An Act To Protect Health Care Consumers from Catastrophic Debt
Maine Legislature, Session 124, LD 1620
Committee Amendment CA_A-SA_A_S444 (Senate)
Amends: 24-A MRSA §4318

SENATE AMENDMENT" Il " to COMMITTEE AMENDMENT "A" to H.P. 
1148, L.D. 1620, Bill, "An Act To Protect Health Care Consumers from Catastrophic 
Debt" 
Amend the amendment by striking out all of section 1 (page 1, lines 13 to 34 and 
'Sec. 1. 24-A MRSA §4318 is enacted to read: 
§4318.· Prohibition against maximum aggregate benefit provisions 
1. Prohibition. An individual or group health plan issued or renewed by a carrier on 
or after the effective date of this section may not include a provision in a policy, contract, 
certificate or agreement that purports to terminate payment of any additional claims for 
coverage of health care services after a defined maximum aggregate dollar amount of 
claims for coverage of health care services on an annual, lifetime or other basis has been 
paid under the health plan for coverage of an insured individual, family or group for 
services received in a provider network. 
2. Specific benefits. This section may not be construed to limit the ability· of a 
carrier to offer a health plan that limits benefits under the health plan for specified health 
care services on an annual basis. 
3. Exceptions. This section does not apply to: 
A. An individual health plan in effect on the effective date of this s~ction with an 
annual or lifetime maximum aggregate benefit limit of less than $1,000,000; 
B. A health plan designed for an employee who works on a part-time, tempormy or 
seasonal basis or designed as shOJi-term coverage for an employee who is fulfilling a 
waiting period for coverage under another employer-sponsored benefit plan; 
C. An individual health plan in effect on the effective date of this section issued 
pursuant to a conversion privilege in a group health insurance policy subject to 
section 2809-A; 
D. A pilot project to offer an individual health plan to a person under 30 years of age 
pursuant to section 2736-C, subsection 10; 
SENATE AMENDMENT 
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SENATE AMENDMENT" A" to COMMITTEE AMENDMENT "A" to H.P. 1148, L.D. 1620 
E. Blanket health insurance as defined in section 2813; and 
F. Annual or lifetime maximum aggregate benefit limits on claims for coverage of 
health care services received outside a provider network. 
4. Disclosure. A health plan issued after the effective date of this section that 
includes an annual or lifetime maximum aggregate benefit limit as permitted under 
subsection 3 must include a disclosure of the applicable limit on the face page of the 
individual policy or group certificate. The disclosure must be printed in a font that is 
larger or bolder than the font used in the body of the face page.' 
SUMMARY 
This amendment allows the establishment of annual or lifetime maximum aggregate 
benefit limits on claims for coverage of health care services received outside a provider 
network. The amendment also corrects a section number to make it read consecutively 
with existing law. 
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SPONSORED BY: ~ 
{\'\~ .(V\1..J:~ .. }l.... 
(Senator MCCORMICK) 
COUNTY: Kennebec 
SENATE AMENDMENT 
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