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§3913.__Reimbursement of member insurer |
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| | | 1.__Reimbursement.__A member insurer may seek reimbursement | | from the association and the association shall reimburse the | | member insurer to the extent claims made by a covered person | | after April 1, 2006 exceed premiums paid on a calendar-year basis | | by the covered person to the member insurer for a covered person | | who meets the following criteria: |
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| | | A. The member insurer sold an individual health plan to the | | covered person between December 1, 1993 and April 1, 2006 | | and the policy that was sold has been continuously renewed | | by the covered person and the carrier has closed its book of | | business for individual health plans sold between December | | 1, 1993 and April 1, 2006; and |
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| | | B. The member insurer is able to determine through the use | | of individual health statements, claims history or any | | reasonable means that at the time the person applied for | | insurance coverage with the member insurer, the covered | | person was diagnosed with one of the following medical | | conditions: acquired immune deficiency syndrome, angina | | pectoris, ascites, chemical dependency cirrhosis of the | | liver, coronary occlusion, cystic fibrosis, Friedreich's | | ataxia, hemophilia, Hodgkin's disease, Huntington's chorea, | | juvenile diabetes, leukemia, metastatic cancer, motor or | | sensory aphasia, multiple sclerosis, muscular dystrophy, | | myasthenia gravis, myotonia, heart disease causing open | | heart surgery, Parkinson's disease, polycystic kidney, | | psychotic disorders, quadriplegia, stroke, syringomyelia or | | Wilson's disease. |
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| | | 2. Rules.__The superintendent may adopt rules to facilitate | | payment to a carrier pursuant to this section. Rules adopted | | pursuant to this subsection are routine technical rules as | | defined in Title 5, chapter 375, subchapter 2-A. |
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| | | 3.__Repeal.__This section is repealed April 1, 2010. |
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| | | Sec. A-16. Application for federal grant. Within 30 days of the effective | | date of this Act, the Superintendent of Insurance shall submit an | | application to the federal Department of Health and Human | | Services, Health Resources and Services Administration for a | | federal seed grant to support the creation and initial operation | | of the Comprehensive Health Insurance Risk Pool Association | | established in the Maine Revised Statutes, Title 24-A, chapter | | 54. |
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