 |
 |
| Title
5. Administrative Procedures And Services | | Title
9-a. Maine Consumer Credit Code | | Title
9. Banks And Financial Institutions | | Title 01. General Provisions | | Title 02. Executive | | Title 03. Legislature | | Title 04. Judiciary | | Title 05. Administrative Procedures And Services | | Title 06. Aeronautics | | Title 07. Agriculture And Animals | | Title 08. Amusements And Sports | | Title 09-a. Maine Consumer Credit Code | | Title 09-b. Financial Institutions | | Title 09. Banks And Financial Institutions | | Title 10. Commerce And Trade | | Title 11. Uniform Commercial Code | | Title 12. Conservation | | Title 13-a. Maine Business Corporation Act (heading. Pl 2001, C. 640, Pt. A, @1 (rp); Pt. B, @7 (aff)) | | Title 13-b. Maine Nonprofit Corporation Act | | Title 13-c. Maine Business Corporation Act (heading. Pl 2001, C. 640, Pt. A, @2 (new); Pt. B, @7 (aff)) | | Title 13. Corporations | | Title 14. Court Procedure -- Civil | | Title 15. Court Procedure -- Criminal | | Title 16. Court Procedure -- Evidence | | Title 17-a. Maine Criminal Code | | Title 17. Crimes | | Title 18-a. Probate Code | | Title 18-b. Trusts (heading. Pl 2003, C. 618, Pt. A, @1 (new); @2 (aff) Effective 7-1-05) | | Title 18. Decedents' Estates And Fiduciary Relations | | Title 19-a. Domestic Relations (heading. Pl 1995, C. 694, Pt. B, @2 (new); Pt. E, @2 (aff)) | | Title 19. Domestic Relations (heading. Repealed 10-1-97 By Pl 1995, C. 694, Pt. B, @1 (rp); Pt. E, @2 (aff)) | | Title 20-a. Education | | Title 20. Education | | Title 21-a. Elections | | Title 21. Elections | | Title 22-a. Health And Human Services (heading. Pl 2003, C. 689, Pt. A, @1 (new)) | | Title 22. Health And Welfare | | Title 23. Highways | | Title 24-a. Maine Insurance Code | | Title 24. Insurance | | Title 25. Internal Security And Public Safety | | Title 26. Labor And Industry | | Title 27. Libraries, History, Culture And Art | | Title 28-a. Liquors (heading. Pl 1987, C. 45, Pt. A, @4 (new)) | | Title 28. Liquors (heading. Pl 1987, C. 45, Pt. A, @3 (rp)) | | Title 29-a. Motor Vehicles (heading. Pl 1993, C. 683, Pt. A, @2 (new); Pt. B, @5 (aff)) | | Title 29. Motor Vehicles (heading. Pl 1993, C. 683, @1 (rp); Pt. B, @5 (aff)) | | Title 31. Partnerships And Associations | | Title 32. Professions And Occupations | | Title 33. Property | | Title 34-a. Corrections | | Title 34-b. Behavioral And Developmental Services (heading. Pl 1995, C. 560, Pt. K, @7 (rpr); 2001, C. 354, @3 (amd)) | | Title 34. Public Institutions And Corrections (heading. Pl 1983, C. 459, @5 (rp)) | | Title 36. Taxation | | Title 37-a. Department Of Defense And Veterans Services | | Title 37-b. Defense, Veterans And Emergency Management (heading. Pl 1997, C. 455, @9 (rpr)) | | Title 37. Veterans' Services | | Title 38. Waters And Navigation | | Title 39-a. Workers' Compensation (enacted By Pl 1991, C. 885, Pt. A, @8) | | Title 39. Workers' Compensation (repealed By Pl 1991, C. 885, Pt. A, @7) |
|
|
|
|
| search a lawyer |
|
|
| ACTS, STATUTES |
|
|
|
|
|
|
|
|
|
|
|
|
| Home > Statutes > Usa Maine |
|
USA Statutes : maine
Title : Title 24-A. MAINE INSURANCE CODE
Chapter : Chapter 68. NURSING HOME CARE AND LONG-TERM CARE INSURANCE POLICIES
|
|
Title 24-A - §5051-A. Required and prohibited provisions
Title 24-A: MAINE INSURANCE CODE
Chapter 68: NURSING HOME CARE AND LONG-TERM CARE INSURANCE POLICIES
§5051-A. Required and prohibited provisions
1. Prohibited provisions. A long-term care policy may not:
A. Contain coverage for skilled nursing facilities only;
[1989, c. 556, Pt. B, §3 (new).]
