reglab/statecodes huggingface dataset:
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 450 - WORKERS' COMPENSATION INSURANCE - EXPERIENCE RATING › Section 031-450-5 - Revision of Loss Reports Used in the Experience Rating Calculation

Current through 2024-29, July 17, 2024
The experience rating plan filed by the designated advisory
				  organization shall provide for the submission of corrected incurred loss
				  reports for the purpose of recalculating the employer's experience modification
				  factor. If the correction results in a decrease, it shall apply retroactively
				  to the current policy from its date of inception and to all affected policies
				  in force at any time during the two-year period preceding the current policy's
				  effective date, or such longer period as may be specified in the plan. Valid
				  reasons for filing a corrected loss report must include, at a minimum:
A.
Erroneous information.
If the original loss report did not accurately report the insurer's paid loss
				and reserve, or if the employer can demonstrate that the information used by
				the insurer in paying a loss or estimating an incurred loss was incorrect and
				that the insurer knew or should have known at the time of the payment date or
				required valuation date that the information was incorrect.
B.
Third-party recovery.
If
				the insurer receives a payment in satisfaction or compromise of a claim against
				a third party arising out of the same occurrence as a claim against the
				employer, the amount of the recovery, net of reasonable equitably apportioned
				litigation costs, shall be deducted from the incurred loss to the extent that
				the anticipated recovery was not previously recognized in calculating the
				incurred loss. For revisions made under this Subsection, the minimum required
				period of retroactivity for corrections shall be extended from two years to
				four years preceding the current policy's effective date.
C.
Change in governing
				classification.
When an employer's operations are reclassified and the
				reclassification is not based on a change in operations, the employer's
				experience modification factor shall be recalculated, effective the same day as
				the reclassification becomes effective, on the basis of expected loss figures
				for the experience period that are consistent with the new
				classification.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 450 - WORKERS' COMPENSATION INSURANCE - EXPERIENCE RATING › Section 031-450-6 - Aggravation of Prior Work-Related Injuries

Current through 2024-29, July 17, 2024
A.
Definitions.
For purposes of this Section:
(1)
"Subsequent injury"
means an injury giving rise to a claim for which benefits have been paid
				pursuant to
				 39-A M.R.S.A.
				§212 or §
										213,
				with the exception of any injury that was subsequently determined by the
				Workers' Compensation Board not to be compensable.
(2)
"Prior lost-time work-related
				injury"
means an injury to a claimant for which benefits have been
				paid before the date of the subsequent injury pursuant to
				 39-A M.R.S.A.
				§212 or §
										213,
				with the exception of any injury that was subsequently determined by the
				Workers' Compensation Board not to be compensable.
(3)
"Aggravates or combines with a
				prior lost-time work-related injury to produce incapacity":
A
				subsequent injury, as defined in Paragraph 1 above, aggravates or combines with
				a prior lost-time work-related injury, as defined in Paragraph 2 above, to
				produce incapacity, when the insurer or self-insurer covering the prior injury
				has reimbursed the insurer or self-insurer covering the subsequent injury for
				compensation benefits paid pursuant to
				 39-A M.R.S.A.
				§212 or §
										213,
				unless the subsequent injury claim was subsequently determined by the Workers'
				Compensation Board not to be apportionable to the prior carrier. For purposes
				of this Paragraph, reimbursement includes internal fund transfers or accounting
				recognition if the same carrier is on the risk for both injuries.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 450 - WORKERS' COMPENSATION INSURANCE - EXPERIENCE RATING › Section 031-450-7 - Changes in Ownership

Current through 2024-29, July 17, 2024
Incurred experience shall be used in future experience
				  modification factors for a business throughout the experience rating period,
				  regardless of any change in ownership, control, management, or operations,
				  unless there has been both a substantial change in operations and a
bona fide
change in majority ownership of the business, in
				  which case experience incurred before the change shall be disregarded.
A.
Substantial change in
				operations.
For the purposes of this Section, "substantial change in
				operations" shall mean a change in operation of the employer sufficient to
				cause a change in the governing risk classification assignment and a change in
				the process and hazard of the operations. If an entity is subject to multiple
				classifications as a result of its operation of separate and distinct
				businesses, the determination whether there has been a substantial change of
				operations shall be made separately for each business if the experience is
				separable, and shall otherwise depend on whether discontinued operations
				represent a majority of the incurred losses during the rating period applicable
				at the time of the change.
B. Bona
				fide
change in majority ownership.
For the purposes of this
				Section, "
bona fide
change in majority ownership" shall mean
				that either the former owners of the business or its predecessor entity now
				collectively own or control less than 50% of the business, or the new owners of
				the business previously collectively owned or controlled less than one-third of
				the business or its predecessor entity. Ownership or control shall be
				considered whether exercised directly or through related parties, security
				interests, options to repurchase, or any arrangement designed to retain
de facto
control or otherwise avoid the application of this
				Rule.
C.
Acquisition of
				physical assets.
If an entity acquires most or all of the physical
				assets of a business by sale or lease from another entity and the seller then
(1) Becomes entirely inactive with no
				employees, or
(2) Retains a few
				employees for the purpose of closing out its affairs prior to dissolution as a
				legal entity, or
(3) Retains a few
				clerical employees for the purpose of carrying on operations in connection with
				investment of its financial assets,
the acquiring entity shall be considered the purchaser of the
				  business for purposes of this Section.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 450 - WORKERS' COMPENSATION INSURANCE - EXPERIENCE RATING › Section 031-450-8 - Right to Hearing

