§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).
Structure Maine Revised Statutes
TITLE 24-A: MAINE INSURANCE CODE
Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT
Subchapter 1: HEALTH PLAN REQUIREMENTS
24-A §4301. Definitions (REPEALED)
24-A §4302. Reporting requirements
24-A §4303-A. Provider profiling programs
24-A §4303-B. Disclosure related to provider networks
24-A §4303-C. Protection from surprise bills and bills for out-of-network emergency services
24-A §4303-D. Provider directories
24-A §4304. Utilization review
24-A §4306. Enrollee choice of primary care provider
24-A §4306-A. Patient access to obstetrical and gynecological care
24-A §4309-A. Compliance with the Affordable Care Act
24-A §4310. Access to clinical trials
24-A §4311. Access to prescription drugs
24-A §4312. Independent external review
24-A §4313. Carrier liability; cause of action
24-A §4314. Access to eye care providers
24-A §4314-A. Coverage for early refills of prescription eye drops
24-A §4315. Coverage of prosthetic devices
24-A §4316. Coverage for telehealth services
24-A §4317. Pharmacy providers
24-A §4317-A. Prescription drug coverage; out-of-pocket expenses for coinsurance
24-A §4317-B. Orally administered cancer therapy
24-A §4317-C. Coverage for prescription insulin drugs; limit on out-of-pocket costs
24-A §4317-D. Coverage of HIV prevention drugs
24-A §4317-E. Coverage for emergency supply of chronic maintenance drugs
24-A §4319-A. Guaranteed issue
24-A §4319-B. Medical loss ratio reporting for dental insurance plans
24-A §4320. No lifetime or annual limits on health plans
24-A §4320-A. Coverage of preventive and primary health services
24-A §4320-B. Extension of dependent coverage
24-A §4320-C. Emergency services
24-A §4320-D. Comprehensive health coverage
24-A §4320-E. Reinsurance, risk corridors and risk adjustment
24-A §4320-G. Applicability to health plans grandfathered under the Affordable Care Act
24-A §4320-H. Payment reform pilot projects (REALLOCATED FROM TITLE 24-A, SECTION 4320)
24-A §4320-I. Coverage for the cost of testing for bone marrow donation suitability
24-A §4320-J. Coverage for abuse-deterrent opioid analgesic drug products
24-A §4320-K. Coverage for services provided by a naturopathic doctor
24-A §4320-L. Nondiscrimination
24-A §4320-M. Coverage for abortion services
24-A §4320-N. Step therapy (REALLOCATED FROM TITLE 24-A, SECTION 4320-M)
24-A §4320-O. Coverage for services provided by a physician assistant
24-A §4320-P. Coverage for health care services for COVID-19
24-A §4320-R. Mandatory offer of coverage for certain adults with disabilities
24-A §4320-S. Coverage for dental services for cancer patients
24-A §4320-U. Coverage for fertility services (REALLOCATED FROM TITLE 24-A, SECTION 4320-S)