reglab/housing_qa huggingface dataset:
24-A ME Rev Stat § 2847-A (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2847-A. Penalty for failure to notify of hospitalization

 §2847-A. Penalty for failure to notify of hospitalization An insurance policy may not include a provision permitting the insurer to impose a penalty for the failure of any person to notify the insurer of an insured person's hospitalization for emergency treatment. For purposes of this section, "emergency treatment" has the same meaning as defined in Title 22, section 1829.   [PL 1991, c. 695, §5 (NEW); PL 1991, c. 824, Pt. A, §51 (NEW).]This section applies to policies and certificates executed, delivered, issued for delivery, continued or renewed in this State after the effective date of this section. For purposes of this section, all policies are deemed to be renewed no later than the next yearly anniversary of the contract date.   [PL 1991, c. 695, §5 (NEW); PL 1991, c. 824, Pt. A, §51 (NEW).]SECTION HISTORY PL 1991, c. 695, §5 (NEW). PL 1991, c. 824, §A51 (NEW).
24-A ME Rev Stat § 2847-B (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2847-B. Jury service

 §2847-B. Jury service 1.  Prohibition.  An insurer that issues group or blanket health care contracts providing coverage for medical care to residents of this State may not terminate coverage for any person covered under those contracts because the person has been summonsed for or is engaged in jury service under Title 14, chapter 305, subchapter I‑A.   [PL 1991, c. 695, §5 (NEW); PL 1991, c. 824, Pt. A, §51 (NEW).] 2.  Application.  This section applies to all policies and any certificate executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 1991. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.   [PL 1991, c. 695, §5 (NEW); PL 1991, c. 824, Pt. A, §51 (NEW).] SECTION HISTORY PL 1991, c. 695, §5 (NEW). PL 1991, c. 824, §A51 (NEW).
24-A ME Rev Stat § 2847-C (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2847-C. Notification prior to cancellation; restrictions on cancellation, termination or lapse due to cognitive impairment or functional incapacity

 §2847-C. Notification prior to cancellation; restrictions on cancellation, termination or lapse due to cognitive impairment or functional incapacity An insurer shall provide for notification of the insured person and another person, if designated by the insured, prior to cancellation of a health insurance certificate for nonpayment of premium.   [PL 2011, c. 123, §3 (AMD); PL 2011, c. 123, §5 (AFF).]Within 90 days after cancellation due to nonpayment of premium, a policyholder, a person authorized to act on behalf of the policyholder or a dependent of the policyholder covered under a health insurance policy or certificate may request reinstatement on the basis that the loss of coverage was a result of the policyholder's cognitive impairment or functional incapacity. An insurer may require a medical demonstration that the policyholder suffered from cognitive impairment or functional incapacity at the time of cancellation. If the medical demonstration is waived or substantiates the existence of a cognitive impairment or functional incapacity at the time of policy cancellation to the satisfaction of the insurer, the policy must be reinstated. The medical demonstration may be at the expense of the policyholder.   [PL 2011, c. 123, §3 (NEW); PL 2011, c. 123, §5 (AFF).]A policy reinstated pursuant to this section must cover any loss or claim occurring from the date of the cancellation. Within 15 days after request from an insurer, a policyholder of a policy reinstated pursuant to this section shall pay any unpaid premium from the date of the last premium payment at the rate that would have been in effect had the policy remained in force. If the premium is not paid as required, the policy may not be reinstated and the insurer is not responsible for claims incurred after the initial date of cancellation. If an insurer denies a request for reinstatement, the insurer shall notify the policyholder that the policyholder may request a hearing before the superintendent.   [PL 2011, c. 123, §3 (NEW); PL 2011, c. 123, §5 (AFF).]The superintendent may adopt rules to implement the requirements of this section. The rules may include, but are not limited to, definitions, minimum disclosure requirements, notice provisions and the right of reinstatement. Rules adopted pursuant to this section are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.   [PL 2011, c. 123, §3 (AMD); PL 2011, c. 123, §5 (AFF).]The requirements of this section apply to all policies and certificates executed, delivered, issued for delivery, continued or renewed in this State.   [PL 1991, c. 695, §5 (NEW); PL 1991, c. 824, Pt. A, §51 (NEW).]SECTION HISTORY PL 1991, c. 695, §5 (NEW). PL 1991, c. 824, §A51 (NEW). PL 2011, c. 123, §3 (AMD). PL 2011, c. 123, §5 (AFF).
24-A ME Rev Stat § 2847-D (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2847-D. Penalty for noncompliance with utilization review programs

