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Maine.gov > PFR Home > Insurance Regulation > Company Services > Review Checklists > H21 - Other Out-of-State Groups Associations / Trusts / Labor Union Groups / Debtor Groups / Other Groups

Maine Bureau of Insurance
Form Filing Review Requirements Checklist

H21 - Other
Out-of-State Groups
Associations/Trusts/Labor Union Groups/Debtor Groups/Other Groups

(Amended 11/2011)

REVIEW REQUIREMENTS

REFERENCE

DESCRIPTION OF REVIEW

STANDARDS REQUIREMENTS

LOCATION OF

STANDARD IN FILING

In addition to the requirements in Maine insurance law that pertains to the particular line of insurance (see appropriate checklist) Out-of-state groups must also comply with the following:

 

 

 

Labor Union Groups

24-A M.R.S.A. §2805

1. The members eligible for insurance under the policy shall be all of the members of the union or organization or all of any class or classes thereof
2. The premium for the policy shall be paid either from funds of the union or organization, or from funds contributed by the insured members specifically for their insurance, or from both.
3. Except as provided in section 2736-C, section 2808-B and chapter 36, an insurer may exclude or limit the coverage on any person as to whom evidence of individual insurability is not satisfactory to the insurer.

 

Association Groups

24-A M.R.S.A. § 2805-A

 

 

24-A M.R.S.A. §2701(2)(C)(1-A), §2736, §2736-A, 2736-B, §2736-C
24-A M.R.S.A. §2850-B(5)

This section includes information on the requirements of the Association including, but not limited to,: the association must have had a minimum of 50 persons when the association was originally formed, shall have been organized & maintained in good faith for purposes other than that of obtaining insurance, shall have been in active existence for at least 2 years, hold regular meetings not less than annually to further purposes of the members, collect dues or contributions from members, and the members must have voting privileges and representation on the governing board and committees. See §2805-A for additional requirements.
Association Groups are subject to the requirements concerning guaranteed issue, rating and rate filing that apply to individual health insurance.
Guaranteed Renewal; Cessation of Business – If coverage to an employer through an association is terminated, the carrier shall renew the coverage with the employer becoming the policyholder.  If coverage to an individual member of an association is terminated, the carrier shall renew the coverage with the individual becoming the policyholder.

 

Association Groups and Trust Groups

24-A M.R.S.A. §2808-B(4)
Bulletin 210

A carrier that provides a health plan to an association or trust must be actively marketing in the small group market in Maine if the plan provides coverage to employees of the association members or trust members.

 

Trust Groups

24-A M.R.S.A. § 2806

This section states who the coverage can be sold to within the trust, how the premium is to be paid, and upon whom the insurer can exclude or limit coverage. See §2806 for greater detail.

 

Debtor Groups

24-A M.R.S.A. §2807

This section describes what is the allowable make-up of the group

 

Credit Union Groups

24-A M.R.S.A. § 2807-A

 

 

 

24-A M.R.S.A. §2701(2)(C)(1-A), §2736, §2736-A, 2736-B, §2736-C

This section states the requirements under which coverage can be issued to a Credit Union Group. Briefly summarized the requirements are:
1. The members eligible for insurance are all of the members of the credit union or credit unions or all of any class or classes thereof
2. The premium for the policy shall be paid either from funds of the credit union or from funds contributed by the insured members specifically for their insurance, or from both.
3. Except as provided in section 2736-C, section 2808-B and chapter 36, an insurer may exclude or limit the coverage on any member as to whom evidence of individual insurability is not satisfactory to the insurer.
Credit Union Groups are subject to the requirements concerning guaranteed issue, rating and rate filing that apply to individual health insurance.

 

Other Groups

24-A M.R.S.A. § 2808

 

 

24-A M.R.S.A. §2701(2)(C)(1-A), §2736, §2736-A, 2736-B, §2736-C

The requirements for Other Groups found in §2808 are:
A. The policyholder is a bona fide group formed for purposes other than procurement of insurance,
B. The issuance of the group policy would be actuarially sound;
C. The issuance of the group policy would result in economies of acquisition or administration;
D. The benefits are reasonable in relation to the premiums charged.
Other Groups are subject to the requirements concerning guaranteed issue, rating and rate filing that apply to individual health insurance.

 

All out-of-state groups (Associations, Trusts, etc.)

24-A M.R.S.A. § 2412(1-A)

All out-of-state group policy filings must clearly identify the type of group the group purports to be and must specifically identify the group policyholder and group policyholder number. Certificates filed with variable language in lieu of specifying the group policyholder and group policyholder number will be rejected.

 

Last Updated: August 22, 2012