LD 1496
pg. 19
Page 18 of 41 An Act To Reduce Maine's Health Insurance Rates and Expand Consumer Choice ... Page 20 of 41
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LR 541
Item 1

 
§3913.__Reimbursement of member insurer

 
1.__Reimbursement.__A member insurer may seek reimbursement
from the association and the association shall reimburse the
member insurer to the extent claims made by a covered person
after April 1, 2006 exceed premiums paid on a calendar-year basis
by the covered person to the member insurer for a covered person
who meets the following criteria:

 
A. The member insurer sold an individual health plan to the
covered person between December 1, 1993 and April 1, 2006
and the policy that was sold has been continuously renewed
by the covered person and the carrier has closed its book of
business for individual health plans sold between December
1, 1993 and April 1, 2006; and

 
B. The member insurer is able to determine through the use
of individual health statements, claims history or any
reasonable means that at the time the person applied for
insurance coverage with the member insurer, the covered
person was diagnosed with one of the following medical
conditions: acquired immune deficiency syndrome, angina
pectoris, ascites, chemical dependency cirrhosis of the
liver, coronary occlusion, cystic fibrosis, Friedreich's
ataxia, hemophilia, Hodgkin's disease, Huntington's chorea,
juvenile diabetes, leukemia, metastatic cancer, motor or
sensory aphasia, multiple sclerosis, muscular dystrophy,
myasthenia gravis, myotonia, heart disease causing open
heart surgery, Parkinson's disease, polycystic kidney,
psychotic disorders, quadriplegia, stroke, syringomyelia or
Wilson's disease.

 
2. Rules.__The superintendent may adopt rules to facilitate
payment to a carrier pursuant to this section. Rules adopted
pursuant to this subsection are routine technical rules as
defined in Title 5, chapter 375, subchapter 2-A.

 
3.__Repeal.__This section is repealed April 1, 2010.

 
Sec. A-16. Application for federal grant. Within 30 days of the effective
date of this Act, the Superintendent of Insurance shall submit an
application to the federal Department of Health and Human
Services, Health Resources and Services Administration for a
federal seed grant to support the creation and initial operation
of the Comprehensive Health Insurance Risk Pool Association
established in the Maine Revised Statutes, Title 24-A, chapter
54.


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