reglab/housing_qa huggingface dataset:
24-A ME Rev Stat § 4248 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4248. Coverage for services of certified nurse practitioners; certified midwives; certified nurse midwives (REALLOCATED FROM TITLE 24-A, SECTION 4245)

 §4248. Coverage for services of certified nurse practitioners; certified midwives; certified nurse midwives (REALLOCATED FROM TITLE 24-A, SECTION 4245)1.  Required coverage for services upon referral of primary care provider.  A health maintenance organization that issues individual and group health care contracts shall provide coverage under those contracts for services performed by a participating certified nurse practitioner, participating certified midwife or participating certified nurse midwife to a patient who is referred to the participating certified nurse practitioner, participating certified midwife or participating certified nurse midwife by a primary care provider when those services are within the lawful scope of practice of the participating certified nurse practitioner, participating certified midwife or participating certified nurse midwife.   [PL 2021, c. 79, §4 (AMD).] 2.  Required coverage for self-referred services.  With respect to individual and group health care contracts that do not require the selection of a primary care provider, a health maintenance organization shall provide coverage under those contracts for services performed by a participating certified nurse practitioner, participating certified midwife or participating certified nurse midwife when those services are covered services and when they are within the lawful scope of practice of the participating certified nurse practitioner, participating certified midwife or participating certified nurse midwife.   [PL 2021, c. 79, §4 (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, §38 (RAL).] 4.  Application.  The requirements of this section apply to all individual and 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, §28 (NEW).] SECTION HISTORY RR 1999, c. 1, §38 (RAL). PL 2003, c. 517, §B28 (AMD). PL 2021, c. 79, §4 (AMD).
24-A ME Rev Stat § 4250 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4250. Coverage for hospice care services (REALLOCATED FROM TITLE 24-A, SECTION 4249)

 §4250. Coverage for hospice care services (REALLOCATED FROM TITLE 24-A, SECTION 4249)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.   [RR 2001, c. 1, §36 (RAL).]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.   [RR 2001, c. 1, §36 (RAL).][RR 2001, c. 1, §36 (RAL).] 2.  Coverage for hospice care services.  All health maintenance organization individual and group health 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.   [RR 2001, c. 1, §36 (RAL).] 3.  Application.  The requirements of this section apply to all individual and 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, §29 (NEW).] SECTION HISTORY RR 2001, c. 1, §36 (RAL). PL 2003, c. 517, §B29 (AMD).
24-A ME Rev Stat § 4252 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4252. Offer of coverage for breast reduction surgery and symptomatic varicose vein surgery

 §4252. Offer of coverage for breast reduction surgery and symptomatic varicose vein surgery All health maintenance organization individual and 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, §4 (NEW); PL 2005, c. 128, §5 (AFF).]SECTION HISTORY PL 2005, c. 128, §4 (NEW). PL 2005, c. 128, §5 (AFF).
24-A ME Rev Stat § 4253 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4253. Enrollment for individuals or families establishing eligibility for MaineCare

 §4253. Enrollment for individuals or families establishing eligibility for MaineCare When an individual or family is eligible for MaineCare and is also eligible for health maintenance organization coverage provided by an employer through a health maintenance organization, the health maintenance organization must permit the individual or family to enroll in the health maintenance organization coverage without regard to any enrollment season restrictions.   [PL 2007, c. 448, §12 (NEW).]Revisor's Note: §4253. Coverage for hearing aids (As enacted by PL 2007, c. 452, §4 is REALLOCATED TO TITLE 24-A, SECTION 4255)SECTION HISTORY PL 2007, c. 448, §12 (NEW). PL 2007, c. 452, §4 (NEW). PL 2007, c. 695, Pt. A, §30 (RAL).
24-A ME Rev Stat § 4254 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4254. Coverage for colorectal cancer screening

