LD 394
pg. 18
Page 17 of 21 An Act To Create a High-risk Pool in the Health Insurance Market Page 19 of 21
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LR 516
Item 1

 
lifetime benefits available through the association less any
benefits received from a similar organization in the former
domiciliary state.

 
3.__Eligibility without application.__The board shall develop
a list of medical or health conditions for which a person is
eligible for plan coverage without applying for health insurance
under subsection 1.__A person who can demonstrate the existence
or history of any medical or health conditions on the list
developed by the board may not be required to provide the
evidence specified in subsection 1. The board may amend the list
from time to time as appropriate.

 
4.__Exclusions from eligibility.__A person is not eligible for
coverage under the plan if:

 
A.__The person has or obtains health insurance coverage
substantially similar to or more comprehensive than a plan
policy or would be eligible to have coverage if the person
elected to obtain it, except that:

 
(1)__A covered person may maintain other coverage for
the period of time the person is satisfying a
preexisting condition waiting period under a plan
policy; and

 
(2)__A covered person may maintain plan coverage for
the period of time the person is satisfying a
preexisting condition waiting period under another
health insurance policy intended to replace the plan
policy;

 
B.__The person is determined eligible for health care
benefits under the MaineCare program pursuant to Title 22;

 
C.__The person previously terminated plan coverage, unless
12 months have elapsed since the person's last termination;

 
D.__The person has met the lifetime maximum benefit amount
under the plan of $3,000,000;

 
E.__The person is an inmate or resident of a public
institution; or

 
F.__The person's premiums are paid for or reimbursed under
any government-sponsored program or by any government agency
or health care provider, except as an otherwise qualifying
full-time employee, or dependent thereof, of a government
agency or health care provider.


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