2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 33: HEALTH INSURANCE CONTRACTS › 24-A §2742. Child coverage

§2742. Child coverage
1.  Definitions.
For the purposes of this section, unless the context otherwise indicates, the following terms have the following meanings.
A. "Dependent children" means children who are under 19 years of age and are children, stepchildren or adopted children of, or children placed for adoption with the policyholder, member or spouse of the policyholder or member.   [PL 1993, c. 666, Pt. A, §3 (NEW).]
B. "Placed for adoption" means the assumption and retention of a legal obligation by a person for the total or partial support of a child in anticipation of adoption of the child. If the legal obligation ceases to exist, the child is no longer considered placed for adoption.   [PL 1993, c. 666, Pt. A, §3 (NEW).]
[PL 1993, c. 666, Pt. A, §3 (RPR).]
2.  Coverage.
All insurance policies or plans issued in accordance with the requirements of section 2741 must provide unmarried women policyholders with the coverage or option of coverage for dependent children, under the same terms and conditions and at appropriate rates as are extended to married policyholders with dependents.
[PL 1991, c. 200, Pt. B, §3 (NEW).]
3.  Financial dependency.
Financial dependency of dependent children on the policyholder or the spouse of the policyholder may not be required as a condition for eligibility coverage.
[PL 1991, c. 200, Pt. B, §3 (NEW).]
4.  Adopted children.
All individual policies issued in accordance with the requirements of this section must provide the same benefits to dependent children placed for adoption with the policyholder or spouse of the policyholder under the same terms and conditions as apply to natural dependent children or stepchildren of the policyholder or spouse of the policyholder, irrespective of whether the adoption has become final.
[PL 1993, c. 666, Pt. A, §4 (NEW).]
5.  Compliance.
An insurer issuing policies under this chapter must comply with 42 United States Code, Section 1396g‑1. If a parent is required by a court or administrative order to provide health coverage for a child and the parent is eligible for family health coverage through an insurer, the insurer shall permit either of the child's parents or the Department of Health and Human Services to enroll the child under the family coverage without regard to any enrollment season restrictions if the child is otherwise eligible for the coverage. An insurer must provide policy information to the custodial parent of any dependent child so that the custodial parent can obtain benefits for the child directly from the insurer. An insurer must permit the custodial parent of any dependent child to submit claims for covered services without the approval of the noncustodial parent. If the custodial parent approves, an insurer must permit the provider to submit claims for covered services without the approval of the noncustodial parent. An insurer shall make payment on claims submitted under this section directly to the custodial parent or, if the custodial parent approves, to the provider.
[PL 1997, c. 795, §8 (AMD); PL 2003, c. 689, Pt. B, §6 (REV).]
6.  Nondiscrimination.
An insurer may not impose requirements on a state agency that has been assigned the rights of an individual eligible for medical assistance and who is covered for health benefits from the insurer that are different from requirements applicable to an agent or assignee of any other individual so covered. If a child is otherwise eligible for health coverage, an insurer may not refuse to provide the coverage for the child because the child is eligible for medical assistance under Title 22.
[PL 1997, c. 795, §9 (NEW).]
SECTION HISTORY
PL 1975, c. 276, §2 (NEW). PL 1991, c. 200, §B3 (RPR). PL 1993, c. 666, §§A3,4 (AMD). PL 1995, c. 418, §C2 (AMD). PL 1997, c. 795, §§8,9 (AMD). PL 2003, c. 689, §B6 (REV).