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Maine - Compensation & Benefit Legislation

MAINE - AASHOWME

Demonstrates www.BenefitsReview.com™ site. Illustrates insurance carriers' coverages within the State.

 

MAINE - ADOPTED CHILD HEALTH CARE MANDATE

OBRA 1993 (Federal) requires group health plans to honor medical and child support orders. Also, plans must treat adopted children like biological children covered by the plan, and plans are precluded from applying pre-existing condition exclusions to an adopted child where no such exclusion applies to a newborn biological child. Health plans that covered the cost of pediatric vaccines as of May 1, 1993, and fail to continue that level of coverage, will be subject to an excise tax penalty applicable to plans that fail to meet the health care continuation coverage requirements under OBRA 1993.

 

Mandatory coverage of birth of adopted children is included in state's newborn health care mandate.

 

Preventive care for children: No.

 

(Maine Rev. Stat. Ann. title 24-A, Sections 2832, 2833, 2834)

 

MAINE - ALCOHOLISM & DRUG ABUSE

Mandatory coverage.

 

Minimum yearly inpatient coverage: no statutory requirements.

 

Minimum yearly outpatient coverage: no statutory requirements.

 

Minimum lifetime coverage: no statutory requirements.

 

(Maine Rev. Stat. Ann. 24-A Section 2842)

 

MAINE - CAFETERIA PLAN TAX LAWS

State income tax, unemployment insurance tax on salary reduction: No. Follows FUTA.

 

MAINE - CONTINUATION OF COVERAGE CONVERSIONS

Events Triggering Continuation of Coverage:

 

MAINE - COORDINATION OF BENEFITS

State reports no statutory requirements.

 

MAINE - COST-OF-LIVING

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian cost-of-living data and U.S. Automobile Cost Survey.

 

MAINE - DRUG TESTING AND EMPLOYEE ASSISTANCE BENEFITS

Who is Covered by Statute:.All employers, employees, and applicants. (Employees at nuclear power plants are exempt.) Written policy is required. Employers with 20 or more full-time employees must establish an EAP as a condition for employee drug testing.

 

Applicant Testing:.Applicant testing is allowed, but only after a conditional offer of employment has been made.

 

Employee Testing: Employee testing is allowed for probable cause Random testing is permitted with union-management agreement and for safety-sensitive positions. EAP-related testing is permitted, but only for rehabilitation purposes; results are not disclosable to employer.

 

How Test Results are Used: Test results may be used as a factor to screen out drug-using applicants or to discharge or discipline employees; an employee's first offense results in referral to an EAP. Discharge is permitted for refusal to take test or for failure to comply with or complete a rehabilitation program within a 6-month period. Applicants and employees have 3 days after a positive test to product evidence explaining or contesting result.

 

Enforcement of Statutes:.Enforcement is by private civil action; state pursues violation of statute.

 

Employee Remedies: Employees may seek back pay (3 times lost wages), attorney's fees and court costs, reinstatement, civil damages, and injunctive relief.

 

Employer Penalties: None.

 

Who Pays for Testing: Employees and applicants shall pay all the costs of subsequent tests and samples taken.

 

Employee Assistance Benefits: Employer with more than 20 employees must have in existence an EAP before establishing any substance abuse testing program.

 

Other Requirements: Policy must be approved by state Department of Labor. Employees affected by new policy must be given 30 days' notice; changes to existing policy are effective 60 days after notice. employers must consult with employees before implementing employee part of program. Employers do not have to consult with present employees before implementing employee part of program. Employers do not have to consult with present employees about applicant part of program. Probable-cause finding must be written. Employee returning to workforce after drug related absence may be tested between 90 days and 1 year following first confirmed test.

 

(Maine Rev. Stat. Ann. tit. 26, Sections 681-690)

 

MAINE - GROUP HEALTH CODE ADDITIONS (MANDATED)

Access to Care: An employer that fails to provide health care benefits to an employee is liable to the employee for the amount of benefits and subject to a fine of $100 to $500 for each violation. (Maine Rev. Stat. Ann. tit. 26, Section 626-A.

 

AIDS: Policies must not provide more restrictive benefits for sickness or disability resulting from AIDS or HIV related diseases than for other sicknesses. (Maine Rev. Stat. Ann. tit. 24-A, Sections 2750, 2846.)

