reglab/statecodes huggingface dataset:
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 865 - STANDARDS FOR FERTILITY COVERAGE › Section 031-865-7 - Benefit Mandate Defrayal

Current through 2024-29, July 17, 2024
1. This section
				establishes the method for reporting by carriers and payment of reimbursement
				if some or all of the benefits required by this rule are subject to cost
				defrayal under the federal Affordable Care Act.
2. For the purposes of this subsection,
				benefits subject to cost defrayal are benefits that:
(A) Are required by and do not exceed the
				limitations in
				24-A
				M.R.S. §4320-U or in this
				rule;
(B) Are provided by a health
				plan purchased on the Maine Health Insurance Marketplace;
(C) Include only the carrier's share of the
				claim payment required by Subsection 4(2) and not any additional amount
				voluntarily offered by the carrier;
(D) Were not within the scope of coverage of
				the benchmark plan used to define the required essential health benefits under
				24-A M.R.S. § 4320-D(2), as in effect at the time of enactment of
				24-A
				M.R.S. §4320-U; and
(E) Have been determined by the
				Superintendent, after consultation with the federal Centers for Medicare and
				Medicaid Services, to be subject to the federal Affordable Care Act's
				requirement to defray the cost of those benefits.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 865 - STANDARDS FOR FERTILITY COVERAGE › Section 031-865-8 - Severability

Current through 2024-29, July 17, 2024
If any section, term, or provision of this rule shall be
				  deemed invalid for any reason, any remaining section, term, or provision shall
				  remain in full force and effect.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 870 - HEALTH CARE PRACTITIONER SELF-REFERRALS › Section 031-870-1 - Authority and Purpose

Current through 2024-29, July 17, 2024
This Rule is adopted by the Superintendent of Insurance,
				  pursuant to
				   24-A M.R.S.A.
				  §212 and 22 M. R.S.A. §§ 2085
				  and 2087, to provide standards and procedures for the administration of 22
				  M.R.S.A. Chapter 414, the Health Care Practitioner Self-Referral Act. The
				  purpose of this Rule is to set forth criteria for determining whether there are
				  adequate safeguards against the conflict of interest that may arise when health
				  care practitioners self-refer patients to facilities in which they have an
				  investment interest, and to establish a process whereby a health care
				  practitioner can apply to the Superintendent for an exemption authorizing
				  referrals to a practitioner-owned facility.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 870 - HEALTH CARE PRACTITIONER SELF-REFERRALS › Section 031-870-2 - Definitions

Current through 2024-29, July 17, 2024
A. "Community," with respect to a health care
				practitioner, means the smallest geographic service area (town, region, county,
				state) that encompasses 80% of the practitioner's clients.
B. "Outside facility" means a facility that
				is not part of the practitioner's individual or group
				practice.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 870 - HEALTH CARE PRACTITIONER SELF-REFERRALS › Section 031-870-3 - Prohibited Referrals

Current through 2024-29, July 17, 2024
A health care practitioner may not refer any patient to an
				  outside facility in which he or she is an investor, other than:
A. To a facility certified by the
				Superintendent as an exempt practitioner-owned facility pursuant to Section
				4 of this Rule;
B. To a facility within which the
				practitioner directly provides health services and will be personally involved
				in the referred patient's care;
C.
				Pursuant to a contract with a health maintenance organization, or under a
				preferred provider arrangement, in which the patient is enrolled; or
D. An independent publicly traded facility in
				compliance with
				 22 M.R.S.A.
				§2085(3).
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 870 - HEALTH CARE PRACTITIONER SELF-REFERRALS › Section 031-870-4 - Certification of Exempt Practitioner-Owned Facilities

Current through 2024-29, July 17, 2024
A facility in which a health care practitioner has an
				  investment interest may be certified to accept self-referrals from the
				  practitioner only if the practitioner demonstrates to the satisfaction of the
				  Superintendent that the facility satisfies the requirements of this
				  Section.
A. Community need. No
				feasible source of alternative financing is available and community need for
				the practitioner-owned facility is further demonstrated by at least one of the
				following criteria:
1. There is no other
				facility of reasonable quality that provides appropriate service to the
				community;
2. The use of other
				facilities is onerous or creates too great a hardship for patients;
				or
3. The facility is formed to own
				or lease medical equipment that replaces obsolete or otherwise inadequate
				equipment in or under the control of a hospital located in a federally
				designated health manpower shortage area; or
4. The fees charged by the facility for the
				health care service are competitive with the fees charged outside the
				community.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 870 - HEALTH CARE PRACTITIONER SELF-REFERRALS › Section 031-870-5 - Application for Certification

