LD 1611
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Page 38 of 47 An Act To Provide Affordable Health Insurance to Small Businesses and Individua... Page 40 of 47
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LR 2137
Item 1

 
§2332-E. Standardized claim forms

 
On or after December 1, 1993, all All nonprofit hospital or
medical service organizations and nonprofit health care plans
providing payment or reimbursement for diagnosis or treatment of
a condition or a complaint by a licensed physician or
chiropractor must accept the current standardized claim form for
professional services approved by the Federal Government in
electronic format. On or after December 1, 1993, all All
nonprofit hospital or medical service organizations and nonprofit
health care plans providing payment or reimbursement for
diagnosis or treatment of a condition or a complaint by a
licensed hospital must accept the current standardized claim form
for professional or facility services, as applicable, approved by
the Federal Government and submitted electronically. A nonprofit
hospital or medical service organization or nonprofit health care
plan may not be required to accept a claim submitted on a form
other than the applicable form specified in this section and may
not be required to accept a claim that is not submitted
electronically.

 
Sec. D-4. 24-A MRSA §423-D is enacted to read:

 
§423-D.__Annual report

 
The superintendent shall adopt routine technical rules as
defined in Title 5, chapter 375, subchapter 2-A regarding
specifications for an annual report to be filed by each
authorized insurer on or before March 1st of each year, or within
any reasonable extension of time that the superintendent for good
cause may have granted on or before March 1st.__The annual
reports must provide the public with general, understandable and
comparable financial information relative to the operations of
authorized insurers.__Such information must include, but is not
limited to, medical claims expense, administrative expense and
underwriting gain for each line segment of the market in this
State in which the insurer participates.__The superintendent
shall develop standardized definitions of each reported measure.

 
Sec. D-5. 24-A MRSA §1952, as enacted by PL 1995, c. 673, Pt. A,
§3, is amended to read:

 
§1952. Licensure

 
A person or entity may not market, sell, offer or arrange for
a package of one or more health benefit plans underwritten by 2
or more carriers without first being licensed by the
superintendent. The superintendent shall specify by rule
standards and procedures for the issuance and renewal of licenses


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