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Maine.gov > PFR Home > Insurance Regulation > Company Services > Review Checklists > Individual Life - L02I, L03I, L04I, L05I, L07I, L08

Maine Bureau of Insurance
Form Filing Review Requirements Checklist
Individual Life

L02I, L03I, L04I, L05I, L07I, L08
(Amended 12/2011)

REVIEW REQUIREMENTS

REFERENCE                                             

DESCRIPTION OF REVIEW

STANDARDS REQUIREMENTS

LOCATION OF

STANDARD IN FILING

Payment of Premiums

24-A M.R.S.A. §2504

There shall be a provision relating to the time and place of payment of premiums

 

Third Party Notice, Cancellation and Reinstatement for cognitive impairment or functional incapacity.

Rule 585
24-A M.R.S.A. §2556

Third party notice of cancellation and reinstatement for cognitive impairment or functional incapacity.

 

Grace Period

24-A M.R.S.A. §2505

There shall be a provision that a grace period of 30 days or at the option of the insurer, of one month of not less than 30 days or of 4 weeks in the case of industrial life insurance policy shall be allowed within which the payment of any premium after the first maybe made and that the policy shall remain in force.  The insurer may impose an interest charge not to exceed 6% per annum for the number of days of grace elapsing before the payment of the premium, and whether or not such interest charge is imposed, if an claim arises under the policy during such period of grace the amount of any premium due or overdue, together with interest and any deferred installment of the annual premium may be deducted form the policy proceeds.  The grace period shall date from the premium due date specified on the policy.

 

Entire Contract

24-A M.R.S.A. §2506

Policy and application, if such application is attached to the policy when issued.
All statements contained in the application shall, in the absence of fraud, be deemed representations and not warranties.

 

Incontestability

24-A M.R.S.A. §2507

There shall be a provision that the policy shall be incontestable after it has been in force during the life time of the insured for a period of not more than 2 years after its date of issue, except for non payment of premium, and at the insurer’s options, provision relating to benefits in the event of total and permanent disability and provisions granting additional benefits specifically against death by accident or accidental means.  Maine law does not allow the use of fraud language in this provision

 

Misstatement of Age

24-A M.R.S.A. §2508

There shall be a provision that if the age of the insured or of any other person whose age is considered in determining the premium or benefit has been misstated, any amount payable or benefits occurring under the policy shall be such as the premium would have purchased at the policy holder’s correct age.

 

Dividends

24-A M.R.S.A. §2509

In participating policies - beginning not later than the 3rd policy year the insurer will annual ascertain and apportion to cash or other dividend option as provided by the policy. See this section for full details

 

Loans

24-A M.R.S.A. §2510
24-A M.R.S.A. §2553

Loan value must be at least equal to the CSV at the end of the then current policy year. This provision must be available after 3 full years' premiums have been paid and after the policy has CSV, if policy is not in default beyond the grace period.
This section shall not apply to term policies or to term insurance benefits provided by rider or supplemental policy provisions or to industrial life insurance policies.
A policy loan is permitted to have a maximum interest rate of 8% each year or an adjustable interest rate that may not exceed:
A. The published monthly average for the calendar month ending 2 months before the date on which the rate is determined or
B. The rate used to compute the cash surrender values under the policy during the applicable period plus 1% each year,

 

Right to Examine

24-A M.R.S.A. §2515-A

Every individual life insurance policy delivered or issued for delivery in the State after December 31, 1976 shall contain a provision therein, or in a separate rider attachment thereto when, delivered, stating in substance that the person to whom the policy is issued shall be permitted to return the policy within 10 days of its delivery to such person and to have a refund of the premium paid.  If after examination of the policy the purchaser is not satisfied with it for any reason.  The provision shall be set forth in the policy under an appropriate caption and if not so printed on the face page of the policy adequate notice of the provision shall be printed or stamped conspicuously on the face page.

 

Reinstatement

24-A M.R.S.A. §2512

There shall be a provision that unless: 1) the policy has been surrendered for its cash surrender value; 2)its cash surrender value has been exhausted or; 3) the paid up term insurance if any has expired: the policy will be reinstated at any time within 3 years or 2 years in the case of industrial life insurance policies, from the date of premium default upon written application, the production of evidence of insurability satisfactory to the insurer; the payment of all premiums in arrears with interest at a rate not to exceed 6% per annum compounded annually and the payment or reinstatement of any other indebtedness to the insurer upon the policy with interest at the policy loan interest rate

 

Unfair trade practice to collect premiums for the term when no insurance is provided

24-A M.R.S.A. §2174

For YRT/ART policies where reinstatement is at attained age and no coverage is afforded between the date of lapse and date of reinstatement, it is considered an unfair trade practice to collect premiums for the term when no insurance is provided.

