LD 1168
pg. 16
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LR 790
Item 1

 
§3909.__Requirements for coverage

 
1.__Coverage offered. The plan must offer in an annually
renewable policy the coverage specified in this section for each
eligible person. If a covered person is also eligible for
Medicare coverage, the plan may not pay or reimburse any person
for expenses paid by Medicare.__A person whose health insurance
coverage is involuntarily terminated for any reason other than
nonpayment of premium may apply for coverage under the plan.__If
such coverage is applied for within 90 days after the involuntary
termination and if premiums are paid for the period starting at
the date of the involuntary termination, the effective date of
the coverage is the date of termination of the previous coverage.

 
2.__Major medical expense coverage.__The plan must offer major
medical expense coverage to every covered person who is not
eligible for Medicare.__The board shall establish the coverage to
be issued by the plan, its schedule of benefits and exclusions
and other limitations, which the board may amend from time to
time subject to the approval of the superintendent. In
establishing the plan coverage, the board shall take into
consideration the levels of health insurance provided in the
State and medical economic factors as determined appropriate.__As
an optional rider, the plan must offer coverage for mental health
benefits as provided in section 2749-C and coverage for maternity
benefits as provided in section 2741 and 2743-A.

 
3.__Rates. Rates for coverage issued by the association must
meet the requirements of this subsection.

 
A.__Rates may not be unreasonable in relation to the
benefits provided, the risk experience and the reasonable
expenses of providing the coverage.

 
B.__Rate schedules must comply with section 2736-C and are
subject to approval by the superintendent.

 
C.__Subject to approval by the superintendent, standard risk
rates for coverage issued by the association must be
established by the association using reasonable actuarial
techniques and must reflect anticipated experiences and
expenses of such coverage for standard risks. The premium
for the standard risk rates must range from a minimum of
125% to a maximum of 150% of the weighted average of rates
charged by those insurers and health maintenance
organizations with individuals enrolled in similar medical
insurance plans.

 
4.__Compliance with state law.__Products offered by the


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