reglab/housing_qa huggingface dataset:
24-A ME Rev Stat § 2837-C (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2837-C. Coverage for breast cancer treatment

 §2837-C. Coverage for breast cancer treatment 1.  Inpatient care.  All group health policies providing coverage for medical and surgical benefits, except accidental injury, specified disease, hospital indemnity, Medicare supplement, long-term care and other limited benefit health insurance policies and contracts, must ensure that inpatient coverage with respect to the treatment of breast cancer is provided for a period of time determined by the attending physician, after providing notice to the patient regarding the coverage required by this subsection and in consultation with the patient, to be medically appropriate following a mastectomy, a lumpectomy or a lymph node dissection for the treatment of breast cancer.   Nothing in this subsection may be construed to require the provision of inpatient coverage if the attending physician and patient determine that a shorter period of hospital stay is appropriate.   In implementing the requirements of this subsection, a group health policy may not modify the terms and conditions of coverage based on the determination by any enrollee to request less than the minimum coverage required under this subsection.   All group health policies must provide written notice to each enrollee under the contract regarding the coverage required by this subsection. The notice must be prominently positioned in any literature or correspondence made available or distributed by the plan and must be transmitted in the next mailing made by the plan to the enrollee or as part of any yearly information packet sent to the enrollee, whichever is earlier. The notice must also be made available to any physician participating in the insurer's provider network.   [PL 2015, c. 227, §3 (AMD); PL 2015, c. 227, §5 (AFF).] 2.  Reconstruction.  All group health policies providing coverage for mastectomy surgery must provide coverage for reconstruction of the breast on which surgery has been performed and surgery and reconstruction of the other breast to produce a symmetrical appearance if the patient elects reconstruction and in the manner chosen by the patient and the physician.   [PL 1997, c. 408, §6 (NEW); PL 1997, c. 408, §8 (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, §15 (NEW).] SECTION HISTORY RR 1995, c. 1, §17 (COR). PL 1995, c. 295, §4 (NEW). PL 1995, c. 369, §3 (NEW). PL 1997, c. 408, §6 (RPR). PL 1997, c. 408, §8 (AFF). PL 2003, c. 517, §B15 (AMD). PL 2015, c. 227, §3 (AMD). PL 2015, c. 227, §5 (AFF).
24-A ME Rev Stat § 2837-D (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2837-D. Medical food coverage for inborn error of metabolism

 §2837-D. Medical food coverage for inborn error of metabolism 1.  Inborn error of metabolism; special modified low-protein food product.  As used in this section, "inborn error of metabolism" means a genetically determined biochemical disorder in which a specific enzyme defect produces a metabolic block that may have pathogenic consequences at birth or later in life. As used in this section, "special modified low-protein food product" means food formulated to reduce the protein content to less than one gram of protein per serving and does not include foods naturally low in protein.   [PL 1995, c. 369, §3 (NEW).] 2.  Required coverage.  All group insurance policies and contracts, except accidental injury, specified disease, hospital indemnity, Medicare supplement, long-term care and other limited benefit health insurance policies and contracts, must provide coverage for metabolic formula and special modified low-protein food products that have been prescribed by a licensed physician for a person with an inborn error of metabolism. The policies and contracts must reimburse:   A. For metabolic formula; and   [PL 1995, c. 369, §3 (NEW).]B. Up to $3,000 per year for special modified low-protein food products.   [PL 1995, c. 369, §3 (NEW).][PL 1995, c. 369, §3 (NEW).] 3.  Application.  The requirements of this section apply to all policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 1996. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.   [PL 1995, c. 369, §3 (NEW).] SECTION HISTORY RR 1995, c. 1, §17 (RNU). PL 1995, c. 369, §3 (NEW).
24-A ME Rev Stat § 2837-E (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2837-E. Coverage for Pap tests

 §2837-E. Coverage for Pap tests All group health insurance policies, contracts and certificates must provide coverage for screening Pap tests recommended by a physician.   [PL 2003, c. 517, Pt. A, §7 (AMD); PL 2003, c. 517, Pt. A, §13 (AFF).]SECTION HISTORY PL 1995, c. 617, §3 (NEW). PL 1995, c. 617, §6 (AFF). PL 2003, c. 517, §A7 (AMD). PL 2003, c. 517, §A13 (AFF).
24-A ME Rev Stat § 2837-H (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2837-H. Coverage for prostate cancer screening (REALLOCATED FROM TITLE 24-A, SECTION 2837-F)

