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Health Plan Requirements | Midpage
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Maine Revised Statutes
Title 24-A
Chapter 56-A
1
Health Plan Requirements
4301-A
Definitions
4302
Reporting requirements
4303
Plan requirements
4303-A
Provider profiling programs
4303-B
Disclosure related to provider networks
4303-C
Protection from surprise bills and bills for out-of-network emergency services
4303-D
Provider directories
4303-E
Dispute resolution process for surprise bills and bills for out-of-network emergency services
4303-F
Reimbursement for ambulance services and participation of ambulance service providers in carrier networks
4303-G
Provider maintenance of certification requirements
4304
Utilization review
4304-A
Prior authorization for rehabilitative or habilitative services
4305
Quality of care
4306
Enrollee choice of primary care provider
4306-A
Patient access to obstetrical and gynecological care
4307
Construction
4308
Indemnification
4309
Adoption of rules
4309-A
Compliance with the Affordable Care Act
4310
Access to clinical trials
4311
Access to prescription drugs
4311-A
Access to pain management services
4312
Independent external review
4313
Carrier liability; cause of action
4314
Access to eye care providers
4314-A
Coverage for early refills of prescription eye drops
4315
Coverage of prosthetic devices
4316
Coverage for telehealth services
4317
Pharmacy providers
4317-A
Prescription drug coverage; out-of-pocket expenses for coinsurance
4317-B
Orally administered cancer therapy
4317-C
Coverage for prescription insulin drugs; limit on out-of-pocket costs
4317-D
Coverage of HIV prevention drugs
4317-E
Coverage for emergency supply of chronic maintenance drugs
4318-A
Comparable health care service incentive program
4318-B
Access to lower-priced services
4319
Rebates
4319-A
Guaranteed issue
4319-B
Medical loss ratio reporting for dental insurance plans
4320
No lifetime or annual limits on health plans
4320-A
Coverage of preventive and primary health services
4320-B
Extension of dependent coverage
4320-C
Emergency services
4320-D
Comprehensive health coverage
4320-E
Reinsurance, risk corridors and risk adjustment
4320-F
Oversight of plans offered on the American Health Benefit Exchange and the SHOP Exchange
4320-G
Applicability to health plans grandfathered under the Affordable Care Act
4320-I
Coverage for the cost of testing for bone marrow donation suitability
4320-J
Coverage for abuse-deterrent opioid analgesic drug products
4320-K
Coverage for services provided by a naturopathic doctor
4320-L
Nondiscrimination
4320-M-1
Coverage for abortion services
4320-O
Coverage for services provided by a physician associate
4320-P-1
Coverage for health care services for COVID-19
4320-R-1
Mandatory offer of coverage for certain adults with disabilities
4320-S-1
Coverage for dental services for cancer patients
4320-T
Implementation of federal mental health parity laws
4320-V
Coverage for donor breast milk