 §4254. 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, §7 (AMD).] 2.  Required coverage.  All health maintenance organization individual and 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, §8 (AMD).]B. At high risk for colorectal cancer.   [PL 2019, c. 86, §9 (AMD).][PL 2019, c. 86, §§8, 9 (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, §4 (NEW); PL 2007, c. 516, §5 (AFF).] Revisor's Note: §4254. Coverage for medically necessary infant formula (As enacted by PL 2007, c. 595, §4 is REALLOCATED TO TITLE 24-A, SECTION 4256) SECTION HISTORY PL 2007, c. 516, §4 (NEW). PL 2007, c. 516, §5 (AFF). PL 2007, c. 595, §4 (NEW). PL 2007, c. 595, §5 (AFF). PL 2007, c. 695, Pt. C, §16 (RAL). PL 2019, c. 86, §§7-9 (AMD).
24-A ME Rev Stat § 4255 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4255. Coverage for hearing aids (REALLOCATED FROM TITLE 24-A, SECTION 4253)

 §4255. Coverage for hearing aids (REALLOCATED FROM TITLE 24-A, SECTION 4253)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, §30 (RAL).] 2.  Required coverage.  All health maintenance organization individual and group health insurance contracts 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, §30 (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, §5 (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, §5 (AMD).][PL 2019, c. 418, §5 (AMD).] 3.  Application of coverage.   [PL 2019, c. 418, §6 (RP).] 4.  Limits; coinsurance; deductibles.  Except as otherwise provided in this section, 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.   [PL 2007, c. 695, Pt. A, §30 (RAL).] SECTION HISTORY PL 2007, c. 695, Pt. A, §30 (RAL). PL 2015, c. 494, Pt. A, §30 (AMD). PL 2019, c. 418, §§5, 6 (AMD).
24-A ME Rev Stat § 4256 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4256. Coverage for medically necessary infant formula (REALLOCATED FROM TITLE 24-A, SECTION 4254)

 §4256. Coverage for medically necessary infant formula (REALLOCATED FROM TITLE 24-A, SECTION 4254)All individual and group health maintenance organization policies, contracts and certificates must provide coverage for amino acid-based elemental infant formula for children 2 years of age and under in accordance with this section.   [PL 2007, c. 695, Pt. C, §16 (RAL).]1.  Determination of medical necessity.  Coverage for amino acid-based elemental infant formula must be provided when a licensed physician has submitted documentation that the amino acid-based elemental infant formula is medically necessary health care as defined in section 4301‑A, subsection 10‑A, that the amino acid-based elemental infant formula is the predominant source of nutritional intake at a rate of 50% or greater and that other commercial infant formulas, including cow milk-based and soy milk-based formulas have been tried and have failed or are contraindicated. A licensed physician may be required to confirm and document ongoing medical necessity at least annually.   [PL 2007, c. 695, Pt. C, §16 (RAL).] 2.  Method of delivery.  Coverage for amino acid-based elemental infant formula must be provided without regard to the method of delivery of the formula.   [PL 2007, c. 695, Pt. C, §16 (RAL).] 3.  Required diagnosis.  Coverage for amino acid-based elemental infant formula must be provided when a licensed physician has diagnosed and through medical evaluation has documented one of the following conditions:   A. Symptomatic allergic colitis or proctitis;   [PL 2007, c. 695, Pt. C, §16 (RAL).]B. Laboratory- or biopsy-proven allergic or eosinophilic gastroenteritis;   [PL 2007, c. 695, Pt. C, §16 (RAL).]C. A history of anaphylaxis;   [PL 2007, c. 695, Pt. C, §16 (RAL).]D. Gastroesophageal reflux disease that is nonresponsive to standard medical therapies;   [PL 2007, c. 695, Pt. C, §16 (RAL).]E. Severe vomiting or diarrhea resulting in clinically significant dehydration requiring treatment by a medical provider;   [PL 2007, c. 695, Pt. C, §16 (RAL).]F. Cystic fibrosis; or   [PL 2007, c. 695, Pt. C, §16 (RAL).]G. Malabsorption of cow milk-based or soy milk-based infant formula.   [PL 2007, c. 695, Pt. C, §16 (RAL).][PL 2007, c. 695, Pt. C, §16 (RAL).] 4.  Health savings accounts.  Coverage for amino acid-based elemental infant formula under a health insurance policy, contract or certificate issued in connection with a health savings account as authorized under Title XII of the federal Medicare Prescription Drug, Improvement, and Modernization Act of 2003 may be subject to the same deductible and out-of-pocket limits that apply to overall benefits under the policy, contract or certificate.   [PL 2007, c. 695, Pt. C, §16 (RAL).] SECTION HISTORY PL 2007, c. 695, Pt. C, §16 (RAL).
24-A ME Rev Stat § 4257 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4257. Coverage for services provided by independent practice dental hygienist

