An Act To Ensure Patient Protections in the Health Insurance Laws
Maine Legislature, Session 128, LD 1279
Committee: Insurance and Financial Services
Sponsors: JACKSON, BREEN, CHIPMAN, GRATWICK, LIBBY, GATTINE, MARTIN, MASTRACCIO
Amends: 24-A MRSA §2742-B, 24-A MRSA §2850, 24-A MRSA §4318, 24-A MRSA §4320

Legislative Document
No. 1279
S.P. 431
In Senate, April 4, 2017
An Act To Ensure Patient Protections in the Health Insurance Laws
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed.
HEATHER J.R. PRIEST
Secretary of the Senate
Presented by Senator JACKSON of Aroostook.
Cosponsored by Senators: BREEN of Cumberland, CHIPMAN of Cumberland, GRATWICK 
of Penobscot, LIBBY of Androscoggin, Representatives: GATTINE of Westbrook, MARTIN 
of Eagle Lake, MASTRACCIO of Sanford.
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  24-A MRSA §2742-B, sub-§1, as amended by PL 2007, c. 514, §§1 to 3, 
is repealed. 
Sec. 2.  24-A MRSA §2742-B, sub-§2, as amended by PL 2007, c. 514, §4, is 
further amended to read: 
2.  Offer of coverage.  Notwithstanding section 2703, subsection 3, an An individual 
or group health insurance policy that offers dependent coverage for a dependent child 
must offer such coverage, at the option of the policyholder, until the dependent child is 25 
years of age.  An insurer may require, as a condition of eligibility for coverage in 
accordance with this section, that a person seeking coverage for a dependent child 
provide written documentation on an annual basis that the dependent child meets the 
requirements in subsection 1. 
Sec. 3.  24-A MRSA §2850, sub-§2, as amended by PL 2011, c. 364, §18, is 
further amended to read: 
2.  Limitation.  An individual, group or blanket contract issued by an insurer may not 
impose a preexisting condition exclusion except as provided in this subsection.  A 
preexisting condition exclusion may not exceed 12 months from the date of enrollment, 
including the waiting period, if any.  For purposes of this subsection, "waiting period" 
includes any period between the time a substantially complete application for an 
individual or small group health plan is filed and the time the coverage takes effect.  A 
preexisting condition exclusion may not be more restrictive than as follows. 
A.  In a group contract, a preexisting condition exclusion may relate only to 
conditions for which medical advice, diagnosis, care or treatment was recommended 
or received during the 6-month period ending on the earlier of the date of enrollment 
in the contract and the date of enrollment in a prior contract covering the same group 
if there has not been a gap in coverage of greater than 90 days between contracts.  An 
exclusion may not be imposed relating to pregnancy as a preexisting condition. 
B.  In an individual contract not subject to paragraph C, or in a blanket policy, a 
preexisting condition exclusion may relate only to conditions manifesting in 
symptoms that would cause an ordinarily prudent person to seek medical advice, 
diagnosis, care or treatment or for which medical advice, diagnosis, care or treatment 
was recommended or received during the 12 months immediately preceding the date 
of application or to a pregnancy existing on the effective date of coverage. 
C.  An individual policy issued on or after January 1, 1998 to a federally eligible 
individual as defined in section 2848 may not contain a preexisting condition 
exclusion. 
D.  A routine preventive screening or test yielding only negative results may not be 
considered to be diagnosis, care or treatment for the purposes of this subsection. 
E.  Genetic information may not be used as the basis for imposing a preexisting 
condition exclusion in the absence of a diagnosis of the condition relating to that 
information.  For the purposes of this paragraph, "genetic information" has the same 
meaning as set forth in the Code of Federal Regulations. 
F.  Except for individual health plans in effect on March 23, 2010 that have 
grandfathered status under the federal Affordable Care Act, a carrier as defined in 
section 4301-A, subsection 3 offering a health plan as defined in section 4301-A, 
subsection 7 may not apply a preexisting condition exclusion to any enrollee under 19 
years of age.  A preexisting condition exclusion may not be imposed on any enrollee 
after January 1, 2014 to the extent prohibited by the federal Affordable Care Act. 
Sec. 4.  24-A MRSA §4318, as amended by PL 2011, c. 364, §33, is repealed. 
Sec. 5.  24-A MRSA §4320, as enacted by PL 2011, c. 364, §34, is amended to 
read: 
§4320.  No lifetime or annual limits on health plans 
Notwithstanding the requirements of section 4318, a A carrier offering a an 
individual or group health plan subject to the federal Affordable Care Act may not: 
1.  Establish lifetime limits.  Establish lifetime limits on the dollar value of benefits 
for any participant or beneficiary; or 
2.  Establish annual limits.  Establish annual limits on the dollar value of essential 
benefits, except that, prior to January 1, 2014, health plans may include restricted annual 
limits on essential benefits consistent with the requirements of the federal Affordable 
Care Act and may establish annual limits consistent with waivers granted by the 
Secretary of the United States Department of Health and Human Services. 
SUMMARY 
This bill allows children 26 years of age and younger to remain on their parents' 
health insurance policy.  It clarifies that carriers offering individual or group health plans 
may not establish lifetime or annual limits on the dollar value of benefits.  It clarifies that 
individual, group and blanket health plans may not impose a preexisting condition 
exclusion on any enrollee.