 §2837-H. Coverage for prostate cancer screening (REALLOCATED FROM TITLE 24-A, SECTION 2837-F)1.  Definition.  As used in this section, "services for the early detection of prostate cancer" means the following procedures provided to a man for the purpose of early detection of prostate cancer:   A. A digital rectal examination; and   [RR 1997, c. 2, §52 (RAL).]B. A prostate-specific antigen test.   [RR 1997, c. 2, §52 (RAL).][RR 1997, c. 2, §52 (RAL).] 2.  Required coverage for prostate cancer screening.  All group insurance policies and contracts except accidental injury, specified disease, hospital indemnity, Medicare supplement, long-term care and other limited benefit health insurance policies and contracts must provide coverage for services for the early detection of prostate cancer. The contracts must reimburse for services for the early detection of prostate cancer, if recommended by a physician, at least once a year for men 50 years of age or older until a man reaches the age of 72.   [RR 1997, c. 2, §52 (RAL).] 3.  Application.  The requirements of this section apply to all policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State on or after September 1, 1998. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.   [RR 1997, c. 2, §52 (RAL).] SECTION HISTORY RR 1997, c. 2, §52 (RAL).
24-A ME Rev Stat § 2838 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2838. Community health service coverage (REPEALED)

 §2838. Community health service coverage (REPEALED)SECTION HISTORY PL 1979, c. 419, §2 (NEW). PL 1979, c. 558, §10 (NEW). PL 1979, c. 663, §148 (AMD). PL 1979, c. 663, §149 (RAL). PL 1983, c. 515, §5 (RP).
24-A ME Rev Stat § 2839 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2839. Rates filed

 §2839. Rates filed A policy of group or blanket health insurance may not be delivered in this State until a copy of the rates to be used in calculating the premium for these policies has been filed for informational purposes with the superintendent. The filing must include the base rates and a description of any procedures to be used to adjust the base rates to reflect factors including but not limited to age, gender, health status, claims experience, group size and coverage of dependents. Notwithstanding this section, rates for group Medicare supplement, nursing home care or long-term care insurance contracts and for certain association groups and other groups specified in section 2701, subsection 2, paragraph C must be filed in accordance with section 2736. Rates for small group health insurance subject to section 2808-B are subject to the additional filing requirements specified in that section. A filing required under this section must be made electronically in a format required by the superintendent unless exempted by rule adopted by the superintendent. Rules adopted pursuant to this section are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.   [PL 2011, c. 238, Pt. C, §1 (AMD).]SECTION HISTORY PL 1979, c. 558, §10 (NEW). PL 1979, c. 663, §149 (RAL). PL 1985, c. 648, §11 (AMD). PL 2003, c. 428, §E2 (AMD). PL 2009, c. 14, §5 (AMD). PL 2011, c. 238, Pt. C, §1 (AMD).
24-A ME Rev Stat § 2839-A (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2839-A. Notice of rate increase

 §2839-A. Notice of rate increase 1.  Notice of rate increase on existing policies.  An insurer offering group health insurance, except for accidental injury, specified disease, hospital indemnity, disability income, Medicare supplement, long-term care or other limited benefit group health insurance, must provide written notice by mail or electronically of a rate increase to all affected policyholders or others who are directly billed for group coverage at least 60 days before the effective date of any increase in premium rates. An increase in premium rates may not be implemented until 60 days after the notice is provided. For small group health plan rates subject to section 2808‑B, subsection 2‑B, if the increase is pending approval at the time of notice, the disclosure must state that the increase is subject to regulatory approval.   [PL 2011, c. 90, Pt. F, §2 (AMD).] 1-A.  Notice of rate increase on existing policies renewed in calendar year 2006.   [PL 2005, c. 400, Pt. A, §2 (NEW); MRSA T. 24-A §2839-A, sub-§1-A (RP).] 2.  Notice of rate increase on new business.  When an insurer offering group health insurance, except for accidental injury, specified disease, hospital indemnity, disability income, Medicare supplement, long-term care or other limited benefit group health insurance, quotes a rate for new business, it must disclose any rate increase that the insurer anticipates implementing within the following 90 days. If the quote is in writing, the disclosure must also be in writing. If such disclosure is not provided, an increase may not be implemented until at least 90 days after the date the quote is provided. For small group health plan rates subject to section 2808‑B, subsection 2‑B, if the increase is pending approval at the time of notice, the disclosure must state that the increase is subject to regulatory approval.   [PL 2005, c. 121, Pt. F, §1 (AMD).] 3.  Notice of rate increase on new business for calendar year 2006.   [PL 2005, c. 400, Pt. A, §2 (NEW); MRSA T. 24-A §2839-A, sub-§3 (RP).] SECTION HISTORY PL 2001, c. 432, §7 (NEW). PL 2005, c. 121, §F1 (AMD). PL 2005, c. 400, §A2 (AMD). PL 2011, c. 90, Pt. F, §2 (AMD).
24-A ME Rev Stat § 2839-B (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2839-B. Large group rates

