Sec. 1. 24-A MRSA §4303, sub-§9 is enacted to read:

9.__Absolute discretion clauses.__A carrier may not include in a health plan contract with a plan sponsor, contract holder or enrollee or in a contract with another carrier to cover excess losses a clause that gives the carrier or its designated agent the sole or absolute discretion to interpret or construe contract terms or determine enrollee eligibility for benefits in a manner that is conclusive and binding on all parties to the contract.

SUMMARY

This bill prohibits carriers from using absolute discretion clauses in health plan contracts.