Current through 2024-29, July 17, 2024
Applicants for an exemption must file a signed affidavit that
				  describes in detail how the applicant has made the determination that each of
				  the requirements have been met. The affidavit should be accompanied by
				  documents that support the affirmations made in the affidavit. Examples of
				  supporting documentation include but are not limited to the following:
A. Documents from the facility that describe
				investment terms.
B. Marketing
				materials which demonstrate that investment opportunities are offered equally
				to health care practitioners and other potential investors.
C. Copies of any loan arrangement between the
				practitioner and the facility.
D.
				Copies of any forms or a written description of how the health care
				practitioner discloses his or her investment interest to patients being
				referred to the facility. To the extent that alternative facilities are
				reasonably available, the health care practitioner must demonstrate how
				patients are informed of the alternative facilities.
E. A description of the internal utilization
				review program, including a copy of the goals and the bylaws or rules of
				operation of the program, and a list of the names and licensure and specialty
				certification status of the persons who will be conducting the
				review.
F. Documents demonstrating
				that the investor's attempts to secure financing from alternative sources for
				this venture have failed.
The Superintendent may request any additional documents
				  necessary to make the finding whether each of the requirements of this Rule has
				  been met. Such documents must be made available within thirty days after a
				  written request by the Superintendent, or the application will be denied. The
				  applicant with good cause may request an extension of time, which shall not be
				  unduly denied by the Superintendent.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 870 - HEALTH CARE PRACTITIONER SELF-REFERRALS › Section 031-870-6 - Completeness of Request

Current through 2024-29, July 17, 2024
Within 30 days after the submission of an application, the
				  Superintendent shall either acknowledge in writing that the application is
				  complete or inform the applicant why the application is incomplete and specify
				  the materials known to be missing. The Superintendent will render a decision
				  within 90 days after the date of the letter acknowledging that the application
				  is complete.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 870 - HEALTH CARE PRACTITIONER SELF-REFERRALS › Section 031-870-7 - Re-evaluation of Exempt Facilities

Current through 2024-29, July 17, 2024
The Superintendent may from time to time require a
				  re-evaluation of certified exempt facilities to verify compliance with this
				  Rule or any statutory requirements.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 870 - HEALTH CARE PRACTITIONER SELF-REFERRALS › Section 031-870-8 - Public Hearing

Current through 2024-29, July 17, 2024
Public hearings may be convened at the Superintendent's
				  initiative or requested pursuant to
				   24-A M.R.S.A.
				  §229.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 870 - HEALTH CARE PRACTITIONER SELF-REFERRALS › Section 031-870-9 - Severability

Current through 2024-29, July 17, 2024
If any section, term, provision, or application of this Rule
				  is adjudged invalid for any reason, that 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 880 - SALE OF INSURANCE PRODUCTS BY FINANCIAL INSTITUTIONS AND SUPERVISED LENDERS › Section 031-880-I - AUTHORITY

Current through 2024-29, July 17, 2024
This rule is promulgated pursuant to the authority granted to
				  the Director of the Office of Consumer Credit Regulation, the Superintendent of
				  the Bureau of Banking and the Superintendent of the Bureau of Insurance
				  pursuant to 9-A M.R.S.A. §4 - 407;
				   9-B M.R.S.A.
				  §§416 and
				  448(5);
				  and
				   24-A
				  M.R.S.A.
				  §1443-A(3).
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 880 - SALE OF INSURANCE PRODUCTS BY FINANCIAL INSTITUTIONS AND SUPERVISED LENDERS › Section 031-880-II - PURPOSE

Current through 2024-29, July 17, 2024
This rule establishes requirements with respect to signage,
				  physical location and identification of insurance agencies, producers and
				  consultants in connection with the sale of insurance products by financial
				  institutions, financial institution holding companies, credit unions,
				  supervised lenders and their affiliates, in order to minimize customer
				  confusionand provide adequate consumer protections.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 880 - SALE OF INSURANCE PRODUCTS BY FINANCIAL INSTITUTIONS AND SUPERVISED LENDERS › Section 031-880-III - DEFINITIONS

