reglab/housing_qa huggingface dataset:
24-A ME Rev Stat § 4220 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4220. Fees

 §4220. Fees 1.  Every health maintenance organization subject to this chapter shall pay to the superintendent the following fees:   A. For filing an initial application for a certificate of authority, $500;   [PL 1975, c. 503 (NEW).]B. For filing each annual report, $50.   [PL 1975, c. 503 (NEW).][PL 1975, c. 503 (NEW).] 2.  Fees charged under this section shall be distributed as follows: 50% to the superintendent and 50% to the Commissioner of Health and Human Services.   [PL 1975, c. 503 (NEW); PL 2003, c. 689, Pt. B, §7 (REV).] SECTION HISTORY PL 1975, c. 293, §4 (AMD). PL 1975, c. 503 (NEW). PL 2003, c. 689, §B7 (REV).
24-A ME Rev Stat § 4221 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4221. Penalties and enforcement

 §4221. Penalties and enforcement 1.  The superintendent may levy an administrative penalty in an amount not less than $100 nor more than $500, if reasonable notice in writing is given of the intent to levy the penalty and the health maintenance organization has a reasonable time within which to remedy the defect in its operations that gave rise to the penalty citation. The superintendent may augment this penalty by an amount equal to the sum that the superintendent calculates to be the damages suffered by enrollees or other members of the public.   [RR 2021, c. 1, Pt. B, §349 (COR).] 2.  If the superintendent or the Commissioner of Health and Human Services shall for any reason have cause to believe that any violation of this chapter has occurred or is threatened, the superintendent or Commissioner of Health and Human Services may give notice to the health maintenance organization and to the representatives, or other persons who appear to be involved in such suspected violation, to arrange a conference with the alleged violators or their authorized representatives for the purpose of attempting to ascertain the facts relating to such suspected violation and, in the event it appears that any violation has occurred or is threatened, to arrive at an adequate and effective means of correcting or preventing such violation.   Proceedings under this subsection shall not be governed by any formal procedural requirements and may be conducted in such manner as the superintendent or the Commissioner of Health and Human Services may deem appropriate under the circumstances.   [PL 1975, c. 503 (NEW); PL 2003, c. 689, Pt. B, §7 (REV).] 3.  The superintendent may issue an order directing a health maintenance organization or a representative of a health maintenance organization to cease and desist from engaging in any act or practice in violation of this chapter.   Within 10 days after service of the order of cease and desist, the respondent may request a hearing on the question of whether acts or practices in violation of this chapter have occurred.   [PL 1975, c. 503 (NEW).] 4.  In the case of any violation under this chapter, if the superintendent elects not to issue a cease and desist order, or in the event of noncompliance with a cease and desist order issued pursuant to this section, the superintendent may apply to the Superior Court to issue an injunction restraining the company in whole or in part from proceeding further with its business, or the superintendent may apply for an order of the court to command performance consistent with contractual obligations of the health maintenance organization.   [RR 2021, c. 1, Pt. B, §350 (COR).] SECTION HISTORY PL 1975, c. 293, §5 (AMD). PL 1975, c. 503 (NEW). PL 1977, c. 694, §437 (AMD). PL 2003, c. 689, §B7 (REV). RR 2021, c. 1, Pt. B, §§349, 350 (COR).
24-A ME Rev Stat § 4222 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4222. Statutory construction and relationship to other laws

 §4222. Statutory construction and relationship to other laws 1.  Except as otherwise specifically provided, provisions of the insurance law and the laws relating to hospital or medical service corporations do not apply to a health maintenance organization granted a certificate of authority under this chapter. This provision does not apply to an insurer or hospital or medical service corporation licensed and regulated pursuant to the insurance laws of this State except with respect to its health maintenance organization activities, whether those activities are conducted through a subsidiary or as a division or line of business, authorized and regulated pursuant to this chapter.   [PL 1993, c. 702, Pt. A, §16 (AMD).] 2.  Solicitation of enrollees by a health maintenance organization granted a certificate of authority or its representatives shall not be construed to violate any provision of law relating to solicitation or advertising by health professionals.   [PL 1975, c. 503 (NEW).] 3.  Any health maintenance organization authorized under this chapter is not deemed to be practicing medicine and is exempt from provisions of law relating to the practice of medicine, except that this subsection may not be asserted by a health maintenance organization as a defense to any action brought by an enrollee pursuant to section 4313.   [PL 1999, c. 742, §1 (AMD).] 4.   [PL 1995, c. 625, Pt. A, §26 (RP).] SECTION HISTORY PL 1975, c. 503 (NEW). PL 1991, c. 861, §3 (AMD). PL 1991, c. 861, §4 (AFF). PL 1993, c. 702, §A16 (AMD). PL 1995, c. 332, §§L2,O7 (AMD). PL 1995, c. 625, §A26 (AMD). PL 1999, c. 742, §1 (AMD).
24-A ME Rev Stat § 4222-A (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4222-A. Rules

