reglab/statecodes huggingface dataset:
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 940 - REQUIREMENTS FOR HEALTH INSURANCE RATE FILINGS AND DATA REPORTING › Section 031-940-4 - Definitions

Current through 2024-29, July 17, 2024
A. "ACA" means the federal Patient Protection
				and Affordable Care Act, Public Law 111-148, as amended
				by the federal Health Care and Education Reconciliation Act of 2010,
				Public Law
				111-152, and any amendments to or regulations or
				guidance issued under those acts.
B. "Carrier" means any insurance company,
				nonprofit hospital and medical service organization, or health maintenance
				organization authorized to issue health coverage in this State.
C. "Community rate" means the rate to be
				charged for a specific benefit plan, family structure (e.g., individual,
				couple, one-parent family, family), and group size (in the case of small group
				rates), prior to any adjustments for age, industry, occupation, geographic
				area, or tobacco use.
D. "Covered
				person" means a policyholder, certificate holder, subscriber, member, enrollee,
				dependent, or other individual entitled to benefits under a health benefit
				plan.
E. "MLR" means the medical
				loss ratio as defined by the ACA.
F. "Potentially unreasonable" means a rate
				filing which exceeds the threshold requiring review pursuant to Section
				2794(a)(2) of the federal Public Health Service Act.
G. "Pure loss ratio" means the ratio of
				incurred claims to earned premiums for a given period, as determined in
				accordance with accepted actuarial principles and practices, and subject to the
				following provisions. For the purposes of this calculation, incurred claims do
				not include any claim adjustment expenses or cost containment expenses. Any
				savings offset payments, access payments, or reinsurance assessments paid
				pursuant to Title 24-A M.R.S.A. § 6913, § 6917, or § 3957, and
				any assessments for transitional reinsurance pursuant to the ACA, are treated
				as incurred claims. Except in situations where the assuming carrier is
				responsible for 100% of the ceding carrier's financial risk and administration
				of the policies, earned premiums and incurred claims must be stated on a direct
				basis without regard to commercial reinsurance. Reimbursements pursuant to the
				transitional reinsurance pursuant to the ACA shall be deducted from incurred
				claims. For individual health plans subject to Title 24-A M.R.S.A. §
				2736-C, reinsurance premiums pursuant to Title 24-A M.R.S.A. § 3958 shall
				be deducted from earned premiums and reimbursements pursuant to Title 24-A
				M.R.S.A. § 3958 shall be deducted from incurred claims.
H. "Small group" refers to small group health
				plans as defined by Title 24-A M.R.S.A. § 2808-B.
I. "Transitional coverage" means a
				non-grandfathered individual or small group policy issued before January 1,
				2014 and subject to the federal transitional policy announced in November 2013
				and extended in March, 2014 and in February, 2016.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 940 - REQUIREMENTS FOR HEALTH INSURANCE RATE FILINGS AND DATA REPORTING › Section 031-940-5 - General Rate Submission Requirements

Current through 2024-29, July 17, 2024
A. A rate
				filing must be submitted whenever a new policy, rider, or endorsement form that
				affects benefits is submitted for approval and whenever there is a change in
				the rates applicable to a previously approved form.
B. Filings must be filed electronically,
				using the System for Electronic Rate and Form Filing (SERFF).
1. Filings must also include a completed
				"Rate Filing Review Requirements Checklist," available on the Bureau's
				website.
2. The Superintendent may
				request additional information as necessary.
3. Group rates are submitted on a "file and
				use" basis for informational purposes, with the exception of small group rates
				subject to Title 24-A M.R.S.A. § 2808-B where the anticipated average
				number of members during the period for which the rates will be in effect does
				not meet standards for full or partial credibility pursuant to the ACA, in
				which case the rates must be filed for prior approval.
4. Rates for individual health plans subject
				to Title 24-A M.R.S.A. § 2736-C are submitted on a "file and use" basis
				for informational purposes if the carrier has elected the guaranteed loss ratio
				option pursuant to Subsection
				8(H) and rate review
				is not required pursuant to the ACA.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 940 - REQUIREMENTS FOR HEALTH INSURANCE RATE FILINGS AND DATA REPORTING › Section 031-940-6 - Requirements for Individual and Small Group Rate Submissions other than ACA Rate Filings

Current through 2024-29, July 17, 2024
A. In addition to
				the requirements of Section
				5, the following rate filings must
				meet the requirements of this section, unless the Superintendent determines
				that the requirement is not appropriate for a particular filing:
1. All individual health insurance rate
				filings, except rate filings for policies subject to the ACA rating
				requirements;
2. Small group rate
				filings subject to Title 24-A M.R.S.A. § 2808-B, except policies subject
				to the ACA rating requirements;
3.
				Association groups as defined by Title 24-A M.R.S.A. § 2805-A and other
				groups as defined by Title 24-A M.R.S.A. § 2808, except as to any employer
				subgroups of the association group when:
a.
				The employer is a member of the group and provides coverage through the group
				as a
bona fide
employee benefit; and
b. Either the employer is a large employer or
				the employer is a small employer and the carrier's anticipated average number
				of members in all small group health plans during the period for which the
				rates will be in effect meets standards for full or partial credibility
				pursuant to the ACA; and
4. Credit union groups as defined by Title
				24-A M.R.S.A. § 2807-A.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 940 - REQUIREMENTS FOR HEALTH INSURANCE RATE FILINGS AND DATA REPORTING › Section 031-940-8 - Individual Health Plans Subject to Title 24-A M.R.S.A. section 2736-C

