reglab/statecodes huggingface dataset:
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 360 - REQUIREMENTS APPLICABLE TO PREFERRED PROVIDER ARRANGEMENTS › Section 031-360-6 - Public hearing

Current through 2024-29, July 17, 2024
A. Any person
				wishing to be notified of proposals for preferred provider arrangements must
				notify the Superintendent in writing.
B. All persons who request notification will
				be mailed notice within ten days of receipt of any filing made pursuant to
				Section
				4 above. Other information contained
				in the filing will be available for inspection at the Bureau of Insurance
				except for any portions deemed confidential pursuant to
				 1 M.R.S.A. §402(3)(A) or
				(B). It is the responsibility of the filing
				party to identify any portions of the application materials or other filings
				for which confidential treatment is sought at the time of the filing of those
				materials. The filing party shall also submit a statement of the legal grounds,
				upon which the claim for confidentiality is based, which shall be specific to
				the materials identified; blanket assertions of confidentiality are not
				sufficient. Determination of confidentiality will be within the
				Superintendent's discretion.
C. Any
				interested or affected person may make a written request for a public hearing
				to the Superintendent within 40 days after the filing. If the person requesting
				the hearing has made a timely request for notification, but timely notice was
				not sent pursuant to Subsection (B), the deadline shall be extended if fairness
				so requires.
D. If the
				Superintendent finds that a person requesting a hearing pursuant to Subsection
				(C) would be aggrieved if the stated grounds were established, and the grounds
				otherwise justify a hearing, then the Superintendent will hold a public hearing
				within 30 days after receipt of the request, or at a later date set by the
				Superintendent.
E. The
				Superintendent may convene a public hearing on the filing on his or her own
				initiative within 60 days after receiving a complete filing or at a later date
				set by the Superintendent.
F.
				Public hearings pursuant to Subsections (D) and (E) shall be held in accordance
				with 5 M.R.S.A. Chapter 375, Subch. IV (§§ 9051-9064 ) and Chapter
				350 of the Bureau of Insurance Rules. The Superintendent will issue a decision
				within 30 days after the close of the hearing.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 360 - REQUIREMENTS APPLICABLE TO PREFERRED PROVIDER ARRANGEMENTS › Section 031-360-7 - Approved preferred provider arrangements

Current through 2024-29, July 17, 2024
A.
				The Superintendent may from time to time require an evaluation of the quality
				assurance program by a professionally recognized, independent third party at
				the expense of the carrier or administrator.
B. The Superintendent may convene a public
				hearing at any time if he or she has reason to believe that the requirements of
				this Rule or any statutory requirement may not be met.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 360 - REQUIREMENTS APPLICABLE TO PREFERRED PROVIDER ARRANGEMENTS › Section 031-360-9 - Annual registration fee and report

Current through 2024-29, July 17, 2024
Each administrator registered under this rule shall pay to
				  the Superintendent a registration fee pursuant to
				   24-A M.R.S.A.
				  §601 subsection 20 and annually
				  thereafter on or before March 1st of each succeeding year so long as such
				  registration is maintained. Annual registration reports in a format prescribed
				  by the Superintendent must be filed with the Superintendent no later than March
				  1st of each year.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 360 - REQUIREMENTS APPLICABLE TO PREFERRED PROVIDER ARRANGEMENTS › Section 031-360-10 - Examination of administrators who handle money

Current through 2024-29, July 17, 2024
A.
				The Superintendent or a designee may examine an administrator who directly or
				indirectly transfers funds, manages funds, adjusts claims, or asserts control
				over the transfer of funds for the purpose of payment of provider services for
				compliance with the requirements of this rule,
				 24-A M.R.S.A.
				§§2674-A and
				1911.
B. Any administrator being
				examined shall provide to the examiner convenient and free access, at all
				reasonable hours at its offices, to all books, records, documents, and other
				papers relating to its business affairs. The examiner shall not have access to
				beneficiary medical records that are protected by state statute.
C. The examiners designated by the
				Superintendent pursuant to this Section may make reports to the Superintendent.
				Any report alleging substantive violations of this Rule, or any applicable
				provisions of the Maine Insurance Code, shall be in writing and be based upon
				facts obtained by the examiners. The report shall be verified by the
				examiner(s).
D. If a report is
				made, the Superintendent shall either deliver a duplicate thereof to the
				administrator being examined or send such duplicate by certified or registered
				mail to the administrator's address specified in the records of the Bureau. The
				Superintendent shall afford the administrator an opportunity to request a
				hearing to object to the report. As a result of the findings of the report, the
				Superintendent may initiate a hearing concerning revocation or suspension of
				registration if the findings of the report so indicate.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 360 - REQUIREMENTS APPLICABLE TO PREFERRED PROVIDER ARRANGEMENTS › Section 031-360-11 - Marketing

