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Maine.gov > PFR Home > Insurance Regulation > Company Services > Review Checklists > Group Life - L02G, L03G, L04G, L05G, L07G, L08

Maine Bureau of Insurance
Form Filing Review Requirements Checklist
Group Life

L02G, L03G, L04G, L05G, L07G, L08
(Amended 11/2011)

REVIEW REQUIREMENTS

REFERENCE

h3>DESCRIPTION OF REVIEW STANDARDS REQUIREMENTS

LOCATION OF STANDARD IN FILING

Employee Groups

24-A M.R.S.A.
§2603

Requirements for Employee Groups

 

Debtor Groups

24-A M.R.S.A. §2604-A

the lives of a group of individuals may be insured under a policy issued to a creditor or its parent holding company, trust, or trustee, or agent by 2 or more creditors, holding companies, affiliates, trustees, or agent considered the policyholder to insure debtors of the creditor.
The amount of credit life may not exceed the unpaid amount of the debt plus earned interest.
Credit card holders are not an acceptable group.
Copies of participation/joinder agreements of 2 or more participating debtors must be submitted.

 

Labor Union Groups

24-A M.R.S.A. §2605-A

Requirements for Labor Union Groups

 

Trustee Groups

24-A M.R.S.A. §2606-A

The lives of a group of individuals may be insured under a policy issued to a trust of a fund established or adopted  by 2 or more employers, labor unions, or similar employee organizations where the trust is considered the policyholder.
Copies of participation/joinder agreements for 2 or more participants must be submitted along with a copy of the trust document.

 

Association Groups

24-A M.R.S.A. §2607-A

The association shall have at the outset a minimum of 50 persons; shall have been organized and maintained in good faith for purposes other than that of obtaining insurance; shall have been in existence for at least 2 years; and shall have a constitution and by-laws that provide: That the association holds regular meetings not less than annually to further the purposes of the members; that the association collects dues or solicits contributions from members; and that the members have voting privileges and representation on the governing board and committees.
Copies of the constitution and by-laws must be submitted. Articles of incorporation, etc. are also helpful.

 

Credit Union Groups

24-A M.R.S.A. §2610-A

The lives of a group of individuals may be insured under a policy issued to a credit union or to a trust, or agent designated by 2 or more credit unions.
Copies of participation/joinder agreements for 2 or more credit unions must be submitted.

 

Other Groups

24-A M.R.S.A. §2612-A

Other Groups - (other than those groups as described above) No group life insurance shall be delivered in this State unless:
A. The policyholder is a bona fide group formed for purposes other than the procurement of insurance;
B. The insurance of the group policy would be actuarially sound;
C. The issuance of the group policy would result in economies of acquisition or administration; and
D. The benefits are reasonable in relation to the premiums charged.
Note: All four above-listed conditions must be met. Actuarial memorandums and rates are required for review.

 

Dependent Coverage

24-A M.R.S.A.
§ 2611-A

Except for a policy issued under § 2604-A, a group life policy may insure the lives of spouses and dependents.

 

Insurability

24-A M.R.S.A.
§ 2617

The policy shall contain a provision setting forth the conditions under which the insurer reserves the right to require E of I satisfactory to the insurer.
Insurer may exclude or limit coverage on any person if E of I is not satisfactory §2603, §2604-A, §2605-A, § 2606-A, § 2607-A, § 2610-A. § 2611-A, and § 2612-A

 

Grace Period

24-A M.R.S.A.
§ 2614

The policyholder is entitled to a grace period of 31 days for the payment of any premium due.
Policy must remain inforce during the grace period.

 

Incontestability

24-A M.R.S.A.
§ 2615

The group life insurance policy shall contain a provision that the validity of the policy shall not be contested, except for non-payment of premium, after it has been inforce for two (2) years from its date of issue.
Note: fraud language is not permitted in Maine's incontestability provision.

 

Representations

24-A M.R.S.A.
§ 2616

All statements made by the policyholder shall be deemed representations and not warrantees.

 

 

Misstatement of Age

24-A M.R.S.A.
§ 2618

Policy shall contain a provision specifying an equitable adjustment of premiums or of benefits or both to be made in the event the age of a person has been misstated. A clear statement of the method of adjustment is required.

 

Payment of Benefits

24-A M.R.S.A.
§ 2619

A provision is required that any sum becoming due by reason of the death of the insured shall be payable to the beneficiary, except that where the policy contains conditions pertaining to family status, the beneficiary may be the family member specified by the policy terms. In the event that there is no beneficiary, a sum not exceeding $2000 may be paid to any person appearing to the insurer to be equitably entitled there to by reason of having incurred funeral or other expenses incident to the last illness or death of the insured.

 

Information as to Insurance

24-A M.R.S.A.
§ 2620

The group life policy shall contain a provision that the insurer will issue to the policyholder for delivery to each person insured printed information as to the insurance protection and benefits.

