Sec. L-1. 24-A MRSA §2808-B, sub-§3, as amended by PL 1997, c. 445, §15 and affected by §32, is further amended to read:
3. Coverage for late enrollees. In providing coverage to late enrollees, small group health plan carriers are allowed to exclude or limit coverage for a late enrollee for 12 months or provide coverage subject to a 12-month preexisting conditions exclusion. The exclusion is subject to the limitations set forth in section 2850 2849-B, subsection 3.
Sec. L-2. 24-A MRSA §2848, sub-§1-B, as amended by PL 1997, c. 777, Pt. B, §4, is further amended to read:
1-B. Federally creditable coverage. "Creditable Federally creditable coverage" means: is defined as follows.
A. Health "Federally creditable coverage" means health benefits or coverage provided under any of the following:
(1) An employee welfare benefit plan as defined in Section 3(1) of the federal Employee Retirement Income Security Act of 1974, 29 United States Code, Section 1001, or a plan that would be an employee welfare benefit plan but for the "governmental plan" or "nonelecting church plan" exceptions, if the plan provides medical care as defined in subsection 2-A, and includes items and services paid for as medical care directly or through insurance, reimbursement or otherwise;
(2) Benefits consisting of medical care provided directly, through insurance or reimbursement and including items and services paid for as medical care under a policy, contract or certificate offered by a carrier;
(3) Part A or Part B of Title XVIII of the Social Security Act, Medicare;
(4) Title XIX of the Social Security Act, Medicaid, other than coverage consisting solely of benefits under Section 1928 of the Social Security Act or a state children's health insurance program under Title XXI of the Social Security Act;
(5) The Civilian Health and Medical Program for the Uniformed Services, CHAMPUS, 10 United States Code, Chapter 55;
(6) A medical care program of the federal Indian Health Care Improvement Act, 25 United States Code, Section 1601 or of a tribal organization;
(7) A state health benefits risk pool;
(8) A health plan offered under the federal Employees Health Benefits Amendments Act, 5 United States Code, Chapter 89;
(9) A public health plan as defined in federal regulations authorized by the federal Public Health Service Act, Section 2701(c)(1)(I), as amended by Public Law 104-191; or
(10) A health benefit plan under Section 5(e) of the Peace Corps Act, 22 United States Code, Section 2504(e).
B. Creditable "Federally creditable coverage" does not include coverage consisting solely of one or more of the following:
(1) Coverage for accident or disability income insurance or any combination of those coverages;
(2) Liability insurance, including general liability insurance and automobile liability insurance;
(3) Coverage issued as a supplement to liability insurance;
(4) Workers' compensation or similar insurance;
(5) Automobile medical payment insurance;
(6) Credit insurance;
(7) Coverage for on-site medical clinics; or
(8) Other similar insurance coverage, specified in federal regulations issued pursuant to Public Law 104-191, under which benefits for medical care are secondary or incidental to other insurance benefits.
C. Creditable "Federally creditable coverage" does not include the following benefits if those benefits are provided under a separate policy, certificate or contract of insurance or are otherwise not an integral part of the plan:
(1) Limited scope dental or vision benefits;
(2) Benefits for long-term care, nursing home care, home health care, community-based care or any combination of those benefits; and
(3) Other similar, limited benefits as specified in federal regulations issued pursuant to Public Law 104-191.
D. Creditable "Federally creditable coverage" does not include the following benefits if the benefits are provided under a separate policy, certificate or contract of insurance, and if no coordination exists between the provision of the benefits and any exclusion of benefits under a group health plan maintained by the same plan sponsor and those benefits are paid for an event without regard to whether benefits are provided for that event under a group health plan maintained by the same plan sponsor:
(1) Coverage only for a specified disease or illness; and
(2) Hospital indemnity or other fixed indemnity insurance.
E. Creditable "Federally creditable coverage" does not include the following if it is offered as a separate policy, certificate or contract of insurance:
(1) Medicare supplemental health insurance under the Social Security Act, Section 1882(g)(1);
(2) Coverage supplemental to the coverage provided under the Civilian Health and Medical Program of the Uniformed Services, CHAMPUS, 10 United States Code, Chapter 55; and
(3) Similar supplemental coverage under a group health plan.
For purposes of this subsection, a "period of continuing federally creditable coverage" means a period in which an individual has maintained federally creditable coverage through one or more plans or programs, with no break in coverage exceeding 63 days. In calculating the aggregate length of a period of continuing federally creditable coverage that includes one or more breaks in coverage, only the time actually covered is counted. A waiting period is not counted as a break in coverage if the individual has other federally creditable coverage during this period.
Sec. L-3. 24-A MRSA §2848, sub-§1-C, as amended by PL 1997, c. 683, Pt. A, §13, is further amended to read:
1-C. Federally eligible individual. "Federally eligible individual" means an individual:
A. Who has had a period of continuing federally creditable coverage, as defined in subsection 1-B, ending not more than 63 days before applying for an individual health plan, with an aggregate length of federally creditable coverage, as defined in subsection 1-B, of at least 18 months;
B. Whose most recent prior federally creditable coverage was under a group health plan, governmental plan, church plan or health insurance coverage offered in connection with any such plan;
C. Who is not eligible for coverage under a group health plan, Part A or Part B of Title XVIII of the Social Security Act, Medicare, or a state plan under Title XIX, Medicaid or any successor program and who does not have other health insurance coverage;
D. Whose most recent federally creditable coverage was not terminated based on nonpayment of premiums, fraud or intentional misrepresentation of material fact; and
E. Who, if offered the option of continuation of coverage under a COBRA continuation provision, as defined by subsection 1-A, or under a similar state program, elected continuation of coverage and has exhausted that coverage.
