reglab/housing_qa huggingface dataset:
24-A ME Rev Stat § 2745-G (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2745-G. Coverage for prostate cancer screening (REALLOCATED FROM TITLE 24-A, SECTION 2745-E)

 §2745-G. Coverage for prostate cancer screening (REALLOCATED FROM TITLE 24-A, SECTION 2745-E)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, §51 (RAL).]B. A prostate-specific antigen test.   [RR 1997, c. 2, §51 (RAL).][RR 1997, c. 2, §51 (RAL).] 2.  Required coverage for prostate cancer screening.  All individual 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, §51 (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, §51 (RAL).] SECTION HISTORY RR 1997, c. 2, §51 (RAL).
24-A ME Rev Stat § 2746 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2746. Optional coverage for chiropractic services (REALLOCATED TO TITLE 24-A, SECTION 2840)

 §2746. Optional coverage for chiropractic services (REALLOCATED TO TITLE 24-A, SECTION 2840)SECTION HISTORY PL 1979, c. 335, §2 (NEW). PL 1979, c. 663, §145 (RAL).
24-A ME Rev Stat § 2747 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2747. Review and arbitration

 §2747. Review and arbitration 1.  Any insurer denying medical expense reimbursement benefits on any of the grounds specified in subsection 2 for a claim filed pursuant to a policy issued under this chapter, other than a policy that is subject to section 4312, shall provide the policy or certificate holder with an opportunity to have the denial reviewed by the insurer and to arbitrate the denial if not satisfied after review. The right to review and arbitrate must be prominently set forth in any written notice sent to the policy or certificate holder denying the claim. The arbitration is nonbinding and must be carried out in accordance with procedures established by the insurer.   [PL 2003, c. 428, Pt. H, §4 (AMD).] 2.  The procedure specified in subsection 1 shall apply to the denial of any medical expense reimbursement benefits based upon:   A. A health condition existing prior to the effective coverage of the policy or certificate; or   [PL 1981, c. 205, §2 (NEW).]B. The lack of medical necessity.   [PL 1981, c. 205, §2 (NEW).][PL 1981, c. 205, §2 (NEW).] SECTION HISTORY PL 1981, c. 205, §2 (NEW). PL 2003, c. 428, §H4 (AMD).
24-A ME Rev Stat § 2748 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2748. Coverage for chiropractic services

 §2748. Coverage for chiropractic services 1.  Therapeutic, adjustive and manipulative services.  Notwithstanding any other provisions of this chapter, every insurer which issues 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, §3 (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 or the limitations, coinsurance, deductibles or exclusions imposed on other providers.   [PL 1985, c. 516, §3 (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, §2 (AMD).] 4.  Application; expiration.   [PL 1989, c. 141, §4 (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, §1 (NEW); PL 2015, c. 111, §4 (AFF).] SECTION HISTORY PL 1985, c. 516, §3 (NEW). PL 1989, c. 141, §§3,4 (AMD). PL 1993, c. 669, §2 (AMD). PL 2015, c. 111, §1 (AMD). PL 2015, c. 111, §4 (AFF).
24-A ME Rev Stat § 2749 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2749. Utilization review data

 §2749. Utilization review data 1.  Report required.  On or before April 1st of each year, any insurer which issues 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 procedure prior to the delivery of contemplated hospitalization, inpatient or outpatient health care or medical services which are prescribed or ordered by a duly licensed physician shall file a report on the results of that evaluation for the preceding year with the superintendent which shall contain the following:   A. The number and type of evaluations performed.   (1) For the purposes of this section, the term "type of evaluations" means the following preutilization review categories: Presurgical inpatient days; setting of medical service, such as inpatient or outpatient services; and the number of days of service;   [PL 1987, c. 168, §4 (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 1987, c. 168, §4 (NEW).]C. The number and result of any appeals by patients or their physicians as a result of initial review decisions to reduce benefits for services as determined through prospective evaluations; and   [PL 1987, c. 168, §4 (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 proximately 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 1987, c. 168, §4 (NEW).][PL 1987, c. 168, §4 (NEW).] 2.  Maine residents.  This section is applicable to evaluations, appeals and complaints relating to Maine residents only.   [PL 1987, c. 168, §4 (NEW).] 3.  Confidentiality.  Any information provided pursuant to this section shall not identify the names of patients.   [PL 1987, c. 168, §4 (NEW).] SECTION HISTORY PL 1987, c. 168, §4 (NEW).
24-A ME Rev Stat § 2749-A (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2749-A. Penalty for failure to notify of hospitalization

 §2749-A. Penalty for failure to notify of hospitalization An insurance policy may not include a provision permitting the insurer to impose a penalty for the failure of any person to notify the insurer of an insured person's hospitalization for emergency treatment. For purposes of this section, "emergency treatment" has the same meaning as defined in Title 22, section 1829.   [PL 1989, c. 767, §3 (NEW).]This section applies to policies and certificates executed, delivered, issued for delivery, continued or renewed in this State after the effective date of this section. For purposes of this section, all policies are deemed to be renewed no later than the next yearly anniversary of the contract date.   [PL 1989, c. 767, §3 (NEW).]SECTION HISTORY PL 1989, c. 767, §3 (NEW).
24-A ME Rev Stat § 2749-B (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2749-B. Penalty for noncompliance with utilization review programs