 

Information to Debtor

24-A M.R.S.A.
§ 2624

A policy insuring the lives of debtors shall contain a provision that the insurer will furnish to the policyholder for delivery to each debtor, a certificate describing the coverage and specifying that the death benefit shall first be applied to reduce or extinguish the debt.

 

Conversion on Termination of Eligibility

24-A M.R.S.A.
§2621

Provision that if the insurance, or any portion of it, on covered person or dependent, ceases because of termination of employment, such person is entitled to have issued without E of I, an individual policy of life insurance without disability or other supplementary benefits, provided application for the individual policy is made and the first premium is paid within 31 days after such termination.

 

Conversion on Termination of Policy

24-A M.R.S.A.
§2622

Provision that if the policy terminates or is amended so as to terminate the insurance of any class, every person insured at the date of termination (including dependents) and who has been insured for at least five (5) years, is entitled to have an individual policy subject to the same conditions and limitations as outlined in § 2621, except that the policy shall not exceed the smaller of 1. The amount of the person's life insurance protection ceasing because of the termination, less the amount of any life insurance for which he becomes eligible under a group policy issued or reinstated by the same or another insurer within 31 days after such termination; and 2. $10,000.

 

Death Pending Conversion

24-A M.R.S.A.
§2623

Provision that if a person insured under the policy (or dependent), dies during the period within which he would have been entitled to an individual policy and before such policy becomes effective, the amount of life insurance which he would have been entitled to under the individual policy shall be payable as a claim under the group policy, whether or not the application or payment of the first premium has been made.

 

Notice of Conversion Right

24-A M.R.S.A.
§2625

If any individual insured becomes entitled to have an individual policy issued without E of I, and is not given notice of rights at least 15 days prior to the expiration of the conversion period, then the individual will have an additional period to exercise this right. The additional period expires 15 days after the individual is given notice but in no event will extend beyond 60 days.
Written notice mailed by the policyholder to the individual at the last known address shall constitute notice.

 

Nonforfeiture

24-A M.R.S.A.
§2613

SNFO required for individual life insurance policies do not apply to group life; however, a group life policy, other than term, must contain a nonforfeiture option that is equitable to the insured persons and to the policyholder.

 

Total Disability

24-A M.R.S.A.
§2628

When active employment is a condition of insurance, the group life policy shall contain a provision that an insured may continue coverage during the insured's total disability by timely payment to the policyholder of that portion, if any, of the premium that would have been required from the insured had the total disability not occurred. The continuation shall be on a premium paying basis for a period of six (6) months from the date of disability, but not beyond the earlier of:
1. Approval of the insurer under any disability provision which the group policy may contain; or
2. The discontinuance of the group policy.

 

AIDS/ARC/HIV

24-A M.R.S.A.
§ 2629

No group life insurance policy may provide more restrictive coverage for death resulting from AIDS, ARC, or HIV-related diseases than the death resulting from any other disease or sickness or exclude coverage for death resulting from AIDS, ARC, or HIV-related diseases, except through an exclusion under which deaths resulting from all sicknesses and diseases are treated the same.
See also 24-A M.R.S.A. § 2159(4) for further information on unfair discrimination.

 

Other

24-A M.R.S.A.
§2619 - §2623
and §2628

Note: Sections 2619 to 2623 and section 2628 do not apply to policies insuring the lives of debtors.

 

Suicide

 

 

24-A M.R.S.A.
§ 2630

 

 

A group life insurance policy delivered or issued for delivery in this State may not contain a more restrictive exclusion from liability for death resulting from suicide than death by suicide, while sane or insane, within 2 years from the date coverage commences or within 2 years of an increase in coverage.

 

AIDS and Medical Lifestyle Standards

Rule 490

The purpose of this rule is to clarify the standards applicable to written informed consent forms required to be completed by persons required to take a test for the presence of the antibody to the Human Immunodeficiency Virus (HIV) or for the Human Immunodeficiency Antigen by an insurer, nonprofit hospital service organization, nonprofit medical service organization, or a nonprofit health care plan, to establish standards for pretest and post-test counseling required to be provided to persons subject to testing as required by 5 M.R.S.A. Section 19203-A, and to establish standards for medical and lifestyle application questions and underwriting.

 

Stranger Originated Life Insurance

24-A M.R.S.A. §6802-A(6) and §6802-A(12-A)

It is a fraudulent act for an insurance company or viatical settlement provider to commit, or permit its employees or its agents to engage in entering into stranger-originated life insurance.

"Stranger-originated life insurance" means an act or practice to initiate a life insurance policy for the benefit of a person who, at the time of the origination of the policy, has no insurable interest in the insured. "Stranger-originated life insurance" includes, but is not limited to, cases in which life insurance is purchased with resources or guarantees from or through a person who, at the time of the inception of the policy, could not lawfully initiate the policy and when, at the time of policy inception, there is an arrangement or agreement to directly or indirectly transfer the ownership of the policy or the policy benefits to another person. A trust that is created to give the appearance of insurable interest and is used to initiate policies for investors violates insurable interest laws and the prohibition against wagering on life.”

 

Last Updated: August 22, 2012