§405-A. Certification of regional insurers or health maintenance organizations to transact individual health insurance

Link to law: http://legislature.maine.gov/legis/statutes/24-A/title24-Asec405-A.html
Published: 2015

§405-A. Certification of regional insurers or health maintenance organizations to transact
individual health insurance








1. Regional insurer or health maintenance organization defined. 
As used in this section, "regional insurer or health maintenance organization" means
an insurer or health maintenance organization that holds a valid certificate of authority
to transact individual health insurance in Connecticut, Massachusetts, New Hampshire, Rhode Island or Vermont.


[
2013, c. 388, Pt. B, §1 (AMD)
.]








2. Certification of regional insurers or health maintenance organizations. 
A regional insurer or health maintenance organization may not transact individual
health insurance in this State by mail, the Internet or otherwise unless the superintendent
has issued a certification that the regional insurer or health maintenance organization
has met the requirements of this subsection. The superintendent shall issue a certification
or deny certification within 30 days of a request.





A. A policy, contract or certificate of individual health insurance offered for sale
in this State by a regional insurer or health maintenance organization must comply
with the applicable individual health insurance laws in the state of domicile of that
regional insurer and must be actively marketed in that state. [2011, c. 90, Pt. C, §3 (NEW).]










B. A regional insurer or health maintenance organization shall meet the requirements
of section 4302 for reporting plan information with respect to individual health plans
offered for sale in this State and disclose to prospective enrollees how the health
plans differ from individual health plans offered by domestic insurers in a format
approved by the superintendent. Health plan policies and applications for coverage
must contain the following disclosure statement or a substantially similar statement
on the face page of the policy or application in a type size of at least 14 points
and font that is easily readable by a person with average eyesight: "This policy is issued by a regional insurer or health maintenance organization
and is governed by the laws and rules of (regional insurer's or health maintenance
organization's state of domicile). This policy may not be subject to all the insurance
laws and rules of the State of Maine, including coverage of certain health care services
or benefits mandated by Maine law. Before purchasing this policy, you should carefully
review the terms and conditions of coverage under this policy, including any exclusions
or limitations of coverage." [2013, c. 388, Pt. B, §2 (AMD).]










C. A regional insurer or health maintenance organization shall meet the requirements
of section 4303, subsection 4 for grievance procedures with respect to health plans
offered for sale in this State. [2011, c. 90, Pt. C, §3 (NEW).]










D. A regional insurer or health maintenance organization shall meet the requirements
of chapter 56-A for provider network adequacy with respect to health plans offered
for sale in this State. [2011, c. 90, Pt. C, §3 (NEW).]










E. A regional insurer or health maintenance organization shall meet the requirements
of chapter 33 with respect to rates for individual health plans offered for sale in
this State. [2011, c. 90, Pt. C, §3 (NEW).]










F. A regional insurer or health maintenance organization shall designate an agent for
receiving service of legal documents or process in the manner provided in this Title. [2011, c. 90, Pt. C, §3 (NEW).]










G. A regional insurer or health maintenance organization shall meet the requirements
of this Title with respect to allowing the superintendent access to records of the
regional insurer or health maintenance organization. [2011, c. 90, Pt. C, §3 (NEW).]







[
2013, c. 388, Pt. B, §2 (AMD)
.]








3. Unfair trade practices. 
The provisions of chapter 23 apply to a regional insurer or health maintenance organization
permitted to transact individual health insurance under this section or section 405.


[
2011, c. 90, Pt. C, §3 (NEW)
.]








4. Taxes; assessments. 
A regional insurer or health maintenance organization transacting individual health
insurance in this State under this section is subject to applicable taxes or assessments
imposed on insurers transacting individual health insurance in this State pursuant
to this Title and Title 36.


[
2011, c. 90, Pt. C, §3 (NEW)
.]








5. Compliance with court orders. 
A regional insurer or health maintenance organization transacting individual health
insurance in this State under this section shall comply with lawful orders from courts
of competent jurisdiction issued in a voluntary dissolution proceeding or in response
to a petition for an injunction by the superintendent asserting that the regional
insurer or health maintenance organization is in a hazardous financial condition.


[
2011, c. 90, Pt. C, §3 (NEW)
.]








6. Exemption from other requirements. 
Except as expressly provided in this section, the requirements of this Title do
not apply to a regional insurer or health maintenance organization permitted to transact
individual health insurance under this section.


[
2011, c. 90, Pt. C, §3 (NEW)
.]








7. Agreement with insurance regulators in other state. 
The superintendent shall enter into a memorandum of understanding or other agreement
with the insurance department of the state of domicile of a regional insurer or health
maintenance organization permitted to transact individual health insurance in this
State under this section with respect to enforcement of the provisions of this section.



[
2011, c. 90, Pt. C, §3 (NEW)
.]








8. Sale of policies. 
An individual health insurance policy, contract or certificate may not be offered
for sale in this State pursuant to this section before January 1, 2014.


[
2011, c. 90, Pt. C, §3 (NEW)
.]





SECTION HISTORY

2011, c. 90, Pt. C, §3 (NEW).
2013, c. 388, Pt. B, §§1, 2 (AMD).
Read Entire Law on legislature.maine.gov