LD 1496
pg. 6
Page 5 of 41 An Act To Reduce Maine's Health Insurance Rates and Expand Consumer Choice ... Page 7 of 41
Download Bill Text
LR 541
Item 1

 
5.__Health maintenance organization.__"Health maintenance
organization" means an organization authorized under chapter 56 to
operate a health maintenance organization in this State.

 
6.__Insurer.__"Insurer" means an entity that is authorized to
write medical insurance or that provides medical insurance in
this State. For the purposes of this chapter, "insurer" includes
an insurance company, a nonprofit hospital and medical service
organization, a fraternal benefit society, a health maintenance
organization, a self-insurance arrangement that provides health
care benefits in this State to the extent allowed under the
federal Employee Retirement Income Security Act of 1974, a 3rd-
party administrator, a multiple-employer welfare arrangement,
another entity providing medical insurance or health benefits
subject to state insurance regulation and a reinsurer that
reinsures health insurance in this State.

 
7.__Medical insurance.__"Medical insurance" means a hospital
and medical expense-incurred policy, nonprofit hospital and
medical service plan, health maintenance organization subscriber
contract or other health care plan or arrangement that pays for
or furnishes medical or health care services whether by insurance
or otherwise, whether sold as an individual or group policy.
"Medical insurance" does not include accidental injury, specified
disease, hospital indemnity, dental, vision, disability income,
Medicare supplement, long-term care or other limited benefit
health insurance or credit insurance; coverage issued as a
supplement to liability insurance; insurance arising out of
workers' compensation or similar law; automobile medical payment
insurance; or insurance under which benefits are payable with or
without regard to fault and that is statutorily required to be
contained in any liability insurance policy or equivalent self-
insurance.

 
8.__Medicare.__"Medicare" means coverage under both Parts A
and B of Title XVIII of the federal Social Security Act, 42
United States Code, Section 1395 et seq., as amended.

 
9.__Plan.__"Plan" means the health insurance plan adopted by
the board pursuant to this chapter.

 
10.__Producer.__"Producer" means a person who is licensed to
sell health insurance in this State.

 
11.__Resident.__"Resident" means an individual who:

 
A.__Is legally located in the United States and has been
legally domiciled in this State for a period to be
established by the board, not to exceed one year, subject to
the approval of the superintendent;


Page 5 of 41 Top of Page Page 7 of 41