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AGENCY UMBRELLA-UNIT NUMBER: 02-031
AGENCY NAME: Department of Professional and Financial Regulation, Bureau of Insurance

CONTACT PERSON: Thomas M. Record, Esq., Senior Staff Attorney, 34 State House Station, Augusta, ME 04333-0034. Tel: (207) 624-8424

EMERGENCY RULES ADOPTED SINCE THE LAST REGULATORY AGENDA: None

CONSENSUS-BASED RULE DEVELOPMENT: It is not anticipated that consensus-based rule development within the meaning of 1999 P.L. c. 307 will be used in formulating any of the proposals listed below.

EXPECTED 2003-2004 RULEMAKING ACTIVITY:

CHAPTER 250: Workers' Compensation Self-Insurance
STATUTORY AUTHORITY: 24-A M.R.S.A. §212 and 39-A M.R.S.A. §403
PURPOSE: to amend current rule to reflect a recent statutory change relating to the working capital offset provision for security calculations and other changes necessary to reflect current business practices.
ANTICIPATED SCHEDULE: Summer 2004
AFFECTED PARTIES: Workers Compensation Self-Insurers

CHAPTER 450: Workers' Compensation Experience Rating
STATUTORY AUTHORITY: 24-A M.R.S.A. §§212 and 2382-D(4)
PURPOSE: to amend current rule to include adjustment to the experience rating plan to exclude consideration of lost-time claims attributable to injuries that are aggravations, or combine with prior lost-time claims.
ANTICIPATED SCHEDULE: Fall 2003
AFFECTED PARTIES: Workers' Compensation Insurers, Employers

CHAPTER 560: Worker' Compensation Insurance - Employee Leasing
STATUTORY AUTHORITY: 24-A M.R.S.A. §§ 212, 2178, 2382-B, and 2386; 32 M.R.S.A. § 14055(2).
PURPOSE: to amend the current law to reflect statutory changes that have occurred since rule's adoption in 1992, to require that all workers' compensation insurance coverage issued to employee leasing companies be written on a multiple coordinated basis and to make other miscellaneous changes based on the Bureau's experience with the Rule
ANTICIPATED SCHEDULE Fall 2003
AFFECTED PARTIES: Workers' Compensation Insurers, Employee Leasing Companies, NCCI

NEW RULE: Workers Compensation Insurance - Group Self-Insurance Reinsurance Vehicles
STATUTORY AUTHORITY: 24-A M.R.S.A. §212 and 39-A M.R.S.A. §403(4-A)(J)
PURPOSE: to administer and effectuate the intent of 39-A M.R.S.A. §403(4-A)
ANTICIPATED SCHEDULE: Winter 2004
AFFECTED PARTIES: Workers' compensation insurers group self-insurers

Property and Casualty Insurance

CHAPTER 630: Rural Medical Access Program
STATUTORY AUTHORITY: 24-A M.R.S.A. §§212 and 6311.
PURPOSE: to amend the calculation of program assessments upon self-insured hospitals and to make other miscellaneous changes.
ANTICIPATED SCHEDULE: Winter 2004
AFFECTED PARTIES: Physicians and hospitals

Health Insurance

Amendments to CHAPTER 130: Minimum Reserve Standards for Individual and Group Health Insurance Contracts
STATUTORY AUTHORITY: 24-A M.R.S.A. §§212 and 925
PURPOSE: to update current rule to reflect revised disability insurance actuarial tables and recent amendments to the NAIC Model Rule.
ANTICIPATED SCHEDULE: Spring 2004
AFFECTED PARTIES: Disability insurers

CHAPTER 275-A: Medicare Supplement Insurance
STATUTORY AUTHORITY: 24 M.R.S.A. § 2328 and 24-A M.R.S.A. §§ 212, 2413(1)(F), 4207(9), 5002, 5003, 5002-A, 5005, and 5010-A
PURPOSE: to reflect statutory changes
ANTICIPATED SCHEDULE: Hearing held September 22, 2003
AFFECTED PARTIES: Medicare supplement insurers and policyholders

