All Rate and Form Filings submitted to the Bureau of Insurance for
review must be accompanied by the completed appropriate transmittal
Document as well as the completed appropriate rate/form review checklist.
The checklist must be completed by the company submitting the filing
and must reference, for each item on the checklist, the location of
each specific item in the filing. The transmittal Document takes the
place of the cover letter requirement. Blank transmittal documents are
attached here for your use.
| REVIEW REQUIREMENTS
|
REFERENCE
|
DESCRIPTION OF
REVIEW
STANDARDS REQUIREMENTS |
LOCATION OF
STANDARD IN FILING |
| Medicare Supplement
policies must comply with all provisions in the most current NAIC
model law with revisions for the following Maine specific deviations:
|
| Guaranteed Issue |
Rule
Chapter 275,§12 |
Maine permits eligible persons to enroll under a policy
up to 90 days from the termination date under Section 12(A)(1). |
|
| Eligibility (additional language) |
Rule
Chapter 275,§12(A)(2) |
Additional language to Section 12(A)(2), an eligible
person includes an individual enrolled under an employee welfare benefit
plan that is primary to Medicare and the plan terminates, or the plan
ceases to provide health benefits to the individual because the individual
leaves the plan. |
|
| Eligibility (additional eligibility provisions)
|
Rule
Chapter 275,§12(B)(7),(8) and 12(C)(2) |
Eligible persons also include, pursuant to Bureau Rule
Chapter 275 Sections 12(B)(7),(8) and 12(C)(2):
The individual is eligible for Medicare Part B and is enrolled in
an individual health plan as defined by Title 24-A M.R.S.A. § 2736-C
and the enrollment in the individual health plan ceases because:
a. The issuer has withdrawn from the individual health insurance market
in Maine; or
b. The issuer is insolvent or is otherwise unable to continue providing
coverage; or 8. The individual is eligible for Medicare Part
B and is enrolled in Title XIX of the Social Security Act (Medicaid),
other than coverage consisting solely of immunization benefits under
Section 1928, and enrollment in Medicaid ceases because the individual
is no longer eligible.
Eligible persons would also include persons described in Section
12(B)(5) (regarding Medicare+Choice products) are entitled to the
same Medicare supplement policy in which the individual was most
recently previously enrolled, if available from the same insurer.
a. If the policy is not available, the insurer shall reinstitute
the prior policy subject to the conditions listed in Section 8(A)(7).
b. If the issuer of the prior policy has become insolvent or has
otherwise ceased doing business, and the prior policy was a standardized
plan defined in Section 9, then the eligible person shall be entitled
to the same plan from any issuer currently offering the plan.
c. If the issuer of the policy has become insolvent or has otherwise
ceased doing business, and the prior policy was not a standardized
plan defined in Section 9, then the eligible person shall be entitled
to a Medicare supplement policy which has a benefit package classified
as Plan A, B, C, D, E, F, or G offered by any issuer. If the prior
coverage included prescription drug benefits, Plans H, I, and J
are included. |
|
| Eligibility (open enrollment) |
Rule
Chapter 275, §11(A) |
Open Enrollment, Section 11(A) Each Medicare beneficiary
shall be entitled to a 6-month open enrollment period beginning on
the date he or she first enrolls for benefits under Medicare Part
B, and each individual enrolled for benefits under Medicare Part B
before turning 65 shall be entitled to an additional 6-month open
enrollment period beginning on his or her 65th birthday.
|
|
| Payment of claims |
Rule
275, §13 |
An issuer shall comply with Section 1882(c)(3) of the
Social Security Act (as enacted by Section 4081(b)(2)(C) of the Omnibus
Budget Reconciliation Act of 1987 (OBRA) 1987, Pub. L. No. 100-203).
|
|
| Guaranteed Renewal |
Rule
Chapter 275 Sec. 8 (A)(5) |
|
|
| Pre-existing Conditions |
§5002-A
and Rule
Chapter 275 Sec. 8 (A)(1) |
No more than 6 months. |
|
| Benefit Levels |
24-A
M.R.S.A. §5002-A and Rule
Chapter 275 Sec. 8 (B) and Sec. 9 |
Standardized Plans |
|
| Permitted Commissions |
Rule
Chapter 275 Sec. 16 |
First year commission is no more than two-hundred percent
(200%) of the commission paid for selling or servicing the policy
in the second year. The commission provided in subsequent (renewal)
years must be the same as that provided in the second year or period
and must be provided for no fewer than five (5) renewal years. |
|
| Required Disclosure |
Rule
275 Sec. 17 |
Shall have a notice prominently printed on the first
page of the policy stating that the policyholder has the right to
return the policy within thirty (30) days of its delivery and to have
the premium refunded if, after examination of the policy. Issuers
shall provide an outline of coverage. |
|
| Conversion (group policies only) |
Rule
Chapter 275, §8(A)(5)(c) and (d) |
Maine requires a conversion privilege on termination
of policy or eligibility. |
|
| Filing of advertisements |
24-A
M.R.S.A. §5006-A, §5010-A,
and Rule
Chapter 275, §19 |
Any advertisement to be used in connection with Medicare
Supplement products must be filed and approved with the Bureau prior
to use.. All advertising materials shall specifically disclose the
availability of Medicare supplemental products to those persons eligible
for Medicare because of disability. |
|
| Continuity of Coverage |
24-A
M.R.S.A. §5002-B |
Must contain the provisions of Persons Provided Continuity
of Coverage, Prohibitions Against Continuity, Low-Cost Drugs For The
Elderly or Disabled Program, and Determination of Benefits. |
|
| Extension of coverage for dependent children
with mental or physical illness |
24-A
M.R.S.A. §2833-A |
Requires health insurance policies to continue coverage for dependent
children up to 24 years of age who are unable to maintain enrollment
in college due to mental or physical illness if they would otherwise
terminate coverage due to a requirement that dependent children of
a specified age be enrolled in college to maintain eligibility. |
|