 §2839-B. Large group rates 1.  Application.  This section applies to group health insurance offered in the large group market as defined in section 2850‑B, except insurance covering only accidental injury, specified disease, hospital indemnity, dental, vision, disability income, long-term care, Medicare supplement or other limited benefit health insurance.   [PL 2003, c. 469, Pt. E, §17 (NEW).] 2.  Annual filing.  Every carrier offering group health insurance specified in subsection 1 shall annually file with the superintendent on or before April 30th a certification signed by a member in good standing of the American Academy of Actuaries or a successor organization that the carrier's rating methods and practices are in accordance with generally accepted actuarial principles and with the applicable actuarial standards of practice as promulgated by an actuarial standards board. The filing must also certify that the carrier has included in its experience any savings offset payments or recovery of those savings offset payments consistent with former section 6913. The filing also must state the number of policyholders, certificate holders and dependents, as of the close of the preceding calendar year, enrolled in large group health insurance plans offered by the carrier. A filing and supporting information are public records except as provided by Title 1, section 402, subsection 3.   [PL 2007, c. 629, Pt. M, §11 (AMD).] 3.  Documentation.  Every carrier shall maintain at its principal place of business a complete and detailed description of its rating practices, including information and documentation that demonstrates that its rating methods and practices are in accordance with generally accepted actuarial principles and with the applicable actuarial standards of practice as promulgated by an actuarial standards board.   [PL 2003, c. 469, Pt. E, §17 (NEW).] SECTION HISTORY PL 2003, c. 469, §E17 (NEW). PL 2007, c. 629, Pt. M, §11 (AMD).
24-A ME Rev Stat § 2840 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2840. Optional coverage for chiropractic services (REALLOCATED FROM TITLE 24-A, SECTION 2746) (REPEALED)

 §2840. Optional coverage for chiropractic services (REALLOCATED FROM TITLE 24-A, SECTION 2746)(REPEALED)SECTION HISTORY PL 1979, c. 663, §145 (RAL). PL 1981, c. 282, §2 (AMD). PL 1985, c. 516, §4 (RP).
24-A ME Rev Stat § 2840-A (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2840-A. Coverage for chiropractic services

 §2840-A. Coverage for chiropractic services 1.  Therapeutic, adjustive and manipulative services.  Notwithstanding any other provisions of this chapter, every insurer which issues group or blanket health care contracts providing coverage for the services of a "physician" or "doctor" to residents of this State shall provide coverage to any subscriber or other person covered under those contracts for those services when performed by a chiropractor, to the extent that the services are within the lawful scope of practice of a chiropractor licensed to practice in this State. Therapeutic, adjustive and manipulative services shall be covered whether performed by an allopathic, osteopathic or chiropractic doctor.   [PL 1985, c. 516, §5 (NEW).] 2.  Limits; coinsurance; deductibles.  Any contract which 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.   [PL 1985, c. 516, §5 (NEW).] 3.  Reports to the Superintendent of Insurance.  Every insurer subject to this section shall report its experience for each calendar year to the Superintendent of Insurance not later than April 30th of the following year. The report must be in a form prescribed by the superintendent and include the amount of claims paid in this State for the services required by this section and the total amount of claims paid in this State for health care contracts. The report must include complaints concerning access to services under this section and the results of those complaints. The superintendent shall compile this data for all insurers in an annual report.   [PL 1993, c. 669, §3 (AMD).] 4.  Application; expiration.   [PL 1989, c. 141, §6 (RP).] 5.  Reimbursement; discrimination.  An insurer subject to this section may not refuse to reimburse a chiropractic provider who participates in the insurer's provider network for providing a health care service or procedure covered by the insurer as long as the chiropractic provider is acting within the lawful scope of that provider's license in the delivery of the covered service or procedure. Consistent with reasonable medical management techniques specified under the insurer's contract with respect to the method, treatment or setting for a covered service or procedure, the insurer may not discriminate based on the chiropractic provider's license. This subsection does not require an insurer to accept all chiropractic providers into a network or govern the amount of the reimbursement paid to a chiropractic provider.   [PL 2015, c. 111, §2 (NEW); PL 2015, c. 111, §4 (AFF).] SECTION HISTORY PL 1985, c. 516, §5 (NEW). PL 1989, c. 141, §§5,6 (AMD). PL 1993, c. 669, §3 (AMD). PL 2015, c. 111, §2 (AMD). PL 2015, c. 111, §4 (AFF).
24-A ME Rev Stat § 2841 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2841. Optional coverage for optometric services

