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USA Statutes : maine
Title : Title 24-A. MAINE INSURANCE CODE
Chapter : Chapter 18. INSURANCE ADMINISTRATORS (HEADING. PL 1989, c. 846, Pt. D, @2 (new))
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Title 24-A - §1902. License required
Title 24-A: MAINE INSURANCE CODE
Chapter 18: INSURANCE ADMINISTRATORS (HEADING: PL 1989, c. 846, Pt. D, @2 (new))
§1902. License required
A person may not act as or profess to be an administrator after August 1, 1990, unless licensed under this chapter. An administrator
doing business in this State on August 1, 1990, shall apply for a license by November 1, 1990. In addition to any other penalty
that may be imposed for violation of this Title, any person violating this section shall, upon conviction, be punished by
a fine of not less than $100 nor more than $1,000 or by imprisonment for less than one year, or both.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
div>
An administrator licensed under this chapter on or before December 31, 2003 shall submit information by March 21, 2004 as
to the types of business conducted by that administrator in this State on a form prescribed by the superintendent.
[2003, c. 469, Pt. E, §3 (new).]
The Revisor's Office cannot provide legal advice or
interpretation of Maine law to the public. If you need legal
advice, please consult
a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007
This page created on: 2005-10-01
Title 24-A - §1903. Application
Title 24-A: MAINE INSURANCE CODE
Chapter 18: INSURANCE ADMINISTRATORS (HEADING: PL 1989, c. 846, Pt. D, @2 (new))
§1903. Application
An applicant for a license shall file with the superintendent an application, on a form prescribed by the superintendent,
that must include or have attached the following:
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
1. The names, addresses and official positions of the individuals who are responsible for the conduct of the affairs of the
administrator, including, but not limited to, all members of the board of directors, board of trustees, executive committee,
or other governing board or committee, the principal officers in the case of a corporation or the partners in the case of
a partnership;
[2003, c. 469, Pt. E, §4 (amd).]
2. An application fee, as specified in section 601, that the superintendent shall apply toward the initial administrator annual
fee if an administrator's license is granted to the applicant; and
[2003, c. 469, Pt. E, §4 (amd).]
3. The specific type of business in which the 3rd-party administrator will or intends to engage.
[2003, c. 469, Pt. E, §5 (new).]
The Revisor's Office cannot provide legal advice or
interpretation of Maine law to the public. If you need legal
advice, please consult
a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007
This page created on: 2005-10-01
Title 24-A - §1904. Bond requirements for administrators
Title 24-A: MAINE INSURANCE CODE
Chapter 18: INSURANCE ADMINISTRATORS (HEADING: PL 1989, c. 846, Pt. D, @2 (new))
§1904. Bond requirements for administrators
1. Every applicant for an administrator's license shall file with the application, and shall maintain in force while licensed,
a fidelity bond, and at the superintendent's discretion, a surety bond, in favor of the Treasurer of State, for the benefit
of covered persons or plan sponsors as their interest may appear, executed by a surety company authorized to do business in
this State and payable to any party injured under the terms of the bond. The bond must be continuous in form and in one of
the following amounts:
A. For an administrator that maintains an ATF but does not maintain a CASA, the greater of $50,000 or 5% of contributions and
premiums projected to be received or collected in the ATF for the following plan year from residents of the State, but not
to exceed $1,000,000;
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
B. For an administrator that maintains a CASA but does not maintain an ATF, the greater of $50,000 or 5% of the claims and
claim expenses projected to be held in the CASA for the following year to pay claims and claim expenses for residents of the
State, but not to exceed $1,000,000; or
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
C. For an administrator that maintains an ATF and a CASA, the greater of $50,000 or 5% of contributions and premiums projected
to be received or collected in the ATF for the following plan year from residents of the State plus 5% of the claims and claim
expenses projected to be held in the CASA accounts for the following year to pay claims and claim expenses for residents of
the State, but not to exceed $1,000,000.
[1993, c. 171, Pt. A, §1 (amd).]
This subsection applies to an administrator who is required to maintain funds in a fiduciary capacity as set forth in section
1909.
[1995, c. 329, §27 (amd).]
