reglab/statecodes huggingface dataset:
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 33: HEALTH INSURANCE CONTRACTS › 24-A §2734. Conforming to statute

§2734. Conforming to statute
1.
No policy provision which is not subject to this chapter shall make a policy, or any portion thereof, less favorable in any respect to the insured or the beneficiary than the provisions thereof which are subject to this chapter.
[PL 1969, c. 132, §1 (NEW).]
2.
A policy delivered or issued for delivery to any person in this State in violation of this chapter shall be held valid but shall be construed as provided in this chapter. When any provision in a policy subject to this chapter is in conflict with any provision of this chapter, the rights, duties, and obligations of the insurer, the insured and the beneficiary shall be governed by the provisions of this chapter.
[PL 1969, c. 132, §1 (NEW).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 33: HEALTH INSURANCE CONTRACTS › 24-A §2735. Age limit

§2735. Age limit
If any such policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if such date falls within a period for which premium is accepted by the insurer or if the insurer accepts a premium after such date, the coverage provided by the policy will continue in force, subject to any right of termination, until the end of the period for which premium has been accepted. In the event the age of the insured has been misstated and if, according to the correct age of the insured, the coverage provided by the policy would not have become effective, or would have ceased prior to the acceptance of such premium or premiums, then the liability of the insurer shall be limited to the refund, upon request, of all premiums paid for the period not covered by the policy.   [PL 1969, c. 132, §1 (NEW).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 33: HEALTH INSURANCE CONTRACTS › 24-A §2735-A. Notice of rate filing and rate increase

§2735-A. Notice of rate filing and rate increase
1.  Notice of rate filing or rate increase on existing policies.
An insurer offering individual health plans as defined in section 2736‑C must provide written notice by first class mail of a rate filing to all affected policyholders at least 60 days before the effective date of any proposed increase in premium rates or any proposed rating formula, classification of risks or modification of any formula or classification of risks. Except as otherwise provided in section 2736‑C, subsection 2‑B, the notice must also inform policyholders of their right to request a hearing pursuant to section 229. The notice must show the proposed rate and, unless otherwise provided in section 2736‑C, subsection 2‑B, state that the rate is subject to regulatory approval. Except as otherwise provided in section 2736‑C, subsection 2‑B, the superintendent may not take final action on a rate filing until 40 days after the date notice is mailed by an insurer. An increase in premium rates may not be implemented until 60 days after the notice is provided or until the effective date under section 2736, whichever is later.
[PL 2011, c. 364, §1 (AMD).]
1-A.  Notice of rate filings or rate increase on existing policies renewed in calendar year 2006.
[PL 2005, c. 400, Pt. A, §1 (NEW); MRSA T. 24-A §2735-A, sub-§1-A (RP).]
2.  Notice of rate increase on new business.
When an insurer offering individual health plans as defined in section 2736-C quotes a rate for new business, it must disclose any rate increase that the insurer anticipates implementing within the following 90 days. If the quote is in writing, the disclosure must also be in writing. If the increase is pending approval at the time of notice, the disclosure must include the proposed rate and state that it is subject to regulatory approval. If disclosure required by this subsection is not provided, an increase may not be implemented until at least 90 days after the date the quote is provided or the effective date under section 2736, whichever is later.
[PL 2001, c. 432, §4 (NEW).]
3.  Notice of rate increase on new business for calendar year 2006.
[PL 2005, c. 400, Pt. A, §1 (NEW); MRSA T. 24-A §2735-A, sub-§3 (RP).]
SECTION HISTORY
PL 2001, c. 432, §4 (NEW). PL 2005, c. 400, §A1 (AMD). PL 2009, c. 244, Pt. C, §4 (AMD). PL 2011, c. 364, §1 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 33: HEALTH INSURANCE CONTRACTS › 24-A §2736. Rate filings on individual health insurance policies

