MRS Title 24-A, Chapter33: HEALTH INSURANCE CONTRACTS
Text current through November 1, 2017, see disclaimer at end of document.
Title 24-A: MAINE INSURANCE CODE
Chapter33: HEALTH INSURANCE CONTRACTS
Table of Contents
Section2701. SCOPE OF CHAPTER 0
Section2702. SHORT TITLE 0
Section2703. SCOPE, FORMAT OF POLICY 0
Section2704. REQUIRED PROVISIONS; CAPTIONS -- OMISSIONS -- SUBSTITUTIONS 0
Section2705. ENTIRE CONTRACT -- CHANGES 0
Section2706. TIME LIMIT ON CERTAIN DEFENSES 0
Section2707. GRACE PERIOD 0
Section2707-A. NOTIFICATION PRIOR TO CANCELLATION; RESTRICTIONS ON LAPSE OR TERMINATION DUE TO COGNITIVE IMPAIRMENT OR FUNCTIONAL INCAPACITY 0
Section2708. REINSTATEMENT 0
Section2709. NOTICE OF CLAIM 0
Section2710. CLAIM FORMS 0
Section2711. PROOFS OF LOSS 0
Section2712. TIME OF PAYMENT OF CLAIMS 0
Section2713. PAYMENT OF CLAIMS 0
Section2713-A. EXPLANATION AND NOTICE TO PARENT 0
Section2714. PHYSICAL EXAMINATION, AUTOPSY 0
Section2715. LEGAL ACTIONS 0
Section2716. CHANGE OF BENEFICIARY 0
Section2717. RIGHT TO EXAMINE AND RETURN POLICY 0
Section2717-A. DISABILITY BENEFIT OFFSETS 0
Section2718. OPTIONAL POLICY PROVISIONS 0
Section2719. CHANGE OF OCCUPATION 0
Section2720. MISSTATEMENT OF AGE 0
Section2721. OVERINSURANCE -- SAME INSURER (REPEALED) 0
Section2721-A. OVERINSURANCE IN ACCIDENT POLICIES -- SAME INSURER 0
Section2721-B. FLIGHT INSURANCE LIMITATION (REPEALED) 0
Section2722. INSURANCE WITH OTHER INSURERS, PROVISION OF SERVICE OR EXPENSE INCURRED BASIS 0
Section2723. INSURANCE WITH OTHER INSURERS -- OTHER BENEFITS 0
Section2723-A. COORDINATION OF BENEFITS 0
Section2724. RELATION OF EARNINGS TO INSURANCE 0
Section2725. UNPAID PREMIUMS 0
Section2726. CONFORMITY WITH STATE STATUTES 0
Section2727. ILLEGAL OCCUPATION 0
Section2728. INTOXICANTS AND NARCOTICS 0
Section2729. RENEWABILITY 0
Section2729-A. LIMITS ON PRIORITY LIENS 0
Section2730. ORDER OF CERTAIN PROVISIONS 0
Section2731. THIRD PARTY OWNERSHIP 0
Section2731-A. "MEDICALLY NECESSARY MASTECTOMY SURGERY" DEFINED (REPEALED) 0
Section2732. REQUIREMENTS OF OTHER JURISDICTIONS 0
Section2733. POLICIES ISSUED FOR DELIVERY IN ANOTHER STATE 0
Section2734. CONFORMING TO STATUTE 0
Section2735. AGE LIMIT 0
Section2735-A. NOTICE OF RATE FILING AND RATE INCREASE 0
Section2736. RATE FILINGS ON INDIVIDUAL HEALTH INSURANCE POLICIES 0
Section2736-A. HEARING 0
Section2736-B. ORDER 0
Section2736-C. INDIVIDUAL HEALTH PLANS 0
Section2737. NONCANCELLABLE DISABILITY INSURANCE DEFINED 0
Section2738. NOTICE AS TO RENEWABILITY 0
Section2739. LAPSE OF POLICY, ADVANCE NOTICE; LIMITATION OF ACTION 0
Section2740. FRANCHISE HEALTH INSURANCE LAW (REPEALED) 0
Section2741. MATERNITY BENEFITS FOR UNMARRIED WOMEN POLICYHOLDERS AND THE MINOR DEPENDENTS OF POLICYHOLDERS WITH DEPENDENT OR FAMILY COVERAGE REQUIRED 0
Section2741-A. MANDATED OFFER OF DOMESTIC PARTNER BENEFITS 0
Section2742. CHILD COVERAGE 0
Section2742-A. EXTENSION OF COVERAGE FOR DEPENDENT CHILDREN 0
Section2742-B. MANDATORY OFFER TO EXTEND COVERAGE FOR DEPENDENT CHILDREN UP TO 25 YEARS OF AGE 0
