CHAPTER 369
H.P. 193 - L.D. 204
An Act to Encourage the Creation of an Alliance for the Purpose of Purchasing Health Insurance
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 24-A MRSA §1951, sub-§2, as amended by PL 1997, c. 616, §1, is further amended to read:
2. Private purchasing alliance. "Private purchasing alliance" or "alliance" means a corporation licensed pursuant to this section established under Title 13-A or Title 13-B to provide health insurance to its members through multiple unaffiliated one or more participating carriers.
Sec. 2. 24-A MRSA §1954, sub-§2, as amended by PL 1997, c. 370, Pt. A, §§1 and 2, is further amended to read:
2. Enrollee choice. Ensure that enrollees have a choice among a reasonable number of competing carriers and types of health benefit plans in accordance with the following.
A. In every portion of the alliance's service area, the alliance must offer at least 3 different carriers. When 3 participating carriers are not reasonably available in some or all of the alliance's service area, the superintendent may waive this requirement in accordance with standards and procedures established by rule pursuant to this chapter.
Sec. 3. 24-A MRSA §2677-A, sub-§2, as enacted by PL 1999, c. 609, §14, is amended to read:
2. Benefit level. The benefit level differential between services rendered by preferred providers and nonpreferred providers may not exceed 20% of the allowable charge for the service rendered, except that the superintendent may waive this requirement for a given benefit plan. Compliance with this requirement for a given benefit plan may be demonstrated on an aggregate basis. This demonstration of compliance must be based on a reasonably anticipated mix of claims certified by a qualified actuary who is a member of the American Academy of Actuaries or a successor organization. As used in this subsection, "allowable charge" means the amount that would be payable for services under the preferred provider arrangement including deductible and coinsurance amounts.
Effective September 21, 2001, unless otherwise indicated.
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