reglab/statecodes huggingface dataset:
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 191 - HEALTHMAINTENANCE ORGANIZATIONS › Section 031-191-7 - Financial Standards

Current through 2024-29, July 17, 2024
A. If an HMO is
				operated by a corporation which is chartered for divergent purposes, separate
				accounts shall be maintained respecting the HMO's operations as distinguished
				from other business functions of the corporation.
B. An HMO shall maintain minimum surplus in
				an amount equal to the greater of:
1) One
				million dollars;
2) Two percent
				(2%) of the first $150 million of annual premium revenues as reported in the
				HMO's most recent annual financial statement and one percent (1%) of the annual
				premium in excess of $150 million;
3) An amount equal to three(3) months'
				uncovered health care expenditures as reported in the HMO's most recent annual
				statement;
4) An amount equal to
				eight percent (8%) of the HMO's annual health expenditures, except those paid
				on a capitated basis, as reported on the HMO's most recent annual financial
				statement; or
5) An amount of
				Risk-Based Capital sufficient to avoid a Company Action Level Risk-Based
				Capital Event as defined in
				24-A M.R.S.
				§6453.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 191 - HEALTHMAINTENANCE ORGANIZATIONS › Section 031-191-9 - Requirements for Evidence of Coverage

Current through 2024-29, July 17, 2024
Evidences of coverage, including group contracts, individual
				  contracts and certificates, must be delivered or issued for delivery to
				  enrollees or group contract holders not more than fifteen (15) days from the
				  later of the effective date of coverage or the date on which the HMO is
				  notified of enrollment, and must, in addition to the requirements of
				  24-A
				  M.R.S. §4207, include:
A.
Essential Information
1) The name, address and telephone number of
				the HMO.
2) How to contact the HMO
				by telephone at no cost to the enrollee.
3) A description of the HMO's service area,
				or reference to a separate document bearing this information.
4) Detailed information on how to obtain
				services during regular office hours.
5) Detailed information on how to obtain
				services after hours.
6) Detailed
				information on how to obtain emergency, urgent and specialty
				services.
7) Detailed information
				on how to obtain coverage for emergency and urgent care outside the service
				area.
8)
(Repealed)
9)
				Detailed information about the availability of assistance regarding coverage,
				complaints, and appeals, including explanations of:
a) How to file a complaint or appeal, and a
				statement of the enrollee's right to contact the Superintendent of Insurance
				for assistance at any time.The statement shall include the Superintendent's
				telephone number and address.
b)
				How to obtain assistance from the Maine Consumer Assistance Program in order to
				understand the enrollee's coverage or appeal rights.The statement shall include
				the Program's telephone number and address.
10) How to select and change providers within
				the HMO's provider network.
11) The
				processes in place for coordination and continuity of care.
12) A description of the medications and
				services covered and excluded under the contract, including a description of
				how a consumer may obtain a copy of the plan's certificate of coverage and a
				copy of the complete formulary or a URL or URLs at which the most current
				certificate of coverage and prescription formulary may be accessed.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 191 - HEALTHMAINTENANCE ORGANIZATIONS › Section 031-191-10 - Maintenance and Access to Records; Response to Inquiries

Current through 2024-29, July 17, 2024
A. For the purposes of determining compliance
				with the law and applicable regulations, the Superintendent may as often as he
				or she deems advisable, examine the accounts, records, documents and
				transactions of an HMO and any person or entity under contract with the HMO
				either directly or indirectly.
B.
				HMOs shall retain records of their affairs and transactions for a period of at
				least 6 years, and shall require any person or entity under contract with the
				HMO, either directly or indirectly, to retain records of their affairs and
				transactions relating to the HMO for a period of at least 6 years.
C. HMOs shall respond to all lawful inquiries
				of the Superintendent that relate to resolution of consumer complaints within
				14 days of receipt of the inquiry and to all other lawful inquiries of the
				Superintendent within 30 days of receipt.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 191 - HEALTHMAINTENANCE ORGANIZATIONS › Section 031-191-11 - Subcontracting

Current through 2024-29, July 17, 2024
A. The execution of a subcontract by an HMO
				shall not relieve the HMO of its liability to any enrollee with whom it has
				contracted for the provision of servicesor for its responsibility for
				compliance with the law or applicable regulations.Services to enrollees shall
				not be delayed, reduced, denied or otherwise hindered because of the financial
				or contractual relationship between the HMO and a subcontractor.
B. All subcontracts for the provision of
				services to enrollees shall incorporate the hold harmless requirements of
				24-A M.R.S.
				§4204(6), and all
				applicable requirements of law and regulation.
C. A contract between an HMO and a network
				administrator shall give the HMO the right, in the event of the administrator's
				insolvency, to require assignment to the HMO of those provisions of network
				participating providers' contracts addressing providers' obligation to furnish
				covered services to the HMO.
D. An
				HMO may not subcontract all responsibility for member grievance system
				operation or resolution to providers or networks under contract with the HMO
				for the provision of services to enrollees, and enrollees shall retain the
				right to pursue a grievance directly with the HMO.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 200 - NON-PROFIT HOSPITAL OR MEDICAL SERVICES ORGANIZATIONS › Section 031-200-1 - Non-profit hospital or medical services organizations