Section2743. NEWBORN CHILDREN COVERAGE 0
Section2743-A. MATERNITY AND ROUTINE NEWBORN CARE 0
Section2744. MENTAL HEALTH SERVICES 0
Section2745. HOME HEALTH CARE COVERAGE 0
Section2745-A. SCREENING MAMMOGRAMS 0
Section2745-B. ACUPUNCTURE SERVICES 0
Section2745-C. COVERAGE FOR BREAST CANCER TREATMENT 0
Section2745-D. MEDICAL FOOD COVERAGE FOR INBORN ERROR OF METABOLISM 0
Section2745-E. OFF-LABEL USE OF PRESCRIPTION DRUGS FOR CANCER 0
Section2745-F. OFF-LABEL USE OF PRESCRIPTION DRUGS FOR HIV OR AIDS 0
Section2745-G. COVERAGE FOR PROSTATE CANCER SCREENING (REALLOCATED FROM TITLE 24-A, SECTION 2745-E) 0
Section2746. OPTIONAL COVERAGE FOR CHIROPRACTIC SERVICES (REALLOCATED TO TITLE 24-A, SECTION 2840) 0
Section2747. REVIEW AND ARBITRATION 0
Section2748. COVERAGE FOR CHIROPRACTIC SERVICES 0
Section2749. UTILIZATION REVIEW DATA 0
Section2749-A. PENALTY FOR FAILURE TO NOTIFY OF HOSPITALIZATION 0
Section2749-B. PENALTY FOR NONCOMPLIANCE WITH UTILIZATION REVIEW PROGRAMS 0
Section2749-C. MANDATED OFFER OF COVERAGE FOR CERTAIN MENTAL ILLNESSES 0
Section2750. ACQUIRED IMMUNE DEFICIENCY SYNDROME 0
Section2751. ASSESSMENT OF MANDATED BENEFITS PROPOSALS; STUDIES OF MANDATED BENEFITS ISSUES (REPEALED) 0
Section2752. MANDATED HEALTH LEGISLATION PROCEDURES 0
Section2753. STANDARDIZED CLAIM FORMS 0
Section2754. COVERAGE FOR DIABETES SUPPLIES 0
Section2755. ASSIGNMENT OF BENEFITS 0
Section2756. COVERAGE FOR CONTRACEPTIVES 0
Section2757. COVERAGE FOR SERVICES OF CERTIFIED NURSE PRACTITIONERS; CERTIFIED NURSE MIDWIVES (REALLOCATED FROM TITLE 24-A, SECTION 2756) 0
Section2758. COVERAGE FOR SERVICES PROVIDED BY REGISTERED NURSE FIRST ASSISTANTS (REALLOCATED FROM TITLE 24-A, SECTION 2756) 0
Section2759. COVERAGE FOR HOSPICE CARE SERVICES 0
Section2760. COVERAGE FOR GENERAL ANESTHESIA FOR DENTISTRY (REALLOCATED FROM TITLE 24-A, SECTION 2759) 0
Section2761. OFFER OF COVERAGE FOR BREAST REDUCTION SURGERY AND SYMPTOMATIC VARICOSE VEIN SURGERY 0
Section2762. COVERAGE FOR HEARING AIDS 0
Section2763. COVERAGE FOR COLORECTAL CANCER SCREENING 0
Section2764. COVERAGE FOR MEDICALLY NECESSARY INFANT FORMULA (REALLOCATED FROM TITLE 24-A, SECTION 2763) 0
Section2765. COVERAGE FOR SERVICES PROVIDED BY INDEPENDENT PRACTICE DENTAL HYGIENIST 0
Section2765-A. COVERAGE FOR SERVICES PROVIDED BY DENTAL HYGIENE THERAPIST 0
Section2766. ENROLLMENT OF DEPENDENT CHILDREN IN DENTAL COVERAGE 0
Section2767. COVERAGE FOR CHILDREN'S EARLY INTERVENTION SERVICES (REALLOCATED FROM TITLE 24-A, SECTION 2766) 0
Section2768. COVERAGE FOR THE DIAGNOSIS AND TREATMENT OF AUTISM SPECTRUM DISORDERS (REALLOCATED FROM TITLE 24-A, SECTION 2766) 0
Section2769. PRESCRIPTION SYNCHRONIZATION 0
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MRS Title 24-A, Chapter33: HEALTH INSURANCE CONTRACTS
Maine Revised Statutes
Title 24-A: MAINE INSURANCE CODE
Chapter33: HEALTH INSURANCE CONTRACTS
§2701. SCOPE OF CHAPTER
Nothing in this chapter shall apply to or affect: [1969, c. 132, §1 (NEW).]
