§2677-A. Payment for nonpreferred providers
                  1. 
                                Nonpreferred providers. 
                                A carrier incorporating a preferred provider arrangement into a health plan shall provide for payment of covered health care services rendered by providers that are not preferred providers.
                                     
                                
                [PL 1999, c. 609, §14 (NEW).]
              
                  2. 
                                Benefit level. 
                                The benefit level differential between services rendered by preferred providers and nonpreferred providers may not exceed 20% of the allowable charge for the service rendered, except that the superintendent may waive this requirement for a given benefit plan.  Compliance with this requirement for a given benefit plan may be demonstrated on an aggregate basis.  This demonstration of compliance must be based on a reasonably anticipated mix of claims certified by a qualified actuary who is a member of the American Academy of Actuaries or a successor organization.  As used in this subsection, "allowable charge" means the amount that would be payable for services under the preferred provider arrangement including deductible and coinsurance amounts.
                                     
                                
                [PL 2001, c. 369, §3 (AMD).]
              
                        SECTION HISTORY
                        
            PL 1999, c. 609, §14 (NEW). PL 2001, c. 369, §3 (AMD).