Current through 2024-29, July 17, 2024
For purposes of this rule, the following terms have the
				  following meanings:
A. "Affiliate"
				shall have the same meaning as set forth in
				 9-A M.R.S.A.
				§4-403(1), with respect
				to supervised lenders, and as set forth in
				 24-A
				M.R.S.A.14432 ) with respect to financial
				institutions.
B. "Financial
				institution" shall mean a financial institution authorized to do business in
				this state, as defined in
				 9-B M.R.S.A.
				§131(17-A) and includes
				a financial institution holding company as defined in
				 9-B M.R.S.A.
				§131(18); a mutual
				holding company as defined in
				 9-B M.R.S.A.
				§1052(2); and a credit
				union authorized to do business in this state as defined in
				 9-B M.R.S.A.
				§131(12-A).
C. "Insurance agency" shall have the same
				meaning as set forth in
				 24-A M.R.S.A.
				§1402(3).
D. "Insurance consultant" shall have the same
				meaning as set forth in
				 24-A M.R.S.A.
				§1402(4).
E. "Insurance producer" shall have the same
				meaning as set forth in
				 24-A M.R.S.A.
				§1402(5).
F. "Insurance product" shall have the same
				meaning as set forth in 9-A M.R.S.A. § 4-403(6) or 9-B M.R.S.A. §
				9-BM.R.S.A. §
									131(22-E),
				as the context may require. For the purposes of this rule, "insurance product"
				does not include group health and group life insurance to the extent authorized
				by Title 24-A, Chapters 31 and 35 when the insured is enrolled in the insurance
				policy; credit life and credit health insurance to the extent authorized by
				Title 24-A, Chapter 37; credit property insurance; credit involuntary
				unemployment insurance; forced placed property insurance; a vendor's single
				interest policy; or any other type of insurance excluded by the Superintendent
				of Insurance pursuant to 9-A M.R.S.A. § 4-401(2), 9-B M.R.S.A.
				§9-BM.R.S.A. § 448(6)24-A or M.R.S.A. § 1443-A(2). For the
				purposes of this rule, "insurance product" also does not include annuities sold
				pursuant to
				 9-B M.R.S.A.
				§443(11), or any rules
				promulgated thereunder.
G.
				"Regulators" shall mean the Bureau of Banking, the Office of Consumer Credit
				Regulation, and the Bureau of Insurance, collectively.
H. "Retail area" shall mean, for financial
				institutions, all space occupied by a financial institution where the "business
				of banking" as defined by
				 9-B M.R.S.A.
				§131(5) may occur or,
				for supervised lenders, all space occupied by a supervised lender where
				consumer credit transactions, as defined by
				 9-A M.R.S.A.
				§1-301(12), are entered
				into.
I. "Supervised lender" shall
				have the same meaning as set forth in
				 9-A M.R.S.A.
				§1-301(39).
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 880 - SALE OF INSURANCE PRODUCTS BY FINANCIAL INSTITUTIONS AND SUPERVISED LENDERS › Section 031-880-V - ENFORCEMENT

Current through 2024-29, July 17, 2024
Compliance with this rule shall be determined by reviewing
				  the cumulative effect of the use of signs, the physical location of insurance
				  sales, and the identification of insurance agencies, producers, and
				  consultants. The regulators shall cooperate in the enforcement of this rule.
				  Examinations for compliance with the statute and rule will be conducted by the
				  Bureau of Banking with respect to financial institutions or their affiliates
				  and by the Office of Consumer Credit Regulation with respect to supervised
				  lenders or their affiliates. Suspected violations of the rule shall be reported
				  to the Bureau of Insurance. Notwithstanding the foregoing, the Bureau of
				  Insurance may conduct investigations, examinations and other enforcement
				  actions with respect to the insurance activities of financial institutions and
				  supervised lenders. Information which is deemed confidential under Title 9-A,
				  Title 9-B, or Title 24-A of the Maine Revised Statutes Annotated shall remain
				  confidential when shared with or communicated between or among the
				  regulators.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 890 - CONSUMER COMPLAINT RATIOS › Section 031-890-1 - Authority and Purpose

Current through 2024-29, July 17, 2024
This Rule is adopted by the Superintendent pursuant to Title
				   24-A M.R.S.A.
				  §§212 and
				  216(2),
				  to define the method for calculating consumer complaint ratios.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 890 - CONSUMER COMPLAINT RATIOS › Section 031-890-2 - Scope

Current through 2024-29, July 17, 2024
This Rule applies to all insurers holding certificates of
				  authority to issue insurance policies or annuity contracts within the state of
				  Maine, except that this rule does not apply to reinsurance, surplus lines
				  insurance, or to complaints under the jurisdiction of the Workers' Compensation
				  Board.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 890 - CONSUMER COMPLAINT RATIOS › Section 031-890-3 - Definitions

