reglab/housing_qa huggingface dataset:
24-A ME Rev Stat § 4205 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4205. Powers of health maintenance organizations

 §4205. Powers of health maintenance organizations 1.  The powers of health maintenance organizations include, but are not limited to the following:   A. Subject to such licensure laws or regulations as are applicable, the purchase, lease, construction, renovation, operation or maintenance of hospitals, medical facilities, or both, and their ancillary equipment, and such property as may reasonably be required for its principal office or for such other purposes as may be necessary in the transaction of the business of the organization;   [PL 1975, c. 503 (NEW).]B. The making of loans to a medical group under contract with it in furtherance of its program or the making of loans to a corporation or corporations under its control for the purpose of acquiring or constructing medical facilities and hospitals or in furtherance of a program providing health care services to enrollees;   [PL 1975, c. 503 (NEW).]C. The furnishing of health care services through providers which are under contract with or employed by the health maintenance organization;   [PL 1975, c. 503 (NEW).]D. The contracting with any person for the performance on its behalf of certain functions such as marketing, enrollment and administration;   [PL 1975, c. 503 (NEW).]E. The contracting with an insurance company licensed in this State for the provision of insurance or indemnity or with a nonprofit hospital or medical service organization for reimbursement against the cost of health care services provided by the health maintenance organization;   [PL 1975, c. 503 (NEW).]F. The offering, in addition to basic health care services, of:   (1) Additional health care services;   (2) Indemnity benefits covering out-of-area services;   (3) Indemnity benefits, in addition to those relating to out-of-area services.   [PL 1975, c. 503 (NEW).][PL 1975, c. 503 (NEW).] SECTION HISTORY PL 1975, c. 503 (NEW).
24-A ME Rev Stat § 4205-A (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4205-A. Continuity of licensure; business combinations

 §4205-A. Continuity of licensure; business combinations When a health maintenance organization authorized pursuant to this chapter merges or consolidates with an insurer or a nonprofit hospital, medical or health care service organization and operations of the surviving entity include those of a health maintenance organization, the surviving entity succeeds on a continuing basis to the authority possessed by the merging entities if:   [PL 1993, c. 702, Pt. A, §13 (NEW).]1.  Plan approved.  The superintendent has approved the plan of merger or consolidation, pursuant to section 4203, subsection 1;   [PL 1993, c. 702, Pt. A, §13 (NEW).] 2.  Entity financially qualified.  The entity is financially qualified pursuant to the provisions of sections 410 and 4204-A; and   [PL 1993, c. 702, Pt. A, §13 (NEW).] 3.  Entity otherwise qualified.  The entity is otherwise qualified pursuant to this chapter.   [PL 1993, c. 702, Pt. A, §13 (NEW).] SECTION HISTORY PL 1993, c. 702, §A13 (NEW).
24-A ME Rev Stat § 4206 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4206. Governing body

 §4206. Governing body 1.  The governing body of any health maintenance organization may include providers, other individuals, or both.   [PL 1975, c. 503 (NEW).] 2.  Such governing body shall establish a mechanism to afford the enrollees an opportunity to participate in matters of policy and operation through the establishment of advisory panels, by the use of advisory referenda on major policy decisions or through the use of other mechanisms.   [PL 1975, c. 503 (NEW).] SECTION HISTORY PL 1975, c. 503 (NEW).
24-A ME Rev Stat § 4208 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4208. Annual and interim reports