Current through 2024-29, July 17, 2024
In addition to the applicable requirements of Section
				  5, Section
				  6, Subsection
				  7(C), Section
				  12, and Section
				  13, rate filings subject to Title
				  24-A M.R.S.A. § 2736-C, which include rate filings for certain group
				  polices specified in Title 24-A M.R.S.A. § 2701(2)(C), must meet the
				  following requirements:
A.
Minimum Required Loss Ratio
: As applicable, state the minimum
				required loss ratio for the form as defined in Title 24-A M.R.S.A. §
				2736-C. Policies issued before December 1, 1993 are subject to the loss ratio
				standards of Section
				7. This subsection does not apply when
				the carrier has elected the guaranteed loss ratio option pursuant to Subsection
				H and rate review is not required pursuant to the ACA.
B.
Rate Differentials between
				Plans
:Unless the Superintendent grants an exception in accordance with
				this subsection, rates for different benefit plans that vary based on benefit
				differences may not exceed the maximum possible difference in benefits. For
				example, the difference in annual premium between a plan with a $250 deductible
				and an otherwise identical plan with a $500 deductible may not exceed $250
				unless an exception is granted. The Superintendent will grant exceptions based
				on the following criteria and conditions:
1.
				The rate differential between plans must be justified based on actual or
				reasonably anticipated differences in utilization that are independent of
				differences in health status or demographics. Generally, some of the difference
				in utilization between richer and leaner benefit plans is due to self-selection
				(based on health status or demographics) by those choosing one plan over the
				other, while some of the difference is due to the incentives associated with
				different cost-sharing levels. While it may not be possible to definitively
				determine how much of the difference in utilization is related to health status
				and demographics, the carrier must make a good faith effort to make this
				distinction.
2. In cases where
				approved rate differences do exceed the maximum possible differences in
				benefits, it must be clearly disclosed to prospective policyholders and
				renewing policyholders. A copy of the disclosure to be used and a description
				of when and how it will be distributed must accompany the proposed rate filing.
This subsection does not apply to policies subject to the ACA
				  rating requirements.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 940 - REQUIREMENTS FOR HEALTH INSURANCE RATE FILINGS AND DATA REPORTING › Section 031-940-9 - Small Group Health Plans Subject to Title 24-A M.R.S.A. section 2808-B

Current through 2024-29, July 17, 2024
In addition to the requirements of Section
				  5 and, if applicable, Sections
				  6 and
				  12, small group rate filings subject
				  to Title 24-A M.R.S.A. § 2808-B, which include rate filings applicable to
				  subgroups as defined in Title 24-A M.R.S.A. § 2808-B(1)(H), must meet the
				  following requirements:
A. Small group
				rates must be filed separately from large group rates or individual rates. The
				carrier must clearly identify the filing as a small group rate
				filing.
B. In addition to the
				general requirements for all filings, small group health rate submissions must
				contain:
1.
Rate Factors
:The
				filing must include the community rate and any formulas or factors used to
				adjust that rate.
a. A carrier may not vary
				the premium rate due to the gender or health status of any covered individual,
				or due to claims experience or policy duration.
b. A carrier may vary the premium rate due to
				family membership to the extent permitted by the ACA.
c. Except as provided in paragraph 3,
				variations based on age must not exceed the limits set forth in set forth in
				Title 24-A M.R.S.A. § 2808-B(2)(D), subparagraphs 4 through 8.
d. Pursuant to the ACA, age variations are
				limited to a ratio of 3 to 1 on or after January 1, 2014 for plans other than
				grandfathered health plans as defined under the ACA and for transitional
				coverage as defined in Subsection
				4(I).
e. Pursuant to the ACA, variations by
				industry or occupation will not be permitted on or after January 1, 2014 for
				plans other than grandfathered health plans as defined under the ACA and for
				transitional coverage as defined in Subsection
				4(I).
f. Variations based on geographic area are
				limited to a ratio of 1.5 to 1.
g.
				Variations based on tobacco use are limited to a ratio of 1.5 to 1.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 940 - REQUIREMENTS FOR HEALTH INSURANCE RATE FILINGS AND DATA REPORTING › Section 031-940-10 - Health Maintenance Organization (HMO) Rate Filings