 §2847-D. Penalty for noncompliance with utilization review programs A policy or certificate issued or renewed after April 8, 1994 may not contain a provision that permits, upon retroactive review and confirmation of medical necessity, the imposition of a penalty of more than $500 for failure to provide notification under a utilization review program. This section does not limit the right of insurers to deny a claim when appropriate prospective or retroactive review concludes that services or treatment rendered were not medically necessary.   [PL 1995, c. 332, Pt. M, §9 (AMD).]SECTION HISTORY PL 1993, c. 645, §B5 (NEW). PL 1995, c. 332, §M9 (AMD).
24-A ME Rev Stat § 2847-E (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2847-E. Coverage for diabetes supplies

 §2847-E. Coverage for diabetes supplies All group insurance policies, contracts and certificates must provide coverage for the medically appropriate and necessary equipment, limited to insulin, oral hypoglycemic agents, monitors, test strips, syringes and lancets, and the out-patient self-management training and educational services used to treat diabetes, if:   [PL 2003, c. 517, Pt. A, §8 (AMD); PL 2003, c. 517, Pt. A, §13 (AFF).]1.  Certification of medical necessity.  The insured's treating physician or a physician who specializes in the treatment of diabetes certifies that the equipment and services are necessary; and   [PL 1995, c. 592, §3 (NEW).] 2.  Provision of medical services.  The diabetes out-patient self-management training and educational services are provided through ambulatory diabetes education facilities authorized by the State's Diabetes Control Project within the Bureau of Health.   [PL 1995, c. 592, §3 (NEW).] The requirements of this section apply to all group policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.   [PL 2003, c. 517, Pt. A, §8 (NEW); PL 2003, c. 517, Pt. A, §13 (AFF).]SECTION HISTORY PL 1995, c. 592, §3 (NEW). PL 2003, c. 517, §A8 (AMD). PL 2003, c. 517, §A13 (AFF).
24-A ME Rev Stat § 2847-F (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2847-F. Gynecological and obstetrical services (REALLOCATED FROM TITLE 24-A, SECTION 2850-A)

 §2847-F. Gynecological and obstetrical services (REALLOCATED FROM TITLE 24-A, SECTION 2850-A)1.  Coverage in managed care plans.  With respect to managed care plans that require group members to select primary care physicians, an insurer that issues group health insurance policies, contracts and certificates must meet the following requirements.   A. The insurer must permit a physician who specializes in obstetrics and gynecology to serve as a primary care physician if the physician qualifies under the insurer's credentialling policy.   [PL 1997, c. 370, Pt. H, §1 (RAL).]B. All group plan contracts must provide coverage for an annual gynecological examination, including routine pelvic and clinical breast examinations, performed by a physician, certified nurse practitioner or certified nurse midwife participating in the plan, without requiring the prior approval of the primary care physician.   [PL 1997, c. 370, Pt. H, §1 (RAL).]C. If the examination specified in paragraph B reveals a gynecological condition for which another visit to the physician participating in the plan is medically required and appropriate, or for any gynecological care beyond the annual examination, the carrier may require the patient or the examining physician, certified nurse practitioner or certified nurse midwife to secure from the patient's primary care physician a referral to the participating physician, certified nurse practitioner or certified nurse midwife from whom such care may be obtained.   [PL 1997, c. 370, Pt. H, §1 (RAL).][PL 2003, c. 517, Pt. A, §9 (AMD); PL 2003, c. 517, Pt. A, §13 (AFF).] 2.  Application.  This section applies to all policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.   [PL 2003, c. 517, Pt. A, §9 (AMD); PL 2003, c. 517, Pt. A, §13 (AFF).] This section does not prohibit a carrier from requiring a physician, certified nurse practitioner or certified nurse midwife participating in the plan to inform a woman's primary care physician prior to each treatment pursuant to this section.   [PL 1997, c. 370, Pt. H, §1 (RAL).]SECTION HISTORY PL 1997, c. 370, §H1 (RAL). PL 2003, c. 517, §A9 (AMD). PL 2003, c. 517, §A13 (AFF).
24-A ME Rev Stat § 2847-H (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2847-H. Coverage for services of certified nurse practitioners; certified midwives; certified nurse midwives (REALLOCATED FROM TITLE 24-A, SECTION 2847-G)

