Sec. A-1. 24 MRSA §2319, first ¶, as amended by PL 1995, c. 332, Pt. N, §1, is further amended to read:
All individual and group nonprofit hospital and medical service organization contracts and certificates must provide that benefits are payable with respect to a newly born child from the moment of birth.
Sec. A-2. 24 MRSA §2320-E, as enacted by PL 1995, c. 617, §1 and affected by §6, is amended to read:
§2320-E. Coverage for Pap tests
All group nonprofit medical service plan contracts and certificates and all nonprofit health care plan contracts and certificates must provide coverage for screening Pap tests recommended by a physician.
Sec. A-3. 24 MRSA §2332-F, first ¶, as enacted by PL 1995, c. 592, §1, is amended to read:
All individual and group nonprofit hospital and medical services plan policies and, contracts and certificates and all nonprofit health care plan policies and, contracts and certificates must provide coverage for the medically appropriate and necessary equipment, limited to insulin, oral hypoglycemic agents, monitors, test strips, syringes and lancets, and the out-patient self-management training and educational services used to treat diabetes, if:
Sec. A-4. 24 MRSA §2332-G, sub-§§1 and 2, as reallocated by RR 1995, c. 2, §49 and affected by §50, are amended to read:
1. Coverage in managed care plans. With respect to managed care plans that require subscribers to select primary care physicians, a nonprofit hospital and medical service organization that issues group contracts and certificates must meet the following requirements.
A. The organization must permit a physician who specializes in obstetrics and gynecology to serve as a primary care physician if the physician qualifies under the organization's credentialling policy.
B. All group plan contracts must provide coverage for an annual gynecological examination, including routine pelvic and clinical breast examinations, performed by a physician, certified nurse practitioner or certified nurse midwife participating in the plan, without requiring the prior approval of the primary care physician.
C. If the examination specified in paragraph B reveals a gynecological condition for which another visit to the physician participating in the plan is medically required and appropriate, or for any gynecological care beyond the annual examination, the carrier may require the patient or the examining physician, certified nurse practitioner or certified nurse midwife to secure from the patient's primary care physician a referral to the participating physician, certified nurse practitioner or certified nurse midwife from whom such care may be obtained.
2. Application. This section applies to all contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 1997. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.
Sec. A-5. 24-A MRSA §2834, first ¶, as amended by PL 1995, c. 332, Pt. N, §3, is further amended to read:
All group and blanket health insurance policies and certificates providing coverage on an expense incurred expense-incurred basis must provide that health insurance benefits are payable for a newly born child of the insured or subscriber from the moment of birth. An adopted child is deemed to be newly born to the adoptive parents from the date of the signed placement agreement. Preexisting conditions of an adopted child may not be excluded from coverage.
Sec. A-6. 24-A MRSA §2834, last ¶, as amended by PL 1997, c. 604, Pt. C, §3, is further amended to read:
The requirements of this section apply to all policies and certificates delivered or issued for delivery in this State more than 120 days after the effective date of this Act.
Sec. A-7. 24-A MRSA §2837-E, as enacted by PL 1995, c. 617, §3 and affected by §6, is amended to read:
§2837-E. Coverage for Pap tests
All group health insurance policies and, contracts, except accidental injury, specified disease, hospital indemnity, Medicare supplement, long-term care and other limited benefit health insurance policies and contracts, and certificates must provide coverage for screening Pap tests recommended by a physician.
Sec. A-8. 24-A MRSA §2847-E, as enacted by PL 1995, c. 592, §3, is amended to read:
§2847-E. Coverage for diabetes supplies
All group insurance policies and, contracts, except accidental injury, specified disease, hospital indemnity, Medicare supplement, long-term care and other limited benefit health insurance policies and contracts, and certificates must provide coverage for the medically appropriate and necessary equipment, limited to insulin, oral hypoglycemic agents, monitors, test strips, syringes and lancets, and the out-patient self-management training and educational services used to treat diabetes, if:
1. Certification of medical necessity. The insured's treating physician or a physician who specializes in the treatment of diabetes certifies that the equipment and services are necessary; and
2. Provision of medical services. The diabetes out-patient self-management training and educational services are provided through ambulatory diabetes education facilities authorized by the State's Diabetes Control Project within the Bureau of Health.