Sec. L-4. 24-A MRSA §2848, sub-§5, as repealed and replaced by PL 1993, c. 349, §52, is amended to read:
5. Waiting period. "Waiting period" means a period of time after the effective date of enrollment during which a health insurance plan excludes coverage for the diagnosis or treatment of any or all medical conditions.
Sec. L-5. 24-A MRSA §2849-A, sub-§1, as amended by PL 1991, c. 695, §8, is further amended to read:
1. Policies subject to this section. This section applies to group and blanket policies that provide hospital or medical expense coverage or specific indemnity during hospital confinement. This section does not apply to group policies providing coverage only for dental expense or to group long-term care policies as defined in section 5051 or group short-term and long-term disability policies.
Sec. L-6. 24-A MRSA §2849-A, sub-§2, as enacted by PL 1989, c. 867, §8 and affected by §10, is amended to read:
2. Requirement. Every group policy subject to this section must provide a reasonable extension of benefits for a person who is totally disabled on the date the group policy is discontinued, or on the date coverage for a subgroup in the policy is discontinued. A premium may not be charged during the period of extension. For a policy providing hospital or medical expense coverage, an extension of benefits provision is reasonable if it provides benefits for covered expenses directly relating to the condition causing total disability for at least 6 months following the effective date of discontinuance. For a policy providing benefits for loss of time from work or specific indemnity during hospital confinement, "extension of benefits" means that discontinuance of the policy during a disability has no effect on benefits payable for that disability or confinement.
Sec. L-7. 24-A MRSA §2849-B, sub-§3, as amended by PL 1997, c. 777, Pt. B, §§5 and 6, is further amended to read:
3. Exception for late enrollees. Notwithstanding subsection 2, this section does not provide continuity of coverage for a late enrollee except as provided in this subsection. A late enrollee may be excluded from coverage for a waiting period of not more than 12 months based on medical underwriting or preexisting conditions. If a shorter waiting period or no waiting period is imposed, coverage for the late enrollee may exclude preexisting conditions for the lesser of 18 months, reduced by any federally creditable coverage, or 12 months. The exclusion is subject to the limitations set forth in section 1850. For purposes of this section, a "late enrollee" is a person who requests enrollment in a group plan following the initial enrollment period provided under the terms of the plan, except that a person is not a late enrollee if:
A. The request for enrollment is made within 30 days after termination of coverage under a prior contract or policy and the individual did not request coverage initially under the succeeding contract or policy or terminated coverage under the succeeding contract because that individual was covered under a prior contract or policy and:
(1) Coverage under that contract or policy ceased because the individual became ineligible for reasons other than fraud or material misrepresentation, including, but not limited to, termination of employment, termination of the group policy or group contract under which the individual was covered, death of a spouse or divorce; or
(2) Employer contributions toward that coverage were terminated;
B. A court has ordered that coverage be provided for a spouse or minor child under a covered employee's plan and the request for coverage is made within 30 days after issuance of the court order;
C-1. That person was covered by the Cub Care program under Title 22, section 3174-R, and the request for replacement coverage is made while coverage is in effect or within 30 days from the termination of coverage; or
D. That person was previously ineligible for coverage and the request for enrollment is made within 30 days of the date the person becomes eligible.
Sec. L-8. 24-A MRSA §2850, sub-§1, as amended by PL 1997, c. 370, Pt. C, §5, is further amended to read:
1. Application. This section applies to individual and, group and blanket medical insurance contracts subject to chapters 33 and 35, except Medicare supplement contracts, converted contracts issued under section 2809-A and contracts designed to cover specific diseases, hospital indemnity or accidental injury only.
Sec. L-9. 24-A MRSA §2850, sub-§2, as repealed and replaced by PL 1997, c. 445, §29 and affected by §32, is amended to read:
2. Limitation. An individual or group contract issued by an insurer may not impose a preexisting condition exclusion except as provided in this subsection. A preexisting condition exclusion may not exceed 12 months, including the waiting period, if any. A preexisting condition exclusion may not be more restrictive than as follows.
A. In a group contract, a preexisting condition exclusion may relate only to conditions for which medical advice, diagnosis, care or treatment was recommended or received during the 6 months immediately preceding the effective date of coverage enrollment. An exclusion may not be imposed relating to pregnancy as a preexisting condition.
B. In an individual contract not subject to paragraph C, or in a blanket policy, a preexisting condition exclusion may relate only to conditions manifesting in symptoms that would cause an ordinarily prudent person to seek medical advice, diagnosis, care or treatment or for which medical advice, diagnosis, care or treatment was recommended or received during the 12 months immediately preceding the effective date of coverage application or to a pregnancy existing on the effective date of coverage.
C. An individual policy issued on or after January 1, 1998 to a federally eligible individual as defined in section 2848 may not contain a preexisting condition exclusion.
D. A routine preventive screening or test yielding only negative results may not be deemed considered to be diagnosis, care or treatment for the purposes of this subsection.
E. Genetic information may not be used as the basis for imposing a preexisting condition exclusion in the absence of a diagnosis of the condition relating to that information. For the purposes of this paragraph, "genetic information" has the same meaning as set forth in the Code of Federal Regulations.
Sec. L-10. 24-A MRSA §2850-B, sub-§1, ¶B, as enacted by PL 1997, c. 445, §30 and affected by §32, is amended to read:
B. Group and blanket medical insurance contracts subject to chapter 35 except:
(1) Medicare supplement policies subject to chapter 67; and
(2) Contracts designed to cover specific diseases, hospital indemnity or accidental injury only.
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