 §4257. Coverage for services provided by independent practice dental hygienist 1.  Services provided by independent practice dental hygienist.  All individual and group health maintenance organization contracts that include coverage for dental services shall provide coverage for dental services performed by an independent practice dental hygienist licensed under Title 32, chapter 143 when those services are covered services under the contract and when they are within the lawful scope of practice of the independent practice dental hygienist.   [PL 2015, c. 429, §15 (AMD).] 2.  Limits; coinsurance; deductibles.  A 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.   [PL 2009, c. 307, §4 (NEW); PL 2009, c. 307, §6 (AFF).] 3.  Coordination of benefits with dental insurance.  If an enrollee eligible for coverage under this section is eligible for coverage under a dental insurance policy or contract and a health maintenance organization policy or contract, the insurer providing dental insurance is the primary payer responsible for charges under subsection 1 and the health maintenance organization providing health coverage is the secondary payer.   [PL 2009, c. 307, §4 (NEW); PL 2009, c. 307, §6 (AFF).] 4.  Application.  The requirements of this section apply 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 2009, c. 307, §4 (NEW); PL 2009, c. 307, §6 (AFF).] SECTION HISTORY PL 2009, c. 307, §4 (NEW). PL 2009, c. 307, §6 (AFF). PL 2015, c. 429, §15 (AMD).
24-A ME Rev Stat § 4258 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4258. Coverage for children's early intervention services

 §4258. Coverage for children's early intervention services 1.  Definition.  For purposes of this section, "children's early intervention services" means services provided by licensed occupational therapists, physical therapists, speech-language pathologists or clinical social workers working with children from birth to 36 months of age with an identified developmental disability or delay as described in the federal Individuals with Disabilities Education Act, Part C, 20 United States Code, Section 1411, et seq.   [PL 2009, c. 634, §4 (NEW); PL 2009, c. 634, §5 (AFF).] 2.  Required coverage.  All individual and group health maintenance organization policies, contracts and certificates must provide coverage for children's early intervention services in accordance with this subsection.   A. A referral from the child's primary care provider is required.   [PL 2009, c. 634, §4 (NEW); PL 2009, c. 634, §5 (AFF).]B. The policy, contract or certificate may limit coverage to $3,200 per year for each child not to exceed $9,600 by the child's 3rd birthday.   [PL 2009, c. 634, §4 (NEW); PL 2009, c. 634, §5 (AFF).]C. The policy, contract or certificate 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 2009, c. 634, §4 (NEW); PL 2009, c. 634, §5 (AFF).][PL 2009, c. 634, §4 (NEW); PL 2009, c. 634, §5 (AFF).] Revisor's Note: §4258. Coverage for the diagnosis and treatment of autism spectrum disorders (As enacted by PL 2009, c. 635, §4; §6 is REALLOCATED TO TITLE 24-A, SECTION 4259) SECTION HISTORY PL 2009, c. 634, §4 (NEW). PL 2009, c. 634, §5 (AFF). PL 2009, c. 635, §4 (NEW). PL 2009, c. 635, §6 (AFF). PL 2011, c. 420, Pt. A, §27 (RAL).
24-A ME Rev Stat § 4260 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS|24-A §4260. Dental benefit waiting period

 §4260. Dental benefit waiting period 1.  Enrollee defined.  For the purposes of this section, unless the context otherwise indicates, "enrollee" means a person who is covered under an individual or group contract provided by a health maintenance organization.   [PL 2019, c. 605, §7 (NEW).] 2.  No waiting period for enrollee under 19 years of age.  A health maintenance organization that issues individual or group dental insurance or individual or group contracts that include coverage for dental services may not impose a waiting period, as defined in section 2848, subsection 5, for any dental or oral health service or treatment, except for orthodontic treatment, for an enrollee if the enrollee is under 19 years of age.   [PL 2019, c. 605, §7 (NEW).] SECTION HISTORY PL 2019, c. 605, §7 (NEW).
24-A ME Rev Stat § 4346 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-B: MAINE CONSUMER CHOICE HEALTH PLAN|24-A §4346. Maine Consumer Choice Health Plan (REPEALED)

