F.__The superintendent may develop additional standards and adopt rules to set the fee required in paragraph A and to adopt other rules as necessary to carry out the purposes of this subsection in accordance with section 4309.

6.__Offer of point-of-service option required. A carrier that restricts access to providers shall offer all eligible enrollees in a managed care plan a point-of-service option as an additional benefit for the enrollee to accept or reject.

Sec. 7. 24-A MRSA §4308, sub-§2 is enacted to read:

2.__Right to sue.__ An enrollee's right to sue a carrier is governed by the following.

A.__A carrier shall exercise ordinary care when making health care treatment decisions and is liable for damages for harm to an enrollee proximately caused by the failure of the carrier to exercise ordinary care.

B.__A carrier is liable for damages for harm to an enrollee proximately caused by the health care treatment decisions made by its employees, agents, ostensible agents or representatives who are acting on behalf of the carrier and over whom the carrier has the right to exercise influence or control when that influence or control results in the failure to exercise ordinary care.

C.__In an action under this subsection, the burden is on the carrier to prove that a length of hospital stay or course of treatment approved or denied by the carrier was consistent with medically appropriate care.

D.__Standards of care required by paragraphs A and B do not require a carrier to provide to an enrollee treatment that is not covered by the health plan provided by the carrier.

E.__The laws of the State prohibiting a person from practicing medicine may not be asserted by a carrier as a defense in any action.

F.__In an action against a carrier, a finding that a physician or other health care provider is an employee, agent, ostensible agent or representative of the carrier may not be based solely on proof that the person's name appears in a listing of approved physicians or health care providers made available to enrollees under a health plan.