and
				senior management and the domestic insurance carrier's board and senior
				management.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 705 - CORPORATE GOVERNANCE ANNUAL DISCLOSURE › Section 031-705-5 - Severability

Current through 2024-29, July 17, 2024
If any provision of this Rule, or the application thereof to
				  any person or circumstance, is held invalid, that determination shall not
				  affect other provisions or applications of this Rule that can be given effect
				  without the invalid provision or application, and to that end the provisions of
				  this Rule are severable.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 705 - CORPORATE GOVERNANCE ANNUAL DISCLOSURE › Section 031-705-6 - Effective Date

Current through 2024-29, July 17, 2024
This rule is effective November 6, 2019 (filing 2019-193).
				  The initial CGAD filings by domestic insurance carriers are due June 1,
				  2020.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 710 - STANDARDS FOR DETERMINING HAZARDOUS FINANCIAL CONDITIONS FOR INSURANCE COMPANIES › Section 031-710-1 - Purpose

Current through 2024-29, July 17, 2024
The purpose of this rule is to set forth standards to
				  identify insurance carriers and other risk-bearing entities regulated by the
				  Superintendent in hazardous financial condition and to impose, as appropriate,
				  underwriting restrictions and other supervisory conditions necessary to limit a
				  carrier's exposure to insurance or investment risk in order to protect the
				  interests of the public, policyholders, holders of certificates of insurance,
				  or claimants.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 710 - STANDARDS FOR DETERMINING HAZARDOUS FINANCIAL CONDITIONS FOR INSURANCE COMPANIES › Section 031-710-2 - Authority

Current through 2024-29, July 17, 2024
This rule is promulgated pursuant to
				   24 M.R.S.A.
				  §2317;
				   24-A M.R.S.A.
				  §§12-A,
				  212,
				  231(5),
				  417,
				  797,
				  3423,
				  3424,
				  4351 -
				  4407,
				  6104,
				  6714,
				  6718, and
				  7111; and
				  
				  39-A M.R.S.A.
				  §§403(3)(C)(6),
				  403(3)(E),
				  403(4-A)(A),
				  and
				  403(8)(C).
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 710 - STANDARDS FOR DETERMINING HAZARDOUS FINANCIAL CONDITIONS FOR INSURANCE COMPANIES › Section 031-710-3 - Scope

Current through 2024-29, July 17, 2024
This rule applies to all risk-bearing entities regulated by
				  the Superintendent and doing business in this State, as follows:
A. For purposes of this rule, "insurance
				carrier" means an insurer authorized or required to be authorized under
				24-A
				M.R.S.A. §404, a nonprofit organization
				authorized to provide benefit plans under
				24 M.R.S.A.
				§2301, a health maintenance
				organization, or a domestic risk retention group that is a captive
				insurer.
B. To the limited extent
				consistent with the nature of the regulated entity's operations and the scope
				of the Superintendent's statutory authority, the provisions of this rule that
				are applicable to insurance carriers also apply to special purpose reinsurance
				vehicles, eligible surplus lines insurers, mutual assessment plan insurers,
				fraternal benefit societies, foreign risk retention groups, multiple-employer
				welfare arrangements, captive insurers that are not risk retention groups,
				service contract providers that do not maintain reimbursement insurance
				policies qualifying under
				24-A M.R.S.A.
				§7103(5)(A), and group
				workers' compensation self-insurers.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 710 - STANDARDS FOR DETERMINING HAZARDOUS FINANCIAL CONDITIONS FOR INSURANCE COMPANIES › Section 031-710-5 - Determination of Hazardous Financial Condition