Current through 2024-29, July 17, 2024
A. An administrator may market and otherwise
				make available preferred provider arrangements to licensed health maintenance
				organizations, carriers, fraternal benefit societies, or self-insuring
				employers or health and welfare trust funds, and to their subscribers, provided
				that, in performing these functions, the administrator shall provide
				administrative services only and shall not accept underwriting risk in the form
				of a premium or capitation payment for its services except as provided for in
				24-A M.R.S.A. Chapter 56-A Subchapter III.
B. In those cases where an administrator
				makes a preferred provider arrangement available to a health maintenance
				organization, the health maintenance organization shall continue to market and
				offer health care services, including at a minimum basic health care services
				as defined at
				 24-A M.R.S.A.
				§4202-A(1). All such
				services, to the extent otherwise consistent with this Rule and other
				applicable law, may be offered through a preferred provider arrangement, or
				through a combination of arrangements including a preferred provider
				arrangement.
(1) No schedule of charges,
				including an amended schedule, for enrollee coverage for health care services,
				including services provided through a preferred provider arrangement, may be
				used by a health maintenance organization until a copy of the schedule, or
				amended schedule, has been filed with and approved by the
				Superintendent.
(2) The charges for
				the enrollee coverage for health care services including services provided
				through a preferred provider arrangement will be subject to the review required
				by
				24-A
				M.R.S.A. §4207.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 360 - REQUIREMENTS APPLICABLE TO PREFERRED PROVIDER ARRANGEMENTS › Section 031-360-12 - Severability

Current through 2024-29, July 17, 2024
If any provision or application of this Rule shall be judged
				  invalid for any reason, such judgment shall not affect, impair, or invalidate
				  any other provision or application of this Rule, and the remaining provisions
				  and applications shall continue in full force and effect.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 365 - STANDARDS FOR INDEPENDENT DISPUTE RESOLUTION OF EMERGENCY MEDICAL SERVICE BILLS › Section 031-365-1 - Authority and Purpose

Current through 2024-29, July 17, 2024
This rule is adopted pursuant to
				  24-A M.R.S.
				  §§212 and
				  4303-E,
				  to implement the Independent Dispute Resolution (IDR) process established by PL
				  2019, chapter 668,
An Act To Protect Consumers from Surprise Emergency
				  Medical Bills
.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 365 - STANDARDS FOR INDEPENDENT DISPUTE RESOLUTION OF EMERGENCY MEDICAL SERVICE BILLS › Section 031-365-2 - Applicability and Scope

Current through 2024-29, July 17, 2024
1. This rule shall
				apply to the following entities:
A. A carrier,
				including a participating self-insured health plan.
B. A patient who is eligible to initiate IDR
				under
				22
				M.R.S. §1718-D.
C. A provider that has rendered emergency
				services to an eligible patient, or that has rendered emergency services on an
				out-of-network basis to a patient covered by a carrier's health plan and is
				unable in good faith to negotiate agreement with the carrier on the payment
				amount within 30 calendar days after the carrier has given the provider notice
				as required in paragraph 6(1)(C).
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 365 - STANDARDS FOR INDEPENDENT DISPUTE RESOLUTION OF EMERGENCY MEDICAL SERVICE BILLS › Section 031-365-3 - Definitions

Current through 2024-29, July 17, 2024
The following definitions apply for purposes of this
				  rule:
1. "Carrier" has the same
				meaning as in
				24-A M.R.S.
				§4301-A(3). Unless the
				context otherwise indicates, "carrier" also includes a participating
				self-insured health benefit plan.
2. "Control" has the same meaning as in
				24-A
				M.R.S.
				§222(2)(B).
3. "Eligible patient" means:
A. an uninsured person who has received a
				bill for emergency services totaling $750 from one or more providers for a
				single visit; or
B. a person
				covered under a nonparticipating self-insured health plan who has received a
				surprise bill for emergency services or a bill for covered emergency services
				rendered by an out-of-network provider, and did not knowingly elect to obtain
				the services from an out-of-network provider.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 365 - STANDARDS FOR INDEPENDENT DISPUTE RESOLUTION OF EMERGENCY MEDICAL SERVICE BILLS › Section 031-365-5 - Conflict of interest

Current through 2024-29, July 17, 2024
1. No person may be
				selected as an IDRE if it owns or controls, is owned or controlled by, or is
				under common control with:
A. any national,
				state, or local illness, health benefit, or public advocacy group;
B. any national, state, or local society or
				association of hospitals, physicians, or other providers of health care
				services; or
C. any national,
				state, or local association of insurance carriers.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 365 - STANDARDS FOR INDEPENDENT DISPUTE RESOLUTION OF EMERGENCY MEDICAL SERVICE BILLS › Section 031-365-6 - Responsibilities of Carriers