§2736. Rate filings on individual health insurance policies
1.  Filing of rate information.
Every insurer shall file for approval by the superintendent every rate, rating formula, classification of risks and every modification of any formula or classification that it proposes to use in connection with individual health insurance policies and certain group policies specified in section 2701. If the filing applies to individual health plans as defined in section 2736‑C, the insurer shall simultaneously file a copy with the Attorney General. Every such filing must state the effective date of the filing. Every such filing must be made not less than 60 days in advance of the stated effective date, unless the 60-day requirement is waived by the superintendent, and the effective date may be suspended by the superintendent for a period of time not to exceed 30 days. A filing required under this section must be made electronically in a format required by the superintendent unless exempted by rule adopted by the superintendent. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A.
[PL 2009, c. 439, Pt. C, §1 (RPR).]
2.  Filing; information.
When a filing is not accompanied by the information upon which the insurer supports such filing, or the superintendent does not have sufficient information to determine whether such filing meets the requirements that rates not be excessive, inadequate or unfairly discriminatory, the superintendent shall require the insurer to furnish the information upon which it supports the filing. A filing and all supporting information, except for protected health information required to be kept confidential by state or federal statute and descriptions of the amount and terms or conditions or reimbursement in a contract between an insurer and a 3rd party, are public records notwithstanding Title 1, section 402, subsection 3, paragraph B and become part of the official record of any hearing held pursuant to section 2736‑A.
[PL 2009, c. 439, Pt. C, §2 (AMD).]
3.  Criteria for special rate hearings.
[PL 2009, c. 244, Pt. C, §5 (RP).]
4.  Special rate hearing.
[PL 2009, c. 244, Pt. C, §6 (RP).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1973, c. 585, §12 (AMD). PL 1977, c. 493, §3 (RPR). PL 1979, c. 558, §§6,7 (AMD). PL 1985, c. 648, §10 (AMD). PL 1997, c. 344, §8 (AMD). PL 2001, c. 432, §§5,6 (AMD). PL 2003, c. 428, §F2 (AMD). PL 2003, c. 469, §§E9,10 (AMD). PL 2007, c. 629, Pt. M, §§1, 2 (AMD). PL 2009, c. 14, §4 (AMD). PL 2009, c. 244, Pt. C, §§5, 6 (AMD). PL 2009, c. 244, Pt. G, §1 (AMD). PL 2009, c. 439, Pt. C, §§1, 2 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 33: HEALTH INSURANCE CONTRACTS › 24-A §2736-A. Hearing

§2736-A. Hearing
If at any time the superintendent has reason to believe that a filing does not meet the requirements that rates not be excessive, inadequate or unfairly discriminatory or that the filing violates any of the provisions of chapter 23, the superintendent shall cause a hearing to be held. If a filing proposes an increase in rates in an individual health plan as defined in section 2736‑C, the superintendent shall cause a hearing to be held at the request of the Attorney General. In any hearing conducted under this section, the insurer has the burden of proving rates are not excessive, inadequate or unfairly discriminatory.   [PL 2011, c. 364, §2 (AMD).]
Hearings held under this section must conform to the procedural requirements set forth in the Maine Administrative Procedure Act, Title 5, chapter 375, subchapter 4.   [PL 2003, c. 469, Pt. E, §11 (AMD).]
SECTION HISTORY
PL 1977, c. 493, §4 (NEW). PL 1977, c. 694, §422 (AMD). PL 1979, c. 330, §2 (AMD). PL 1979, c. 558, §8 (RPR). PL 2003, c. 469, §E11 (AMD). PL 2007, c. 629, Pt. M, §3 (AMD). PL 2009, c. 439, Pt. C, §3 (AMD). PL 2011, c. 364, §2 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 33: HEALTH INSURANCE CONTRACTS › 24-A §2736-B. Order

§2736-B. Order
The superintendent shall issue an order or decision within 30 days after the close of the hearing, or of any rehearing or reargument or within such other period as the superintendent for good cause may require, but not to exceed an additional 30 days. In the order or decision, the superintendent shall either approve or disapprove the rate filing. If the superintendent disapproves the rate filing, the superintendent shall establish the date on which the filing is no longer effective, specify the filing the superintendent would approve and authorize the insurer to submit a new filing in accordance with the terms of the order or decision.   [PL 1989, c. 269, §14 (AMD).]
SECTION HISTORY
PL 1979, c. 558, §9 (NEW). PL 1989, c. 269, §14 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 33: HEALTH INSURANCE CONTRACTS › 24-A §2737. Noncancellable disability insurance defined

§2737. Noncancellable disability insurance defined
"Noncancellable disability insurance" means insurance against disability resulting from sickness, ailment or bodily injury, but not including insurance solely against accidental injury, under any contract which does not give the insurer the option to cancel or otherwise terminate the contract at or after one year from its effective date or renewal date.   [PL 1969, c. 132, §1 (NEW).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 33: HEALTH INSURANCE CONTRACTS › 24-A §2738. Notice as to renewability

