| | | 1.__Dirigo Health Insurance.__Dirigo Health shall arrange for | | the provision of health benefits coverage through Dirigo Health | | Insurance.__Dirigo Health Insurance must comply with all relevant | | requirements of this Title.__Dirigo Health Insurance may be | | offered by health insurance carriers that apply to the board and | | meet qualifications described in this section and any additional | | qualifications set by the board.__If health insurance carriers do | | not apply to offer and deliver Dirigo Health Insurance, the board | | shall have Dirigo Health provide access to health insurance by | | establishing a nonprofit health plan or through an existing | | public plan.__To qualify as a carrier of Dirigo Health Insurance, | | a health insurance carrier must: |
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| | | A.__Provide the comprehensive health services and benefits | | as determined by the board, including a standard benefit | | package and any supplemental benefits the board wishes to | | make available; and |
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| | | (1)__Providers participating in Dirigo Health Insurance | | do not charge plan enrollees or 3rd parties for covered | | health care services in excess of the amount reimbursed | | to that provider by Dirigo Health Insurance; and |
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| | | (2) Providers participating in Dirigo Health Insurance | | do not refuse to provide services to a plan enrollee on | | the basis of health status, medical condition, previous | | insurance status, race, color, creed, age, national | | origin, citizenship status, gender, sexual orientation, | | disability or marital status. |
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| | | Health insurance carriers that seek to qualify to provide Dirigo | | Health Insurance must also qualify as health plans in MaineCare. |
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| | | 2.__Contracting authority.__Dirigo Health has contracting | | authority and powers to administer Dirigo Health Insurance as set | | out in this subsection. |
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| | | A.__Dirigo Health may contract with health insurance | | carriers licensed to sell health insurance in this State or | | other private or public 3rd-party administrators to provide | | Dirigo Health Insurance.__In addition: |
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| | | (1)__Dirigo Health shall issue requests for proposals | | from health insurance carriers; |
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| | | (2)__Dirigo Health may include quality control, disease | | management and cost-containment provisions in the contracts with | | participating health insurance carriers |
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