Current through 2024-29, July 17, 2024
1. Upon receipt of a
				claim for covered emergency services rendered by an out-of-network provider, a
				carrier shall:
A. pay the claim based on an
				allowable charge calculated in accordance with paragraph B, unless the carrier
				and provider negotiate a different amount or the patient knowingly elected to
				obtain the services from an out-of-network provider. The carrier shall pay the
				allowable charge to the provider, subject to the following adjustments:
(1) Payment shall be made net of the
				coinsurance, copayment, deductible, and any other out-of-pocket expense for
				which the enrollee is responsible under subsection
				3;
(2) To the extent that the enrollee has paid
				the provider more than the cost sharing required by subparagraph (1), the
				carrier shall pay the excess to the enrollee and deduct that amount from the
				payment otherwise due to the provider;
(3) Payment shall be made net of any amounts
				already paid by the carrier; and
(4) If the carrier is a secondary payer, the
				enrollee's and carrier's responsibility shall be reduced as called for by
				applicable coordination of benefits procedures;
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 365 - STANDARDS FOR INDEPENDENT DISPUTE RESOLUTION OF EMERGENCY MEDICAL SERVICE BILLS › Section 031-365-7 - Process to Submit and Resolve Disputes

Current through 2024-29, July 17, 2024
1. The
				out-of-network provider or eligible patient requesting IDR (the "applicant")
				shall submit an application in a form and manner prescribed by the
				Superintendent.
2. The applicant
				shall provide the following information, to the extent known to the applicant:
A. the name and contact information of the
				patient, the provider or providers, and, unless the applicant is an uninsured
				patient, the carrier or self-insured health benefit plan;
B. the fee that is the subject of the dispute
				and a copy of the bill;
C. the
				claim number or numbers and date or dates of service;
D. if the application is submitted by a
				provider, the following additional information:
(1) the provider's level of training,
				education, and experience;
(2) an
				explanation of the circumstances and complexity of the particular case,
				including time and place of the service;
(3) individual patient characteristics, if
				relevant; and
(4) the provider's
				usual charge for comparable services rendered to uninsured patients, patients
				treated on an out-of-network basis, patients treated under contracts with other
				carriers or self-insured plans, and, if applicable, patients treated under a
				contract with the carrier or plan involved in the dispute that was terminated
				or that expired within one year before the date the service was
				rendered;
E. an agreement
				to be bound by the outcome of the IDR, to submit to the jurisdiction of the
				Superintendent and the courts of this State, and if the applicant is an
				out-of-network provider, to refrain from billing the enrollee more than the
				applicable out-of-pocket costs permitted by
				22 M.R.S.
				§1718(D)(2).
F. any other information the applicant deems
				relevant; and
G. an attestation
				affirming that the information provided by the applicant is true and
				accurate.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 365 - STANDARDS FOR INDEPENDENT DISPUTE RESOLUTION OF EMERGENCY MEDICAL SERVICE BILLS › Section 031-365-8 - 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 365 - STANDARDS FOR INDEPENDENT DISPUTE RESOLUTION OF EMERGENCY MEDICAL SERVICE BILLS › Section 031-365-9 - Effective date

Current through 2024-29, July 17, 2024
This rule is effective October 24, 2020. This rule applies to
				  all IDR applications relating to services rendered on or after October 1, 2020.
				  The 2022 amendments are effective May 1, 2022.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 370 - GROUP LEGAL SERVICES INSURANCE › Section 031-370-1 - Purpose

Current through 2024-29, July 17, 2024
The purpose of this rule is to establish standards for
				  issuance of certificates of authority, approval of policy forms and adequacy of
				  reserves under contracts of group legal services insurance.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 370 - GROUP LEGAL SERVICES INSURANCE › Section 031-370-2 - 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-A M.R.S.A.
				  Sections212,
				  2882,
				  2887
				  and
				  2888.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 370 - GROUP LEGAL SERVICES INSURANCE › Section 031-370-3 - Applicability and scope

Current through 2024-29, July 17, 2024
This rule shall apply to all legal service insurance policies
				  as defined in Title
				   24-A M.R.S.A.
				  Section2883 and insurers authorized to issue
				  such policies.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 370 - GROUP LEGAL SERVICES INSURANCE › Section 031-370-4 - Certificate of authority

Current through 2024-29, July 17, 2024
An application for a certificate of authority to transact the
				  business of legal services insurance must satisfy the following
				  requirements:
A. If the applicant is
				not authorized to transact health insurance business in this State, information
				must be provided on forms prescribed by the Superintendent to adequately
				demonstrate that the applicant is qualified to be so authorized; and
B. The applicant must demonstrate the
				willingness and ability to assure that the promised benefits can be provided.
				In making this determination the superintendent shall consider so far as
				applicable:
(1) The adequacy of surplus
				funds;
(2) Any agreement with
				lawyers or paralegal personnel for the provision of legal services;
(3) The financial soundness of the
				applicant's arrangements for legal services; and
(4) Any additional information considered
				relevant.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 370 - GROUP LEGAL SERVICES INSURANCE › Section 031-370-5 - Policy forms