Current through 2024-29, July 17, 2024
The following words and phrases, when used in this Rule,
				  shall have the following meanings:
A.
				"Beneficiary" means any individual legally entitled to proceeds or benefits
				under a policy of insurance.
B.
				"Bureau" means the Bureau of Insurance.
C. "Consumer Complaint" means a written
				communication from an insurance consumer primarily expressing a grievance that
				results in the need for the Bureau to conduct further investigation or to
				communicate in writing with a regulated entity for a response or resolution to
				the complaint.
D. "Consumer
				Complaint Ratio" means the ratio of the number of consumer complaints to the
				direct written premiums for a line of insurance or combined lines of
				insurance.
E. "Consumer Complaint
				Index" means the ratio of an insurer's consumer complaint share to its market
				share for a line of insurance or combined lines of insurance.
F. "Consumer Complaint Share" means the
				percentage of consumer complaints received by the Bureau against an insurer for
				any given line of insurance, compared to the total consumer complaints received
				by the Bureau for that line of insurance.
G. "Direct Written Premium" means
				consideration paid, or to be paid, to the insurer for the issuance and delivery
				or renewal of any binder, policy of insurance or certificate of insurance or
				annuity written.
H. "Consumer"
				means:
1. A policyholder, certificateholder,
				or beneficiary under an insurance policy or annuity contract; or
2. An applicant for
				insurance.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 890 - CONSUMER COMPLAINT RATIOS › Section 031-890-4 - Computing the Consumer Complaint Ratio

Current through 2024-29, July 17, 2024
A. Direct
				written premiums in Maine for the reporting period will be subdivided by line
				of insurance for each insurer.
B.
				Consumer complaint information for the reporting period will be subdivided by
				line of insurance for each insurer.
C. The insurer's consumer complaint ratio for
				a line of insurance will be calculated by dividing the number of consumer
				complaints by the direct written premiums for that line of insurance.
D. Only those insurers with sufficient
				premium volume to produce credible consumer complaint ratios will be
				included.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 890 - CONSUMER COMPLAINT RATIOS › Section 031-890-5 - Computing the Consumer Complaint Index

Current through 2024-29, July 17, 2024
A. All
				direct written premiums in Maine for the reporting period will be compared to
				determine the market share of insurance business for each insurer by line of
				insurance.
B. Consumer complaint
				information will be subdivided by line of insurance for each insurer.
C. The consumer complaint share will be
				determined for each insurer by line of insurance based on consumer complaints
				received by the Bureau.
D. An
				insurer complaint index, for each insurer, will be calculated by dividing the
				consumer complaint share by line of insurance by the market share of direct
				written premium for that line of insurance.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 890 - CONSUMER COMPLAINT RATIOS › Section 031-890-6 - Supplementary Reporting of Direct Written Premiums

Current through 2024-29, July 17, 2024
A.
				If the Superintendent determines that the lines of health insurance enumerated
				in the Annual Statement are insufficiently specific, the Superintendent may
				require insurers to itemize their premium writings in accordance with
				supplemental reporting forms prescribed by the Superintendent. Requirements for
				such information will be imposed on a prospective basis only.
B. The Superintendent may consolidate lines
				of insurance into a single category, either in addition to or instead of the
				individual lines, and each category shall be treated as a single "line of
				insurance" for purposes of this Rule.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 890 - CONSUMER COMPLAINT RATIOS › Section 031-890-7 - Effective Date

Current through 2024-29, July 17, 2024
The effective date of this Rule is June 21, 1998. Amendments
				  to this rule are effective May 4, 2002.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 900 - LARGE COMMERCIAL RISKS › Section 031-900-1 - Authority

Current through 2024-29, July 17, 2024
This Rule is promulgated by the Superintendent of Insurance
				  pursuant to Title
				   24-A M.R.S.A.
				  Sections212 and
				  1450(3).
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 900 - LARGE COMMERCIAL RISKS › Section 031-900-2 - Purpose

Current through 2024-29, July 17, 2024
The purpose of this Rule is to establish standards for
				  determining when an insured is a "large commercial insurance risk" within the
				  meaning of
				   24-A M.R.S.A.
				  Section1450(3), which
				  authorizes producers to receive a fee in lieu of or in combination with
				  commission for the sale of certain property and casualty insurance
				  transactions.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 900 - LARGE COMMERCIAL RISKS › Section 031-900-3 - Scope

Current through 2024-29, July 17, 2024
The Rule applies to property and casualty insurance policies
				  on subjects of insurance resident, located or expressly to be performed in this
				  State.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 900 - LARGE COMMERCIAL RISKS › Section 031-900-4 - Severability

Current through 2024-29, July 17, 2024
If any provision of this Rule, or its application to any
				  person or circumstance, is held invalid, such determination shall not affect
				  other provisions or application of this Rule which can be given effect without
				  the invalid provision or application.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 900 - LARGE COMMERCIAL RISKS › Section 031-900-5 - Definitions