§2738. Notice as to renewability
The superintendent shall have the right to make the following requirements:   [PL 1973, c. 585, §12 (AMD).]
1.
When a policy has neither a brief description nor a separate statement printed on the first page and on the filing back, referring to the renewal conditions of the policy, a separately captioned provision, setting forth the conditions under which the policy may be renewed, must appear on the first page of the policy. The caption shall be clear and definite and shall be approved by the superintendent; but any one of the following captions is acceptable:
"RENEWAL SUBJECT TO CONSENT OF COMPANY.
RENEWAL SUBJECT TO COMPANY CONSENT.
RENEWABLE AT OPTION OF COMPANY."
[PL 1973, c. 585, §12 (AMD).]
2.
If the policy is not renewable, a separate, appropriately captioned provision on the first page of the policy shall so state.
[PL 1969, c. 132, §1 (NEW).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1973, c. 585, §12 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 33: HEALTH INSURANCE CONTRACTS › 24-A §2739. Lapse of policy, advance notice; limitation of action

§2739. Lapse of policy, advance notice; limitation of action
An individual policy of health insurance issued or delivered in this State, except a policy which by its terms is renewable or continuable with the insurer's consent, or except a policy the premiums for which are payable monthly or at shorter intervals, may not terminate or lapse for nonpayment of any premium until the expiration of 3 months from the due date of such premium, unless the insurer, within not less than 10 nor more than 45 days prior to such due date, has mailed, postage prepaid, duly addressed to the insured at the insured's last address shown by the insurer's records, a notice showing the amount of such premium and its due date. If such a notice is not so sent, the insured may pay the premium in default at any time within such period of 3 months. The affidavit of any officer, clerk or agent of the insurer, or of any other person authorized to mail such notice, that the notice required by this section has been duly mailed by the insurer in the manner required is prima facie evidence that such notice was duly given. An action may not be maintained on any policy to which this section applies and that has lapsed for nonpayment of any premium unless such action is commenced within 2 years from the due date of such premium.   [RR 2021, c. 1, Pt. B, §241 (COR).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). RR 2021, c. 1, Pt. B, §241 (COR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 33: HEALTH INSURANCE CONTRACTS › 24-A §2740. Franchise health insurance law (REPEALED)

§2740. Franchise health insurance law
(REPEALED)
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1973, c. 205 (AMD). PL 1995, c. 332, §C1 (RP).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 33: HEALTH INSURANCE CONTRACTS › 24-A §2741. Maternity benefits for unmarried women policyholders and the minor dependents of policyholders with dependent or family coverage required

§2741. Maternity benefits for unmarried women policyholders and the minor dependents of policyholders with dependent or family coverage required
All health insurance policies and plans shall provide, at appropriate rates, the same maternity benefits for unmarried women policyholders and the minor dependents of policyholders with dependent or family coverage under the same terms and conditions as such maternity coverage is provided to married policyholders or the wives of policyholders with maternity coverage. This requirement shall apply to all insurance policies and plans issued or renewed after the effective date of this Act.   [PL 1975, c. 276, §2 (NEW).]
SECTION HISTORY
PL 1975, c. 276, §2 (NEW). PL 1975, c. 428, §2 (NEW). PL 1975, c. 561 (NEW). PL 1975, c. 770, §§102,103 (RP).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 33: HEALTH INSURANCE CONTRACTS › 24-A §2741-A. Mandated offer of domestic partner benefits

