Maine Revised Statutes
TITLE 24-A: MAINE INSURANCE CODE
Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT

24-A §4303-C. Protection from surprise bills and bills for out-of-network emergency services - §4303-C. Protection from surprise bills and bills for out-of-network emergency...

24-A §4303-D. Provider directories - §4303-D. Provider directories 1. Requirement. A carrier shall make available...

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

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

24-A §4304. Utilization review - §4304. Utilization review The following requirements apply to health plans...

24-A §4305. Quality of care - §4305. Quality of care A carrier offering or renewing a...

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

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

24-A §4307. Construction - §4307. Construction Nothing in this chapter may be construed to:...

24-A §4308. Indemnification - §4308. Indemnification A contract between a carrier offering or renewing...

24-A §4309. Adoption of rules - §4309. Adoption of rules The superintendent shall adopt rules and...

24-A §4309-A. Compliance with the Affordable Care Act - §4309-A. Compliance with the Affordable Care Act 1. Carriers. A...

24-A §4310. Access to clinical trials - §4310. Access to clinical trials 1. Qualified enrollee. An enrollee...

24-A §4311. Access to prescription drugs - §4311. Access to prescription drugs 1. Formulary. If a health...

24-A §4312. Independent external review - §4312. Independent external review An enrollee has the right to...

24-A §4313. Carrier liability; cause of action - §4313. Carrier liability; cause of action 1. Duty of ordinary...

24-A §4314. Access to eye care providers - §4314. Access to eye care providers 1. Definitions. As used...

24-A §4314-A. Coverage for early refills of prescription eye drops - §4314-A. Coverage for early refills of prescription eye drops 1....

24-A §4315. Coverage of prosthetic devices - §4315. Coverage of prosthetic devices 1. Definition. As used in...

24-A §4316. Coverage for telehealth services - §4316. Coverage for telehealth services 1. Definitions. As used in...

24-A §4317. Pharmacy providers - §4317. Pharmacy providers 1. Contracts with pharmacy providers. Notwithstanding section...

24-A §4317-A. Prescription drug coverage; out-of-pocket expenses for coinsurance - §4317-A. Prescription drug coverage; out-of-pocket expenses for coinsurance 1. Out-of-pocket...

24-A §4317-B. Orally administered cancer therapy - §4317-B. Orally administered cancer therapy 1. Coverage. A carrier that...

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...

24-A §4317-D. Coverage of HIV prevention drugs - §4317-D. Coverage of HIV prevention drugs 1. Definitions. As used...

24-A §4317-E. Coverage for emergency supply of chronic maintenance drugs - §4317-E. Coverage for emergency supply of chronic maintenance drugs 1....

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

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...

24-A §4319. Rebates - §4319. Rebates 1. Rebates required. Carriers must provide rebates in...

24-A §4319-A. Guaranteed issue - §4319-A. Guaranteed issue A carrier offering a health plan in...

24-A §4319-B. Medical loss ratio reporting for dental insurance plans - §4319-B. Medical loss ratio reporting for dental insurance plans 1....

24-A §4320. No lifetime or annual limits on health plans - §4320. No lifetime or annual limits on health plans A...

24-A §4320-A. Coverage of preventive and primary health services - §4320-A. Coverage of preventive and primary health services Notwithstanding any...

24-A §4320-B. Extension of dependent coverage - §4320-B. Extension of dependent coverage A carrier offering a health...

24-A §4320-C. Emergency services - §4320-C. Emergency services If a carrier offering a health plan...

24-A §4320-D. Comprehensive health coverage - §4320-D. Comprehensive health coverage Notwithstanding any other requirements of this...

24-A §4320-E. Reinsurance, risk corridors and risk adjustment - §4320-E. Reinsurance, risk corridors and risk adjustment 1. Transitional reinsurance...

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...

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...

24-A §4320-H. Payment reform pilot projects (REALLOCATED FROM TITLE 24-A, SECTION 4320) - §4320-H. Payment reform pilot projects (REALLOCATED FROM TITLE 24-A, SECTION...