Current through 2024-29, July 17, 2024
The following chapters and provisions of Title 24-A, where
				  and to the extent not inconsistent with Title 24, Chapter 19 and the reasonable
				  implications thereof, shall apply to all organizations subject to Title 24,
				  M.R.S.A., Chapter 19:
A. Chapter 1.
				General Definitions and provisions
B. Chapter 3 The Insurance
				Superintendent
C. Chapter 23. Trade
				Practices and frauds
C. Chapter 23.
				Trade Practices and frauds
D.
				Chapter 49 Continuity of management
E. Chapter 57 Delinquent insurers;
				rehabilitation and liquidation
NOTE:Pursuant to Title 24-A, M.R.S.A., Section 212, and Title
				  24, M.R.S.A., Section 2317 and following a hearing held in Augusta on January
				  13, 1978, the following regulation is re-promulgated.
This regulation is identical to and replaces Regulation 77-1
				  dated March 15, 1977. It has been re-promulgated for the purpose of clarifying
				  its validity.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 210 - STANDARDS FOR PHARMACY BENEFITS MANAGERS › Section 031-210-1 - Authority and Purpose

Current through 2024-29, July 17, 2024
This rule is adopted pursuant to
				  24-A
				  M.R.S. §§
										212,
				  4348(8), and
				  4349(5), to
				  establish licensing requirements for pharmacy benefits managers (PBMs), and to
				  ensure that savings generated from spread pricing or pharmaceutical rebates are
				  passed on to consumers via reductions in premiums or other savings.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 210 - STANDARDS FOR PHARMACY BENEFITS MANAGERS › Section 031-210-2 - Applicability and Scope

Current through 2024-29, July 17, 2024
This rule shall apply to all PBMs as defined in
				  24-A
				  M.R.S. §4347(17) and
				  carriers, as defined in
				  24-A
				  M.R.S. §4347(3), that
				  contract with PBMs. For purposes of this rule, as set forth in
				  24-AM.R.S.
				  §4347(3), the MaineCare
				  program and the state employee health plan are considered carriers, but a
				  multiple-employer welfare arrangement is not considered a carrier if it
				  contracts with a third-party administrator to administer its benefit plan and
				  does not contract separately with a PBM for its prescription drug
				  benefits.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 210 - STANDARDS FOR PHARMACY BENEFITS MANAGERS › Section 031-210-3 - Definitions

Current through 2024-29, July 17, 2024
The definitions applicable to this rule are contained in
				  24-A
				  M.R.S. §4347. In addition to those
				  definitions, the following definitions apply:
1.
Pharmaceutical rebate
.
				"Pharmaceutical rebate" means a discount or other price concession that is paid
				by a manufacturer or third party directly or indirectly to a PBM or a pharmacy,
				other than a discount or price concession that is fully disclosed and reflected
				at the point of sale by incorporation into the ingredient cost paid by the
				carrier and the calculation of the enrollee's cost sharing amount.
2.
Spread pricing
. "Spread
				pricing" means the model of prescription drug pricing in which the PBM charges
				a carrier or other health benefit payer a contracted price for prescription
				drugs that may differ from the price the PBM pays a pharmacy for the
				drugs.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 210 - STANDARDS FOR PHARMACY BENEFITS MANAGERS › Section 031-210-4 - Licensing Requirements

Current through 2024-29, July 17, 2024
1.
Initial
				Licensing
On or after January 1, 2020, any person acting or purporting
				  to act as a PBM shall apply for a license on a form prescribed by the
				  Superintendent. The application must contain the following:
A.
Applicant Information
(1) The name, principal business address, and
				telephone number of the applicant;
(2) The name, address, and telephone number
				of the applicant's agent for service of process located in Maine;
(3) The name, address, telephone number of
				each officer and director of the applicant;
(4) The name, address and telephone number of
				each person who owns 10% or more of the voting securities or equivalent
				ownership rights of the applicant; and
(5) The state in which the applicant is
				domiciled;
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 210 - STANDARDS FOR PHARMACY BENEFITS MANAGERS › Section 031-210-5 - Oversight and Contracting Responsibilities

