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§3913.__Reimbursement of member insurer |
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| | 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: |
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| 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 |
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| 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. |
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| | 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. |
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| | 3.__Repeal.__This section is repealed April 1, 2010. |
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| | 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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