 §4222-A. Rules Subject to the applicable requirements and procedures of the Maine Administrative Procedure Act, Title 5, chapter 375, subchapter II, the superintendent may make, adopt, amend and rescind reasonable rules to aid the administration or effectuation of any provisions of this chapter.   [PL 1993, c. 702, Pt. A, §17 (NEW).]SECTION HISTORY PL 1993, c. 702, §A17 (NEW).
24-A ME Rev Stat § 4223 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4223. Filings and reports as public documents

 §4223. Filings and reports as public documents All applications, filings and reports required under this chapter shall be treated as public documents subject to limitations and exceptions provided in Title 1, chapter 13, subchapter I.   [PL 1985, c. 704, §7 (AMD).]SECTION HISTORY PL 1975, c. 503 (NEW). PL 1985, c. 704, §7 (AMD).
24-A ME Rev Stat § 4224-A (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4224-A. Loss information (REPEALED)

 §4224-A. Loss information (REPEALED)SECTION HISTORY PL 1995, c. 71, §3 (NEW). PL 1997, c. 370, §E7 (AMD). PL 2001, c. 410, §B4 (RP).
24-A ME Rev Stat § 4225 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4225. Commissioner of Health and Human Services' authority to contract

 §4225. Commissioner of Health and Human Services' authority to contract The Commissioner of Health and Human Services, in carrying out the commissioner's obligations under sections 4204, subsection 1, paragraph B; section 4215; and section 4216, subsection 1, may contract with qualified persons to make recommendations concerning the determinations required to be made by the commissioner. Such recommendations may be accepted in full or in part by the Commissioner of Health and Human Services.   [RR 2021, c. 1, Pt. B, §351 (COR).]SECTION HISTORY PL 1975, c. 293, §4 (AMD). PL 1975, c. 503 (NEW). PL 2003, c. 689, §B7 (REV). RR 2021, c. 1, Pt. B, §351 (COR).
24-A ME Rev Stat § 4226 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4226. Federal legislation

 §4226. Federal legislation Nothing in this chapter shall prohibit any health maintenance organization from meeting the requirements of any federal law which would authorize such health maintenance organization to receive federal financial assistance or certification or to enroll beneficiaries assisted by federal funds.   [PL 1975, c. 503 (NEW).]SECTION HISTORY PL 1975, c. 503 (NEW).
24-A ME Rev Stat § 4227 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4227. Choice of alternative coverage

 §4227. Choice of alternative coverage Any employer of more than 50 employees who offers a health maintenance organization, as defined in section 4202‑A, shall also offer its employees, at the time of offering and renewal of the health maintenance organization, the option of selecting alternative health benefits coverage that does not restrict the ability of the covered persons to obtain health care services from the providers of their choice.   [PL 1991, c. 709, §8 (AMD).]Any employer subject to this section shall contribute to the alternative health benefits coverage to the same extent as it contributes to the health maintenance organization.   [PL 1985, c. 704, §8 (NEW).]An employer may not be required to pay more for health benefits as a result of the application of this section than would otherwise be paid.   [PL 1991, c. 709, §8 (AMD).]An employer may satisfy the requirements of this section by offering a point-of-service option but may not satisfy the requirements of this section by contributing to the cost of an individual health plan.   [PL 1997, c. 370, Pt. B, §4 (AMD).]SECTION HISTORY PL 1985, c. 704, §8 (NEW). PL 1991, c. 709, §8 (AMD). PL 1997, c. 370, §B4 (AMD).
24-A ME Rev Stat § 4228 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4228. Utilization review data

