Maine (ME)
Individual Health Insurance Regulations

Learn more about Maine Individual Health Insurance

Health insurance is essential to protect your family’s health against unpredicted events of sickness or injury. Before opting for health coverage, you should go through your family’s medical needs and your budget. Being a Maine resident, you can choose from various health insurance alternatives. The Maine Bureau of Insurance supervises the legislature under which the Maine health insurers can sell private health insurance to individuals and families.

Insurance laws in Maine require that all individual health insurance policies be written on a guaranteed issue basis, meaning insurance carriers are not permitted to deny you coverage due to unfavorable current or past health history. In addition, Maine requires that health insurance carriers, who opt to sell individual health insurance policies, including HMOs, must offer a standardized policy. Regulated by the state, standard policies are required to offer specific benefits and the coverage, benefits co-payments and coinsurance percentages must be identical from all carriers. These same insurance carriers are also permitted to sell other health insurance plans that are non-standardized. There is a 12 month look-back clause and exclusionary period allowable for pre-existing conditions, with credit for prior creditable coverage being required. Elimination riders are not permitted and may not be added to any health insurance policy. Insurance rates can be adjusted by geographical region, age, health, occupation and smoking history.

Request Maine Individual Health Insurance Quotes from any of our multiple providers.

Maine (ME)
Small Group Health Insurance Regulations

In Maine a group is defined as 1 - 50 employees. Small group health insurance in Maine is guarantee issue, which means that no group can be declined health insurance coverage based upon its health status. Each qualified employee may be required to satisfy a waiting period prior to entering the group plan. Once eligible, the health insurance company may impose a 6 month look back / 12 month exclusionary period for pre-existing conditions on applicants not able to provide proof of prior creditable coverage. The use of medical underwriting to determine group rates is not permitted, but they may be adjusted based on age of employees, location of business, work field of business and the smoking history of the employees. Regardless of these rating factors, the most an insurance company can charge a small employer for health insurance is 20% of the standard rate.

Small business owners can request quotes for Maine group health insurance from any of our listed providers.

Maine COBRA and Continuation Coverage

Since Maine is a state the requires the health insurance companies to insure all applicants continuation of group coverage under COBRA regulation is of less importance than in most states. Federal COBRA options are still available to persons that work for a company with more than 19 employees. Any employee can remain on the group health plan for 18 months after leaving employment with the company, regardless of the reason they are leaving. In some cases, a person may be eligible to remain on COBRA for 36 months. This includes person that meet disability guidelines, a widow and the deceased member’s children. The insured would be responsible for premium payment of the coverage along with 2% administrative fees.

However, Maine offers mini-cobra option to individuals who are leaving a group plan with fewer than 20 members and are not federally eligible for COBRA may still be able to continue coverage under their group plan for up to 18 months. Individuals have to elect this option within 31 days. An administrative fee of 2% of the premium amount is added to the amount paid by the employer, and any individual accepting continuation of coverage is fully responsible for the paying the premium. After exhausting COBRA coverage, individuals have option of transferring to an individual conversion product.