§2741-A. Mandated offer of domestic partner benefits
1.  Definition.
[PL 2021, c. 567, §30 (RP).]
2.  Mandated offer of domestic partner benefits.
All individual health insurance policies or contracts issued by any insurer operating pursuant to this chapter must make available to policyholders the option for additional benefits for the domestic partner of a policyholder, at appropriate rates and under the same terms and conditions as those benefits or options for benefits are provided to spouses of married policyholders.
[PL 2001, c. 347, §2 (NEW); PL 2001, c. 347, §5 (AFF).]
3.  Financial dependency.
Financial dependency of a domestic partner on the policyholder may not be required as a condition for eligibility for coverage.
[PL 2001, c. 347, §2 (NEW); PL 2001, c. 347, §5 (AFF).]
4.  Evidence of domestic partnership.
As a condition of eligibility for coverage, an insurer may require a policyholder and the policyholder's domestic partner to sign an affidavit attesting that the policyholder and the policyholder's domestic partner meet the definition of domestic partner under Title 1, section 72, subsection 2‑C and to show documentation of joint ownership or occupancy of real property, such as a joint deed, joint mortgage or a joint lease, or the existence of a joint credit card, joint bank account or powers of attorney in which each domestic partner is authorized to act for the other.
[PL 2021, c. 567, §31 (AMD).]
5.  Preexisting conditions.
A domestic partner is subject to the same provisions on coverage of preexisting conditions as any spouse or dependent of a policyholder.
[PL 2001, c. 347, §2 (NEW); PL 2001, c. 347, §5 (AFF).]
6.  Termination of domestic partner benefits.
An insurer may terminate coverage in accordance with other applicable provisions of this Title for the domestic partner of a policyholder upon notification by the policyholder that the domestic partner relationship has terminated.
[PL 2021, c. 567, §32 (AMD).]
7.  Construction.
This section does not prohibit an insurer from negotiating a policy providing domestic partner benefits to a policyholder that does not comply with the requirements of this section.
[PL 2001, c. 347, §2 (NEW); PL 2001, c. 347, §5 (AFF).]
8.  Exemption.
This section does not apply to accidental injury, specified disease, hospital indemnity, Medicare supplement, disability income, long-term care and other limited benefit health insurance policies.
[PL 2001, c. 347, §2 (NEW); PL 2001, c. 347, §5 (AFF).]
SECTION HISTORY
PL 2001, c. 347, §2 (NEW). PL 2001, c. 347, §5 (AFF). PL 2021, c. 567, §§30-32 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 33: HEALTH INSURANCE CONTRACTS › 24-A §2742-A. Extension of coverage for dependent children

§2742-A. Extension of coverage for dependent children
Notwithstanding section 2703, subsection 3, an individual health insurance policy that provides coverage for a dependent child at certain ages only if the child is a student must continue that coverage if the child is unable to remain enrolled in school on a full-time basis due to a mental or physical illness or an accidental injury. This coverage may be terminated at the age at which coverage for students terminates under the terms of the policy. An insurer may require, as a condition of eligibility for continued coverage in accordance with this section, that the student provide written documentation from a health care provider and the student's school that the student is no longer enrolled in school on a full-time basis due to a mental or physical illness or accidental injury.   [PL 2005, c. 532, §1 (NEW).]
SECTION HISTORY
PL 2005, c. 532, §1 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 33: HEALTH INSURANCE CONTRACTS › 24-A §2742-B. Mandatory offer to extend coverage for dependent children up to 26 years of age

§2742-B. Mandatory offer to extend coverage for dependent children up to 26 years of age
1.  Dependent child; definition.
As used in this section, "dependent child" means the child of a person covered under an individual health insurance policy.
A. [PL 2019, c. 5, Pt. A, §8 (RP).]
B. [PL 2019, c. 5, Pt. A, §8 (RP).]
C. [PL 2019, c. 5, Pt. A, §8 (RP).]
D. [PL 2007, c. 514, §3 (RP).]
[PL 2019, c. 5, Pt. A, §8 (AMD).]
2.  Offer of coverage.
Notwithstanding section 2703, subsection 3, an individual health insurance policy that offers coverage for a dependent child must offer such coverage, at the option of the policyholder, until the dependent child attains 26 years of age. If the dependent child has a disability, the policy must offer coverage in accordance with section 2742‑C.
[PL 2021, c. 520, §1 (AMD).]
3.  Notice.
[PL 2007, c. 514, §5 (NEW); MRSA T. 24-A §2742-B, sub-§3 (RP).]
SECTION HISTORY
PL 2007, c. 115, §1 (NEW). PL 2007, c. 115, §5 (AFF). PL 2007, c. 514, §§1-5 (AMD). PL 2019, c. 5, Pt. A, §8 (AMD). PL 2021, c. 520, §1 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 33: HEALTH INSURANCE CONTRACTS › 24-A §2742-C. Mandatory offer of coverage for certain adults with disabilities