 §4228. Utilization review data 1.  Report required.  On or before April 1st of each year, each health maintenance organization which issues a program of contract in this State that contains a provision whereby in nonemergency cases the insured is required to be prospectively evaluated through a prehospital admission certification, preinpatient service eligibility program or any similar preutilization review or screening procedure prior to the delivery of contemplated hospitalization, inpatient or outpatient health care or medical services which are prescribed or ordered by a duly licensed physician shall file a report on the results of that evaluation for the preceding year with the superintendent which shall contain the following:   A. The number and type of evaluations performed.   (1) For the purposes of this section, the term "type of evaluations" means the following preutilization review categories: presurgical inpatient days; setting of medical service, such as inpatient or outpatient services; and the number of days of service.   (2) The report must separately identify the number of evaluations performed in which the health care services requested or provided include chiropractic services and the results of those evaluations;   [PL 1993, c. 669, §5 (AMD).]B. The result of the evaluation, such as whether the medical necessity of the level of service contemplated by the patient's physician was agreed to or whether benefits paid for the service were reduced by the health maintenance organization;   [PL 1987, c. 168, §5 (NEW).]C. The number and result of any appeals by patients or their physicians as a result of initial review decisions to reduce benefits for services as determined through prospective evaluations; and   [PL 1987, c. 168, §5 (NEW).]D. Any complaints filed in a court of competent jurisdiction and served upon a health maintenance organization filing under this section stating a cause of action against that organization on the basis of damages to patients alleged to have been proximately caused by a delay, reduction or denial of medical benefits by the organization, as determined through prospective evaluations, and the determination of liability or other disposition of the complaint.   [PL 1987, c. 168, §5 (NEW).][PL 1993, c. 669, §5 (AMD).] 2.  Maine residents.  This section is applicable to evaluations, appeals and complaints relating to Maine residents only.   [PL 1987, c. 168, §5 (NEW).] 3.  Confidentiality.  Any information provided pursuant to this section shall not identify the names of patients.   [PL 1987, c. 168, §5 (NEW).] SECTION HISTORY PL 1987, c. 168, §5 (NEW). PL 1993, c. 669, §5 (AMD).
24-A ME Rev Stat § 4229 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4229. Acquired Immune Deficiency Syndrome

 §4229. Acquired Immune Deficiency Syndrome No policy, contract or certificate delivered or issued for delivery in this State may provide more restrictive coverage for Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex or HIV related diseases than for any other disease or sickness or exclude coverage for AIDS, ARC or HIV related diseases except through an exclusion under which all sicknesses and diseases are treated the same.   [PL 1989, c. 176, §9 (NEW).]SECTION HISTORY PL 1989, c. 176, §9 (NEW).
24-A ME Rev Stat § 4230 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4230. Trade practices and frauds (REPEALED)

 §4230. Trade practices and frauds (REPEALED)SECTION HISTORY PL 1989, c. 345, §2 (NEW). PL 1995, c. 332, §O9 (RP).
24-A ME Rev Stat § 4232 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4232. Replacement coverage

 §4232. Replacement coverage 1.  Group hospital, medical or surgical expenses, or service benefits.  Any insurer or nonprofit health insurance plan that issues replacement coverage with respect to group hospital, medical or surgical expenses or service benefits within a period of 60 days from the date of discontinuance of a prior health maintenance organization contract or policy providing the hospital, medical or surgical expenses or service benefits shall immediately cover all enrollees who were validly covered under the previous health maintenance organization contract or policy at the date of discontinuance and who would otherwise be eligible for coverage under the succeeding insurer's or nonprofit health insurance plan's contract, regardless of any provisions in that contract relating to active employment, hospital confinement or pregnancy.   [PL 1989, c. 842, §18 (NEW).] 2.  Preexisting conditions.  No provision in a succeeding insurer's or nonprofit hospital or medical service corporation's contract of replacement coverage may reduce or exclude benefits to enrollees covered under the prior health maintenance organization's contract on the date of discontinuance, on the basis that the condition giving rise to benefits preexisted the effective date of the succeeding contract, except to the extent that benefits for the condition would have been reduced or excluded under the prior contract.   [PL 1989, c. 842, §18 (NEW).] SECTION HISTORY PL 1989, c. 842, §18 (NEW).
24-A ME Rev Stat § 4233 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4233. Registration, regulation and supervision of holding company systems

 §4233. Registration, regulation and supervision of holding company systems 1.   [PL 1995, c. 332, Pt. O, §11 (RP).] 2.  Every domestic health maintenance organization is subject to the requirements of section 221‑A. At the superintendent's request, a domestic health maintenance organization must make available to the superintendent the audit work papers of any accountant who has audited that health maintenance organization.   Upon timely notice to a health maintenance organization, the superintendent may review, photocopy or otherwise record the audit work papers generated by any accountant who has audited that health maintenance organization.   Health maintenance organization work papers under the superintendent's custody or control are confidential and not subject to public inspection.   The work papers of a health maintenance organization's parent, subsidiaries or other corporate affiliates are deemed to be the work papers of that health maintenance organization to the extent the work papers affect the health maintenance organization's final equity determination and reference any transaction between the health maintenance organization and its parent, subsidiaries or corporate affiliates.   As a condition of engaging an auditing accountant, the health maintenance organization shall require the accountant to:   A. Retain for a period of at least 6 years any work papers prepared in connection with the accountant's audit of that health maintenance organization; and   [PL 1993, c. 313, §36 (NEW).]B. Provide, at the request of the health maintenance organization, the original or copies of any work papers created by the accountant in connection with an audit of that health maintenance organization.   [PL 1993, c. 313, §36 (NEW).]For purposes of this subsection, the term "work papers" includes, but is not limited to, originals or copies of any schedules, analyses, reconciliations, abstracts, memoranda, narratives, flow charts, company records or other documents prepared or obtained by the accountant and the accountant's employees in the course of conducting an audit of the health maintenance organization.   [PL 1993, c. 313, §36 (NEW).] SECTION HISTORY PL 1989, c. 842, §18 (NEW). PL 1993, c. 313, §36 (RPR). PL 1995, c. 332, §O11 (AMD).
24-A ME Rev Stat § 4233-A (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4233-A. Extension of coverage for dependent children