 §4208. Annual and interim reports 1.  Every health maintenance organization shall file annual and quarterly financial statements substantially similar to those required of health insurers under sections 423, 423-A and 423-D, verified by at least 3 principal officers, and shall provide a copy of each statement to the Commissioner of Health and Human Services. The superintendent may by rule or order require the filing of more frequent reports.   [PL 2017, c. 169, Pt. A, §11 (AMD).] 1-A.  The annual and quarterly statements must be prepared in accordance with the National Association of Insurance Commissioners annual and quarterly statement instructions and must follow practices and procedures prescribed by the National Association of Insurance Commissioners accounting practices and procedures manual for health maintenance organizations. If the health maintenance organization is operated as a division or line of business by an insurer or by a nonprofit hospital or medical service corporation, the superintendent shall designate the applicable portions of the financial statement form that must be filed, so as to eliminate information that is inapplicable to health maintenance organizations that are not separately incorporated and to minimize duplication between the statement filed under this section and the overall financial statement of the insurer or nonprofit hospital or medical service corporation.   [PL 2017, c. 169, Pt. A, §11 (NEW).] 1-B.  Every health maintenance organization shall file an annual audit opinion substantially similar to those required of insurers under section 221‑A.   [PL 2017, c. 169, Pt. A, §11 (NEW).] 2.   [PL 1993, c. 313, §34 (RP).] 3.  The annual and quarterly statements must include, if required by the Commissioner of Health and Human Services or by the superintendent:   A. A summary of information compiled pursuant to section 4204 in the form required by the Commissioner of Health and Human Services; and   [PL 2017, c. 169, Pt. A, §11 (AMD).]B. Other information related to the performance of the health maintenance organization that is necessary to enable the superintendent to carry out the superintendent's duties under this chapter.   [PL 1993, c. 313, §35 (NEW).][PL 2017, c. 169, Pt. A, §11 (AMD).] 4.  The superintendent may refuse to continue or may suspend or revoke the certificate of authority of a health maintenance organization failing to file an annual or quarterly statement when due.   [PL 2017, c. 169, Pt. A, §11 (AMD).] SECTION HISTORY PL 1975, c. 293, §4 (AMD). PL 1975, c. 503 (NEW). PL 1991, c. 709, §6 (AMD). PL 1993, c. 313, §§33-35 (AMD). PL 2017, c. 169, Pt. A, §11 (AMD).
24-A ME Rev Stat § 4210 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4210. Open enrollment

 §4210. Open enrollment 1.  After a health maintenance organization has been in operation 24 months, it shall have an annual open enrollment period of at least one month during which it accepts enrollees up to the limits of its capacity, as determined by the health maintenance organization, in the order in which they apply for enrollment. To the extent not inconsistent with the requirements of chapter 36 and sections 2736-C and 2808-B as qualified by section 4222‑B, subsection 3, a health maintenance organization may apply to the superintendent for authorization to impose such underwriting restrictions upon enrollment as are necessary to preserve its financial stability, to prevent excessive adverse selection by prospective enrollees or to avoid unreasonably high or unmarketable charges for enrollee coverage for health care services. The superintendent shall approve or deny the application within 10 days of the receipt of that application from the health maintenance organization.   [PL 1995, c. 332, Pt. O, §4 (AMD).] 2.  Health maintenance organizations providing or arranging for services exclusively on a group contract basis may limit the open enrollment provided for in this section to all members of the group or groups covered by such contracts.   [PL 1975, c. 503 (NEW).] SECTION HISTORY PL 1975, c. 503 (NEW). PL 1995, c. 332, §O4 (AMD).
24-A ME Rev Stat § 4210-A (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4210-A. Continuity of health insurance coverage (REPEALED)

 §4210-A. Continuity of health insurance coverage (REPEALED)SECTION HISTORY PL 1989, c. 867, §§9,10 (NEW). PL 1995, c. 332, §O5 (RP).
24-A ME Rev Stat § 4211 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4211. Complaint system

