LD 1507
pg. 10
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LR 1913
Item 1

 
claim filed pursuant to a policy issued under this chapter, other
than a policy that is subject to section 4312, shall provide the
policy or certificate holder with an opportunity to have the denial
reviewed by the insurer and to arbitrate the denial if not
satisfied after review. The right to review and arbitrate shall
must be prominently set forth in any written notice sent to the
policy or certificate holder denying the claim. The arbitration
shall be is nonbinding and shall must be carried out in accordance
with procedures established by the insurer.

 
Sec. H-5. 24-A MRSA §2808-B, sub-§1, ¶D, as amended by PL 2001, c. 258,
Pt. E, §3 and c. 400, §1 and affected by §2, is repealed and the
following enacted in its place:

 
D.__"Eligible group" means any person, firm, corporation,
partnership, association or subgroup engaged actively in a
business that employed an average of 50 or fewer eligible
employees during the preceding calendar year.

 
(1)__If an employer was not in existence throughout the
preceding calendar year, the determination must be
based on the average number of employees that the
employer is reasonably expected to employ on business
days in the current calendar year.

 
(2)__In determining the number of eligible employees,
companies that are affiliated companies or that are
eligible to file a combined tax return for purposes of
state taxation are considered one employer.

 
(3)__A group is not an eligible group if there is any
one other state where there are more eligible employees
than are employed within this State and the group had
coverage in that state or is eligible for guaranteed
issuance of coverage in that state.

 
(4)__An employer qualifies as an eligible group for 2-
person coverage if the employer provides a carrier with
the following information demonstrating that the
employer's business and employees meet the minimum
qualifications for group coverage in paragraph C:

 
(a)__A copy of the most recent quarterly combined
filing for income tax withholding and unemployment
contributions, Form 941/C1-ME;

 
(b)__For an employee claimed to be an employee eligible for group
coverage whose name is not listed on Form 941/C1-ME, a copy of
the employer's payroll records for the most recent 3 months


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