2. The bond must remain in force and effect until the surety is released from liability by the superintendent or until the
bond is cancelled by the surety. The surety may cancel the bond and be released from further liability under the bond upon
30 days' written notice in advance to the superintendent. The cancellation does not affect any liability incurred or accrued
under the bond before the 30-day period expires. Upon receiving any notice of cancellation, the superintendent shall immediately
notify the licensee.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
3. The administrator's license automatically terminates if the bond required by this section is not in force. Within 30 days
after the bond ceases to be in force, the administrator shall return the license to the superintendent for cancellation.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
The Revisor's Office cannot provide legal advice or
interpretation of Maine law to the public. If you need legal
advice, please consult
a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007
This page created on: 2005-10-01
Title 24-A - §1905. License
Title 24-A: MAINE INSURANCE CODE
Chapter 18: INSURANCE ADMINISTRATORS (HEADING: PL 1989, c. 846, Pt. D, @2 (new))
§1905. License
1. Upon receipt of a complete application for an administrator license, the superintendent shall investigate, to the extent
the superintendent considers advisable, the applicant's experience, background and fitness for the license. The superintendent
may obtain a credit and investigative report relative to the applicant from a recognized and established independent investigation
and reporting agency. The superintendent may establish from time to time a reasonable uniform flat amount that the applicant
must pay for the report. The report cost must be included with the application. The contents of the report are confidential.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
2. If the superintendent finds that the applicant is qualified for an administrator license, the superintendent shall promptly
issue the license, which identifies the types of business in which the applicant may engage; otherwise the superintendent
shall refuse to issue the license and promptly notify the applicant.
[2003, c. 469, Pt. E, §6 (amd).]
3. Sections 1417 and 1418 apply to licenses issued under this chapter.
[1997, c. 457, §29 (amd); §55 (aff).]
4. Unless revoked or suspended under section 1907, an administrator license remains in effect as long as the holder of the
license maintains in force and effect the bond required by section 1904 and pays the annual fee required by section 601 before
the anniversary date of the license.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
5. An administrator shall submit an application to amend its license if the administrator desires to amend the types of business
on its then-current license.
[2003, c. 469, Pt. E, §7 (new).]
The Revisor's Office cannot provide legal advice or
interpretation of Maine law to the public. If you need legal
advice, please consult
a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007
This page created on: 2005-10-01
Title 24-A - §1906. Administrator requirements
Title 24-A: MAINE INSURANCE CODE
Chapter 18: INSURANCE ADMINISTRATORS (HEADING: PL 1989, c. 846, Pt. D, @2 (new))
§1906. Administrator requirements
1. Each administrator shall identify to the superintendent any ownership interest or affiliation of any kind with any plan
sponsor, health care service plan, health maintenance organization or insurer responsible directly or through reinsurance
for providing benefits to any plan for which the administrator provides services as an administrator.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
2. An administrator shall provide services as an administrator only pursuant to a written agreement between the administrator
and the plan sponsor, health care service plan, health maintenance organization or insurer. The administrator shall retain
the written agreement as part of its records for the duration of the agreement and for 7 years after the agreement expires.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
3. An administrator shall maintain, in its principal office for the duration of the written agreement with any plan sponsor
or insurer and for 7 years after the agreement expires, adequate books and records of all transactions involving a plan sponsor,
health care service plan, health maintenance organization or insurer and covered individuals and beneficiaries. These books
and records must be maintained in accordance with generally accepted standards of business recordkeeping. An administrator
is not required to maintain copies of books and records if the originals are returned to the plan sponsor, health care service
plan, health maintenance organization or insurer before the end of the 7-year period. The administrator shall maintain evidence
of the return of the originals for the balance of the 7-year period.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
4. The administrator shall file with the superintendent the names and addresses of the insurers, health care service plans,
health maintenance organizations and plan sponsors with whom the administrator has entered into written agreements. If an
insurer, health care service plan, health maintenance organization or plan sponsor does not assume or bear the risk, the administrator
must disclose the name and address of the ultimate risk bearer. In addition, at the time of a license renewal, the administrator
shall also file with the superintendent for the most recent complete calendar year for all covered individuals in the State
the total number of claims paid by the administrator by each plan sponsor and the total dollar amount of claims paid by each
plan sponsor. This subsection applies to the initial application for an administrator's license and any renewal of a license.
[2001, c. 457, §20 (amd).]