 §4346. Maine Consumer Choice Health Plan (REPEALED)SECTION HISTORY PL 2001, c. 708, §3 (NEW). PL 2001, c. 714, §II2 (AMD). PL 2007, c. 395, §28 (RP).
24-A ME Rev Stat § 4348-A (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-C: HEALTH PLANS THAT PROVIDE PRESCRIPTION DRUG BENEFITS|24-A §4348-A. Use of untrue, deceptive or misleading advertisement prohibited

 §4348-A. Use of untrue, deceptive or misleading advertisement prohibited A pharmacy benefits manager or representative of a pharmacy benefits manager may not cause or knowingly permit the use of any advertisement, promotion, solicitation, representation, proposal or offer that is untrue, deceptive or misleading.   [PL 2021, c. 371, §1 (NEW).]SECTION HISTORY PL 2021, c. 371, §1 (NEW).
24-A ME Rev Stat § 4350-A (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-C: HEALTH PLANS THAT PROVIDE PRESCRIPTION DRUG BENEFITS|24-A §4350-A. Responsibility to use compensation for benefit of covered persons

 §4350-A. Responsibility to use compensation for benefit of covered persons 1.  Compensation used to reduce point-of-sale costs, improve benefits or lower premiums.  All compensation remitted by or on behalf of a pharmaceutical manufacturer, developer or labeler, directly or indirectly, to a carrier, or to a pharmacy benefits manager under contract with a carrier, related to its prescription drug benefits must be:   A. Remitted directly to the covered person at the point of sale to reduce the out-of-pocket cost to the covered person associated with a particular prescription drug; or   [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]B. Remitted to, and retained by, the carrier. Compensation remitted to the carrier must be applied by the carrier in its plan design and in future plan years to offset the premium for covered persons.   [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).][PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] 2.  Compliance.  Beginning March 1, 2021 and annually thereafter, a carrier shall file with the superintendent a report in the manner and form determined by the superintendent demonstrating how the carrier has complied with this section.   [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] SECTION HISTORY PL 2019, c. 469, §8 (NEW). PL 2019, c. 469, §9 (AFF).
24-A ME Rev Stat § 4350-B (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-C: HEALTH PLANS THAT PROVIDE PRESCRIPTION DRUG BENEFITS|24-A §4350-B. Prescription drug formularies; pharmacy and therapeutics committee

 §4350-B. Prescription drug formularies; pharmacy and therapeutics committee 1.  Pharmacy and therapeutics committee; use of formulary.  A carrier, or a pharmacy benefits manager under contract with a carrier, shall establish a pharmacy and therapeutics committee. A carrier shall require its pharmacy and therapeutics committee or the pharmacy and therapeutics committee of the carrier's pharmacy benefits manager to use one or more formularies.   [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] 2.  Pharmacy and therapeutics committee; no conflict of interest for members.  A carrier, or a pharmacy benefits manager under contract with a carrier, may not allow a person with a conflict of interest, as described in paragraph A or B, to be a member of its pharmacy and therapeutics committee. A person may not serve as a member of a pharmacy and therapeutics committee if the person:   A. Is employed, or was employed within the preceding year, by a pharmaceutical manufacturer, developer, labeler, wholesaler or distributor; or   [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]B. Receives compensation, or received compensation within the preceding year, from a pharmaceutical manufacturer, developer, labeler, wholesaler or distributor.   [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).][PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] 3.  Compensation prohibited.  A carrier, or a pharmacy benefits manager under contract with a carrier, shall prohibit its pharmacy and therapeutics committee or any member of the committee from receiving any compensation from a pharmaceutical manufacturer, developer, labeler, wholesaler or distributor.   [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] SECTION HISTORY PL 2019, c. 469, §8 (NEW). PL 2019, c. 469, §9 (AFF).