reglab/statecodes huggingface dataset:
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 745 - INDIVIDUAL HEALTH INSURANCE PILOT PROJECTS FOR PERSONS UNDER 30 YEARS OF AGE › Section 031-745-9 - REPORTING REQUIREMENTS

Current through 2024-29, July 17, 2024
Carriers offering health plans pursuant to this Rule must
				  submit reports to the Superintendent by January 31st
				  of each year that include all of the following information. Carriers may submit
				  a written request for an extension of up to 15 days.
1. The total number of enrollees.
2. The number of enrollees who have left the
				plan.
3. The ages of new
				enrollees.
4. An analysis of
				services used by enrollees, in a format approved by the
				Superintendent.
5. A statement
				regarding the impact of the plan on premiums and availability of coverage in
				the individual market in Maine.
6.
				The number of enrollees who have reached the plan per condition or illness
				maximum, the plan out of pocket maximum, the plan annual maximum, or the plan
				lifetime maximum.
7. The number of
				new enrollees who had coverage within the 90 days prior to applying for the
				pilot project plan and the number who were uninsured. To the extent that the
				information is available from the enrollee's application, the number whose
				prior coverage was in the individual market and the number who were dependents
				covered under their parents' policies.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 745 - INDIVIDUAL HEALTH INSURANCE PILOT PROJECTS FOR PERSONS UNDER 30 YEARS OF AGE › Section 031-745-10 - EFFECTIVE DATE

Current through 2024-29, July 17, 2024
(NOTE: The statute provides that plans may offer pilot
				  project plans to persons under 30 years of age beginning July 1, 2009.)
This rule is effective May 26, 2009.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 755 - HEALTH INSURANCE CLASSIFICATIONS, DISCLOSURE, AND MINIMUM STANDARDS › Section 031-755-1 - Purpose

Current through 2024-29, July 17, 2024
The purpose of this rule is to implement 24-A M.R.S.A.
				  Chapter 32-A to standardize and simplify the terms and coverages of individual
				  health insurance policies, and group health insurance policies and
				  certificates. This rule is also intended to: facilitate public understanding
				  and comparison of coverage; eliminate provisions contained in individual and
				  group health insurance policies that may be misleading or confusing in
				  connection with either the purchase of the coverages or the settlement of
				  claims; and provide for full disclosure in the marketing and sale of individual
				  and group health insurance. This rule is also intended to clarify the meaning
				  of limited benefits health insurance as referred to in 24-A M.R.S.A. chapters
				  33, 35 and 56-A.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 755 - HEALTH INSURANCE CLASSIFICATIONS, DISCLOSURE, AND MINIMUM STANDARDS › Section 031-755-2 - 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
				  2717
				  and 24-A M.R.S.A. Chapter 32-A.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 755 - HEALTH INSURANCE CLASSIFICATIONS, DISCLOSURE, AND MINIMUM STANDARDS › Section 031-755-3 - Applicability and Scope

Current through 2024-29, July 17, 2024
A. This rule
				applies to all individual health insurance policies and group health policies
				and certificates, delivered or issued for delivery in this state on or after
				January 1, 2005, that are not specifically exempted from this rule.
B. This rule shall apply to dental plans and
				vision plans only as specified.
C.
				This rule shall not apply to:
(1) Individual
				policies or contracts issued pursuant to a conversion privilege under a policy
				or contract of group or individual insurance when the group or individual
				policy or contract includes provisions that are inconsistent with the
				requirements of this rule. For purposes of this rule, "conversion privilege"
				means a provision allowing an individual no longer eligible for coverage under
				the policy, such as a covered child who reaches the maximum age for coverage as
				a dependent, to obtain similar coverage under a new policy;
(2) Policies issued to employees or members
				as additions to franchise plans in existence on the effective date of this
				rule. For purposes of this rule, "franchise plans" are those issued pursuant to
				 24-A M.R.S.A.
				§2740 prior to its repeal;
(3) Medicare supplement policies as defined
				in
				 24-A M.R.S.A.
				§5001(4);
(4) Long-term care insurance policies as
				defined in
				 24-A M.R.S.A.
				§§5051(1) or
				5072(3);
(5) Policies designed to supplement TRICARE
				or Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)
				(Chapter 55 of title 10 of the United States Code);
(6) Consumer credit insurance as defined in
				 24-A M.R.S.A.
				§2853(2-C);
(7) Legal services insurance as defined in
				 24-A M.R.S.A.
				§2883;
(8) Group disability income policies and
				certificates; or
(9) Health
				maintenance organization contracts subject to 24-A M.R.S.A. Chapter
				56.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 755 - HEALTH INSURANCE CLASSIFICATIONS, DISCLOSURE, AND MINIMUM STANDARDS › Section 031-755-4 - Policy Definitions