Current through 2024-29, July 17, 2024
In addition to the requirements of Title 24-A M.R.S.A.
				  Chapter 27, all legal services insurance policies and certificates must meet
				  the following requirements:
A.
				Policies and certificates must indicate prominently the name of the insurer and
				full address of its principal place of business.
B. Policies must contain a detailed list and
				description of the legal services provided or the legal matters for which
				expenses are to be reimbursed and the amount of reimbursement. Covered services
				may include handling of the following matters:
(1) Prenuptial Agreement, Annulment,
				Separation, Divorce;
(2) Adoption,
				Guardianship, Conservatorship;
(3)
				Preventive Legal Service, Document Review, Letter-writing;
(4) Employment Contract;
(5) Purchase & Sale Contract, Real Estate
				Transactions;
(6) Defense of Civil
				Suit, Defense of Debt Collection;
(7) Eviction (if tenant);
(8) Wills, Estate Settlements;
(9) Name Changes; and
(10) Other services may be included upon
				demonstration by the insurer satisfactory to the Superintendent that the
				services covered are a proper subject of insurance.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 370 - GROUP LEGAL SERVICES INSURANCE › Section 031-370-6 - Provider contracts

Current through 2024-29, July 17, 2024
Any contracts between the insurer and participating attorneys
				  or other providers of legal services must be filed with the superintendent for
				  the purpose of enabling the superintendent to review whether the insurer has
				  made adequate arrangements for the provision of any promised legal services.
				  Such contracts may not become effective until 30 days after filing.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 370 - GROUP LEGAL SERVICES INSURANCE › Section 031-370-7 - Reserves

Current through 2024-29, July 17, 2024
A. Construction
This section shall be liberally construed to ensure that the
				  insurer shall establish and maintain reserves which place a sound value on its
				  liabilities and which make a good and sufficient provision for all unpaid
				  obligations and contingencies.
B. Definitions
(1) Claim Reserve -- The reserve that
				recognizes the liability for unpaid benefits under the contract on claims which
				have been reported to the insurer.
(2) Incurred but not Reported Reserve -- The
				reserve to recognize liability for claims not yet reported or recorded by the
				insurer, for reopened claims, and for future development on known
				claims.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 375 - GROUP PROPERTY AND CASUALTY INSURANCE › Section 031-375-1 - Authority and Purpose

Current through 2024-29, July 17, 2024
This Rule is adopted pursuant to
				   24-A M.R.S.A.
				  §§212 and
				  2953 to designate the
				  types of insurance that may be issued on a group basis in this State and to
				  establish specific requirements and procedures for group property and casualty
				  policies, certificates of coverage, and rates.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 375 - GROUP PROPERTY AND CASUALTY INSURANCE › Section 031-375-2 - Definitions

Current through 2024-29, July 17, 2024
1. "
Certificate
" means any
				contract or other evidence of insurance, or rider or endorsement thereto,
				issued to a group member under a group policy.
2. "
Group policy
" means a policy
				issued on a collective basis, insuring the interests of two or more persons or
				entities, under which coverage is purchased separately for each group member
				for that member's risks, but does not include the certificates.
3. "
Property and casualty
				insurance
" means any type, or combination of types, of insurance
				authorized by
				24-A M.R.S.A.
				§§705 and
				707,
				and any type of insurance that the Superintendent determines to be
				substantially similar.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 375 - GROUP PROPERTY AND CASUALTY INSURANCE › Section 031-375-3 - Designated Types of Insurance

Current through 2024-29, July 17, 2024
The following types of property and casualty insurance are
				  eligible for writing on a group basis under policies or certificates issued in
				  Maine or covering risks in Maine:
1.
Credit Involuntary Unemployment Insurance
covering the risk of a
				debtor's involuntary unemployment and issued in connection with a loan or other
				consumer credit transaction in compliance with the Maine Consumer Credit
				Insurance Act,
				24-A M.R.S.A.
				§§2851 et seq.
2.
Risk Purchasing Group
				Coverage
qualifying as an eligible type of liability insurance and
				issued to a risk purchasing group in compliance with the Maine Liability Risk
				Retention Act,
				24-A M.R.S.A.
				§§6091 et seq.
3.
Travel Insurance
covering
				financial loss from trip cancellation or interruption, lost or damaged baggage,
				trip or baggage delays, missed connections and/or changes in itinerary, and
				casualty losses due to rental vehicle damage.
4.
Identity Theft Insurance
covering loss resulting from the unauthorized acquisition of personally
				identifying information.
5.
Portable Electronic Device Insurance
as defined in
				24-A M.R.S.A.
				§7001(6).
6.
Tuition Reimbursement
				Insurance
covering liability for tuition and fees following failure to
				matriculate at or withdrawal from school or college because of an illness,
				accidental injury, death, job loss, or closure of an educational
				institution.
7.
Group
				Personal Excess Liability Insurance
providing additional limits of
				coverage to members of a group under their personal automobile, homeowners, or
				watercraft insurance policies and/or providing liability coverages not covered
				in a member's underlying personal insurance policies, such as liability arising
				from the member's unpaid service on the board of directors of a not-for-profit
				organization.
8.
Self-Storage
				Unit Insurance
providing personal property coverage to lessees of
				self-storage units.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 375 - GROUP PROPERTY AND CASUALTY INSURANCE › Section 031-375-4 - Terms of Coverage