Current through 2024-29, July 17, 2024
Any employer that believes it has been aggrieved by the
				  application of the experience rating procedure may seek review by the
				  Superintendent pursuant to
				  
				  24-A M.R.S.A. §2320.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 450 - WORKERS' COMPENSATION INSURANCE - EXPERIENCE RATING › Section 031-450-9 - Interstate Rating

Current through 2024-29, July 17, 2024
Risks which have not had a change in ownership, management,
				  control, or operation or for which the application of this rule is consistent
				  with the designated advisory organization's rating of interstate risks, shall
				  continue to be rated on an interstate basis. Any risk not subject to interstate
				  experience rating as a result of the application of this rule shall be
				  experience rated on its Maine experience.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 450 - WORKERS' COMPENSATION INSURANCE - EXPERIENCE RATING › Section 031-450-10 - Transition

Current through 2024-29, July 17, 2024
A.
Effective date of
				amendments.
The 2007 amendments to this Rule shall be effective on
				March 26, 2007, and, except as provided in Subsections B and C, shall apply to
				all policies issued, renewed, or subject to revised experience modification
				factors on or after the effective date.
B.
Transition period.
Between the effective date of the 2007 amendments and January 1, 2008, a rate,
				rule, or form filing submitted by insurers and advisory organizations is not in
				violation of any applicable provision of this Rule if the filing instead
				complies with the comparable provision of the prior version of the Rule. A
				policy issued or renewed before January 1, 2008 or an experience modification
				factor promulgated before January 1, 2008 is in compliance with this Rule to
				the extent that it complies with a filing properly approved pursuant to this
				Subsection or pursuant to the prior version of this Rule.
C.
Subsequent injury claims.
Section
				6 shall apply to the reporting of all
				subsequent-injury claims whose first report under the unit statistical plan is
				due on or after January 1, 2009. The designated advisory organization shall
				include a brief description of the change in the experience modification
				calculation with all experience rating worksheets with effective dates between
				January 1 and December 31, 2009, explaining that claims for which reports are
				due on or after January 1, 2009 shall be excluded when they are attributable to
				lost time work-related injuries that aggravate or combine with prior lost-time
				work-related injuries to produce incapacity. Before July 1, 2008, the
				designated advisory organization shall file revised experience rating plan
				rules and reporting instructions with the Superintendent for the implementation
				of Section
				6. The Superintendent may postpone the
				effective date of Section
				6 upon a finding that the necessary
				framework for fair and effective implementation will not be in place in time,
				or that there is significant risk that insurers will not be equitably
				compensated.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 460 - WORKERS' COMPENSATION INSURANCE STATISTICAL RECORDING AND REPORTING › Section 031-460-1 - Purpose

Current through 2024-29, July 17, 2024
These rules are promulgated to provide insurers and
				  self-insurers with standards for the recording and reporting of claim
				  information as required by
				   24-A M.R.S.A.
				  §2371 and for the collection and
				  reporting of financial information by insurers as required by
				   24-A M.R.S.A
				  §2372.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 460 - WORKERS' COMPENSATION INSURANCE STATISTICAL RECORDING AND REPORTING › Section 031-460-2 - Other sources of data

Current through 2024-29, July 17, 2024
As provided in § 2371(4), the insurers' and
				  self-insurers' statistical advisory organizations may obtain data from the
				  Workers' Compensation Commission and integrate it with information obtained
				  from other sources in preparation for reporting to the Bureau.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 460 - WORKERS' COMPENSATION INSURANCE STATISTICAL RECORDING AND REPORTING › Section 031-460-3 - Reporting format

Current through 2024-29, July 17, 2024
The Superintendent may establish a reporting format and
				  medium, such as magnetic tape, compatible with the systems used by the
				  statistical advisory organizations and the Bureau's data storage and management
				  information system to provide for an efficient transfer of reports to the
				  Bureau.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 460 - WORKERS' COMPENSATION INSURANCE STATISTICAL RECORDING AND REPORTING › Section 031-460-4 - Preestablished information categories and codes

Current through 2024-29, July 17, 2024
For those sections requiring the reporting of descriptive
				  information, the statistical advisory organizations shall file with the
				  Superintendent preestablished categories and codes of the most common outcomes
				  or responses.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 460 - WORKERS' COMPENSATION INSURANCE STATISTICAL RECORDING AND REPORTING › Section 031-460-5 - Specific provisions

