02-031 C.M.R. ch. 135, § 4 - Definitions

For purposes of this rule:

1. "Actuarial certification" means a written statement by a member in good standing of the American Academy of Actuaries, or other qualified individual acceptable to the Superintendent, that to the best of the actuary's knowledge and judgment, the insurer is in compliance with the applicable laws of the State of Maine and provisions of this rule, based upon an examination by the certifying individual and including a review of the appropriate records and the actuarial assumptions and methods used by the insurer in establishing attachment points and other applicable determinations.

2. "Attachment point" means the claims amount incurred by an insured group beyond which the insurer incurs a liability for payment.

3. "Eligible employee" has the same meaning as provided in 24-A M.R.S. §2808-B, subject to any applicable standards under the federal Affordable Care Act.

4. "Employee benefit excess insurance" means insurance protecting an employer against higher than expected obligations under an employee benefit plan, at retention levels that do not have the effect of making the plan an insured plan. Reinsurance provided to employers that self-insure their workers' compensation exposures pursuant to 39-A M.R.S. §403 does not constitute employee benefit excess insurance. The transaction of employee benefit excess insurance does not constitute the conduct of the business of reinsurance.

5. "Expected claims" means the amount of claims that, in the absence of an employee benefit excess insurance policy or other insurance, is projected to be incurred by an insured group through its health plan.

6. "Group health plan" has the same meaning as provided in Paragraph 2791(a)(1) of the federal Public Health Service Act, but does not include a plan that provides only excepted benefits as described in Subsection 2791(c) of the federal Public Health Service Act.

7. "Small employer" means an employer eligible for a small group health plan under 24-A M.R.S. §2808-B or under the federal Affordable Care Act.

Notes

02-031 C.M.R. ch. 135, § 4