 §4211. Complaint system 1.  Every health maintenance organization shall establish and maintain a complaint system which has been approved by the superintendent, after consultation with the Commissioner of Health and Human Services, to provide reasonable procedures for the resolution of written complaints initiated by enrollees concerning health care services and general operating procedures.   [PL 1975, c. 503 (NEW); PL 2003, c. 689, Pt. B, §7 (REV).] 2.  Each health maintenance organization shall submit to the superintendent and the Commissioner of Health and Human Services an annual report in a form prescribed by the superintendent after consultation with the Commissioner of Health and Human Services that includes:   A. A description of the procedures of such complaint system;   [PL 1975, c. 503 (NEW).]B. The total number and disposition of complaints handled through the complaint system and a compilation of causes underlying the complaints filed. Complaints concerning access to chiropractic providers and the results of those complaints must be separately identified; and   [PL 1993, c. 669, §4 (AMD).]C. The number, amount and disposition of malpractice claims settled during the year by the health maintenance organization.   [PL 1975, c. 503 (NEW).][RR 2003, c. 2, §87 (COR).] 3.  The health maintenance organization shall maintain records of written complaints filed with it concerning other than health care services and shall submit to the superintendent a summary report at such times and in such format as the superintendent may require. Such complaints involving other persons shall be referred to such persons with a copy to the superintendent.   [PL 1975, c. 503 (NEW).] 4.  The superintendent and the Commissioner of Health and Human Services may examine such complaint system.   [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 1993, c. 669, §4 (AMD). RR 2003, c. 2, §87 (COR). PL 2003, c. 689, §B7 (REV).
24-A ME Rev Stat § 4212 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4212. Prohibited practices

 §4212. Prohibited practices 1.  No health maintenance organization, or representative thereof, may cause or knowingly permit the use of advertising which is untrue or misleading, solicitation which is untrue or misleading, or any form of evidence of coverage which is deceptive. For purposes of this chapter:   A. A statement or item of information shall be deemed to be untrue if it does not conform to fact in any respect which is or may be significant to an enrollee of, or person considering enrollment in, a health maintenance organization;   [PL 1975, c. 503 (NEW).]B. A statement or item of information shall be deemed to be misleading, whether or not it may be literally untrue, if, in the total context in which such statement is made or such item of information is communicated, such statement or item of information may be reasonably understood by a reasonable person, not possessing special knowledge regarding health care coverage, as indicating any benefit or advantage or the absence of any exclusion, limitation or disadvantage of possible significance to an enrollee of, or person considering enrollment in, a health maintenance organization, if such benefit or advantage or absence of limitation, exclusion or disadvantage does not in fact exist;   [PL 1975, c. 503 (NEW).]C. An evidence of coverage shall be deemed to be deceptive if the evidence of coverage taken as a whole, and with consideration given to typography and format, as well as language, shall be such as to cause a reasonable person, not possessing special knowledge regarding health maintenance organizations and evidences of coverage therefor, to expect benefits, services, charges or other advantages which the evidence of coverage does not provide or which the health maintenance organization issuing such evidence of coverage does not regularly make available for enrollees covered under such evidence of coverage.   [PL 1975, c. 503 (NEW).][PL 1975, c. 503 (NEW).] 2.  An enrollee may not be cancelled nor denied renewal except for the following:   A. Fraud or material misrepresentation;   [PL 1995, c. 332, Pt. O, §6 (NEW).]B. Failure to pay the charge for coverage;   [PL 1995, c. 332, Pt. O, §6 (NEW).]C. When the provisions of the State's community rating law are applicable, as provided by section 2736‑C, subsection 3, paragraph B and section 2808‑B, subsection 4, paragraph B; or   [PL 1995, c. 332, Pt. O, §6 (NEW).]D. Other reasons promulgated by the superintendent.   [PL 1995, c. 332, Pt. O, §6 (NEW).][PL 1995, c. 332, Pt. O, §6 (RPR).] 3.  No health maintenance organization, unless licensed as an insurer, may use in its name, contracts or literature any of the words "insurance", "casualty", "surety", "mutual" or any other words descriptive of the insurance, casualty or surety business or deceptively similar to the name or description of any insurance or surety corporation doing business in this State.   [PL 1975, c. 503 (NEW).] SECTION HISTORY PL 1975, c. 503 (NEW). PL 1995, c. 332, §O6 (AMD).
24-A ME Rev Stat § 4213 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4213. Regulation of agents