Current through 2024-29, July 17, 2024
In addition to the requirements of Section
				  5 and, to the extent applicable,
				  Sections
				  6,
				  7,
				  8,
				  9,
				  12, and
				  13, HMO rate filings must include a
				  certification by a qualified actuary that the rates are not excessive,
				  inadequate, or unfairly discriminatory, along with adequate supporting
				  information. "Qualified actuary," as used herein, means a member in good
				  standing of the American Academy of Actuaries.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 940 - REQUIREMENTS FOR HEALTH INSURANCE RATE FILINGS AND DATA REPORTING › Section 031-940-11 - Expenses and Investment Income

Current through 2024-29, July 17, 2024
In addition to the requirements of Section
				  5 and, to the extent applicable,
				  Sections
				  6,
				  7,
				  8,
				  9,
				  12, and
				  13, a rate filing or a group of
				  related rate filings for individual or small group policies or contracts that
				  are subject to prior approval, and that cover or are expected to cover more
				  than 2,000 Maine residents, is subject to the following:
A. Expenses: Include a description of any
				expense assumptions used, including, for example, per policy and percentage of
				premium expense for acquisition, maintenance and commissions.
B. Investment income: Include an estimate of
				investment income attributable to the affected policies and how it is reflected
				in the rates.
For filings covering fewer than 2,000 Maine residents, this
				  information must be provided if requested by the
				  Superintendent.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 940 - REQUIREMENTS FOR HEALTH INSURANCE RATE FILINGS AND DATA REPORTING › Section 031-940-12 - Review Pursuant to the ACA

Current through 2024-29, July 17, 2024
A. All rate filings
				that have been identified as "potentially unreasonable" in accordance with the
				ACA and are subject to Section
				13 of this Rule must include Part II
				of the ACA Preliminary Justification for the rate increase, in addition to
				Parts I and III required by Section
				13. Part II is a simple and brief
				narrative describing the data provided in Part I for any product(s) within the
				single risk pool which have rate increases subject to review, and the
				assumptions used to develop the rate increase, including an explanation of the
				most significant factors causing the rate increase.
A-1. All rate filings that have been
				identified as "potentially unreasonable" in accordance with the ACA and which
				relate to transitional coverage as defined in Section
				4 must include the ACA Preliminary
				Justification, Part I rate increase summary (a form that summarizes the data
				used to determine the rate increase) and Part II (the written explanation of
				the rate increase described in Subsection A).
B. A rate increase will be determined to be
				unreasonable if it is excessive or unfairly discriminatory, or if the carrier
				provides data or documentation that is incomplete, inadequate, or otherwise
				does not provide a basis to determine whether the increase is reasonable, and
				fails to correct the deficiency within a reasonable time in response to a
				request by the Bureau.
C. Small
				group rates for credible blocks filed pursuant to Subsection
				9(D) may be
				implemented regardless of whether they are determined to result in an
				unreasonable rate increase.
1. A carrier may
				request a preliminary determination of reasonableness and may modify the filing
				to avoid implementing an unreasonable rate increase.
2. A carrier requesting such a preliminary
				determination should specify the date by which the determination is needed and
				should submit the filing at least 60 days before the preliminary determination
				is needed. The Bureau may or may not be able to honor requests for a
				determination in less than 60 days.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 940 - REQUIREMENTS FOR HEALTH INSURANCE RATE FILINGS AND DATA REPORTING › Section 031-940-13 - Policies Subject to the ACA Rating Requirements

Current through 2024-29, July 17, 2024
A.
				This section applies to individual and small group health plans that were
				issued or renewed on or after January 1, 2014, other than grandfathered plans
				and transitional coverage.
B. In
				addition to the requirements of other sections of this Rule, rate filings for
				policies subject to the ACA rating requirements are subject the following
				requirements:
1. All such filings must
				include the ACA Rate Filing Justification, Part I, the unified rate review
				template. This template is a form that summarizes the data used to determine
				rate increases for the entire single risk pool.
2. If required by Section
				12, such filings must include the ACA
				Rate Filing Justification, Part II, the description justifying the rate
				increase.
3. All such filings must
				include the ACA Rate Filing Justification, Part III, the actuarial memorandum
				and must comply with applicable federal guidance. Part III includes rate filing
				documentation that states and CMS uses to understand the actuarial assumptions,
				justifications and methodologies used to comply with the market rating rules
				and to complete the Part I template.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 940 - REQUIREMENTS FOR HEALTH INSURANCE RATE FILINGS AND DATA REPORTING › Section 031-940-14 - Rebates and Medical Loss Ratio Reporting

