Designation of The heading of the cover letter of any form filing subject to this rule ☐ Classification of shall state the category of coverage set forth in 24-A M.R.S.A. §2694 Coverage that the form is intended to be in. Disclosure All supplemental health policies and certificates shall display prominently by type, stamp, or other appropriate means on the first page of the policy or certificate, or attached to it, in either contrasting color or in boldface type at least equal to the size type used for headings or captions of sections in the [policy][certificate] the following: to Buyer: This is a supplemental health [policy][certificate]. This “Notice [policy][certificate] provides limited benefits. Benefits provided are supplemental and are not intended to cover all medical expenses.” Explanations for any If the policy excludes coverage for work related sicknesses or injuries, ☐ Exclusion of clearly explain whether the coverage is excluded if the enrollee is Coverage for work exempt from requirements from state workers compensation related sicknesses or requirements or has filed an exemption from the workers compensation injuries laws. Explanations All policies must include clear explanations of all of the following ☐ Regarding regarding deductibles: Deductibles Whether it is a calendar or policy year deductible. Clearly advise whether non-covered expenses apply to the deductible. Clearly advise whether it is a per person or family deductible or both. Extension of Benefits 24-A M.R.S.A. Provide an extension of benefits of 6 months for a person who is ☐ totally disabled on the date the group or subgroup policy is discontinued. For a policy providing specific indemnity during hospital confinement, "extension of benefits" means that discontinuance of the policy during a disability has no effect on benefits payable for that confinement. For purposes of determining eligibility for extension of benefits, "total disability" shall be defined no more restrictively than: A. in the case of an insured who was gainfully employed prior to disability, "the inability to engage in any gainful occupation for which
Designation of Classification of Coverage The heading of the cover letter of any form filing subject to this rule shall state the category of coverage set forth in 24-A M.R.S.A. §2694 that the form is intended to be in. ☐ Disclosure All supplemental health policies and certificates shall display prominently by type, stamp, or other appropriate means on the first page of the policy or certificate, or attached to it, in either contrasting color or in boldface type at least equal to the size type used for headings or captions of sections in the [policy][certificate] the following: “Notice to Buyer: This is a supplemental health [policy][certificate]. This [policy][certificate] provides limited benefits. Benefits provided are supplemental and are not intended to cover all medical expenses.” Explanations for any Exclusion of Coverage for work related sicknesses or injuries If the policy excludes coverage for work related sicknesses or injuries, clearly explain whether the coverage is excluded if the enrollee is exempt from requirements from state workers compensation requirements or has filed an exemption from the workers compensation laws. ☐ Explanations Regarding Deductibles All policies must include clear explanations of all of the following regarding deductibles: Whether it is a calendar or policy year deductible. Clearly advise whether non-covered expenses apply to the deductible. Clearly advise whether it is a per person or family deductible or both. ☐ Extension of Benefits 24-A M.R.S.A. Provide an extension of benefits of 6 months for a person who is totally disabled on the date the group or subgroup policy is discontinued. For a policy providing specific indemnity during hospital confinement, "extension of benefits" means that discontinuance of the policy during a disability has no effect on benefits payable for that confinement. For purposes of determining eligibility for extension of benefits, "total disability" shall be defined no more restrictively than: A. in the case of an insured who was gainfully employed prior to disability, "the inability to engage in any gainful occupation for which ☐
group_similar_supplementa.docx