Current through 2024-29, July 17, 2024
A. Except as
				provided in this rule, an individual health insurance policy or group health
				insurance policy or certificate delivered or issued for delivery to any person
				in this state and to which this rule applies shall contain definitions
				respecting the matters set forth below that comply with the requirements of
				this section. Definitions may need to be modified to comply with other
				requirements specified in Section
				3(D).
B. The Superintendent may approve any
				substitute definition that is, in his or her opinion, not less favorable in any
				particular to the insured or beneficiary than the provisions otherwise
				required.
C. "Accident,"
				"accidental injury," and "accidental means" shall be defined to employ "result"
				language and shall not include words that establish an accidental means test or
				use words such as "external, violent, visible wounds" or similar words of
				description or characterization. The definition shall not be more restrictive
				than the following: "accident," "accidental injury," or "accidental means"
				means accidental bodily injury sustained by the insured person that is the
				direct cause of the condition for which benefits are provided and that occurs
				while the insurance is in force.
D.
				"Convalescent nursing home," "extended care facility," or "skilled nursing
				facility" shall be defined in relation to its status, facility, and available
				services.
(1) A definition of the home or
				facility shall not be more restrictive than one requiring that it:
(a) Be operated pursuant to law;
(b) Be approved for payment of Medicare
				benefits or be qualified to receive approval for payment of Medicare benefits,
				if so requested;
(c) Be primarily
				engaged in providing, in addition to room and board accommodations, skilled
				nursing care under the supervision of a duly licensed physician;
(d) Provide continuous twenty-four-hour-a-day
				nursing service by or under the supervision of a registered nurse;
				and
(e) Maintain a daily medical
				record of each patient.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 755 - HEALTH INSURANCE CLASSIFICATIONS, DISCLOSURE, AND MINIMUM STANDARDS › Section 031-755-5 - Prohibited Policy Provisions

Current through 2024-29, July 17, 2024
The restrictions set forth in this section are in addition to
				  any other applicable restrictions as specified in Section
				  3(D).
A. A policy shall not contain provisions
				establishing a probationary or waiting period during which no coverage is
				provided under the policy, except:
(1) A
				policy may specify a probationary or waiting period for sickness not to exceed
				30 days from the effective date of the coverage of the insured person;
				and
(2) A policy may specify a
				probationary or waiting period not to exceed six months for specified diseases
				or conditions and losses resulting from disease or condition related to hernia,
				disorder of reproduction organs, varicose veins, adenoids, appendix, and
				tonsils. However, the permissible six-month exception shall not be applicable
				where the specified diseases or conditions are treated on an emergency basis.
Accident policies shall not contain probationary or waiting
				  periods. Nothing in this subsection is intended to restrict the use of
				  elimination periods for disability income benefits.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 755 - HEALTH INSURANCE CLASSIFICATIONS, DISCLOSURE, AND MINIMUM STANDARDS › Section 031-755-9 - Limited Benefit Health Insurance

Current through 2024-29, July 17, 2024
"Limited benefit health insurance" or "limited benefit
				  coverage," as used in 24-A M.R.S.A. Chapters 33, 35, and 56-A, means only the
				  following types of coverage:
A.
				Coverage designed to supplement TRICARE or the Civilian Health and Medical
				Program of the Uniformed Services (CHAMPUS) (Chapter 55, title 10 of the United
				States Code);
B. Policies that
				cover only dental or vision care;
C. Hospital confinement indemnity coverage as
				defined in Section
				6, Subsection E;
D. Accident only coverage as defined in
				Section
				6, Subsection I;
E. Specified disease coverage as defined in
				Section
				6, Subsection J;
F. Specified accident coverage as defined in
				Section
				6, Subsection K; and
G. Supplemental coverage as defined in
				Section
				6, Subsection L, except that
				supplemental coverage is not limited benefit health insurance if it is
				substantially similar to one of the following types of coverage:
(1) Basic hospital expense coverage as
				defined in Section
				6, Subsection B;
(2) Basic medical-surgical expense coverage
				as defined in Section
				6, Subsection C;
(3) Basic hospital/medical-surgical expense
				coverage as defined in Section
				6, Subsection D;
(4) Major medical expense coverage as defined
				in Section
				6, Subsection F; or
(5) Basic medical expense coverage as defined
				in Section
				6, Subsection G.
For purposes of this subsection, "substantially similar"
				  means that, in the judgment of the Superintendent, there are only minor
				  differences between the supplemental coverage and coverage that would meet the
				  minimum standards of Section
				  6, Subsections B, C, D, F, or
				  G.
Two or more policies sold as a package are not limited
				  benefit health insurance if the combined benefits are substantially similar to
				  one of the types of coverage listed in paragraphs (1) thorough (5)
				  above.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 755 - HEALTH INSURANCE CLASSIFICATIONS, DISCLOSURE, AND MINIMUM STANDARDS › Section 031-755-10 - Transition