Current through 2024-29, July 17, 2024
A. All
				reporting forms relating to MLR and rebates under the ACA that are required to
				be filed with the U.S. Department of Health and Human Services must be
				submitted to the Superintendent on or before the earlier of the date the forms
				are filed with the U.S. Department of Health and Human Services or the date
				they are required to be filed under the ACA, as modified by any extension of
				time granted by the U.S. Department of Health and Human Services or by the
				Superintendent.
B. Except as
				provided in Subsection C, rebates must be paid in the large group, small group,
				and individual markets to the extent required by the ACA and Title 24-A
				M.R.S.A. § 4319.
C. In the
				individual market, if the carrier has elected the guaranteed loss ratio option
				under Subsection
				8(H) and the minimum
				MLR pursuant to the ACA is less than 80%, then the carrier must also provide a
				modified reporting form based on an 80% minimum MLR.If the modified calculation
				indicates that rebates must be paid, the carrier must pay those rebate amounts
				rather than the rebate amounts, if any, indicated by the federal reporting
				form. Such rebates must be paid in the same manner as is required for rebates
				pursuant to the ACA.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 940 - REQUIREMENTS FOR HEALTH INSURANCE RATE FILINGS AND DATA REPORTING › Section 031-940-15 - MEWAs and Captives

Current through 2024-29, July 17, 2024
A. For purposes of
				this section, the following definitions apply:
1. "Captive" means a captive insurance
				company licensed pursuant to Title 24-A M.R.S.A. Chapter 83.
2. "MEWA" means a multiple-employer welfare
				arrangement licensed pursuant to Title 24-A M.R.S.A. Chapter 81.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 940 - REQUIREMENTS FOR HEALTH INSURANCE RATE FILINGS AND DATA REPORTING › Section 031-940-16 - Effective Date

Current through 2024-29, July 17, 2024
The provisions of this rule are effective March 1, 2000. The
				  2001 amendments are effective February 26, 2002. The 2004 amendments are
				  effective May 3, 2004. The 2006 amendments are effective March 12, 2006. The
				  2012 amendments are effective April 10, 2012. The 2016 amendments are effective
				  April 19, 2016 (filing 2016-069).
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 940 - REQUIREMENTS FOR HEALTH INSURANCE RATE FILINGS AND DATA REPORTING › Appendix 031-940-A - Annual Data Collection

Current through 2024-29, July 17, 2024
To enable the Bureau to monitor the impact of small group and
				  individual health insurance reform laws on those markets, all carriers in those
				  markets must submit the following information (unless otherwise specified)
				  annually on or before April 30. This information must be filed in an electronic
				  format prescribed by the Superintendent.
All carriers offering or renewing individual health plans
				  subject to Title 24-A § 2736-C and carriers offering small group health
				  plans subject to Title 24-A M.R.S.A. § 2808-B must provide the following
				  data:
A. Demographic information: For on-exchange and off-exchange
				  separately for each type of metal level plan ((Catastrophic, Bronze, Silver
				  (including 73, 87 and 94% cost sharing reduction plans and no cost sharing
				  reduction plans), Gold and Platinum)) including grandfathered and transitional
				  coverage, report the number of Maine covered persons by age as of the current
				  year to reflect open enrollment results.
B. Experience data for individual and small group separately:
				  For all plans combined, provide earned premium and incurred claims for the
				  prior calendar year.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 942 - RATING FACTORS AND LOSS RATIO REQUIREMENTS FOR HEALTH PLANS › Section 031-942-1 - Authority and Purpose

Current through 2024-29, July 17, 2024
The Superintendent of Insurance adopts this rule, pursuant to
				   24-AM.R.S.
				  §§212,
				  2736-C(2)(D),
				  2808-B(2)(D),
				  and
				  4319(4),
				  to establish standards for age rating and for compliance with medical loss
				  ratio requirements for health plans.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 942 - RATING FACTORS AND LOSS RATIO REQUIREMENTS FOR HEALTH PLANS › Section 031-942-2 - Uniform Age Curve

Current through 2024-29, July 17, 2024
1. All rates filed
				with the Superintendent on or after the effective date of this Rule for
				individual and small group health plans, as defined in
				24-AM.R.S.
				§§2736-C(1)(C) and
				2808-B(1)(G),
				shall use the age rating factors in the table attached as an appendix to this
				Rule.
2. For each age, the table
				shows the ratio of the premium for a covered person at that age to the premium
				for a similarly situated covered person who is 21 years old. The applicable age
				factor as of the effective date of coverage shall continue to apply for the
				remainder of the plan year.
3. If a
				covered family has more than three dependent children who are less than 21
				years old, the ages of the three oldest shall be used when calculating the rate
				for the family, as well as the ages of all dependent children aged 21 or
				older.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 942 - RATING FACTORS AND LOSS RATIO REQUIREMENTS FOR HEALTH PLANS › Section 031-942-3 - Minimum Medical Loss Ratio

Current through 2024-29, July 17, 2024
Unless Section 2718 of the
Federal Public Health
				  Service Act
is repealed, or its enforcement is enjoined by a final and
				  enforceable judgment of a court of competent jurisdiction, a carrier that
				  complies with Section 2718 there by satisfies the requirements of
				  24-AM.R.S. §4319 to
				  maintain the required minimum medical loss ratio or provide rebates to
				  insureds.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 942 - RATING FACTORS AND LOSS RATIO REQUIREMENTS FOR HEALTH PLANS › Section 031-942-4 - Severability

