Maine Revised Statutes Title 24-A Sec. 5016 – Notification prior to cancellation; restrictions on lapse or termination due to cognitive impairment or functional incapacity
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1. Notice of cancellation. An insurer that issues Medicare supplement policies shall provide notification to the insured person and another person, if designated by the insured, prior to cancellation of a Medicare supplement policy for nonpayment of premiums.
[PL 2011, c. 123, §4 (NEW); PL 2011, c. 123, §5 (AFF).]
Terms Used In Maine Revised Statutes Title 24-A Sec. 5016
- Dependent: A person dependent for support upon another.
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- Medicare: means the "Health Insurance for the Aged Act" Title XVIII of the Social Security Amendments of 1965, as amended. See Maine Revised Statutes Title 24-A Sec. 5001
- Medicare supplement policy: means a group or individual policy of accident and sickness insurance or a subscriber contract of a nonprofit hospital or medical service organization or nonprofit health care plan or health maintenance organization other than a policy issued pursuant to a contract under the federal Social Security Act, 42 United States Code § 1395, et seq. See Maine Revised Statutes Title 24-A Sec. 5001
- Superintendent: means the Superintendent of Insurance. See Maine Revised Statutes Title 24-A Sec. 5001
2. Right to reinstatement. Within 90 days after cancellation, termination or lapse of coverage due to nonpayment of premium, a policyholder, a person authorized to act on behalf of the policyholder or a dependent of the policyholder covered under the policy may request reinstatement of the policy on the basis that the loss of coverage was a result of the policyholder’s cognitive impairment or functional incapacity. An insurer may require a medical demonstration that the policyholder suffered from cognitive impairment or functional incapacity at the time of cancellation, termination or lapse. If the medical demonstration is waived or substantiates the existence of a cognitive impairment or functional incapacity at the time of policy cancellation to the satisfaction of the insurer, the policy must be reinstated. The medical demonstration may be at the expense of the policyholder.
A policy reinstated pursuant to this subsection must cover any loss or claim occurring from the date of the termination, cancellation or lapse and must be issued without any evidence of insurability. Within 15 days after request from an insurer, a policyholder of a policy reinstated pursuant to this subsection shall pay any unpaid premium from the date of the last premium payment at the rate that would have been in effect had the policy remained in force. If the premium is not paid as required, the policy may not be reinstated and the insurer is not responsible for claims incurred after the initial date of cancellation. If an insurer denies a request for reinstatement, the insurer shall notify the policyholder that the policyholder may request a hearing before the superintendent.
[PL 2011, c. 123, §4 (NEW); PL 2011, c. 123, §5 (AFF).]
3. Rules. The superintendent may adopt rules to implement the requirements of this section. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2?A. The requirements of this section apply to all policies and certificates executed, delivered, issued for delivery, continued or renewed in this State.
[PL 2011, c. 123, §4 (NEW); PL 2011, c. 123, §5 (AFF).]
SECTION HISTORY
PL 2011, c. 123, §4 (NEW). PL 2011, c. 123, §5 (AFF).