The requirements of this section apply to all group policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.
Sec. A-9. 24-A MRSA §2847-F, sub-§§1 and 2, as reallocated by PL 1997, c. 370, Pt. H, §1, are amended to read:
1. Coverage in managed care plans. With respect to managed care plans that require group members to select primary care physicians, an insurer that issues group health insurance policies and, contracts and certificates must meet the following requirements.
A. The insurer must permit a physician who specializes in obstetrics and gynecology to serve as a primary care physician if the physician qualifies under the insurer's credentialling policy.
B. All group plan contracts must provide coverage for an annual gynecological examination, including routine pelvic and clinical breast examinations, performed by a physician, certified nurse practitioner or certified nurse midwife participating in the plan, without requiring the prior approval of the primary care physician.
C. If the examination specified in paragraph B reveals a gynecological condition for which another visit to the physician participating in the plan is medically required and appropriate, or for any gynecological care beyond the annual examination, the carrier may require the patient or the examining physician, certified nurse practitioner or certified nurse midwife to secure from the patient's primary care physician a referral to the participating physician, certified nurse practitioner or certified nurse midwife from whom such care may be obtained.
2. Application. This section applies to all policies and, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 1997. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.
Sec. A-10. 24-A MRSA §4240, as enacted by PL 1995, c. 592, §4, is amended to read:
§4240. Coverage for diabetes supplies
All health maintenance organization individual and group health contracts and certificates must provide coverage for the medically appropriate and necessary equipment, limited to insulin, oral hypoglycemic agents, monitors, test strips, syringes and lancets, and the out-patient self-management training and educational services used to treat diabetes, if:
1. Certification of medical necessity. The enrollee's treating physician or a physician who specializes in the treatment of diabetes certifies that the equipment and services are necessary; and
2. Provision of medical services. The diabetes out-patient self-management training and educational services are provided through ambulatory diabetes education facilities authorized by the State's Diabetes Control Project within the Bureau of Health.
The requirements of this section apply to all group policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.
Sec. A-11. 24-A MRSA §4241, sub-§§1 and 2, as enacted by PL 1995, c. 617, §5 and affected by §6, are amended to read:
1. Coverage in managed care plans. With respect to managed care plans that require enrollees to select primary care physicians, a health maintenance organization that issues group policies and, contracts and certificates must meet the following requirements.
A. The health maintenance organization must permit a physician who specializes in obstetrics and gynecology to serve as a primary care physician if the physician qualifies under the organization's credentialling policy.
B. All group plan contracts must provide coverage for an annual gynecological examination, including routine pelvic and clinical breast examinations, performed by a physician, certified nurse practitioner or certified nurse midwife participating in the plan, without requiring the prior approval of the primary care physician.
C. If the examination specified in paragraph B reveals a gynecological condition for which another visit to the physician participating in the plan is medically required and appropriate, or for any gynecological care beyond the annual examination, the carrier may require the patient or the examining physician, certified nurse practitioner or certified nurse midwife to secure from the patient's primary care physician a referral to the participating physician, certified nurse practitioner or certified nurse midwife from whom such care may be obtained.
2. Application. This section applies to all policies and, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 1997. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.
Sec. A-12. 24-A MRSA §4242, as reallocated by RR 1995, c. 2, §53, is amended to read:
All health maintenance organization plan contracts and certificates must provide coverage for screening Pap tests recommended by a physician.
Sec. A-13. Application. This Part applies to all policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State on or after July 1, 2004. For purposes of this Part, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.
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