Chapter 36: CONTINUITY OF HEALTH INSURANCE COVERAGE HEADING: PL 1989, C. 867, §8 (NEW)
§2850. Limitations on exclusion and waiting periods
This section applies to individual, group and blanket medical insurance contracts subject to chapters 33 and 35, except
Medicare supplement contracts, converted contracts issued under section 2809-A and contracts designed to cover specific diseases,
hospital indemnity or accidental injury only.
1999, c. 256, Pt. L, §8 (AMD)
As used in this section, unless the context otherwise indicates, the following terms have the following meanings.
A. "Date of enrollment" means the effective date of coverage or, if earlier, the first day of the waiting period for such coverage. [2001, c. 258, Pt. E, §9 (NEW).]
B. "Preexisting condition exclusion," with respect to coverage, means a limitation or exclusion of benefits relating to a condition
based on the fact or perception that the condition was present, or that the person was at particularized risk of developing
the condition, before the date of enrollment for coverage, whether or not any medical advice, diagnosis, care or treatment
was recommended or received before that date. [2001, c. 258, Pt. E, §9 (NEW).]
2001, c. 258, Pt. E, §9 (RPR)
An individual, group or blanket contract issued by an insurer may not impose a preexisting condition exclusion except as provided in this subsection. A
preexisting condition exclusion may not exceed 12 months from the date of enrollment, including the waiting period, if any. For purposes of this subsection, "waiting period" includes any period between the
time a substantially complete application for an individual or small group health plan is filed and the time the coverage takes effect. A preexisting condition exclusion may not be more restrictive than as follows.
A. In a group contract, a preexisting condition exclusion may relate only to conditions for which medical advice, diagnosis,
care or treatment was recommended or received during the 6-month period ending on the earlier of the date of enrollment in the contract and the date of enrollment in a prior contract covering the same group if there has not been a gap in coverage
of greater than 90 days between contracts. An exclusion may not be imposed relating to pregnancy as a preexisting condition. [2009, c. 244, Pt. E, §7 (AMD).]
B. In an individual contract not subject to paragraph C, or in a blanket policy, a preexisting condition exclusion may relate
only to conditions manifesting in symptoms that would cause an ordinarily prudent person to seek medical advice, diagnosis,
care or treatment or for which medical advice, diagnosis, care or treatment was recommended or received during the 12 months
immediately preceding the date of application or to a pregnancy existing on the effective date of coverage. [1999, c. 256, Pt. L, §9 (AMD).]
C. An individual policy issued on or after January 1, 1998 to a federally eligible individual as defined in section 2848 may
not contain a preexisting condition exclusion. [1997, c. 445, §29 (NEW); 1997, c. 445, §32 (AFF).]
D. A routine preventive screening or test yielding only negative results may not be considered to be diagnosis, care or treatment
for the purposes of this subsection. [1999, c. 256, Pt. L, §9 (AMD).]
E. Genetic information may not be used as the basis for imposing a preexisting condition exclusion in the absence of a diagnosis
of the condition relating to that information. For the purposes of this paragraph, "genetic information" has the same meaning
as set forth in the Code of Federal Regulations. [1997, c. 445, §29 (NEW); 1997, c. 445, §32 (AFF).]
F. Except for individual health plans in effect on March 23, 2010 that have grandfathered status under the federal Affordable
Care Act, a carrier as defined in section 4301-A, subsection 3 offering a health plan as defined in section 4301-A, subsection
7 may not apply a preexisting condition exclusion to any enrollee under 19 years of age. A preexisting condition exclusion
may not be imposed on any enrollee after January 1, 2014 to the extent prohibited by the federal Affordable Care Act. [2011, c. 364, §18 (NEW).]
2011, c. 364, §18 (AMD)
1989, c. 867, §§8,10 (NEW).
1991, c. 695, §11 (AMD).
1993, c. 477, §A15 (AMD).
1993, c. 477, §F1 (AFF).
1993, c. 547, §4 (AMD).
1997, c. 370, §C5 (AMD).
1997, c. 445, §§28,29 (AMD).
1997, c. 445, §32 (AFF).
1999, c. 256, §§L8,9 (AMD).
2001, c. 258, §§D3,E9 (AMD).
2007, c. 199, Pt. A, §8 (AMD).
2009, c. 244, Pt. E, §7 (AMD).
2011, c. 364, §18 (AMD).
Data for this page extracted on 10/16/2012 08:29:52.
The Revisor's Office cannot provide legal advice or
interpretation of Maine law to the public. If you need legal
advice, please consult
a qualified attorney.