Current through 2024-29, July 17, 2024
If any provision of this rule, or the application thereof to
				  any person or circumstance, is held invalid, that determination shall not
				  affect other provisions or applications of this rule that can be given effect
				  without the invalid provision or application, and to that end the provisions of
				  this rule are severable.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 942 - RATING FACTORS AND LOSS RATIO REQUIREMENTS FOR HEALTH PLANS › Appendix - Uniform Age Curve

Current through 2024-29, July 17, 2024
Age
Ratio
Age
Ratio
Age
Ratio
14 and younger
0.765
31
1.159
48
1.635
15
0.833
32
1.183
49
1.706
16
0.859
33
1.198
50
1.786
17
0.885
34
1.214
51
1.865
18
0.913
35
1.222
52
1.952
19
0.941
36
1.230
53
2.040
20
0.970
37
1.238
54
2.135
21
1.000
38
1.246
55
2.230
22
1.000
39
1.262
56
2.333
23
1.000
40
1.278
57
2.437
24
1.000
41
1.302
58
2.548
25
1.004
42
1.325
59
2.603
26
1.024
43
1.357
60
2.714
27
1.048
44
1.397
61
2.810
28
1.087
45
1.444
62
2.873
29
1.119
46
1.500
63
2.952
30
1.135
47
1.563
64 and older
3.000
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 945 - ANNUAL REPORT SUPPLEMENT FOR HEALTH INSURERS › Section 031-945-1 - Purpose

Current through 2024-29, July 17, 2024
This rule establishes standards, procedures, and forms that
				  health insurers and health maintenance organizations must use in filing the
				  annual report supplement required by
				   24-AM.R.S.A.
				  §423-D.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 945 - ANNUAL REPORT SUPPLEMENT FOR HEALTH INSURERS › Section 031-945-2 - Authority

Current through 2024-29, July 17, 2024
This rule is promulgated by the Superintendent pursuant to
				   24-A M.R.S.A.
				  §§212 and
				  423-D.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 945 - ANNUAL REPORT SUPPLEMENT FOR HEALTH INSURERS › Section 031-945-3 - Applicability and Scope

Current through 2024-29, July 17, 2024
Except as provided in this section, the filing requirements
				  contained in this rule apply to all health insurers and health maintenance
				  organizations and to all insurers writing employee benefit excess (stop-loss)
				  insurance as defined in
				   24-A M.R.S.A.
				  §707(1) (C-1) with
				  respect to health benefit plans. The requirements apply to companies renewing
				  existing policies, whether or not they currently offer those policies for new
				  issue. The reporting requirements do not apply to the types of health insurance
				  identified as an exception to the definition of health insurance in
				   24-AM.R.S.A.
				  §704(2). Therefore,
				  insurers engaged in only the following types of health insurance or any
				  combination of the following shall file blank reports, providing only their
				  contact information, but shall not otherwise be subject to this rule:
				  accidental injury, specified disease, hospital indemnity, dental, vision,
				  disability income, long-term care, Medicare supplement, or other limited
				  benefit health insurance as defined in Rule 755.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 945 - ANNUAL REPORT SUPPLEMENT FOR HEALTH INSURERS › Section 031-945-4 - Filing Requirements

Current through 2024-29, July 17, 2024
Health insurers and health maintenance organizations subject
				  to this rule shall submit the annual report supplement to the Superintendent on
				  or before March 1st of each year for the year
				  immediately preceding. The reporting entity may submit a written request for an
				  extension for good cause to the Superintendent prior to March
				  1st. The Superintendent shall evaluate and grant a
				  request for an extension on a timely basis if good cause has been
				  demonstrated.
Health insurers and health maintenance organizations shall
				  use information consistent with that reported in their annual statutory
				  financial statements and reconcile the annual report supplement to the
				  applicable pages of their statements.
The annual report supplement shall be filed in an electronic
				  format prescribed by the Superintendent.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 945 - ANNUAL REPORT SUPPLEMENT FOR HEALTH INSURERS › Section 031-945-5 - Annual Report Supplement Contents

Current through 2024-29, July 17, 2024
Annually, the Superintendent shall provide the form in which
				  the annual report supplement shall be prepared by health insurers and health
				  maintenance organizations. Appendices A and B provide the forms and
				  instructions for use for the reporting of calendar year 2009 information. The
				  forms and instructions for subsequent years will be substantially similar
				  accounting only for revisions to the National Association of Insurance
				  Commissioners' annual statutory financial statements.
Appendix A provides the forms and instructions for health
				  insurers and health maintenance organizations with direct written health
				  insurance premium in the State of Maine totaling more than $2,000,000 for the
				  reporting year, excluding the types of health insurance identified in section
				  3 as being excluded from the filing
				  requirements. Appendix B provides the forms and instructions for all other
				  health insurers and health maintenance organizations subject to this rule.
				  Insurers that had no health business of any kind in force at any time during
				  the year or during the previous year do not need to file a report. Insurers
				  that had health insurance in force during the year or during the previous year
				  but had no business of the types subject to this rule in force at any time
				  during the year shall file blank reports, providing only their contact
				  information.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 945 - ANNUAL REPORT SUPPLEMENT FOR HEALTH INSURERS › Section 031-945-6 - Public Information