§2742-C. Mandatory offer of coverage for certain adults with disabilities
1.  Definitions.
As used in this section, unless the context otherwise indicates, the following terms have the following meanings.
A. "Dependent child" has the same meaning as in section 2742‑B, subsection 1.   [PL 2021, c. 520, §2 (NEW).]
B. "Disability" means a physical, mental, intellectual or developmental disability that renders a person incapable of self-sustaining employment.   [PL 2021, c. 520, §2 (NEW).]
[PL 2021, c. 520, §2 (NEW).]
2.  Offer of coverage.
An individual health insurance policy that offers coverage for a dependent child must offer such coverage, at the option of the policyholder, for a dependent child with a disability, regardless of age.
[PL 2021, c. 520, §2 (NEW).]
3.  Proof of disability.
A policyholder shall furnish proof of a dependent child's disability to the insurer within 31 days of the dependent child's attainment of the limiting age established in section 2742‑B, subsection 2 and subsequently as may be required by the insurer, but the insurer may not require proof more frequently than annually after the 2-year period following the dependent child's attainment of the limiting age.
[PL 2021, c. 520, §2 (NEW).]
SECTION HISTORY
PL 2021, c. 520, §2 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 33: HEALTH INSURANCE CONTRACTS › 24-A §2743. Newborn children coverage

§2743. Newborn children coverage
All individual health insurance policies providing coverage on an expense-incurred basis must provide that health insurance benefits are payable with respect to a newly born child of the insured or subscriber from the moment of birth.   [PL 1997, c. 604, Pt. C, §2 (AMD).]
The coverage for newly born children must consist of coverage of injury, sickness or other benefits provided by the policy, including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities.   [PL 1997, c. 604, Pt. C, §2 (AMD).]
If payment of a specific premium or subscription fee is required to provide coverage for a child, the policy or contract may require that notification of birth of a newly born child and payment of the required premium or fees must be furnished to the insurer or nonprofit service or indemnity corporation within 31 days after the date of birth in order to have the coverage continue beyond that 31-day period. The payment may be required to be retroactive to the date of birth. Benefits required by section 2743‑A must be paid regardless of whether coverage under this section is elected.   [PL 1997, c. 604, Pt. C, §2 (AMD).]
The requirements of this section apply to all policies delivered or issued for delivery in this State more than 120 days after the effective date of this Act.   [PL 1997, c. 604, Pt. C, §2 (AMD).]
SECTION HISTORY
PL 1975, c. 770, §104 (NEW). PL 1995, c. 332, §N2 (AMD). PL 1997, c. 604, §C2 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 33: HEALTH INSURANCE CONTRACTS › 24-A §2743-A. Maternity and routine newborn care

§2743-A. Maternity and routine newborn care
An insurer that issues individual contracts providing maternity benefits, including benefits for childbirth, shall provide coverage for services related to maternity and routine newborn care, including coverage for hospital stay, in accordance with the attending physician's or attending certified nurse midwife's determination in conjunction with the mother that the mother and newborn meet the criteria outlined in the "Guidelines for Perinatal Care," published by the American Academy of Pediatrics and the American College of Obstetrics and Gynecology. For the purposes of this section, "routine newborn care" does not include any services provided after the mother has been discharged from the hospital. For the purposes of this section, "attending physician" includes the obstetrician, pediatrician or other physician attending the mother and newborn. Benefits for routine newborn care required by this section are part of the mother's benefit. The mother and the newborn are treated as one person in calculating the deductible, coinsurance and copayments for coverage required by this section.   [PL 2001, c. 258, Pt. A, §2 (AMD).]
SECTION HISTORY
PL 1995, c. 615, §2 (NEW). PL 2001, c. 258, §A2 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 33: HEALTH INSURANCE CONTRACTS › 24-A §2743-B. Maternity and postpartum care

§2743-B. Maternity and postpartum care
An insurer that issues individual contracts providing maternity benefits shall provide coverage for 12 months following childbirth for postpartum care services and support necessary to transition a patient to a healthy and stable condition that meets the recommendations of the American College of Obstetricians and Gynecologists outlined in the "Optimizing Postpartum Care" opinion published May 2018. The postpartum care services and support provided in accordance with this section must include coverage for development of a postpartum care plan; contact with the patient within 3 weeks of the end of pregnancy; a comprehensive postpartum visit, including a full assessment of the patient's physical, social and psychological well-being; treatment of complications of pregnancy and childbirth, including pelvic floor disorders and postpartum depression; assessment of risk factors for cardiovascular disease; and care related to pregnancy loss.   [PL 2021, c. 691, §1 (NEW).]
SECTION HISTORY
PL 2021, c. 691, §1 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 33: HEALTH INSURANCE CONTRACTS › 24-A §2745-B. Acupuncture services