Current through 2024-29, July 17, 2024
1.
Fiduciary Duty
A. A carrier that
				contracts with a PBM must ensure that the contract specifies that the PBM acts
				as the carrier's agent in administering the carrier's prescription drug
				benefits, and owes a fiduciary duty to the carrier that obligates the PBM to:
(1) Act prudently and solely in the best
				interest of the carrier in its management of activities related to the
				carrier's prescription drug benefits;
(2) Account for and disclose to the carrier
				all compensation that it receives so that the carrier may use it in compliance
				with subsection 2; and
(3) Ensure
				compliance with all other requirements of this rule and other applicable
				law.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 210 - STANDARDS FOR PHARMACY BENEFITS MANAGERS › Section 031-210-6 - 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 220 - CREDIT LIFE AND HEALTH INSURANCE › Section 031-220-1 - Purpose

Current through 2024-29, July 17, 2024
This rule establishes procedures and guidelines for filing
				  credit life and health insurance rates and experience filings. The rule is
				  intended to inform those filing credit experience and rate filings of the types
				  of data which are required to permit the Bureau to appropriately review the
				  filings submitted.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 220 - CREDIT LIFE AND HEALTH INSURANCE › Section 031-220-2 - AUTHORITY

Current through 2024-29, July 17, 2024
Pursuant to Title
				   24-A M.R.S.A.,
				  Section212 and Chapter 37, the following Rule
				  governing credit life and credit health insurance in the State of Maine is
				  hereby adopted by the Insurance Superintendent.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 220 - CREDIT LIFE AND HEALTH INSURANCE › Section 031-220-3 - Scope

Current through 2024-29, July 17, 2024
This Rule applies to all insurance which is subject to Title
				  24-A M.R.S.A., Chapter 37, except that Sections
				  9,
				  10, and
				  13 do not apply to noncontributory
				  credit insurance.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 220 - CREDIT LIFE AND HEALTH INSURANCE › Section 031-220-4 - Definitions

Current through 2024-29, July 17, 2024
A. "Amount Financed" as used in Title
				 24-A M.R.S.A.,
				Sections2604-A(4) and
				2855(1)
				(A), shall have the same meaning as that set
				forth in Title
				 9-A M.R.S.A.,
				Section1-301(5).
B. "Open-end Credit" as used in Title
				 24-A M.R.S.A.,
				Sections2855 and
				2859,
				and in this Rule shall have the same meaning as that set forth in Title
				 9-A M.R.S.A.,
				Section1-301(26).
C. "Closed-end credit" means any type of
				credit transaction other than open-end credit.
D. "Insurance charge" means an amount paid by
				a debtor to a creditor for credit insurance.
E. "Premium" means an amount paid by a
				creditor to an insurer for credit insurance.
F. "Truncated Coverage" means a credit
				insurance benefit with a term of insurance coverage that is shorter than the
				full term of the credit transaction or the remaining term at the time the
				insurance coverage is elected.
G.
				"Critical Period Disability Coverage" means credit disability insurance with a
				benefit equal to a specified number of monthly payments or the remaining
				payments on the loan, whichever is less.
H. "Noncontributory credit insurance" means
				credit insurance for which no insurance charge is made to the debtor and there
				is no differential in finance, interest, service or other similar charge made
				to debtors who are in like circumstances, except for their insured or
				noninsured status.
I. "Plan of
				Insurance" unless otherwise filed and approved means:
(1) credit life insurance on a flat rated
				basis other than revolving accounts (i.e. including joint and single life
				coverage, decreasing and non-decreasing insurance; outstanding balance and
				single premium);
(2) credit life
				insurance on a revolving account basis;
(3) credit life insurance on age-graded
				basis;
(4) credit accident and
				health insurance other than on revolving accounts combining outstanding balance
				and single premium but separately for each combination of waiting period and
				retroactive or non-retroactive;
(5)
				credit accident and health insurance on a revolving account basis separately
				for each combination of waiting period and retroactive or
				non-retroactive.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 220 - CREDIT LIFE AND HEALTH INSURANCE › Section 031-220-5 - Application or Notice of Proposed Insurance

Current through 2024-29, July 17, 2024
Title
				   24-A
				  M.R.S.A., Section2857, Subsection
				  4
				  requires the copy of the application or notice of proposed insurance to be
				  separate from the credit instrument, unless the information is prominently set
				  forth in it. The copy of the application for, or notice of, proposed insurance
				  shall be deemed to be prominently set forth in the credit instrument if set
				  forth in a separate provision in type at least equal in size and prominence to
				  the type used for the other provisions thereof, provided the name of the debtor
				  proposed for insurance, and figures relating to the amount and term of the
				  coverage, and the rate or amount of payment for insurance by the debtor need
				  not be contained in a separate provision of the instrument as long as they are
				  included elsewhere in the instrument.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 220 - CREDIT LIFE AND HEALTH INSURANCE › Section 031-220-6 - Truncated Coverage Notice

