An Act To Comply with the Health Insurance Exchange Provision of the Patient Protection and Affordable Care Act
Sec. 1. 5 MRSA §12004-G, sub-§14-H is enacted to read:
|Health care||Board of Directors of the Maine Health Benefit Exchange||Expenses Only||24-A MRSA §7004|
Sec. 2. 24-A MRSA c. 89 is enacted to read:
MAINE HEALTH BENEFIT EXCHANGE ACT
§ 7001. Short title
This chapter may be known and cited as "the Maine Health Benefit Exchange Act."
§ 7002. Definitions
As used in this chapter, unless the context otherwise indicates, the following terms have the following meanings.
(1) Coverage only for accident or disability income insurance or any combination thereof;
(2) Coverage issued as a supplement to liability insurance;
(3) Liability insurance, including general liability insurance and automobile liability insurance;
(4) Workers' compensation or similar insurance;
(5) Automobile medical payment insurance;
(6) Credit-only insurance;
(7) Coverage for on-site medical clinics; or
(8) Insurance coverage similar to any coverage listed in subparagraphs (1) to (7), as specified in federal regulations issued pursuant to the federal Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, under which benefits for health care services are secondary or incidental to other insurance benefits.
(1) Limited-scope dental or vision benefits;
(2) Benefits for long-term care, nursing home care, home health care, community-based care or any combination thereof; or
(3) Limited benefits similar to those listed in subparagraphs (1) and (2), as specified in federal regulations issued pursuant to the federal Health Insurance Portability and Accountability Act of 1996, Public Law 104-191.
(1) Coverage only for a specified disease or illness; or
(2) Hospital indemnity or other fixed indemnity insurance.
(1) Medicare supplemental health insurance as defined under the United States Social Security Act, Section 1882(g)(1) of ;
(2) Coverage supplemental to the coverage provided under 10 United States Code, Chapter 55; or
(3) Supplemental coverage similar to coverage listed in subparagraphs (1) and (2) provided under a group health plan.
§ 7003. Maine Health Benefit Exchange established; declaration of necessity
§ 7004. Board of Directors of Maine Health Benefit Exchange
The Board of Directors of the Maine Health Benefit Exchange, as established in Title 5, section 12004-G, subsection 14-H, is established to supervise the exchange.
§ 7005. Limitation on liability
§ 7006. Duties of board; plan of operation
§ 7007. Availability of coverage
§ 7008. Powers and duties of the Maine Health Benefit Exchange
(1) There is no affordable qualified health plan available through the exchange or the individual's employer covering the individual; or
(2) The individual meets the requirements for any other exemption from the individual responsibility requirement or penalty;
(1) A list of the individuals who are issued a certification under paragraph J, including the name and taxpayer identification number of each individual;
(2) The name and taxpayer identification number of each individual who was an employee of an employer but who was determined to be eligible for the premium tax credit under Section 1401 of the Federal Act because:
(a) The employer did not provide the minimum essential coverage; or
(b) The employer provided the minimum essential coverage, but it was determined under Section 1401 of the Federal Act to either be unaffordable to the employee or not provide the required minimum actuarial value; and
(3) The name and taxpayer identification number of:
(a) Each individual who notifies the exchange under Section 1411(b)(4) of the Federal Act that the individual has changed employers; and
(b) Each individual who ceases coverage under a qualified health plan during a plan year and the effective date of that cessation;
(1) Conduct public education activities to raise awareness of the availability of qualified health plans;
(2) Distribute fair and impartial information concerning enrollment in qualified health plans and the availability of premium tax credits under Section 1401 of the Federal Act and cost-sharing reductions under Section 1402 of the Federal Act;
(3) Facilitate enrollment in qualified health plans;
(4) Provide referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman established under 42 United States Code, Section 300gg-93 (2010), or any other appropriate state agency or agencies, for an enrollee with a grievance, complaint or question regarding a health benefit plan or coverage or a determination under that plan or coverage; and
(5) Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the exchange;
(1) Educated health care consumers who are enrollees in qualified health plans;
(2) Individuals and entities with experience in facilitating enrollment in qualified health plans;
(3) Representatives of small businesses and self-employed individuals;
(4) The MaineCare program; and
(5) Advocates for enrolling hard-to-reach populations;
(1) Investigate the affairs of the exchange;
(2) Examine the properties and records of the exchange; and
(3) Require periodic reports in relation to the activities undertaken by the exchange; and
§ 7009. Health benefit plan certification
(1) The exchange has determined that at least one qualified dental plan is available to supplement the plan's coverage; and
(2) The carrier makes prominent disclosure at the time it offers the plan, in a form approved by the exchange, that the plan does not provide the full range of essential pediatric dental benefits and that qualified dental plans providing those benefits and other dental benefits not covered by the plan are offered through the exchange;
(1) Is licensed and in good standing to offer health insurance coverage in this State;
(2) Offers at least one qualified health plan in the silver level and at least one plan in the gold level as described in Section 1302(d)(1)(B) and Section 1302(d)(1)(C) of the Federal Act through each component of the exchange in which the carrier participates. As used in this subparagraph, "component" means the SHOP exchange and the exchange;
(3) Charges the same premium rate for each qualified health plan without regard to whether the plan is offered through the exchange and without regard to whether the plan is offered directly from the carrier or through an insurance producer;
(4) Does not charge any cancellation fees or penalties in violation of section 7007, subsection 4; and
(5) Complies with the regulations developed by the secretary under Section 1311(c) of the Federal Act and such other requirements as the exchange may establish;
(1) Claims payment policies and practices;
(2) Periodic financial disclosures;
(3) Data on enrollment;
(4) Data on disenrollment;
(5) Data on the number of claims that are denied;
(6) Data on rating practices;
(7) Information on cost sharing and payments with respect to any out-of-network coverage;
(8) Information on enrollee and participant rights under Title I of the Federal Act; and
(9) Other information as determined appropriate by the secretary.
The information required in this paragraph must be provided in plain language, as that term is defined in Section 1311(e)(3)(B) of the Federal Act; and
§ 7010. Funding; publication of costs
§ 7011. Relation to other laws
This chapter, and any action taken by the exchange pursuant to this chapter, may not be construed to preempt or supersede the authority of the superintendent to regulate the business of insurance within this State. Except as expressly provided to the contrary in this chapter, all health carriers offering qualified health plans in this State shall comply fully with all applicable health insurance laws of this State and rules adopted and orders issued by the superintendent.
§ 7012. Licensing of navigators
A navigator for the exchange, as selected pursuant to section 7008, subsection 2, paragraph N, must be licensed as a producer pursuant to chapter 16.
Sec. 3. Staggered terms. Notwithstanding the Maine Revised Statutes, Title 24-A, section 7004, subsection 2, of the initial members appointed to the Board of Directors of the Maine Health Benefit Exchange, 2 members serve an initial term of 4 years, 4 members serve an initial term of 5 years and 4 members serve an initial term of 6 years.
This bill establishes the Maine Health Benefit Exchange pursuant to the federal Patient Protection and Affordable Care Act. The exchange is established as authorized by federal law to facilitate the purchase of health care coverage by individuals and small businesses. The bill requires coverage to be available through the exchange no later than January 1, 2014. The bill authorizes the use of an assessment or user fee on health insurance carriers to support the operations of the exchange.