Chapter 199
H.P. 1053 - L.D. 1503
PART A
Sec. A-1. 24-A MRSA §2834-B, sub-§3, as amended by PL 1999, c. 256, Pt. B, §1, is further amended to read:
3. Requirement.
If a policy makes coverage available with respect to dependents of certificate holders, the policy must provide for a dependent special enrollment period when a person becomes a dependent of an eligible individual through marriage, birth or adoption or placement for adoption or , if a court order is issued changing custody of a child or if a dependent who has other coverage loses eligibility under that coverage. During this period, the dependent may be enrolled under the plan as a dependent of the eligible individual and, in the case of the birth or adoption of a child, the spouse of the eligible individual may be enrolled as a dependent if otherwise eligible for coverage. If the eligible individual is not already enrolled or is enrolled in a different benefit package, the individual may enroll during this period.
Sec. A-2. 24-A MRSA §2834-B, sub-§4, as amended by PL 1999, c. 256, Pt. B, §2, is further amended to read:
4. Length of period.
A dependent special enrollment period under this section must be a period of not less than 30 days and must begin on the later latest of:A. The date dependent coverage is made available; or
B. The date of the marriage, birth or adoption or placement for adoption or the date of the court order . ; and
C. The date a dependent loses other coverage.
Sec. A-3. 24-A MRSA §2834-B, sub-§5, as amended by PL 1999, c. 256, Pt. B, §§3 and 4, is further amended to read:
5. No waiting period.
If an individual seeks to enroll a dependent during the first 30 days of a dependent special enrollment period, the coverage of the dependent becomes effective:A. In the case of marriage, no later than the first day of the first month beginning after the date the completed request for enrollment is received;
B. In the case of a dependent's birth, as of the date of the birth;
C. In the case of a dependent's adoption or placement for adoption, as of the date of the adoption or placement for adoption; or
D. In the case of a court order changing custody of a child, as of the date of the order . ; or
E. In the case of a dependent who loses other coverage, as of the date of application for enrollment.
Sec. A-4. 24-A MRSA §2849-B, sub-§3, ¶A-1 is enacted to read:
A-1. That person incurs a claim under a prior contract or policy that would meet or exceed that contract or policy’s lifetime limit on all benefits, and a request for enrollment is made not later than 30 days after a claim is denied in whole or in part due to the operation of a lifetime limit on all benefits.
Sec. A-5. 24-A MRSA §2849-B, sub-§4, as amended by PL 1993, c. 477, Pt. A, §13 and affected by Pt. F, §1, is further amended to read:
4. Prohibition against discontinuity.
Except as provided in this section, in an individual or , a group or blanket policy subject to this section, the insurer or health maintenance organization must, for any person described in subsection 2, waive any medical underwriting or preexisting conditions exclusion to the extent that benefits would have been payable under a prior contract or policy if the prior contract or policy were still in effect or to the extent that benefits would have been payable under the prior contract or policy if not for the operation of a lifetime limit on all benefits. The succeeding policy is not required to duplicate any benefits covered by the prior contract or policy.
Sec. A-6. 24-A MRSA §2849-C, sub-§2, ¶B, as enacted by PL 2001, c. 258, Pt. C, §1, is amended to read:
B.
The certification described in this paragraph is a written certification of:
(1) The period of federally creditable coverage of the individual under the plan and the coverage, if any, under the COBRA continuation provision; and
(2) The waiting period, if any, imposed with respect to the individual for any coverage under the plan . ; and
(3) An educational statement regarding the federal Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, consistent with federal law.
Sec. A-7. 24-A MRSA §2849-C, sub-§4, as enacted by PL 2001, c. 258, Pt. C, §1, is amended to read:
4. Notice.
A carrier may not impose a preexisting condition exclusion before notifying the individual providing the individual with notice consistent with federal law of the individual's continuity rights and giving the individual an opportunity to provide a certification as described in subsection 2 or alternative evidence of prior coverage as described in subsection 3.
Sec. A-8. 24-A MRSA §2850, sub-§2, as amended by PL 2001, c. 258, Pt. D, §3, is further amended to read:
2. Limitation.
An individual or , 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 an individual files 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 months immediately preceding the date of enrollment. An exclusion may not be imposed relating to pregnancy as a preexisting condition.
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.
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.
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.
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.