Current through 2024-29, July 17, 2024
A. Employee's prior
				workers' compensation claim history shall include all workers' compensation
				claim known or accessible to the insurer or self-insurer, including claims on
				injuries occurring prior to January 1, 1987.
B. Attorney involvement shall mean the
				earliest date the attorney's representation is known by the insurer or
				self-insurer.
C. Information
				reported pursuant to § 2371(2)(B)(3) shall be limited to the date of
				maximum medical improvement.
D. If
				there is more than one hearing date for a single claim, the dates of each
				hearing shall be recorded, but the claim information may be based on the
				hearing which results in a decision.
E. Identification of offsets pursuant to
				§ 2371(5) shall also include the following:
(1) Whether the insurer was eligible for
				recoveries from the Second Injury Fund;
(2) The dollar amount recovered from the
				Second Injury Fund; and
(3) Whether
				recovery was restricted by an inadequate balance in the Second Injury
				Fund.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 460 - WORKERS' COMPENSATION INSURANCE STATISTICAL RECORDING AND REPORTING › Section 031-460-6 - Forms

Current through 2024-29, July 17, 2024
The statistical advisory organization shall develop and file
				  with the Superintendent a set of forms or a description of the method to be
				  used to collect the data required by § 2371. Such filing shall be made not
				  later than July 1, 1988.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 460 - WORKERS' COMPENSATION INSURANCE STATISTICAL RECORDING AND REPORTING › Section 031-460-7 - Frequency of reports

Current through 2024-29, July 17, 2024
Reports of experience required by § 2371 shall be
				  submitted to the Superintendent of Insurance on a monthly basis unless
				  otherwise specified by the Superintendent. The monthly submissions shall
				  include the specified information on the following cases:
A. New claims not previously
				reported;
B. Claims that have been
				controverted, modified, discontinued, suspended, commuted, settled, or
				otherwise closed and for which such status change has not previously been
				reported; and
C. Open claims not
				otherwise reported on in the prior six months.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 460 - WORKERS' COMPENSATION INSURANCE STATISTICAL RECORDING AND REPORTING › Section 031-460-8 - Periodic profitability reports

Current through 2024-29, July 17, 2024
The reports required pursuant to section 2372(1) shall be
				  submitted quarterly on a policy year basis, unless otherwise permitted by the
				  Superintendent, for all policy years 1987 and subsequent.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 460 - WORKERS' COMPENSATION INSURANCE STATISTICAL RECORDING AND REPORTING › Section 031-460-9 - Residual market report

Current through 2024-29, July 17, 2024
The reports required pursuant to section 2372(4) shall be
				  submitted on a policy year basis for all policy years 1987 and subsequent.
				  Quarterly reports shall be filed on incomplete policy years as well as those
				  completed.
History. -- Effective. 3-21-88.
History. -- Statutory Authority.--
				   24-A M.R.S.A.
				  §§212,
				  2323,
				  2371,
				  and
				  2372.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 470 - WORKERS' COMPENSATION INSURANCE PREMIUM AUDIT AND ADJUSTMENT › Section 031-470-1 - Purpose

Current through 2024-29, July 17, 2024
The purpose of this chapter is to require insurers to
				  complete final premium audits within 120 days of the termination of a workers'
				  compensation insurance policy so that the insured receives reasonably prompt
				  notice of his obligations under the policy.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 470 - WORKERS' COMPENSATION INSURANCE PREMIUM AUDIT AND ADJUSTMENT › Section 031-470-2 - Final premium

Current through 2024-29, July 17, 2024
For the purposes of this chapter "final premium" shall mean
				  the premium determined using payroll or other appropriate premium basis and the
				  rates, rules, and classifications approved for use during the policy
				  period.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 470 - WORKERS' COMPENSATION INSURANCE PREMIUM AUDIT AND ADJUSTMENT › Section 031-470-3 - Premium determination

Current through 2024-29, July 17, 2024
An insurer may determine the final premium after the policy
				  expiration date using the actual premium basis, proper classifications, and
				  approved rates and rating rules that apply during the period of
				  coverage.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 470 - WORKERS' COMPENSATION INSURANCE PREMIUM AUDIT AND ADJUSTMENT › Section 031-470-4 - Time limit

Current through 2024-29, July 17, 2024
Except for policies issued subject to retrospective rating,
				  the final premium shall be established not later than 120 days after the policy
				  ends.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 470 - WORKERS' COMPENSATION INSURANCE PREMIUM AUDIT AND ADJUSTMENT › Section 031-470-5 - Limit on subsequent premium adjustments

