Sec. E-1. 24-A MRSA §2701, sub-§2, ¶C, as enacted by PL 1995, c. 332, Pt. J, §1, is amended to read:
C. Section Sections 2736, 2736-A, 2736-B and 2736-C applies apply to:
(1) Association groups as defined by section 2805-A, except associations of employers; and
(2) Other groups as defined by section 2808, except employee leasing companies registered pursuant to Title 32, chapter 125.
Sec. E-2. 24-A MRSA §2736-C, sub-§3, ¶A, as amended by PL 1997, c. 445, §9 and affected by §32, is further amended to read:
A. Coverage must be guaranteed to all residents of this State other than those eligible without paying a premium for Medicare Part A. On or after January 1, 1998, coverage must be guaranteed to all legally domiciled federally eligible individuals, as defined in section 2848, regardless of the length of time they have been legally domiciled in this State. Except for federally eligible individuals, coverage need not be issued to an individual whose coverage was terminated for nonpayment of premiums during the previous 91 days or for fraud or intentional misrepresentation of material fact during the previous 12 months. When a managed care plan, as defined by section 4301, provides coverage a carrier may:
(1) Deny coverage to individuals who neither live nor reside within the approved service area of the plan for at least 6 months of each year; and
(2) Deny coverage to individuals if the carrier has demonstrated to the superintendent's satisfaction that:
(a) The carrier does not have the capacity to deliver services adequately to additional enrollees within all or a designated part of its service area because of its obligations to existing enrollees; and
(b) The carrier is applying this provision uniformly to individuals and groups without regard to any health-related factor.
A carrier that denies coverage in accordance with this paragraph may not enroll individuals residing within the area subject to denial of coverage or groups or subgroups within the service that area for a period of 180 days after the date of the first denial of coverage.
Sec. E-3. 24-A MRSA §2808-B, sub-§1, ¶D, as repealed and replaced by PL 1997, c. 445, §12 and affected by §32, is amended to read:
D. "Eligible group" means any person, firm, corporation, partnership, association or subgroup engaged actively in a business that employed an average of 50 or fewer eligible employees during the preceding calendar year, more of whom are employed within this State than in any other state.
(1) If an employer was not in existence throughout the preceding calendar year, the determination must be based on the average number of employees that the employer is reasonably expected to employ on business days in the current calendar year.
(2) In determining the number of eligible employees, companies that are affiliated companies or that are eligible to file a combined tax return for purposes of state taxation are considered one employer.
(3) A group is not an eligible group if there is any one other state where there are more eligible employees than are employed within this State and the group had coverage in that state or is eligible for guaranteed issuance of coverage in that state.
Sec. E-4. 24-A MRSA §2808-B, sub-§2, ¶E, as repealed and replaced by PL 1999, c. 256, Pt. E, §1, is amended to read:
E. The superintendent may exempt from the requirements of this subsection authorize a carrier to establish a separate community rate for an association group organized pursuant to section 2805-A or a trustee group organized pursuant to section 2806 that offers a, as long as association group membership or eligibility for participation in the trustee group is not conditional on health status, claims experience or other risk selection criteria and all small group health plan plans offered by the carrier through that association or trustee group:
(1) Complies Are otherwise in compliance with the premium rate requirements of this subsection; and
(2) Guarantees issuance and renewal to all persons and their dependents within Are offered on a guaranteed issue basis to all eligible employers that are members of the association or are eligible to participate in the trustee group except that a professional association may require that a minimum percentage of the eligible professionals employed by a subgroup be members of the association in order for the subgroup to be eligible for issuance or renewal of coverage through the association. The minimum percentage must not exceed 90%. For purposes of this subparagraph, "professional association" means an association that:
(a) Serves a single profession that requires a significant amount of education, training or experience or a license or certificate from a state authority to practice that profession;
(b) Has been actively in existence for 5 years;
(c) Has a constitution and bylaws or other analogous governing documents;
(d) Has been formed and maintained in good faith for purposes other than obtaining insurance;
(e) Is not owned or controlled by a carrier or affiliated with a carrier;
(f) Does not make membership in the association conditional on health status or claims experience;
(g) Has a least 1,000 members if it is a national association; 200 members if it is a state or local association;
(h) All members and dependents of members are eligible for coverage regardless of health status or claims experience; and
(i) Is governed by a board of directors and sponsors annual meetings of its members.
Producers may only market association memberships, accept applications for membership or sign up members in the professional association where the individuals are actively engaged in or directly related to the profession represented by the professional association.
Sec. E-5. 24-A MRSA §2848, sub-§1-B, as amended by PL 1999, c. 256, Pt. L, §2, is further amended by amending the last blocked paragraph to read:
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. For purposes of this subsection and subsection 1-C, "group health plan" has the same meaning as specified in the federal Public Health Service Act, Title XXVII, Section 2791(a).
Sec. E-6. 24-A MRSA §2849, sub-§4, as repealed and replaced by PL 1993, c. 349, §53, is repealed.
Sec. E-7. 24-A MRSA §2849-B, sub-§2, ¶A, as amended by PL 1999, c. 36, §2, is further amended to read:
A. That person was covered under an individual or group contract or policy issued by any nonprofit hospital or medical service organization, insurer, health maintenance organization, or was covered under an uninsured employee benefit plan that provides payment for health services received by employees and their dependents or a governmental program, including, but not limited to, those listed in section 2848, subsection 1-B, paragraph A, subparagraphs (3) to (10). For purposes of this section, the individual or group policy under which the person is seeking coverage is the "succeeding policy." The group or individual contract or policy or the, uninsured employee benefit plan or governmental program that previously covered the person is the "prior contract or policy"; and
Sec. E-8. 24-A MRSA §2849-B, sub-§3, as amended by PL 1999, c. 256, Pt. L, §7, 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 2850. 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. E-9. 24-A MRSA §2850, sub-§1-A, as enacted by PL 1997, c. 445, §28 and affected by §32, is repealed and the following enacted in its place:
1-A. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings.
A. "Date of enrollment" means the effective date of coverage or, if earlier, the first day of the waiting period for such coverage.
B. "Preexisting condition exclusion," with respect to coverage, means a limitation or exclusion of benefits relating to a condition based on the fact or perception that the condition was present, or that the person was at particularized risk of developing the condition, before the date of enrollment for coverage, whether or not any medical advice, diagnosis, care or treatment was recommended or received before that date.
Sec. E-10. 24-A MRSA §2850-B, sub-§3, as enacted by PL 1997, c. 445, §30 and affected by §32, is amended by amending the first paragraph to read:
3. Renewal. Renewal Coverage may not be cancelled, and renewal must be guaranteed to all individuals, to all groups and to all eligible members and their dependents in those groups except:
Sec. E-11. 24-A MRSA §2850-B, sub-§4, ¶B, as enacted by PL 1997, c. 445, §30 and affected by §32, is amended to read:
B. Carriers that cease to write new small group business continue to be governed by section 2808-B with respect to business conducted after that section small group contracts in force and their renewal or replacement contracts.
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