Colorectal Cancer Coverage must be provided for colorectal cancer screening (including ☐ Screening colonoscopies if recommended by a health care provider as the 24-A M.R.S.A. colorectal cancer screening test) for asymptomatic individuals who are §4309-A fifty years of age or older; or less than 50 years of age and at high risk for colorectal cancer. If a colonoscopy is recommended as the colorectal cancer screening and a lesion is discovered and removed during the colonoscopy benefits must be paid for the screening colonoscopy as the primary procedure. Must clearly disclose preventive screenings vs diagnostic services. Continuity of 24-A M.R.S.A. If an enrollee has been undergoing a course of treatment with a ☐ Prescription Drugs §4303(7)(A) prescription drug by prior authorization of a carrier and the enrollee’s coverage with one carrier is replaced with coverage from another carrier pursuant to section 2849-B, the replacement carrier shall honor the prior authorization for that prescription drug and provide coverage in the same manner as the previous carrier until the replacement carrier conducts a review of the prior authorization for that prescription drug with the prescribing provider. Policies must include a notice enrollee’s of the right to request a review with the provider, carrier’s enrollee’s and the replacing carrier must honor the prior authorization carrier’s for a period not to exceed 6 months if the provider enrollee’s participates in the review and requests the prior authorization be continued. The replacing carrier is not required to provide benefits for conditions or services not otherwise covered under the replacement policy, and cost sharing may be based on the copayments and coinsurance requirements of the replacement policy. Contraceptives 24-A M.R.S.A. All contracts that provide coverage for prescription drugs or outpatient ☐ medical services must provide coverage for all prescription contraceptives or for outpatient contraceptive services, respectively, to the same extent that coverage is provided for other prescription drugs or outpatient medical services. 24-A M.R.S.A. §2847-G(4) Coverage required under this section must include coverage for contraceptive supplies in accordance with the following requirements.
Colorectal Cancer Screening 24-A M.R.S.A. §4309-A Coverage must be provided for colorectal cancer screening (including colonoscopies if recommended by a health care provider as the colorectal cancer screening test) for asymptomatic individuals who are fifty years of age or older; or less than 50 years of age and at high risk for colorectal cancer. If a colonoscopy is recommended as the colorectal cancer screening and a lesion is discovered and removed during the colonoscopy benefits must be paid for the screening colonoscopy as the primary procedure. Must clearly disclose preventive screenings vs diagnostic services. ☐ Continuity of Prescription Drugs 24-A M.R.S.A. §4303(7)(A) If an enrollee has been undergoing a course of treatment with a prescription drug by prior authorization of a carrier and the enrollee’s coverage with one carrier is replaced with coverage from another carrier pursuant to section 2849-B, the replacement carrier shall honor the prior authorization for that prescription drug and provide coverage in the same manner as the previous carrier until the replacement carrier conducts a review of the prior authorization for that prescription drug with the enrollee’s prescribing provider. Policies must include a notice of the carrier’s right to request a review with the enrollee’s provider, and the replacing carrier must honor the prior carrier’s authorization for a period not to exceed 6 months if the enrollee’s provider participates in the review and requests the prior authorization be continued. The replacing carrier is not required to provide benefits for conditions or services not otherwise covered under the replacement policy, and cost sharing may be based on the copayments and coinsurance requirements of the replacement policy. ☐ Contraceptives 24-A M.R.S.A. 24-A M.R.S.A. §2847-G(4) All contracts that provide coverage for prescription drugs or outpatient medical services must provide coverage for all prescription contraceptives or for outpatient contraceptive services, respectively, to the same extent that coverage is provided for other prescription drugs or outpatient medical services. Coverage required under this section must include coverage for contraceptive supplies in accordance with the following requirements. ☐
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