Current through 2024-29, July 17, 2024
1. A group policy
				must provide insured group members with terms of coverage that are no less
				favorable to the insured than would be required for comparable nongroup
				policies, at rates that are neither inadequate, excessive, nor unfairly
				discriminatory.
2. No group policy
				or certificate shall contain any deductible or self-insured retention shared
				among group members or applicable to the group itself, and a certificate under
				a group policy may only provide for a deductible or self-insured retention if
				it is applicable to the group member strictly on an individual basis.
3. No group policy or certificate shall be
				subject to any group or sub-group aggregate liability limit.Any liability limit
				applicable to a group member shall:
(A) be
				separate and apart from any liability limit to which any other group member
				insured under the group policy may be subject; and
(B) operate unaffected by the experience of
				any other group member or the overall experience of the group itself.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 375 - GROUP PROPERTY AND CASUALTY INSURANCE › Section 031-375-5 - Certificate of Coverage

Current through 2024-29, July 17, 2024
Each insured group member must receive a certificate of
				  coverage, on a form acceptable to and approved by the Superintendent, that
				  contains all material terms and conditions of coverage affecting the group
				  member.If a certificate of coverage incorporates the group policy by reference,
				  the insurer shall either attach a copy of the group policy to the certificate
				  or notify the group member that a copy of the group policy is available on
				  request.The insurer may comply with this Section by directing all group members
				  to the insurer's publicly accessible web site where a complete sample of the
				  terms and conditions of the group policy may be viewed and
				  downloaded.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 375 - GROUP PROPERTY AND CASUALTY INSURANCE › Section 031-375-6 - Termination of Coverage

Current through 2024-29, July 17, 2024
An insurer may not cancel or nonrenew a group policy or
				  coverage of group members under a group policy except in accordance with
				   24-A M.R.S.A.
				  §§2952 or
				  7006.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 375 - GROUP PROPERTY AND CASUALTY INSURANCE › Section 031-375-7 - Severability

Current through 2024-29, July 17, 2024
If any section or provision of this Rule is adjudged invalid
				  for any reason, the judgmentshall 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 380 - PROVIDER PROFILING DISCLOSURES › Section 031-380-1 - 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
				  4303-A.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 380 - PROVIDER PROFILING DISCLOSURES › Section 031-380-2 - PURPOSE

Current through 2024-29, July 17, 2024
The purpose of this Rule is to establish requirements for the
				  disclosure of data by a carrier to a provider as required by
				  24-A M.R.S.A.
				  §4303-A.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 380 - PROVIDER PROFILING DISCLOSURES › Section 031-380-4 - DEFINITIONS

Current through 2024-29, July 17, 2024
Terms defined in
				  24-A M.R.S.A.
				  §4301-A have the same meanings when used
				  in this Rule. At the time of adoption of this Rule, the following terms have
				  the following statutory definitions:
1. "Carrier" means:
A. An insurance company licensed in
				accordance with the
Maine Insurance Code
(Title 24-A M.R.S.A.)
				to provide health insurance;
B. A
				health maintenance organization licensed pursuant to chapter 56 of the
Insurance Code
;
C.
				A preferred provider arrangement administrator registered pursuant to chapter
				32 of the
Insurance Code
;
D. A fraternal benefit society, as defined by
				 24-A M.R.S.A.
				§4101;
E. A nonprofit hospital or medical service
				organization or health plan licensed pursuant to Title 24 M.R.S.A.;
F. A multiple-employer welfare arrangement
				licensed pursuant to chapter 81 of the
Insurance
				Code
;
G. A self-insured
				employer subject to state regulation as described in
				24-A M.R.S.A.
				§2848-A; or
H. Notwithstanding any other provision of the
Insurance Code
, an entity offering coverage in this State that
				is subject to the requirements of the federal
Affordable Care
				Act
.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 380 - PROVIDER PROFILING DISCLOSURES › Section 031-380-5 - DISCLOSURE OF PROVIDER PROFILING DATA

