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organized under Title 13-B and authorized pursuant to Title 24, | chapter 19 or by proposing the expansion of an existing public | plan. If the board proposes the establishment of a nonprofit health | care plan or the expansion of an existing public plan, the board | shall submit its proposal, including, but not limited to, a funding | mechanism to capitalize a nonprofit health care plan and any | recommended legislation to the joint standing committee of the | Legislature having jurisdiction over health insurance matters. | Dirigo Health may not provide access to health insurance by | establishing a nonprofit health care plan or through an existing | public plan without specific legislative approval. |
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| | 3. Carrier participation requirements. 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 that meets the requirements for mandated coverage | for specific health services, specific diseases and for | certain providers of health services under Title 24 and this | Title and any supplemental benefits the board wishes to make | available; and |
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| (1)__Providers contracting with a carrier contracted to | provide coverage to plan enrollees do not charge plan | enrollees or 3rd parties for covered health care | services in excess of the amount allowed by the carrier | the provider has contracted with, except for applicable | copayments, deductibles or coinsurance or as provided | in section 4204, subsection 6; |
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| (2)__Providers contracting with a carrier contracted to | provide coverage to plan enrollees 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.__This subparagraph may | not be construed to require a provider to furnish | medical services that are not within the scope of that | provider's license; and |
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| (3)__Providers contracting with a carrier contracted to | provide coverage to plan enrollees are reimbursed at | the negotiated reimbursement rates between the carrier | and its provider network. |
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