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PUBLIC LAWS OF MAINE
First Regular Session of the 120th

PART B

     Sec. B-1. 24-A MRSA §2803-A, sub-§§2 and 3, as enacted by PL 1995, c. 71, §2, are amended to read:

     2. Disclosure of basic loss information. Upon written request, every insurer shall provide loss information concerning a group policy or contract to its policyholder at least 60 days prior to renewal of the policy or contract and again 6 months from the date the policy becomes effective within 21 business days of the date of the request.

     3. Transmittal of request. If a policyholder requests loss information from an An insurance agent producer or other authorized representative, the representative or agent who receives a request for loss information in accordance with this section shall transmit the request for loss information to the insurer within 4 working business days.

     Sec. B-2. 24-A MRSA §2803-A, sub-§4, as amended by PL 1997, c. 370, Pt. E, §5, is further amended to read:

     4. Exception. An insurer is not required to provide the loss information described in this section to for a group that is eligible for small group coverage pursuant to section 2808-B.

     Sec. B-3. 24-A MRSA §4222-B, sub-§§17 to 19 are enacted to read:

     17. Section 2803-A, relating to disclosure of loss information, applies to health maintenance organizations.

     18. The requirement of section 2809-A, subsection 11 to continue group coverage under certain circumstances applies to health maintenance organizations.

     19. Section 12-A, relating to penalties, applies to health maintenance organizations.

     Sec. B-4. 24-A MRSA §4224-A, as amended by PL 1997, c. 370, Pt. E, §7, is repealed.

     Sec. B-5. 24-A MRSA §4303, sub-§8 is enacted to read:

     8. Maximum allowable charges. All policies, contracts and certificates executed, delivered and issued by a carrier under which the insured or enrollee may be subject to balance billing when charges exceed a maximum considered usual, customary and reasonable by the carrier or that contain contractual language of similar import must be subject to the following.

     Sec. B-6. 24-A MRSA §4304, sub-§6 is enacted to read:

     6. Notice. A notice issued by a carrier or its contracted utilization review entity in response to a request by or on behalf of an insured or enrollee for authorization of medical services that advises that the requested service has been determined to be medically necessary must also advise whether the service is covered under the policy or contract under which the insured or enrollee is covered. Nothing in this subsection requires a carrier to provide coverage for services performed when the insured or enrollee is no longer covered by the health plan.

     Sec. B-7. 24-A MRSA §5002-B, sub-§2-A is enacted to read:

     2-A. Low-cost drugs for the elderly or disabled program. An issuer that offers standardized plans that include prescription drug benefits shall permit an insured who has a plan from the same issuer without prescription drug benefits to purchase a plan with prescription drug benefits under the following circumstances:

The purchase of a plan with prescription drug benefits by an insured pursuant to this subsection does not affect eligibility for coverage under the low-cost drugs for the elderly or disabled program established by Title 22, section 254 if the insured is not covered by a Medicare supplement plan with prescription drug benefits at the time of reapplying for coverage under the low-cost drugs for the elderly or disabled program established by Title 22, section 254.

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