CHAPTER 197
H.P. 794 - L.D. 1082
An Act to Ensure Fair Pricing for Consumers of Health Care Services under Managed Care Plans
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 24-A MRSA §2185 is enacted to read:
§2185. Calculation of health benefits based on actual cost
All health insurance policies, health maintenance organization plans and subscriber contracts or certificates of nonprofit hospital or medical service organizations with respect to which the insurer or organization has negotiated discounts with providers must provide for the calculation of all covered health benefits, including without limitation all coinsurance, deductibles and lifetime maximum benefits, on the basis of the net negotiated cost and must fully reflect any discounts or differentials from charges otherwise applicable to the services provided. With respect to policies or plans involving risk-sharing compensation arrangements, net negotiated costs may be calculated at the time services are rendered on the basis of reasonably anticipated compensation levels and are not subject to retrospective adjustment at the time a cost settlement between a provider and the insurer or organization is finalized.
Effective September 19, 1997, unless otherwise indicated.
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