 

Alcoholism and Drug Abuse Treatment: Group policies covering hospital care must extend coverage to residential treatment at a hospital of free standing licensed residential treatment center and to outpatient care rendered by licensed providers. Reasonable coinsurance, deductibles, exclusions, and limitations are permitted. Exemption for policies covering 20 or fewer employees. (Maine Rev. Stat. Ann. tit. 24-A, Section 2842.)

 

Breast Reconstruction: Insurers providing coverage for mastectomy also must provide benefits for reconstructive surgery on an affected breast as well as on the other breast in order to produce a symmetrical appearance. (S80, 1995) (Maine Rev. Stat. Ann. tit. 24, Section 2320-C, tit. 24-A, Section 2745-C, 2837-C, 4237.)

 

Cardiac Rehabilitation: Insurers must make available to groups of or more coverage for cardiac rehabilitation. (Maine Rev. Stat. Ann. tit. 24-A, Section 2845.)

 

Coverage Conversion: Group policies covering hospital, surgical, or major medical expenses must offer conversion rights to employees ceasing membership due to termination of employment or the policy, to the dependents of such employees, to surviving spouses or children of deceased employees, and to spouses or children whose eligibility ceases because they cease to be a qualified family member. (Maine Rev. Stat. Ann. tit. 24-A, Section 2809-A.) Insurers are prevented from denying coverage to those who change jobs or become self-employed. Under 1993 health care reform, premiums must be based on community ratings, and insurers cannot base premiums on gender, health status, claims experience, or policy duration. However, until 1997, the premium may take into account age, smoking status, occupation or industry, and geography. Individuals eligible for continuity of coverage under plans including HMOs or governmental programs must be allowed to purchase coverage under an individual, non-renewable short term policy for a term not exceeding twelve months. (H321, 1995) (Maine Rev. Stat. Ann. tit. 24 Section 2349, 24-A, Section 2736-C, 24-A, Section 2849-B.)

 

Enteral Formula: Effective 1/1/96, insurers including HMO's must provide coverage of up to $3,000 per year for metabolic formula and special modified low protein food products prescribed by licensed physicians for individuals with inborn error or metabolism -- a genetically determined biochemical disorder in which a specific enzyme defect produces a metabolic block that may have pathogenic consequences at birth or later in life. (H401, 1995) (Maine Rev. Stat. Ann. tit. 24 Sections 2320-C, 2745-C, 2837-C, 4237.)

 

Health Maintenance Organizations: Chiropractors: Effective 1/1/96, HMOs must cover services provided by participating chiropractors through patient self-referral up to a maximum of 36 visits during a 12 month period. Participating primary care providers, however, must be supplied with information concerning chiropractors' diagnoses and care plans. (HP287, LD391, 1995) (Maine Rev. Stat. Ann. tit. Section 24-A MRSA, 4236, 3.)

 

Home Health Care: Insurers must make available coverage for home health care services that provides for at least 90 visits per year by a home health care provider. (Maine Rev. Stat. Ann. tit. 24-A, Sections 2745, 2837.)

 

Mammography Screening: Policies must cover costs of mammography screening as described. (Maine Rev. Stat. Ann. tit. 24-A, Section 2837-A.)

 

Maternity Benefits: Policies providing maternity coverage must extend the same coverage to unmarried women and to minor dependents as to married women. (Maine Rev. Stat. Ann. tit. 24-A, Sections 2741, 2832.) Health insurers (including HMOs which provide coverage for maternity and childbirth also must provide coverage for services related to maternity and newborn care. Care of a mother and newborn child must meet criteria outlined in the Guidelines for Perinatal Care, published by the American Academy of Pediatrics and the American College of Obstetrics and Gynecology, which recommends a hospital stay of 48 hours after childbirth. (S670, 1996) (Maine Rev. Stat. Ann. tit. 24 MRSA, Sections 2318-A; 2743-A, 2834-A, 4334-B.)