Current through 2024-29, July 17, 2024
If the insurer has not established the final premium 120 days
				  after the policy period ends, or any extension pursuant to Section
				  7 below, the insurer is prohibited
				  from billing or collecting any additional premium exceeding the latest billed
				  premium immediately prior to the 120-day time limit. However, if the insurer
				  has failed to perform a final premium audit within the 120-day time limit, the
				  insured, upon written request to the insurer, is entitled to a final premium
				  audit for the purpose of determining if the insured has been
				  overcharged.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 470 - WORKERS' COMPENSATION INSURANCE PREMIUM AUDIT AND ADJUSTMENT › Section 031-470-6 - Retrospectively rated policies

Current through 2024-29, July 17, 2024
For policies subject to retrospective rating, the final
				  premium shall be established upon agreement between the carrier and the insured
				  or in accordance with conditions established within the policy, and adjustment
				  of the final retrospective premium shall be permitted only if there is a
				  clerical error.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 470 - WORKERS' COMPENSATION INSURANCE PREMIUM AUDIT AND ADJUSTMENT › Section 031-470-7 - Additional time

Current through 2024-29, July 17, 2024
If the carrier is unable to examine and audit the records of
				  the insured that relate to the calculation of the final premium and the
				  inability is solely due to the failure of the insured to cooperate in the
				  audit, then the 120-day limitation in Section
				  4 above shall begin when the carrier
				  is able to complete the examination and audit of the insured's records. The
				  insurer must notify the insured in writing prior to 120 days from the end of
				  the policy period of the reasons for the inability to establish the final
				  premium.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 470 - WORKERS' COMPENSATION INSURANCE PREMIUM AUDIT AND ADJUSTMENT › Section 031-470-8 - Applicability

Current through 2024-29, July 17, 2024
This chapter shall apply to all policies in both the
				  voluntary market and the residual market. This chapter applies to:
(1) all policies issued or renewed on or
				after May 1, 1988; and (2) all policies in effect on the effective date of this
				chapter, in which cases the 120-day limitation in sections
				4 and
				5 shall run from May 1, 1988.
History. -- Effective. 3-21-88.
History. -- Statutory Authority.--
				   24-A M.R.S.A.
				  §§212,
				  2363.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 490 - ACQUIRED IMMUNE DEFICIENCY SYNDROME AND MEDICAL AND LIFESTYLE STANDARDS RULE › Section 031-490-1 - Authority

Current through 2024-29, July 17, 2024
This rule is promulgated by the Superintendent pursuant to
				   5 M.R.S.A.
				  §19203-A, 24M. R.S.A. § 2316, 24-A
				  M.R.S.A. § 212, M.R.S.A. § 2151-B24-A M.R.S.A. § 2152, 24-A
				  M.R.S.A. § 2159, and
				  24-A M.R.S.A. §
										2412.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 490 - ACQUIRED IMMUNE DEFICIENCY SYNDROME AND MEDICAL AND LIFESTYLE STANDARDS RULE › Section 031-490-2 - Purpose

Current through 2024-29, July 17, 2024
The purpose of this rule is to clarify the standards
				  applicable to written informed consent forms required to be completed by
				  persons required to take a test for the presence of the antibody to the Human
				  Immunodeficiency Virus (HIV) or for the Human Immunodeficiency Antigen by an
				  insurer, nonprofit hospital service organization, nonprofit medical service
				  organization, or a nonprofit health care plan, to establish standards for
				  post-test counseling required to be provided to persons subject to testing as
				  required by
				   5 M.R.S.A.
				  §19203-A, and to establish standards for
				  medical and lifestyle application questions and underwriting.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 490 - ACQUIRED IMMUNE DEFICIENCY SYNDROME AND MEDICAL AND LIFESTYLE STANDARDS RULE › Section 031-490-3 - Definitions

Current through 2024-29, July 17, 2024
A. "Informed Consent" means consent to
				testing for the presence of antibodies to the Human Immunodeficiency Virus or
				for the presence of the Human Immunodeficiency Antigen. The Informed Consent
				shall be based on an actual understanding by the person to be tested:
1. That the test is being
				performed;
2. Of the nature of the
				test;
3. Of the persons to whom the
				results of that test may be disclosed;
4. Of the purpose for which the test results
				may be used; and
5. Of any
				reasonably foreseeable risks and benefits resulting from the test.
The informed consent shall be wholly voluntarily and free
				  from express or implied coercion.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 490 - ACQUIRED IMMUNE DEFICIENCY SYNDROME AND MEDICAL AND LIFESTYLE STANDARDS RULE › Section 031-490-3-A - Approval Required

Current through 2024-29, July 17, 2024
No insurer, nonprofit hospital or medical service
				  organization or nonprofit health care plan shall test applicants for HIV unless
				  the test has been approved by the United States Food and Drug Administration
				  for such use.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 490 - ACQUIRED IMMUNE DEFICIENCY SYNDROME AND MEDICAL AND LIFESTYLE STANDARDS RULE › Section 031-490-4 - Medical and lifestyle application questions and underwriting standards