1. Any policy of liability or workers' compensation insurance with or without supplementary expense coverage therein;
[ 1989, c. 502, Pt. A, §94 (AMD) .]
2. Any group or blanket policy, except that:
A. Sections 2736, 2736-A and 2736-B apply to group Medicare supplement policies as defined in chapter 67, group nursing home care and long-term care insurance policies as defined in chapter 68 or 68-A; [2003, c. 428, Pt. G, §3 (AMD).]
B. Section 2752 applies with respect to mandated benefits for group or blanket health policies; and [1995, c. 332, Pt. J, §1 (AMD).]
C. Sections 2736, 2736-A, 2736-B and 2736-C apply to:
(1) Association groups as defined by section 2805-A, exceptas to any employer subgroups of the association group when the employer is a member of the group and provides coverage through the group as a bona fide employee benefit;
(1-A) Credit union groups as defined by section 2807-A; and
(2) Other groups as defined by section 2808, except:
(a) Employee leasing companies registered pursuant to Title 32, chapter 125; and
(b) As to any employer subgroups of the other group when the employer provides coverage to its employees through the group as a bona fide employee benefit. [2009, c. 244, Pt. F, §1 (AMD).]
[ 2009, c. 244, Pt. F, §1 (AMD) .]
3. Life insurance, endowment or annuity contracts, or contracts supplemental thereto which contain only such provisions relating to health insurance as:
A. Provide additional benefits in case of death or dismemberment or loss of sight by accident or accidental means, or as [1969, c. 132, §1 (NEW).]
B. Operate to safeguard such contracts against lapse, or to give a special surrender value or special benefit or an annuity in the event that the insured or annuitant becomes totally and permanently disabled, as defined by the contract or supplemental contract; [1983, c. 801, §8 (AMD).]
[ 1983, c. 801, §8 (AMD) .]
4. Reinsurance; and
[ 1983, c. 801, §8 (AMD) .]
5. Legal services insurance.
[ 1983, c. 801, §9 (NEW) .]
SECTION HISTORY
1969, c. 132, §1 (NEW). 1983, c. 801, §§8,9 (AMD). 1985, c. 648, §9 (AMD). 1989, c. 502, §A94 (AMD). 1989, c. 556, §A4 (AMD). 1991, c. 701, §5 (AMD). 1995, c. 332, §J1 (AMD). 2001, c. 258, §E1 (AMD). 2003, c. 428, §G3 (AMD). 2005, c. 121, §B1 (AMD). 2009, c. 244, Pt. F, §1 (AMD).
§2702. SHORT TITLE
This chapter may be cited as the "Uniform Health Policy Provision Law". [1969, c. 132, §1 (NEW).]
SECTION HISTORY
1969, c. 132, §1 (NEW).
§2703. SCOPE, FORMAT OF POLICY
No policy of health insurance shall be delivered or issued for delivery to any person in this State unless it otherwise complies with this Title, and complies with the following: [1969, c. 132, §1 (NEW).]
1. The entire money and other considerations therefore shall be expressed therein;
[ 1969, c. 132, §1 (NEW) .]
2. The time when the insurance takes effect and terminates shall be expressed therein;
[ 1969, c. 132, §1 (NEW) .]
3. It shall purport to insure only one person, except that a policy may insure, originally or by subsequent amendment, upon the application of an adult member of a family, who shall be deemed the policyholder, any 2 or more eligible members of that family, including husband, wife, dependent children or any children under a specified age which shall not exceed 23 years and any other person dependent upon the policyholder;
[ 1969, c. 132, §1 (NEW) .]
4. The style, arrangement and overall appearance of the policy shall give no undue prominence to any portion of the text, and every printed portion of the text of the policy and of any endorsements or attached papers shall be plainly printed in light-faced type of a style in general use, the size of which shall be uniform and not less than ten-point with a lower case unspaced alphabet length not less than one hundred and twenty-point; the "text" shall include all printed matter except the name and address of the insurer, name or title of the policy, the brief description, if any, and captions and subcaptions;
[ 1969, c. 132, §1 (NEW) .]
