Code of Maine Rules
02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
031 - BUREAU OF INSURANCE
Chapter 270 - MEDICARE SUPPLEMENT INSURANCE RULE - REVISED
Section 031-270-6 - Prohibited policy provisions

Universal Citation: 02 ME Code Rules ยง 031-270-6

Current through 2024-13, March 27, 2024

(A) A Medicare supplement policy may impose reasonable territorial limitations consistent with those imposed by Medicare but may otherwise limit or exclude coverage only for the following services and conditions:

(1) foot care in connection with corns, calluses, flat feet, fallen arches, weak feet, chronic foot strain, or symptomatic complaints of the feet;

(2) alcoholism, drug addiction, and mental or emotional disorders other than Alzheimer's Disease and related dementias;

(3) illness, medical condition, or treatment, arising out of:
(a) war or act of war (whether declared or undeclared), service in the armed forces or units auxiliary thereto, or participation in a felony, riot, or insurrection;

(b) suicide (sane or insane), attempted suicide, or intentionally self-inflicted injury;

(c) aviation;

(4) cosmetic surgery, other than reconstructive surgery that is incidental to or follows surgery resulting from trauma, infection, or other diseases of the involved part;

(5) treatment provided in a government hospital; any expense to the extent of benefits provided under Medicare, any state or federal workers' compensation, employer's liability, or occupational disease law, any motor vehicle no-fault law, or any other governmental program except Medicaid; services performed by a member of the covered person's immediate family; and services for which no charge is normally made in the absence of insurance;

(6) dental care or treatment;

(7) eye glasses, hearing aids, and examination and prescription for the fitting thereof; and

(8) rest cures, custodial care, transportation, and routine physical examinations;

Limitations or exclusions falling within the foregoing descriptions are permitted, but only to the extent consistent with the mandated benefit requirements of Subparagraph 8(B)(8) below and the other minimum benefit standards set forth in this Rule, provided further that no limitations of the types enumerated in subsections (1), (6), or (8) above may be more restrictive than those of Medicare.

(B) No Medicare supplement policy may use waivers to exclude, limit, or reduce coverage or benefits for specifically named or described pre-existing diseases or physical conditions.

(C) A Medicare supplement policy shall use only the terms "skilled nursing facility" and "intermediate care facility" to refer to nursing care facilities. Terms including, but not limited to "Convalescent Nursing Facility" and "Extended Care Facility," which are not classes of health care facilities licensed under Maine law, shall not be permitted.

(D) No Medicare supplement policy shall use "nursing home," "nursing care," or words of similar generality to describe coverage provided unless coverage is provided for expenses incurred in connection with an insured person's confinement in skilled nursing facilities and intermediate care facilities.

(E) The terms "Medicare Supplement," "Medigap," and words of similar import shall not be used unless the policy is issued in compliance with this Rule.

(F) No Medicare supplement policy or certificate in force in Maine shall contain benefits which duplicate benefits provided by Medicare.

Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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