Current through 2024-29, July 17, 2024
The following requirements apply to any form approved prior
				  to the effective date of this rule that the carrier intends to offer in this
				  state on or after January 1, 2005.
A.
				On or before October 1, 2004, the carrier must submit to the Superintendent a
				list of previously approved forms that the carrier intends to continue offering
				and that are in compliance with this rule.
B. For previously approved forms that the
				carrier intends to continue offering and that do not comply with this rule, the
				carrier must submit, on or before October 1, 2004, for approval by the
				Superintendent, any amendments needed to bring the forms into compliance with
				this rule.
C. On or before December
				31, 2004, the carrier must submit to the Superintendent, for each form on the
				list specified in Subsection A and each form amended pursuant to Subsection B,
				outlines of coverage that comply with Section
				7 of this rule. Outlines of coverage
				submitted pursuant to this subsection do not require approval and may be used
				unless disapproved by the Superintendent.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 755 - HEALTH INSURANCE CLASSIFICATIONS, DISCLOSURE, AND MINIMUM STANDARDS › Section 031-755-11 - Separability

Current through 2024-29, July 17, 2024
If any provision of this rule or the application thereof to
				  any person or circumstance is for any reason held to be invalid, the remainder
				  of the rule and the application of the provision to other persons or
				  circumstances shall not be affected thereby.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 760 - LIFE AND HEALTH REINSURANCE AGREEMENTS › Section 031-760-1 - AUTHORITY

Current through 2024-29, July 17, 2024
This regulation is adopted and promulgated by the
				  Superintendent pursuant to Title
				   24-A M.R.S.A.
				  §731-B(7).
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 760 - LIFE AND HEALTH REINSURANCE AGREEMENTS › Section 031-760-2 - Preamble

Current through 2024-29, July 17, 2024
A. The State of Maine Bureau of Insurance
				recognizes that licensed insurers routinely enter into reinsurance agreements
				that yield legitimate relief to the ceding insurer from strain to surplus.
It is, however, improper for a licensed ceding insurer to
				  enter into a reinsurance agreement for the principal purpose of obtaining
				  significant surplus aid without transferring all of the significant risks
				  inherent in the business being reinsured, as the expected potential liability
				  of the ceding insurer under such agreement remains essentially unchanged by the
				  reinsurance agreement, notwithstanding certain risk elements contained in the
				  agreement, such as catastrophic mortality or extraordinary survival. If the
				  terms of a reinsurance agreement give rise to any of the conditions enumerated
				  in Section
				  4(A), the existence
				  of such condition may constitute a violation or noncompliance with one or more
				  of the following:
(1)
										24-A M.R.S.A.
				§424(2);
(2)
										24-A M.R.S.A.
				§731-B;
(3)
										24-A
				M.R.S.A.
				§417(2)(a);
(4)
										24-A
				M.R.S.A. §4356.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 760 - LIFE AND HEALTH REINSURANCE AGREEMENTS › Section 031-760-3 - Scope

Current through 2024-29, July 17, 2024
This regulation shall apply to all domestic life and accident
				  and health insurers and to all other licensed life and accident and health
				  insurers not subject to a substantially similar regulation in their domiciliary
				  state. This regulation shall also similarly apply to licensed property and
				  casualty insurers with respect to their accident and health business. This
				  regulation does not apply to assumption reinsurance, yearly renewable term
				  reinsurance, stop loss nonproportional reinsurance or catastrophe
				  nonproportional reinsurance.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 760 - LIFE AND HEALTH REINSURANCE AGREEMENTS › Section 031-760-5 - Written agreements

Current through 2024-29, July 17, 2024
A. No reinsurance
				agreement or amendment to any agreement may be used to reduce any liability or
				to establish any asset in any financial statement filed with the Bureau, unless
				the agreement, amendment or a binding letter of intent has been duly executed
				by both parties no later than the date of account of the financial
				statement.
B. In the case of a
				letter of intent, a reinsurance agreement or an amendment to a reinsurance
				agreement must be executed within ninety (90) days from the execution date of
				the letter of intent, in order for credit taken to continue respecting the
				reinsurance ceded.
C. The
				reinsurance agreement shall contain provisions which provide that:
(1) The agreement shall constitute the entire
				agreement between the parties with respect to the business being reinsured and
				all understandings between the parties are expressed in the agreement;
				and
(2) Any change or modification
				to the agreement shall be null and void unless made by amendment to the
				agreement and signed by both parties.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 760 - LIFE AND HEALTH REINSURANCE AGREEMENTS › Section 031-760-6 - Existing agreements

Current through 2024-29, July 17, 2024
Insurers with reserve credits or asset valuations established
				  with respect to reinsurance agreements entered into prior to the effective date
				  of this regulation, which agreements were in compliance with Maine laws and
				  rules then in effect, but which give rise to any of the conditions enumerated
				  in Section
				  4(A), shall have
				  until December 31, 1994 to reduce those reserve credits or asset valuations to
				  zero. No reserve credits or asset which did not conform to requirements then in
				  effect may be established with respect to reinsurance agreements entered into
				  prior to the effective date of this rule.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 760 - LIFE AND HEALTH REINSURANCE AGREEMENTS › Section 031-760-7 - Effective date