Current through 2024-29, July 17, 2024
For the purpose of this Rule, the following terms have the
				  following meanings:
A. "Commercial
				Insurance" means commercial property and casualty insurance.
B. "Producer" means a person or agency
				licensed under Title 24-A M.R.S.A. Chapter 16, or otherwise acting, as a
				property and casualty insurance producer. "Producer" includes resident and
				nonresident licensees.
C. "Insurer"
				means any company, association, organization, partnership, syndicate, business
				trust, corporation or legal entity engaged as an indemnitor or surety, holding
				a certificate of authority issued by the Superintendent or authorized as an
				eligible surplus lines insurer by the Superintendent.
D. "Superintendent" means the Superintendent
				of the Maine Bureau of Insurance.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 900 - LARGE COMMERCIAL RISKS › Section 031-900-6 - Standards

Current through 2024-29, July 17, 2024
A large commercial risk is defined as one whose aggregate
				  annual premiums for commercial property and casualty insurance sold by a
				  producer totals $150,000 or more.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 900 - LARGE COMMERCIAL RISKS › Section 031-900-7 - Self-certification

Current through 2024-29, July 17, 2024
Prior to receiving a fee in lieu of or in combination with
				  commission for the sale of large commercial property and casualty insurance
				  policies as defined in sub-§
									6, the insurance producer must obtain
				  from the insured a written notarized certification of compliance with the
				  standard identified in Subsection
				  6. A record of each certification must
				  be maintained by the producer for a minimum of six years following the
				  termination of the insurance policy. A copy of the certification must be
				  provided to the insurer by the producer. Certification must be obtained upon
				  each policy renewal stating that it meets the standards identified in
				  sub-§
									6.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 900 - LARGE COMMERCIAL RISKS › Section 031-900-8 - Disclosure

Current through 2024-29, July 17, 2024
Prior to receiving a fee in lieu of or in combination with
				  commission for the sale of property and casualty insurance policies, the
				  insurance producer must disclose in writing to the insured that the fee is not
				  a part of the premium charge for the insurance policies, and that the fee will
				  not be a part of any calculation of unearned premium owed by the insurer in the
				  event of policy cancellation. In the event that a fee is charged in combination
				  with commission, the amount of the fee and commission must be disclosed
				  separately in writing by the producer to the insured.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 910 - LIFE INSURANCE ILLUSTRATIONS › Section 031-910-1 - Purpose

Current through 2024-29, July 17, 2024
The purpose of this Rule is to provide rules for life
				  insurance policy illustrations that will protect consumers and foster consumer
				  education. The Rule provides illustration formats, prescribes standards to be
				  followed when illustrations are used, and specifies the disclosures that are
				  required in connection with illustrations. The goals of this Rule are to ensure
				  that illustrations do not mislead purchasers of life insurance and to make
				  illustrations more understandable. Insurers will, as far as possible, eliminate
				  the use of footnotes and caveats and define terms used in the illustration in
				  language that would be understood by a typical person within the segment of the
				  public to which the illustration is directed.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 910 - LIFE INSURANCE ILLUSTRATIONS › Section 031-910-2 - Authority

Current through 2024-29, July 17, 2024
This Rule is adopted by the Superintendent pursuant to Title
				   24-A M.R.S.A.
				  §§212,
				  2151-B, and
				  2152-A.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 910 - LIFE INSURANCE ILLUSTRATIONS › Section 031-910-3 - Applicability and Scope

Current through 2024-29, July 17, 2024
This Rule applies to all group and individual life insurance
				  policies and certificates except:
A.
				Variable life insurance;
B.
				Individual and group annuity contracts;
C. Credit life insurance; or
D. Life insurance policies with no
				illustrated death benefits on any individual exceeding $10,000.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 910 - LIFE INSURANCE ILLUSTRATIONS › Section 031-910-4 - Definitions

Current through 2024-29, July 17, 2024
For the purposes of this Rule:
A. "Actuarial Standards Board" means the
				board established by the American Academy of Actuaries to develop and
				promulgate standards of actuarial practice.
B. "Contract premium" means the gross premium
				that is required to be paid under a fixed premium policy, including the premium
				for a rider for which benefits are shown in the illustration.
C. "Currently payable scale" means a scale of
				non-guaranteed elements in effect for a policy form as of the preparation date
				of the illustration or declared to become effective within the next ninety-five
				(95) days.
D. "Disciplined current
				scale" means a scale of non-guaranteed elements constituting a limit on
				illustrations currently being illustrated by an insurer that is reasonably
				based on actual recent historical experience, as certified annually by an
				illustration actuary designated by the insurer. Standards established by the
				Actuarial Standards Board may be relied upon for further guidance in
				determining the disciplined current scale if the standards:
(1) Are consistent with all provisions of
				this Rule;
(2) Limit a disciplined
				current scale to reflect only actions that have already been taken or events
				that have already occurred;
(3) Do
				not permit a disciplined current scale to include any projected trends of
				improvements in experience or any assumed improvements in experience beyond the
				illustration date; and
(4) Do not
				permit assumed expenses to be less than minimum assumed
				expenses.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 910 - LIFE INSURANCE ILLUSTRATIONS › Section 031-910-5 - Policies to Be Illustrated