 §2847-H. Coverage for services of certified nurse practitioners; certified midwives; certified nurse midwives (REALLOCATED FROM TITLE 24-A, SECTION 2847-G)1.  Required coverage for services upon referral of primary care provider.  An insurer that issues group health insurance policies and contracts shall provide coverage under those contracts for services performed by a certified nurse practitioner, certified midwife or certified nurse midwife to a patient who is referred to the certified nurse practitioner, certified midwife or certified nurse midwife by a primary care provider when those services are within the lawful scope of practice of the certified nurse practitioner, certified midwife or certified nurse midwife.   [PL 2021, c. 79, §3 (AMD).] 2.  Required coverage for self-referred services.  With respect to group health insurance policies and contracts that do not require the selection of a primary care provider, an insurer shall provide coverage under those contracts for services performed by a certified nurse practitioner, certified midwife or certified nurse midwife when those services are covered services and when they are within the lawful scope of practice of the certified nurse practitioner, certified midwife or certified nurse midwife.   [PL 2021, c. 79, §3 (AMD).] 3.  Limits; coinsurance; deductibles.  Any contract that provides coverage for services under this section may contain provisions for maximum benefits and coinsurance and reasonable limitations, deductibles and exclusions to the extent that these provisions are not inconsistent with the requirements of this section.   [RR 1999, c. 1, §34 (RAL).] 4.  Application.  The requirements of this section apply to all group policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.   [PL 2003, c. 517, Pt. B, §19 (NEW).] SECTION HISTORY RR 1999, c. 1, §34 (RAL). PL 2003, c. 517, §B19 (AMD). PL 2021, c. 79, §3 (AMD).
24-A ME Rev Stat § 2847-I (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2847-I. Coverage for services provided by registered nurse first assistants (REALLOCATED FROM TITLE 24-A, SECTION 2847-G)

 §2847-I. Coverage for services provided by registered nurse first assistants (REALLOCATED FROM TITLE 24-A, SECTION 2847-G)1.  Definitions.  As used in this section, unless the context otherwise indicates, the following terms have the following meanings.   A. "Perioperative nursing" means a practice of nursing in which the nurse provides preoperative, intraoperative and postoperative nursing care to surgical patients.   [RR 1999, c. 1, §35 (RAL).]B. "Recognized program" means a program that addresses all content of the core curriculum for registered nurse first assistants as established by the Association of Operating Room Nurses or its successor organization.   [RR 1999, c. 1, §35 (RAL).]C. "Registered nurse first assistant," or "RNFA," means a person who:   (1) Is licensed as a registered nurse under Title 32, chapter 31;   (2) Is experienced in perioperative nursing; and   (3) Has successfully completed a recognized program.   [RR 1999, c. 1, §35 (RAL).][RR 1999, c. 1, §35 (RAL).] 2.  Institutional powers.  Each health care institution, as defined in Title 22, chapter 405, may establish specific procedures for the appointment and reappointment of registered nurse first assistants and for granting, renewing and revising their clinical privileges.   [RR 1999, c. 1, §35 (RAL).] 3.  Required coverage for services.  Notwithstanding any other provisions of this chapter, an insurer that issues group health insurance policies and contracts that provide coverage for surgical first assisting benefits or services shall provide coverage and payment under those contracts to a registered nurse first assistant who performs services that are within the scope of a registered nurse first assistant's qualifications. The provisions of this subsection apply only if reimbursement for an assisting physician would be covered and a registered nurse first assistant who performed those services is used as a substitute. This section does not apply to policies or contracts that cover only specified diseases.   [RR 1999, c. 1, §35 (RAL).] 4.  Limits; coinsurance; deductibles.  Any contract that provides coverage for the services required by this section may contain provisions for maximum benefits and coinsurance and reasonable limitations, deductibles and exclusions to the extent that these provisions are not inconsistent with the requirements of this section.   [RR 1999, c. 1, §35 (RAL).] 5.  Application.  The requirements of this section apply to all group policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.   [PL 2003, c. 517, Pt. B, §20 (NEW).] SECTION HISTORY RR 1999, c. 1, §35 (RAL). PL 2003, c. 517, §B20 (AMD).
24-A ME Rev Stat § 2847-J (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2847-J. Coverage for hospice care services