Current through 2024-29, July 17, 2024
This regulation shall become effective August 11,
				  1993.
History. -- Effective. 8-11-93.
History. -- Statutory Authority.-- 24-A M.R.S.A.
				  §731B(7).
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 765 - HEALTH INSURANCE EMERGENCY PLANNING AND PROCEDURES › Section 031-765-1 - AUTHORITY

Current through 2024-29, July 17, 2024
This Rule is adopted by the Superintendent pursuant to
				   24-A M.R.S.A.
				  §§211,
				  212,
				  471,
				  472,
				  478, and
				  4309.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 765 - HEALTH INSURANCE EMERGENCY PLANNING AND PROCEDURES › Section 031-765-2 - PURPOSE

Current through 2024-29, July 17, 2024
The purpose of this Rule is to establish requirements and
				  procedures for carriers offering health plans to prepare for public health
				  emergencies.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 765 - HEALTH INSURANCE EMERGENCY PLANNING AND PROCEDURES › Section 031-765-3 - APPLICABILITY AND SCOPE

Current through 2024-29, July 17, 2024
This Rule applies to any carrier offering a health plan in
				  Maine, as defined at
				   24-A M.R.S.A.
				  §4301-A. Medicare Advantage, Medicare
				  Part D, Medicare supplement, TRICARE supplement plans, and dental plans are not
				  subject to the requirements of this Rule.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 765 - HEALTH INSURANCE EMERGENCY PLANNING AND PROCEDURES › Section 031-765-4 - DEFINITIONS

Current through 2024-29, July 17, 2024
For purposes of this Rule, "Public Health Emergency" means an
				  existing or imminent likelihood of need for a significant increase in health
				  care services or insurance benefit payments due to injuries or
				  sickness."
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 765 - HEALTH INSURANCE EMERGENCY PLANNING AND PROCEDURES › Section 031-765-5 - STANDARDS OF EMERGENCY PREPAREDNESS

Current through 2024-29, July 17, 2024
Carriers subject to this rule must be capable of implementing
				  the following actions within 72 hours in the event that the Superintendent
				  issues a direction, rule, or order to do so pursuant to 24AM.R.S.A. § 478.
1. Suspension of plan rules for prior
				medical authorization, pre-certification, and utilization review.
2. Suspension of plan requirements for
				accessing prescription drugs, including prior approval requirements, refill
				limitations, and co-payments. This includes, but is not limited to, suspension
				of formulary requirements that are more stringent than treatment guidelines
				established by the United States Centers for Disease Control.
3. Suspension of incentives or requirements
				for enrollees to obtain health services from contracted network
				providers.
4. Suspension of rate
				increases, extensions of grace periods, suspension of termination of coverage
				for employees losing group coverage, and easing of enrollment
				requirements.
5. Suspension of cost
				barriers for accessing needed services, including co-payments, co-insurance,
				and deductibles.
6. Suspension of
				time limits for filing claims.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 765 - HEALTH INSURANCE EMERGENCY PLANNING AND PROCEDURES › Section 031-765-6 - CONTINGENCY PLANNING REQUIREMENTS

Current through 2024-29, July 17, 2024
Within 30 days after the effective date of this Rule,
				  carriers offering health insurance plans in this state shall provide the
				  Superintendent with the following information.
1. The name and contact information for an
				officer of the company primarily responsible for public insurance emergency
				planning in Maine. If this contact information changes the carrier shall notify
				the Superintendent within 72 hours.
2. A description of health insurance coverage
				in force in Maine, which must be updated at least annually. Carriers shall
				provide updated descriptions within 72 hours after a request by the
				Superintendent. At a minimum, the description must include the following:
i. The number of group and blanket policy
				enrollees.
ii. The number of
				individual policy enrollees.
iii.
				The number of enrollees who have coverage for prescription
				medications.
iv. The number of
				enrollees who have coverage for influenza and pneumococcal
				vaccinations.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 765 - HEALTH INSURANCE EMERGENCY PLANNING AND PROCEDURES › Section 031-765-7 - REPORTING REQUIREMENTS

