Maine Revised Statutes
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).

Structure Maine Revised Statutes

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 Definitions (REPEALED)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 §4301-A. Definitions

24-A §4302. Reporting requirements

24-A §4303. Plan 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 §4303-E. Dispute resolution process for surprise bills and bills for out-of-network emergency services

24-A §4303-F. Reimbursement for ambulance services and participation of ambulance service providers in carrier networks

24-A §4304. Utilization review

24-A §4305. Quality of care

24-A §4306. Enrollee choice of primary care provider

24-A §4306-A. Patient access to obstetrical and gynecological care

24-A §4307. Construction

24-A §4308. Indemnification

24-A §4309. Adoption of rules

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 §4318. Prohibition against maximum aggregate benefit provisions (REALLOCATED FROM TITLE 24-A, SECTION 4317) (REPEALED)

24-A §4318-A. Comparable health care service incentive program (WHOLE SECTION TEXT EFFECTIVE UNTIL 1/1/24) (WHOLE SECTION TEXT REPEALED 1/1/24)

24-A §4318-B. Access to lower-priced services (WHOLE SECTION TEXT EFFECTIVE UNTIL 1/1/24) (WHOLE SECTION TEXT REPEALED 1/1/24)

24-A §4319. Rebates

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-F. Oversight of plans offered on the American Health Benefit Exchange and the SHOP Exchange

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-Q. Coverage for services provided by a certified registered nurse anesthetist (REALLOCATED FROM TITLE 24-A, SECTION 4320-P)

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-T. Implementation of federal mental health parity laws (WHOLE SECTION TEXT EFFECTIVE UNTIL 4/30/28) (WHOLE SECTION TEXT REPEALED 4/30/28) (REALLOCATED FROM TITLE 24-A, SECTION 4320-R)

24-A §4320-U. Coverage for fertility services (REALLOCATED FROM TITLE 24-A, SECTION 4320-S)