1. Required coverage. A carrier offering a health plan in this State shall provide coverage for one early refill of a prescription for eye drops if the following criteria are met:
A. The enrollee requests the refill no earlier than the date on which 70% of the days of use authorized by the prescribing health care provider have elapsed; [PL 2015, c. 91, §1 (NEW); PL 2015, c. 91, §2 (AFF).]
B. The prescribing health care provider indicated on the original prescription that a specific number of refills are authorized; [PL 2015, c. 91, §1 (NEW); PL 2015, c. 91, §2 (AFF).]
C. The refill requested by the enrollee does not exceed the number of refills indicated on the original prescription; [PL 2015, c. 91, §1 (NEW); PL 2015, c. 91, §2 (AFF).]
D. The prescription has not been refilled more than once during the period authorized by the prescribing health care provider prior to the request for an early refill; and [PL 2015, c. 91, §1 (NEW); PL 2015, c. 91, §2 (AFF).]
E. The prescription eye drops are a covered benefit under the enrollee’s health plan. [PL 2015, c. 91, §1 (NEW); PL 2015, c. 91, §2 (AFF).]

[PL 2015, c. 91, §1 (NEW); PL 2015, c. 91, §2 (AFF).]

Ask an insurance law question, get an answer ASAP!
Click here to chat with a lawyer about your rights.

Terms Used In Maine Revised Statutes Title 24-A Sec. 4314-A

  • Carrier: means :
A. See Maine Revised Statutes Title 24-A Sec. 4301-A
  • Enrollee: means an individual who is enrolled in a health plan or a managed care plan. See Maine Revised Statutes Title 24-A Sec. 4301-A
  • Health plan: means a plan offered or administered by a carrier that provides for the financing or delivery of health care services to persons enrolled in the plan, other than a plan that provides only accidental injury, specified disease, hospital indemnity, Medicare supplement, disability income, long-term care or other limited benefit coverage not subject to the requirements of the federal Affordable Care Act. See Maine Revised Statutes Title 24-A Sec. 4301-A
  • Provider: means a practitioner or facility licensed, accredited or certified to perform specified health care services consistent with state law. See Maine Revised Statutes Title 24-A Sec. 4301-A
  • 2. Cost sharing. A carrier may impose a deductible, copayment or coinsurance requirement for an early refill under this section as permitted under the health plan.

    [PL 2015, c. 91, §1 (NEW); PL 2015, c. 91, §2 (AFF).]

    SECTION HISTORY

    PL 2015, c. 91, §1 (NEW). PL 2015, c. 91, §2 (AFF).