Current through 2024-29, July 17, 2024
1. Carriers with
				health insurance plans covering Maine residents shall promptly provide any
				information requested by the Superintendent regarding an existing or potential
				public health emergency, including claims information.
2. Carriers offering health insurance plans
				in Maine shall file reports meeting the requirements of Section
				6 within 30 days after the effective
				date of this Rule. Reports shall be verified by the oath of the officer
				designated in Section
				6, subsection
				1 of this Rule and by one other
				principal officer of the carrier. Updated reports shall be provided to the
				Superintendent within 72 hours after a request made to address an existing or
				potential public health emergency. Business continuity plans shall be held by
				the Superintendent as confidential information in the same manner as insurers'
				business plans. If the insurer considers any other information that it files
				pursuant to this Rule to be confidential pursuant to Maine law, the insurer
				shall file a request for protection from disclosure, identifying with
				particularity the information the insurer considers to be confidential and the
				reasons the insurer believes the information filed is not a public record
				within the meaning of the Maine Freedom of Access Law,
				 1 M.R.S.A.
				§§401
et
				seq.
3. The Superintendent
				may, but is not required to, exempt carriers with fewer than 500 insured lives
				in Maine from the reporting requirements of this Rule.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 770 - WORKERS' COMPENSATION INSURANCE; PROFESSIONAL HOCKEY PLAYERS › Section 031-770-1 - Purpose

Current through 2024-29, July 17, 2024
The purpose of this Rule is to fulfill the requirements of
				  1991 Public Law Chapter 872, Section 14 by establishing a requirement that
				  workers' compensation insurers adjust the premium of any professional hockey
				  team to reflect the employers' contractual obligations to continue salary and
				  medical benefits during the course of any injury.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 770 - WORKERS' COMPENSATION INSURANCE; PROFESSIONAL HOCKEY PLAYERS › Section 031-770-2 - Authority

Current through 2024-29, July 17, 2024
This Rule is adopted pursuant to 1991 Public Law of Maine
				  Chapter 872, Section 14 and
				   24-A M.R.S.A.
				  §212.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 770 - WORKERS' COMPENSATION INSURANCE; PROFESSIONAL HOCKEY PLAYERS › Section 031-770-3 - Definitions

Current through 2024-29, July 17, 2024
For purposes of this Rule, the following terms have the
				  following meanings:
A. "Injury" means
				any injury or other medical condition for which benefits may be awarded
				pursuant to 39-A M.R.S.A.;
B.
				"Insurer" means any insurer issuing a workers' compensation insurance policy on
				a voluntary basis and Maine Employers' Mutual Insurance Company.
C. "Professional hockey player" and "player"
				mean a person who, as an employee of an employer who holds a workers'
				compensation insurance policy delivered or issued for delivery in Maine and for
				wages, earnings, or salary within the meaning of Title 39-A M.R.S.A.,
				participates in the game of ice hockey.
D. "Professional hockey team" and "team" mean
				the employer who holds a workers' compensation insurance policy delivered or
				issued for delivery in Maine and who employs professional hockey players
				engaged in the game of ice hockey.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 770 - WORKERS' COMPENSATION INSURANCE; PROFESSIONAL HOCKEY PLAYERS › Section 031-770-5 - Grievances

Current through 2024-29, July 17, 2024
Any professional hockey team dissatisfied with the amount of
				  a premium adjustment provided pursuant to this Rule may request relief from the
				  Superintendent of Insurance.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 770 - WORKERS' COMPENSATION INSURANCE; PROFESSIONAL HOCKEY PLAYERS › Section 031-770-6 - Effective date

Current through 2024-29, July 17, 2024
This Rule is effective April 20, 1994.
History. -- Effective. 4-20-94.
History. -- Statutory Authority.--
				   24-A M.R.S.A.
				  §212 and 1991 Public Law Chap. 872,
				  § 14.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 780 - ACTUARIAL OPINION AND MEMORANDUM › Section 031-780-1 - Authority

Current through 2024-29, July 17, 2024
This rule is promulgated by the Superintendent pursuant to
				  Title
				  24-A M.R.S.A.
				  Sections212 and
				  952-A.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 780 - ACTUARIAL OPINION AND MEMORANDUM › Section 031-780-2 - Purpose

Current through 2024-29, July 17, 2024
The purpose of this rule is to prescribe:
A. Requirements for statements of actuarial
				opinion that are to be submitted in accordance with Title
				 24-A M.R.S.A.
				Section952-A, and for memoranda in support
				thereof,
B. Rules applicable to the
				appointment of an appointed actuary; and
C. Guidance as to the meaning of "adequacy of
				reserves."
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 780 - ACTUARIAL OPINION AND MEMORANDUM › Section 031-780-3 - Scope

Current through 2024-29, July 17, 2024
This rule shall apply to all life insurance companies and
				  fraternal benefit societies doing business in this State and to all life
				  insurance companies and fraternal benefit societies which are authorized to
				  reinsure life insurance, annuities or accident and health insurance business in
				  this State. This rule shall be applied in a manner that allows the appointed
				  actuary to utilize his or her professional judgment in performing the asset
				  analysis and developing the actuarial opinion and supporting memoranda,
				  consistent with relevant actuarial standards of practice. However, the
				  Superintendent shall have the authority to specify specific methods of
				  actuarial analysis and actuarial assumptions when, in the Superintendent's
				  judgment, these specifications are necessary for an acceptable opinion to be
				  rendered relative to the adequacy of reserves and related items.
This rule shall be applicable to all annual statements filed
				  with the Superintendent after the effective date of this rule. A statement of
				  opinion on the adequacy of the reserves and related actuarial items based on an
				  asset adequacy analysis in accordance with Section
				  6 of this rule, and a memorandum in
				  support thereof in accordance with Section
				  7 of this rule, shall be required each
				  year.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 780 - ACTUARIAL OPINION AND MEMORANDUM › Section 031-780-4 - Definitions

