reglab/housing_qa huggingface dataset:
24-A ME Rev Stat § 4317-B (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 1: HEALTH PLAN REQUIREMENTS|24-A §4317-B. Orally administered cancer therapy

 §4317-B. Orally administered cancer therapy 1.  Coverage.  A carrier that provides coverage for cancer chemotherapy treatment shall provide coverage for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells that is equivalent to the coverage provided for intravenously administered or injected anticancer medications. An increase in patient cost sharing for anticancer medications may not be used to achieve compliance with this section.   [PL 2013, c. 449, §1 (NEW); PL 2013, c. 449, §2 (AFF).] 2.  Construction.  This section may not be construed to prohibit or limit a carrier's ability to establish a prescription drug formulary or to require a carrier to cover an orally administered anticancer medication on the sole basis that it is an alternative to an intravenously administered or injected anticancer medication.   [PL 2013, c. 449, §1 (NEW); PL 2013, c. 449, §2 (AFF).] SECTION HISTORY PL 2013, c. 449, §1 (NEW). PL 2013, c. 449, §2 (AFF).
24-A ME Rev Stat § 4317-C (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 1: HEALTH PLAN REQUIREMENTS|24-A §4317-C. Coverage for prescription insulin drugs; limit on out-of-pocket costs

 §4317-C. Coverage for prescription insulin drugs; limit on out-of-pocket costs 1.  Definition.  As used in this section, "insulin" has the same meaning as in Title 32, section 13786-D, subsection 1, paragraph A.   [PL 2019, c. 666, Pt. A, §1 (NEW).] 2.  Limit on out-of-pocket costs.  A carrier that provides coverage for prescription insulin drugs may not impose any deductible, copayment, coinsurance or other cost-sharing requirement on an enrollee for that coverage that results in out-of-pocket costs to the enrollee that exceed $35 per prescription for a 30-day supply of covered prescription insulin drugs, regardless of the amount of insulin needed to fill the enrollee's insulin prescriptions.   [PL 2019, c. 666, Pt. A, §1 (NEW).] 3.  Other cost sharing.  This section does not prevent a carrier from setting an enrollee's cost-sharing requirement for one or more insulin drugs at an amount lower than the maximum amount specified in this section.   [PL 2019, c. 666, Pt. A, §1 (NEW).] 4.  Rules.  The superintendent may adopt rules to implement and administer this section to align with applicable federal requirements. Rules adopted pursuant to this section are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A.   [PL 2019, c. 666, Pt. A, §1 (NEW).] SECTION HISTORY PL 2019, c. 666, Pt. A, §1 (NEW).
24-A ME Rev Stat § 4318 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 1: HEALTH PLAN REQUIREMENTS|24-A §4318. Prohibition against maximum aggregate benefit provisions (REALLOCATED FROM TITLE 24-A, SECTION 4317) (REPEALED)

 §4318. Prohibition against maximum aggregate benefit provisions (REALLOCATED FROM TITLE 24-A, SECTION 4317)(REPEALED)SECTION HISTORY RR 2009, c. 2, §70 (RAL). PL 2011, c. 364, §33 (AMD). PL 2019, c. 5, Pt. A, §22 (RP).
24-A ME Rev Stat § 4318-B (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 1: HEALTH PLAN REQUIREMENTS|24-A §4318-B. Access to lower-priced services (WHOLE SECTION TEXT EFFECTIVE UNTIL 1/1/24) (WHOLE SECTION TEXT REPEALED 1/1/24)

