LD 1611
pg. 17
Page 16 of 47 An Act To Provide Affordable Health Insurance to Small Businesses and Individua... Page 18 of 47
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LR 2137
Item 1

 
(4)__Dirigo Health may require that eligible
individuals certify that all their dependents are
enrolled in Dirigo Health Insurance or are covered by
another creditable plan.

 
(5)__Dirigo Health may require an eligible individual
who is currently employed by an eligible employer that
does not offer health insurance to certify that the
current employer did not provide access to an employer-
sponsored benefits plan in the 12-month period
immediately preceding the eligible individual's
application.

 
(6)__Dirigo Health may limit the number of plan
enrollees.

 
(7)__Dirigo Health may establish other criteria for
participation.

 
3.__Enrollment in Dirigo Health Insurance.__Dirigo Health
shall perform, at a minimum, the following functions to
facilitate enrollment in Dirigo Health Insurance.

 
A. Dirigo Health shall publicize the availability of Dirigo
Health Insurance to businesses, self-employed individuals
and others eligible to enroll in Dirigo Health Insurance.

 
B. Dirigo Health shall screen all eligible individuals and
employees for eligibility for subsidies under section 6918
and eligibility for MaineCare.__To facilitate the screening
and referral process, Dirigo Health shall provide a single
application form for Dirigo Health and MaineCare.__The
application materials must inform applicants of subsidies
available through Dirigo Health and of the additional
coverage available through MaineCare.__It must allow an
applicant to choose on the application form to apply or not
to apply for MaineCare or for a subsidy.__It must allow an
applicant to provide household financial information
necessary to determine eligibility for MaineCare or a
subsidy.__Except when the applicant has declined to apply
for MaineCare or a subsidy, an application must be treated
as an application for Dirigo Health, for a subsidy and for
MaineCare.__MaineCare must make the final determination of
eligibility for MaineCare.

 
4.__Quality improvement, disease management and cost
containment.__Dirigo Health shall promote quality improvement,
disease management and cost-containment programs as part of its
administration of Dirigo Health Insurance.


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