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.
2024 Plan Year QHP & SADP Requirements Checklists
Please review the SERFF General Instructions page and Plan Management General Instructions Page on SERFF as they have been updated for 2023 plan submissions.
- Small Group Major Medical Plans (DOC) - NON-GRANDFATHERED REVISED 04/13/23
- Individual Major Medical Plans (DOC) - NON-GRANDFATHERED REVISED 04/13/23
- Small Group HMO and Individual HMO Plans (DOC) - NON-GRANDFATHERED REVISED 04/13/23
- Maine's 2023 Benchmark Essential Health Benefits Chart (PDF) - REVISED 6/1/22
- Qualified Stand Alone Small Group & Individual Dental 2023 (DOC) REVISED 04/13/23
- Maine's 2023 Benchmark Pediatric Dental Checklist (PDF) - REVISED 6/16/22
- FEDVIP 2023 Benchmark Pediatric Dental Services Chart (PDF) - REVISED 6/16/22
- Individual Health Policies including Qualified SADP (DOC) Subject to Title 24-A M.R.S.A § 2736-C - (H15I, H16I.005B, H16I.005C, HOrg02I.005B, HOrg02I.005C REVISED 3/10/20
- Small Group Health Plans including Qualified SADP Policies (DOC) - (H15G.003, H16G.003A, H16G.003D,H16G.003G, HOrg02G.004E, H24G.003, H25G.003) REVISED 3/16/20
- Student Health Policies (H04) Health - Blanket Accident/Sickness (DOC)
- URRT Supplement Template (XLS) REVISED 2/12/19
The documents on this page are also available in hard copy by contacting the Bureau.