All Rate and Form Filings submitted to the Bureau of Insurance for review must be accompanied by the appropriate rate and/or form review checklists for the product being submitted. The checklists must be completed and must reference, for each requirement on the checklist, the location (i.e. form, page number, paragraph, etc.) of each standard in the filing.
If you have any questions about the Health and Life checklists, please contact Amanda Alley, Senior Insurance Analyst, at Amanda.Alley@maine.gov or call 207-624-8455.
The documents on this page are also available in hard copy by contacting the Bureau.
Non-QHP Requirements Checklists
Accident & Health Form Filing Requirements
- Group Accident Only (DOC) - (H02G) REVISED 11/21/19
- Individual Accident Only (DOC) - (H02I) REVISED 6/5/20
- Group Accidental Death & Dismemberment (DOC) - (H03G) REVISED 11/21/19
- Individual Accidental Death & Dismemberment (DOC) - (H03I) REVISED 11/21/19
- Blanket Accident and Sickness (DOC) - (H04) REVISED 3/17/21
- Blanket Accident Only (DOC) - (H04) REVISED 3/17/21
- Student Health Insurance - ACA Compliant (DOC) - (H22) REVISED 10/1/21
- Group Specified Disease (DOC) - (H07G) REVISED 3/17/21
- Individual Specified Disease (DOC) - (H07I) REVISED 3/17/21
- Group Dental NON-Qualified (DOC) - (H10G) REVISED 04/13/23
- Individual Dental NON-Qualified (DOC) - (H10I) REVISED 04/13/23
- Group Disability Income (DOC) - (H11G) REVISED 11/2/20
- Individual Disability Income (DOC) - (H11I) REVISED 11/2/20
- Group Disability - Maine Tax Credit Qualified STD and LTD (DOC) - (H11G.004 Other) REVISED 11/2/20
- Excess/Stop Loss (DOC) - (H12G) REVISED 9/2/21
- Group Short Term Care (DOC) (H13G) REVISED 10/1/18
- Group Hospital Confinement Indemnity (DOC) - (H14G) REVISED 3/17/21
- Individual Hospital Confinement Indemnity (DOC) - (H14I) REVISED 3/17/21
- Group Hospital/Surgical/Medical Expense (DOC) - (H15G) AMENDED 10/1/21
- Large Group Major Medical PY23 (DOC) - (H16G) REVISED 6/16/22
- Large Group Major Medical PY24 (DOC) - (H16G)
- Individual Major Medical SHORT-TERM, LIMITED-DURATION (DOC) - (H16I.004) REVISED 10/1/21
- Short-term, Limited-duration Policy - Summary of Plan Benefits (DOC)
- Group Indemnity Other Than Hospital (DOC) - (H23G) REVISED 3/17/21
- Individual Indemnity Other Than Hospital (DOC) - (H23I) REVISED 3/17/21
- Group Similar Supplemental to Major Medical (DOC) (H25G) REVISED 10/1/21
- Large Group HMO-POS PY23 (DOC) - (HOrg02G) REVISED 6/16/22
- Large Group HMO-POS PY24 (DOC) - (HOrg02G)
- Group & Individual Long Term Care/Partnership (DOC) - (LTC03G and LTC03I) REVISED 11/21/19
- Group Medicare Supplement (DOC) - (MS05G) REVISED 10/2/18
- Individual Medicare Supplement (DOC) - (MS05I) REVISED 10/2/18
- Group Vision Plans (DOC) - (H20G) REVISED 04/13/23
- Individual Vision Plans (DOC) - (H20I) AMENDED 04/13/23
- Prescription Drug Coverage Only (DOC) – (H17G and H17I) REVISED 9/9/21
- Out-of-State Groups, Associations/Trusts/ Labor Union Group/Debtor Groups/Other Groups (DOCX) - (H21 Other) REVISED 1/25/21
- Association Questionnaire (DOC)
- Legal Services Coverage (DOC) (H21-Other) REVISED 9/9/21
- MEWAs (DOC) - (H21 Other) REVISED 04/13/23
- Multi-Line Applications (DOC) REVISED 11/2/20
- Health Application (DOC) REVISED 11/2/20
Rate Filing Requirements
- Credit (DOC)- (CR02G & CR04G )
- Individual Health Policies, other than Medicare Supplement, Long Term Care, and Individual Health Plans (DOC) - (H01, H02I, H03I, H07I, H08I, H09I, H10I, H11I, H13I, H14I, H16I.004, H17I, H19I, H20I)
- Group Health including Qualified SADP (DOC) Policies Subject to Title 24-A M.R.S.A. § 2839 H02G, H03G, H04, H07G, H08G, H09G, H10G, H11G, H12, H13G, H14G, H15G.002, H16G.002A, H16G.002B, H16G.002C, H16G.004, H17G, H18G, H19G, H20G, HOrg02G.003B
- Individual Health Plans (DOC) - (H15I, H16I.005A, H16I.005B, H16I.005C, HOrg02I.005B, HOrg02I.005C) REVISED 3/10/20
- Long Term Care/Nursing Home Care (DOC) - (LTC03G, LTC03I) - subject to Rule 420 (policies issued prior to 10/1/04)
- Long Term Care (DOC) - (LTC03G, LTC03I) - Initial Rate Filing for policies subject to Rule 425 (policies issued on and after 10/1/04)
- Long Term Care (DOC) - (LTC03G, LTC03I) - Rate Revision Filing for policies subject to Rule 425 (policies issued on and after 10/1/04)
- Medicare Supplement (DOC) - (MS02G, MS02I, MS05G, MS05I)
Life, Annuity & Credit Form Filing Requirements
- Annuities (DOC) - REVISED 11/21/19
- Variable Annuities (DOC) - REVISED 11/21/19
- Group Life (DOC) - REVISED 4/5/21
- Individual Life (DOC) - REVISED 5/3/21
- Variable Life (DOC) - REVISED 12/9/20
- Life Settlements and Viatical Settlements (DOC) (LS01 and VS01) NEW 4/5/18
- Illustrations (DOC) - (L08)
- Group Credit Life and/or Disability (DOC) - (CR04G and/or CR02G) REVISED 12/10/20
- Individual Credit Life and/or Disability (DOC) - (CR04I and/or CR02I) REVISED 12/10/20
- Life, Annuity & Credit APPLICATIONS (DOC) (Group & Individual)