Current through 2024-29, July 17, 2024
A. For truncated
				credit life insurance and/or credit disability insurance, a notice must appear
				in bold print on the face of the individual policy or group certificate or as
				an endorsement attached to the face page of the individual policy or group
				certificate. If the same policy or certificate form is used for both truncated
				and other types of coverage, a check box may be used such that the notice
				applies only if the box is checked.
B. Unless alternative language is approved by
				the Superintendent, the notice shall be worded as follows:
(1) For truncated credit life insurance:
				"Notice: The term of your loan is longer than the term of this insurance. The
				death benefit is only payable if death occurs during the term of the
				insurance."
(2) For truncated
				credit disability insurance: "Notice: The term of your loan is longer than the
				term of this insurance. Disability benefits will not be paid for any period of
				disability beginning or continuing after the termination date of this
				insurance."
(3) For truncated
				credit life and disability insurance: "Notice: The term of your loan is longer
				than the term of this insurance. The death benefit is only payable if death
				occurs during the term of the insurance. Disability benefits will not be paid
				for any period of disability beginning or continuing after the termination date
				of this insurance."
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 220 - CREDIT LIFE AND HEALTH INSURANCE › Section 031-220-7 - Amount of insurance

Current through 2024-29, July 17, 2024
A. For credit life
				insurance provided in connection with open-end credit, the amount of insurance
				permitted under Title
				 24-A M.R.S.A.,
				Section2855(1) (A) shall at
				no time exceed the balance upon which a finance charge may be imposed,
				including any (a) principal amounts which the debtor has drawn, or used to make
				purchases, whether or not these amounts have been charged to the debtor's
				account, and (b) earned finance or insurance charges which are uncollected or
				past due.
B. For credit life
				insurance provided in connection with closed-end credit, the amount of
				insurance permitted under Title
				 24-A M.R.S.A.,
				Section2855(1) (A) shall at
				no time exceed the aggregate of remaining unpaid installments reduced by the
				value of the unearned finance charge calculated according to the actuarial
				method.
C. If the benefit under
				credit life or credit disability insurance will be insufficient to extinguish
				the amount of indebtedness at the time of death or disability (excluding any
				indebtedness due only to delinquency in payments by the debtor), this fact must
				be prominently disclosed in the group certificate or individual
				policy.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 220 - CREDIT LIFE AND HEALTH INSURANCE › Section 031-220-8 - Basis of premiums

Current through 2024-29, July 17, 2024
A. If a single
				insurance charge is made to the debtor, whether or not the charge is financed,
				a single premium must be used.
B.
				Premiums for credit insurance provided in connection with open-end credit
				transactions shall be calculated on the basis of the balance upon which a
				finance charge may be imposed, including any principal amounts upon which no
				finance charge is actually imposed, plus any earned finance or insurance
				charges which are uncollected or delinquent.
C. In no event shall any anticipated
				delinquency value be included in the amount on which the insurance premiums are
				calculated.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 220 - CREDIT LIFE AND HEALTH INSURANCE › Section 031-220-11 - Refund

Current through 2024-29, July 17, 2024
A. If credit life insurance on a debtor
				terminates prior to expiration of the period for which a charge for such
				insurance has been made to the debtor, by reason of early discharge of
				indebtedness by cash or refinancing, or by payment of a lump sum disability
				insurance claim, or otherwise, except by payment of a death claim under the
				credit life insurance policy, a refund of such charge for insurance shall be
				made to the debtor, or credited to his account.
B. If credit accident and health insurance on
				a debtor terminates prior to expiration of the period for which a charge for
				such insurance has been made to the debtor, for any reason whatsoever except
				for payment of a lump sum disability insurance benefit, a refund of such charge
				for insurance shall be made to the debtor, or to his beneficiary or estate, as
				appropriate.
C. In any refinancing
				or consolidation of an indebtedness, no policy provision covering the new
				indebtedness shall operate to deny benefits which would have been payable had
				the refinancing or consolidation not taken place.
D. The following formulae for computing
				refunds of credit insurance premiums are hereby declared acceptable to the
				Superintendent for the kinds of coverage specified. Other refund formulae which
				any insurer desires to use must be filed with and approved by the
				Superintendent prior to use.
(1) Monthly
				premium credit accident and health and monthly premium credit life refunds
				shall be either the full monthly premium or nothing, according to subsection
				F.
(2) Single premium credit life
				and credit accident and health refunds shall be calculated on the "Rule of
				Anticipation" method.
(3) For
				purposes of this rule, the "Rule of Anticipation" provides a refund equal to
				the premium cost of scheduled benefits subsequent to the date of cancellation
				or termination, computed at the schedule of premium rates in effect on the date
				of issue of the coverage.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 220 - CREDIT LIFE AND HEALTH INSURANCE › Section 031-220-12 - Beneficiary