5. An administrator may use advertising pertaining to the plan only if that advertising has been approved in advance by the
plan sponsor, health care service plan, health maintenance organization or insurer.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
6. Upon receiving instructions from the plan sponsor, health care service plan, health maintenance organization or insurer,
an administrator shall deliver promptly to covered individuals or beneficiaries all policies, certificate booklets, termination
notices or other written communications.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
7. An administrator may not receive compensation from a plan sponsor, health care service plan, health maintenance organization
or insurer that is contingent upon the loss ratio of the plan. This subsection does not, however, prevent the administrator
from engaging in cost containment activities with a plan sponsor, health care service plan, health maintenance organization
or insurer.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
8. An administrator may not receive from any plan sponsor, health care service plan, health maintenance organization, insurer,
covered individual or beneficiary under a plan any compensation or other payments except as expressly set forth in the written
agreement between the administrator and the plan sponsor, health care service plan, health maintenance organization or insurer.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
9. Upon request of the superintendent, an administrator shall make available for examination, either at the Bureau of Insurance
or at the licensee's principal place of business, all basic organizational documents, including, but not limited to, articles
of incorporation, articles of association, partnership agreements, trade name certificates, trust agreements, shareholder
agreements and other applicable documents and all amendments to those documents, bylaws, rules and regulations or similar
documents regulating the conduct of the administrator's internal affairs.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
10. When acting as an administrator, the acts of an insurance administrator are deemed to be the acts of the plan sponsor, health
care service plan, health maintenance organization, fraternal benefit society, nonprofit hospital or medical service organization
or insurer.
[1997, c. 457, §30 (new).]
11. In addition to any other applicable provisions of law, the plan sponsor, health care service plan, health maintenance organization,
fraternal benefit society, nonprofit hospital or medical service organization or insurer is accountable and may be penalized
by the superintendent, as provided for in this Title, for the actions of its administrators.
[1997, c. 457, §30 (new).]
The Revisor's Office cannot provide legal advice or
interpretation of Maine law to the public. If you need legal
advice, please consult
a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007
This page created on: 2005-10-01
Title 24-A - §1907. License suspension, revocation or denial
Title 24-A: MAINE INSURANCE CODE
Chapter 18: INSURANCE ADMINISTRATORS (HEADING: PL 1989, c. 846, Pt. D, @2 (new))
§1907. License suspension, revocation or denial
Any license issued under this chapter may be suspended or revoked after notice to the licensee and an opportunity for hearing
and any application for license may be denied after notice and opportunity for hearing:
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
1. For any of the grounds for suspension or revocation of a license set forth in section 1417; or
[1997, c. 457, §31 (amd); §55 (aff).]
2. If the licensee or applicant:
A. Is using any method or practice in conducting business that renders further transaction of business in this State hazardous
or injurious to covered individuals or the public;
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
B. Is affiliated with and is under the same general management as another administrator that transacts business in this State
without being licensed under this chapter; or
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
C. Has failed to report a conviction as required by section 1908.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
The Revisor's Office cannot provide legal advice or
interpretation of Maine law to the public. If you need legal
advice, please consult
a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007
This page created on: 2005-10-01
Title 24-A - §1908. Criminal convictions
Title 24-A: MAINE INSURANCE CODE
Chapter 18: INSURANCE ADMINISTRATORS (HEADING: PL 1989, c. 846, Pt. D, @2 (new))
§1908. Criminal convictions
Any administrator and any individual listed on the application, as required by section 1903, who is convicted of a crime punishable
by imprisonment for more than one year shall report that conviction to the superintendent within 30 days after judgment is
entered. Within that 30-day period, the administrator shall also provide the superintendent with a copy of the judgment and
any commitment order and any other relevant documents relating to disposition of the criminal action.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
The Revisor's Office cannot provide legal advice or
interpretation of Maine law to the public. If you need legal
advice, please consult
a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007
This page created on: 2005-10-01
Title 24-A - §1909. Fiduciary accounts and duties
Title 24-A: MAINE INSURANCE CODE
Chapter 18: INSURANCE ADMINISTRATORS (HEADING: PL 1989, c. 846, Pt. D, @2 (new))
§1909. Fiduciary accounts and duties
1. Administrators shall hold in a fiduciary capacity all contributions and premiums received or collected on behalf of a plan
sponsor or insurer, except service fees owed to the administrator pursuant to the written agreement between the plan sponsor,
insurer, health care service plan or health maintenance organization and the administrator. These funds may not be used as
general operating funds of the administrator. All contributions and premiums received or collected by the administrator from
residents of this State that the administrator holds more than 30 days or deposits into an account that is not under the control
