§2804. Employee groups
A group of individuals may be insured under a policy issued to an employer or to the trustees of a fund established by an employer, which employer or trustees shall be deemed the policyholder, to insure employees of the employer for the benefit of persons other than the employer, subject to the following requirements. [PL 1981, c. 147, §2 (RPR).]
1. The employees eligible for insurance under the policy must be all of the employees of the employer, or all of any class or classes thereof. The policy may provide that the term "employees" includes the employees of one or more subsidiary corporations and the employees, individual proprietors, and partners of one or more affiliated corporations, proprietorships or partnerships if the business of the employer and of the affiliated corporations, proprietorships or partnerships is under common control. The policy may provide that the term "employees" includes the individual proprietor or partners if the employer is an individual proprietorship or partnership. The policy may provide that the term "employees" includes retired employees and directors of a corporate employer. A policy issued to insure the employees of a public body may provide that the term "employees" includes elected or appointed officials. If authorized by the school boards of the alternative organizational structure's member school administrative units pursuant to Title 20‑A, section 1001, an alternative organizational structure established pursuant to Title 20‑A, section 1461‑B may contract for group health insurance that is offered to all eligible employees and retirees of the alternative organizational structure and its member school administrative units and their dependents in one or more employment classifications.
[PL 2015, c. 420, §3 (AMD).]
2. The premium for the policy shall be paid either from the employer's funds or from funds contributed by the insured employees, or from both. Except as provided in subsection 3, a policy on which no part of the premium is to be derived from funds contributed by the insured employees must insure all eligible employees, except those who reject such coverage in writing.
[PL 1981, c. 147, §2 (RPR).]
3. Except as provided in section 2736‑C, section 2808‑B and chapter 36, an insurer may exclude or limit the coverage on any person as to whom evidence of individual insurability is not satisfactory to the insurer.
[PL 1999, c. 256, Pt. G, §1 (AMD).]
4.
[PL 1981, c. 147, §2 (RP).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1969, c. 177, §49 (AMD). PL 1981, c. 147, §2 (RPR). PL 1989, c. 867, §§2,10 (AMD). PL 1999, c. 256, §G1 (AMD). PL 2015, c. 420, §3 (AMD).
Structure Maine Revised Statutes
TITLE 24-A: MAINE INSURANCE CODE
Chapter 35: GROUP AND BLANKET HEALTH INSURANCE
24-A §2801. Scope of chapter -- short title
24-A §2802. Group insurance defined
24-A §2803-A. Loss information
24-A §2804-A. Private purchasing alliances
24-A §2804-B. Group disability income protection plan
24-A §2805. Labor union groups
24-A §2805-A. Association groups
24-A §2807-A. Credit union groups
24-A §2808-A. Rating practices in group health insurance (REPEALED)
24-A §2808-B. Small group health plans
24-A §2809. Coverage of family, dependents; continuation of coverage
24-A §2809-A. Conversion on termination of policy or eligibility
24-A §2810. Group health insurance payments; beneficiaries
24-A §2811. Payment of expenses
24-A §2812. Readjustment of premium rate (REPEALED)
24-A §2812-A. Dividends and experience refunds
24-A §2813. "Blanket health insurance" defined
24-A §2814. Blanket health insurance; payments; beneficiaries
24-A §2815. Legal liability of policyholders
24-A §2817. Applicant's statements; waivers, amendments
24-A §2818. Statements in application
24-A §2819. New employees, members
24-A §2821. Individual certificates
24-A §2823-A. Explanation and notice to parent
24-A §2823-B. Standardized claim forms
24-A §2825. Forms for proof of loss
24-A §2826. Examination, autopsy
24-A §2827. Time for payment of benefits
24-A §2827-A. Assignment of benefits
24-A §2829-A. Disability benefit offsets
24-A §2830. Omissions, modifications: superintendent may approve
24-A §2831. Hospital, medical benefits; direct payment
24-A §2832-A. Mandated offer of domestic partner benefits
24-A §2833-A. Extension of coverage for dependent children
24-A §2833-B. Mandatory offer to extend coverage for dependent children up to 26 years of age
24-A §2833-C. Mandatory offer of coverage for certain adults with disabilities
24-A §2834. Newborn children coverage
24-A §2834-A. Maternity and routine newborn care
24-A §2834-B. Dependent special enrollment period
24-A §2834-C. Compliance with federal law
24-A §2834-D. Maternity and postpartum care
24-A §2835. Mental health services
24-A §2836. Limits on priority liens
24-A §2837. Home health care coverage
24-A §2837-A. Screening mammograms
24-A §2837-B. Acupuncture services
24-A §2837-C. Coverage for breast cancer treatment
24-A §2837-D. Medical food coverage for inborn error of metabolism
24-A §2837-E. Coverage for Pap tests
24-A §2837-F. Off-label use of prescription drugs for cancer
24-A §2837-G. Off-label use of prescription drugs for HIV or AIDS
24-A §2837-H. Coverage for prostate cancer screening (REALLOCATED FROM TITLE 24-A, SECTION 2837-F)
24-A §2838. Community health service coverage (REPEALED)
24-A §2839-A. Notice of rate increase
24-A §2839-B. Large group rates
24-A §2840-A. Coverage for chiropractic services
24-A §2841. Optional coverage for optometric services
24-A §2842. Equitable health care for substance use disorder treatment
24-A §2843. Mental health services coverage
24-A §2844. Coordination of benefits
24-A §2845. Cardiac rehabilitation coverage
24-A §2846. Acquired Immune Deficiency Syndrome
24-A §2847. Utilization review data
24-A §2847-A. Penalty for failure to notify of hospitalization
24-A §2847-D. Penalty for noncompliance with utilization review programs
24-A §2847-E. Coverage for diabetes supplies
24-A §2847-F. Gynecological and obstetrical services (REALLOCATED FROM TITLE 24-A, SECTION 2850-A)
24-A §2847-G. Coverage for contraceptives
24-A §2847-J. Coverage for hospice care services
24-A §2847-L. Offer of coverage for breast reduction surgery and symptomatic varicose vein surgery
24-A §2847-M. Enrollment for individuals or families establishing eligibility for MaineCare
24-A §2847-N. Coverage for colorectal cancer screening
24-A §2847-O. Coverage for hearing aids (REALLOCATED FROM TITLE 24-A, SECTION 2847-M)
24-A §2847-Q. Coverage for services provided by independent practice dental hygienist
24-A §2847-R. Enrollment of dependent children in dental coverage
24-A §2847-U. Coverage for services provided by dental therapist