Current through 2024-29, July 17, 2024
The primary beneficiary shall be the creditor as his interest
				  may appear. After the creditor's interest is satisfied, other benefits or
				  refunds, if any, will be paid to the secondary beneficiary named by the insured
				  debtor or if no named secondary beneficiary survives the insured, such other
				  benefits or refunds, if any, shall be paid to the estate of the
				  insured.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 220 - CREDIT LIFE AND HEALTH INSURANCE › Section 031-220-13 - Reporting

Current through 2024-29, July 17, 2024
A. Each insurer doing a credit life and/or
				credit accident and health insurance business in the State of Maine shall file
				annually, prior to June 1, reports of its credit life insurance and credit
				accident and health insurance experience in this State on forms prescribed by
				the Superintendent and attached to this Rule as Appendix A. The experience
				reports shall be filed in an electronic format prescribed by the
				Superintendent. The reporting method is file and use. Experience filings will
				be reviewed for compliance with the requirements of this Rule. Any deficiencies
				will be brought to the attention of the carrier. If the rates have already been
				implemented, corrective action may be required. If the carrier desires to
				receive confirmation prior to implementation the carrier should provide to the
				Bureau the cover letter in duplicate requesting the confirmation. Every effort
				will be made to process filings within 60 days of the June 1
				deadline.
B. Each insurer may
				report experience and determine rate deviations either by combining experience
				for all policyholders in this state or, if sufficiently credible as defined
				below, by splitting experience into two or more cases.
(1) "Case" means either a "Single Account
				Case" or a "Multiple Account Case" or a "Pooled Account Case" as follows:
a. "Single Account Case" means a case
				consisting of only one account as defined in Section
				4. The account must meet the
				credibility standards of Paragraph (2) below.
b. "Multiple Account Case" means two or more
				accounts of the same insurer, having similar underwriting characteristics,
				which are combined by the insurer for premium rating purposes and which, when
				combined, meet the credibility standards of Paragraph (2) below.
c. "Pooled Account Case" means a combination
				of all the insurer's accounts of the same plan of insurance, excluding all
				cases defined in (a) and (b) above. A pooled account case must meet the
				credibility standards of Paragraph (2) below.
Experience reports for multiple account cases and pooled
				  account cases must include a list of the accounts included in the case.
Once a case is established, it cannot be changed unless such
				  change is according to the case determination guidelines of the insurer and is
				  approved by the Superintendent. However, if a case ceases to meet the
				  credibility standards of Paragraph (2) below, it must be combined with another
				  case.
Experience reported for a Multiple Account Case or a Pooled
				  Account Case must exclude experience on any accounts that terminated during the
				  three-year experience period.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 220 - CREDIT LIFE AND HEALTH INSURANCE › Section 031-220-14 - Conformity With Regulation

Current through 2024-29, July 17, 2024
All credit rates submitted to the Bureau shall be certified
				  as to conformity with this regulation by company actuary or responsible company
				  official. The accompanying data submitted to the Bureau shall also be certified
				  as to accuracy to the best of the submitting official's
				  knowledge.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 220 - CREDIT LIFE AND HEALTH INSURANCE › Section 031-220-15 - Expense Allowances and Commissions

Current through 2024-29, July 17, 2024
A. Fees
				paid to a lender for handling or processing credit life or credit health
				insurance may not exceed 10% of prima facie premiums as defined by this
				rule.
B. In addition to fees
				allowed by subsection A, a commission not exceeding 5% of prima facie premiums
				may be paid to a creditor who is a licensed credit insurance agent.
For purposes of this section and
				   24-A M.R.S.A.
				  §2860-A, "lender" means creditor.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 220 - CREDIT LIFE AND HEALTH INSURANCE › Section 031-220-16 - Effective Date

Current through 2024-29, July 17, 2024
This rule as last amended was effective October 1, 1987.
				  Amendments adopted in 2006 shall take effect on October 1, 2006.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 231 - CERTIFICATES OF AUTHORITY FOR INSURANCE COMPANIES › Section 031-231-1 - Authority and Purpose

Current through 2024-29, July 17, 2024
The Superintendent of Insurance has adopted this Rule,
				  pursuant to
				   24-AM.R.S.A.
				  §§212,
				  404,
				  413,
				  414,
				  2151-B, and
				  2186,
				  in order to set standards and procedures under which an insurance company may
				  apply for a Certificate of Authority to transact the business of insurance in
				  Maine or for amendment of an existing Certificate of
				  Authority.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 231 - CERTIFICATES OF AUTHORITY FOR INSURANCE COMPANIES › Section 031-231-2 - Scope

Current through 2024-29, July 17, 2024
This Rule applies to all insurers for which a Certificate of
				  Authority is required pursuant to
				  
