insurance or a rate increase for group health insurance. It specifies the requirements for the notice. See these sections for more details Penalty for failure to 24-A M.R.S.A. No penalty for hospitalization for emergency treatment. ☐ notify of hospitalization Persons under the Policies cannot contain the following provision: and ☐ “Intoxicants influence of alcohol or narcotics. The insurer is not liable for any loss sustained or contracted narcotics in consequence of the insured’s being intoxicated or under the influence of any narcotic or of any hallucinogenic drug, unless administered on the advice of a physician.” PPOs Payment for 24-A M.R.S.A. The benefit level differential between services rendered by preferred ☐ – Non-preferred Providers providers and non-preferred providers may not exceed 20% of the allowable charge for the service rendered. Pre-existing condition PHSA §2704 Prohibits the imposition of a preexisting condition exclusion by all ☐ exclusions for child PHSA §1255 group plans and nongrandfathered individual market plans. under age 19 (75 Fed Reg Pre-existing condition 45 CFR exclusions §147.108) Prohibited practices An enrollee may not be cancelled or denied renewal except for or ☐ material misrepresentation and/or failure to pay premiums for 2850-B(3) coverage. PHSA§2712 Rescissions prohibited (75 Fed Reg Rescissions are prohibited except in cases of fraud or intentional 37188, misrepresentation of material fact. Coverage may not be cancelled 45 CFR except with 30 days prior notice to each enrolled person who would be §147.128) affected. Prohibition against Carriers are prohibited from including or enforcing absolute discretion ☐ Absolute Discretion provisions in health plan contracts, certificates, or agreements. Clauses Prohibition on 45 CFR An issuer does not provide EHB if its benefit design, or the ☐ Discrimination §156.1259(a) implementation of its benefit design, discriminates based on an individual's age, expected length of life, present or predicted disability, degree of medical dependency, quality of life, or other health conditions.
insurance or a rate increase for group health insurance. It specifies the requirements for the notice. See these sections for more details Penalty for failure to notify of hospitalization 24-A M.R.S.A. No penalty for hospitalization for emergency treatment. ☐ Persons under the influence of alcohol or narcotics Policies cannot contain the following provision: “Intoxicants and narcotics. The insurer is not liable for any loss sustained or contracted in consequence of the insured’s being intoxicated or under the influence of any narcotic or of any hallucinogenic drug, unless administered on the advice of a physician.” ☐ PPOs – Payment for Non-preferred Providers 24-A M.R.S.A. The benefit level differential between services rendered by preferred providers and non-preferred providers may not exceed 20% of the allowable charge for the service rendered. ☐ Pre-existing condition exclusions for child under age 19 Pre-existing condition exclusions PHSA §2704 PHSA §1255 (75 Fed Reg 45 CFR §147.108) Prohibits the imposition of a preexisting condition exclusion by all group plans and nongrandfathered individual market plans. ☐ Prohibited practices Rescissions prohibited 2850-B(3) PHSA§2712 (75 Fed Reg 37188, 45 CFR §147.128) An enrollee may not be cancelled or denied renewal except for or material misrepresentation and/or failure to pay premiums for coverage. Rescissions are prohibited except in cases of fraud or intentional misrepresentation of material fact. Coverage may not be cancelled except with 30 days prior notice to each enrolled person who would be affected. ☐ Prohibition against Absolute Discretion Clauses Carriers are prohibited from including or enforcing absolute discretion provisions in health plan contracts, certificates, or agreements. ☐ Prohibition on Discrimination 45 CFR §156.1259(a) An issuer does not provide EHB if its benefit design, or the implementation of its benefit design, discriminates based on an individual's age, expected length of life, present or predicted disability, degree of medical dependency, quality of life, or other health conditions. ☐
individual_major_medical_plans-non-grandfathered.docx