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Form Filing Review Requirements Checklist

(Life, Annuity, Credit and Health)
(NEW 11/16/2012)







Disclosure Authorization

24-A M.R.S.A. §2208

The following items must be present on an insurer's application or claim form if it contains a disclosure authorization:
1. Be signed by a consumer or an authorized representative (POA, parent, legal guardian) 2. Be written in plain language. 3. Be dated. 4. Specify the types of persons authorized to disclose information about the consumer.  (Neither non-specific persons, nor non-specific entities may be authorized to disclose information on the proposed insured.) 5. State the nature of the information to be disclosed (must exclude HIV). 6. Names the regulated entity to which the consumer is authorizing the information to be disclosed. Watch for applications which allow release of information to non-regulated entities, such as employers. This would not be allowed. 7. Specify the period of time the authorization is valid. In the case of life, disability, annuity, or LTC, the maximum time period is 30 months from the date the authorization is signed. 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 evaluate 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 and claim forms must include the following statement or a substantially similar statement permanently affixed: "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 denial of insurance benefit." Exception for Reinsurers



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.       


Representations in Application

24-A M.R.S.A.

24-A M.R.S.A.

There shall be a provision that all statements contained in any such application for insurance shall be deemed representations and not warranties.


Third Party Notice, Cancellation and Reinstatement

24-A M.R.S.A. §2556
Rule 585
24-A M.R.S.A.

24-A M.R.S.A. §2707-A

24-A M.R.S.A.

Rule 580

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



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.”



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.


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


Requirements for Replacement of Individual Health Insurance

Rule 755 §8

An application form for individual health insurance shall include a question designed to elicit information as to whether the insurance to be issued is intended to replace any other health insurance presently in force.  A supplementary application or other form to be signed by the applicant containing the question may be used.


Short Term Policy Limitations

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.


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.



Disclosure of Benefit Offsets

24-A M.R.S.A.

24-A M.R.S.A. §2829-A

If the benefits under the policy are subject to reduction due to other sources of income, the insurer shall provide the applicant, at or before the time of application, with a clear and conspicuous written notice on the application form, or in a separate document, accurately explaining all types of other sources of income that may result in a reduction of the benefits.







Disclose Rating Practices to Applicants

Rule 425 § 9

Requires the insurer to disclose at the time of application that premiums may be increased, and a history of premium increases for the policy or similar policies occurring in the last 10 years in Maine or any other state. The insurer must obtain the applicant’s signed acknowledgement of receiving this information.  Insurer must provide written notice of an upcoming rate increase to all policyholders and certificate holders at least 60 days before the effective date.


Inflation Protection

Rule 425 § 13

Rule 425 § 13(A)

Certification that all policyholders or certificate holders are offered a 5% compound inflation benefit or alternative inflation protection complying with Section 13.
Requirements for optional inflation protection benefit at compounded annual rate of at least 5%, or specified alternative provisions.


Nonforfeiture Benefit

§ 26(B), (D), (E)

§ 26(C), (D), (E)

Requirements for optional nonforfeiture benefits.

Requirements for mandatory contingent nonforfeiture benefits if the policyholder declines the offer of a nonforfeiture provision.


Prohibition against post-claims underwriting

Rule 425 § 11

Requires two conspicuous cautionary notices to applicant regarding the truthfulness and completeness of answers to medical questions, and warns of remedies available to insurer when applicant fails to heed the notices.


Replacing Existing Insurance: Cautionary Notice to Applicant

Rule 425 § 14

Application must include specific questions to determine whether the insured has another long-term care policy/certificate in force or whether a long-term care policy or certificate is intended to replace any other accident and sickness or long-term care policy or certificate presently in force.  If the sale involves replacement of a current policy, Appendix A notice is required.




Last Updated: October 22, 2013