Maine Revised Statutes Title 24-A Sec. 2674-A – Requirements for administrators and carriers
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1. Registration fee. All administrators of a preferred provider arrangement shall register with the superintendent and pay an annual registration fee pursuant to section 601, subsection 20. The superintendent shall by rule establish criteria for the registration, including minimum solvency requirements. Rules adopted pursuant to this subsection are routine technical rules pursuant to Title 5, chapter 375, subchapter II?A.
[PL 1999, c. 609, §10 (NEW).]
Terms Used In Maine Revised Statutes Title 24-A Sec. 2674-A
- Administrator: means any person, other than a carrier, that administers a preferred provider arrangement. See Maine Revised Statutes Title 24-A Sec. 2671
- Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
- Carrier: means an insurance company licensed in accordance with this Title, a fraternal benefit society authorized pursuant to chapter 55 or a nonprofit hospital or medical service organization licensed pursuant to Title 24. See Maine Revised Statutes Title 24-A Sec. 2671
- Enrollee: means an individual entitled to reimbursement for expenses of health care services under a health plan. See Maine Revised Statutes Title 24-A Sec. 2671
- 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. See Maine Revised Statutes Title 24-A Sec. 2671
- Preferred provider: means a provider who enters into a preferred provider arrangement with an administrator or carrier. See Maine Revised Statutes Title 24-A Sec. 2671
- Preferred provider arrangement: means a contract, agreement or arrangement between a carrier or administrator and a provider in which the provider agrees to provide services to a health plan enrollee whose plan benefits include incentives for the enrollee to use the services of that provider. See Maine Revised Statutes Title 24-A Sec. 2671
- Provider: means an individual or entity duly licensed or otherwise legally authorized to provide health care services, including, but not limited to, the treatment of physical health and mental health and provision for medical supplies and pharmaceutical supplies. See Maine Revised Statutes Title 24-A Sec. 2671
- Superintendent: means the Superintendent of Insurance. See Maine Revised Statutes Title 24-A Sec. 2671
2. Compilation of current listing. The bureau shall compile and maintain a current listing of administrators and carriers offering preferred provider arrangements authorized under this chapter.
[PL 1999, c. 609, §10 (NEW).]
3. Prohibition against insurance risk. Except as specifically authorized in section 2676, an administrator may provide administrative services only and may not accept insurance risk.
[PL 1999, c. 609, §10 (NEW).]
4. Approval required before marketing or making available. A carrier may not issue a health plan incorporating a preferred provider arrangement and an administrator may not market or otherwise make available a preferred provider arrangement until the superintendent pursuant to section 2673?A has approved the arrangement.
[PL 1999, c. 609, §10 (NEW).]
5. Registration as insurance administrator. In addition to meeting the requirements of the preferred provider arrangement, each preferred provider administrator who directly or indirectly transfers funds, manages funds, adjusts claims or asserts control over the transfer of funds for the purpose of payment of provider services shall register with the superintendent as an insurance administrator pursuant to chapter 18.
[PL 1999, c. 609, §10 (NEW).]
6. Provision of document to beneficiary. Each preferred provider administrator shall inform all carriers that the carriers must provide to each enrollee of any health plan subject to this chapter a plan description that complies with the requirements of and rules adopted under chapter 56?A, subchapter I.
[PL 1999, c. 609, §10 (NEW).]
SECTION HISTORY
PL 1999, c. 609, §10 (NEW).