 §4318-B. Access to lower-priced services (CONTAINS TEXT WITH VARYING EFFECTIVE DATES)(WHOLE SECTION TEXT EFFECTIVE UNTIL 1/1/24)(WHOLE SECTION TEXT REPEALED 1/1/24)1.  Services from out-of-network provider; lower prices.  Beginning January 1, 2019, if an enrollee covered under a health plan other than a health maintenance organization plan elects to obtain a covered comparable health care service as defined in section 4318‑A, subsection 1, paragraph A from an out-of-network provider at a price that is the same or less than the statewide average for the same covered health care service based on data reported on the publicly accessible health care costs website of the Maine Health Data Organization, the carrier shall allow the enrollee to obtain the service from the out-of-network provider at the provider's charge and, upon request by the enrollee, shall apply the payments made by the enrollee for that comparable health care service toward the enrollee's deductible and out-of-pocket maximum as specified in the enrollee's health plan as if the health care services had been provided by an in-network provider. A carrier may use the average price paid to a network provider for the covered comparable health care service under the enrollee's health plan in lieu of the statewide average price on the Maine Health Data Organization's publicly accessible website as long as the carrier uses a reasonable method to calculate the average price paid and the information is available to enrollees through a website accessible to the enrollee and a toll-free telephone number that provide, at a minimum, information relating to comparable health care services. The enrollee is responsible for demonstrating to the carrier that payments made by the enrollee to the out-of-network provider should be applied toward the enrollee's deductible or out-of-pocket maximum pursuant to this section. The carrier shall provide a downloadable or interactive online form to the enrollee for the purpose of making such a demonstration and may require that copies of bills and proof of payment be submitted by the enrollee. For the purposes of this section, "out-of-network provider" means a provider located in Massachusetts, New Hampshire or this State that is enrolled in the MaineCare program and participates in Medicare.   [PL 2017, c. 232, §9 (NEW).] 2.  Rules.  The superintendent may adopt rules as necessary to implement this section. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.   [PL 2017, c. 232, §9 (NEW).] 3.  Repeal.  This section is repealed January 1, 2024.   [PL 2017, c. 232, §9 (NEW).] SECTION HISTORY PL 2017, c. 232, §9 (NEW).
24-A ME Rev Stat § 4319 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 1: HEALTH PLAN REQUIREMENTS|24-A §4319. Rebates

 §4319. Rebates 1.  Rebates required.  Carriers must provide rebates in the large group, small group and individual markets if the medical loss ratio under subsection 2 is less than the minimum medical loss ratio under subsection 3.   [PL 2019, c. 5, Pt. A, §23 (AMD).] 2.  Medical loss ratio.  For purposes of this section, the medical loss ratio is the ratio of the numerator to the denominator as described in paragraphs A and B, respectively, plus any credibility adjustment. For the purposes of this subsection:   A. The numerator is the amount expended on reimbursement for clinical services provided to enrollees and activities that improve health care quality; and   [PL 2011, c. 90, Pt. D, §5 (NEW).]B. The denominator is the total amount of premium revenue excluding federal and state taxes and licensing and regulatory fees paid and after accounting for payments or receipts for risk adjustment, risk corridors and reinsurance pursuant to federal law.   [PL 2011, c. 90, Pt. D, §5 (NEW).][PL 2019, c. 5, Pt. A, §23 (AMD).] 3.  Minimum medical loss ratio.  The minimum medical loss ratio is:   A. In the large group market, 85%;   [PL 2011, c. 90, Pt. D, §5 (NEW).]B. In the small group market, 80%; and   [PL 2011, c. 90, Pt. D, §5 (NEW).]C. In the individual market, 80%.   [PL 2019, c. 5, Pt. A, §23 (AMD).][PL 2019, c. 5, Pt. A, §23 (AMD).] 4.  Rules.  The superintendent may adopt rules to implement this section in a substantially similar manner as required under the federal Affordable Care Act in effect as of January 1, 2019, including, but not limited to, rules establishing the period for which the medical loss ratio is calculated. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A.   [PL 2019, c. 5, Pt. A, §23 (NEW).] SECTION HISTORY PL 2011, c. 90, Pt. D, §5 (NEW). PL 2019, c. 5, Pt. A, §23 (AMD).
24-A ME Rev Stat § 4319-A (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 1: HEALTH PLAN REQUIREMENTS|24-A §4319-A. Guaranteed issue

 §4319-A. Guaranteed issue A carrier offering a health plan in this State in the individual, small group or large group market must offer to an individual or group in the State all health plans that are approved for sale in the applicable market and must accept any individual or group that applies for any of those health plans in accordance with the requirements of section 2736‑C, subsection 3 and section 2808‑B, subsection 4 and section 2850‑B.   [PL 2019, c. 5, Pt. A, §24 (NEW).]SECTION HISTORY PL 2019, c. 5, Pt. A, §24 (NEW).
24-A ME Rev Stat § 4320 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 1: HEALTH PLAN REQUIREMENTS|24-A §4320. No lifetime or annual limits on health plans