Current through 2024-29, July 17, 2024
Filings made pursuant to this rule are "public records" under
				   1 M.R.S.A.
				  §402(3) and will be
				  available for public inspection pursuant to
				   1 M.R.S.A. §408.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 945 - ANNUAL REPORT SUPPLEMENT FOR HEALTH INSURERS › Section 031-945-7 - Failure to File

Current through 2024-29, July 17, 2024
Any health insurer or health maintenance organization that
				  fails to file the annual report supplement by the later of March
				  1st or a date of extension granted by the
				  Superintendent pursuant to Section
				  4, violates this rule and may be
				  subject to penalties as permitted under
				   24-AM.R.S.A.
				  §§12-A and
				  215.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 945 - ANNUAL REPORT SUPPLEMENT FOR HEALTH INSURERS › Section 031-945-8 - Effective Date

Current through 2024-29, July 17, 2024
This rule is effective February 13, 2005, and requires filing
				  of data for calendar years 2004 and later. The 2008 amendments are applicable
				  to reports filed in 2008 and later for calendar years 2007 and later. The 2009
				  amendments (filing 2009-683) are applicable to reports filed in 2010 and later
				  for calendar years 2009 and later.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 950 - NAVIGATOR CERTIFICATION AND TRAINING FOR HEALTH BENEFIT MARKETPLACES › Section 031-950-1 - Authority and Purpose

Current through 2024-29, July 17, 2024
This rule is adopted pursuant to
				  24-A M.R.S.
				  §§212 and
				  2188,
				  to establish standards and procedures for the certification of navigators to
				  perform the activities and duties identified in
				  24-A
				  M.R.S. §2188 and Subsection 1311(i) of
				  the federal
Affordable Care Act
.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 950 - NAVIGATOR CERTIFICATION AND TRAINING FOR HEALTH BENEFIT MARKETPLACES › Section 031-950-2 - Applicability and Scope

Current through 2024-29, July 17, 2024
This rule applies to navigators providing services in Maine
				  for a Health Benefit Exchange or Marketplace established pursuant to Section
				  1311 of the federal
Affordable Care Act
("the
				  Marketplace").
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 950 - NAVIGATOR CERTIFICATION AND TRAINING FOR HEALTH BENEFIT MARKETPLACES › Section 031-950-4 - 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 960 - HURRICANE DEDUCTIBLES › Section 031-960-1 - Purpose

Current through 2024-29, July 17, 2024
The purpose of this Rule is to implement
				  
				  24-A M.R.S. §3061. Section 3061 applies
				  to insurance policies that provide coverage to owner-occupied properties used
				  solely for residential purposes and having four or fewer apartments. This
				  statute requires that the Superintendent adopt, as routine technical rules,
				  procedures and standards for insurers that use hurricane deductibles. This Rule
				  prescribes uniform policy standards for hurricane deductibles and the form of
				  notice concerning those deductibles that insurers must give to named
				  insureds.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 960 - HURRICANE DEDUCTIBLES › Section 031-960-2 - Authority

Current through 2024-29, July 17, 2024
The Superintendent promulgates this Rule pursuant to
				   24-A M.R.S.
				  §§212 and
				  3061.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 960 - HURRICANE DEDUCTIBLES › Section 031-960-3 - Definitions

Current through 2024-29, July 17, 2024
A. "Forecast zone" means a forecast area
				published by the National Weather Service for the State of Maine.
B. "Hurricane" means a weather event for
				which the National Weather Service has issued a hurricane warning for the
				applicable part of the State of Maine.
C. "Hurricane deductible" means a policy
				provision, specifically applicable to losses resulting from a hurricane, that
				defines the amount of covered loss the insured must bear.
D. "Hurricane warning" means an announcement
				by the National Weather Service that sustained winds of 74 miles per hour or
				higher are expected somewhere in a specified area in association with a
				tropical, subtropical, or post-tropical cyclone.
E. "National Weather Service" means the
				component of the National Oceanic and Atmospheric Administration, or its
				successor, that includes the National Hurricane Center.
F. "Policy" means an insurance contract
				subject to M.R.S. Title 24-A, Chapter 41, Subchapter 5, the
Property
				Insurance Cancellation Control Act
.
G. "Superintendent" means the Superintendent
				of Insurance.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 960 - HURRICANE DEDUCTIBLES › Section 031-960-4 - Standards for Hurricane Deductibles

Current through 2024-29, July 17, 2024
An insurer electing to use a hurricane deductible must comply
				  with this Rule and all relevant provisions of M.R.S. Title 24-A. This Rule sets
				  the minimum standards that an insurer must meet with respect to a hurricane
				  deductible.
A. A hurricane deductible
				may:
(1) Be applied only during the period
				that starts when the National WeatherService issues a hurricane warning for a
				forecast zone that includes any part of the municipality in which the insured
				property is located and ends twenty-four (24) hours after the National Weather
				Service terminates the last hurricane warning for that forecast zone;
(2) Apply whether or not hurricane force
				winds reach the property insured under a policy;
(3) Apply to all direct and consequential
				losses caused by or resulting from wind, precipitation, or wind-driven objects;
				and
(4) Be expressed as either a
				specific dollar amount or a percentage of the policy's property
				coverage.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 960 - HURRICANE DEDUCTIBLES › Section 031-960-5 - Notice of Hurricane Deductible