 

Suicide and Limitation of Liability

24-A M.R.S.A. §2525(B)(5)

Death within two (2) years from the date of issue of the policy as a result of suicide while sane or insane, claim will not be paid.
Premiums will be returned

 

Time Limit on Legal Action

24-A M.R.S.A.
§2525(A)

 A provision limiting the time within which an action at law or in equity may be commenced on such a policy to less than 3 years after the case of action has accrued.

 

Excluded or Restricted Cause of Death

§2525(B)

Policies may contain provisions that exclude or restrict liability for death under any one or more of the following:
1. War (declared or undeclared), action of military forces, service in the military or in civilian auxiliary;
2. Aviation or any air travel or flight;
3. Specified hazardous occupations or avocations;
4. While the insured is a resident outside the continental US and Canada;
5. Suicide as above, also applies to increases in face amount.
Exceptions: provisions in life insurance policies or supplemental benefits relating to disability benefits or additional benefits
In the event of death by accident or accidental means.

 

Agent Binding Authority

24-A M.R.S.A. §2422 and §2526(1)

The authorized agent of an insurer shall be regarded as in the place of the insurer in all respects regarding any insurance affected by him or her.

 

Mortality Tables

24-A M.R.S.A. §2532(8)

Rule Chapter 340 Article VI

Insurance Contracts are calculated on the basis of the 1980 CSO Mortality Table. Industrial contracts are based on the 1961 Standard Industrial Mortality Tables. 2001 CSO Mortality tables may be used in lieu of 1980 CSO Mortality tables.

 

Nonforfeiture

24-A M.R.S.A. §2528 – 2534

SNFO apply Any paid up non forfeiture benefit available under the policy in the event of default in a premium payment due on any policy anniversary shall be such that its present value as of such anniversary shall be at least equal to the cash surrender value than provided for by the policy or if none is provided for the case surrender value which would have been required by section 2529 to 2534 in the absence of the condition that premiums shall have been paid for at least a specified period.
This does not apply to reinsurance, group insurance, pure endowments, annuities and reversionary annuities, term policies of uniform amount and decreasing term.

 

Exemption from Creditors

24-A M.R.S.A. §2428-2432

Certain policies shall be exempt from claims of creditors and the rights of beneficiaries and assignees shall be protected.

 

Payment of claim

24-A M.R.S.A.
§2513

 There shall be a provision that when the benefits under the policy shall become payable by reason of the death of the insured, settlement shall be made upon receipt of due proof of death and, at the insurer’s option, surrender of the policy and proof of the interest of the claimant.  If an insurer shall specify a particular period prior to the expiration of which settlement shall be made, such period shall not exceed 2 months from the receipt of such proofs.

 

AIDS and Medical Lifestyle Standards

Rule 490

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 pretest and post-test counseling required to be provided to persons subject to testing as required by 5 M.R.S.A. Section 19203-A, and to establish standards for medical and lifestyle application questions and underwriting.

 

Notice Requirements

Rule 585

All policies subject to this Rule shall include notice of the right:
1. To receive notification that an individual life insurance policy that has been in force for at least one year may not be terminated for nonpayment of premium, unless at least 21 days prior to the expiration of the policy’s grace period, the insurer has mailed a notice of cancellation to the policyholder and any third party designated by the policyholder by name and address in writing;
2. To designate a third party to receive notification pursuant to Section 4 of the Rule; and
3.  To change a third-party designation.

 

Stranger Originated Life Insurance

24-A M.R.S.A. §6802-A(6) and §6802-A(12-A)

It is a fraudulent act for an insurance company or viatical settlement provider to commit, or permit its employees or its agents to engage in entering into stranger-originated life insurance.

"Stranger-originated life insurance" means an act or practice to initiate a life insurance policy for the benefit of a person who, at the time of the origination of the policy, has no insurable interest in the insured. "Stranger-originated life insurance" includes, but is not limited to, cases in which life insurance is purchased with resources or guarantees from or through a person who, at the time of the inception of the policy, could not lawfully initiate the policy and when, at the time of policy inception, there is an arrangement or agreement to directly or indirectly transfer the ownership of the policy or the policy benefits to another person. A trust that is created to give the appearance of insurable interest and is used to initiate policies for investors violates insurable interest laws and the prohibition against wagering on life.”

 

Last Updated: August 22, 2012