An Act To Ensure Patient Protections in the Health Insurance Laws
Maine Legislature, Session 128, LD 1279
Committee Amendment CA_A_S377 (Senate)
Amends: 24-A MRSA §2736-C, 24-A MRSA §2742-B, 24-A MRSA §2833-B, 24-A MRSA §2849-B, 24-A MRSA §2850, 24-A MRSA §4233-B, 24-A MRSA §4318, 24-A MRSA §4320

COMMITTEE AMENDMENT "A" to S.P. 431, L.D. 1279, Bill, "An Act To 
Ensure Patient Protections in the Health Insurance Laws" 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'Sec. 1. 24-A MRSA §2736-C, sub-§11, as enacted by PL 2013, c. 271, §1, is 
amended to read: 
11. Open enrollment; rules. Notwithstanding subsection 3, on or after January 1, 
2014, a carrier may restrict enrollment in individual health plans to open enrollment 
periods and special enrollment periods eonsistent with requirements of the federal 
Affordable Care A.et to the extent not inconsistent with applicable federal law. 
The 
superintendent may adopt rules establishing minimum open enrollment dates and 
minimum criteria for special enrollment periods for all individual health plans offered in 
this State. Rules adopted pursuant to this subsection are routine technical rules as defined 
in Title 5, chapter 375. subchapter 2-A. 
Sec. 2. 24-A MRSA §2742-B, as amended by PL 2007, c. 514, §§1 to 5, is further 
amended to read: 
§2742-B. Mandatory offer to extend coverage for dependent children up to 26 years 
of age 
1. Dependent child; definition. As used in this section, "dependent child" means 
the child of a person covered under an individual health insurance policy when that child: 
A. Is unmarried; 
B. Has no dependent of the child's own; and 
C. Is a resident of this State or is enrolled as a full-time student at an accredited 
public or private institution of higher education. 
2. Offer of coverage. Notwithstanding section 2703, subsection 3, an individual 
health insurance policy that offers coverage for a dependent child must offer such 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT ':A" to S.P. 431, L.D. 1279 
coverage, at the option of the policyholder, until the dependent child is-:U- attains 26 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 §2833-B, as amended by PL 2007, c. 514, §§6 to 10, is 
further amended to read: 
§2833-B. Mandatory offer to extend coverage for dependent children up to 26 years 
of age 
1. Dependent child; definition. As used in this section, "dependent child" means 
the child of a person covered under a group health insurance policy when that child: 
A. Is unmarried; 
B. Has no dependent of the child's own; and 
C. Is a resident of this State or is enrolled as a full-time student at an accredited 
public or private institution of higher education. 
2. 
Offer of coverage. Notwithstanding section 2822, a group health insurance 
policy that offers coverage for a dependent child must offer such coverage, at the option 
of the policyholder, until the dependent child is---2,-5- attains 26 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. 4. 24-A MRSA §2849-B, sub-§8, as amended by PL 2011, c. 90, Pt. G, §2, 
is repealed. 
Sec. 5. 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 exespt as provided in this subseetion. 
A 
preexisting condition exclusion may not exceed 12 months from the date of enrollment, 
ineluding the 1.vaiting period, if any. For purposes of this subsection, "waiting period" 
includes any period bet\veen the time a substantially eomplete application for an 
individual or small group health plan is filed and the time the coverage takes effect. A 
preexisting condition exelusion may not be more restrieti.ve than as follows. This 
subsection does not limit a carrier's ability to restrict enrollment in an individual contract 
to open enrollment and special enrollment periods in accordance with section 2736-C, 
subsection 11. 
A. 
In a group contrast, a preexisting eondition exelusion may relate only to 
eonditions for whieh medieal advise, diagnosis, eare or treatment v,ras reeommended 
or reeei11ed dur..ng the 6 month period ending on the earlier of the date of enrollment 
in the eontraet and the date of enrollment in a prior contract covering the same group 
if there has not been a gap in eoverage of greater than 90 days between eontraets. An 
exelrndon mav not he imnoserl relatinl! to nrel!tlancw as a nreexistinl! eonrlition 
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C011MITTEEAMENDMENT" A" to S.P. 431, L.D. 1279 
B. In an indi11idual oontraot not subjeot to paragraph C, or in a blanket polio:y, a 
preexisting oondition exolusion may relate only to oonditions manifesting in 
symptoms that would oause an ordinarily prudent person to seek medioal ad11ioe, 
diagnosis, oare or treatment or for v.41.ioh medioal advioe, diagnosis, oare or treatment 
was reoommended or recei11ed during the 12 months immediately preceding the date 
of application or to a pregnano:y existing on the effootii,re 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 n:ot oontain a preeKisting condition 
exclusion. 