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...

24-A §4320-J. Coverage for abuse-deterrent opioid analgesic drug products - §4320-J. Coverage for abuse-deterrent opioid analgesic drug products 1. Definitions....

24-A §4320-K. Coverage for services provided by a naturopathic doctor - §4320-K. Coverage for services provided by a naturopathic doctor 1....

24-A §4320-L. Nondiscrimination - §4320-L. Nondiscrimination 1. Nondiscrimination. An individual may not, on the...

24-A §4320-M. Coverage for abortion services - §4320-M. Coverage for abortion services 1. Required coverage. A carrier...

24-A §4320-N. Step therapy (REALLOCATED FROM TITLE 24-A, SECTION 4320-M) - §4320-N. Step therapy (REALLOCATED FROM TITLE 24-A, SECTION 4320-M) 1....

24-A §4320-O. Coverage for services provided by a physician assistant - §4320-O. Coverage for services provided by a physician assistant 1....

24-A §4320-P. Coverage for health care services for COVID-19 - §4320-P. Coverage for health care services for COVID-19 Notwithstanding any...

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

24-A §4320-R. Mandatory offer of coverage for certain adults with disabilities - §4320-R. Mandatory offer of coverage for certain adults with disabilities...

24-A §4320-S. Coverage for dental services for cancer patients - §4320-S. Coverage for dental services for cancer patients 1. Required...

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) - §4320-T. Implementation of federal mental health parity laws (CONTAINS TEXT...

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

Subchapter 2: CONSUMER HEALTH CARE DIVISION

24-A §4321. Consumer Health Care Division - §4321. Consumer Health Care Division 1. Division established. The Consumer...

24-A §4322. Consumer Health Care Division Advisory Council (REPEALED) - §4322. Consumer Health Care Division Advisory Council (REPEALED) SECTION HISTORY...

Subchapter 2-A: HEALTH INSURANCE CONSUMER ASSISTANCE PROGRAM

24-A §4326. Health Insurance Consumer Assistance Program - §4326. Health Insurance Consumer Assistance Program 1. Establishment. The Health...

Subchapter 3: DOWNSTREAM RISK

24-A §4331. Definitions - §4331. Definitions As used in this subchapter, unless the context...

24-A §4332. Safe harbor and waiver - §4332. Safe harbor and waiver 1. Authority for safe harbor....

24-A §4333. Requirements for downstream risk arrangements - §4333. Requirements for downstream risk arrangements 1. Permissible downstream risk...

24-A §4334. Substantial insurance risk; substantial enrollment risk - §4334. Substantial insurance risk; substantial enrollment risk 1. Substantial insurance...

24-A §4335. Contractual provisions - §4335. Contractual provisions Full copies of contracts and summary descriptions...

24-A §4336. Disclosure requirements for organizations with downstream risk arrangements - §4336. Disclosure requirements for organizations with downstream risk arrangements 1....

24-A §4337. Requirements related to subcontracting arrangements - §4337. Requirements related to subcontracting arrangements 1. Physician groups. A...

24-A §4338. Downstream risk arrangements that exceed risk threshold described in section 4334 - §4338. Downstream risk arrangements that exceed risk threshold described in...

24-A §4339. Contractual provisions to demonstrate financial viability - §4339. Contractual provisions to demonstrate financial viability If a carrier...

24-A §4340. Financial viability - §4340. Financial viability Each carrier and downstream entity requesting a...

24-A §4341. Limitations on premium transfer - §4341. Limitations on premium transfer The superintendent may deny a...

24-A §4342. Related provisions - §4342. Related provisions The superintendent may deny a request for...

24-A §4343. Rules - §4343. Rules The superintendent may adopt rules establishing application procedures...

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Maine Revised Statutes TITLE 24-A: MAINE INSURANCE CODE Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT

Maine Revised Statutes
TITLE 24-A: MAINE INSURANCE CODE
Chapter 56-A: HEALTH PLAN IMPROVEMENT ACT