 §2749-B. Penalty for noncompliance with utilization review programs A health insurance policy issued or renewed in this State after April 8, 1994 may not contain a provision that permits, upon retroactive review and confirmation of medical necessity, the imposition of a penalty of more than $500 for failure to provide notification under a utilization review program. This section 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, §4 (AMD).]SECTION HISTORY PL 1993, c. 645, §B3 (NEW). PL 1995, c. 332, §M4 (AMD).
24-A ME Rev Stat § 2750 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2750. Acquired Immune Deficiency Syndrome

 §2750. Acquired Immune Deficiency Syndrome No individual or family health insurance policy delivered or issued for delivery in this State may 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 sickness and diseases are treated the same. This section shall not apply to a policy providing benefits for specific diseases or accidental injury only.   [PL 1989, c. 176, §5 (NEW).]SECTION HISTORY PL 1989, c. 176, §5 (NEW).
24-A ME Rev Stat § 2751 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2751. Assessment of mandated benefits proposals; studies of mandated benefits issues (REPEALED)

 §2751. Assessment of mandated benefits proposals; studies of mandated benefits issues (REPEALED)SECTION HISTORY PL 1989, c. 556, §A5 (NEW). PL 1989, c. 875, §§I4,5 (AMD). PL 1991, c. 333, §2 (AMD). PL 1991, c. 701, §7 (RP).
24-A ME Rev Stat § 2753 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2753. Standardized claim forms

 §2753. Standardized claim forms All insurers providing individual medical expense insurance on an expense-incurred basis providing payment or reimbursement for diagnosis or treatment of a condition or a complaint by a health care practitioner must accept the current standardized claim form for professional services approved by the Federal Government and submitted electronically. All insurers providing individual medical expense insurance on an expense-incurred basis providing payment or reimbursement for diagnosis or treatment of a condition or a complaint by a licensed hospital must accept the current standardized claim form for professional or facility services, as applicable, approved by the Federal Government and submitted electronically. An insurer may not be required to accept a claim submitted on a form other than the applicable form specified in this section and may not be required to accept a claim that is not submitted electronically, except from a health care practitioner who is exempt pursuant to Title 24, section 2985. All services provided by a health care practitioner in an office setting must be submitted on the standardized federal form used by noninstitutional providers and suppliers. Services in a nonoffice setting may be billed as negotiated between the insurer and health care practitioner. For purposes of this section, "office setting" means a location where the health care practitioner routinely provides health examinations, diagnosis and treatment of illness or injury on an ambulatory basis whether or not the office is physically located within a facility.   [PL 2005, c. 97, §2 (AMD).]SECTION HISTORY PL 1993, c. 477, §D10 (NEW). PL 1993, c. 477, §F1 (AFF). PL 2003, c. 218, §6 (AMD). PL 2003, c. 469, §D6 (AMD). PL 2003, c. 469, §D9 (AFF). PL 2005, c. 97, §2 (AMD).
24-A ME Rev Stat § 2754 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2754. Coverage for diabetes supplies

 §2754. Coverage for diabetes supplies All individual health 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 the medically appropriate and necessary equipment, limited to insulin, oral hypoglycemic agents, monitors, test strips, syringes and lancets, and the out-patient self-management training and educational services used to treat diabetes, if:   [PL 1995, c. 592, §2 (NEW).]1.  Certification of medical necessity.  The insured's treating physician or a physician who specializes in the treatment of diabetes certifies that the equipment and services are necessary; and   [PL 1995, c. 592, §2 (NEW).] 2.  Provision of medical services.  The diabetes out-patient self-management training and educational services are provided through ambulatory diabetes education facilities authorized by the State's Diabetes Control Project within the Bureau of Health.   [PL 1995, c. 592, §2 (NEW).] SECTION HISTORY PL 1995, c. 592, §2 (NEW).
24-A ME Rev Stat § 2755 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2755. Assignment of benefits

 §2755. Assignment of benefits All policies providing benefits for medical or dental care on an expense-incurred basis must contain a provision permitting the insured to assign benefits for such care to the provider of the care. An assignment of benefits under this section does not affect or limit the payment of benefits otherwise payable under the policy.   [PL 1999, c. 21, §2 (AMD).]SECTION HISTORY PL 1997, c. 604, §E2 (NEW). PL 1999, c. 21, §2 (AMD).
24-A ME Rev Stat § 2757 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2757. Coverage for services of certified nurse practitioners; certified midwives; certified nurse midwives (REALLOCATED FROM TITLE 24-A, SECTION 2756)

