LD 1611
pg. 14
Page 13 of 47 An Act To Provide Affordable Health Insurance to Small Businesses and Individua... Page 15 of 47
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LR 2137
Item 1

 
1.__Dirigo Health Insurance.__Dirigo Health shall arrange for
the provision of health benefits coverage through Dirigo Health
Insurance.__Dirigo Health Insurance must comply with all relevant
requirements of this Title.__Dirigo Health Insurance may be
offered by health insurance carriers that apply to the board and
meet qualifications described in this section and any additional
qualifications set by the board.__If health insurance carriers do
not apply to offer and deliver Dirigo Health Insurance, the board
shall have Dirigo Health provide access to health insurance by
establishing a nonprofit health plan or through an existing
public plan.__To qualify as a carrier of Dirigo Health Insurance,
a health insurance carrier must:

 
A.__Provide the comprehensive health services and benefits
as determined by the board, including a standard benefit
package and any supplemental benefits the board wishes to
make available; and

 
B.__Ensure that:

 
(1)__Providers participating in Dirigo Health Insurance
do not charge plan enrollees or 3rd parties for covered
health care services in excess of the amount reimbursed
to that provider by Dirigo Health Insurance; and

 
(2) Providers participating in Dirigo Health Insurance
do not refuse to provide services to a plan enrollee on
the basis of health status, medical condition, previous
insurance status, race, color, creed, age, national
origin, citizenship status, gender, sexual orientation,
disability or marital status.

 
Health insurance carriers that seek to qualify to provide Dirigo
Health Insurance must also qualify as health plans in MaineCare.

 
2.__Contracting authority.__Dirigo Health has contracting
authority and powers to administer Dirigo Health Insurance as set
out in this subsection.

 
A.__Dirigo Health may contract with health insurance
carriers licensed to sell health insurance in this State or
other private or public 3rd-party administrators to provide
Dirigo Health Insurance.__In addition:

 
(1)__Dirigo Health shall issue requests for proposals
from health insurance carriers;

 
(2)__Dirigo Health may include quality control, disease
management and cost-containment provisions in the contracts with
participating health insurance carriers


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