 §2841. Optional coverage for optometric services 1.  Coverage required to be made available.  Every insurer which issues for delivery in this State group health policies which provide coverage on an expense-incurred basis for the services of a "physician" or "doctor" to residents of this State shall make available to all groups coverage for such services when performed by an optometrist, to the extent the services are within the scope of the practice of an optometrist licensed to practice in this State.   [PL 1981, c. 254, §2 (NEW).] 2.  Policy.  The group or blanket policy making available coverage for the services referred to in this section shall contain provisions for maximum benefits and coinsurance, and reasonable limitations, deductibles and exclusions.   [PL 1981, c. 254, §2 (NEW).] SECTION HISTORY PL 1981, c. 254, §§2,3 (NEW).
24-A ME Rev Stat § 2845 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2845. Cardiac rehabilitation coverage

 §2845. Cardiac rehabilitation coverage 1.  Requirement.  Every insurer which issues group health care contracts providing coverage for hospital care to residents of this State shall make available to groups of 20 or more persons, at the option of the policyholder, benefits as required by this section to any certificate holder or other person covered under those contracts for the expense of cardiac rehabilitation.   [PL 1987, c. 293, §2 (NEW).] 2.  Cardiac rehabilitation.  "Cardiac rehabilitation" means multidisciplinary, medically necessary treatment of persons with documented cardiovascular disease, which shall be provided in either a hospital or other setting. That treatment shall include outpatient treatment which is initiated within 26 weeks after the diagnosis of that disease and physician-recommended continuance of Phase II rehabilitation services for up to 36 sessions in a hospital or community-based setting and up to 36 Phase III sessions in a community-based setting.   [PL 1987, c. 293, §2 (NEW).] 3.  Limitations.  Benefits required to be made available pursuant to this section may be made subject to any reasonable limitation, maximum benefit, coinsurance, deductible or exclusion provisions applicable to overall benefits under the policy or certificate.   [PL 1987, c. 293, §2 (NEW).] 4.  Application.  The requirements of this section shall apply to all policies and certificates executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 1988. For purposes of this section only, all group policies shall be deemed to be renewed no later than the next yearly anniversary of the contract date.   [PL 1987, c. 293, §2 (NEW).] SECTION HISTORY PL 1987, c. 293, §2 (NEW).
24-A ME Rev Stat § 2846 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2846. Acquired Immune Deficiency Syndrome

 §2846. Acquired Immune Deficiency Syndrome A group health insurance policy or certificate delivered or issued for delivery in this State may not provide more restrictive benefits for sickness or disablement or the related expenses resulting from Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex (ARC) or HIV related diseases than for any other sickness or disabling condition or exclude benefits for AIDS, ARC or HIV related diseases except through an exclusion under which all sicknesses and diseases are treated the same. This section does not apply to a policy providing benefits for specific diseases or accidental injury only.   [PL 2003, c. 517, Pt. B, §17 (AMD).]SECTION HISTORY PL 1989, c. 176, §6 (NEW). PL 2003, c. 517, §B17 (AMD).
24-A ME Rev Stat § 2847 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 35: GROUP AND BLANKET HEALTH INSURANCE|24-A §2847. Utilization review data

 §2847. Utilization review data 1.  Report required.  On or before April 1st of each year, any insurer or 3rd-party administrator which issues or administers a program or contract in this State providing coverage for hospital care 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 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. 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;   [PL 1989, c. 556, Pt. C, §3 (NEW).]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 insurer;   [PL 1989, c. 556, Pt. C, §3 (NEW).]C. The number and result of any appeals by the patients or their physicians as a result of initial review decisions to reduce benefits for services as determined through prospective evaluations; and   [PL 1989, c. 556, Pt. C, §3 (NEW).]D. Any complaints filed in a court of competent jurisdiction and served upon an insurer filing under this section stating a cause of action against that insurer on the basis of damages to patients alleged to have been approximately caused by a delay, reduction or denial of medical benefits by the insurer, as determined through prospective evaluations, and the determination of liability or other disposition of the complaint.   [PL 1989, c. 556, Pt. C, §3 (NEW).][PL 1989, c. 556, Pt. C, §3 (NEW).] 2.  Residents.  This section is applicable to evaluations, appeals and complaints relating to residents of this State only.   [PL 1989, c. 556, Pt. C, §3 (NEW).] 3.  Confidentiality.  Any information provided pursuant to this section shall not identify the patients.   [PL 1989, c. 556, Pt. C, §3 (NEW).] SECTION HISTORY PL 1989, c. 556, §C3 (NEW).