of the plan sponsor, health care service plan, health maintenance organization or insurer, must be placed in a special fiduciary
account, designated as an ATF. All resident and quasi-resident licensees required to maintain an ATF under this section shall
maintain the ATF with one or more financial institutions located within the State and subject to jurisdiction of the courts
of this State. Funds belonging to 2 or more plans may be held in the same ATF, provided the administrator's records clearly
indicate the funds belonging to each plan. Checks drawn on the ATF must indicate on the face of the checks that the checks
are drawn on the administrator's ATF.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
2. The administrator may make the following disbursements from the ATF:
A. Contributions and premiums due insurers or other persons providing life, accident and health, or workers' compensation coverage
for a plan;
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
B. Return contributions and premiums to a plan or covered individual;
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
C. Commissions or administrative fees due to the administrator when earned under a written agreement; and
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
D. Transfers into the CASA of the administrator.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
3. For each plan for which an ATF is required, the balance in the ATF must at all times be the amount deposited plus accrued
interest, if any, less authorized disbursements. If the balance at the financial institution, with respect to the ATF, is
less than the amount deposited plus accrued interest, if any, less authorized disbursements, the administrator is presumed,
for purposes of license revocation or suspension, to have misappropriated funds and to have acted in a financially irresponsible
manner.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
4. Before establishing an ATF that is interest bearing or income producing, the administrator shall disclose the nature of
the account to the plan sponsor, health care service plan, health maintenance organization or insurer on whose behalf the
funds are to be held. The administrator shall secure written consent and authorization from the plan sponsor, health care
service plan, health maintenance organization or insurer for the investment of the money and disposition of the interest or
earnings. An administrator may not make any investment that assumes a risk other than the risk that the obligor might not
pay the principal when due. The administrator may not use specialized techniques or strategies that incur additional risks
to generate higher returns or to extend maturities. Such techniques include, but are not limited to, the use of financial
futures or options, buying on margins and pledging of ATF balances.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
5. Administrators may place ATF funds in interest bearing or income producing investments and retain the interest or income
on the funds, provided the administrator obtains the prior written authorization of the plan sponsors, health care service
plans, health maintenance organizations or insurers on whose behalf the funds are to be held. In addition to savings and
checking accounts, an administrator may invest in the following:
A. Direct obligations of the United States or government agency securities with maturities of not more than one year;
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
B. Certificates of deposit, with a maturity of not more than one year, issued by financial institutions insured by the Federal
Deposit Insurance Corporation (FDIC) or Federal Savings and Loan Insurance Corporation (FSLIC), provided any such deposit
does not exceed the maximum level of insurance protection provided to certificates of deposit held by those institutions;
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
C. Repurchase agreements with financial institutions or government securities dealers recognized as primary dealers by the
Federal Reserve System provided:
(1) The value of the repurchase agreement is collateralized with assets that are allowable investments for ATF funds;
(2) The collateral has a market value, at the time the repurchase agreement is entered into, at least equal to the value
of the repurchase agreement; and
(3) The repurchase agreement does not exceed 30 days;
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
D. Commercial paper, provided the commercial paper is rated at least P-1 by Moody's Investors Service, Inc. or at least A-1
by Standard & Poor's Corporation; or
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
E. Money market funds, provided the money market fund invests exclusively in assets that are allowable investments pursuant
to paragraphs A to D for ATF funds.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
Each investment transaction must be made in the name of the administrator's ATF. The administrator shall maintain evidence
of any such investments. Each investment transaction must flow through the administrator's ATF.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
6. The administrator shall hold in a fiduciary capacity all money that the administrator receives to pay claims and claim adjustment
expenses. All resident and quasi-resident licensees shall place all such money for claims and claim adjustment expenses for
residents of this State, whether received from a plan sponsor, health care service plan, health maintenance organization or
insurer or from the administrator's ATF, in a special fiduciary account in a financial institution located in this State.
The account must be designated a CASA. Funds belonging to 2 or more plans may be held in the same CASA, provided the administrator's
records clearly indicate the funds belonging to each plan. Checks drawn on the CASA must indicate on the face of the checks
that the checks are drawn on the administrator's CASA.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
7. No deposit may be made into a CASA and no disbursement may be made from a CASA except for claims and claim adjustment expenses.
