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Maine Bureau of Insurance
Form Filing Review Requirements Checklist
Health Insurance Applications

(Amended 11/2011)

REVIEW REQUIREMENTS

REFERENCE

DESCRIPTION OF REVIEW STANDARDS REQUIREMENTS

LOCATION OF STANDARD IN FILING

Classifications, Disclosure and Minimum Standards

Rule 755

Must comply with all applicable provisions of Rule 755 including, but not limited to, application requirements located in Sections 6, 7, and 8.

 

Content of disclosure authorization

24-A M.R.S.A. §2208

If the application contains a disclosure authorization it must contain the following: 1. Be signed by a consumer or authorized representative.  2.  Be written in plain language.  3.  Be dated.  4.  Specify the types of persons authorized to disclose information about the consumer.  5.  State the na6ture of the information to be disclosed (must exclude HIV).  6.  Names the regulated entities to which the consumer is authorizing the information to be disclosed.  Watch for applications which allow release of information to nonregulated entities, such as employers.  This would not be allowed.  7.  Specify the period of time the authorization is valid.  In the case of LTC the maximum time period is 30 months from the date the authorization is signed. In the case of health or medical insurance, the term of coverage of the policy and any renewals of that policy.  8.  Specify the purpose for which the information is collected.  9.  State that the consumer or authorized representative has a right to a copy of the authorization.  10.  Advise the consumer how to revoke the authorization and that revocation may be a basis for denying an application or a claim for benefits.  11.  Advise that failure to sign the authorization may impair the ability of a regulated insurance agency to evacuate claims or process applications and may be a basis for denying an application or claim for benefits.

 

Fraud warning

24-A M.R.S.A. §2186

All applications must contain the following statement, or similar statement: "It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines or a denial of insurance benefits."  Except for Reinsurers,

 

HIV/AIDS/ARC

24-A M.R.S.A. §2159

Disclosure authorizations should instruct providers not to disclose whether any test for HIV has been taken or the results of those tests using the following suggested caveat or a caveat of similar effect : "This authorization excludes divulging whether tests for the presence of the HIV antibody have been performed and excludes divulging the results of such tests.  Such test results shall not be disclosed or published.  Nothing in this caveat will prohibit this authorization from divulging the fact that the applicant has AIDS/ARC."
No application may ask health questions which require the applicant to reveal if any test for HIV has been taken or which require the applicant to reveal the results of such tests.  Questions or statements concerning any of the following must have a disclaimer: "any disorder," "blood disorder," "diagnosis or treatment," "immune system disorders," "sexually transmitted disease," "tests performed," "visits to a doctor/clinic/hospital," or any questions asking directly aboutAIDS or ARC.  A recommended disclaimer is: "Answer this (these) questions 'NO' if you have tested positive for HIV but have not developed either symptoms or the disease AIDS."  If there is more than one question to which this disclaimer applies, simply identify each such question with an asterisk.  An alternative acceptable disclaimer is "(EXCEPT FOR HIV)" inserted in the question.
Medical questions requiring the disclosure of AIDS/ARC may not have an historical period of time that is longer than other reportable conditions.

 

Limitations of Short Term Policy

24-A M.R.S.A. §2849-B(1) and (8)(B)

  • warning that applicant may purchase no more than two consecutive contracts, and that total short term policy is limited to 365 days aggregate
  • warning that policy does not count as “creditable coverage” for limiting preexisting conditions exclusions in individual health insurance issued to applicant after short term policy has terminated, together with disclosure that it is creditable to group policy.

 

Non-renewable clause

24-A M.R.S.A. §2849-B(8)(A)

In addition to application provisions for all health policies, warning that policy is not renewable and not subject to any limitation on preexisting conditions exclusions

 

SHORT TERM POLICY APPLICATIONS:

 

 

 

Single Application

Rule 750, Sec. 9

A single application must be used for all available individual & small group health plans. Application must list all deductible options available for all plans and must also contain options to purchase all benefits for which offers of coverage are mandated by law.

 

Third Party Notice, Cancellation and Reinstatement

Rule 580
24-A M.R.S.A. §2707-A
24-A M.R.S.A. §2847-C
24-A M.R.S.A. §5016

Third party notice of cancellation and reinstatement for cognitive impairment or functional incapacity.

 

 

Last Updated: August 22, 2012