02-031 C.M.R. ch. 755, § 9 - Limited Benefit Health Insurance

"Limited benefit health insurance" or "limited benefit coverage," as used in 24-A M.R.S.A. Chapters 33, 35, and 56-A, means only the following types of coverage:

A. Coverage designed to supplement TRICARE or the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) (Chapter 55, title 10 of the United States Code);

B. Policies that cover only dental or vision care;

C. Hospital confinement indemnity coverage as defined in Section 6, Subsection E;

D. Accident only coverage as defined in Section 6, Subsection I;

E. Specified disease coverage as defined in Section 6, Subsection J;

F. Specified accident coverage as defined in Section 6, Subsection K; and

G. Supplemental coverage as defined in Section 6, Subsection L, except that supplemental coverage is not limited benefit health insurance if it is substantially similar to one of the following types of coverage:

(1) Basic hospital expense coverage as defined in Section 6, Subsection B;

(2) Basic medical-surgical expense coverage as defined in Section 6, Subsection C;

(3) Basic hospital/medical-surgical expense coverage as defined in Section 6, Subsection D;

(4) Major medical expense coverage as defined in Section 6, Subsection F; or

(5) Basic medical expense coverage as defined in Section 6, Subsection G.

For purposes of this subsection, "substantially similar" means that, in the judgment of the Superintendent, there are only minor differences between the supplemental coverage and coverage that would meet the minimum standards of Section 6, Subsections B, C, D, F, or G.

Two or more policies sold as a package are not limited benefit health insurance if the combined benefits are substantially similar to one of the types of coverage listed in paragraphs (1) thorough (5) above.

Notes

02-031 C.M.R. ch. 755, § 9