 §2757. Coverage for services of certified nurse practitioners; certified midwives; certified nurse midwives (REALLOCATED FROM TITLE 24-A, SECTION 2756)1.  Required coverage for services upon referral of primary care provider.  An insurer that issues individual health insurance policies and contracts shall provide coverage under those contracts for services performed by a certified nurse practitioner, certified midwife or certified nurse midwife to a patient who is referred to the certified nurse practitioner, certified midwife or certified nurse midwife by a primary care provider when those services are within the lawful scope of practice of the certified nurse practitioner, certified midwife or certified nurse midwife.   [PL 2021, c. 79, §2 (AMD).] 2.  Required coverage for self-referred services.  With respect to individual health insurance policies and contracts that do not require the selection of a primary care provider, an insurer shall provide coverage under those contracts for services performed by a certified nurse practitioner, certified midwife or certified nurse midwife when those services are covered services and when they are within the lawful scope of practice of the certified nurse practitioner, certified midwife or certified nurse midwife.   [PL 2021, c. 79, §2 (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, §32 (RAL).] SECTION HISTORY RR 1999, c. 1, §32 (RAL). PL 2021, c. 79, §2 (AMD).
24-A ME Rev Stat § 2758 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2758. Coverage for services provided by registered nurse first assistants (REALLOCATED FROM TITLE 24-A, SECTION 2756)

 §2758. Coverage for services provided by registered nurse first assistants (REALLOCATED FROM TITLE 24-A, SECTION 2756)1.  Definitions.  As used in this section, unless the context otherwise indicates, the following terms have the following meanings.   A. "Perioperative nursing" means a practice of nursing in which the nurse provides preoperative, intraoperative and postoperative nursing care to surgical patients.   [RR 1999, c. 1, §33 (RAL).]B. "Recognized program" means a program that addresses all content of the core curriculum for registered nurse first assistants as established by the Association of Operating Room Nurses or its successor organization.   [RR 1999, c. 1, §33 (RAL).]C. "Registered nurse first assistant," or "RNFA," means a person who:   (1) Is licensed as a registered nurse under Title 32, chapter 31;   (2) Is experienced in perioperative nursing; and   (3) Has successfully completed a recognized program.   [RR 1999, c. 1, §33 (RAL).][RR 1999, c. 1, §33 (RAL).] 2.  Institutional powers.  Each health care institution, as defined in Title 22, chapter 405, may establish specific procedures for the appointment and reappointment of registered nurse first assistants and for granting, renewing and revising their clinical privileges.   [RR 1999, c. 1, §33 (RAL).] 3.  Required coverage for services.  Notwithstanding any other provisions of this chapter, an insurer that issues individual health insurance policies and contracts that provide coverage for surgical first assisting benefits or services shall provide coverage and payment under those contracts to a registered nurse first assistant who performs services that are within the scope of a registered nurse first assistant's qualifications. The provisions of this subsection apply only if reimbursement for an assisting physician would be covered and a registered nurse first assistant who performed those services is used as a substitute. This section does not apply to policies or contracts that cover only specified diseases.   [RR 1999, c. 1, §33 (RAL).] 4.  Limits; coinsurance; deductibles.  Any 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.   [RR 1999, c. 1, §33 (RAL).] SECTION HISTORY RR 1999, c. 1, §33 (RAL).
24-A ME Rev Stat § 2759 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2759. Coverage for hospice care services

 §2759. Coverage for hospice care services 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.   [PL 2001, c. 358, Pt. LL, §2 (NEW); PL 2001, c. 358, Pt. LL, §5 (AFF).]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.   [PL 2001, c. 358, Pt. LL, §2 (NEW); PL 2001, c. 358, Pt. LL, §5 (AFF).][PL 2001, c. 358, Pt. LL, §2 (NEW); PL 2001, c. 358, Pt. LL, §5 (AFF).] 2.  Coverage for hospice care services.  All individual health policies 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.   [PL 2001, c. 358, Pt. LL, §2 (NEW); PL 2001, c. 358, Pt. LL, §5 (AFF).] Revisor's Note: §2759. Coverage for general anesthesia for dentistry (As enacted by PL 2001, c. 423, §2 and affected by § 5 is REALLOCATED TO TITLE 24-A, SECTION 2760)SECTION HISTORY RR 2001, c. 1, §31 (RAL). PL 2001, c. 358, §LL2 (NEW). PL 2001, c. 358, §LL5 (AFF). PL 2001, c. 423, §2 (NEW). PL 2001, c. 423, §5 (AFF).
24-A ME Rev Stat § 2761 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2761. Offer of coverage for breast reduction surgery and symptomatic varicose vein surgery

 §2761. Offer of coverage for breast reduction surgery and symptomatic varicose vein surgery All individual 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, §2 (NEW); PL 2005, c. 128, §5 (AFF).]SECTION HISTORY PL 2005, c. 128, §2 (NEW). PL 2005, c. 128, §5 (AFF).