Current through 2024-29, July 17, 2024
1.
Initial Disclosure
A.
Required disclosure
. At least 60 days before using or publicly
				disclosing the results of a provider profiling program, a carrier shall
				disclose to providers:
(1) The methodologies,
				criteria, data, and analysis the carrier uses to evaluate provider quality,
				performance, and cost, including but not limited to unit cost, price, and
				cost-efficiency ratings. A carrier satisfies the requirements of this
				Subparagraph by describing the data used in the evaluation, the source of the
				data, the time period subject to evaluation, and, if applicable, the types of
				claims used in the evaluation, including any adjustments to the data and
				exclusions from the data;
(2) All
				ratings and other profiling information specific to a provider that will be
				posted on the Internet or otherwise disclosed to plan enrollees or prospective
				enrollees.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 380 - PROVIDER PROFILING DISCLOSURES › Section 031-380-6 - APPEALS

Current through 2024-29, July 17, 2024
Pursuant to
				  24-A M.R.S.A.
				  §§4303-A(1) and
				  4303-A(4),
				  a carrier shall establish a process that affords a provider the opportunity to
				  review and dispute its provider profiling result within 30 days after being
				  provided with its provider profile. The appeal process must:
1. Afford the provider the opportunity to
				correct material errors, submit additional information for consideration, and
				seek review of data and performance ratings;
2. Afford the provider the opportunity to
				review any information or evaluation prepared by a third party and used by the
				carrier as part of its provider profiling program. However, if the third party
				provides a right to review and correct that data, any appeal from the carrier's
				determination pursuant to this paragraph is limited to whether the carrier
				accurately portrayed the information and not to the underlying determination
				made by the third party; and
3.
				Allow the provider to request reconsideration of its provider profiling result
				and submit supplemental information, including information demonstrating any
				computational or data errors.
4.
				In order to avoid unnecessary duplication of effort, the appeal process
				established by the carrier to afford the provider an opportunity to review and
				dispute its provider profiling result may incorporate the requirements of
				Section 5, Subsections 3 and 4, except that the carrier must allow for a
				separate appeal of its response to the provider's request for clarification and
				correction under Section 5, Subsections 3 and 4.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 380 - PROVIDER PROFILING DISCLOSURES › Section 031-380-7 - 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 390 - MOTOR VEHICLE INSURANCE IDENTIFICATION CARDS › Section 031-390-1 - Purpose

Current through 2024-29, July 17, 2024
The purpose of this Rule is to prescribe standards for the
				  uniform motor vehicle insurance identification card form required to be
				  utilized by insurers pursuant to
				   24-A M.R.S.A.
				  Section2412(7).
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 390 - MOTOR VEHICLE INSURANCE IDENTIFICATION CARDS › Section 031-390-3 - AUTHORITY

Current through 2024-29, July 17, 2024
This rule is adopted pursuant to the authority of
				   24-A M.R.S.A.
				  Sections212 and
				  2412 (
				  (7).
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 391 - Motor Vehicle Insurance Identification Cards › Section 031-391-1 - DEFINITIONS

Current through 2024-29, July 17, 2024
1. "
Insurance identification
				card
" is as defined in
				29-A M.R.S.
				§1551(4).
2. "
Portable electronic device
"
				is as defined in
				29-A M.R.S.
				§1551(11-A).
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 391 - Motor Vehicle Insurance Identification Cards › Section 031-391-2 - PURPOSE

Current through 2024-29, July 17, 2024
1. The purpose of this Rule is to prescribe,
				pursuant to
				24-A M.R.S.
				§2412(7), paper and
				electronic formats and content for the motor vehicle insurance identification
				card required under Title 29-A as evidence of liability insurance or financial
				responsibility, and pursuant to
				 29-A M.R.S.
				§1601(10)
				identification of persons excluded from coverage.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 391 - Motor Vehicle Insurance Identification Cards › Section 031-391-3 - INSURANCE IDENTIFICATION CARD STANDARDS

Current through 2024-29, July 17, 2024
1. An
				insurer that delivers, issues for delivery, or renews in this State a policy
				insuring against liability arising out of the ownership, maintenance, or use of
				any motor vehicle must provide the named insured with a form of insurance
				identification card for each vehicle for which the policy provides liability
				coverage satisfying the requirements of
				29-A M.R.S.
				§1605.
2. An insurance identification card may be
				provided in the following formats:
A. An image
				capable of displaying in a readable manner the information required in
				paragraphs 3 through 6 below on a portable electronic device as described in
				Section
				4 below; or
B. The card described in Section
				5 below.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 391 - Motor Vehicle Insurance Identification Cards › Section 031-391-4 - ELECTRONIC INSURANCE IDENTIFICATION CARDS