CHAPTER 320: Minimum Standards for Alcoholism and Substance Abuse Benefits
STATUTORY AUTHORITY: 24 M.R.S.A. §2329, Title 24-A M.R.S.A., §§ 212 and 2842
PURPOSE: to reflect statutory changes enacted by 2003 P.L. ch. 20, Part VV
ANTICIPATED SCHEDULE: Winter 2003
AFFECTED PARTIES: health insurers, HMOs, alcoholism and substance abuse providers, persons covered under group health insurance and HMO contracts

CHAPTER 330: Minimum Standards for Mental Illness Benefits
STATUTORY AUTHORITY: 24 M.R.S.A. §2325-A, 24-A M.R.S.A. §§ 212, 2843 and 4234-A.
PURPOSE: to reflect statutory changes enacted by 2003 P.L. ch. 20, Part VV
ANTICIPATED SCHEDULE: Winter 2003
AFFECTED PARTIES: insurers, HMOs, mental health providers, persons covered under group health insurance and HMO contracts

CHAPTER 425: Nursing Home Care Insurance and Long Term Care Insurance
STATUTORY AUTHORITY: 24-A M.R.S.A. §§505 and 5053
PURPOSE: to update in light of NAIC Model Regulation requirements relating to nonforfeiture values and other standards as required by 1999 PL chapters 292 and 521 and to reflect the need to establish standards for tax qualified policies pursuant to 2001 PL chapter 679.
ANTICIPATED SCHEDULE: Fall 2003
AFFECTED PARTIES: General public and long term care insurers and updates should encourage products to be more attractive and desirable

NEW RULE: Chapter 755: Health Insurance Minimum Standards (major substantive)
STATUTORY AUTHORITY: 24-A M.R.S.A. §§212, 2717 and Chapter 32-A
PURPOSE: The purpose of this rule is to implement 24-A M.R.S.A. Chapter 32-A to standardize and simplify the terms and coverages of individual health insurance policies, and group health insurance policies and certificates. This rule is also intended to: facilitate public understanding and comparison of coverage; eliminate provisions contained in individual and group health insurance policies that may be misleading or confusing in connection with either the purchase of the coverages or the settlement of claims; and provide for full disclosure in the marketing and sale of individual and group health insurance. This rule is also intended to clarify the meaning of limited benefits health insurance as referred to in 24-A M.R.S.A. chapters 33, 35 and 56-A .
ANTICIPATED SCHEDULE: Hearing scheduled November 18, 2003
AFFECTED PARTIES: Health Carriers

CHAPTER 850: Health Plan Accountability
STATUTORY AUTHORITY: 24-A M.R.S.A. §4303(2)
PURPOSE: routine technical amendment to reflect 2003 P.L. ch. 108 statutory change relating to credentialing of health care providers who participate in HMO networks
ANTICIPATED SCHEDULE: To be included with other Chapter 850 amendments below.
AFFECTED PARTIES: HMOs, health care providers

CHAPTER 850: Health Plan Accountability (major substantive)
STATUTORY AUTHORITY: 24-A M.R.S.A. §4303(1)(A)(6)
PURPOSE: amendment to adopt the criteria to be used by the Superintendent to determine whether exceptions to the travel restrictions in the rule shall be granted.
ANTICIPATED SCHEDULE: To be provisionally adopted by December 31, 2003
AFFECTED PARTIES: health insurers, HMOs, health care providers and practitioners, persons covered under health insurance and HMO contracts

CHAPTER 940: Requirements for Health Insurance Rate Filings and Data Reporting
STATUTORY AUTHORITY: Amendments required due to changes to 24-A M.R.S.A. §2808-B.
PURPOSE: to reflect 2003 statutory changes with respect to small group rate regulation and miscellaneous matters.
ANTICIPATED SCHEDULE: Spring 2004
AFFECTED PARTIES: Health insurers, HMOs.

PROPOSED NEW RULE CHAPTER 790: Coordination of Benefits
STATUTORY AUTHORITY: 24 M.R.S.A. § 2332-A and 24-A M.R.S.A. §§ 212, 2723-A, 2844, and 4218
PURPOSE: to establish protocols for claim payments when coverage is provided under multiple health plans in order that claims may be paid promptly and claims delays and misunderstandings may be reduced.
ANTICIPATED SCHEDULE: Spring 2004
AFFECTED PARTIES: Health carriers and other claims payers subject to the jurisdiction of the Superintendent.

