reglab/housing_qa huggingface dataset:
24-A ME Rev Stat § 2762 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2762. Coverage for hearing aids

 §2762. Coverage for hearing aids 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. 452, §2 (NEW).] 2.  Required coverage.  All individual health policies and contracts must provide coverage for the purchase of a hearing aid for each hearing-impaired ear for an individual covered under the policy or contract 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, §28 (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, §1 (AMD).]C. The policy or contract may limit coverage to $3,000 per hearing aid for each hearing-impaired ear every 36 months.   [PL 2019, c. 418, §1 (AMD).][PL 2019, c. 418, §1 (AMD).] 3.  Application of coverage.   [PL 2019, c. 418, §2 (RP).] 4.  Limits; coinsurance; deductibles.  Except as otherwise provided in this section, any policy or 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. 452, §2 (NEW).] SECTION HISTORY PL 2007, c. 452, §2 (NEW). PL 2015, c. 494, Pt. A, §28 (AMD). PL 2019, c. 418, §§1, 2 (AMD).
24-A ME Rev Stat § 2763 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2763. Coverage for colorectal cancer screening

 §2763. 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, §1 (AMD).] 2.  Required coverage.  All individual health insurance policies and contracts 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, §2 (AMD).]B. At high risk for colorectal cancer.   [PL 2019, c. 86, §3 (AMD).][PL 2019, c. 86, §§2, 3 (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, §2 (NEW); PL 2007, c. 516, §5 (AFF).] Revisor's Note: §2763. Coverage for medically necessary infant formula (As enacted by PL 2007, c. 595, §2 is REALLOCATED TO TITLE 24-A, SECTION 2764)SECTION HISTORY RR 2007, c. 2, §11 (RAL). PL 2007, c. 516, §2 (NEW). PL 2007, c. 516, §5 (AFF). PL 2007, c. 595, §2 (NEW). PL 2007, c. 595, §5 (AFF). PL 2019, c. 86, §§1-3 (AMD).
24-A ME Rev Stat § 2764 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2764. Coverage for medically necessary infant formula (REALLOCATED FROM TITLE 24-A, SECTION 2763)

 §2764. Coverage for medically necessary infant formula (REALLOCATED FROM TITLE 24-A, SECTION 2763)All individual health insurance 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.   [RR 2007, c. 2, §11 (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.   [RR 2007, c. 2, §11 (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.   [RR 2007, c. 2, §11 (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;   [RR 2007, c. 2, §11 (RAL).]B. Laboratory- or biopsy-proven allergic or eosinophilic gastroenteritis;   [RR 2007, c. 2, §11 (RAL).]C. A history of anaphylaxis;   [RR 2007, c. 2, §11 (RAL).]D. Gastroesophageal reflux disease that is nonresponsive to standard medical therapies;   [RR 2007, c. 2, §11 (RAL).]E. Severe vomiting or diarrhea resulting in clinically significant dehydration requiring treatment by a medical provider;   [RR 2007, c. 2, §11 (RAL).]F. Cystic fibrosis; or   [RR 2007, c. 2, §11 (RAL).]G. Malabsorption of cow milk-based or soy milk-based infant formula.   [RR 2007, c. 2, §11 (RAL).][RR 2007, c. 2, §11 (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.   [RR 2007, c. 2, §11 (RAL).] SECTION HISTORY RR 2007, c. 2, §11 (RAL).
24-A ME Rev Stat § 2765 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2765. Coverage for services provided by independent practice dental hygienist

 §2765. Coverage for services provided by independent practice dental hygienist 1.  Services provided by independent practice dental hygienist.  An insurer that issues individual dental insurance or health insurance that includes 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, §11 (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, §2 (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 insurance policy or contract, the insurer providing dental insurance is the primary payer responsible for charges under subsection 1 and the insurer providing individual health insurance is the secondary payer.   [PL 2009, c. 307, §2 (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, §2 (NEW); PL 2009, c. 307, §6 (AFF).] SECTION HISTORY PL 2009, c. 307, §2 (NEW). PL 2009, c. 307, §6 (AFF). PL 2015, c. 429, §11 (AMD).
24-A ME Rev Stat § 2765-A (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2765-A. Coverage for services provided by dental therapist

 §2765-A. Coverage for services provided by dental therapist 1.  Services provided by dental therapist.  An insurer that issues individual dental insurance or health insurance that includes coverage for dental services shall provide coverage for dental services performed by a dental therapist 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 dental therapist.   [PL 2019, c. 388, §3 (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 2013, c. 575, §5 (NEW); PL 2013, c. 575, §10 (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 insurance policy or contract, the insurer providing dental insurance is the primary payer responsible for charges under subsection 1 and the insurer providing individual health insurance is the secondary payer.   [PL 2013, c. 575, §5 (NEW); PL 2013, c. 575, §10 (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 2013, c. 575, §5 (NEW); PL 2013, c. 575, §10 (AFF).] SECTION HISTORY PL 2013, c. 575, §5 (NEW). PL 2013, c. 575, §10 (AFF). PL 2015, c. 429, §12 (AMD). PL 2019, c. 388, §3 (AMD).
24-A ME Rev Stat § 2766 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2766. Enrollment of dependent children in dental coverage