For each plan for which a CASA is required, the balance in the CASA must at all times be the amount deposited less claims
and claims adjustment expenses paid. If the CASA balance is less than that amount, the administrator shall be presumed, for
purposes of license revocation or suspension, to have misappropriated funds and to have acted in a financially irresponsible
manner.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
8. Administrators shall maintain detailed books and records that reflect all transactions involving the receipt and disbursement
of:
A. Contributions and premiums received on behalf of a plan sponsor, health care service plan, health maintenance organization
or insurer; and
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
B. Claims and claim adjustment expenses received and paid on behalf of a plan sponsor, health care service plan, health maintenance
organization or insurer.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
9. The detailed preparation, journalizing and posting of books and records required by subsection 8 must be maintained on a
timely basis and all journal entries for receipts and disbursements must be supported by evidential matter that must be referenced
in the journal entry so that receipts and disbursements may be traced for verification. Administrators shall prepare and
maintain monthly financial institution account reconciliations of any ATF and CASA established by the administrator. Reconciliation
of accounts is timely if accomplished not more than 45 days after the end of the month in which the transaction occurred.
The reconciliation must include, at a minimum, the following:
A. The source and amount of any money received and deposited by the administrator, and the date of receipt and deposit;
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
B. The date each disbursement was made, the person to whom the disbursement was made and a written explanation of any difference
between the amount disbursed and the amount billed or authorized; and
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
C. A description of the disbursement in sufficient detail to identify the source document substantiating the purpose of the
disbursement.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
10. Failure to accurately maintain the required books and records in a timely manner is deemed to be untrustworthy, hazardous
or injurious to participants in the plan or the public and financially irresponsible.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
The Revisor's Office cannot provide legal advice or
interpretation of Maine law to the public. If you need legal
advice, please consult
a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007
This page created on: 2005-10-01
Title 24-A - §1910. Unauthorized activities
Title 24-A: MAINE INSURANCE CODE
Chapter 18: INSURANCE ADMINISTRATORS (HEADING: PL 1989, c. 846, Pt. D, @2 (new))
§1910. Unauthorized activities
Nothing in this chapter may be construed to permit any person or entity to receive or collect charges, contributions or premiums
for, or adjust or settle claims in connection with, any type of life or accident or health benefit, unless the person or entity
is authorized through the insurance laws of a state or the Employee Retirement Income Security Act of 1974, 29 United States
Code, Section 1001, et seq. as amended, to provide those benefits.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
The Revisor's Office cannot provide legal advice or
interpretation of Maine law to the public. If you need legal
advice, please consult
a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007
This page created on: 2005-10-01
Title 24-A - §1911. Audits and examinations
Title 24-A: MAINE INSURANCE CODE
Chapter 18: INSURANCE ADMINISTRATORS (HEADING: PL 1989, c. 846, Pt. D, @2 (new))
§1911. Audits and examinations
The superintendent may designate examiners or consultants, as appropriate, to perform an audit of an administrator when the
superintendent considers an audit necessary. Administrators shall make all records and books of account available to the
examiners or consultants, and shall otherwise facilitate the performance of the audit. All claims information respecting
individual claimants must be kept confidential.
[1989, c. 846, Pt. D, §2 (new); Pt. E, §4 (aff).]
The Revisor's Office cannot provide legal advice or
interpretation of Maine law to the public. If you need legal
advice, please consult
a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007
This page created on: 2005-10-01
Title 24-A - §1912. Standardized claim forms
Title 24-A: MAINE INSURANCE CODE
Chapter 18: INSURANCE ADMINISTRATORS (HEADING: PL 1989, c. 846, Pt. D, @2 (new))
§1912. Standardized claim forms
All administrators who administer claims and who provide payment or reimbursement for diagnosis or treatment of a condition
or a complaint by a licensed health care practitioner must accept the current standardized claim form for professional services
approved by the Federal Government and submitted electronically. All administrators who administer claims and who provide
payment or reimbursement for diagnosis or treatment of a condition or a complaint by a licensed hospital must accept the current
standardized claim form for professional or facility services, as applicable, approved by the Federal Government and submitted
electronically. An administrator may not be required to accept a claim submitted on a form other than the applicable form
specified in this section and may not be required to accept a claim that is not submitted electronically, except from a health
care practitioner who is exempt pursuant to Title 24, section 2985. All services provided by a health care practitioner in
an office setting must be submitted on the standardized federal form used by noninstitutional providers and suppliers. Services
in a nonoffice setting may be billed as negotiated between the administrator and health care practitioner. For purposes of
this section, "office setting" means a location where the health care practitioner routinely provides health examinations,
diagnosis and treatment of illness or injury on an ambulatory basis whether or not the office is physically located within
a facility.
[2005, c. 97, §1 (amd).]
The Revisor's Office cannot provide legal advice or
interpretation of Maine law to the public. If you need legal
advice, please consult
a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007
This page created on: 2005-10-01
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