 §4233-A. Extension of coverage for dependent children An individual or group health maintenance organization contract that provides coverage for a dependent child at certain ages only if the child is a student must continue that coverage if the child is unable to remain enrolled in school on a full-time basis due to a mental or physical illness or an accidental injury. This coverage may be terminated at the age at which coverage for students terminates under the terms of the contract. A health maintenance organization may require, as a condition of eligibility for continued coverage in accordance with this section, that the student provide written documentation from a health care provider and the student's school that the student is no longer enrolled in school on a full-time basis due to a mental or physical illness or accidental injury.   [PL 2007, c. 115, §3 (AMD); PL 2007, c. 115, §5 (AFF).]SECTION HISTORY PL 2005, c. 532, §3 (NEW). PL 2007, c. 115, §3 (AMD). PL 2007, c. 115, §5 (AFF).
24-A ME Rev Stat § 4233-B (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4233-B. Mandatory offer to extend coverage for dependent children up to 26 years of age

 §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.   A. [PL 2019, c. 5, Pt. A, §18 (RP).] B. [PL 2019, c. 5, Pt. A, §18 (RP).] C. [PL 2019, c. 5, Pt. A, §18 (RP).] D. [PL 2007, c. 514, §13 (RP).] [PL 2019, c. 5, Pt. A, §18 (AMD).] 2.  Offer of coverage.  An individual or group health maintenance organization contract that offers coverage for a dependent child must offer such coverage, at the option of the parent, until the dependent child attains 26 years of age.   [PL 2019, c. 5, Pt. A, §18 (AMD).] 3.  Notice.   [PL 2007, c. 514, §15 (NEW); MRSA T. 24-A §4233-B, sub-§3 (RP).] SECTION HISTORY PL 2007, c. 115, §4 (NEW). PL 2007, c. 115, §5 (AFF). PL 2007, c. 514, §§11-15 (AMD). PL 2019, c. 5, Pt. A, §18 (AMD).
24-A ME Rev Stat § 4234-B (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4234-B. Maternity and routine newborn care

 §4234-B. Maternity and routine newborn care Individual and group contracts and certificates issued by a health maintenance organization that provide maternity benefits, including benefits for childbirth, shall provide coverage for services related to maternity and routine newborn care, including coverage for hospital stay, in accordance with the attending physician's or attending certified nurse midwife's determination in conjunction with the mother that the mother and newborn meet the criteria outlined in the "Guidelines for Perinatal Care," published by the American Academy of Pediatrics and the American College of Obstetrics and Gynecology. For the purposes of this section, "routine newborn care" does not include any services provided after the mother has been discharged from the hospital. For the purposes of this section, "attending physician" includes the obstetrician, pediatrician or other physician attending the mother and newborn. Benefits for routine newborn care required by this section are part of the mother's benefit. The mother and the newborn are treated as one person in calculating the deductible, coinsurance and copayments for coverage required by this section.   [PL 2003, c. 517, Pt. B, §23 (AMD).]SECTION HISTORY PL 1995, c. 615, §4 (NEW). PL 2001, c. 258, §A4 (AMD). PL 2003, c. 517, §B23 (AMD).
24-A ME Rev Stat § 4234-C (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4234-C. Newborn children coverage

 §4234-C. Newborn children coverage All individual and group health maintenance organization contracts must provide that benefits are payable with respect to a newly born child from the moment of birth.   [PL 1997, c. 604, Pt. C, §4 (NEW).]The coverage for newly born children must consist of coverage of injury, sickness or other benefits provided by the contract, including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities.   [PL 1997, c. 604, Pt. C, §4 (NEW).]If payment of a specific premium or subscription fee is required to provide coverage for a child, the contract may require that notification of birth of a newly born child and payment of the required fees must be furnished to the nonprofit hospital or medical service organization within 31 days after the date of birth in order to have the coverage continue beyond that 31-day period. The payment may be required to be retroactive to the date of birth. Benefits required by section 4234‑B must be paid regardless of whether coverage under this section is elected.   [PL 1997, c. 604, Pt. C, §4 (NEW).]The requirements of this section apply to all contracts delivered or issued for delivery in this State on or after the effective date of this Act.   [PL 1997, c. 604, Pt. C, §4 (NEW).]SECTION HISTORY PL 1997, c. 604, §C4 (NEW).