Current through 2024-29, July 17, 2024
Upon receiving the named insured's agreement in compliance
				  with the
Maine Uniform Electronic Transactions Act
,
				  10 M.R.S.
				  §§9401 -
				  9420, an
				  insurer may provide the information required by Section
				  3 above in an electronic format that
				  is displayable on a portable electronic device. In lieu of the statement
				  required in paragraph 3(3)(B) above, an electronic insurance identification
				  card shall include a statement that the operator of the insured vehicle must be
				  able to display evidence of liability insurance or financial responsibility on
				  the demand of a law enforcement officer.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 391 - Motor Vehicle Insurance Identification Cards › Section 031-391-5 - PAPER INSURANCE IDENTIFICATION CARDS

Current through 2024-29, July 17, 2024
1.
				An insurer may provide the information required by Section
				3 in paper format that complies with
				this Section.
A. A paper insurance
				identification card must be at least 21/8 inches by
				31/8 inches. An insurer may provide a paper
				insurance identification card that is printed on an 8½ inch by 11 inch
				sheet.
B. A paper insurance
				identification card must display the required information substantially as
				follows:
Maine Motor Vehicle Insurance Identification
							 Card
[Insurance Company Name]
The coverage provided by this policy meets the
							 minimum limits prescribed by law.
INSURED
EXCLUDED OPERATOR(S)
POLICY NUMBER
EFFECTIVE DATE EXPIRATION DATE
VEHICLE DESCRIPTION
YEAR VEHICLE IDENTIFICATION NUMBER
MAKE/MODEL
This card should be kept in the insured vehicle and
							 presented on the demand of a law enforcement officer.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 391 - Motor Vehicle Insurance Identification Cards › Section 031-391-6 - SEVERABILITY

Current through 2024-29, July 17, 2024
1. 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 this Rule, and the Rule shall otherwise
				remain in full force and effect.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 391 - Motor Vehicle Insurance Identification Cards › Section 031-391-7 - EFFECTIVE DATE

Current through 2024-29, July 17, 2024
This rule is effective June 21, 2014 (filing
				  2014-116).
The 2021 amendment is effective January 1, 2022 (filing
				  2021-258).
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 400 - REQUIREMENTS RELATING TO AUTHORIZED INSURERS TERMINATING OR MODIFYING AN EXISTING CERTIFICATE OF AUTHORITY (MAINE) › Section 031-400-1 - AUTHORITY

Current through 2024-29, July 17, 2024
This Rule is promulgated by the Superintendent of Insurance
				  pursuant to 24-A, M.R.S.A. Section 415-A.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 400 - REQUIREMENTS RELATING TO AUTHORIZED INSURERS TERMINATING OR MODIFYING AN EXISTING CERTIFICATE OF AUTHORITY (MAINE) › Section 031-400-2 - Purpose

Current through 2024-29, July 17, 2024
The purpose of this rule is to continue the requirements
				  established by emergency Rule Chapter 380 applicable to withdrawal plans which
				  are filed by authorized insurers desiring to limit or surrender their existing
				  license, in order to safeguard the interests of residents of this state
				  consistent with the intent of Section 415-A, Title 24-A, M.R.S.A.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 400 - REQUIREMENTS RELATING TO AUTHORIZED INSURERS TERMINATING OR MODIFYING AN EXISTING CERTIFICATE OF AUTHORITY (MAINE) › Section 031-400-3 - Submission of plan

Current through 2024-29, July 17, 2024
At least 60 days prior to the proposed effective date of its
				  action, an insurer intending to cease to maintain its existing certificate of
				  authority, in whole or in part, shall submit to the Superintendent for approval
				  a plan of withdrawal which comports with the requirements of Section 415-A and
				  this Rule.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 400 - REQUIREMENTS RELATING TO AUTHORIZED INSURERS TERMINATING OR MODIFYING AN EXISTING CERTIFICATE OF AUTHORITY (MAINE) › Section 031-400-4 - Public protection provisions of plan

Current through 2024-29, July 17, 2024
Any such plan submitted shall include but not be limited to
				  public protection provisions as follows:
A. Policies in-force at the intended date of
				withdrawal shall be continued pursuant to terms of the policy(ies) and
				provisions of applicable cancellation control acts contained in Title 24-A,
				M.R.S.A.
(1) The Maine Automobile Insurance
				Cancellation Control Act.
(2) The
				Maine Property Insurance Cancellation Control Act.
(3) AN ACT Relating to Cancellation and
				Nonrenewal of Property and Casualty Insurance Contracts.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 400 - REQUIREMENTS RELATING TO AUTHORIZED INSURERS TERMINATING OR MODIFYING AN EXISTING CERTIFICATE OF AUTHORITY (MAINE) › Section 031-400-5 - Review of application