 §2847-J. Coverage for hospice care services 1.  Definitions.  As used in this section, unless the context otherwise indicates, the following terms have the following meanings.   A. "Hospice care services" means services provided on a 24-hours-a-day, 7-days-a-week basis to a person who is terminally ill and that person's family. "Hospice care services" includes, but is not limited to, physician services; nursing care; respite care; medical and social work services; counseling services; nutritional counseling; pain and symptom management; medical supplies and durable medical equipment; occupational, physical or speech therapies; volunteer services; home health care services; and bereavement services.   [PL 2001, c. 358, Pt. LL, §3 (NEW); PL 2001, c. 358, Pt. LL, §5 (AFF).]B. "Person who is terminally ill" means a person that has a medical prognosis that the person's life expectancy is 12 months or less if the illness runs its normal course.   [PL 2001, c. 358, Pt. LL, §3 (NEW); PL 2001, c. 358, Pt. LL, §5 (AFF).][PL 2001, c. 358, Pt. LL, §3 (NEW); PL 2001, c. 358, Pt. LL, §5 (AFF).] 2.  Coverage for hospice care services.  All group insurance policies and contracts must provide coverage for hospice care services to a person who is terminally ill. Hospice care services must be provided according to a written care delivery plan developed by a hospice care provider and the recipient of hospice care services. Coverage for hospice care services must be provided whether the services are provided in a home setting or an inpatient setting.   [PL 2001, c. 358, Pt. LL, §3 (NEW); PL 2001, c. 358, Pt. LL, §5 (AFF).] 3.  Application.  The requirements of this section apply to all group policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.   [PL 2003, c. 517, Pt. B, §21 (NEW).] Revisor's Note: §2847-J. Coverage for general anesthesia for dentistry (As enacted by PL 2001, c. 423, §3 and affected by §5 is REALLOCATED TO TITLE 24-A, SECTION 2847-K) SECTION HISTORY RR 2001, c. 1, §33 (RAL). PL 2001, c. 358, §LL3 (NEW). PL 2001, c. 358, §LL5 (AFF). PL 2001, c. 423, §3 (NEW). PL 2001, c. 423, §5 (AFF). PL 2003, c. 517, §B21 (AMD).
24-A ME Rev Stat § 2847-L (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2847-L. Offer of coverage for breast reduction surgery and symptomatic varicose vein surgery

 §2847-L. Offer of coverage for breast reduction surgery and symptomatic varicose vein surgery All group health insurance policies, contracts and certificates must make available coverage for breast reduction surgery and symptomatic varicose vein surgery determined to be medically necessary health care as defined in section 4301‑A, subsection 10‑A.   [PL 2005, c. 128, §3 (NEW); PL 2005, c. 128, §5 (AFF).]SECTION HISTORY PL 2005, c. 128, §3 (NEW). PL 2005, c. 128, §5 (AFF).
24-A ME Rev Stat § 2847-M (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2847-M. Enrollment for individuals or families establishing eligibility for MaineCare

 §2847-M. Enrollment for individuals or families establishing eligibility for MaineCare When an individual or family is eligible for MaineCare and is also eligible for health insurance coverage provided by an employer, the insurer must permit the individual or family to enroll in the health insurance coverage without regard to any enrollment season restrictions.   [PL 2007, c. 448, §11 (NEW).]Revisor's Note: §2847-M. Coverage for hearing aids (As enacted by PL 2007, c. 452, §3 is REALLOCATED TO TITLE 24-A, SECTION 2847-O)SECTION HISTORY PL 2007, c. 448, §11 (NEW). PL 2007, c. 452, §3 (NEW). PL 2007, c. 695, Pt. A, §29 (RAL).
24-A ME Rev Stat § 2847-N (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2847-N. Coverage for colorectal cancer screening