				  24-AM.R.S.A. §404.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 231 - CERTIFICATES OF AUTHORITY FOR INSURANCE COMPANIES › Section 031-231-4 - Newly Formed Domestic Insurers

Current through 2024-29, July 17, 2024
Any business entity domiciled in Maine that desires to
				  commence business as an insurer shall submit an application for a Certificate
				  of Authority on the most current Uniform Certificate of Authority Primary
				  Application form, or its successor form, published by the National Association
				  of Insurance Commissioners or its successor organization, and shall provide all
				  information requested therein and such additional information as the
				  Superintendent may request in the course of reviewing the application,
				  sufficient to demonstrate compliance with the following requirements, except to
				  the extent that particular requirements may be waived or modified by the
				  Superintendent upon a finding that they are not applicable to the circumstances
				  of the application.
A.
Corporate Organization
The Applicant must comply, as applicable, with the
				  organizational requirements of Chapter 47, 51, 53, or 83 of the Maine Insurance
				  Code, Title 24-AM.R.S.A. If a mutual or reciprocal insurer, the Applicant must
				  demonstrate that it has an adequate initial membership base.
B.
Business Name
The Applicant shall not use a business name deceptively
				  similar to that of any insurer currently holding a valid Certificate of
				  Authority. No application will be entertained that proposes to use a name that
				  has been reserved by another business entity with the Superintendent or the
				  Maine Secretary of State, until the period of the other business's reservation
				  has expired or the reserved name has been withdrawn.
C.
Deposit Requirements
The Applicant must deposit qualifying assets with the
				  Treasurer of State with a minimum fair market value of $100,000 as security for
				  all its policyholders, in compliance with the requirements of 24-AM.R.S.A.
				  Chapter 15 (§§ 1251
et seq.
).
D.
Capital and Surplus
(1) The Applicant must possess initial
				capital and/or surplus in an amount at least equal to the minimum amount
				prescribed in
				 24-AM.R.S.A.
				§410(1) for all lines
				of insurance the Applicant transacts or seeks authorization to transact in
				Maine or elsewhere. Initial capital and/or surplus shall be calculated in the
				same manner as provided in Subsection
				3(D). The initial
				free surplus requirement may not be satisfied through surplus notes or other
				encumbered assets.
(2) The
				Applicant's initial surplus must also be sufficient to demonstrate to the
				satisfaction of the Superintendent that the Applicant will be reasonably
				assured of maintaining adequate risk-based capital to support the business the
				Applicant plans to write, at a level consistent with sound management and no
				less than the company action level.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 231 - CERTIFICATES OF AUTHORITY FOR INSURANCE COMPANIES › Section 031-231-6 - Amendment of Certificate of Authority

Current through 2024-29, July 17, 2024
An Applicant seeking amendment of an existing Certificate of
				  Authority shall submit an application on the most current Uniform Certificate
				  of Authority Corporate Amendment form, or its successor form, published by the
				  National Association of Insurance Commissioners, or its successor organization,
				  and shall provide all information requested therein and such additional
				  information as the Superintendent may request in the course of reviewing the
				  application, sufficient to demonstrate, to the extent applicable to the nature
				  of the proposed amendment, that the Applicant is qualified. When the amendment
				  involves new lines of business or other substantial change in operations, the
				  required showing shall include, without limitation, a demonstration that the
				  insurer has demonstrated a sound business plan and adequate capital and/or
				  surplus to support the new operations consistent with Subsection
				  3(D). If the
				  Applicant is requesting to add new lines of business to its Certificate of
				  Authority, the Applicant must demonstrate experience consistent with the
				  requirements of Subparagraph
				  3(E) (1)(d) and all
				  other applicable requirements of Subsection 3(E).
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 231 - CERTIFICATES OF AUTHORITY FOR INSURANCE COMPANIES › Section 031-231-7 - Reinstatement of Certificate of Authority

Current through 2024-29, July 17, 2024
An Applicant whose Certificate of Authority has been
				  suspended and seeks reinstatement must demonstrate to the satisfaction of the
				  Superintendent that it has complied with any conditions of reinstatement
				  prescribed in the order of suspension and that the reasons for the suspension
				  should no longer act as a bar to the Applicant's doing business in Maine. If
				  the Applicant has undergone a substantial change in operations, management, or
				  capital structure, the Superintendent may require compliance with such
				  provisions of Section
				  3 as the Superintendent determines to
				  be appropriate in the circumstances.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 231 - CERTIFICATES OF AUTHORITY FOR INSURANCE COMPANIES › Section 031-231-8 - Issuance of Certificate of Authority

