An Act To Strengthen Access Requirements and Review Standards for Health Insurance Plans
Maine Legislature, Session 126, LD 1676
Committee Amendment CA_B_H719 (House)
Amends: 24-A MRSA §4303

COMMITTEE AMENDMENT ,]3" to H.P. 1199, L.D. 1676, Bill, "An Act To 
Strengthen Access Requirements and Review Standards for Health Insurance Plans" 
Amend the bill by striking out the title and substituting the following: 
'An Act To Strengthen Disclosure to Consumers about Provider Networks in Health 
Insurance Plans' 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'Sec. 1. 24-A MRSA §4303, sub-§19 is enacted to read: 
19. Disclosure related to provider networks. A carrier offering a managed care 
plan shall prominently disclose to applicants, prospective emollees and emollees 
information about the carrier's provider network for the applicable managed care plan, 
including whether there are hospitals, health care facilities, physicians or other providers 
not included in the plan's network and any differences in an emollee's financial 
responsibilities for payment of covered services to a participating provider and to a 
provider not included in a provider network. The superintendent may adopt rules that set 
forth the manner, content and required disclosure of the information in accordance with 
this subsection. Rules adopted pursuant to this subsection are routine technical rules as 
defined in Title 5, chapter 375, subchapter 2-A.' 
SUMMARY 
This amendment is the minority report of the committee and replaces the bill. The 
amendment requires a health insurance carrier to disclose information about its provider 
networks, including whether there are any hospitals, health care facilities, physicians or 
other providers not included in the provider's network and any differences in an emollee's 
financial responsibilities for payment of covered services to a participating provider and 
to a provider not included in a provider network. 
The amendment authorizes the 
Superintendent of Insurance to adopt rules setting forth the manner, content and required 
disclosure of the information and specifies that those rules are routine technical rules. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT ,B, to H.P. 1199, L.D. 1676 
This amendment does not include the additional provision included in the majority 
report, which requires a health insurance carrier to disclose upon request from a provider 
the reason for not including the provider in the carrier's provider network. 
FISCAL l\OTE l{E(.!LJRED 
(See attached) 
COMMITTEE AMENDMENT 
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LD 1676 
LR 2395(03) 
An Act To Strengthen Access Requirements and Review Standards for Health Insurance Plans 
Fiscal Note for Bill as Amended by'Committee Amendment .13' CH--/l ci) 
Committee: Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - General Fund 
Minor cost increase - Other Special Revenue Funds 
Fiscal Detail and Notes 
Any additional costs to the Bureau of Insurance in the Department of Professional and Financial Regulation or to the 
State Employee Health Insurance Program are expected to be minor and can be absorbed within existing budgeted 
resources, 
LR2395(03) - Fiscal Note - Page 1 of 1