§2745-B. Acupuncture services
All individual insurance policies providing coverage for acupuncture must provide coverage for those services when performed by an acupuncturist licensed pursuant to Title 32, chapter 113‑B, subchapter II, under the same conditions that apply to the services of a licensed physician.   [PL 1995, c. 671, §9 (AMD).]
SECTION HISTORY
PL 1991, c. 647, §2 (NEW). PL 1995, c. 671, §9 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 33: HEALTH INSURANCE CONTRACTS › 24-A §2745-C. Coverage for breast cancer treatment

§2745-C. Coverage for breast cancer treatment
1.  Inpatient care.
All individual health policies providing coverage for medical and surgical benefits, except accidental injury, specified disease, hospital indemnity, Medicare supplement, long-term care and other limited benefit health insurance policies and contracts, must ensure that inpatient coverage with respect to the treatment of breast cancer is provided for a period of time determined by the attending physician, after providing notice to the patient regarding the coverage required by this subsection and in consultation with the patient, to be medically appropriate following a mastectomy, a lumpectomy or a lymph node dissection for the treatment of breast cancer.
Nothing in this subsection may be construed to require the provision of inpatient coverage if the attending physician and patient determine that a shorter period of hospital stay is appropriate.
In implementing the requirements of this subsection, an individual health policy may not modify the terms and conditions of coverage based on the determination by any enrollee to request less than the minimum coverage required under this subsection.
All individual health policies must provide written notice to each enrollee under the contract regarding the coverage required by this subsection. The notice must be prominently positioned in any literature or correspondence made available or distributed by the plan and must be transmitted in the next mailing made by the plan to the enrollee or as part of any yearly information packet sent to the enrollee, whichever is earlier. The notice must also be made available to any physician participating in the insurer's provider network.
[PL 2015, c. 227, §2 (AMD); PL 2015, c. 227, §5 (AFF).]
2.  Reconstruction.
All individual health policies providing coverage for mastectomy surgery must provide coverage for reconstruction of the breast on which surgery has been performed and surgery and reconstruction of the other breast to produce a symmetrical appearance if the patient elects reconstruction and in the manner chosen by the patient and the physician.
[PL 1997, c. 408, §4 (NEW); PL 1997, c. 408, §8 (AFF).]
SECTION HISTORY
RR 1995, c. 1, §15 (COR). PL 1995, c. 295, §3 (NEW). PL 1995, c. 369, §2 (NEW). PL 1997, c. 408, §4 (RPR). PL 1997, c. 408, §8 (AFF). PL 2015, c. 227, §2 (AMD). PL 2015, c. 227, §5 (AFF).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 33: HEALTH INSURANCE CONTRACTS › 24-A §2745-D. Medical food coverage for inborn error of metabolism

§2745-D. Medical food coverage for inborn error of metabolism
1.  Inborn error of metabolism; special modified low-protein food product.
As used in this section, "inborn error of metabolism" means a genetically determined biochemical disorder in which a specific enzyme defect produces a metabolic block that may have pathogenic consequences at birth or later in life. As used in this section, "special modified low-protein food product" means food formulated to reduce the protein content to less than one gram of protein per serving and does not include foods naturally low in protein.
[PL 1995, c. 369, §2 (NEW).]
2.  Required coverage.
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 metabolic formula and special modified low-protein food products that have been prescribed by a licensed physician for a person with an inborn error of metabolism. The policies and contracts must reimburse:
A. For metabolic formula; and   [PL 1995, c. 369, §2 (NEW).]
B. Up to $3,000 per year for special modified low-protein food products.   [PL 1995, c. 369, §2 (NEW).]
[PL 1995, c. 369, §2 (NEW).]
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 January 1, 1996. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.
[PL 1995, c. 369, §2 (NEW).]
SECTION HISTORY
RR 1995, c. 1, §15 (RNU). PL 1995, c. 369, §2 (NEW).
2023 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).
2023 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).
2023 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).
2023 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).
2023 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).
2023 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).
2023 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).
2023 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).
2023 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).
2023 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).
2023 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).
2023 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).
2023 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).