02- 031 C.M.R. ch. 745, § 6 - GUARANTEED ISSUE AND MANDATORY BENEFIT INCREASES

1. The guaranteed issue requirements of 24-A M.R.S.A. §2736-C apply to plans approved pursuant to this Rule only with respect to Maine residents who apply for coverage prior to the age of 30.

2. All plans issued pursuant to this Rule must provide for a mandatory increase in benefits effective at the first annual renewal after the enrollee reaches the age of 30.

A. Benefits under the plan for persons 30 and over must be the same as benefits under one of the carrier's standardized health insurance plans (Standardized Plan A or Standardized Plan(B).

B. Upon providing the enrollee with at least 60 days notice, the carrier may increase premiums to the same level as would apply to a new enrollee for one of the carrier's standardized plans.

C. The notice of rate increase must advise the enrollee of all of the carrier's other individual health insurance plans available in the State of Maine on a guaranteed issue basis pursuant to 24-A M.R.S.A. §2736-C.

D. A carrier's rate revisions for the standardized plans must reflect the combined claims experience of those who purchased the standardized plans directly and those who receive standardized plan benefits pursuant to this subsection.

3. Between the ninetieth and sixtieth day before an enrollee's thirtieth birthday, a carrier must provide the enrollee with that written notification of the mandatory increase in plan benefits and the enrollee's guaranteed issue rights submitted for approval pursuant to Section 5 of this Rule.

4. Carriers must advise enrollees that they are nearing plan maximums when claims received by the carrier reach 75% of any annual or lifetime maximum contained in the policy and provide the enrollee with written notification regarding the guaranteed issue rights to enroll in other individual policies offered in Maine without being subject to a preexisting condition exclusion. A carrier may not enforce annual or lifetime maximums unless the required notice has been provided.

Notes

02- 031 C.M.R. ch. 745, § 6