Maine Revised Statutes Title 24-A Sec. 5052 – Specific standards
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1. Standards for long-term care, home health care and nursing home care policies. The superintendent may adopt rules to establish specific standards for policy provisions of long-term care, home health care and nursing home care policies. The standards must be in addition to and in accordance with applicable laws of this State, including chapters 33 and 35, and may include, but are not limited to:
A. Terms of renewability; [PL 1985, c. 648, §12 (NEW).]
B. Initial and subsequent conditions of eligibility; [PL 1985, c. 648, §12 (NEW).]
C. Nonduplication of coverage; [PL 1985, c. 648, §12 (NEW).]
D. Probationary periods; [PL 1985, c. 648, §12 (NEW).]
E. Benefit limitations, exceptions and reductions; [PL 1985, c. 648, §12 (NEW).]
F. Elimination periods; [PL 1985, c. 648, §12 (NEW).]
G. Requirements for replacement; [PL 1985, c. 648, §12 (NEW).]
H. Recurrent confinements; and [PL 1985, c. 648, §12 (NEW).]
I. Definition of terms. [PL 1985, c. 648, §12 (NEW).]
[PL 1997, c. 604, Pt. D, §3 (AMD).]
Terms Used In Maine Revised Statutes Title 24-A Sec. 5052
- Nursing home: means any facility located in this State which is licensed by the Department of Health and Human Services as a skilled nursing facility or intermediate care facility and any equivalent facility located in another state or country and licensed according to the laws of that jurisdiction. See Maine Revised Statutes Title 24-A Sec. 5051
- Nursing home care policy: means a group or individual policy of health insurance or a subscriber contract of a nonprofit hospital or medical service organization or nonprofit health care plan which is advertised, marketed or designed primarily to provide benefits on either an expense-incurred or indemnity basis for confinements or costs associated with confinements of a covered person in a nursing home. See Maine Revised Statutes Title 24-A Sec. 5051
2. Prohibited policy provision. The superintendent may adopt rules that specify prohibited provisions not otherwise specifically authorized by law that, in the opinion of the superintendent, are unjust, unfair, inequitable or unfairly discriminatory to any person insured or proposed for coverage under a long-term care, home health care or nursing home care policy.
[PL 1997, c. 604, Pt. D, §3 (AMD).]
SECTION HISTORY
PL 1985, c. 648, §12 (NEW). PL 1997, c. 604, §D3 (AMD).