| Be it enacted by the People of the State of Maine as follows: |
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| | Sec. 1. 24 MRSA §2332-G, sub-§1, as reallocated by RR 1995, c. 2, §49 | and affected by §50, is amended to read: |
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| | 1. Coverage in managed care plans. With respect to managed | care plans that require subscribers to select primary care | physicians, a nonprofit hospital and medical service organization | that issues group contracts must meet the following requirements. |
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| A. The organization must permit a physician who specializes | in obstetrics and gynecology to serve as a primary care | physician if the physician qualifies under the | organization's credentialling policy. |
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| B. All group plan contracts must provide coverage for an | annual gynecological examination, including routine pelvic | and clinical breast examinations, primary, preventive and | therapeutic obstetrics and gynecological services indicated | for a woman's health care and required as a result of any | gynecological examination or as a result of a gynecological | condition, performed by a physician, certified nurse | practitioner or certified nurse midwife participating in the | plan, without requiring the prior approval of the primary | care physician. The contract may require the participating | obsterical-gynecological provider to provide written notice | of the services provided and any treatment plan to the | woman's primary care physician. |
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| C. If the examination specified in paragraph B reveals a | gynecological condition for which another visit to the | physician participating in the plan is medically required | and appropriate, or for any gynecological care beyond the | annual examination, the carrier may require the patient or | the examining physician, certified nurse practitioner or | certified nurse midwife to secure from the patient's primary | care physician a referral to the participating physician, | certified nurse practitioner or certified nurse midwife from | whom such care may be obtained. |
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| | Sec. 2. 24-A MRSA §2847-F, sub-§1, as reallocated by PL 1997, c. 370, | Pt. H, §1, is amended to read: |
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| | 1. Coverage in managed care plans. With respect to managed | care plans that require group members to select primary care | physicians, an insurer that issues group health insurance | policies and contracts must meet the following requirements. |
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| A. The insurer must permit a physician who specializes in | obstetrics and gynecology to serve as a primary care | physician if the physician qualifies under the insurer's | credentialling policy. |
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