As a resident of Maine you have a variety of private health insurance plans to choose from including individuals and group plans provided by an employer. Depending on your income or employment status, you may also be eligible for Maine State-funded affordable health insurance for individuals and families, and federal programs such as Medicaid and COBRA.
Maine is a guarantee issue state for individual policies. That means private insurance companies are forbidden by law to refuse to issue you a health care policy because of current or past health conditions, age, gender or lifestyle. Elimination riders are not permitted. However, insurance companies are permitted a 12-month look-back and exclusionary period for pre-existing conditions. Note that pregnancy is considered a pre-existing condition and can be excluded for up to 10 months.
Credit for prior creditable coverage is required. Under Maine law, companies that sell individual health insurance coverage must offer a standardize policy. That means that specific benefits, co-pays and coinsurance percentages of the coverage must be identical from all carriers, although the companies are not prohibited from selling non-standardized individual policies, as well. Premiums for individual policies in Maine are limited and can’t be adjusted because of your age, gender, health, claims history or length of time you’ve had a policy. Insurance companies are allowed to vary premiums by 20% from the adjusted community rate because of where you live in the state, your age, the type of work you do and whether or not you are or have ever been a smoker.
Maine is also a guarantee issue state for group health plans issued to small businesses. If your Maine health insurance is provided through an employer, coverage cannot be denied because of the past or current health of anyone in the group. However, a 12-month exclusionary period and 6-month look-back period for pre-existing conditions can be applied if you don’t have proof of prior creditable coverage. Maine does not allow group health insurance issuers to medically underwrite policies to determine the premium they will charge the entire group. Insurers can, however, adjust rates based on age, where the business is located, the business’s work field and the smoking habits of employees, although the highest premium cannot be greater than 20% of the standard rate.
Maine is a guarantee issue state for individual policies. That means private insurance companies are forbidden by law to refuse to issue you a health care policy because of current or past health conditions, age, gender or lifestyle. Elimination riders are not permitted. However, insurance companies are permitted a 12-month look-back and exclusionary period for pre-existing conditions. Note that pregnancy is considered a pre-existing condition and can be excluded for up to 10 months.
Credit for prior creditable coverage is required. Under Maine law, companies that sell individual health insurance coverage must offer a standardize policy. That means that specific benefits, co-pays and coinsurance percentages of the coverage must be identical from all carriers, although the companies are not prohibited from selling non-standardized individual policies, as well. Premiums for individual policies in Maine are limited and can’t be adjusted because of your age, gender, health, claims history or length of time you’ve had a policy. Insurance companies are allowed to vary premiums by 20% from the adjusted community rate because of where you live in the state, your age, the type of work you do and whether or not you are or have ever been a smoker.
Maine is also a guarantee issue state for group health plans issued to small businesses. If your Maine health insurance is provided through an employer, coverage cannot be denied because of the past or current health of anyone in the group. However, a 12-month exclusionary period and 6-month look-back period for pre-existing conditions can be applied if you don’t have proof of prior creditable coverage. Maine does not allow group health insurance issuers to medically underwrite policies to determine the premium they will charge the entire group. Insurers can, however, adjust rates based on age, where the business is located, the business’s work field and the smoking habits of employees, although the highest premium cannot be greater than 20% of the standard rate.
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