Skip Maine state header navigation

Agencies | Online Services | Help

Skip First Level Navigation | Skip All Navigation

Life Health

All Rate and Form Filings submitted to the Bureau of Insurance for review must be accompanied by the appropriate rate and/or form review checklists for the product being submitted.  The checklists must be completed and must reference, for each requirement on the checklist, the location (i.e. form, page number, paragraph, etc.) of each standard in the filing.


BENEFIT/PROVISION REQUIREMENT

REFERENCE

DESCRIPTION OF REVIEW
STANDARDS REQUIREMENT

IDENTIFY LOCATION OF STANDARD IN FILING OR EXPLAIN IF REQUIREMENT IS INAPPLICABLE

Electronic (SERFF) Submission Requirements

24-A M.R.S.A. §2412 (2)

Bulletin 360

All filings must be filed electronically, using the NAIC System for Electronic Rate and Form Filing (SERFF). See http://www.serff.com.

 

FILING FEES

24-A M.R.S.A. §601(17)

$20.00 for Rate filings, rating rules filings, insurance policy, forms, riders, endorsements and certificates. See General Instructions page in SERFF for additional information on filing fee structure.

Filing fees must be submitted by EFT in SERFF at the time of submission of the filing.

All filings require a filing fee unless specifically excluded per 24-A M.R.S.A. §4222(1), and/or are a required annual report.

 

GROUNDS FOR DISAPPROVAL
(FORM FILINGS ONLY)

24-A M.R.S.A. §2413

Seven categories of the grounds for disapproving a filing.

 

ADVERTISING  for
Long Term Care Policies

Rule 425, Sec. 21

Every insurer, health care service plan or other entity providing long-term care insurance in this state shall file with the superintendent for prior approval a copy of any long-term care insurance advertisement intended for use in this state, whether through written, radio, television, internet or other medium. If the advertisement has not been affirmatively approved or disapproved within 30 days after filing, it will be deemed approved.

 

 

 

 

 

ADVERTISING for
Medicare Supplement Policies

24-A M.R.S.A.  §5006-A

§5010-A

Rule 275 Sec. 19

Any advertisement to be used in connection with Medicare Supplement products must be filed and approved with the Bureau prior to use.. All advertising materials shall specifically disclose the availability of Medicare supplemental products to those persons eligible for Medicare because of disability.

 

READABILITY

24-A M.R.S.A. §2441

Minimum of 50.  Riders, endorsements, applications all must be scored. They may be scored either individually or in conjunction with the policy/certificate to which they will be attached. Exceptions: Federally mandated forms/language, Groups > 1000, Group Annuities as funding vehicles.

 

REPRESENTATIONS IN APPLICATIONS

24-A M.R.S.A. §2411

All statements and descriptions in any application for insurance or for an annuity contract, by or in behalf of the insured or annuitant, are deemed to be representations and not warranties.

 

VARIABILITY OF LANGUAGE

24-A M.R.S.A.
§2412


 §2413

Forms with variable bracketed information must include all the possible language that might be placed within the brackets. The use of too many variables will result in filing disapproval as Bureau staff may not be able to determine whether the filing is compliant with Maine laws and regulations.

 

General Requirements for Life, Accident and Health, Annuity and Credit filings - Word format

 

2015 Plan Year Qualified Medical and Dental Plan Submission Requirements

Please review the SERFF General Instructions page and plan Management General Instructions Page on serff as they have been updated for 2015 plan submissions.

Word - PDF NON-GRANDFATHERED - SMALL Group Major Medical Plans  -  (H16G.003A, H16G.003B, H16G.003C, H16G.003D, H16G.003E, H16G.003F, H16G.003G)
Word - PDF NON-GRANDFATHERED - INDIVIDUAL MAJOR MEDICAL PLANS - (H16I)
Word - PDF NON-GRANDFATHERED SMALL GROUP (HOrg02G.004A) AND INDIVIDUAL (HOrg01) HMO PLANS
Word - PDF Maine’s Benchmark Essential Health Benefits Checklist
Word - PDF Preventive Health Services Checklist
Word - PDF Qualified Stand Alone Dental Checklist
Word -- PDF Maine’s Benchmark Pediatric Dental Checklist
Word -- PDF Benchmark Pediatric Dental Services Chart
Word -- PDF

Stand Alone Dental Rate Filing Review Requirements Checklist Individual Health Policies Subject to Title 24-A M.R.S.A § 2736 - (H02I, H03I, H07I, H08I, H09I, H10I, H11I, H13I, H14I, H16I.004, H17I, H19I, H20I)

Word -- PDF

Stand Alone Dental Rate Filing Review Requirements Checklist Group Health Policies Subject to Title 24-A M.R.S.A. § 2839 H02G, H03G, H04, H07G, H08G, H09G, H10G, H11G, H12, H13G, H14G, H15G.002, H16G.002A, H16G.002B, H16G.002C, H16G.004, H17G, H18G, H19G, H20G, HOrg02G.003B

Word -- HTML Individual Health Plans - (H15I, H16I.005A, H16I.005B, H16I.005C, HOrg02I.005B, HOrg02I.005C)
Word -- HTML Small Group Health Plans- (H15G.003, H16G.003A, H16G.003D,H16G.003G, HOrg02G.004E)

