An Act to Amend the Laws Governing Insurance Coverage of
Maine Legislature, Session 132, LD 1310
Committee: Health Coverage, Insurance and Financial Services
Sponsors: BALDACCI
Amends: 24-A MRSA §4320-A

Legislative Document
No. 1310
S.P. 540
In Senate, March 27, 2025
An Act to Amend the Laws Governing Insurance Coverage of 
Preventive and Primary Health Services
Reference to the Committee on Health Coverage, Insurance and Financial Services 
suggested and ordered printed.
DAREK M. GRANT
Secretary of the Senate
Presented by Senator BALDACCI of Penobscot.
Cosponsored by Senator: HAGGAN of Penobscot, Representative: MORRIS of Turner.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  24-A MRSA §4320-A, sub-§3-A, as enacted by PL 2021, c. 638, §2, is 
amended to read:
3-A.  Parity in cost sharing for primary care and behavioral health office visits; 
individual or small group health plan.  An individual or small group health plan with an 
effective date on or after January 1, 2023 must provide coverage without cost sharing for 
the first primary care office visit and first behavioral health office visit in each plan year 
and may not apply a deductible or coinsurance to the 2nd or 3rd primary care and 2nd or 
3rd behavioral health office visits in a plan year.  Any copayments for primary care office 
visits and behavioral health office visits in a plan year count toward the deductible. After 
the first behavioral health office visit, a health plan may not apply a copayment amount to 
a behavioral health office visit that is greater than the copayment for a primary care office 
visit. For the purposes of this subsection, “behavioral health office visit” means an office 
visit to address mental health and substance use conditions. This subsection does not apply 
to a plan offered for use with a health savings account unless the federal Internal Revenue 
Service determines that the benefits required by this section are permissible benefits in a 
high deductible health plan as defined in the federal Internal Revenue Code, Section 
223(c)(2) or to a health plan that has no deductible, no coinsurance and out-of-pocket limits 
that meet the applicable federal requirements.  The superintendent may adopt rules as 
necessary to address the coordination of the requirements of this subsection for coverage 
without cost sharing for the first primary care visit and the requirements of this section with 
respect to coverage of an annual well visit. 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 §4320-A, sub-§3-B, as enacted by PL 2021, c. 638, §3, is 
amended to read:
3-B.  Parity in cost sharing for primary care and behavioral health office visits; 
group health plan.  A group health plan, other than a small group health plan subject to 
subsection 3‑A, with an effective date on or after January 1, 2023 must provide coverage 
without cost sharing for the first primary care office visit and first behavioral health office 
visit in each plan year.  After the first behavioral health office visit, a health plan may not 
apply a copayment amount to a behavioral health office visit that is greater than the 
copayment for a primary care office visit. For the purposes of this subsection, “behavioral 
health office visit” means an office visit to address mental health and substance use 
conditions. This subsection does not apply to a plan offered for use with a health savings 
account unless the federal Internal Revenue Service determines that the benefits required 
by this section are permissible benefits in a high deductible health plan as defined in the 
federal Internal Revenue Code, Section 223(c)(2) or to a health plan that has no deductible, 
no coinsurance and out-of-pocket limits that meet the applicable federal requirements.  The 
superintendent may adopt rules as necessary to address the coordination of the 
requirements of this subsection for coverage without cost sharing for the first primary care 
visit and the requirements of this section with respect to coverage of an annual well visit. 
Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, 
chapter 375, subchapter 2‑A.
SUMMARY
This bill amends the laws governing parity in cost sharing for primary care and 
behavioral health office visits to provide that those laws do not apply to health plans that 
have no deductible, no coinsurance and out-of-pocket limits that meet the applicable federal 
requirements.