 §2766. Enrollment of dependent children in dental coverage 1.  Offer of dependent coverage; enrollment period.  All individual dental insurance policies and contracts that offer dependent coverage must offer the opportunity to enroll a dependent child in the dental insurance coverage at appropriate rates during the following periods:   A. From birth to 30 days of age; and   [PL 2009, c. 578, §2 (NEW); PL 2009, c. 578, §4 (AFF).]B. Any open or annual enrollment period.   [PL 2009, c. 578, §2 (NEW); PL 2009, c. 578, §4 (AFF).]Revisor's Note: §2766. Coverage for children's early intervention services (As enacted by PL 2009, c. 634, §2; §5 is REALLOCATED TO TITLE 24-A, SECTION 2767)Revisor's Note: §2766. Coverage for the diagnosis and treatment of autism spectrum disorders (As enacted by PL 2009, c. 635, §2; §6 is REALLOCATED TO TITLE 24-A, SECTION 2768) [PL 2009, c. 578, §2 (NEW); PL 2009, c. 578, §4 (AFF).] SECTION HISTORY PL 2009, c. 578, §2 (NEW). PL 2009, c. 578, §4 (AFF). PL 2009, c. 634, §2 (NEW). PL 2009, c. 634, §5 (AFF). PL 2009, c. 635, §2 (NEW). PL 2009, c. 635, §6 (AFF). PL 2011, c. 420, Pt. A, §23 (RAL). PL 2011, c. 420, Pt. A, §24 (RAL).
24-A ME Rev Stat § 2766-A (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2766-A. Dental benefit waiting period

 §2766-A. 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 policy or contract provided by an insurer.   [PL 2019, c. 605, §5 (NEW).] 2.  No waiting period for enrollee under 19 years of age.  An insurer that issues individual dental insurance or health insurance that includes 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, §5 (NEW).] SECTION HISTORY PL 2019, c. 605, §5 (NEW).
24-A ME Rev Stat § 2767 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2767. Coverage for children's early intervention services (REALLOCATED FROM TITLE 24-A, SECTION 2766)

 §2767. Coverage for children's early intervention services (REALLOCATED FROM TITLE 24-A, SECTION 2766)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 2011, c. 420, Pt. A, §23 (RAL).] 2.  Required coverage.  All individual health insurance 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 2011, c. 420, Pt. A, §23 (RAL).]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 2011, c. 420, Pt. A, §23 (RAL).]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 2011, c. 420, Pt. A, §23 (RAL).][PL 2011, c. 420, Pt. A, §23 (RAL).] SECTION HISTORY PL 2011, c. 420, Pt. A, §23 (RAL).
24-A ME Rev Stat § 2769 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2769. Prescription synchronization

 §2769. Prescription synchronization 1.  Synchronization.  If a health plan provides coverage for prescription drugs, a carrier:   A. Shall permit and apply a prorated daily cost-sharing rate to a prescription that is dispensed by a pharmacist in the carrier's network for less than a 30-day supply if the prescriber or pharmacist determines that filling or refilling the prescription for less than a 30-day supply is in the best interest of the patient and the patient requests or agrees to less than a 30-day supply in order to synchronize the refilling of that prescription with the patient's other prescriptions;   [PL 2015, c. 93, §1 (NEW); PL 2015, c. 93, §2 (AFF).]B. May not deny coverage for the dispensing of a medication prescribed for the treatment of a chronic illness that is made in accordance with a plan developed by the carrier, the insured, the prescriber and a pharmacist to synchronize the filling or refilling of multiple prescriptions for the insured. The carrier shall allow a pharmacy to override any denial codes indicating that a prescription is being refilled too soon in order to synchronize the patient's prescriptions; and   [PL 2015, c. 93, §1 (NEW); PL 2015, c. 93, §2 (AFF).]C. May not use payment structures incorporating prorated dispensing fees. Dispensing fees for partially filled or refilled prescriptions must be paid in full for each prescription dispensed, regardless of any prorated copay for the insured or fee paid for alignment services.   [PL 2015, c. 93, §1 (NEW); PL 2015, c. 93, §2 (AFF).][PL 2015, c. 93, §1 (NEW); PL 2015, c. 93, §2 (AFF).] 2.  Application; exclusion.  The requirements of this section do not apply to a prescription for:   A. Solid oral doses of antibiotics; or   [PL 2015, c. 93, §1 (NEW); PL 2015, c. 93, §2 (AFF).]B. Solid oral doses that are dispensed in their original container as indicated in the federal Food and Drug Administration Prescribing Information or are customarily dispensed in their original packaging to assist a patient with compliance.   [PL 2015, c. 93, §1 (NEW); PL 2015, c. 93, §2 (AFF).][PL 2015, c. 93, §1 (NEW); PL 2015, c. 93, §2 (AFF).] SECTION HISTORY PL 2015, c. 93, §1 (NEW). PL 2015, c. 93, §2 (AFF).
24-A ME Rev Stat § 2770 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2770. Absolute discretion clauses