Current through 2024-29, July 17, 2024
The Superintendent shall promptly undertake a review of the
				  application for withdrawal upon its receipt, and may conduct a hearing if
				  deemed necessary to inquire into the propriety of the plan of
				  withdrawal.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 400 - REQUIREMENTS RELATING TO AUTHORIZED INSURERS TERMINATING OR MODIFYING AN EXISTING CERTIFICATE OF AUTHORITY (MAINE) › Section 031-400-6 - Effective date

Current through 2024-29, July 17, 2024
This rule shall be effective October 13, 1987.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 420 - Nursing Home Care Insurance and Long-Term Care Insurance › Section 031-420-1 - Purpose

Current through 2024-29, July 17, 2024
The purpose of this rule is to set forth ongoing requirements
				  applicable to nursing home and long term care insurance policies issued prior
				  to October 1, 2004.
(Drafting Note: Maine Insurance Rule Chapter 425
				  establishes rating standards and requirements applicable to long-term care
				  insurance policies issued on and after October 1,
				  2004.)
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 420 - Nursing Home Care Insurance and Long-Term Care Insurance › Section 031-420-2 - 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-A M.R.S.A.
				  §§212,
				  5052,
				  5053,
				  5078, and
				  5083.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 420 - Nursing Home Care Insurance and Long-Term Care Insurance › Section 031-420-3 - Appliability and scope

Current through 2024-29, July 17, 2024
This rule shall apply to all Nursing Home Care and Long-Term
				  Care insurance policies as defined in Title
				   24-A M.R.S.A.
				  §§5051 and
				  5071 issued prior to
				  October 1, 2004. It does not apply to any rate filing that is subject to
				  Sections
				  9,
				  10, or 20 of Rule 425. The provisions
				  of this rule do not apply to certain long-term care insurance policies issued
				  prior to October 1, 1990 to employer, labor union, and association groups or to
				  individuals pursuant to group conversion privileges.
(Drafting Note: See
				   24-A M.R.S.A.
				  §5051 for specifics.)
The provisions of this rule do not apply to a group nursing
				  home care or long-term care insurance policy offered to a resident of Maine
				  under a group policy issued in another state.
(Drafting Note: This rule does not apply to contracts
				  issued or issued for delivery in other states even if the insured becomes a
				  resident of this state.)
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 420 - Nursing Home Care Insurance and Long-Term Care Insurance › Section 031-420-4 - Definitions

Current through 2024-29, July 17, 2024
A. "Adverse benefit trigger determination"
				means a claims denial determining that the insured has not satisfied a required
				clinical standard for benefit eligibility, including, when applicable under the
				contract, the existence or degree of cognitive impairment, chronic illness, or
				inability to perform one or more specified activities of daily living. The term
				is described more fully in Bureau of Insurance Rule 425, Sections 27 and 28.
B. "Authorized representative"
				means:
1. A person to whom an insured has
				given express written consent to represent the insured in a standard appeal or
				an external review;
2. A person
				authorized by law to provide consent to request in an internal appeal or an
				external review for an insured; or
3. A family member of an insured or an
				insured's treating health care professional when the insured is unable to
				provide consent to request an internal appeal or an external review
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 420 - Nursing Home Care Insurance and Long-Term Care Insurance › Section 031-420-5 - Rating standards prior to May 1, 2008

Current through 2024-29, July 17, 2024
A.
				Prior to May 1, 2008, benefits under long-term care and nursing home care
				insurance policies shall be deemed reasonable in relation to premiums provided
				the expected loss ratio is at least 60 percent, calculated in a manner which
				provides for adequate reserving of the long-term care insurance risk. In
				evaluating the expected loss ratio, due consideration shall be given to all
				relevant factors, including:
1. Statistical
				credibility of incurred claims experience and earned premiums;
2. The period for which rates are computed to
				provide coverage;
3. Experienced
				and projected trends;
4.
				Concentration of experience within early policy duration;
5. Expected claim fluctuation;
6. Experience refunds, adjustments or
				dividends;
7. Renewability
				features;
8. All appropriate
				expense factors;
9.
				Interest;
10. Experimental nature
				of the coverage;
11. Policy
				reserves;
12. Mix of business by
				risk classification; and
13.
				Product features such as long elimination periods, high deductibles and high
				maximum limits.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 420 - Nursing Home Care Insurance and Long-Term Care Insurance › Section 031-420-8 - Notice of Rate Increase

Current through 2024-29, July 17, 2024
The insurer shall provide written notice by first class mail
				  of a rate increase to all affected policyholders and to group certificate
				  holders who are directly billed for coverage at least 90 days before the
				  effective date of any increase in premium rates. An increase in premium rates
				  may not be implemented until 90 days after the notice is
				  provided.