LD 1239
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Page 1 of 15 An Act Concerning Universal Health Insurance Page 3 of 15
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LR 186
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Centers for Disease Control and Prevention guidelines in
effect on the year of issuance or renewal of the policy.

 
E.__If approved by the superintendent, the policy may
include provisions with financial incentives encouraging a
policyholder to receive health care services at a center
of excellence or other high-quality provider designated by
the carrier based on objective quality indicators.

 
Rules adopted pursuant to this subsection are routine
technical rules as defined in Title 5, chapter 375, subchapter
2-A.

 
Sec. A-2. 24-A MRSA §2808-B, sub-§8-A is enacted to read:

 
8-A. Primary health care policy.__All carriers offering
small group health plans in this State shall offer a primary
health care policy, referred to in this subsection as "the
policy".__The superintendent shall adopt rules that define the
benefit design for the policy in accordance with the
following.

 
A. The policy must provide coverage that emphasizes
primary and preventive care, including, but not limited
to, well-adult and well-child visits and health
screenings.

 
B. The annual maximum limit payable on the policy per
member covered under the small group health plan,
including dependents, must be determined as follows:

 
(1)__For a member whose income is between 100% and
200% of the federal nonfarm income federal poverty
level, the annual maximum limit payable on the policy
is $2,000 per member covered under the policy;

 
(2) For a member whose income is between 200% and
300% of the federal nonfarm income federal poverty
level, the annual maximum limit payable on the policy
is $5,000 per member covered under the policy;

 
(3) For a member whose income is between 300% and
400% of the federal nonfarm income federal poverty
level, the annual maximum limit payable on the policy
is $10,000 per member covered under the policy; and

 
(4) For a member whose income is above 400% of the
federal nonfarm income federal poverty level, the
annual maximum limit payable on the policy is $25,000
per member covered under the policy.


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