 §2770. Absolute discretion clauses An individual health insurance policy, contract or certificate, including, but not limited to, a disability income insurance policy, contract or certificate, may not contain a provision purporting to reserve sole or absolute discretion to the insurer to interpret the terms of the contract, to provide standards of interpretation or review, to determine eligibility for benefits, to determine the amount of benefits or to resolve factual disputes. An insurer may not enforce a provision in a policy, contract or certificate that was offered, executed, delivered or issued for delivery in this State and has been continued or renewed by an individual policy holder in this State that purports to reserve sole or absolute discretion to the insurer to interpret the terms of the contract, to provide standards of interpretation or review, to determine eligibility for benefits, to determine the amount of benefits or to resolve factual disputes.   [PL 2019, c. 179, §1 (NEW).]SECTION HISTORY PL 2019, c. 179, §1 (NEW).
24-A ME Rev Stat § 2772 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 34: LICENSURE OF MEDICAL UTILIZATION REVIEW ENTITIES|24-A §2772. Minimum standards

 §2772. Minimum standards A utilization review program of the applicant must meet the following minimum standards.   [PL 1989, c. 556, Pt. C, §2 (NEW).]1.  Notification of adverse decisions.  Notification of an adverse decision by the utilization review agent must be provided to the insured or other party designated by the insured within a time period to be determined by the superintendent through rulemaking and must include the name of the utilization review agent who made the decision.   [PL 1993, c. 602, §5 (AMD).] 2.  Reconsideration of determinations.  All licensees shall maintain a procedure by which insureds, patients or providers may seek reconsideration of determinations of the licensee.   [PL 1989, c. 556, Pt. C, §2 (NEW).] 3.  Accessibility of representatives.  A representative of the licensee must be accessible by telephone to insureds, patients or providers and the superintendent may adopt standards of accessibility by rule.   [RR 2015, c. 1, §27 (COR).] 3-A.  Medical utilization review criteria.  The licensee must have written medical utilization review criteria to be employed in the review process. The criteria must be available for review as a part of any review conducted pursuant to section 2774, subsection 1 and a copy of the criteria must be provided to the bureau upon request.   [PL 1995, c. 332, Pt. M, §7 (NEW).] 4.  Information materials; confidentiality.  A copy of the materials designed to inform applicable patients of the requirements of the utilization plan and the responsibilities and rights of patients under the plan and an acknowledgment that all applicable state and federal laws to protect the confidentiality of individual medical records are followed must be filed with the bureau.   [PL 1989, c. 556, Pt. C, §2 (NEW).] 5.  Penalty for noncompliance with utilization review programs.  A medical utilization review program may not recommend or implement a penalty of more than $500 for failure to provide notification. This subsection does not limit the right of insurers to deny a claim when appropriate prospective or retroactive review concludes that services or treatment rendered were not medically necessary.   [PL 1995, c. 332, Pt. M, §8 (AMD).] 6.  Prohibited activities.  A medical utilization review entity shall ensure that an employee does not perform medical utilization review services involving a health care provider or facility in which that employee has a financial interest.   [RR 1993, c. 2, §15 (RNU).] SECTION HISTORY PL 1989, c. 556, §C2 (NEW). RR 1993, c. 2, §15 (COR). PL 1993, c. 602, §§5,6 (AMD). PL 1993, c. 645, §B4 (AMD). PL 1995, c. 332, §§M7,8 (AMD). RR 2015, c. 1, §27 (COR).
24-A ME Rev Stat § 2773 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 34: LICENSURE OF MEDICAL UTILIZATION REVIEW ENTITIES|24-A §2773. Utilization review services

 §2773. Utilization review services As used in this chapter, unless the context indicates otherwise, "utilization review services" or "medical utilization review services" means a program or process by which a person, partnership or corporation, on behalf of an insurer, nonprofit service organization, 3rd-party administrator, health maintenance organization, preferred provider organization or employer that is a payor for or that arranges for payment of medical services, seeks to review the utilization, appropriateness or quality of medical services provided to a person whose medical services are paid for, partially or entirely, by that insurer, nonprofit service organization, 3rd-party administrator, health maintenance organization, preferred provider organization or employer. The terms include these programs or processes whether they apply prospectively or retrospectively to medical services. Utilization review services include, but are not limited to, the following:   [PL 1993, c. 602, §7 (AMD).]1.  Second opinion programs.  Second opinion programs;   [PL 1989, c. 556, Pt. C, §2 (NEW).] 2.  Prehospital admission certification.  Prehospital admission certification;   [PL 1989, c. 556, Pt. C, §2 (NEW).] 3.  Preinpatient service eligibility certification.  Preinpatient service eligibility certification; and   [PL 1989, c. 556, Pt. C, §2 (NEW).] 4.  Concurrent hospital review.  Concurrent hospital review to determine appropriate length of stay.   [PL 1989, c. 556, Pt. C, §2 (NEW).] SECTION HISTORY PL 1989, c. 556, §C2 (NEW). PL 1993, c. 602, §7 (AMD).