02-031-755 Me. Code R. § 3

Current through 2024-46, November 13, 2024

Section 031-755-3 - Applicability and Scope

A. This rule applies to all individual health insurance policies and group health policies and certificates, delivered or issued for delivery in this state on or after January 1, 2005, that are not specifically exempted from this rule.

B. This rule shall apply to dental plans and vision plans only as specified.

C. This rule shall not apply to:

(1) Individual policies or contracts issued pursuant to a conversion privilege under a policy or contract of group or individual insurance when the group or individual policy or contract includes provisions that are inconsistent with the requirements of this rule. For purposes of this rule, "conversion privilege" means a provision allowing an individual no longer eligible for coverage under the policy, such as a covered child who reaches the maximum age for coverage as a dependent, to obtain similar coverage under a new policy;

(2) Policies issued to employees or members as additions to franchise plans in existence on the effective date of this rule. For purposes of this rule, "franchise plans" are those issued pursuant to 24-A M.R.S.A. §2740 prior to its repeal;

(3) Medicare supplement policies as defined in 24-A M.R.S.A. §5001(4);

(4) Long-term care insurance policies as defined in 24-A M.R.S.A. §§5051(1) or 5072(3);

(5) Policies designed to supplement TRICARE or Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) (Chapter 55 of title 10 of the United States Code);

(6) Consumer credit insurance as defined in 24-A M.R.S.A. §2853(2-C);

(7) Legal services insurance as defined in 24-A M.R.S.A. §2883;

(8) Group disability income policies and certificates; or

(9) Health maintenance organization contracts subject to 24-A M.R.S.A. Chapter 56.

D. The requirements contained in this rule shall be in addition to those contained in any other applicable statutes and rules including, but not limited to, 24-A M.R.S.A. Chapters 27, 32, 33, 35, 36 and 56-A and Rules 140, 320, 330, 360, 530, 590, 600, 850 and 940.

02-031 C.M.R. ch. 755, § 3