Current through 2024-29, July 17, 2024
A. No question shall be used on an
				application for insurance which is designed to establish the sexual orientation
				of the applicant. Specifically prohibited practices include, but are not
				limited to, utilization of the marital status, "living arrangements,"
				occupation, gender, medical history, beneficiary designation, or zip code or
				other territorial classification of an applicant to establish or aid in
				establishing the applicant's sexual orientation.
B. No question shall be used which requests
				an applicant to reveal whether the person has obtained an HIV test or the
				results of an HIV test taken prior to the application for insurance
				coverage.
C. Questions relating to
				medical and other factual matters intending to reveal the possible existence of
				a medical condition are permissible if they are not used in order to establish
				the sexual orientation of the applicant.
D. Questions relating to the applicant's
				having or having been diagnosed as having or having been advised to seek
				treatment for a sexually transmitted disease are permissible.
E. For purposes of rating an applicant for
				health and life insurance, an insurer may impose territorial rates, but only if
				the rates are based on sound actuarial principles and are related to actual or
				reasonably anticipated experience.
F. No decisions concerning rates, rating
				classification, limitations to coverage, or insurability of any person shall be
				made because an applicant has demonstrated AIDS-related concerns by seeking
				counseling from health care professionals.
G. No decisions concerning rates, rating
				classification, limitations to coverage, or insurability of any person shall be
				made on the basis of information concerning an applicant's sexual
				orientation.
H. No insurer or
				nonprofit entity may make any decision concerning rates, rating classification,
				limitations to coverage, or insurability of any person on the basis of T-cell
				tests. Insurers and nonprofit entities may utilize T-cell tests in order to
				determine whether further diagnostic tests are necessary.
I. Any failure to comply with the terms of
				this section shall be deemed an unfair trade practice within the meaning of
				Chapter 23 of the Insurance Code (Title 24-A). The remedies provided in Chapter
				23 shall not be exclusive but shall be in addition to any other remedies
				available by law.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 490 - ACQUIRED IMMUNE DEFICIENCY SYNDROME AND MEDICAL AND LIFESTYLE STANDARDS RULE › Section 031-490-5 - Informed consent to AIDS testing

Current through 2024-29, July 17, 2024
A. Title
				 5 M.R.S.A.
				§19203-A requires that an HIV test be
				voluntary and undertaken only with a patient's knowledge and understanding that
				an HIV test is planned. A written informed consent of the person to be tested
				must be obtained prior to testing. Informed Consent forms as required by
				 5 M.R.S.A.
				§19203-A shall be filed with the
				Superintendent of Insurance consistent with
				 24-A M.R.S.A.
				§2412 and subject to 24-A § 601
				filing fee requirements.
B. The
				Informed Consent forms may be in the standardized format provided by Attachment
				A. The form may be filed in a different format if the basis for each divergence
				from the standardized form is explained by the insurer or nonprofit entity and
				the Superintendent finds that the proposed form includes all the information
				contained in the standard form and is not inaccurate, misleading, or
				inconsistent with any applicable law or rule.
C. When an Informed Consent form is filed by
				the insurer or nonprofit entity with the Superintendent for approval, the
				following disclosures shall be included in that filing:
1. HIV testing protocol employed;
2. Manner of reporting HIV test results to
				the Medical Information Bureau (MIB);
3. Nature of written AIDS informational
				materials provided to the applicant, including copies of material if not widely
				available; and
4. Manner of
				providing post-test counseling.
At least 30 days prior to implementing any change in the
				  procedures or material disclosed in Paragraphs 1 through 4, the insurer or
				  nonprofit entity shall file any proposed changes with the
				  Superintendent.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 490 - ACQUIRED IMMUNE DEFICIENCY SYNDROME AND MEDICAL AND LIFESTYLE STANDARDS RULE › Section 031-490-6 - Test Results and Counseling

Current through 2024-29, July 17, 2024
A. Prior to or at
				the time an applicant is requested to obtain an HIV Test, the insurer or
				nonprofit entity shall notify the applicant of the availability of Post-test
				Counseling if test results are positive
B.
Post-test counseling.
"Post-test counseling" must include:
1. Personal counseling that includes, at a
				minimum, a discussion of:
(a) The test
				results and the reliability and significance of the test results. The person
				providing post-test counseling shall communicate the result confidentially and
				through personal contact;
(b)
				Information on good preventive practices and risk reduction plans;
				and
(c) Referrals for medical care
				and information and referrals for support services, including social, emotional
				support and legal services, as needed;
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 490 - ACQUIRED IMMUNE DEFICIENCY SYNDROME AND MEDICAL AND LIFESTYLE STANDARDS RULE › Section 031-490-7 - Medical Information Bureau

Current through 2024-29, July 17, 2024
If Positive HIV test results are reported to the Medical
				  Information Bureau they shall be reported in a nonspecific manner, as generic
				  blood disorders.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 490 - ACQUIRED IMMUNE DEFICIENCY SYNDROME AND MEDICAL AND LIFESTYLE STANDARDS RULE › Section 031-490-8 - Approval of forms Required

