Rules for Individual Health Insurance in Maine

Getting medical insurance in Maine for your family is a must. It protects you from the overwhelming cost of medical expenses should you or your family get sick or injured. You need to take time to think about your health insurance options before you choose a medical insurance plan. In Maine, insurance companies sell policies under the supervision of the Maine Bureau of Insurance.

No insurance company in Maine can refuse to insure you based on your medical history in Maine. This is because all health insurance policies in Maine must be guarantee issued, not medically underwritten. Standardized policies must also be offered by all individual medical insurance providers under state law; this includes HMO's. The state determines exactly what coverage has to be included in a standardized policy, as well as the co-payments, co-insurance percentages, and specific benefits they provide. Of course, insurance companies also sell policies that are not standardized. Prior creditable coverage must be shown. Providers can view one year of medical history and exclude conditions seen during that time. The rates you pay are determined by where you live, your age, your sex, your job, whether or not you have smoked in the past, and your health. Maine does not permit the use of elimination riders.

Rules for Small Group Maine Health Insurance

Small group medical insurance in Maine is available for employers who insure groups of 1 to 50 people. Small Group Maine Health Insurance coverage cannot be refused based on health conditions; they are guarantee issued. New employees who qualify for their employer's insurance plan may need to wait a determined amount of time before they can join the medical insurance plan. Applicants who cannot prove any prior coverage must allow the insurance provider to view the previous 6 months of their medical history and exclude conditions existing within the past year. The rate the group pays can be changed based on how many employees are insured, their ages, their smoking history, and what kind of business they work for. No matter what, though, the rate cannot be 20% above or below the state's standard insurance rate.

Continuation Coverage and COBRA in Maine

COBRA is not all that important in Maine since state laws require continuation of group health insurance coverage in Maine. If an individual was part of a group plan with over 20 members, they can take advantage of the federal COBRA options available to them. COBRA allows employees who quit or are fired to keep their group insurance for 18 months as long as they continue to pay for it, plus a 2% fee. Widows of the insured, children of an insured person who has died, or disabled persons are eligible for 36 months of COBRA.

If a person leaves a group health insurance plan in Maine that was made up of fewer than 20 persons but cannot get COBRA, Maine's mini-COBRA laws cover them. This allows them to stay in the same insurance group as long as they request to do so within 30 days of leaving their job. They must pay their regular premiums plus 2% in administration fees. You can switch to an individual conversion product after mini-COBRA runs out.

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