LD 1496
pg. 31
Page 30 of 41 An Act To Reduce Maine's Health Insurance Rates and Expand Consumer Choice ... Page 32 of 41
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LR 541
Item 1

 
Sec. B-18. 24-A MRSA §4207, sub-§5, as amended by PL 2003, c. 469, Pt.
E, §19, is further amended to read:

 
5. A schedule or an amendment to a schedule of charge for
enrollee health coverage for health care services may not be used
by any health maintenance organization unless it complies with
section 2736, 2808-B 2808-C or 2839, whichever is applicable.

 
Sec. B-19. 24-A MRSA §4210, sub-§1, as amended by PL 1995, c. 332, Pt.
O, §4, is further amended to read:

 
1. After a health maintenance organization has been in
operation 24 months, it shall have an annual open enrollment
period of at least one month during which it accepts enrollees up
to the limits of its capacity, as determined by the health
maintenance organization, in the order in which they apply for
enrollment. To the extent not inconsistent with the requirements
of chapter 36 and sections 2736-C and 2808-B 2808-C as qualified
by section 4222-B, subsection 3, a health maintenance
organization may apply to the superintendent for authorization to
impose such underwriting restrictions upon enrollment as are
necessary to preserve its financial stability, to prevent
excessive adverse selection by prospective enrollees or to avoid
unreasonably high or unmarketable charges for enrollee coverage
for health care services. The superintendent shall approve or
deny the application within 10 days of the receipt of that
application from the health maintenance organization.

 
Sec. B-20. 24-A MRSA §4212, sub-§2, ¶C, as enacted by PL 1995, c. 332,
Pt. O, §6, is amended to read:

 
C. When the provisions of the State's community rating law
are applicable, as provided by section 2736-C, subsection 3,
paragraph B and section 2808-B, subsection 4, paragraph B;
or

 
Sec. B-21. 24-A MRSA §4222-B, sub-§3, as enacted by PL 1995, c. 332,
Pt. O, §8, is amended to read:

 
3. The requirements of sections 2736-C and 2808-B, 2808-C
community rating law, apply to health maintenance organizations,
except that a health maintenance organization is not required to
offer coverage or accept applications from an eligible group or
individual located outside the health maintenance organization's
approved service area.

 
Sec. B-22. 24-A MRSA §4346, sub-§1, ¶D, as enacted by PL 2001, c. 708,
§3, is amended to read:

 
D. "Eligible employee" or "employee" means an individual
who:


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