Current through 2024-29, July 17, 2024
No insurer, nonprofit hospital or medical service
				  organization or nonprofit health care plan shall require applicants for
				  insurance to take an HIV test prior to obtaining the Superintendent's approval
				  of the consent form and information required to be filed pursuant to Section
				  5 of this Rule.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 490 - ACQUIRED IMMUNE DEFICIENCY SYNDROME AND MEDICAL AND LIFESTYLE STANDARDS RULE › Section 031-490-9 - Severability

Current through 2024-29, July 17, 2024
If any section, term, or provision of this Rule shall be
				  adjudged invalid for any reason, such judgment shall not impair or invalidate
				  any other section, term, or provision of this Rule, and the remaining sections,
				  terms, and provisions shall remain in full force and effect.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 490 - ACQUIRED IMMUNE DEFICIENCY SYNDROME AND MEDICAL AND LIFESTYLE STANDARDS RULE › Section 031-490-10 - Effective date

Current through 2024-29, July 17, 2024
The effective date of this Rule shall be May 1, 1989. The
				  effective date of the 1998 revisions shall be June 1, 1998. The effective date
				  of the 2008 revisions shall be February 13, 2008 (filing 2008-73).
(DRAFTING NOTE: Insurers and nonprofit entities are
				  reminded that obligations to obtain the informed consent and to provide
				  post-test counseling of persons who test positive for HIV in connection with
				  applications for insurance exist irrespective of whether this Rule is in
				  effect.)
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 490 - ACQUIRED IMMUNE DEFICIENCY SYNDROME AND MEDICAL AND LIFESTYLE STANDARDS RULE › Attachment 031-490-B - Points to Cover for a Positive HIV Result

Current through 2024-29, July 17, 2024
Emotional impact of test
____ Emotional/coping assessment
____ Support system assessment
____ Suicide assessment
____ Follow-up appointment if necessary
Meaning of test
____ Anonymity/Confidentiality and restrictions on release of
				  test results
____ Nature and reliability
____ Difference between HIV and AIDS; HIV disease
				  progression
Medical follow-up
____ Prompt medical evaluation
____ Importance of early treatment
____ Immune system protection
____ Co-factors
____ STD / HEP / TB screening
____ Pregnancy options
Risk reduction
____ Importance of risk reduction for health maintenance and
				  protection of partners
____ Risk/harm reduction plan formulated
Partner Counseling and Referral Services
____ Importance of informing sex/needle-sharing
				  partner(s)
____ Assistance offered (coaching, role-play, or actually
				  talking with partners)
____ Offer and explain Maine CDC Anonymous Partner
				  Notification
____ Request assistance from Maine CDC
____ Client will: ____ use Maine CDC PCRS
____ History of blood/ semen/body fluid/organ donation
				  discussed
COUNSELOR SIGNATURE / DATE:
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 530 - PROVISIONAL MEDICAL OR DISABILITY PAYMENTS TO WORKERS' COMPENSATION CLAIMANTS › Section 031-530-1 - Purpose

Current through 2024-29, July 17, 2024
This Rule establishes procedural requirements governing the
				  payment of medical and disability benefits by health, disability, and workers'
				  compensation insurance companies so that injured workers whose workers'
				  compensation claims have been controverted and who are awaiting Workers'
				  Compensation Board determinations shall not incur any unnecessary financial
				  burden.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 530 - PROVISIONAL MEDICAL OR DISABILITY PAYMENTS TO WORKERS' COMPENSATION CLAIMANTS › Section 031-530-2 - Authority

Current through 2024-29, July 17, 2024
This Rule is adopted by the Superintendent of Insurance,
				  after consultation with the chair of the Workers' Compensation Board, pursuant
				  to 39-AM.R.S.A. § 222(3) and 24-A M.R.S.A. § 24-AM.R.S.A. § 212.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 530 - PROVISIONAL MEDICAL OR DISABILITY PAYMENTS TO WORKERS' COMPENSATION CLAIMANTS › Section 031-530-3 - Definitions

Current through 2024-29, July 17, 2024
A.
"Insured health plan"
means any plan for the payment of medical or disability benefits for which
				payment or provision of services is secured under a medical or disability
				insurance policy, health maintenance organization contract, or similar product
				regulated by the Superintendent of Insurance.
B.
"Health carrier"
means
				the insurance company, nonprofit health service corporation, or other entity
				responsible for payment of benefits or provision of services under an insured
				health plan.
C.
"Workers'
				compensation carrier"
includes a self-insured
				employer.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 530 - PROVISIONAL MEDICAL OR DISABILITY PAYMENTS TO WORKERS' COMPENSATION CLAIMANTS › Section 031-530-4 - Provisional payments required