Current through 2024-29, July 17, 2024
A. Each insurer
				marketing policies to which this Rule is applicable shall notify the
				Superintendent whether a policy form is to be marketed with or without an
				illustration. Within 60 days after the effective date of this Rule, the insurer
				shall identify in writing all policy forms being actively marketed and whether
				or not an illustration will be used with them. For policy forms filed after the
				effective date of this Rule, the identification shall be made at the time of
				filing. Any previous identification may be changed by notice to the
				Superintendent.
B. If the insurer
				identifies a policy form as one to be marketed without an illustration, any use
				of an illustration for any policy using that form prior to the first policy
				anniversary is prohibited.
C. If a
				policy form is identified by the insurer as one to be marketed with an
				illustration, a basic illustration prepared and delivered in accordance with
				this Rule is required, except that a basic illustration need not be provided to
				individual members of a group or to individuals insured under multiple lives
				coverage issued to a single applicant unless the coverage is marketed to these
				individuals. The illustration furnished an applicant for a group life insurance
				policy or policies issued to a single applicant on multiple lives may be either
				an individual or composite illustration representative of the coverage on the
				lives of members of the group or the multiple lives covered.
D. Potential enrollees of non-term group life
				subject to this Rule shall be furnished a quotation with the enrollment
				materials. The quotation shall show potential policy values for sample ages and
				policy years on a guaranteed and non-guaranteed basis appropriate to the group
				and the coverage. This quotation shall not be considered an illustration for
				purposes of this Rule, but all information provided shall be consistent with
				Subsection
				6(B) of this Rule. A
				basic illustration shall be provided at delivery of the certificate to
				enrollees for non-term group life who enroll for more than the minimum premium
				necessary to provide pure death benefit protection. In addition, the insurer
				shall make a basic illustration available to any non-term group life enrollee
				who requests it.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 910 - LIFE INSURANCE ILLUSTRATIONS › Section 031-910-6 - General Rules and Prohibitions

Current through 2024-29, July 17, 2024
A. An
				illustration used in the sale of a life insurance policy shall satisfy the
				applicable requirements of this Rule, be clearly labeled "life insurance
				illustration" and contain the following basic information:
(1) Name of insurer;
(2) Name and business address of producer or
				insurer's authorized representative, if any;
(3) Name, age and sex of proposed insured,
				except where a composite illustration is permitted under this Rule;
(4) Underwriting or rating classification
				upon which the illustration is based;
(5) Generic name of policy, the company
				product name, if different, and form number;
(6) Initial death benefit; and
(7) Dividend option election or application
				of non-guaranteed elements, if applicable.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 910 - LIFE INSURANCE ILLUSTRATIONS › Section 031-910-8 - Standards for Supplemental Illustrations

Current through 2024-29, July 17, 2024
A.
				A supplemental illustration may be provided so long as:
(1) It is appended to, accompanied by, or
				preceded by a basic illustration that complies with this Rule.
(2) The non-guaranteed elements shown are not
				more favorable to the policy owner than the corresponding elements based on the
				scale used in the basic illustration;
(3) It contains the same statement required
				of a basic illustration that non-guaranteed elements are not guaranteed;
				and
(4) For a policy that has a
				contract premium, the contract premium underlying the supplemental illustration
				is equal to the contract premium shown in the basic illustration. For policies
				that do not require a contract premium, the premium outlay underlying the
				supplemental illustration shall be equal to the premium outlay shown in the
				basic illustration.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 910 - LIFE INSURANCE ILLUSTRATIONS › Section 031-910-10 - Annual Report; Notice to Policy Owners

Current through 2024-29, July 17, 2024
A.
				In the case of a policy designated as one for which illustrations will be used,
				the insurer shall provide each policy owner with an annual report on the status
				of the policy that shall contain at least the following information:
(1) For universal life policies, the report
				shall include the following:
(a) The
				beginning and end date of the current report period;
(b) The policy value at the end of the
				previous report period and at the end of the current report period;
(c) The total amounts that have been credited
				or debited to the policy value during the current report period, identifying
				each by type (e.g., interest, mortality, expense, and riders);
(d) The current death benefit at the end of
				the current report period on each life covered by the policy;
(e) The net cash surrender value of the
				policy as of the end of the current report period;
(f) The amount of outstanding loans, if any,
				as of the end of the current report period; and
(g) For fixed premium policies: If, assuming
				guaranteed interest, mortality and expense loads and continued scheduled
				premium payments, the policy's net cash surrender value is such that it would
				not maintain insurance in force until the end of the next reporting period, a
				notice to this effect shall be included in the report; or
(h) For flexible premium policies: If,
				assuming guaranteed interest, mortality and expense loads, the policy's net
				cash surrender value will not maintain insurance in force until the end of the
				next reporting period unless further premium payments are made, a notice to
				this effect shall be included in the report.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 910 - LIFE INSURANCE ILLUSTRATIONS › Section 031-910-11 - Annual Certifications