 

ADDITIONAL ACCIDENT & HEALTH FORM FILING REQUIREMENTS

Word/HTML Group Accident Only - (H02G)
Word/HTML Individual Accident Only - (H02I)
Word/HTML Group Accidental Death & Dismemberment - (H03G)
Word/HTML Individual Accidental Death & Dismemberment - (H03I)
Word/HTML Blanket Accident and Sickness - (H04)
Word/HTML Blanket Accident Only - (H04)
Word/PDF Blanket Accident/Sickness STUDENT ONLY - (H04.001)
Word/HTML Group Specified Disease - (H07G)
Word/HTML Individual Specified Disease - (H07I)
Word/HTML Group Dental - (H10G)
Word/HTML Individual Dental - (H10I)
Word/HTML Group Disability Income - (H11G)
Word/HTML Individual Disability Income - (H11I)
Word/HTML Excess/Stop Loss - (H12)
Word/HTML Group Short Term Care (H13G)
Word/HTML Group Hospital Confinement Indemnity - (H14G)
Word/HTML Individual Hospital Confinement Indemnity - (H14I)
Word/HTML Group Hospital/Surgical/Medical Expense - (H15G)
Word/HTML Group Major Medical - (H16G)
Word/HTML Individual Major Medical - (H16I)
Word/HTML Individual Major Medical Short Term - (H16I.004)
Word/HTML Group HMO/POS - (HOrg02G)
Word/HTML Individual HMO/POS - (HOrg02I)
Word/HTML Group & Individual Long Term Care/Partnership - (LTC03G and LTC03I)
Word/HTML Group Medicare Supplement - (MS05G)
Word/HTML Individual Medicare Supplement - (MS05I)
Word/HTML Group Vision Plans - (H20G)
Word/HTML Individual Vision Plans - (H20I)
Word/HTML Individual Basic Hospital Expense - (H21 Other)
Word/HTML Individual Basic Hospital/Medical-Surgical Expense - (H21 Other)
Word/HTML Individual Basic Medical Expense - (H21 Other)
Word/HTML Individual Basic Medical-Surgical Expense - (H21 Other)
Word/HTML Group Supplemental Health Coverage Policies - (H21 Other)
Word/HTML Individual Supplemental Health Coverage Policies - (H21 Other)
Word/HTML Out-of-State Groups, Associations/Trusts/
Labor Union Group/Debtor Groups/Other Groups - (H21 Other)
Word/HTML/PDF Association Questionnaire
Word/HTML MEWAs - (H21 Other)
Word/HTML Multi-Line Applications
Word/HTML Health Application


ADDITIONAL RATE FILING REQUIREMENTS

Word/HTML Credit - (CR02G & CR04G )
Word/HTML Group Health Policies, other than Small Group Health Plans- (H02G, H03G, H04, H07G, H08G, H09G, H10G, H11G, H13G, H14G, H15G.002, H16G.002A, H16G.002B, H16G.002C, H16G.004, H17G, H18G, H19G, H20G, HOrg02G.003B)
Word/HTML Individual Health Plans - (H15I, H16I.005A, H16I.005B, H16I.005C, HOrg02I.005B, HOrg02I.005C)
Word/HTML Individual Health Policies, other than Medicare Supplement, Long Term Care, and Individual Health Plans - (H02I, H03I, H07I, H08I, H09I, H10I, H11I, H13I, H14I, H16I.004, H17I, H19I, H20I)
Word/HTML Long Term Care/Nursing Home Care - (LTC03G, LTC03I) - subject to Rule 420 (policies issued prior to 10-01-04)
Word/HTML Long Term Care - (LTC03G, LTC03I) - Initial Rate Filing for policies subject to Rule 425 (policies issued on and after 10-01-04)
Word/HTML Long Term Care - (LTC03G, LTC03I) - Rate Revision Filing for policies subject to Rule 425 (policies issued on and after 10-01-04)
Word/HTML Medicare Supplement - (MS02G, MS02I, MS05G, MS05I)
Word/HTML Small Group Health Plans- (H15G.003, H16G.003A, H16G.003D,H16G.003G, HOrg02G.004E)


ADDITIONAL LIFE, ANNUITY & CREDIT FORM FILING REQUIREMENTS

Word/HTML Annuities - (A02G, A02I, A02.1G, A02.1I, A05G, A05I, A06.1G, A06.1I, A10)
Word/HTML Variable Annuities - (A03G, A03I, A06G, A06I, A07G.002, A07I.002, A10)
Word/HTML Group Life - (L02G, L03G, L04G, L05G, L07G, L08)
Word/HTML Individual Life - (L02I, L03I, L04I, L05I, L07I, L08)
Word/HTML Variable Life - (L06G, L06I, L08)
Word/HTML Illustrations - (L08)
Word/HTML Group Credit Life and/or Disability - (CR04G and/or CR02G)
Word/HTML Individual Credit Life and/or Disability - (CR04I and/or CR02I)
Word/HTML Life, Annuity & Credit APPLICATIONS (Group & Individual)

Last Updated: August 8, 2014