Current through 2024-29, July 17, 2024
A. If a workers'
				compensation claimant is awaiting a Board determination on a claim in which the
				employer or workers' compensation carrier has filed a notice of controversy
				contesting the work-relatedness of the claimant's condition, and the claimant
				is covered under an insured health plan, then the health carrier must determine
				eligibility and provide benefits to the claimant, according to the terms of the
				health plan but without regard to any policy exclusion for work-related injury
				or disease.
B. The health carrier
				may require the claimant to pursue the claim through the mediation level
				established pursuant to
				 39-A M.R.S.A.
				§153(6) in order to
				preserve his or her entitlement to provisional payments. If the mediation
				results in an agreement that the condition is not work-related, or if there is
				no agreement and the claimant elects not to prosecute the workers' compensation
				claim further, the health carrier must either abide by that decision or file a
				petition with the Board pursuant to
				 39-AM.R.S.A.
				§305. The health carrier's liability for
				provisional benefit payments ceases if the Board determines that the claimant's
				condition is work-related, if the employer acknowledges for purposes of the
				Workers' Compensation Law that the claimant's condition is work-related, or if
				the employer or workers' compensation carrier makes or agrees to make any
				payment, to or for the benefit of the claimant, in settlement of the workers'
				compensation claim.
C. Unless a
				shorter period is provided for by law or by the terms of the health plan, any
				payments required by this Section shall be paid to or on behalf of the claimant
				within the following time limits. For periodic disability benefits, payment
				shall be made in full by the end of each 30-day period during which the
				claimant is entitled to benefits, subject to proof of loss. Other payments
				shall be made within 60 days after the health carrier receives proof of loss.
				Provided, however, that no payment is due until 10 days after the health
				carrier has received both:
(1) a request for
				provisional payment acknowledging the existence of a disputed workers'
				compensation claim; and
(2) proof
				that a notice of controversy has been filed.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 530 - PROVISIONAL MEDICAL OR DISABILITY PAYMENTS TO WORKERS' COMPENSATION CLAIMANTS › Section 031-530-5 - Offset

Current through 2024-29, July 17, 2024
A. The health carrier may exercise the right
				of offset at any time after receiving a request for payment pursuant to Section
				4, by notifying the workers'
				compensation carrier in writing of the amount of provisional payment that has
				been or will be made and requesting reimbursement. A notice of offset is
				effective immediately upon receipt and remains in effect until expressly
				rescinded in writing.
B. If the
				health carrier is no longer liable for provisional payments, pursuant to
				Section
				4, and a notice of offset is in
				effect, the workers' compensation carrier is obligated to reimburse the health
				carrier in such amounts and at such times as it would otherwise be obligated to
				pay the claimant, until the amount requested, reduced by any amount the health
				carrier has not yet paid or has already sought to recover directly from the
				claimant, has been paid in full.
C.
				If the workers' compensation carrier makes any payment directly to the claimant
				or health care provider within the meaning of
				39-A
				M.R.S.A. §206, rather than to the health
				carrier, while a notice of offset is in effect, the full amount of that payment
				shall be considered an obligation to the claimant for purposes of Subsection
				5(B), and the
				appropriate reimbursement to the health carrier shall be due immediately from
				the workers' compensation carrier. Any resulting overpayment may be recovered
				from the claimant by the workers' compensation carrier once the health carrier
				has been paid.
D. If the health
				carrier accepts a claim and pays provisional benefits, the workers'
				compensation carrier must treat the services as medically necessary and as
				rendered by an appropriate provider in compliance with all applicable
				procedural requirements. However, this Subsection does not exempt claimants or
				providers from compliance with notice requirements set forth in Subsection
				206(9) and Section 208 of the Workers' Compensation Act, Title 39-A M.R.S.A.,
				or in rules adopted by the Workers' Compensation Board, to the extent that such
				requirements by their terms are generally applicable to controverted
				claims.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 530 - PROVISIONAL MEDICAL OR DISABILITY PAYMENTS TO WORKERS' COMPENSATION CLAIMANTS › Section 031-530-6 - Optional Participation by Uninsured Health Plans

Current through 2024-29, July 17, 2024
If a self-funded employee benefit plan or a governmental
				  benefit program, including but not limited to MaineCare, makes provisional
				  payments in a manner consistent with this Rule and agrees to submit to the
				  jurisdiction of the Superintendent for the limited purpose of resolving
				  disputes and enforcing the plan's provisional payment obligation, the plan may
				  file a notice of offset with the workers' compensation carrier pursuant to this
				  Section. The workers' compensation carrier shall honor such notices of offset
				  as if they had been filed by health carriers.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 530 - PROVISIONAL MEDICAL OR DISABILITY PAYMENTS TO WORKERS' COMPENSATION CLAIMANTS › Section 031-530-7 - Penalty