Current through 2024-29, July 17, 2024
A. An insurer
				electing to use a hurricane deductible shall notify the named insured in
				writing that a hurricane deductible applies to the policy. The hurricane
				deductible notice must comply with this section.
B. The notice shall accompany the issuance of
				each new policy to which a hurricane deductible applies and each renewal of a
				policy to which a hurricane deductible applies.
C. The notice must appear on the policy
				declarations page and contain the following statement or a substantially
				similar statement:
"$[amount]" deductible applies to losses under this policy's
				  property coverage, unless the losses are hurricane-related. The deductible for
				  all hurricane-related losses is $[amount] .A deductible is the part of a loss
				  that you must bear.
"$[amount]" shall be replaced with "[amount] percent" for any
				  deductible calculated as a percentage of the policy's property coverage.
D. If an insurer uses a notice in
				lieu of the notice specified in Section
				5(C) above, the
				notice must comply with the
Insurance Policy Language Simplification
				Act
,
				24-A M.R.S.
				§§2438 -
				2445.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 960 - HURRICANE DEDUCTIBLES › Section 031-960-6 - Severability

Current through 2024-29, July 17, 2024
If any section or provision of this Rule is adjudged invalid
				  for any reason, the judgment shall not impair or invalidate any other section
				  or provision of the Rule, and the remaining sections or provisions shall remain
				  in full force and effect.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 980 - STANDARDS FOR SAFEGUARDING CUSTOMER INFORMATION › Section 031-980-1 - Authority and Purpose

Current through 2024-29, July 17, 2024
The Superintendent has adopted this Rule, pursuant to
				   24-AM.R.S.A.
				  §§212 and
				  2220 and 15U. S.C.
				  §§ 6801(b) and 6805(b)(2), to establish standards for developing and
				  implementing administrative, technical, and physical safeguards to protect the
				  security, confidentiality, and integrity of customer information.
A. Subsection 501(a) of the
				Gramm-Leach-Bliley Act, codified at
				15U.S.C. §
										6801(a), provides that it is
				the policy of the Congress that each financial institution has an affirmative
				and continuing obligation to respect the privacy of its customers and to
				protect the security and confidentiality of those customers' nonpublic personal
				information. Subsection 501(b), codified at
				15U.S.C. §
										6801(b), requires the state
				insurance regulatory authorities to establish appropriate standards relating to
				administrative, technical, and physical safeguards:
(1) to ensure the security and
				confidentiality of customer records and information;
(2)to protect against any anticipated threats
				or hazards to the security or integrity of such records; and
(3)to protect against unauthorized access to
				or use of records or information that could result in substantial harm or
				inconvenience to a customer.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 980 - STANDARDS FOR SAFEGUARDING CUSTOMER INFORMATION › Section 031-980-2 - Scope

Current through 2024-29, July 17, 2024
This Rule applies to all regulated insurance entities, as
				  defined in
				   24-AM.R.S.A.
				  §2204(23), and to all
				  other persons and business entities engaged in insurance activities subject to
				  functional regulation by the Maine Superintendent of Insurance pursuant to the
				  Gramm-Leach-Bliley Act,
				  15
				  U.S.C. §
										6805(a)(6),
				  except for eligible surplus lines insurers that are in compliance with the
				  privacy laws of their jurisdictions of domicile.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 980 - STANDARDS FOR SAFEGUARDING CUSTOMER INFORMATION › Section 031-980-3 - Definitions

Current through 2024-29, July 17, 2024
For purposes of this Rule, the following definitions
				  apply:
A.
"Customer"
means an individual who has an ongoing relationship with a regulated
				insurance entity under which the regulated insurance entity provides one or
				more insurance products or services to the individual that are to be used
				primarily for personal, family or household purposes.
B.
"Customer information"
means any nonpublic personal information as defined in the Gramm-Leach-Bliley
				Act, 15 U.S.C. §
										6809(4), or personal
				information as defined in the Maine Insurance Information and Privacy
				Protection Act,
				 24-AM.R.S.A.
				§2204(20), whether in
				paper, electronic, or other form, that is maintained by or on behalf of a
				regulated insurance entity and relates to a customer or former customer of the
				regulated insurance entity.
C.
"Customer information systems"
means the electronic or
				physical methods used to access, collect, store, use, transmit, protect, or
				dispose of customer information.
D.
"Service provider"
means a person that maintains, processes,
				or otherwise is permitted access to customer information through its provision
				of services directly to a regulated insurance entity.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 980 - STANDARDS FOR SAFEGUARDING CUSTOMER INFORMATION › Section 031-980-4 - Information Security Program