 §4213. Regulation of agents The superintendent may, after notice and hearing pursuant to the Maine Administrative Procedure Act, Title 5, chapter 375, subchapter II, promulgate such reasonable rules and regulations as are necessary to provide for the licensing of agents. An agent means a person directly or indirectly associated with a health maintenance organization who engages in solicitation or enrollment.   [PL 1977, c. 694, §433 (AMD).]SECTION HISTORY PL 1975, c. 503 (NEW). PL 1977, c. 694, §433 (AMD).
24-A ME Rev Stat § 4214 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4214. Powers of insurers and nonprofit hospital or medical service corporations

 §4214. Powers of insurers and nonprofit hospital or medical service corporations 1.  Subject to the provisions of sections 222, 3479 to 3482 and chapters 13 and 13-A, an insurance company licensed in this State or a nonprofit hospital, medical or health care service organization may establish, maintain, own, merge with, organize and operate a health maintenance organization under this chapter, either directly as a division or line of business, or indirectly through a subsidiary or affiliate. Subject to the provisions of section 222 and chapters 13 and 13-A, 2 or more such insurance companies, or nonprofit hospital, medical or health care service organizations, or subsidiaries or affiliates, may jointly organize and operate a health maintenance organization. The business of an insurer or hospital or medical service corporation that establishes, maintains, owns, merges with, organizes or operates a health maintenance organization is considered to include the providing of health care by a health maintenance organization.   [PL 1993, c. 702, Pt. A, §14 (AMD).] 1-A.  A domestic insurer that establishes, maintains, merges with or organizes and operates a health maintenance organization as a division or line of business is governed in its investment of funds allocated to that line of business by the provisions of section 4204, subsection 3‑A.   [PL 1993, c. 702, Pt. A, §15 (NEW).] 2.  Notwithstanding any provision of this Title, an insurer or a nonprofit hospital and medical service corporation may contract with a health maintenance organization to provide insurance or similar protection against the cost of care provided through health maintenance organizations and to provide coverage in the event of the failure of the health maintenance organization to meet its obligations.   [PL 1975, c. 503 (NEW).] 3.  The enrollees of a health maintenance organization constitute a permissible group, under such laws, and shall not be counted as part of any group for the purposes of chapter 35. Among other things, under such contracts, the insurer or nonprofit hospital or medical service corporation may make benefit payments to health maintenance organizations for health care services rendered by providers pursuant to the health maintenance organization.   [PL 1975, c. 503 (NEW).] 4.   [PL 1989, c. 842, §16 (RP).] SECTION HISTORY PL 1975, c. 503 (NEW). PL 1989, c. 842, §16 (AMD). PL 1993, c. 702, §§A14,15 (AMD).
24-A ME Rev Stat § 4215 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4215. Examinations

 §4215. Examinations 1.  The superintendent may make an examination of the affairs of any health maintenance organization as often as the superintendent considers it necessary for the protection of the interests of the people of this State, but not less frequently than once every 3 years. The superintendent may defer making an examination for no more than 2 additional years. In lieu of the superintendent's making an examination of a foreign or alien health maintenance organization, the superintendent may accept a full report of the most recent examination certified by the chief regulatory official of another state with responsibility for the financial oversight of health maintenance organizations.   [PL 2021, c. 16, §13 (AMD).] 2.  The Commissioner of Health and Human Services may make an examination concerning the quality of health care services of any health maintenance organization as often as the commissioner considers it necessary for the protection of the interests of the people of this State, but not less frequently than once every 3 years.   [RR 2021, c. 1, Pt. B, §346 (COR).] 3.  Every health maintenance organization shall submit its books and records relating to health care services to such examinations and in every way facilitate them. For the purpose of examinations, the superintendent and the Commissioner of Health and Human Services may administer oaths to and examine the officers and agents of the health maintenance organization.   [PL 1975, c. 503 (NEW); PL 2003, c. 689, Pt. B, §7 (REV).] 4.  The expenses of examinations under this section shall be assessed against the organization being examined and remitted to the superintendent or the Commissioner of Health and Human Services for whom the examination is being conducted.   [PL 1975, c. 503 (NEW); PL 2003, c. 689, Pt. B, §7 (REV).] 5.  In lieu of such examination, the superintendent or Commissioner of Health and Human Services may accept the report of an examination made by persons holding comparable office of another state.   [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). PL 2021, c. 16, §13 (AMD). RR 2021, c. 1, Pt. B, §346 (COR).
24-A ME Rev Stat § 4217 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4217. Rehabilitation, liquidation or conservation of health maintenance organizations