NEW RULE: Electronic Claims Submission; Hardship Exemptions
STATUTORY AUTHORITY: 24 M.R.S.A. §2985
PURPOSE: to define the standards for "hardship exemptions" from the responsibility of small health care practitioners to file claims electronically
ANTICIPATED SCHEDULE: Summer-fall 2004
AFFECTED PARTIES: small health care practitioners, health insurers, HMOs

NEW RULE: Health Claims Experience; Annual Statement Supplement
STATUTORY AUTHORITY: 24-A M.R.S.A. §423-D
PURPOSE: to specify standards for an insurer and HMO annual statement supplement required by 2003 P.L. c. 469.
ANTICIPATED SCHEDULE: Spring, 2004
AFFECTED PARTIES: health insurers and HMOs

Life and Disability Insurance

CHAPTER 340: Mortality Tables for Determining Minimum Reserves and Nonforfeiture Benefits
STATUTORY AUTHORITY: 24-A M.R.S.A. §§212, 953 and 2532-A
PURPOSE: to adopt the 2001 CSO mortality table
ANTICIPATED SCHEDULE: Fall 2003
AFFECTED PARTIES: life insurers

NEW RULE: Annuity Disclosure
STATUTORY AUTHORITY: 24-A M.R.S.A. §212, 2151-B AND 2152
PURPOSE: to require disclosure of information to assist consumers in purchasing annuities
ANTICIPATED SCHEDULE: 2004
AFFECTED PARTIES: Insurers that issue annuities, Consumers

Miscellaneous

CHAPTER 230: Requirements for a Certificate of Authority
STATUTORY AUTHORITY: 24-A M.R.S.A. §212
PURPOSE: to implement clarifying changes recommended during Rule Review Process and other miscellaneous changes
ANTICIPATED SCHEDULE: Spring 2004
AFFECTED PARTIES: Applicants for authority to transact insurance

RULE 541: Educational Requirements for Insurance Professionals
STATUTORY AUTHORITY: 24-A M.R.S.A. §§212, 601(23), 1483(2) and 1485
PURPOSE: to update rule to simplify procedures, to promote uniformity with other states and to clarify other ambiguities that have been found to exist since the rule was adopted.
ANTICIPATED SCHEDULE: Winter 2004
AFFECTED PARTIES: Continuing education course vendors, insurance producers

CHAPTER 740: Credit for Reinsurance
STATUTORY AUTHORITY: 24-A M.R.S.A. §731-B
PURPOSE: to reflects statutory changes enacted by 2001 P.L. c. 47
ANTICIPATED SCHEDULE: Spring 2004
AFFECTED PARTIES: Insurers and companies writing reinsurance

NEW RULE: Chapter 980: Standards for Safeguarding Consumer Information
Statutory Authority: 24-A M.R.S.A. §212 and 2220, 15 U.S.C. §§6801(b) and 6805(b)(2)
PURPOSE: to establish standards for developing and implementing administrative, technical and physical safeguards to protect the security, confidentiality and integrity of consumer information
ANTICIPATED SCHEDULE: Fall 2003
AFFECTED PARTIES: Insurers

NEW RULE: Privacy
STATUTORY AUTHORITY: 24-A M.R.S.A. §2220
PURPOSE: to carry out the purposes of the Insurance Information and Privacy Act
ANTICIPATED SCHEDULE: as determined necessary
AFFECTED PARTIES: Insurers, Insurance Consumers

NEW RULE: CPA Audits
STATUTORY AUTHORITY: 24-A M.R.S.A. §§212 and 221-A
PURPOSE: to administer the provisions of §221-A in a manner clearly consistent with the NAIC Model Audit Regulation as recently amended. The NAIC Model Audit Regulation as amended will become an accreditation standard in 2004.
ANTICIPATED SCHEDULE: Fall 2003
AFFECTED PARTIES: Insurers

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