 

Mental Health: Group policies covering hospital care must extend coverage to inpatient care, day treatment services, and outpatient services for conditions arising from mental illness. Reasonable coinsurance, deductibles, exclusions, and limitations are permitted. Exemptions for policies covering 20 or fewer employees. (Maine Rev. Stat. Ann. tit. 24-A, Section 2843.) Effective 7/1/96, insurers including HMOs must provide coverage for diagnosis and treatment of mental illness under terms no less extensive than benefits provided for diagnosis and treatment of physical illnesses. Specified mental illnesses covered include schizophrenia; bipolar disorder; pervasive developmental disorder, or autism; paranoia; panic disorder; obsessive-compulsive disorder; or major depressive disorder. (H432, 1995)

 

MEWAs: Multiple employer welfare arrangements must meet certain state standards in order to operate, including that an arrangement be nonprofit, be established by an organization maintained for at least one year for purposes other than obtaining or providing insurance, and that it not deny coverage to any otherwise eligible employer or employee/dependent on the basis of health status or claims experience. Every arrangement also must provide evidence of benefits to each covered employee, maintain specific excess insurance and appropriate loss reserves, hold its funds in trust in the name of the arrangement, and make all contracts and administrators or service companies available for inspection. MEWAs are defined to be employer welfare benefit plans or other arrangements that are established to provide health benefits to the employees of two or more employers or to their beneficiaries. The term does not include arrangements established or maintained pursuant to agreements deemed to be collective bargaining agreements under ERISA. (Maine Rev. Stat. Ann. tit. 24-A, Section 6601.)

 

Newborns: Policies providing family coverage must provide benefits for newborns from the moment of birth for injury or sickness including treatment of medically diagnosed congenital defects and birth abnormalities. (Maine Rev. Stat. Ann. tit. 24-A, Sections 2743, 2834.) Policies must offer unmarried women the option of coverage from their dependent children from the date of birth. (Maine Rev. Stat. Ann. tit. 24-A, Section 2832.)

 

Policies for Small Employers: Carriers for small employers must offer a standard plan similar to those plans typically sold to small employers and a basic plan, which emphasizes preventive care, but contains fewer benefits and costs 20 percent less than the standard plan. (Maine Rev. Stat. Ann. tit. 24-A, Section 2808-B.). Employees eligible to participate in standardized plans include full time employees with work weeks of 30 hours of more, sole proprietors, partners, or independent contractors. Temporary or substitute employees are ineligible. Employers may elect to treat as eligible those employees who are part time and work a week of 10 hours of more, as well as an employer's retirees. (Maine Rev. Stat. Ann. tit. 24-A, Section 2808-B.) Policies for groups 20 or fewer employees are not required to include coverage for alcoholism or drug abuse treatment for mental illness. (Maine Rev. Stat. Ann. tit. 24-A, Sections 2842, 2843.)

 

Providers: Chiropractors, psychologists, certified licensed social workers, and licensed psychiatric nurses: Costs for services must be covered if the provider is licensed, the service is within the provider's scope of services, and the service is covered by the policy. (Maine Rev. Stat. Ann. tit. 24-A, Sections 33-2744, 33-2743, 33-2835, 33-2840-A.) Optometric services: Insurers must make available coverage for services provided by a licensed optometrist. (Maine Rev. Stat. Ann. tit. 24-A, Section 2841.)

 

Optional Benefits: Cooperative Agreements: Two or more hospitals or nonprofit mental health care providers may enter into cooperative agreements in which sharing of patient services; personnel; instructional programs; mental health services; support services and facilities; or medical, diagnostic, or laboratory facilities or procedures may occur. (H548, 1995)

 

MAINE - GROUP HEALTH FOR SMALL EMPLOYERS

For insurance plans offered to small employers:

 

MAINE - GROUP LIFE CODE ADDITIONS

Employer required to pay part of premium: No.

 

Percent of employees who must elect coverage (if employees pay part of premium): No statutory requirement.

 

Percent of employees who must be covered if employer pays all of premium: 100%.

 

Minimum number of employees in group plan: No statutory requirement.

 

Employer prohibited as beneficiary: Yes.

 

Grace period (days): 31.

 

Mandatory conversion: Yes.

 

Other provisions: Insurer may not restrict or exclude coverage for death resulting from AIDS, ARC, or HIV.