Current through 2024-29, July 17, 2024
A. The board of
				directors of each insurer shall appoint one or more illustration
				actuaries.
B. The illustration
				actuary shall certify that the disciplined current scale used in illustrations
				is in conformity with the Actuarial Standard of Practice for Compliance with
				the NAIC Model Regulation on Life Insurance Illustrations promulgated by the
				Actuarial Standards Board, and that the illustrated scales used in
				insurer-authorized illustrations meet the requirements of this Rule.
C. The illustration actuary shall:
(1) Be a member in good standing of the
				American Academy of Actuaries;
(2)
				Be familiar with the standard of practice regarding life insurance policy
				illustrations;
(3) Not have been
				found by the Superintendent, following appropriate notice and hearing to have:
(a) Violated any provision of, or any
				obligation imposed by, the insurance law or other law in the course of his or
				her dealings as an illustration actuary;
(b) Been found guilty of fraudulent or
				dishonest practices;
(c)
				Demonstrated his or her incompetence, lack of cooperation, or untrustworthiness
				to act as an illustration actuary; or
(d) Resigned or been removed as an
				illustration actuary within the past five (5) years as a result of acts or
				omissions indicated in any adverse report on examination or as a result of a
				failure to adhere to generally acceptable actuarial standards;
(4) Not fail to notify the
				Superintendent of any action taken by a commissioner of another state similar
				to that under Paragraph (3) above;
(5) Disclose in the annual certification
				whether, since the last certification, a currently payable scale applicable for
				business issued within the previous five (5) years and within the scope of the
				certification has been reduced for reasons other than changes in the experience
				factors underlying the disciplined current scale. If non-guaranteed elements
				illustrated for new policies are not consistent with those illustrated for
				similar in force policies, this must be disclosed in the annual certification.
				If non-guaranteed elements illustrated for both new and in force policies are
				not consistent with the non-guaranteed elements actually being paid, charged or
				credited to the same or similar forms, this must be disclosed in the annual
				certification; and
(6) Disclose in
				the annual certification the method used to allocate overhead expenses for all
				illustrations:
(a) Fully allocated
				expenses;
(b) Marginal expenses;
				or
(c) A generally recognized
				expense table based on fully allocated expenses representing a significant
				portion of insurance companies and approved by the National Association of
				Insurance Commissioners or by the Superintendent.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 910 - LIFE INSURANCE ILLUSTRATIONS › Section 031-910-12 - Penalties

Current through 2024-29, July 17, 2024
In addition to any other penalties provided by the laws of
				  this State, an insurer or producer that violates this Rule is subject to
				  disciplinary action pursuant to Title
				   24-A M.R.S.A.
				  §§12-A and
				  2165-A.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 910 - LIFE INSURANCE ILLUSTRATIONS › Section 031-910-13 - Separability

Current through 2024-29, July 17, 2024
If any provision of this Rule or its application to any
				  person or circumstance is for any reason held to be invalid by any court of
				  law, the remainder of the Rule and its application to other persons or
				  circumstances shall not be affected.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 910 - LIFE INSURANCE ILLUSTRATIONS › Section 031-910-14 - Effective Date

Current through 2024-29, July 17, 2024
This Rule shall become effective
September 16,
				  1999
and shall apply to policies sold three months or more after
				  the effective date.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 915 - ANNUITY DISCLOSURE › Section 031-915-1 - Purpose

Current through 2024-29, July 17, 2024
The purpose of this rule is to provide standards for the
				  disclosure of certain minimum information about annuity contracts to protect
				  consumers and foster consumer education. The rule specifies the minimum
				  information which must be disclosed, the method for disclosing it and the use
				  and content of illustrations, if used, in connection with the sale of annuity
				  contracts. The goal of this rule is to ensure that purchasers of annuity
				  contracts understand certain basic features of annuity
				  contracts.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 915 - ANNUITY DISCLOSURE › Section 031-915-2 - 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
				  2151-B.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 915 - ANNUITY DISCLOSURE › Section 031-915-3 - Applicability and Scope

