LD 1611
pg. 6
Page 5 of 47 An Act To Provide Affordable Health Insurance to Small Businesses and Individua... Page 7 of 47
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LR 2137
Item 1

 
6.__Eligible individual. "Eligible individual" means:

 
A. A self-employed individual who:

 
(1)__Works and resides in the State; and

 
(2)__Is organized as a sole proprietorship or in any
other legally recognized manner in which a self-
employed individual may organize, a substantial part of
whose income derives from a trade or business through
which the individual has attempted to earn taxable
income;

 
B.__An unemployed individual who resides in this State; or

 
C.__An individual employed in an eligible business that does
not offer health insurance.

 
7.__Employer.__"Employer" means the owner or responsible agent
of a business authorized to sign contracts on behalf of the
business.

 
8.__Executive director.__"Executive director" means the
Executive Director of Dirigo Health.

 
9.__Health insurance carrier.__"Health insurance carrier"
means:

 
A.__An insurance company licensed in accordance with this
Title to provide health insurance;

 
B.__A health maintenance organization licensed pursuant to
chapter 56;

 
C.__A preferred provider arrangement administrator
registered pursuant to chapter 32; or

 
D.__A nonprofit hospital or medical service organization or
health plan licensed pursuant to Title 24.

 
10.__Health plan in Medicaid.__"Health plan in Medicaid" means
a health insurance carrier that meets the requirements of 42 Code
of Federal Regulations, Part 438 (2002) and has a contract with
the Department of Human Services to provide MaineCare-covered
services to individuals enrolled in MaineCare.

 
11.__Participating employer. "Participating employer" means an
eligible business whose employees are plan enrollees in Dirigo
Health Insurance.


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