 

(Maine Rev. Stat. Ann. tit. 24-A, Sections 2603, 2614, 2621, 2622, 2629)

 

MAINE - HOLIDAYS

January 1, Washington's Birthday (or 3rd Monday in February), Memorial Day (or last Monday in May), July 4, Labor Day (or 1st Monday in September), Veterans Day, and December 25 are state holidays in all 50 states and in the District of Columbia. Other holidays under State law include: Martin Luther King's birthday (or 3rd Monday in January), Columbus Day (or 2nd Monday in October), Sunday. Other: Any day proclaimed by Governor or President. If January 1, July 4, November 11, or December 25 falls on Sunday, following Monday is a holiday. (Maine Rev. Stat. Ann. Tit. 9-B Section 141)

 

MAINE - IMMIGRATION (PREVAILING WAGE POLICY)

See U.S. Federal General Administrative Letter 1-2000

 

MAINE - JURY DUTY & WITNESS TIME OFF

Employer Restriction For Discharging Employee For Taking Leave For Jury Service: Yes.

 

Remedies and Penalties: Violator is guilty of a Class E crime. Employee can bring civil action within 90 days of discharge for lost wages and health insurance benefits, reinstatement and reasonable attorney fees. Damages may not exceed 6 weeks' lost wages.

 

Other Requirements: None reported. (Maine Rev. Stat. Ann. tit. 14, Section 1218.)

 

Employer Restriction For Discharging Employee For Taking Leave to be a Witness: State reports no statutory requirements.

 

Remedies and Penalties: State reports no statutory requirements.

 

Other Requirements: None reported.

 

MAINE - LEAVES OF ABSENCE

Employers Subject to Leave Laws: Employers with more than 25 employees.

 

Criteria for Eligibility: Must be employed for more than 1 consecutive year.

 

Maximum length of leave: 10 weeks in a 2 year period.

 

Paid Leave: Employer has discretion.

 

Acceptable Reasons for Leave: Birth/adoption or serious illness of child, parent, or spouse, or employee's illness.

 

Employment Guarantees After Leave: Entitled to reinstatement in the same or equivalent position held prior to leave.

 

Use of Vacation or other Time-off Benefits: State reports no statutory requirements.

 

Certification Required: Employer may require certification of illness if leave is taken to care for an ill child, parent, or spouse, or employee's illness.

 

Effect Of Leave on Other Benefits: Benefits may continue at employee's expense.

 

Effect of Seniority Accrual During Leave: Seniority benefits do not accrue while on leave.

 

Minimum Requirements for Notification to Employer: 30 days notice for non-emergencies is required.

 

Conditions for Denial of a Request For Leave: State reports no statutory requirements.

 

(Maine Rev. Stat. Ann. tit. 26, Sections 844 - 845.)

 

See U.S. Federal Family and Medical Leave Act

 

MAINE - LONG TERM DISABILITY CODE ADDITIONS

State does not require employer to provide long term disability benefits; although many employers do in order to remain competitive in hiring/retention of employees.

 

See LEAVES OF ABSENCE (above), WORKERS' COMPENSATION (below) and U.S. Federal Americans With Disabilities Act

 

MAINE - MANDATED PROVIDERS

Chiropractors, psychologists, and social workers. Optometrists is an employer option. Mandatory coverage for clinical nurse specialists and acupuncturists. Direct access to an obstetrician/gynecologist is mandatory. (Maine. Rev. Stat. Ann. Tit. 24-A Sections 2744, 2835, 2837-B, 2840-A, 2841, 2847-F)

 

MAINE - MENTAL HEALTH CARE

Mandatory coverage.

 

Minimum weekly inpatient coverage: 60 days.

 

Minimum weekly outpatient coverage: $2,000.

 

Minimum lifetime coverage: $100,000.

 

(Maine Rev. Stat. Ann. tit. 24-A, Section 2843)

 

MAINE - MINIMUM WAGE

$5.75 per hour (effective January 1, 2002). $6.25 per hour (effective January 1, 2003).

 

Exemptions: Certain professionals, agriculture workers, domestics, and outside sales. Apprentices and handicapped workers in special environments may be exempt by special certificate. (Maine Rev. Stat. Ann. tit. 26, Sections 663, 664, 666, 667)

 

See U.S. Minimum Wage

 

MAINE - NEW HIRE REPORTING

Who is required to report: All employers.

 

Who must be reported: All new employees and rehires.