Current through 2024-29, July 17, 2024
A. "Actuarial Opinion" means the opinion of
				an Appointed actuary regarding the adequacy of the reserves and related
				actuarial items based on an asset adequacy analysis in accordance with Section
				6 of this rule and with applicable
				Actuarial Standards of Practice.
B.
				"Actuarial Standards Board" means the board established by the American Academy
				of Actuaries to develop and promulgate standards of actuarial
				practice.
C. "Annual statement"
				means that statement required by Title
				 24-A M.R.S.A.
				Section423 to be filed by the company with
				the Superintendent annually.
D.
				"Appointed actuary" means an individual who is appointed or retained in
				accordance with the requirements set forth in Section
				5(C) of this rule to
				provide the actuarial opinion and supporting memorandum as required by Title
				 24-A M.R.S.A.
				Section952-A.
E. "Asset adequacy analysis" means an
				analysis that meets the standards and other requirements referred to in Section
				5(D) of this
				rule.
F. "Commissioner" means the
				insurance supervisory regulator of another state.
G. "Company" means a life insurance company,
				fraternal benefit society or reinsurer subject to the provisions of this
				rule.
H. "NAIC" means the National
				Association of Insurance Commissioners.
I. "Qualified actuary" means an individual
				who meets the requirements set forth in Section5(B) of this
				rule.
J. "Superintendent" means the
				Maine Superintendent of Insurance.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 780 - ACTUARIAL OPINION AND MEMORANDUM › Section 031-780-5 - General Requirements

Current through 2024-29, July 17, 2024
A. Submission of
				Statement of Actuarial Opinion
(1) There is
				to be included on or attached to Page 1 of the annual statement for each year
				beginning with the year in which this rule becomes effective the statement of
				an appointed actuary, entitled "Statement of Actuarial Opinion," setting forth
				an opinion relating to reserves and related actuarial items held in support of
				policies and contracts, in accordance with Section
				6 of this rule.
(2) Upon written request by the company, the
				Superintendent may grant an extension of the date for submission of the
				statement of actuarial opinion.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 780 - ACTUARIAL OPINION AND MEMORANDUM › Section 031-780-6 - Statement of Actuarial Opinion Based On an Asset Adequacy Analysis

Current through 2024-29, July 17, 2024
A. General Description. The statement of
				actuarial opinion submitted in accordance with this section shall consist of:
(1) A paragraph identifying the appointed
				actuary and his or her qualifications (see Subsection (B)(1));
(2) A scope paragraph identifying the
				subjects on which an opinion is to be expressed and describing the scope of the
				appointed actuary's work, including a tabulation delineating the reserves and
				related actuarial items that have been analyzed for asset adequacy and the
				method of analysis, (see Subsection (B)(2)) and identifying the reserves and
				related actuarial items covered by the opinion that have not been so
				analyzed;
(3) A reliance paragraph
				describing those areas, if any, where the appointed actuary has deferred to
				other experts in developing data, procedures or assumptions, (e.g., anticipated
				cash flows from currently owned assets, including variation in cash flows
				according to economic scenarios (see Subsection (B(3)), supported by a
				statement of each such expert in the form prescribed by Subsection (E);
				and
(4) An opinion paragraph
				expressing the appointed actuary's opinion with respect to the adequacy of the
				supporting assets to mature the liabilities (see Subsection (B)(6)).
(5) One or more additional paragraphs will be
				needed in individual company cases as follows:
(a) If the appointed actuary considers it
				necessary to state a qualification of his or her opinion;
(b) If the appointed actuary must disclose an
				inconsistency in the method of analysis or basis of asset allocation used at
				the prior opinion date with that used for this opinion.
(c) If the appointed actuary must disclose
				whether additional reserves as of the prior opinion date are released as of
				this opinion date, and the extent of the release.
(d) If the appointed actuary chooses to add a
				paragraph briefly describing the assumptions that form the basis for the
				actuarial opinion.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 780 - ACTUARIAL OPINION AND MEMORANDUM › Section 031-780-8 - Effective Date

Current through 2024-29, July 17, 2024
This rule applies to annual statements for 1995 and
				  subsequent years. The 2006 revision applies to annual statements for 2007 and
				  subsequent years.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 790 - PROCEDURES FOR RESOLVING COORDINATION OF BENEFITS DISPUTES › Section 031-790-1 - Purpose and Scope

