An Act to Require Health Insurance Coverage for Specialized Risk
Maine Legislature, Session 132, LD 0784
Sponsors: BAILEY, COPELAND
Amends: 24-A MRSA §4317-F

Legislative Document
No. 784
S.P. 343
In Senate, March 4, 2025
An Act to Require Health Insurance Coverage for Specialized Risk 
Screening for First Responders
Received by the Secretary of the Senate on February 26, 2025.  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 BAILEY of York.
Cosponsored by Representative COPELAND of Saco and
Senators: NANGLE of Cumberland, TIPPING of Penobscot, Representatives: MATHIESON 
of Kittery, SHAGOURY of Hallowell.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  24-A MRSA §4317-F is enacted to read:
§4317-F.  Coverage of specialized risk screening associated with health of first 
responders
1.  Definitions.  As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings.
A.  "First responder" means an employee or occasional employee or volunteer that is a 
member of a state, county or municipal government entity that provides or has the 
authority to provide fire, emergency medical, emergency communications, correctional 
or police services.
B.  "Specialized risk screening" means any of the following standard, medically 
accepted tests: 
(1)  Tests for evidence of any cancer with a known employment-related risk of 
exposure for a first responder;
(2) Blood tests, including tests conducted for a complete blood count, 
comprehensive metabolic panel, renal panel and hepatic panel;
(3) Mammography, colonoscopy or prostate examinations regardless of the age of 
the person who is the subject of the examination;
(4) Tests of any measure of serum activity of lipoprotein-associated phospholipase 
enzyme A2, oxidized low-density lipoprotein or additional indicators of 
endovascular inflammation; or
(5) Tests to measure vitamin deficiencies, nutritional deficits and mineral levels.
2.  Eligible enrollee.  An enrollee is eligible for coverage under this section if the 
enrollee meets the following conditions:
A.  The enrollee is a first responder;  
B.  As determined by the enrollee's provider, the enrollee's receipt of specialized risk 
screening has meaningful potential for preventive clinical benefit to the enrollee; and  
C.  The enrollee's provider has determined that specialized risk screening is medically 
appropriate based upon the satisfaction of the conditions in paragraphs A and B.  
3.  Coverage for specialized risk screening.  A carrier offering a health plan in this 
State may not deny coverage to an enrollee for specialized risk screening recommended by 
a provider pursuant to subsection 2.  
4.  Limits on prior authorization.  Notwithstanding any requirements in section 4320-
A to the contrary, a carrier may not subject any specialized risk screening to any prior 
authorization requirement, except that: 
A. A carrier may request verification of an enrollee's status as a first responder; and 
B. A carrier may request prior authorization if the specialized risk screening will be 
conducted by a recognized first responder health or wellness care provider, as defined 
in rules adopted by the bureau, or a laboratory not affiliated with the enrollee's provider. 
Rules adopted pursuant to this paragraph are routine technical rules as defined in Title 
5, chapter 375, subchapter 2-A.
5.  Cost sharing prohibited. A health plan may not impose any deductible, copayment, 
coinsurance or other cost-sharing requirement for the costs of specialized risk screening. 
This subsection does not apply to a health plan offered for use with a health savings account 
unless the federal Internal Revenue Service determines that the requirements in this 
subsection are permissible in a high deductible health plan as defined in the federal Internal 
Revenue Code, Section 223(c)(2).
Sec. 2.  Application. The requirements of this Act apply to all policies, contracts and 
certificates executed, delivered, issued for delivery, continued or renewed in this State on 
or after January 1, 2027.  For purposes of this Act, all contracts are deemed to be renewed 
no later than the next yearly anniversary of the contract date.
SUMMARY
For policies issued or renewed on or after January 1, 2027, this bill prohibits a health 
insurance carrier from denying coverage to an enrollee who is a first responder for 
specialized risk screening recommended by a health care provider. It limits the ability of a 
health insurance carrier to require prior authorization for specialized risk screening. It also 
prohibits a carrier from imposing any out-of-pocket costs for specialized risk screening 
except for high deductible health plans offered for use in connection with a health savings 
account to the extent required under federal regulations.