Sec. 1. 24-A MRSA §4203, sub-§3, ¶S, as amended by PL 1997, c. 370, Pt. F, §1, is further amended to read:

S. A list of the names and addresses of all physicians and facilities with which the health maintenance organization has or will have agreements. If products are offered that pay full benefits only when providers within a subset of the contracted physicians or facilities are utilized, a list of the providers in that limited network must be included, as well as a list of the geographic areas where the products are offered. Nothing in this paragraph may be construed to prohibit a health maintenance organization from offering products that provide financial incentives to its members to utilize designated providers in a network, as long as the entire network meets access standards.

Sec. 2. 24-A MRSA §4303, sub-§1, as amended by PL 1999, c. 742, §6, is further amended to read:

1. Demonstration of adequate access to providers. A carrier offering a managed care plan shall provide to its members reasonable access to health care services in accordance with standards developed by rule by the superintendent. These standards must consider the geographical and transportational problems in rural areas. All managed care plans covering residents of this State must provide reasonable access to providers consistent with the access-to-services requirements of any applicable bureau rule. Nothing in this subsection may be construed to prohibit a managed care plan from offering products that provide financial incentives to its members to utilize designated providers in a network, as long as the entire network meets access standards.

SUMMARY

This bill clarifies that the access standards requirements under the laws governing health maintenance organizations and health plans do not prohibit insurance products that give financial incentives to members who elect to use certain designated providers in a network.