Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 270 - MEDICARE SUPPLEMENT INSURANCE RULE - REVISED › Section 031-270-8 - Minimum benefit standards

Current through 2024-29, July 17, 2024
No insurance policy may be advertised, solicited, or issued
				  for delivery in this State as a Medicare supplement policy unless it meets the
				  following minimum standards. These are minimum standards and do not preclude
				  the inclusion of other provisions or benefits which are not inconsistent with
				  these standards.
If a nonprofit hospital or medical service plan is prohibited
				  from issuing subscriber contracts that meet the minimum benefit standards of
				  this Rule, the plan may issue a contract including such of those benefits as
				  are permitted, in conjunction with some other contract or policy supplying the
				  remaining benefits, and the combination shall be treated as a single policy for
				  purposes of this Rule.
(A) General
				Standards:
(1) A Medicare supplement policy
				may not indemnify against losses resulting from sickness on a different basis
				than losses resulting from accidents.
(2) A Medicare supplement policy shall
				provide that benefits designed to cover cost sharing amounts under Medicare
				will be changed automatically to coincide with any changes in the applicable
				Medicare deductible amount and copayment percentage factors. Premiums may be
				modified to correspond with such changes, provided that such modifications
				comply with all applicable rating requirements imposed under Maine
				law.
(3) A "noncancellable,"
				"guaranteed renewable," or "noncancellable and guaranteed renewable" Medicare
				supplement policy shall not:
(a) provide for
				termination of coverage of a spouse solely because of the occurrence of an
				event specified for termination of coverage of the insured, other than the
				nonpayment of premium, or
(b) be
				cancelled or nonrenewed by the insurer solely on the grounds of deterioration
				of health or on the basis of age.
(4) Termination of a Medicare supplement
				policy shall be without prejudice to coverage of any continuous loss that
				commenced while the policy was in force, but the extension of benefits beyond
				the period during which the policy was in force may be predicated upon the
				continuous total disability of the insured, limited to the duration of the
				policy benefit period, if any, or payment of the maximum benefits.
(5) Except as authorized by the
				Superintendent, an insurer shall neither cancel nor nonrenew a Medicare
				supplement policy or certificate for any reason other than nonpayment of
				premium or material misrepresentation.
(6) If a group Medicare supplement insurance
				policy is terminated by the group policyholder, or if a certificate holder
				under such a policy ceases to be a member of the group, the policyholder or the
				insurer shall offer continuation or replacement coverage as follows:
(a) If the group policy is replaced by
				another group Medicare supplement policy purchased by the same policyholder,
				the succeeding insurer shall offer coverage to all persons covered under the
				old group policy on its date of termination. Coverage under the new group
				policy shall not result in any exclusion for pre-existing conditions that would
				have been covered under the group policy being replaced.
(b) If a certificate holder's group
				membership terminates while the group policy remains in force, the insurer
				shall, if the policyholder so elects, offer continuation of coverage under the
				group policy.
(c) If the conditions
				of subparagraph (a) or (b) for replacement or continuation of group coverage
				are not satisfied, the insurer shall offer the certificate holder at least the
				following choices, without any exclusion for pre-existing conditions that would
				have been covered under the former group policy:
(i) an individual Medicare supplement policy
				that provides for the continuation of the benefits contained in the group
				policy; and
(ii) an individual
				Medicare supplement policy that provides only such benefits as are required to
				meet the minimum standards.