Sec. B-1. 24 MRSA §2332-A, sub-§2, as enacted by PL 1993, c. 666, Pt. B, §1, is amended to read:
2. Medicaid and Cub Care programs. Nonprofit service organizations may not consider the availability or eligibility for medical assistance under 42 United States Code, Section 13969, referred to as "Medicaid," or Title 22, section 3174-R, referred to as the "Cub Care program," when considering coverage eligibility or benefit calculations for subscribers and covered family members.
A. To the extent that payment for coverage expenses has been made under the Medicaid program or the Cub Care program for health care items or services furnished to an individual, the State is considered to have acquired the rights of the covered subscriber or family member to payment by the nonprofit service organization for those health care items or services. Upon presentation of proof that the Medicaid program or the Cub Care program has paid for covered items or services, the nonprofit service organization shall make payment to the Medicaid program or the Cub Care program according to the coverage provided in the contract or certificate.
B. A nonprofit service organization may not impose requirements on a state agency that has been assigned the rights of an individual eligible for Medicaid or Cub Care coverage and covered by a subscriber contract that are different from
requirements applicable to an agent or assignee of any other covered individual.
Sec. B-2. 24-A MRSA §2808-B, sub-§1, ¶E, as enacted by PL 1995, c. 332, Pt. D, §1, is amended to read:
E. "Late enrollee" means an eligible employee or dependent who requests enrollment in a small group health plan following the initial minimum 30-day enrollment period provided under the terms of the plan, except that, an eligible employee or dependent is not considered a late enrollee if the eligible employee or dependent meets the requirements of section 2849-B, subsection 3, paragraph A, B, C C-1 or D.
Sec. B-3. 24-A MRSA §2844, sub-§2, as enacted by PL 1993, c. 666, Pt. B, §2, is amended to read:
2. Medicaid and Cub Care programs. Insurers may not consider the availability or eligibility for medical assistance under 42 United States Code, Section 13969, referred to as "Medicaid," or Title 22, section 3174-R, referred to as the "Cub Care program," when considering coverage eligibility or benefit calculations for insureds and covered family members.
A. To the extent that payment for coverage expenses has been made under the Medicaid program or the Cub Care program for health care items or services furnished to an individual, the State is considered to have acquired the rights of the insured or family member to payment by the insurer for those health care items or services. Upon presentation of proof that the Medicaid program or the Cub Care program has paid for covered items or services, the insurer shall make payment to the Medicaid program or the Cub Care program according to the coverage provided in the contract or certificate.
B. An insurer may not impose requirements on a state agency that has been assigned the rights of an individual eligible for Medicaid or Cub Care coverage and covered by a subscriber contract that are different from requirements applicable to an agent or assignee of any other covered individual.
Sec. B-4. 24-A MRSA §2848, sub-§1-B, ¶A, as enacted by PL 1997, c. 445, §20 and affected by §32, is amended to read:
A. Health benefits or coverage provided under any of the following:
(1) An employee welfare benefit plan as defined in Section 3(1) of the federal Employee Retirement Income Security Act of 1974, 29 United States Code, Section 1001, or a plan that would be an employee welfare benefit plan but for the "governmental plan" or "nonelecting church plan" exceptions, if the plan provides medical care as defined in subsection 2-A, and includes items and services paid for as medical care directly or through insurance, reimbursement or otherwise;
(2) Benefits consisting of medical care provided directly, through insurance or reimbursement and including items and services paid for as medical care under a policy, contract or certificate offered by a carrier; or
(3) Part A or Part B of Title XVIII of the Social Security Act, Medicare;
(4) Title XIX of the Social Security Act, Medicaid, other than coverage consisting solely of benefits under Section 1928 of the Social Security Act or a state children's health insurance program under Title XXI of the Social Security Act;
(5) The Civilian Health and Medical Program for the Uniformed Services, CHAMPUS, 10 United States Code, Chapter 55;
(6) A medical care program of the federal Indian Health Care Improvement Act, 25 United States Code, Section 1601 or of a tribal organization;
(7) A state health benefits risk pool;
(8) A health plan offered under the federal Employees Health Benefits Amendments Act, 5 United States Code, Chapter 89;
(9) A public health plan as defined in federal regulations authorized by the federal Public Health Service Act, Section 2701(c)(1)(I), as amended by Public Law 104-191; or
(10) A health benefit plan under Section 5(e) of the Peace Corps Act, 22 United States Code, Section 2504(e).
Sec. B-5. 24-A MRSA §2849-B, sub-§3, ¶C, as amended by PL 1995, c. 332, Pt. F, §5, is repealed.
Sec. B-6. 24-A MRSA §2849-B, sub-§3, ¶C-1 is enacted to read:
C-1. That person was covered by the Cub Care program under Title 22, section 3174-R, and the
request for replacement coverage is made while coverage is in effect or within 30 days from the termination of coverage; or
Emergency clause. In view of the emergency cited in the preamble, this Act takes effect July 1, 1998.
Effective July 1, 1998.
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