Section 031-270-8 - Minimum benefit standardsNo insurance policy may be advertised, solicited, or issued for delivery in this State as a Medicare supplement policy unless it meets the following minimum standards. These are minimum standards and do not preclude the inclusion of other provisions or benefits which are not inconsistent with these standards.
If a nonprofit hospital or medical service plan is prohibited from issuing subscriber contracts that meet the minimum benefit standards of this Rule, the plan may issue a contract including such of those benefits as are permitted, in conjunction with some other contract or policy supplying the remaining benefits, and the combination shall be treated as a single policy for purposes of this Rule.
(A) General Standards:(1) A Medicare supplement policy may not indemnify against losses resulting from sickness on a different basis than losses resulting from accidents.(2) A Medicare supplement policy shall provide that benefits designed to cover cost sharing amounts under Medicare will be changed automatically to coincide with any changes in the applicable Medicare deductible amount and copayment percentage factors. Premiums may be modified to correspond with such changes, provided that such modifications comply with all applicable rating requirements imposed under Maine law.(3) A "noncancellable," "guaranteed renewable," or "noncancellable and guaranteed renewable" Medicare supplement policy shall not:(a) provide for termination of coverage of a spouse solely because of the occurrence of an event specified for termination of coverage of the insured, other than the nonpayment of premium, or(b) be cancelled or nonrenewed by the insurer solely on the grounds of deterioration of health or on the basis of age.(4) Termination of a Medicare supplement policy shall be without prejudice to coverage of any continuous loss that commenced while the policy was in force, but the extension of benefits beyond the period during which the policy was in force may be predicated upon the continuous total disability of the insured, limited to the duration of the policy benefit period, if any, or payment of the maximum benefits.(5) Except as authorized by the Superintendent, an insurer shall neither cancel nor nonrenew a Medicare supplement policy or certificate for any reason other than nonpayment of premium or material misrepresentation.(6) If a group Medicare supplement insurance policy is terminated by the group policyholder, or if a certificate holder under such a policy ceases to be a member of the group, the policyholder or the insurer shall offer continuation or replacement coverage as follows: (a) If the group policy is replaced by another group Medicare supplement policy purchased by the same policyholder, the succeeding insurer shall offer coverage to all persons covered under the old group policy on its date of termination. Coverage under the new group policy shall not result in any exclusion for pre-existing conditions that would have been covered under the group policy being replaced.(b) If a certificate holder's group membership terminates while the group policy remains in force, the insurer shall, if the policyholder so elects, offer continuation of coverage under the group policy.(c) If the conditions of subparagraph (a) or (b) for replacement or continuation of group coverage are not satisfied, the insurer shall offer the certificate holder at least the following choices, without any exclusion for pre-existing conditions that would have been covered under the former group policy: (i) an individual Medicare supplement policy that provides for the continuation of the benefits contained in the group policy; and(ii) an individual Medicare supplement policy that provides only such benefits as are required to meet the minimum standards.(B) Minimum Benefit Standards. The following minimum benefits shall be provided under a Medicare supplement policy: (1) Coverage of Part A Medicare eligible expenses for hospitalization to the extent not covered by Medicare from the 61st day through the 90th day in any Medicare benefit period;(2) Coverage for either all or none of the Medicare Part A inpatient hospital deductible amount;(3) Coverage of Part A Medicare eligible expenses incurred as daily hospital charges during use of Medicare's lifetime hospital inpatient reserve days;(4) Upon exhaustion of all Medicare hospital inpatient coverage including the lifetime reserve days, coverage of ninety percent (90%) of all Medicare Part A eligible expenses for hospitalization not covered by Medicare subject to a lifetime maximum benefit of an additional 365 days;(5) Coverage under Medicare Part A for the reasonable cost of the first three (3) pints of blood (or equivalent quantities of packed red blood cells, as defined under federal regulations) unless replaced in accordance with federal regulations or already paid for under Part B;(6) Coverage for the coinsurance amount of Medicare eligible expenses under Part B regardless of hospital confinement, subject to a maximum calendar year out-of-pocket amount equal to the Medicare Part B deductible ($75) maximum benefit;(7) Effective January 1, 1990, coverage under Medicare Part B for the reasonable cost of the first three (3) pints of blood (or equivalent quantities of packed red blood cells, as defined under federal regulations), unless replaced in accordance with federal regulations or already paid for under Part A, subject to the Medicare deductible amount.(8) Chiropractic services shall be covered at least to the extent required by 24 M.R.S.A. § 2303-C, 24-A M.R.S.A. § 274824-A and M.R.S.A. § 2840-A. Group policies subject to the requirements of 24 M.R.S.A. §§2325-A and 2329 or 24-A M.R.S.A. §§ 2842 and 2843 must provide at least the minimum required benefits for treatment of substance abuse and mental illness.02-031 C.M.R. ch. 270, § 8