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practices are in accordance with generally accepted actuarial | | principles and with the applicable actuarial standards of practice | | as promulgated by an actuarial standards board.__The filing must | | also certify that the carrier has included in its experience any | | savings offset payments or recovery of those savings offset | | payments consistent with section 6913. The filing also must state | | the number of policyholders, certificate holders and dependents, as | | of the close of the preceding calendar year, enrolled in large | | group health insurance plans offered by the carrier. A filing and | | supporting information are public records except as provided by | | Title 1, section 402, subsection 3. |
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| | | 3.__Documentation.__Every carrier shall maintain at its | | principal place of business a complete and detailed description | | of its rating practices, including information and documentation | | that demonstrates that its rating methods and practices are in | | accordance with generally accepted actuarial principles and with | | the applicable actuarial standards of practice as promulgated by | | an actuarial standards board. |
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| | | Sec. E-18. 24-A MRSA §4203, sub-§3, ¶S, as amended by PL 1997, c. 370, | | Pt. F, §1, is further amended to read: |
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| | | S. A list of the names and addresses of all physicians and | | facilities with which the health maintenance organization | | has or will have agreements. If products are offered that | | pay full benefits only when providers within a subset of the | | contracted physicians or facilities are utilized, a list of | | the providers in that limited network must be included, as | | well as a list of the geographic areas where the products | | are offered. This paragraph may not be construed to | | prohibit a health maintenance organization from offering a | | health plan that includes financial provisions designed to | | encourage members to use designated providers in a network | | in accordance with section 4303, subsection 1, paragraph A. |
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| | | Sec. E-19. 24-A MRSA §4207, sub-§5, as repealed and replaced by PL | | 1993, c. 645, Pt. A, §6, is amended to read: |
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| | | 5. A schedule or an amendment to a schedule of charge for | | enrollee health coverage for health care services may not be used | | by any health maintenance organization unless it complies with | | section 2736, 2808-B or 2839, whichever is applicable. |
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| | | Sec. E-20. 24-A MRSA §4303, sub-§1, as amended by PL 1999, c. 742, §6, | | is further amended to read: |
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| | | 1. Demonstration of adequate access to providers. A Except | | as provided in paragraph A, a carrier offering a managed care | | plan shall provide to its members reasonable access to |
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