 

Exempt from reporting: No exemptions.

 

Form(s) to file: W-4 form or other mutually agreeable means.

 

Filing deadline: Within 7 days of beginning of employment.

 

Employer information to be included: Name, address, and employment security reference number.

 

Employee information to be included: Name, address, SSN, and date of hire.

 

Penalty for failure to report: Written notice of delinquency in filling will be followed by a fine of up to $200 for subsequent violations.

 

(Maine Rev. Stat. Ann. tit. 19, Section 2154)

 

MAINE - NEWBORN CARE MANDATE

Mandated coverage.

 

Preventive care for children: No. (Maine Rev. Stat. Ann. title 24-A, Sections 2832, 2833, 2834)

 

MAINE - PARENTAL LEAVE

See U.S. Federal Family and Medical Leave Act

 

MAINE - PRE-EXISTING CONDITIONS

For insurance plans offered to small employers, permitted to exclude coverage to late enrollees for pre-existing conditions. (Maine Rev. Stat. Ann. tit. 24-A, Section 2808-B)

 

See U.S. Federal Health Insurance Portability & Accountability Act

 

MAINE - PROTECTED CLASSIFICATIONS

Age:  Yes.

Race:  Yes.

Color:  Yes.

National Origin: Yes.

Ancestry: Yes.

Religion: Yes.

Sex:  Yes.

Pregnancy:  Yes.

Sexual Harassment: Yes.

 

(Me. Rev. Stat. Ann. tit. 5, Sections 4571, 4572, 4572-A, 4574, 4651 et seq.)

 

MAINE - SALARY SURVEY

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian wages & salaries (covering 3,000 positions).

 

MAINE - SHORT TERM DISABILITY CODE ADDITIONS

State does not require employer or employee participation in short term disability plans.

 

MAINE - TERMINATION & SEVERANCE PAY

Date pay is due if employee is discharged: Earlier of payday or within 2 weeks.

 

Date due if employee resigns: Earlier of payday or within 2 weeks.

 

Wages: Yes.

 

Vacation Pay: Yes.

 

Holiday: No.

 

Sick leave: No.

 

Severance: No.

 

(Maine Rev. Stat. Ann. tit. 26 Sections 625-B, 626. See Bellino v. Schlumberger Technologies, Inc., 753 F. Supp. 391 (D. ME 1990))

 

MAINE - UNEMPLOYMENT TAX

Employer Contributions:

 

 

Voluntary Contribution Provision: Yes. Within 30 days of mailing notice.

 

(Maine Rev. Stat. Ann. tit. 26 Section 1221.)

 

MAINE - VACATION PAY

See TERMINATION & SEVERANCE PAY (above)

 

MAINE - VOTING TIME OFF

State reports no statutory requirements.

 

MAINE - WORKERS' COMPENSATION

Private Employers: Mandatory as to all employments, including corporate executives. Corporate officers who are 20% shareholders and sole proprietors may reject coverage. Elective as to self-employed persons or partners.

 

Public Employers: Mandatory as to state, counties, cities, towns, and quasi-municipal corporations. Includes firefighters, police, volunteer firefighters and emergency medical services personnel.

 

Exceptions: Domestic workers, seasonal (works less than 26 weeks per year, full or part-time) or casual agricultural or aqua-cultural employees. (Note: Employers of 6 or fewer agricultural or aqua-cultural employees except if employer maintains liability insurance policy with limits of not less than $100,000 per employee and medical coverage of not less than $1,000.) Maritime employee in interstate or foreign commerce. Commission paid real estate salesperson or broker. (Note: Provided that broker or salesperson is independent contractor and signs contract with agency indicating such.) Independent contractor; employee harvesting 150 cords of wood from farm wood lot; voluntary participant in employer-sponsored athletic event. Elected or appointed executive officers of a charitable, religious, educational or other non-profit corporation. (Note: No compensation allowed if injury or death of employee is brought about by willful intention of self or another, or by intoxication while on duty).

 

Special Coverage Provisions: Voluntary as to excluded employments. Parent, spouse, or child of sole proprietor, partner, or corporate officer who is a 20% shareholder or shareholders of a professional corporation may reject coverage.

 

(U.S. Chamber of Commerce, 1994 Analysis of Workers' Compensation Laws.)