An Act To Limit Allowable Health Care Charges in Certain Specified Situations
Maine Legislature, Session 127, LD 0251
Committee: Insurance and Financial Services
Sponsors: GRATWICK, MORRISON, DILL, DUTREMBLE, MIRAMANT, WHITTEMORE, HAMANN
Amends: 24-A MRSA §4303

Legislative Document 
No. 251 
S.P. 89 
In Senate, February 3, 2015 
An Act To Limit Allowable Health Care Charges in Certain 
Specified Situations 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
HEATHER J.R. PRIEST 
Secretary of the Senate 
Presented by Senator GRATWICK of Penobscot. 
Cosponsored by Representative MORRISON of South Portland and 
Senators: DILL of Penobscot, DUTREMBLE of York, MIRAMANT of Knox, 
WHITTEMORE of Somerset, Representatives: HAMANN of South Portland, McCREIGHT of 
Harpswell. 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  24-A MRSA §4303, sub-§8-A, as enacted by PL 2011, c. 238, Pt. A, §1, 
is amended to read: 
8-A.  Protection from balance billing by providers.  An enrollee's responsibility for 
payment under a managed care plan must be limited as provided in this subsection. 
A.  The terms of a managed care plan must provide that the enrollee's responsibility 
for the cost of covered health care rendered by participating providers is limited to 
the cost-sharing provisions expressly disclosed in the contract, such as deductibles, 
copayments and coinsurance, and that if the enrollee has paid the enrollee's share of 
the charge as specified in the plan, the carrier shall hold the enrollee harmless from 
any additional amount owed to a participating provider for covered health care. 
B.  Every provider agreement with a participating provider must be in writing and 
must set forth that if the carrier fails to pay for health care services as set forth in the 
contract, the enrollee is not liable to the provider for any sums owed by the carrier. 
C.  A participating provider may not collect or attempt to collect any charge from an 
enrollee for covered health care beyond the amount permitted by the terms of the 
plan, notwithstanding the carrier's insolvency, the carrier's failure to pay the amount 
owed by the carrier, any other breach by the carrier of the provider agreement or the 
failure of the provider agreement to include the written hold harmless provision 
required by paragraph B. 
D.  An enrollee's responsibility for the cost of covered health care rendered by an out-
of-network provider in the hospital or other health care facility of a participating 
provider is limited to the cost-sharing provisions expressly disclosed in the contract 
for services rendered by participating providers.  If the enrollee has paid the enrollee's 
share of the charge as specified in the managed care plan, the carrier shall hold the 
enrollee harmless from any additional amount owed to an out-of-network provider for 
covered health care.  An enrollee is not liable to any out-of-network provider working 
within the hospital or health care facility of a participating provider for any charge 
beyond the amount permitted by the terms of the cost-sharing provisions of the plan. 
SUMMARY 
This bill limits a health plan enrollee's responsibility for the cost of covered health 
care when an enrollee receives health care services from an out-of-network provider at a 
participating hospital or other health care facility to the cost-sharing provisions for 
participating providers.