An Act To Consolidate Patient Bills by Directing Health Insurers To Collect Copayments and Deductibles
Maine Legislature, Session 130, LD 0530
Committee: Health Coverage, Insurance and Financial Services
Sponsors: CLAXTON, TEPLER
Amends: 24-A MRSA §4303-F

Legislative Document
No. 530
S.P. 217
In Senate, February 24, 2021
An Act To Consolidate Patient Bills by Directing Health Insurers To 
Collect Copayments and Deductibles
Received by the Secretary of the Senate on February 22, 2021.  Referred to the Committee 
on Health Coverage, Insurance and Financial Services pursuant to Joint Rule 308.2 and ordered 
printed.
DAREK M. GRANT
Secretary of the Senate
Presented by Senator CLAXTON of Androscoggin.
Cosponsored by Representative TEPLER of Topsham.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  24-A MRSA §4303-F is enacted to read:
§4303-F.  Carriers responsible for collection of cost-sharing amounts 
1.  Collection of cost-sharing amounts. A carrier offering a health plan that includes 
cost-sharing requirements for copayments, coinsurance or deductibles shall collect the 
amount of any copayment, coinsurance or deductible due under the terms of a health plan 
owed by an enrollee, or the party responsible for making payments on an enrollee's behalf, 
by issuing one consolidated bill for the cost-sharing requirements related to health care 
services provided to an enrollee for each episode of care. 
2.  Cost-sharing collection policy. A carrier shall develop cost-sharing collection 
guidelines and make information about the guidelines available to each enrollee, including 
the posting of the guidelines on its publicly accessible website.
3.  No incentives permitted. Except as provided in subsection 7, a carrier may not 
induce, incentivize or otherwise require:
A.  A provider to collect the amount of any copayment, coinsurance or deductible 
directly from an enrollee or the party responsible for making payments on an enrollee's 
behalf; or
B.  An enrollee to pay the amount of any copayment, coinsurance or deductible directly 
to a provider.
4.  No discontinuance of coverage.  A carrier may not discontinue coverage for an 
enrollee under a health plan based on an enrollee's failure to pay the amount of any 
copayment, coinsurance or deductible as required under the terms of a health plan.
5.  Reimbursement of provider.  A carrier that is obligated under the terms of a health 
plan to pay for health care services rendered to an enrollee shall reimburse the provider 
directly in an amount equal to the rate specified in the provider's agreement with the carrier, 
including any copayment, coinsurance or deductible payable by an enrollee under the terms 
of the plan.
6.  No delay in payment.  A carrier may not withhold or otherwise delay payment to 
a provider because an enrollee has not paid the carrier any applicable copayment, 
coinsurance or deductible.
7.  Exception.  This section does not require a carrier to collect any copayment, 
coinsurance or deductible applicable to any health care services delivered by a pharmacy 
provider in an outpatient setting.
Sec. 2.  Application.  The requirements of this Act apply to all health insurance 
policies, contracts and certificates executed, delivered, issued for delivery, continued or 
renewed in this State on or after January 1, 2023.  For purposes of this Act, all contracts 
are deemed to be renewed no later than the next yearly anniversary of the contract date.
SUMMARY
This bill clarifies that cost-sharing amounts in health plans must be collected by 
carriers.  The bill applies to health plans issued or renewed in this State on or after January 
1, 2023.