D. A routine pre11enti,,re soreening or test yielding only negati'le results may n:ot be 
considered to be diagnosis, oare or treatment for the purposes of this subsection. 
E. 
Genetic information may notbe used as the basis for imposing a preexisting 
oondition exolusion in the absence of a diagnosis of the oondition 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 Maroh 23, 2010 that have 
grandfathered status under the federal Affordable Care Act, a oarrier as defined in 
seotion 4301 A, subseotion 3 offering a health plan as defined in section 4301 A, 
subseotion 7 may not apply a preexisting oondition exclusion to any enrollee under 19 
years of age. A preexisting condition exolusion may not be imposed on any enrollee 
after January 1. 2014 to the extent prohibited by the federal Affordable Care Aot. 
Sec. 6. 24-A MRSA §4233-B, as amended by PL 2007, c. 514, §§11 to 15, is 
further amended to read: 
§4233-B. Mandatory offer to extend coverage for dependent children up to 26 years 
of age 
1. Dependent child; definition. As used in this section, "dependent child" means 
the child of a person covered under an individual or group health maintenance 
organization contract when that child: 
A. Is unmarried; 
B. Has no dependent of the child's own; and 
C. Is a resident of this State or is enrolled as a full-time student at an accredited 
public or private institution of higher education. 
2. 
Offer of coverage. An individual or group health maintenance organization 
contract that offers coverage for a dependent child shall offer such coverage, at the option 
of the contract holder, until the dependent child is--2& attains 26 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. 7. 24-A MRSA §4318, as amended by PL 2011, c. 364, §33, is repealed. 
Sec. 8. 24-A MRSA §4320, as enacted by PL 2011, c. 364, §34, is amended to 
read: 
COMMITTEE AMENDMENT 
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COI\.1:MITTEE AMENDMENT "A "to S.P. 431, L.D. 1279 
§4320. No lifetime or annual limits on health plans 
Notwithstanding the requirements of seotion 4318, a A carrier offering a @ 
individual or group health plan subjeot to the federal Affordable Care A.et 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, e-xoept that, prior to January 1, 2014, health plans may inolude restrioted annual 
limits on essential benefits oonsistent vlith the requirements of the federal A.ffordable 
Care Aot and may establish annual limits oonsistent with waivers granted by the 
Seoretary of the United States Department of Health and Human Servioes as determined 
by the superintendent to the extent not inconsistent with applicable federal law.' 
SUMMARY 
This amendment is the minority report of the committee and replaces the bill. Like 
the bill, the amendment allows children younger than 26 years of age to remain on their 
parents' health insurance policy. The amendment adds provisions not included in the bill 
to make the change also applicable to group health plans and health maintenance 
organization individual and group health plans. 
The amendment retains the provision in the bill prohibiting individual, group and 
blanket health plans from imposing a preexisting condition exclusion on any enrollee, but 
adds language to allow a carrier to restrict enrollment in individual health plans to open 
enrollment and special enrollment periods established in rule. 
The amendment clarifies that carriers offering individual or group health plans may 
not establish lifetime or annual limits on the dollar value of benefits. The amendment 
specifies that the provision prohibiting annual limits on the dollar value of benefits 
applies to the dollar value of essential health benefits as determined by the 
Superintendent of Insurance to the extent not inconsistent with federal law. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Fiscal Detail and Notes 
Approved: 02/22/18 ;!Wac. 
LD 1279 
LR 1487(02) 
An Act To Ensure Patient Protections in the Health Insurance Laws 
Fiscal Note for Bill as Amended by Committee Amendment "If (_5-31]) 
Committee: Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - Other Special Revenue Funds 
Any additional costs to the Department of Professional and Financial Regulation from the provisions of this bill are 
expected to be minor and can be absorbed within existing budgeted resources. 
LR1487(02) - Fiscal Note - Page 1 of 1