 §4320. No lifetime or annual limits on health plans A carrier offering a health plan in the individual, small group or large group market, as those markets are defined under applicable federal law, may not:   [PL 2019, c. 5, Pt. A, §25 (AMD).]1.  Establish lifetime limits.  Establish lifetime limits on the dollar value of benefits for any participant or beneficiary; or   [PL 2011, c. 364, §34 (NEW).] 2.  Establish annual limits.  Establish annual limits on the dollar value of essential benefits.   [PL 2019, c. 5, Pt. A, §25 (AMD).] 3.  Application.  This section applies to health plans offered or renewed in this State in the individual, small group and large group markets, as those markets are defined under applicable federal law. A health plan may contain annual dollar limits to the extent allowed under the federal Affordable Care Act as of January 1, 2019 if the plan has been continuously renewed since that date, but the plan may not impose any new limits or reduce any existing limit in effect as of January 1, 2019.   [PL 2019, c. 5, Pt. A, §25 (NEW).] Revisor's Note: §4320. Payment reform pilot projects (As enacted by PL 2011, c. 270, §2 is REALLOCATED TO TITLE 24-A, SECTION 4320-H) SECTION HISTORY RR 2011, c. 1, §43 (RAL). PL 2011, c. 270, §2 (NEW). PL 2011, c. 364, §34 (NEW). PL 2019, c. 5, Pt. A, §25 (AMD).
24-A ME Rev Stat § 4320-B (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 1: HEALTH PLAN REQUIREMENTS|24-A §4320-B. Extension of dependent coverage

 §4320-B. Extension of dependent coverage A carrier offering a health plan subject to the requirements of the federal Affordable Care Act that provides dependent coverage of children shall continue to make such coverage available for an adult child until the child turns 26 years of age, consistent with the federal Affordable Care Act.   [PL 2011, c. 364, §34 (NEW).]SECTION HISTORY PL 2011, c. 364, §34 (NEW).
24-A ME Rev Stat § 4320-C (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 1: HEALTH PLAN REQUIREMENTS|24-A §4320-C. Emergency services

 §4320-C. Emergency services If a carrier offering a health plan provides or covers any benefits with respect to services in an emergency facility or setting, the plan must cover emergency services without prior authorization. Cost-sharing requirements, such as a deductible, copayment amount or coinsurance rate, for out-of-network services are the same as requirements that would apply if such services were provided in network, and any payment made by an enrollee pursuant to this section must be applied to the enrollee's in-network cost-sharing limit. The enrollee's responsibility for payment for covered out-of-network emergency services must be limited so that if the enrollee has paid the enrollee's share of the charge as specified in the plan for in-network services, the carrier shall hold the enrollee harmless from any additional amount owed to an out-of-network provider for covered emergency services and make payment to the out-of-network provider in accordance with section 4303‑C or, if there is a dispute, in accordance with section 4303‑E. A carrier offering a health plan in this State shall also comply with the requirements of section 4304, subsection 5.   [PL 2019, c. 668, §4 (AMD).]SECTION HISTORY PL 2011, c. 364, §34 (NEW). PL 2019, c. 238, §3 (AMD). PL 2019, c. 668, §4 (AMD).
24-A ME Rev Stat § 4320-E (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 1: HEALTH PLAN REQUIREMENTS|24-A §4320-E. Reinsurance, risk corridors and risk adjustment

 §4320-E. Reinsurance, risk corridors and risk adjustment 1.  Transitional reinsurance program.  The superintendent shall establish a transitional reinsurance program for calendar years 2014, 2015 and 2016 as required by Section 1341 of the federal Affordable Care Act.   [PL 2011, c. 364, §34 (NEW).] 2.  Risk corridors.  A carrier shall make any payments required under the risk corridors program established by the Secretary of the United States Department of Health and Human Services for calendar years 2014, 2015 and 2016 as required by Section 1342 of the federal Affordable Care Act.   [PL 2011, c. 364, §34 (NEW).] 3.  Risk adjustment.  The superintendent shall establish a risk adjustment program as required by Section 1343 of the federal Affordable Care Act.   [PL 2011, c. 364, §34 (NEW).] SECTION HISTORY PL 2011, c. 364, §34 (NEW).
24-A ME Rev Stat § 4320-F (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 1: HEALTH PLAN REQUIREMENTS|24-A §4320-F. Oversight of plans offered on the American Health Benefit Exchange and the SHOP Exchange