Current through 2024-29, July 17, 2024
This Rule is adopted by the Superintendent, pursuant to
				  24 M.R.S.A. §
										2332-A and 24-A M.R.S.A. §§
				  24-AM.R.S.A. §§ 212, 2723A, 2844, 4218, in order to provide for the
				  orderly transfer of information needed to pay claims promptly and reduce claims
				  payment delays and misunderstandings. This Rule applies to all health carriers
				  and other entities subject to the jurisdiction of the Superintendent of
				  Insurance.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 790 - PROCEDURES FOR RESOLVING COORDINATION OF BENEFITS DISPUTES › Section 031-790-2 - Definitions

Current through 2024-29, July 17, 2024
The following terms, when used in this Rule, shall have the
				  following meanings unless the context clearly indicates otherwise:
A. "Coordination of benefits provision" or
				"COB provision" means a contractual provision that establishes an order in
				which plans intend to pay their claims, and describes how benefits provided by
				the plan will be calculated when the plan is secondary to avoid duplication of
				payment.
B. "Carrier" means an
				insurer, a health maintenance organization, a preferred provider arrangement
				administrator, a fraternal benefit society, a nonprofit hospital or medical
				service organization or health plan, a multiple-employer welfare arrangement,
				or a self-insured employer subject to state regulation as described in
				 24-A M.R.S.A,
				§2848-A.
C. "Plan" means a health benefit plan issued
				or administered by a carrier.
D.
				"Primary plan" means a plan whose benefits for a person's health care coverage
				must be determined before taking the existence of any other plan into
				consideration.
E. "Secondary plan"
				means a plan which is not a Primary Plan.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 790 - PROCEDURES FOR RESOLVING COORDINATION OF BENEFITS DISPUTES › Section 031-790-3 - Information Sharing

Current through 2024-29, July 17, 2024
A.
General.
A carrier whose plan contains a coordination of benefits
				or COB provision may require covered persons to disclose whether they are
				covered by other plans and to provide sufficient information to determine which
				plan is primary. A secondary plan may require a covered person to claim
				benefits under the primary plan as a condition of coverage under the secondary
				plan.
B.
Streamlined Benefit
				Administration.
Carriers are encouraged to develop procedures for
				coordinating claims processing when claimants are insured by multiple plans and
				reimbursement from another carrier is known to be available.
C.
Information Sharing.
Each
				carrier shall provide to any other carrier with which it seeks to coordinate
				benefits, to any carrier which seeks information to determine whether it has a
				right to coordinate benefits with it, any information it acquires that the
				other carrier needs or may consider relevant to determining priority of
				payment. Relevant information includes, but is not limited to, the identity of
				other carriers and plans and the identity of a claimant's custodial parent.
				Such information must be provided promptly after receiving a request to provide
				information to the other carrier and receiving complete information from the
				claimant.
D.
Suspension of
				filing deadlines.
Submission of a timely claim to one carrier when there
				is multiple coverage shall suspend all other applicable filing deadlines for a
				minimum of 120 days after that carrier has adjudicated the claim, as long as
				the claimant provides all information requested by all carriers within a
				reasonable time after the request.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 790 - PROCEDURES FOR RESOLVING COORDINATION OF BENEFITS DISPUTES › Section 031-790-4 - Interim Dispute Resolution

Current through 2024-29, July 17, 2024
A. The interim
				dispute resolution requirements of this Rule apply to the following types of
				health plans:
(1) All health insurance
				policies; nonprofit hospital, medical, or health service contracts; and similar
				health coverage contracts, whether offered on a group basis or on an
				individual, family, blanket, or "nongroup" basis;
(2) Coverage through health maintenance
				organizations;
(3) The medical
				payments coverage in automobile insurance policies; and
(4) Self-insured plans subject to state
				regulation as described in
				 24-A M.R.S.A,
				§2848-A.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 790 - PROCEDURES FOR RESOLVING COORDINATION OF BENEFITS DISPUTES › Section 031-790-5 - Severability

Current through 2024-29, July 17, 2024
If any section, term, provision, or application of this Rule
				  is adjudged invalid for any reason, such judgment shall not impair or
				  invalidate any other section, term, provision, or application, and the
				  remainder of this Rule shall continue in full force and
				  effect.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 825 - PROCEDURES AND STANDARDS FOR OBTAINING A HARDSHIP EXEMPTION FROM SUBMITTING ELECTRONIC HEALTH CLAIMS › Section 031-825-1 - Purpose and Scope