B. Exclude coverage for skilled, intermediate or custodial care received by a resident of a skilled nursing or intermediate
care facility;
[1989, c. 556, Pt. B, §3 (new).]
C. Require a prior hospital stay as a condition for any policy benefits;
[1989, c. 556, Pt. B, §3 (new).]
D. Require a prior skilled nursing facility stay as a condition for intermediate care facility benefits; or
[1989, c. 556, Pt. B, §3 (new).]
E. Require prior institutionalization as a condition of receipt of home health care benefits.
[1989, c. 556, Pt. B, §3 (new).]
[1989, c. 556, Pt. B, §3 (new).]
2. Required provisions. A long-term care policy must provide:
A. Custodial care benefits that are at least 50% of those provided for skilled nursing care in a nursing facility provided
that the benefits need not exceed usual, customary and reasonable charges;
[1989, c. 556, Pt. B, §3 (new).]
B. Benefits for home health care services rendered by a home health care provider;
[1989, c. 556, Pt. B, §3 (new).]
C. Home health care coverage for at least 90 visits in any continuous 12-month period during which coverage is in force; and
[1989, c. 556, Pt. B, §3 (new).]
D. Per visit benefits for home health care services which are at least 50% of the daily benefit for skilled nursing facility
confinement provided that the benefit need not exceed usual, customary and reasonable charges.
[1989, c. 556, Pt. B, §3 (new).]
[1989, c. 556, Pt. B, §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 - §5051-B. Alternative policies
Title 24-A: MAINE INSURANCE CODE
Chapter 68: NURSING HOME CARE AND LONG-TERM CARE INSURANCE POLICIES
§5051-B. Alternative policies
1. Innovative long-term care products permitted. Notwithstanding section 5051-A, an insurer, organization or plan may offer a long-term care policy, within the meaning
of section 5051, subsection 1, which does not meet one or more of the requirements of section 5051-A if the Superintendent
of Insurance finds that:
A. For each requirement of section 5051-A which is not satisfied, there is a valid reason why that requirement is inappropriate
for the policy design in question;
[1989, c. 556, Pt. B, §3 (new).]
B. The total package of benefits provided is at least as comprehensive as that required by section 5051-A; and
[1989, c. 556, Pt. B, §3 (new).]
C. Availability of the policy would be in the best interest of the public taking into consideration the following factors:
(1) Whether the policy accomplishes the goal of providing dependable benefits for long-term care; and
(2) Whether the plans for marketing the policy contain adequate safeguards to minimize any confusion that may be caused to
consumers by the failure of the policy to fall within the established guidelines of this section.
[1989, c. 556, Pt. B, §3 (new).]
[1989, c. 556, Pt. B, §3 (new).]
2. Qualifications for tax incentives. If the superintendent finds that a policy meets the criteria of subsection 1, the superintendent, in determining whether
to certify the policy for tax incentives under section 5054, shall consider the policy to comply with each of the requirements
of section 5051-A.
[1989, c. 556, Pt. B, §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 - §5051. Definitions
Title 24-A: MAINE INSURANCE CODE
Chapter 68: NURSING HOME CARE AND LONG-TERM CARE INSURANCE POLICIES
§5051. Definitions
As used in this chapter, unless the context indicates otherwise, the following terms have the following meanings.
[1985, c. 648, §12 (new).]
1. Long-term care policy. "Long-term care policy" means a group or individual policy of health insurance, a subscriber contract of a nonprofit hospital
or medical service organization or nonprofit health care plan or a life insurance rider which is advertised, marketed or designed
primarily to provide coverage for not less than 12 consecutive months for each covered person on an expense-incurred basis,
indemnity basis, prepaid or other basis for one or more necessary or medically necessary diagnostic, preventive, therapeutic,
rehabilitative, maintenance or personal care services, provided in a setting other than an acute care unit of a hospital.
The term does not include:
A. A policy or contract defined as Medicare supplement insurance pursuant to chapter 67;
[1985, c. 648, §12 (new).]
B. A policy or contract issued prior to October 1, 1990, to one or more employers or labor organizations or of the trustees
of a fund established by one or more employers or labor organizations, or combination of both, or for members or former members,
or combination of both, of the labor organizations;
[1989, c. 556, Pt. B, §1 (amd).]
