H12 - Excess/Stop Loss Policies
All Rate and Form Filings submitted to the Bureau of Insurance for
review must be accompanied by the completed appropriate transmittal
Document as well as the completed appropriate rate/form review checklist.
The checklist must be completed by the company submitting the filing
and must reference, for each item on the checklist, the location of
each specific item in the filing. The transmittal Document takes the
place of the cover letter requirement. Blank transmittal documents are
attached here for your use.
| REVIEW REQUIREMENTS
|
REFERENCE
|
DESCRIPTION OF
REVIEW
STANDARDS REQUIREMENTS |
LOCATION OF
STANDARD IN FILING |
| Continuity of coverage |
Bureau position &
24-A
M.R.S.A. §2849 |
Must certify that underlying plan will comply with
Maine’s continuity law |
|
| Tail Coverage |
Bureau position and
24-A
MRSA §2452(2), §2413(1)(B)
and
§707(1)(C-1) |
An extended reporting period “tail
coverage” of at least 6 months must be offered on all excess
policies, during which the employer may make payment to the health
care provider or facility on behalf of the employee, and report
the loss to the insurer for reimbursement purposes. If an employer requests coverage that does not include tail coverage the carrier may provide such coverage, but must provide the employer with a disclosure notice approved by the Bureau, clearly advising that the policy is issued without tail-coverage. |
|
| Minimum attachment point/aggregate retention |
Bureau
position and 24-A
MRSA § 707(1)(C-1) |
Must
have a minimum attachment point of $20,000 individual and 120% of
expected aggregate. |
|
| Disclosure
authorization requirements |
Bureau position |
Must
certify that underlying plan will comply with the disclosure and
authorization requirements cited in §2208
and §2215
|
|
| Rates |
24-A
M.R.S.A.
§2304-A |
Rates must be filed for all Excess/Stop Loss Policy
filings. |
|