Current through 2024-29, July 17, 2024
Violation of this Rule is subject to the penalties provided
				  in
				  24-AM.R.S.A.
				  §12-A.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 530 - PROVISIONAL MEDICAL OR DISABILITY PAYMENTS TO WORKERS' COMPENSATION CLAIMANTS › Section 031-530-8 - Severability

Current through 2024-29, July 17, 2024
If any section, term, provision, or application of this Rule
				  shall be 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 530 - PROVISIONAL MEDICAL OR DISABILITY PAYMENTS TO WORKERS' COMPENSATION CLAIMANTS › Section 031-530-9 - Effective date

Current through 2024-29, July 17, 2024
The effective date of this Rule is June 27, 1990. This Rule
				  shall apply to all claims that have not been finally resolved by that date. The
				  2002 Amendments are effective June 29, 2002, and shall apply to all claims
				  filed on or after that date. The 2005 Amendments are effective July 31, 2005.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 540 - PREMIUM TRUST ACCOUNT FIDUCIARY DUTIES › Section 031-540-1 - DEFINITIONS

Current through 2024-29, July 17, 2024
a. "Premium" is as defined in
				24-A M.R.S.
				§2403.
b. "Return premium" is premium owed to the
				policyholder because of policy cancellation, rate adjustment, or coverage or
				benefit reduction.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 540 - PREMIUM TRUST ACCOUNT FIDUCIARY DUTIES › Section 031-540-2 - AUTHORITY AND PURPOSE

Current through 2024-29, July 17, 2024
The purpose of this Rule is to prescribe, pursuant to
				  24-A M.R.S.
				  §§212 and
				  1449,
				  minimum standards and requirements regarding the fiduciary obligations of
				  insurance producers.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 540 - PREMIUM TRUST ACCOUNT FIDUCIARY DUTIES › Section 031-540-3 - FIDUCIARY OBLIGATIONS

Current through 2024-29, July 17, 2024
An insurance producer who is licensed or required to be
				  licensed in this State, and who receives or holds premiums or return premiums
				  for risks in this State, must comply with
				  24-A M.R.S.
				  §1449 and this Rule.
A. An insurance producer shall receive and
				hold all premiums and return premiums as trust funds in a fiduciary capacity
				and not as his or her personal assets.
B. In order to meet the fiduciary obligations
				of this Rule, an insurance producer shall set up one or more separate premium
				trust accounts in a national or state bank, savings institution, or credit
				union and maintain therein all premiums and return premiums received by the
				insurance producer until actually remitted to the insurer or other person
				entitled thereto.
C. Under no
				circumstances shall an insurance producer place fiduciary funds in a personal
				or business operating account.
D.
				The premium trust account must not be encumbered in any manner, including but
				not limited to pledging any funds in the account as collateral for a loan or
				other obligation.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 540 - PREMIUM TRUST ACCOUNT FIDUCIARY DUTIES › Section 031-540-4 - REQUIREMENTS FOR PREMIUM TRUST ACCOUNTS

Current through 2024-29, July 17, 2024
A. A
				premium trust account shall be in the name of the insurance producer or the
				producer's agency and include the words "premium trust account." Checks drawn
				on the trust account shall contain the insurance producer's or insurance
				agency's name and the words "premium trust account." If a producer or agency
				business name is used, it must be a name under which the producer or agency is
				licensed. Notwithstanding this subsection, insurance producers and agencies may
				continue to use supplies of noncomplying checks existing on the effective date
				of this Rule.
B. A non-licensee
				may not be a signatory on a licensee's trust account, unless the non-licensee
				is an employee of the licensee and has specific written responsibility for the
				licensee's trust account.
C. An
				insurance producer shall not deposit any funds other than premiums,
				commissions, and return premiums to a premium trust account, except as follows:
(1) Funds contributed by or on behalf of the
				producer to the extent reasonably sufficient to pay bank charges;
(2) Funds an insurance producer may deem
				necessary for advancing premiums or establishing reserves for the paying of
				return premiums;
(3) Fees paid by
				or on behalf of the policyholder as permitted under
				24-A M.R.S.
				§1450(3);
(4) Nonadmitted premium taxes payable by the
				producer and premium tax refunds received by the producer; and
(5) Funds for contingencies that may arise in
				the course of receiving and transmitting premiums, return premiums, or other
				fiduciary funds.
Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 540 - PREMIUM TRUST ACCOUNT FIDUCIARY DUTIES › Section 031-540-5 - RECORDKEEPING REQUIREMENTS

Current through 2024-29, July 17, 2024
A. Adequate records
				shall be maintained to establish ownership of all funds in the trust account,
				from whom they were received, and for whom they are held.
B. All accounting records relating to the
				business of insurance shall be maintained in a manner that facilitates an
				audit.
C. An insurance producer
				shall maintain, and make available to the Superintendent upon request, all
				records of each transaction concerning each premium trust account that the
				producer keeps under this Rule, as well as any related records, for six years
				from the date of the transaction.