02- 031 C.M.R. ch. 281, § 6 - General

A. Benefit Levels. If the benefit levels required in Section 3 above exceed the benefit levels provided under the group contract from which conversion is made, the conversion policy or certificate may provide benefits which are at the level of those provided under the group contract in lieu of those benefits required in Section 3.

B. Alternate Plan. The insurer may, at its option, also offer alternative plans for group health conversion in addition to those required by this Rule. However no alternative plan may be offered unless the plans outlined in Section 3 are offered with equal emphasis.

C. Information Requested by Insurer. A converted policy or certificate may include a provision whereby the insurer may request information in advance of any premium due date of such policy or certificate of any person covered thereunder as to whether (i) he/she is covered for similar benefits by another hospital, surgical, medical or major medical expense insurance policy; hospital or medical service contract; medical practice or other prepayment plan; or by any other plan or program, (ii) he/she is covered for similar benefits under any arrangement of coverage for individuals in a group, whether on an insured or uninsured basis, or (iii) similar benefits are provided for or available to such person, pursuant to or in accordance with the requirements of any state or federal law.

Failure of any covered person to respond to a request of the insurer made pursuant to this subsection may be deemed by the insurer to be a statement by the covered person that he or she is not covered for similar benefits by any other program, plan, policy, contract or other arrangement of coverage as to which the insurer requested information.

D. Group health insurance policies, by whatever name called, which are issued in connection with a "self-insured" or "self-funded" plan and which provide for the payment of benefits to employees or members under specified circumstances shall contain conversion provisions that are consistent with Title 24-A M.R.S.A., Section2809-A and this Rule and which reflect the total coverage provided the employee or member.

Notes

02- 031 C.M.R. ch. 281, § 6

Effective. 7-1-85.
Statutory Authority.-- 24 M.R.S.A. §2330; 24-A M.R.S.A. §§212 and 2809A.