Sec. D-1. 24-A MRSA §5051, sub-§1, ¶E, as enacted by PL 1989, c. 556, Pt. B, §1, is amended to read:
E. A policy or contract offered primarily to provide basic hospital expense coverage, basic medical-surgical expense coverage, hospital confinement indemnity coverage, major medical expense coverage, disability income protection, accident only accident-only coverage, specified disease or specified accident coverage, home health care coverage or limited benefit health coverage.
Sec. D-2. 24-A MRSA §5051, sub-§3-A is enacted to read:
3-A. Home health care policy. "Home health 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 that is advertised, marketed or designed primarily to provide benefits on either an expense-incurred or indemnity basis for confinements or costs associated with home health care services. For purposes of this definition, a policy is deemed to provide primarily home health care benefits if 50% or more of benefits payable or anticipated to be payable under the policy are related to home health care services. The term does not include:
A. A policy or contract defined as Medicare supplement insurance pursuant to chapter 67;
B. A policy or contract issued to one or more employers or labor organizations or to the trustees of a fund established by one or more employers or labor organizations, or combination of both, or for members or former members, or combination of both, of the labor organizations;
C. A policy or contract issued to any professional, trade or occupational association for its members, former members or retired members, or combination of members, if the association:
(1) Is composed of individuals all of whom are actively engaged in the same profession, trade or occupation;
(2) Has been maintained in good faith for purposes other than obtaining insurance; and
(3) Has been in existence for at least 2 years prior to the date of its initial offering of the policy or plan to its members; or
D. Individual policies or contracts issued pursuant to a conversion privilege under a policy or contract of group or individual insurance, when that group or individual policy or contract includes provisions that are inconsistent with the requirements of this chapter.
Sec. D-3. 24-A MRSA §5052, as enacted by PL 1985, c. 648, §12, is amended to read:
1. Standards for long-term care, home health care and nursing home care policies. The superintendent may promulgate adopt rules to establish specific standards for policy provisions of long-term care, home health care and nursing home care policies. The standards shall 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;
B. Initial and subsequent conditions of eligibility;
C. Nonduplication of coverage;
D. Probationary periods;
E. Benefit limitations, exceptions and reductions;
F. Elimination periods;
G. Requirements for replacement;
H. Recurrent confinements; and
I. Definition of terms.
2. Prohibited policy provision. The superintendent may promulgate adopt rules that specify prohibited provisions not otherwise specifically authorized by law which 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.
Sec. D-4. 24-A MRSA §5052-A, as enacted by PL 1991, c. 200, Pt. C, §1, is amended to read:
§5052-A. Trial examination period
Nursing home care, home health care and long-term care policies must have a notice prominently printed on the first page of the policy or certificate or attached to the first page stating in substance that the applicant has the right to return the policy or certificate within 30 days of its delivery and to have the premium refunded if for any reason, after examination of the policy or certificate, the applicant is not satisfied.
Sec. D-5. 24-A MRSA §5053, as amended by PL 1991, c. 200, Pt. C, §2, is further amended to read:
§5053. Rulemaking, disclosure standards, compensation
The superintendent may promulgate adopt reasonable rules to provide for the full and fair disclosure of information in connection with the sale of long-term care, home health care and nursing home care policies, including, but not limited to, an outline of coverage requirements and requirements relating to the replacement sale of the policies and compensation or commission to an agent or representative for the sale of a nursing home care, home health care or long-term care policy or certificate.
The superintendent may promulgate adopt reasonable rules setting or limiting the rate of compensation or commission to an agent or other representative for the sale of a nursing home care, home health care or long-term care policy or certificate and regarding replacement sale of a nursing home care, home health care or long-term care policy or certificate.
Sec. D-6. 24-A MRSA §5054, sub-§1, as enacted by PL 1989, c. 556, Pt. B, §4, is amended to read:
1. Filing of form. Any insurer, nonprofit hospital or medical service organization, or nonprofit health care plan may, at the time it files a policy or contract for approval for issuance or delivery in the State, or at any time thereafter, request that the superintendent certify the policy or contract as a long-term care policy within the meaning of section 5051.
Within 60 days of receipt of a request for certification, the superintendent shall:
A. Certify in writing that the policy or contract complies with this section;
B. Deny the request in writing, stating the reasons for denial; or
C. Notify the insurer or nonprofit hospital or medical service organization or nonprofit health care plan, in writing, that an insufficient basis exists for determining whether a certification should be made, indicating in what respects the request was insufficient.
Sec. D-7. 24-A MRSA §5056, first ¶, as enacted by PL 1991, c. 200, Pt. C, §3, is amended to read:
Every insurer, health care service plan or other entity marketing nursing home care, home health care or long-term care insurance coverage in this State, directly or through its producers, shall:
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