C. A policy or contract issued prior to October 1, 1990, to any professional, trade or occupational association for its members,
former members or retired members or combination of all members, if the association:
(1) Is composed of individuals all of whom are actively engaged in the same profession, trade or occupation;
(2) Has been maintained in good faith for purposes other than obtaining insurance; and
(3) Has been in existence for at least 2 years prior to the date of its initial offering of the policy or plan to its members;
and
[1989, c. 556, Pt. B, §1 (amd).]
D. Individual policies or contracts issued pursuant to a conversion privilege under a policy or contract of group or individual
insurance when that group or individual policy or contract:
(1) Was issued prior to October 1, 1990; and
(2) Includes provisions which are inconsistent with the requirements of this chapter; and
[1989, c. 556, Pt. B, §1 (rpr).]
E. A policy or contract offered primarily to provide basic hospital expense coverage, basic medical-surgical expense coverage,
hospital confinement indemnity coverage, major medical expense coverage, disability income protection, accident-only coverage,
specified disease or specified accident coverage, home health care coverage or limited benefit health coverage.
[1997, c. 604, Pt. D, §1 (amd).]
[1997, c. 604, Pt. D, §1 (amd).]
2. Nursing home. "Nursing home" means any facility located in this State which is licensed by the Department of Health and Human Services
as a skilled nursing facility or intermediate care facility and any equivalent facility located in another state or country
and licensed according to the laws of that jurisdiction.
[1985, c. 648, §12 (new); 2003, c. 689, Pt. B, §6 (rev).]
3. Nursing home care policy. "Nursing home care policy" means a group or individual policy of health insurance or a subscriber contract of a nonprofit
hospital or medical service organization or nonprofit health care plan which is advertised, marketed or designed primarily
to provide benefits on either an expense-incurred or indemnity basis for confinements or costs associated with confinements
of a covered person in a nursing home. For purposes of this definition, a policy is deemed to primarily provide nursing home
benefits if 50% or more of benefits payable or anticipated to be payable under the policy are related to nursing home confinements.
The term does not include:
A. A policy or contract defined as Medicare supplement insurance pursuant to chapter 67;
[1985, c. 648, §12 (new).]
B. A policy or contract issued to one or more employers or labor organizations or of the trustees of a fund established by
one or more employers or labor organizations, or combination of both, or for members or former members, or combination of
both, of the labor organizations;
[1985, c. 648, §12 (new).]
C. A policy or contract issued to any professional, trade or occupational association for its members, former members or retired
members, or combination of members if, the association:
(1) Is composed of individuals all of whom are actively engaged in the same profession, trade or occupation;
(2) Has been maintained in good faith for purposes other than obtaining insurance; and
(3) Has been in existence for at least 2 years prior to the date of its initial offering of the policy or plan to its members;
or
[1985, c. 648, §12 (new).]
D. Individual policies or contracts issued pursuant to a conversion privilege under a policy or contract of group or individual
insurance, when such group or individual policy or contract includes provisions which are inconsistent with the requirements
of this chapter.
[1985, c. 648, §12 (new).]
[1985, c. 648, §12 (new).]
3-A. Home health care policy. "Home health care policy" means a group or individual policy of health insurance or a subscriber contract of a nonprofit
hospital or medical service organization or nonprofit health care plan that is advertised, marketed or designed primarily
to provide benefits on either an expense-incurred or indemnity basis for confinements or costs associated with home health
care services. For purposes of this definition, a policy is deemed to provide primarily home health care benefits if 50%
or more of benefits payable or anticipated to be payable under the policy are related to home health care services. The term
does not include:
A. A policy or contract defined as Medicare supplement insurance pursuant to chapter 67;
[1997, c. 604, Pt. D, §2 (new).]
B. A policy or contract issued to one or more employers or labor organizations or to the trustees of a fund established by
one or more employers or labor organizations, or combination of both, or for members or former members, or combination of
both, of the labor organizations;
[1997, c. 604, Pt. D, §2 (new).]
C. A policy or contract issued to any professional, trade or occupational association for its members, former members or retired
members, or combination of members, if the association:
(1) Is composed of individuals all of whom are actively engaged in the same profession, trade or occupation;
(2) Has been maintained in good faith for purposes other than obtaining insurance; and
(3) Has been in existence for at least 2 years prior to the date of its initial offering of the policy or plan to its members;
or
[1997, c. 604, Pt. D, §2 (new).]