5. The exceptions and reductions of indemnity shall be set forth in the policy and, other than those contained in sections 2705 to 2729, shall be printed, at the insurer's option, either included with the benefit provision to which they apply, or under an appropriate caption such as "Exceptions", or "Exceptions and Reductions", except that if an exception or reduction specifically applies only to a particular benefit of the policy, a statement of such exception or reduction shall be included with the benefit provision to which it applies;
[ 1969, c. 132, §1 (NEW) .]
6. Each such form, including riders and endorsements, shall be identified by a form number in the lower left-hand corner of the first page thereof; and
[ 1969, c. 132, §1 (NEW) .]
7. The policy shall contain no provision purporting to make any portion of the charter, rules, constitution or bylaws of the insurer a part of the policy unless such portion is set forth in full in the policy, except in the case of the incorporation of, or reference to, a statement of rates or classification of risks, or short-rate table filed with the superintendent.
[ 1973, c. 585, §12 (AMD) .]
SECTION HISTORY
1969, c. 132, §1 (NEW). 1973, c. 585, §12 (AMD).
§2704. REQUIRED PROVISIONS; CAPTIONS -- OMISSIONS -- SUBSTITUTIONS
1. Except as provided in subsection 2, each such policy delivered or issued for delivery to any person in this State shall contain the provisions specified in sections 2705 to 2716, in the words in which the same appear; except that the insurer may, at its option, substitute for one or more of such provisions corresponding provisions of different wording approved by the superintendent which are in each instance not less favorable in any respect to the insured or the beneficiary. Each such provision shall be preceded individually by the applicable caption shown, or, at the option of the insurer, by such appropriate individual or group captions or subcaptions as the superintendent may approve.
[ 1973, c. 585, §12 (AMD) .]
2. If any such provision is in whole or in part inapplicable to or inconsistent with the coverage provided by a particular form of policy, the insurer, with the approval of the superintendent, shall omit from such policy any inapplicable provision or part of a provision, and shall modify any inconsistent provision or part of a provision in such manner as to make the provision as contained in the policy consistent with the coverage provided by the policy.
[ 1973, c. 585, §12 (AMD) .]
SECTION HISTORY
1969, c. 132, §1 (NEW). 1973, c. 585, §12 (AMD).
§2705. ENTIRE CONTRACT -- CHANGES
There shall be a provision as follows: [1969, c. 132, §1 (NEW).]
Entire contract; changes: This policy, including the endorsements and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall be valid until approved by an executive officer of the insurer and unless such approval be endorsed hereon or attached hereto. No agent has authority to change this policy or to waive any of its provisions. [1969, c. 132, §1 (NEW).]
SECTION HISTORY
1969, c. 132, §1 (NEW).
§2706. TIME LIMIT ON CERTAIN DEFENSES
There shall be a provision as follows: [1969, c. 132, §1 (NEW).]
Time limit on certain defenses: (a) After 3 years from the date of issue of this policy no misstatements, except fraudulent misstatements, made by the applicant in the application for such policy shall be used to void the policy or to deny a claim for loss incurred or disability, as defined in the policy, commencing after the expiration of such 3-year period. [1969, c. 132, §1 (NEW).]
1. The foregoing policy provision shall not be so construed as to affect any legal requirement for avoidance of a policy or denial of a claim during such initial 3-year period, nor to limit the application of sections 2717 through 2723 in the event of misstatement with respect to age or occupation or other insurance.
[ 1969, c. 132, §1 (NEW) .]
2. A policy which the insured has the right to continue in force subject to its terms by the timely payment of premium 1 until at least age 50 or, 2 in the case of a policy issued after age 44, for at least 5 years from its date of issue, may contain in lieu of the foregoing the following provision, from which the clause in parentheses may be omitted at the insurer's option, under the caption "Incontestable:"
[ 1969, c. 132, §1 (NEW) .]
After this policy has been in force for a period of 3 years during the lifetime of the insured (excluding any period during which the insured is disabled), it shall become incontestable as to the statements contained in the application. [1969, c. 132, §1 (NEW).]
(b) No claim for loss incurred or disability, as defined in the policy, commencing after 3 years from the date of issue of this policy shall be reduced or denied on the ground that a disease or physical condition not excluded from coverage by name or specific description effective on the date of loss had existed prior to the effective date of coverage of this policy. [1969, c. 132, §1 (NEW).]