Current through 2024-29, July 17, 2024
A.
Grant of Application
If the Applicant satisfies the applicable requirements of
				  this Rule and the Superintendent finds no ground for denying the application
				  pursuant to Section
				  9, the Superintendent shall promptly
				  issue the Applicant a Certificate of Authority.
B.
Conditional Licensure
If the Superintendent determines upon reviewing the
				  application that the Applicant is qualified to transact insurance in this State
				  only for a specialized or limited purpose, or that conditional licensure is
				  otherwise necessary in order to provide adequate assurance that the Applicant
				  is qualified to transact insurance in this State, the Superintendent shall
				  issue, concurrently with the decision to grant licensure, a written order
				  specifying the conditions of licensure and, if applicable, the procedures and
				  criteria by which the Applicant may obtain an unconditional Certificate of
				  Authority.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 231 - CERTIFICATES OF AUTHORITY FOR INSURANCE COMPANIES › Section 031-231-9 - Denial of Application

Current through 2024-29, July 17, 2024
A.
Grounds
				for Denial
The Superintendent may deny the Applicant a Certificate of
				  Authority, upon finding that any of the following conditions exists:
(1) Failure to comply with the requirements
				of this Rule or other applicable law.
(2) Evidence of misconduct or unfitness in
				the management of the Applicant or in the management of any of its
				affiliates.
(3) The termination of
				the Applicant's Certificate of Authority or denial of its application for
				licensure in another jurisdiction, unless the Applicant proves to the
				satisfaction of the Superintendent that the circumstances of the termination or
				denial do not justify denial of the Maine application.
(4) Two or more of the following unfavorable
				financial trends:
(a) A year-to-year decrease
				of the Applicant's risk-based capital ratio by more than 100 percentage points
				in each of the two most recent years.
(b) A cumulative decrease of surplus in
				excess of 25% over the three most recent years.
(c) A ratings downgrade of two or more levels
				over the past two years by any one of the nationally recognized ratings service
				organizations.
(d) Adjustments to
				reserves due to under-reserving in excess of 10% of surplus in either of the
				two most recent years.
(e) Decrease
				of profitability in each of the three most recent years.
(f) Negative cash flow from operations in
				each of the last three years.
(g)
				Reliance on contributions to surplus from a parent or an affiliate, in order to
				maintain an adequate level of surplus.
(h) Any other financial trend identified by
				the Superintendent that indicates a deterioration in the Applicant's financial
				condition over the most recent preceding three-year period.
When assessing financial trends, the analyst shall consider
				  the change in the Applicant's premium volume and asset size as well as any
				  other material changes to the operations of the Applicant.
(5) Failure of the Applicant to
				update its application or to provide additional information requested by the
				Superintendent within a reasonable timeframe, not to exceed 30 days.
(6) Any other compelling evidence
				demonstrating that the Applicant is not qualified to transact insurance in this
				State.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 231 - CERTIFICATES OF AUTHORITY FOR INSURANCE COMPANIES › Section 031-231-10 - Miscellaneous Provisions

Current through 2024-29, July 17, 2024
A.
Review
				Procedures
The review process for applications for a Certificate of
				  Authority shall be conducted in accordance with the following
				  procedures.
(1) Application reviews
				will be conducted continuously throughout the year. The Superintendent may
				withhold final determination on applications filed after October 1 of each year
				until 30 days after receipt of the annual financial statements which are due
				March 1 of the following year.
(2)
				The Financial Analysis Division shall make a recommendation to the
				Superintendent concerning applications which have been reviewed and findings
				reached thereon. The Superintendent shall consider the recommendation and make
				a decision on the application. Written notice of the decision shall be mailed
				to the Applicant within 30 days after the date of decision.
(3) Unless there is good cause for expediting
				or postponing review, applications will be considered in the order in which
				they are filed. An Applicant is not entitled to priority treatment on the
				ground that affiliated insurers are licensed in this State.
(4) The Applicant may expect a period of at
				least two months before final review of the application, in order,
inter alia,
to allow for background investigations, inquiry
				regarding claims settlement practices, and the gathering of any necessary
				information not filed with the initial application. Additional time will be
				required, if it is necessary to wait for the Applicant to provide additional
				information or a response to an inquiry.
(5) If an Applicant has any tax liability
				owing to this State, the Application will be withdrawn from consideration and
				will not be accepted for filing until the tax liability is fully
				discharged.
(6) Any person
				aggrieved by a decision on an application for a Certificate of Authority may
				seek an administrative hearing before the Superintendent under
				 24-AM.R.S.A.
				§229, by filing a written request with
				the Bureau within 90 days after the complainant learned or reasonably should
				have learned of the decision.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 231 - CERTIFICATES OF AUTHORITY FOR INSURANCE COMPANIES › Section 031-231-11 - Effective date