 §4320-F. Oversight of plans offered on the American Health Benefit Exchange and the SHOP Exchange 1.  Superintendent's authority preserved.  Except as otherwise expressly provided by applicable law, the requirements established by this Title, Title 24 and rules adopted by the superintendent continue to apply to carriers and health plans and are not extinguished or modified in any way by:   A. Certification of a health plan as a qualified health plan or any other determination made by the American Health Benefit Exchange or the SHOP Exchange pursuant to the federal Affordable Care Act; or   [PL 2011, c. 364, §34 (NEW).]B. Recognition by the applicable federal agency of a carrier as a qualified nonprofit health insurance issuer or as an issuer of multistate qualified health plans, or of a health plan as a multistate qualified health plan, pursuant to the federal Affordable Care Act.   [PL 2011, c. 364, §34 (NEW).][PL 2011, c. 364, §34 (NEW).] 2.  Coordination with exchanges.  The superintendent has all additional powers and duties conferred upon a state insurance regulator with respect to the American Health Benefit Exchange and the SHOP Exchange by the federal Affordable Care Act. The superintendent may enter into agreements with the American Health Benefit Exchange and the SHOP Exchange relating to coordination of responsibilities, and such agreements may provide for the superintendent to assume additional authority relating to the certification of qualified health plans or the authorization of a carrier to participate in the American Health Benefit Exchange or the SHOP Exchange.   [PL 2011, c. 364, §34 (NEW).] SECTION HISTORY PL 2011, c. 364, §34 (NEW).
24-A ME Rev Stat § 4320-G (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 1: HEALTH PLAN REQUIREMENTS|24-A §4320-G. Applicability to health plans grandfathered under the Affordable Care Act

 §4320-G. Applicability to health plans grandfathered under the Affordable Care Act A health plan that is exempt from certain requirements of the federal Affordable Care Act because it has grandfathered status is also exempt, to the same extent, from substantially similar provisions in this Title and Title 24 enacted after January 1, 2011, except to the extent that those provisions state that they apply to grandfathered health plans.   [PL 2011, c. 364, §34 (NEW).]SECTION HISTORY PL 2011, c. 364, §34 (NEW).
24-A ME Rev Stat § 4320-I (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 1: HEALTH PLAN REQUIREMENTS|24-A §4320-I. Coverage for the cost of testing for bone marrow donation suitability

 §4320-I. Coverage for the cost of testing for bone marrow donation suitability 1.  Required coverage.  A carrier offering a health plan in this State shall provide coverage for laboratory fees up to $150 arising from human leukocyte antigen testing performed to establish bone marrow transplantation suitability in accordance with the following requirements:   A. The enrollee covered under the health plan must meet the criteria for testing established by the National Marrow Donor Program, or its successor organization;   [PL 2013, c. 603, §1 (NEW); PL 2013, c. 603, §2 (AFF).]B. The testing must be performed in a facility that is accredited by a national accrediting body with requirements that are substantially equivalent to or more stringent than those of the College of American Pathologists and is certified under the federal Clinical Laboratories Improvement Act of 1967, 42 United States Code, Section 263a;   [PL 2013, c. 603, §1 (NEW); PL 2013, c. 603, §2 (AFF).]C. At the time of the testing, the enrollee covered under the health plan must complete and sign an informed consent form that authorizes the results of the test to be used for participation in the National Marrow Donor Program, or its successor organization, and acknowledges a willingness to be a bone marrow donor if a suitable match is found; and   [PL 2013, c. 603, §1 (NEW); PL 2013, c. 603, §2 (AFF).]D. The carrier may limit each enrollee to one test per lifetime.   [PL 2013, c. 603, §1 (NEW); PL 2013, c. 603, §2 (AFF).][PL 2013, c. 603, §1 (NEW); PL 2013, c. 603, §2 (AFF).] 2.  Prohibition on cost-sharing.  A carrier may not impose any deductible, copayment, coinsurance or other cost-sharing requirement on an enrollee for the coverage required under this section.   [PL 2013, c. 603, §1 (NEW); PL 2013, c. 603, §2 (AFF).] SECTION HISTORY PL 2013, c. 603, §1 (NEW). PL 2013, c. 603, §2 (AFF).
24-A ME Rev Stat § 4320-J (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 1: HEALTH PLAN REQUIREMENTS|24-A §4320-J. Coverage for abuse-deterrent opioid analgesic drug products