Current through 2024-29, July 17, 2024
A.
				For the purposes of making a determination of hazardous financial condition,
				the Superintendent may:
1 Disallow any credit
				or amount receivable resulting from transactions with a reinsurer which is
				insolvent, impaired, or otherwise subject to a delinquency
				proceeding;
2 Adjust or disallow
				values of assets and investments relating to, or arising out of transactions
				with, entities affiliated with the carrier, consistent with the NAIC Accounting
				Practices and Procedures Manual and any other accounting practices lawfully
				permitted or prescribed by the Superintendent or by the applicable domiciliary
				regulator;
3 Disallow the stated
				value of accounts receivable if collectability of the asset is unlikely based
				upon aging of the account balance or financial condition of a debtor(s); or
4 In making a determination of
				surplus, assign a liability value when there is a substantial risk that the
				carrier will be required to fund within the next twelve months any liability,
				pledge, or guarantee contingently undertaken by the carrier.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 710 - STANDARDS FOR DETERMINING HAZARDOUS FINANCIAL CONDITIONS FOR INSURANCE COMPANIES › Section 031-710-6 - Judicial Review

Current through 2024-29, July 17, 2024
If the Superintendent has issued an order before hearing as
				  provided in Section
				  5, any person upon whom such order is
				  served may waive the Superintendent's hearing and apply for any immediate
				  judicial relief available under law and without first exhausting administrative
				  remedies. Title
				   24-A M.R.S.A.
				  §236 (appeal from the Superintendent)
				  shall apply as to appeals from the Superintendent's order made after
				  hearing.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 710 - STANDARDS FOR DETERMINING HAZARDOUS FINANCIAL CONDITIONS FOR INSURANCE COMPANIES › Section 031-710-7 - Separability

Current through 2024-29, July 17, 2024
If any provisions of this rule be held invalid, the remainder
				  shall not be affected. This rule shall not be construed to abrogate or limit
				  the Superintendent's authority to take any action authorized by other
				  applicable laws.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 710 - STANDARDS FOR DETERMINING HAZARDOUS FINANCIAL CONDITIONS FOR INSURANCE COMPANIES › Section 031-710-8 - Effective Date

Current through 2024-29, July 17, 2024
This rule became effective August 2, 1993. The 2014
				  amendments to this rule become effective August 17, 2014.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 735 - Term and Universal Life Insurance Reserve Financing › Section 031-735-1 - Authority and Purpose

Current through 2024-29, July 17, 2024
The Superintendent of Insurance adopts this rule pursuant to
				  24-A M.R.S.
				  §§212 and
				  731-B(2-B)
				  & (7), to implement uniform national standards for reserve financing
				  arrangements pertaining to life insurance policies with guaranteed nonlevel
				  gross premiums, life insurance policies with guaranteed nonlevel benefits, and
				  universal life insurance policies with secondary guarantees; and to ensure
				  that, with respect to each such financing arrangement, adequate security,
				  including adequate Primary Security as defined in Subsection 4(7), is held by
				  or on behalf of ceding insurers in the forms and amounts required herein. In
				  general, reinsurance ceded for reserve financing purposes involves arrangements
				  where some or all of the assets used to secure the reinsurance treaty or to
				  capitalize the reinsurer have one or more of the following characteristics:
(1) they are issued by the ceding
				insurer or its affiliates;
(2) they
				are not unconditionally available to satisfy the general account obligations of
				the ceding insurer; or
(3) they
				create a reimbursement, indemnification, or other similar obligation on the
				part of the ceding insurer or any if its affiliates (other than a payment
				obligation under a derivative contract acquired in the normal course and used
				to support and hedge liabilities pertaining to the actual risks in the policies
				ceded pursuant to the reinsurance treaty).
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 735 - Term and Universal Life Insurance Reserve Financing › Section 031-735-2 - Applicability

Current through 2024-29, July 17, 2024
This rule applies to all reinsurance treaties that cede
				  liabilities pertaining to Covered Policies, as defined in Subsection 4(2),
				  issued by any domestic life insurer. In the event of a direct conflict between
				  this rule and the Credit for Reinsurance Rule, 02-031 CMR ch. 740, the
				  provisions of this rule shall control as applied to such treaties, but Rule 740
				  shall only be superseded to the extent of any conflict.