Source: https://www1.maine.gov/pfr/insurance/review_checklists/Rate_filing_Ind_Basic_MedicalSurgical_Expense.htm
Timestamp: 2015-03-02 15:23:06
Document Index: 577513157

Matched Legal Cases: ['§2703', '§2704', '§2707', '§2709', '§2736', '§2736', '§2738', '§2743', '§2749', '§2749', '§2761', '§2723', '§2766']

Individual Basic Medical-Surgical Expense - H21 : Form & Rate Filing Review Checklists : Bureau of Insurance
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Individual Basic Medical-Surgical Expense - H21
General format 24-A M.R.S.A. §2703 Readability, term of policy described, cost disclosed, form number in bottom left corner
Required provisions 24-A M.R.S.A. §2704
Must comply with all applicable provisions of Rule 755 including, but not limited to, Sections 4, 5, 6(A), 6(C), 7(A), 7(B), and 7(D)
30 days Notification prior to cancellation
24-A M.R.S.A. §2707-A, Rule 580
10 days prior notice, reinstatement required if insured has an organic brain disorder Notice of claim
24-A M.R.S.A. §2709
No policy for health insurance shall provide for priority over the insured of payment for any hospital, nursing, medical or surgical services
Guaranteed Issue Products 24-A M.R.S.A. §2736-C
24-A M.R.S.A. §2736-C, Rule 750
Carriers offering individual health plans in the state must have these plans available for purchase. Benefit levels defined in the Rule.
24-A M.R.S.A. §2738
Defined as under 19 years of age and are children, stepchildren or adopted children of, or children placed for adoption with the policyholder, member or spouse of the policyholder or member, no financial dependency requirement, court ordered coverage Newborn coverage 24-A M.R.S.A. §2743
Newborns are automatically covered under the plan from the moment of birth for the first 31 days Coverage for breast cancer treatment
Penalty for noncompliance with utilization review
24-A M.R.S.A. §2749-B
Mental health mandated offer
24-A M.R.S.A. §2749-C
24-A M.R.S.A. §2761
24-A M.R.S.A. §2723-A(3)
Coverage must be provided for dental services performed by a licensed independent practice dental hygienist services under the contract and when they are when those services are covered within the lawful scope of practice of the independent practice dental hygienist.
24-A M.R.S.A. §2766
Policies and contracts must provide coverage for autism spectrum disorders for an individual covered under a policy or contract who is 5 years of age or under in accordance with the following.
The policy or contract must provide coverage for any assessments, evaluations or tests by a licensed physician or licensed psychologist to diagnose whether an individual has an autism spectrum disorder.
The policy or contract must provide coverage for the treatment of autism spectrum disorders when it is determined by a licensed physician or licensed psychologist that the treatment is medically necessary.
The policy or contract may not include any limits on the number of visits.
The policy or contract may limit coverage for applied behavior analysis to $36,000 per year. An insurer may not apply payments for coverage unrelated to autism spectrum disorders to any maximum benefit established under this paragraph.
All individual health insurance policies and contracts must provide coverage for children's early intervention services in accordance with this subsection. A referral from the child's primary care provider is required. The policy or contract may limit coverage to $3,200 per year for each child not to exceed $9,600 by the child's 3rd birthday.
http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title20-section1432&num=0&edition=prelim.