D. Individual policies or contracts issued pursuant to a conversion privilege under a policy or contract of group or individual
insurance, when that group or individual policy or contract includes provisions that are inconsistent with the requirements
of this chapter.
[1997, c. 604, Pt. D, §2 (new).]
[1997, c. 604, Pt. D, §2 (new).]
4. Home health care provider. "Home health care provider" has the same meaning as set forth in section 2745.
[1989, c. 556, Pt. B, §2 (new).]
5. Home health care services. "Home health care services" has the same meaning as set forth in section 2745, subsections 1 and 2, except that the requirements
of section 2745, subsection 1, paragraph A shall not apply.
[1989, c. 556, Pt. B, §2 (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 - §5052-A. Trial examination period
Title 24-A: MAINE INSURANCE CODE
Chapter 68: NURSING HOME CARE AND LONG-TERM CARE INSURANCE POLICIES
§5052-A. Trial examination period
Nursing home care, home health care and long-term care policies must have a notice prominently printed on the first page of
the policy or certificate or attached to the first page stating in substance that the applicant has the right to return the
policy or certificate within 30 days of its delivery and to have the premium refunded if for any reason, after examination
of the policy or certificate, the applicant is not satisfied.
[1997, c. 604, Pt. D, §4 (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
Title 24-A - §5052. Specific standards
Title 24-A: MAINE INSURANCE CODE
Chapter 68: NURSING HOME CARE AND LONG-TERM CARE INSURANCE POLICIES
§5052. Specific standards
1. Standards for long-term care, home health care and nursing home care policies. The superintendent may adopt rules to establish specific standards for policy provisions of long-term care, home health
care and nursing home care policies. The standards must be in addition to and in accordance with applicable laws of this
State, including chapters 33 and 35, and may include, but are not limited to:
A. Terms of renewability;
[1985, c. 648, § 12 (new).]
B. Initial and subsequent conditions of eligibility;
[1985, c. 648, § 12 (new).]
C. Nonduplication of coverage;
[1985, c. 648, § 12 (new).]
D. Probationary periods;
[1985, c. 648, § 12 (new).]
E. Benefit limitations, exceptions and reductions;
[1985, c. 648, § 12 (new).]
F. Elimination periods;
[1985, c. 648, § 12 (new).]
G. Requirements for replacement;
[1985, c. 648, § 12 (new).]
H. Recurrent confinements; and
[1985, c. 648, § 12 (new).]
I. Definition of terms.
[1985, c. 648, § 12 (new).]
[1997, c. 604, Pt. D, §3 (amd).]
2. Prohibited policy provision. The superintendent may adopt rules that specify prohibited provisions not otherwise specifically authorized by law that,
in the opinion of the superintendent, are unjust, unfair, inequitable or unfairly discriminatory to any person insured or
proposed for coverage under a long-term care, home health care or nursing home care policy.
[1997, c. 604, Pt. D, §3 (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
Title 24-A - §5053. Rulemaking, disclosure standards, compensation
Title 24-A: MAINE INSURANCE CODE
Chapter 68: NURSING HOME CARE AND LONG-TERM CARE INSURANCE POLICIES
§5053. Rulemaking, disclosure standards, compensation
The superintendent may adopt reasonable rules to provide for the full and fair disclosure of information in connection with
the sale of long-term care, home health care and nursing home care policies, including, but not limited to, an outline of
coverage requirements and requirements relating to the replacement sale of the policies and compensation or commission to
an agent or representative for the sale of a nursing home care, home health care or long-term care policy or certificate.
[1997, c. 604, Pt. D, §5 (amd).]
div>
The superintendent may adopt reasonable rules setting or limiting the rate of compensation or commission to an agent or other
representative for the sale of a nursing home care, home health care or long-term care policy or certificate and regarding
replacement sale of a nursing home care, home health care or long-term care policy or certificate.
[1997, c. 604, Pt. D, §5 (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
Title 24-A - §5054. Certification by superintendent
Title 24-A: MAINE INSURANCE CODE
Chapter 68: NURSING HOME CARE AND LONG-TERM CARE INSURANCE POLICIES
§5054. Certification by superintendent
1. Filing of form. Any insurer, nonprofit hospital or medical service organization, or nonprofit health care plan may, at the time it files
a policy or contract for approval for issuance or delivery in the State, or at any time thereafter, request that the superintendent
certify the policy or contract as a long-term care policy within the meaning of section 5051.
