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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. |
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| | 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 E, §3 and c. 400, §1 and affected by §2, is repealed and the | following enacted in its place: |
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| 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. |
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| (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. |
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| (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. |
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| (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. |
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| (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: |
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| (a)__A copy of the most recent quarterly combined | filing for income tax withholding and unemployment | contributions, Form 941/C1-ME; |
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| (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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