LD 1168
pg. 17
Page 16 of 20 An Act To Reduce Individual Health Insurance Premiums Page 18 of 20
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LR 790
Item 1

 
association must comply with all relevant requirements of this
Title applicable to individual health insurance, including
requirements for mandated coverage for specific health care
services and specific diseases and for certain providers of health
care services.

 
5.__Other sources primary. The association must be payor of
last resort of benefits whenever any other benefit or source of
3rd-party payment is available.__The coverage provided by the
association must be considered excess coverage, and benefits
otherwise payable under association coverage must be reduced by
all amounts paid or payable through any other health insurance
and by all hospital and medical expense benefits paid or payable
under any short-term, accident, dental-only, vision-only, fixed
indemnity, limited benefit or credit insurance; coverage issued
as a supplement to liability insurance; workers' compensation
coverage; automobile medical payment; liability insurance,
whether or not provided on the basis of fault; and by any
hospital or medical benefits paid or payable by any insurer or
insurance arrangement or any hospital or medical benefits paid or
payable under or provided pursuant to any state or federal law or
program.

 
6.__Recovery of claims paid.__An amount paid or payable by
Medicare or any other governmental program or any other insurance
or self-insurance maintained in lieu of otherwise statutorily
required insurance may not be made or recognized as a claim under
such a policy or be recognized as or towards satisfaction of an
applicable deductible or out-of-pocket maximum or be used to
reduce the limits of benefits available under the plan.__The
association has a cause of action against a covered person for
the recovery of the amount of any benefits paid to the covered
person that should not have been claimed or recognized as claims
because of the provisions of this subsection or because the
benefits are otherwise not covered.__Benefits due from the
association may be reduced or refused as a setoff against any
amount recoverable under this subsection.

 
§3910.__Eligibility for coverage

 
1.__Eligibility; application for coverage.__A resident is
eligible for coverage under the plan if the resident provides
evidence of rejection, a requirement of restrictive riders, a
rate increase or a preexisting conditions limitation on a
qualified plan, the effect of which is to substantially reduce
coverage from that received by a person considered a standard
risk by at least one member insurer within 6 months of the date
of the certificate, or if the resident meets other eligibility
requirements adopted by rule by the superintendent that are not


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