Current through 2024-29, July 17, 2024
This Rule is effective
August 9, 2005
andapplies to all applications pending on that date or filed after
				  that date, except that the Applicant may elect to have its application reviewed
				  pursuant to former Rule 230, if a final application was pending on the
				  effective date of this Rule, or if a preliminary application was pending or
				  approved on the effective date of this Rule and a final application is
				  submitted on or before September 1, 2005.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 235 - ANNUAL AUDITED FINANCIAL REPORTS › Section 031-235-1 - Authority and Purpose

Current through 2024-29, July 17, 2024
This Rule is adopted by the Superintendent of Insurance
				  pursuant to
				  24 M.R.S.A.
				  §2317(2) and 24-A
				  M.R.S.A. §§ 212, 221-A(5), 4218, in order to ensure that the annual
				  audited financial reports required pursuant to
				  24-A M.R.S.A.
				  §221-A and other applicable provisions
				  of the Maine Insurance Code are prepared in compliance with the standards
				  established by the National Association of Insurance
				  Commissioners.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 235 - ANNUAL AUDITED FINANCIAL REPORTS › Section 031-235-2 - Scope

Current through 2024-29, July 17, 2024
This Rule applies to all insurers and health maintenance
				  organizations required to file audited financial reports pursuant to
				  24-A M.R.S.A.
				  §§221-A and
				  4233(2),
				  and to all nonprofit corporations regulated under Title 24 M.R.S.A., subject to
				  the same exemptions and limitations that would apply under
				  24-A M.R.S.A.
				  §221-A and this Rule if they were
				  authorized as insurers. For purposes of this Rule, the term "insurer" includes
				  health maintenance organizations and nonprofit corporations regulated under
				  Title 24 M.R.S.A. If an insurer is publicly traded, this Rule and the standards
				  incorporated by reference herein apply only to the extent that they do not
				  conflict with applicable federal law and applicable standards promulgated by
				  the Public Company Accounting Oversight Board. For SOX-Compliant Insurers, as
				  defined in Section
				  16, the provisions of this Rule are
				  superseded to the extent provided therein. Compliance with this Rule does not
				  limit in any way the insurer's duty to provide such additional information as
				  the Superintendent may request pursuant the Superintendent's examination
				  authority or other applicable law.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 235 - ANNUAL AUDITED FINANCIAL REPORTS › Section 031-235-3 - Contents of Annual Audited Financial Report

Current through 2024-29, July 17, 2024
The annual audited financial report shall report the
				  financial position of the insurer as of the end of the most recent calendar
				  year and the results of its operations, cash flows, and changes in capital and
				  surplus for the year then ended. Financial statements, opinions, and reports
				  filed pursuant to this Rule must be prepared in conformity with the statutory
				  accounting practices prescribed or permitted by the insurance supervisory
				  official of the insurer's state of domicile for insurers' regulatory financial
				  statements, with due consideration given to the procedures illustrated in the
Financial Condition Examiners Handbook
or its successor
				  publication promulgated by the National Association of Insurance
				  Commissioners.
The financial statements included in the audited financial
				  report shall be prepared in a form and using language and groupings
				  substantially the same as the relevant sections of the annual statement of the
				  insurer filed with the Superintendent. The financial statements shall be
				  comparative, presenting the amounts as of December 31 of the most recent year
				  and the amounts as of the immediately preceding December 31, except for newly
				  formed insurers for which comparative data does not exist. The annual audited
				  financial report shall include the following:
A. Narrative "Report of Independent Certified
				Public Accountant";
B. Balance
				sheet reporting admitted assets, liabilities, capital, and surplus;
C. Statement of operations;
D. Statement of cash flows;
E. Statement of changes in capital and
				surplus; and F. Notes to financial statements, as required by the appropriate
				NAIC
Annual Statement Instructions
and the NAIC
Accounting Practices and Procedures Manual
.The notes shall
				include a reconciliation of differences, if any, between the audited statutory
				financial statements and the annual statement filed pursuant to
				24-A M.R.S.A.
				§423, with a written description of the
				nature of these differences.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 235 - ANNUAL AUDITED FINANCIAL REPORTS › Section 031-235-4 - Time for Filing of Annual Audited Financial Report

Current through 2024-29, July 17, 2024
An insurer shall file its audited financial report with the
				  Superintendent on or before June 1 of each year, or such other date as may be
				  provided by law or ordered by the Superintendent upon 90 days' notice to the
				  insurer. Extensions of the filing date may be granted by the Superintendent for
				  30-day periods upon a showing by the insurer and its independent certified
				  public accountant of the reasons for requesting an extension and a
				  determination by the Superintendent that there is good cause for an extension.
				  The request for extension must be submitted in writing at least ten days before
				  the due date in sufficient detail to permit the Superintendent to make an
				  informed decision on the requested extension.