Within 60 days of receipt of a request for certification, the superintendent shall:
A. Certify in writing that the policy or contract complies with this section;
[1989, c. 556, Pt. B, §4 (new).]
B. Deny the request in writing, stating the reasons for denial; or
[1989, c. 556, Pt. B, §4 (new).]
C. Notify the insurer or nonprofit hospital or medical service organization or nonprofit health care plan, in writing, that
an insufficient basis exists for determining whether a certification should be made, indicating in what respects the request
was insufficient.
[1997, c. 604, Pt. D, §6 (amd).]
[1997, c. 604, Pt. D, §6 (amd).]
2. Standards for compliance. The superintendent shall certify a policy or contract submitted for review under this section as a long-term care policy
if the superintendent finds that the policy or contract:
A. Is a long-term care policy within the meaning of section 5051; and
[1989, c. 556, Pt. B, §4 (new).]
B. Complies with all standards applicable to long-term care policies as set forth in this chapter and in chapters 27, 33 and
35 and in rules adopted pursuant to any of those chapters by the superintendent. Waivers granted under the rules shall be
taken into consideration.
[1989, c. 556, Pt. B, §4 (new).]
[1989, c. 556, Pt. B, §4 (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 - §5055. Tax incentives available
Title 24-A: MAINE INSURANCE CODE
Chapter 68: NURSING HOME CARE AND LONG-TERM CARE INSURANCE POLICIES
§5055. Tax incentives available
1. Reduced premium tax. Any insurance company choosing to offer an insurance policy which is certified by the superintendent as a long-term care
policy shall qualify for the reduced tax on premiums collected under Title 36, section 2513.
[1989, c. 556, Pt. B, §4 (new).]
2. Income tax reduction. Any person paying premiums for a policy or contract which is certified by the superintendent as a long-term care policy
shall qualify for the income tax deduction provided for in Title 36, section 5122.
[1989, c. 556, Pt. B, §4 (new).]
3. Credit for employers. An employer providing long-term care benefits to its employees may qualify for the tax credit provided by Title 36, section
2525 or 5217-B.
[1989, c. 556, Pt. B, §4 (new).]
4. Life insurance riders. With respect to life insurance riders that qualify as long-term care policies, the tax incentives provided by this section
shall apply only to that portion of the premium attributable to the rider.
[1989, c. 556, Pt. B, §4 (new).]
5. Provision of records. Any person who holds a group long-term care policy pursuant to or under which premiums are paid in whole or in part by certificate
holders or other 3rd parties shall provide to those certificate holders or 3rd parties adequate and timely records to enable
those persons to have knowledge of the tax reduction to which they may be entitled under subsection 2 and under Title 36,
section 5122.
[1989, c. 556, Pt. B, §4 (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 - §5056. Standards for marketing
Title 24-A: MAINE INSURANCE CODE
Chapter 68: NURSING HOME CARE AND LONG-TERM CARE INSURANCE POLICIES
§5056. Standards for marketing
Every insurer, health care service plan or other entity marketing nursing home care, home health care or long-term care insurance
coverage in this State, directly or through its producers, shall:
[1997, c. 604, Pt. D, §7 (amd).]
1. Policy comparison. Establish marketing procedures to ensure that any comparison of policies by its agents or other producers is fair and accurate;
[1991, c. 200, Pt. C, §3 (new).]
2. Excessive insurance. Establish marketing procedures to ensure that excessive insurance is not sold or issued. The procedures must include a
specific standard for persons covered by Medicaid;
[1991, c. 200, Pt. C, §3 (new).]
3. Replacement policy. Establish marketing procedures that set forth a mechanism or formula for determining whether a replacement policy or certificate
contains benefits clearly and substantially greater than the benefits under the replaced policy; and
[1991, c. 200, Pt. C, §3 (new).]
4. Compliance procedures. Establish auditable procedures for verifying compliance with the standards set out in this section.
[1991, c. 200, Pt. C, §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 - §5057. Applicability
Title 24-A: MAINE INSURANCE CODE
Chapter 68: NURSING HOME CARE AND LONG-TERM CARE INSURANCE POLICIES
§5057. Applicability
This chapter applies only to policies and certificates issued before January 1, 2000.
[1999, c. 292, §1 (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
|
|
|
|
