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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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