 §2847-N. Coverage for colorectal cancer screening 1.  Colorectal cancer screening.  For the purposes of this section, "colorectal cancer screening" means all colorectal cancer examinations and laboratory tests recommended by a health care provider in accordance with the most recently published colorectal cancer screening guidelines of a national cancer society.   [PL 2019, c. 86, §4 (AMD).] 2.  Required coverage.  All group health insurance policies, contracts and certificates must provide coverage for colorectal cancer screening for asymptomatic individuals who are:   A. At average risk for colorectal cancer according to the most recently published colorectal cancer screening guidelines of a national cancer society; or   [PL 2019, c. 86, §5 (AMD).]B. At high risk for colorectal cancer.   [PL 2019, c. 86, §6 (AMD).][PL 2019, c. 86, §§5, 6 (AMD).] 3.  Billing.  If a colonoscopy is recommended by a health care provider as the colorectal cancer screening test in accordance with this section and a lesion is discovered and removed during that colonoscopy, the health care provider must bill the insurance company for a screening colonoscopy as the primary procedure.   [PL 2007, c. 516, §3 (NEW); PL 2007, c. 516, §5 (AFF).] Revisor's Note: §2847-N. Coverage for medically necessary infant formula (As enacted by PL 2007, c. 595, §3 is REALLOCATED TO TITLE 24-A, SECTION 2847-P) SECTION HISTORY PL 2007, c. 516, §3 (NEW). PL 2007, c. 516, §5 (AFF). PL 2007, c. 595, §3 (NEW). PL 2007, c. 595, §5 (AFF). PL 2007, c. 695, Pt. C, §15 (RAL). PL 2019, c. 86, §§4-6 (AMD).
24-A ME Rev Stat § 2847-O (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2847-O. Coverage for hearing aids (REALLOCATED FROM TITLE 24-A, SECTION 2847-M)

 §2847-O. Coverage for hearing aids (REALLOCATED FROM TITLE 24-A, SECTION 2847-M)1.  Hearing aid; definition.  For purposes of this section, "hearing aid" means a nonexperimental, wearable instrument or device designed for the ear and offered for the purpose of aiding or compensating for impaired human hearing, excluding batteries and cords and other assistive listening devices, including, but not limited to, frequency modulation systems.   [PL 2007, c. 695, Pt. A, §29 (RAL).] 2.  Required coverage.  All group health insurance policies, contracts and certificates must provide coverage for the purchase of a hearing aid for each hearing-impaired ear for an individual covered under the policy, contract or certificate in accordance with the following requirements.   A. The hearing loss must be documented by a physician or audiologist licensed pursuant to Title 32, chapter 137.   [PL 2015, c. 494, Pt. A, §29 (AMD).]B. The hearing aid must be purchased in accordance with federal and state laws, regulations and rules for the sale and dispensing of hearing aids.   [PL 2019, c. 418, §3 (AMD).]C. The policy, contract or certificate may limit coverage to $3,000 per hearing aid for each hearing-impaired ear every 36 months.   [PL 2019, c. 418, §3 (AMD).][PL 2019, c. 418, §3 (AMD).] 3.  Application of coverage.   [PL 2019, c. 418, §4 (RP).] 4.  Limits; coinsurance; deductibles.  Except as otherwise provided in this section, any policy, contract or certificate that provides coverage for services under this section may contain provisions for maximum benefits and coinsurance and reasonable limitations, deductibles and exclusions to the extent that these provisions are not inconsistent with the requirements of this section.   [PL 2007, c. 695, Pt. A, §29 (RAL).] SECTION HISTORY PL 2007, c. 695, Pt. A, §29 (RAL). PL 2015, c. 494, Pt. A, §29 (AMD). PL 2019, c. 418, §§3, 4 (AMD).