 §4320-J. Coverage for abuse-deterrent opioid analgesic drug products 1.  Definitions.  As used in this section, unless the context otherwise indicates, the following terms have the following meanings.   A. "Abuse-deterrent opioid analgesic drug product" means a brand or generic opioid analgesic drug product approved by the federal Food and Drug Administration with abuse-deterrent labeling claims that indicate the drug product is expected to result in a meaningful reduction in abuse.   [PL 2015, c. 371, §1 (NEW); PL 2015, c. 371, §2 (AFF).]B. "Cost sharing" means any coverage limit, copayment, coinsurance, deductible or other out-of-pocket expense associated with a health plan.   [PL 2015, c. 371, §1 (NEW); PL 2015, c. 371, §2 (AFF).]C. "Opioid analgesic drug product" means a drug product in the opioid analgesic drug class prescribed to treat moderate to severe pain or other conditions, whether in immediate release or extended release, long-acting form and whether or not combined with other drug substances to form a single drug product or dosage form.   [PL 2015, c. 371, §1 (NEW); PL 2015, c. 371, §2 (AFF).][PL 2015, c. 371, §1 (NEW); PL 2015, c. 371, §2 (AFF).] 2.  Required coverage.  A carrier offering a health plan in this State shall provide coverage for abuse-deterrent opioid analgesic drug products listed on any formulary, preferred drug list or other list of drugs used by the carrier on a basis not less favorable than that for opioid analgesic drug products that are not abuse-deterrent and are covered by the health plan. An increase in enrollee cost sharing to achieve compliance with this section may not be implemented.   [PL 2015, c. 371, §1 (NEW); PL 2015, c. 371, §2 (AFF).] SECTION HISTORY PL 2015, c. 371, §1 (NEW). PL 2015, c. 371, §2 (AFF).
24-A ME Rev Stat § 4320-K (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT|Subchapter 1: HEALTH PLAN REQUIREMENTS|24-A §4320-K. Coverage for services provided by a naturopathic doctor

 §4320-K. Coverage for services provided by a naturopathic doctor 1.  Services provided by a naturopathic doctor.  A carrier offering a health plan in this State shall provide coverage for health care services performed by a naturopathic doctor licensed under Title 32, chapter 113‑B, subchapter 3 when those services are covered services under the health plan when performed by any other health care provider and when those services are within the lawful scope of practice of the naturopathic doctor.   [PL 2017, c. 340, §1 (NEW).] 2.  Limits; deductible; copayment; coinsurance.  A carrier may offer a health plan containing a provision for a deductible, copayment or coinsurance requirement for a health care service provided by a naturopathic doctor as long as the deductible, copayment or coinsurance does not exceed the deductible, copayment or coinsurance applicable to the same service provided by other health care providers.   [PL 2017, c. 340, §1 (NEW).] 3.  Network participation.  A carrier shall demonstrate that the carrier's provider network includes reasonable access, in accordance with section 4303, to all covered services that are within the lawful scope of practice of a naturopathic doctor. A carrier may not exclude a provider from participation in the carrier's provider network solely because the provider is a naturopathic doctor as long as the provider is willing to meet the same terms and conditions as other participating providers. This subsection does not require a carrier to contract with all naturopathic doctors or require a carrier to provide coverage under a health plan for any service provided by a participating naturopathic doctor that is not within the health plan's scope of coverage.   [PL 2017, c. 340, §1 (NEW).] 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 2017, c. 340, §1 (NEW).] SECTION HISTORY PL 2017, c. 340, §1 (NEW).