 §4217. Rehabilitation, liquidation or conservation of health maintenance organizations Any rehabilitation, liquidation or conservation of a health maintenance organization must be deemed to be the rehabilitation, liquidation or conservation of an insurance company and must be conducted under the supervision of the superintendent pursuant to the laws governing the rehabilitation, liquidation or conservation of insurance companies. The superintendent may institute summary proceedings in the same manner as provided in the laws governing delinquent insurers, and the superintendent may apply for an order directing the superintendent to rehabilitate, liquidate or conserve a health maintenance organization when in the superintendent's opinion the continued operation of the health maintenance organization would be hazardous either to the enrollees or to the people of this State.   [RR 2021, c. 1, Pt. B, §348 (COR).]SECTION HISTORY PL 1975, c. 503 (NEW). RR 2021, c. 1, Pt. B, §348 (COR).
24-A ME Rev Stat § 4218 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4218. Regulations

 §4218. Regulations The superintendent may, after notice and hearing pursuant to the Maine Administrative Procedure Act, Title 5, chapter 375, subchapter II, promulgate reasonable rules and regulations as are necessary or proper to carry out this chapter. Such rules and regulations shall be subject to review in accordance with sections 229 to 236.   [PL 1977, c. 694, §435 (AMD).]SECTION HISTORY PL 1975, c. 503 (NEW). PL 1977, c. 694, §435 (AMD).
24-A ME Rev Stat § 4218-A (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4218-A. Compliance with the Affordable Care Act

 §4218-A. Compliance with the Affordable Care Act The superintendent may adopt and amend rules, establish standards and enforce federal statutes and regulations in order to carry out the purposes of the federal Affordable Care Act. Rules or amendments to rules adopted pursuant to this section, including amendments to major substantive rules, are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.   [PL 2011, c. 364, §19 (NEW).]SECTION HISTORY PL 2011, c. 364, §19 (NEW).
24-A ME Rev Stat § 4219 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4219. Administrative procedures

 §4219. Administrative procedures 1.  When the superintendent has cause to believe that grounds exist for the suspension or revocation of a certificate of authority, the superintendent shall notify the health maintenance organization and the Commissioner of Health and Human Services in writing specifically stating the grounds for suspension or revocation. The Commissioner of Health and Human Services, or the commissioner's designated representative, shall participate in any disciplinary proceedings. In the process of determining whether grounds for suspension or revocation exist the findings of the commissioner with respect to matters relating to the quality of health care services provided are conclusive and binding upon the Superintendent of Insurance. The duration of and conditions attached to any suspension are determined by the superintendent after a hearing held in accordance with Title 5, chapter 375, subchapter IV.   [PL 1997, c. 592, §72 (AMD); PL 2003, c. 689, Pt. B, §7 (REV).] 2.  The Superintendent of Insurance, acting in concert with the Commissioner of Health and Human Services, has the authority to amend, modify or refuse to renew any certificate of authority for cause, pursuant to the Maine Administrative Procedure Act, Title 5, chapter 375, subchapter IV.   [PL 1977, c. 694, §436 (RPR); PL 2003, c. 689, Pt. B, §7 (REV).] SECTION HISTORY PL 1975, c. 503 (NEW). PL 1977, c. 694, §436 (RPR). PL 1997, c. 592, §72 (AMD). PL 2003, c. 689, §B7 (REV).