Current through 2024-29, July 17, 2024
This Rule is adopted by the Superintendent, pursuant to
				  requirements of and authority set forth in
				   24M.R.S.A.
				  §§2332-E,
				  2985
				  and 24-A M.R.S.A. §§ 1912, 2436, 2680, 2753, 2823-B, 4235, and 212,
				  to establish procedures for health care practitioners to request exemptions to
				  the requirement that they submit claims in electronic data format.
Title
				   24 M.R.S.A.
				  §2985 requires health care practitioners
				  who directly bill for health care services to submit claims in electronic data
				  format to a carrier, as defined in 24-A, § 4301-A(3). Section 2985
				  provides that a health care practitioner or group of health care practitioners
				  with fewer than 10 full-time equivalent employees is exempt until October 16,
				  2005. Beginning on that date, such practitioners and groups may apply to the
				  Superintendent of Insurance for a continued exemption based upon hardship. The
				  statute requires the Superintendent to adopt rules relating to the process for
				  requesting a hardship exemption and the standards for determining whether a
				  practitioner has demonstrated hardship.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 825 - PROCEDURES AND STANDARDS FOR OBTAINING A HARDSHIP EXEMPTION FROM SUBMITTING ELECTRONIC HEALTH CLAIMS › Section 031-825-2 - Definitions

Current through 2024-29, July 17, 2024
The term "Health Care Practitioner," when used in this Rule,
				  means physicians and all others certified, registered or licensed in the
				  healing arts, including, but not limited to, nurses, podiatrists, optometrists,
				  chiropractors, physical therapists, dentists, psychologists and physicians'
				  assistants.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 825 - PROCEDURES AND STANDARDS FOR OBTAINING A HARDSHIP EXEMPTION FROM SUBMITTING ELECTRONIC HEALTH CLAIMS › Section 031-825-3 - Hardship exemption application process

Current through 2024-29, July 17, 2024
A. A health
				care practitioner must submit a written application for exemption by December
				16, 2005, or within 60 days after opening a practice in this state or becoming
				eligible for a hardship exemption.
B. The written application for an exemption
				must include:
1. Names and medical license
				numbers of the principals of the practice.
2. Physical location and mailing address of
				the practice.
3. Type of practice
				(e.g., dental, behavioral health).
4. The reason or reasons for requesting an
				exemption.
5. The number of
				full-time equivalent employees, including non-medical personnel, employed by
				the practice.
6. The number of
				doctors, nurses and other medical personnel employed by the practice.
7. The average number of patients seen per
				month.
8. Annual gross health care
				claims and billings generated by the practice.
9. A statement advising whether the
				practitioner has:
a. Access to telephone
				services
b. Access to a
				computer
c. Access to an internet
				service provider or to cable services.
10. An analysis of how much it would cost the
				practitioner to set up and maintain electronic billing capability during the
				first year, including the cost of complying with Federal rules regulating the
				security of protected electronic health information. The analysis must also
				compare the annual cost of electronic billing to the annual cost of the
				practitioner's current billing methodology.
11. Any other information requested by the
				Superintendent.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 825 - PROCEDURES AND STANDARDS FOR OBTAINING A HARDSHIP EXEMPTION FROM SUBMITTING ELECTRONIC HEALTH CLAIMS › Section 031-825-4 - Standards for demonstrating hardship

Current through 2024-29, July 17, 2024
A hardship waiver may be granted upon a finding by the
				  Superintendent that:
A. The health
				care practitioner or group of health care practitioners has fewer than ten
				full-time equivalent employees. The method of calculating the number of
				full-time equivalent employees shall conform to federal law requiring health
				care practitioners to submit claims electronically if they have more than ten
				full-time employees; and
B. There
				are significant technological impediments that make it difficult for the health
				care practitioner to submit claim forms electronically, the cost of compliance
				would have a significant impact on the health care practitioner, granting the
				waiver is warranted based on other considerations or unusual
				circumstances.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 825 - PROCEDURES AND STANDARDS FOR OBTAINING A HARDSHIP EXEMPTION FROM SUBMITTING ELECTRONIC HEALTH CLAIMS › Section 031-825-5 - Severability

Current through 2024-29, July 17, 2024
If any section, term, provision, or application of this Rule
				  is adjudged invalid for any reason, such judgment shall not impair or
				  invalidate any other section, term, provision, or application, and the
				  remainder of this Rule shall continue in full force and effect as
				  adopted.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 825 - PROCEDURES AND STANDARDS FOR OBTAINING A HARDSHIP EXEMPTION FROM SUBMITTING ELECTRONIC HEALTH CLAIMS › Section 031-825-6 - Effective Date

Current through 2024-29, July 17, 2024
This Rule is effective September 13, 2005
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 830 - VALUATION OF LIFE INSURANCE POLICIES › Section 031-830-1 - Authority

Current through 2024-29, July 17, 2024
This rule is promulgated by the Superintendent pursuant to
				  Title
				  24-A M.R.S.A.
				  Sections212,
				  953, and
				  957-A.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 830 - VALUATION OF LIFE INSURANCE POLICIES › Section 031-830-2 - Purpose

Current through 2024-29, July 17, 2024
A. The purpose of this rule is to provide:
(1) Tables of select mortality factors and
				rules for their use;
(2) Rules
				concerning a minimum standard for the valuation of plans with nonlevel premiums
				or benefits; and
(3) Rules
				concerning a minimum standard for the valuation of plans with secondary
				guarantees.