An Act To Encourage Health Insurance Consumers To Comparison Shop for Health Care Procedures and Treatment
Maine Legislature, Session 127, LD 1305
Committee Amendment CA_A_S406 (Senate)
Amends: 24-A MRSA §4303-C

COMMITTEE AMENDMENT "A" to S.P. 470, L.D. 1305, Bill, "An Act To 
Encourage Health Insurance Consumers To Comparison Shop for Health Care Procedures 
and Treatment" 
Amend the bill by striking out the title and substituting the following: 
'An Act To Improve Transparency and Help Consumers Compare Costs for Health 
Care Procedures and Treatment' 
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-C is enacted to read: 
§4303-C. Payments for health care services; estimates 
A carrier offering a health plan in this State shall comply with the following 
requirements with respect to payments for health care services. 
1. Payment information; availability on website. By January I, 2018, a carrier 
shall establish an interactive mechanism on its publicly accessible website that enables an 
enrollee to request and obtain from the carrier information on the payments made by the 
carrier to network providers for health care services. The interactive mechanism must 
allow an enrollee seeking information about the cost of a particular health care service to 
compare costs among network providers. If a carrier is unable to comply under this 
subsection, a carrier may satisfy the requirements of this subsection by providing a link 
on its publicly accessible website to enable an enrollee to obtain payment information for 
that carrier through the publicly accessible website established by the Maine Health Data 
Organization pursuant to Title 22, section 8712, subsection 2. 
2. Estimate of out-of-pocket costs. Beginning January I. 2018, within a reasonable 
time of an enrollee's request, a carrier shall provide a good faith estimate of the amount 
the enrollee will be responsible to pay out of pocket for a proposed nonemergency 
procedure or service that is a medically necessary covered benefit from a carrier's 
network provider, including any copayment, deductible, coinsurance or other out-of-
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT" A" to S.P. 470, L.D. 1305 
pocket amount for any covered benefit, based on the information available to the carrier 
at the time the request is made. This subsection does not prohibit a carrier from imposing 
cost-sharing requirements disclosed in the enrollee's certificate of coverage for 
unforeseen health care services that arise out of the nonemergency procedure or service 
or for a procedure or service provided to an enrollee that was not included in the original 
estimate. A carrier shall notify an enrollee that these are estimated costs, and that the 
actual amount the enrollee will be responsible to pay may vary due to unforeseen 
circumstances that arise out of the proposed nonemergency procedure or service. For 
purposes of this subsection, "nonemergency procedure or service" means a nonemergency 
health care procedure or health care service in the following categories only: 
A. Office visits; 
B. Physical and occupational therapy services; 
C. Integrative medicine services; 
D. Mental health services; 
E. Obstetrical and gynecological services; 
F. Radiology and imaging services; and 
G. Laboratory services.' 
SUMMARY 
This amendment is the majority report of the committee. The amendment replaces the 
bill, changes the title and does the following. 
The amendment requires a health insurance carrier by January 1, 2018 to establish an 
interactive mechanism on its publicly accessible website that enables an enrollee to 
request and obtain from the carrier information on the payments made by the carrier to 
network providers for health care services. The interactive mechanism must allow an 
enrollee seeking information about the cost of a particular health care service to compare 
costs among network providers. The amendment allows a carrier that is unable to comply 
to provide a link on its publicly accessible website to enable an enrollee to use the Maine 
Health Data Organization's CompareMaine website. 
The amendment requires health insurance carriers beginning January 1, 2018 to 
provide a good faith estimate, within a reasonable time of a request, of the estimated 
amount of the out-of-pocket costs to be paid by the enrollee for a proposed nonemergency 
procedure or service from a network provider. The amendment defines a nonemergency 
procedure or service as a procedure or service in one of the following 7 categories: office 
visits; physical and occupational therapy services; integrative medicine services; mental 
health services; obstetrical and gynecological services; radiology and imaging services; 
and laboratory services. 
COMMITTEE AMENDMENT 
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