An Act Regarding Notice Provided by Insurance Carriers to Health Care Providers
Maine Legislature, Session 127, LD 0704
Committee: Insurance and Financial Services
Sponsors: BECK, GRATWICK
Amends: 24-A MRSA §4320-J

Legislative Document 
No. 704 
H.P. 480 
House of Representatives, March 5, 2015 
An Act Regarding Notice Provided by Insurance Carriers to Health 
Care Providers 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
ROBERT B. HUNT 
Clerk 
Presented by Representative BECK of Waterville. 
Cosponsored by Senator GRATWICK of Penobscot. 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  24-A MRSA §4320-J is enacted to read: 
§4320-J.  Notice of grace period 
If an enrollee is covered by an insurance product purchased through the American 
Health Benefit Exchange pursuant to the federal Affordable Care Act and is in the 3-
month grace period under 45 Code of Federal Regulations, Section 156.270(d)(2015) and 
a provider, or a representative of a provider, requests information from a carrier regarding 
the enrollee's eligibility, coverage or health plan benefits or the status of a claim or claims 
for services provided to the enrollee and the information requested is regarding the 
enrollee's eligibility, coverage or health plan benefits or a claim for services provided on 
a date within the 2nd or 3rd month of the 3-month grace period, the carrier shall inform 
the provider that the enrollee is in the 3-month grace period. 
1.  Information provided.  The carrier shall provide the information required under 
this section through the same medium through which the provider or representative of the 
provider sought the information.  The information to be provided by the carrier must 
include: 
A.  The purpose of the notice; 
B.  The enrollee's name and any unique identification numbers; 
C.  The name of the carrier and the carrier's unique health plan identifier; 
D.  The specific date upon which the grace period for the enrollee began and the 
specific date it expires; and 
E.  A clear statement regarding whether the carrier intends to exercise its right under 
the federal Affordable Care Act to pend claims for the enrollee and subsequently not 
pay claims for care provided to the enrollee during the grace period if the enrollee 
fails to make premium payments or whether the carrier intends on recouping claims 
payments for services rendered during the grace period. 
2.  Failure to provide information.  If a carrier does not provide information 
required by this section, the carrier must pay for all claims for services provided by a 
provider to the relevant enrollee during the time the enrollee was in the grace period. 
3.  Waiver.  The notice required by this section may not be waived by contract, and 
contract provisions in conflict with this section are void and of no effect. 
4.  Effective date.  This section takes effect January 1, 2016. 
SUMMARY 
This bill requires insurance carriers, beginning January 1, 2016, to give health care 
providers notice that an enrollee covered by an insurance product purchased through the 
American Health Benefit Exchange is in the 3-month grace period under 45 Code of 
Federal Regulations, Section 156.270(d)(2015).