Current through 2024-29, July 17, 2024
This rule applies to all group and individual annuity
				  contracts and certificates except:
A.
				Immediate and deferred annuities that contain no non-guaranteed
				elements;
B.
(1) Annuities used to fund:
(a) An employee pension plan which is covered
				by the Employee Retirement Income Security Act (ERISA);
(b) A plan described by Sections 401(a),
				401(k) or 403(b) of the Internal Revenue Code, where the plan, for purposes of
				ERISA, is established or maintained by an employer,
(c) A governmental or church plan defined in
				Section 414 of the Internal Revenue Code or a deferred compensation plan of a
				state or local government or a tax exempt organization under Section 457 of the
				Internal Revenue Code; or
(d) A
				nonqualified deferred compensation arrangement established or maintained by an
				employer or plan sponsor.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 915 - ANNUITY DISCLOSURE › Section 031-915-5 - Standards for the Disclosure Document and Buyer's Guide

Current through 2024-29, July 17, 2024
A.
(1)
				Where the application for an annuity contract is taken in a face-to-face
				meeting, the applicant shall at or before the time of application be given both
				the disclosure document described in Subsection B and the appropriate Buyer's
				Guide.
(2) Where the application
				for an annuity contract is taken by means other than in a face-to-face meeting,
				the applicant shall be sent both the disclosure document and the Buyer's Guide
				no later than five business days after the completed application is received by
				the insurer.
(a) With respect to an
				application received as a result of a direct solicitation through the mail:
(i) Providing a Buyer's Guide in a mailing
				inviting prospective applicants to apply for an annuity contract shall be
				deemed to satisfy the requirement that the Buyer's Guide be provided no later
				than five business days after receipt of the application.
(ii) Providing a disclosure document in a
				mailing inviting a prospective applicant to apply for an annuity contract shall
				be deemed to satisfy the requirement that the disclosure document be provided
				no later than five business days after receipt of the application.
(b) With respect to an application
				received via the Internet:
(i) Taking
				reasonable steps to make the Buyer's Guide available for viewing and printing
				on the insurer's website shall be deemed to satisfy the requirement that the
				Buyer's Guide be provided no later than five business days after receipt of the
				application.
(ii) Taking reasonable
				steps to make the disclosure document available for viewing and printing on the
				insurer's website shall be deemed to satisfy the requirement that the
				disclosure document be provided no later than five business days after receipt
				of the application.
(c)
				A solicitation for an annuity contract provided in other than a face-to-face
				meeting shall include a statement that the proposed applicant may contact the
				insurance department of the state for a free annuity Buyer's Guide. In lieu of
				the foregoing statement, an insurer may include a statement that the
				prospective applicant may contact the insurer for a free annuity Buyer's
				Guide.
(d) Where the Buyer's Guide
				and disclosure document are not provided at or before the time of application,
				a free look period of no less than 15 days shall be provided for the applicant
				to return the annuity contract without penalty. This free look shall run
				concurrently with any other free look provided under state law or rule.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 915 - ANNUITY DISCLOSURE › Section 031-915-6 - Standards for Annuity Illustrations

Current through 2024-29, July 17, 2024
A. An insurer
				or producer may elect to provide a consumer an illustration at any time,
				provided that the illustration is in compliance with this section and:
(1) Is clearly labeled as an
				illustration;
(2) Includes a
				statement referring consumers to the disclosure document and Buyer's Guide
				provided to them at time of purchase for additional information about their
				annuity; and
(3) Is prepared by the
				insurer, or is prepared for the insurer by a third party using software that is
				authorized by the insurer before its use, under a system of control maintained
				by the insurer over the use of illustrations.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 915 - ANNUITY DISCLOSURE › Section 031-915-7 - Report to Contract Owners

Current through 2024-29, July 17, 2024
For annuities in the payout period that include
				  non-guaranteed elements, and for deferred annuities in the accumulation period,
				  the insurer shall provide each contract owner with a report, at least annually,
				  on the status of the contract that contains at least the following
				  information:
A. The beginning and end
				date of the current report period;
B. The accumulation and cash surrender value,
				if any, at the end of the previous report period and at the end of the current
				report period;
C. The total
				amounts, if any, that have been credited, charged to the contract value or paid
				during the current report period; and
D. The amount of outstanding loans, if any,
				as of the end of the current report period.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 915 - ANNUITY DISCLOSURE › Section 031-915-8 - Penalties

Current through 2024-29, July 17, 2024
In addition to any other penalties provided by the laws of
				  this state, an insurer or producer that violates a requirement of this rule
				  shall be guilty of a violation of 24-A M.R.S.A. Chapter 23.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 915 - ANNUITY DISCLOSURE › Section 031-915-9 - Separability

Current through 2024-29, July 17, 2024
If any provision of this rule or its application to any
				  person or circumstance is for any reason held to be invalid by any court of
				  law, the remainder of the rule and its application to other persons or
				  circumstances shall not be affected.