Public Laws

124th Legislature

First Regular Session


Parts: A B C D E F G H I J

Chapter 244

H.P. 821 - L.D. 1180

PART E

Sec. E-1. 24-A MRSA 2834-C is enacted to read:

2834-C. Compliance with federal law

1. Application. This section applies to all group and blanket medical insurance policies issued by nonprofit hospital or medical service organizations, insurers or health maintenance organizations except hospital indemnity, accidental injury, specified disease and long-term care policies.
2. Requirement. Policies subject to this section must comply with the federal Children's Health Insurance Program Reauthorization Act of 2009, Section 311 concerning special enrollment periods in case of termination of coverage under a Medicaid plan or a state child health plan or eligibility for assistance in the purchase of employment-based coverage.

Sec. E-2. 24-A MRSA 2849, sub-3, C, as amended by PL 1997, c. 370, Pt. B, 2, is further amended to read:

C. 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, impose Impose a preexisting condition exclusion period or waiting period on that person, except as provided in this section; or

Sec. E-3. 24-A MRSA 2849, sub-3-A is enacted to read:

3-A. Persons subject to a preexisting condition exclusion. Notwithstanding subsection 3, paragraph C, an insurer or health maintenance organization may impose a preexisting condition exclusion period on a person who was subject to a preexisting condition exclusion under the replaced contract or policy. The preexisting condition exclusion period under the replacement policy or contract must end no later than the date the preexisting condition exclusion period would have ended under the replaced contract or policy.

Sec. E-4. 24-A MRSA 2849-B, sub-3-A is enacted to read:

3-A. Prohibition against discontinuity in group policies. Except as provided in this section, in a group policy subject to this section, the insurer or health maintenance organization shall, for any person described in subsection 2, waive any medical underwriting or preexisting conditions exclusion. The succeeding policy is not required to duplicate any benefits covered by the prior contract or policy.

Sec. E-5. 24-A MRSA 2849-B, sub-3-B is enacted to read:

3-B. Persons subject to a preexisting condition exclusion. Notwithstanding subsection 3-A, an insurer or health maintenance organization may impose a preexisting condition exclusion period on a person who was subject to a preexisting condition exclusion under the prior contract or policy. The preexisting condition exclusion period under the succeeding policy or contract must end no later than the date the preexisting condition exclusion period would have ended under the prior contract or policy.

Sec. E-6. 24-A MRSA 2849-B, sub-4, as amended by PL 2007, c. 199, Pt. A, 5, is further amended to read:

4.Prohibition against discontinuity in individual and blanket policies. Except as provided in this section, in an individual , 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. E-7. 24-A MRSA 2850, sub-2, A, as amended by PL 1999, c. 256, Pt. L, 9, is further amended to read:

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 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.

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