Current through 2024-29, July 17, 2024
A.
Program
				Required.
Each regulated insurance entity shall implement a written,
				comprehensive information security program that includes administrative,
				technical, and physical safeguards for the protection of customer information.
				The administrative, technical, and physical safeguards included in the
				information security program shall be appropriate to the size and complexity of
				the regulated insurance entity and the nature and scope of its
				activities.
B.
Deference
				to Primary Regulator.
If a regulated insurance entity is domiciled in
				another jurisdiction or subject to the primary jurisdiction of a different
				functional regulator, and the statutes and regulations administered by its
				domiciliary regulator or primary functional regulator establish standards for
				protecting the security of customer information which are substantially similar
				to those established by this Rule, then good faith compliance with those
				standards to the satisfaction of the regulated insurance entity's primary
				regulator shall constitute compliance with this Rule.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 980 - STANDARDS FOR SAFEGUARDING CUSTOMER INFORMATION › Section 031-980-5 - Objectives of Information Security Program

Current through 2024-29, July 17, 2024
A regulated insurance entity's information security program
				  shall be designed to:
A.Ensure the
				security and confidentiality of customer information;
B.Protect against any anticipated threats or
				hazards to the security or integrity of the information; and
C.Protect against unauthorized access to or
				use of the information that could result in substantial harm or inconvenience
				to any customer.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 980 - STANDARDS FOR SAFEGUARDING CUSTOMER INFORMATION › Section 031-980-6 - Examples of Methods of Development and Implementation

Current through 2024-29, July 17, 2024
The actions and procedures described below are examples of
				  methods of implementation of the requirements of Sections
				  4 and
				  5 of this Rule. These examples are
				  non-exclusive illustrations of actions and procedures that regulated insurance
				  entities may follow to implement Sections
				  4 and
				  5 of this Rule.
A.
Assessing Risk.
The
				regulated insurance entity:
(1) Identifies
				reasonably foreseeable internal or external threats that could result in
				unauthorized disclosure, misuse, alteration, or destruction of customer
				information or customer information systems;
(2) Assesses the likelihood and potential
				damage of these threats, taking into consideration the sensitivity of customer
				information; and
(3) Assesses the
				sufficiency of policies, procedures, customer information systems, and other
				safeguards in place to control risks.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 980 - STANDARDS FOR SAFEGUARDING CUSTOMER INFORMATION › Section 031-980-7 - Violations

Current through 2024-29, July 17, 2024
Violations of this Rule are subject to disciplinary sanctions
				  as provided in
				   24-AM.R.S.A.
				  §12-A, in addition to any other remedies
				  that may be provided by law.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 980 - STANDARDS FOR SAFEGUARDING CUSTOMER INFORMATION › Section 031-980-8 - Effective Date

Current through 2024-29, July 17, 2024
Each regulated insurance entity shall establish and implement
				  an information security program, including appropriate policies and systems
				  pursuant to this Rule, by July 1, 2005.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 032 - OFFICE OF SECURITIES › Chapter 504 - BROKER-DEALER AND AGENT LICENSING › Section 032-504-1 - Definitions

Current through 2024-29, July 17, 2024
For the purposes of this chapter, the following definitions
				  shall apply:
1.
Act
.
				"Act" means the Maine Uniform Securities Act,
				32 M.R.S.A.
				§§16101 to
				16702.
2.
Administrator
.
				"Administrator" has the same meaning as in
				32
				M.R.S.A.§16102(1).
3.
Agent
. "Agent" has the same
				meaning as in
				32 M.R.S.A.
				§16102(2).
4.
Branch office
."Branch office"
				has the same meaning as in
				32 M.R.S.A.
				§16410(1)(F).
5.
Broker-dealer
.
				"Broker-dealer" has the same meaning as in
				32 M.R.S.A.
				§16102(4).
6.
CRD
. "CRD" means the
				Internet-based Central Registration Depository.
7.
Form BD
. "Form BD" means the
				Uniform Application for Broker-Dealer Registration, a uniform form that is
				hereby adopted for use in the State of Maine.
8.
Form BDW
. "Form BDW" means
				the Uniform Request for Broker-Dealer Withdrawal, a uniform form that is hereby
				adopted for use in the State of Maine.
9.
Form BR
. "Form BR" means the
				Uniform Branch Office Registration Form, a uniform form that is hereby adopted
				for use in the State of Maine.
10.
Form U-4
. "Form U-4" means the Uniform Application for Securities
				Industry Registration or Transfer, a uniform form that is hereby adopted for
				use in the State of Maine.
11.
Form U-5
. "Form U-5" means the Uniform Termination Notice for
				Securities Industry Registration, a uniform form that is hereby adopted for use
				in the State of Maine.
12.
NASD
."NASD" means the self-regulatory agency commonly known as the
				National Association of Securities Dealers.
13.
SEC
. "SEC" means the United
				States Securities and Exchange Commission.