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claim filed pursuant to a policy issued under this chapter, other | | than a policy that is subject to section 4312, shall provide the | | policy or certificate holder with an opportunity to have the denial | | reviewed by the insurer and to arbitrate the denial if not | satisfied after review. The right to review and arbitrate shall | | must be prominently set forth in any written notice sent to the | | policy or certificate holder denying the claim. The arbitration | shall be is nonbinding and shall must be carried out in accordance | | with procedures established by the insurer. |
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| | | Sec. H-5. 24-A MRSA §2808-B, sub-§1, ¶D, as amended by PL 2001, c. 258, | | Pt. E, §3 and c. 400, §1 and affected by §2, is repealed and the | | following enacted in its place: |
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| | | D.__"Eligible group" means any person, firm, corporation, | | partnership, association or subgroup engaged actively in a | | business that employed an average of 50 or fewer eligible | | employees during the preceding calendar year. |
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| | | (1)__If an employer was not in existence throughout the | | preceding calendar year, the determination must be | | based on the average number of employees that the | | employer is reasonably expected to employ on business | | days in the current calendar year. |
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| | | (2)__In determining the number of eligible employees, | | companies that are affiliated companies or that are | | eligible to file a combined tax return for purposes of | | state taxation are considered one employer. |
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| | | (3)__A group is not an eligible group if there is any | | one other state where there are more eligible employees | | than are employed within this State and the group had | | coverage in that state or is eligible for guaranteed | | issuance of coverage in that state. |
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| | | (4)__An employer qualifies as an eligible group for 2- | | person coverage if the employer provides a carrier with | | the following information demonstrating that the | | employer's business and employees meet the minimum | | qualifications for group coverage in paragraph C: |
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| | | (a)__A copy of the most recent quarterly combined | | filing for income tax withholding and unemployment | | contributions, Form 941/C1-ME; |
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| | | (b)__For an employee claimed to be an employee eligible for group | | coverage whose name is not listed on Form 941/C1-ME, a copy of | | the employer's payroll records for the most recent 3 months |
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