Genetic information PHSA §2753 An issuer is not allowed to: Adjust premiums based on genetic ☐ (GINA), coverage is not (74 Fed Reg information; Request/require genetic testing; Collect genetic based on 51664, information from an individual prior to/in connection with enrollment 45 CFR in a plan, or at any time for underwriting purposes. §148.180) Period 24-A M.R.S.A. There shall be a provision that a grace period of 31 days will be ☐ granted for the payment of each premium falling due after the first premium, during which grace period the policy shall continue in force. Guaranteed issue and 24-A M.R.S.A. Requires guaranteed issue and renewal. ☐ renewal PHSA §2702 Guaranteed renewable (45 CFR May only non-renew or cancel coverage for nonpayment of premiums, §148.122) fraud, market exit, movement outside of service area, or cessation of bona-fide association membership. Health plan Standards in this rule include, but are not limited to, required ☐ accountability provisions for grievance and appeal procedures, emergency services, access and utilization review standards. Legal actions No action at law or in equity shall be brought to recover on this policy prior to the expiration of 60 days after written proof of loss has been furnished in accordance with the requirements of this policy. No such action shall be brought after the expiration of 3 years after the time written proof of loss is required to be furnished. Limitations & Exclusions 45 CFR Limitations and exclusions must be substantially similar or more ☐ 156.115 favorable to the insured as found in the Maine EHB benchmark plan. Notice of Policy Changes A carrier may make minor modifications to the coverage, terms and ☐ and Modifications conditions of the policy consistent with other applicable provisions of state and federal laws as long as the modifications meet the conditions specified in this paragraph and are applied uniformly to all policyholders of the same product. PHSA 2715 Notice of Policy Changes (75 Fed Reg Provide 60 days advance notice to enrollees before the effective date of 41760) any material modification including changes in preventive benefits. Notice of Rate Increase 24-A M.R.S.A. Requires that insurers provide a minimum of 60 days written notice to ☐ affected policyholders prior to a rate filing for individual health
Genetic information (GINA), coverage is not based on PHSA §2753 (74 Fed Reg 51664, 45 CFR §148.180) An issuer is not allowed to: Adjust premiums based on genetic information; Request/require genetic testing; Collect genetic information from an individual prior to/in connection with enrollment in a plan, or at any time for underwriting purposes. ☐ Period 24-A M.R.S.A. There shall be a provision that a grace period of 31 days will be granted for the payment of each premium falling due after the first premium, during which grace period the policy shall continue in force. ☐ Guaranteed issue and renewal Guaranteed renewable 24-A M.R.S.A. PHSA §2702 (45 CFR §148.122) Requires guaranteed issue and renewal. May only non-renew or cancel coverage for nonpayment of premiums, fraud, market exit, movement outside of service area, or cessation of bona-fide association membership. ☐ Health plan accountability Standards in this rule include, but are not limited to, required provisions for grievance and appeal procedures, emergency services, access and utilization review standards. ☐ Legal actions No action at law or in equity shall be brought to recover on this policy prior to the expiration of 60 days after written proof of loss has been furnished in accordance with the requirements of this policy. No such action shall be brought after the expiration of 3 years after the time written proof of loss is required to be furnished. Limitations & Exclusions 45 CFR 156.115 Limitations and exclusions must be substantially similar or more favorable to the insured as found in the Maine EHB benchmark plan. ☐ Notice of Policy Changes and Modifications Notice of Policy Changes PHSA 2715 (75 Fed Reg 41760) A carrier may make minor modifications to the coverage, terms and conditions of the policy consistent with other applicable provisions of state and federal laws as long as the modifications meet the conditions specified in this paragraph and are applied uniformly to all policyholders of the same product. Provide 60 days advance notice to enrollees before the effective date of any material modification including changes in preventive benefits. ☐ Notice of Rate Increase 24-A M.R.S.A. Requires that insurers provide a minimum of 60 days written notice to affected policyholders prior to a rate filing for individual health ☐
individual_major_medical_plans-non-grandfathered.docx