Maine Revised Statutes Title 24-A Sec. 2849-C – Certifications of coverage
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1. Application. This section applies to:
B. Group and blanket health insurance contracts subject to chapter 35, except:
(1) Medicare supplement policies subject to chapter 67; and
(2) Contracts designed to cover specific diseases, hospital indemnity or accidental injury only. [PL 2001, c. 258, Pt. C, §1 (NEW).]
[PL 2001, c. 258, Pt. C, §1 (NEW).]
Terms Used In Maine Revised Statutes Title 24-A Sec. 2849-C
- COBRA continuation provision: means any of the following:
A. See Maine Revised Statutes Title 24-A Sec. 2848Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other. Federally creditable coverage: means health benefits or coverage provided under any of the following:
(1) An employee welfare benefit plan as defined in Section 3(1) of the federal Employee Retirement Income Security Act of 1974, 29 United States Code § 1001, or a plan that would be an employee welfare benefit plan but for the "governmental plan" or "nonelecting church plan" exceptions, if the plan provides medical care as defined in subsection 2?A, and includes items and services paid for as medical care directly or through insurance, reimbursement or otherwise;
(2) Benefits consisting of medical care provided directly, through insurance or reimbursement and including items and services paid for as medical care under a policy, contract or certificate offered by a carrier;
(3) Part A or Part B of Title XVIII of the Social Security Act, Medicare;
(4) Title XIX of the Social Security Act, Medicaid, other than coverage consisting solely of benefits under Section 1928 of the Social Security Act;
(4-A) A state children's health insurance program under Title XXI of the Social Security Act;
(5) The Civilian Health and Medical Program for the Uniformed Services, CHAMPUS, 10 United States Code, Chapter 55;
(6) A medical care program of the federal Indian Health Care Improvement Act, 25 United States Code § 1601 et seq. See Maine Revised Statutes Title 24-A Sec. 2848health insurance: means insurance of human beings against bodily injury, disablement or death by accident or accidental means, or the expense thereof, or against disablement or expense resulting from sickness, and every insurance appertaining thereto, including provision for the mental and emotional welfare of human beings by defraying the costs of legal services only to the extent provided for in chapter 38. See Maine Revised Statutes Title 24-A Sec. 704 Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide. Waiting period: means a period of time after the date of enrollment during which a health insurance plan excludes coverage for the diagnosis or treatment of any or all medical conditions. See Maine Revised Statutes Title 24-A Sec. 2848
2. Requirement for certification of period of creditable coverage. The requirement for a certification of the period of creditable coverage is as follows.
A. A carrier, as defined in section 4301?A, subsection 3, must provide the certification described in paragraph B with respect to health plans subject to this section:
(1) At the time an individual ceases to be covered under the plan or otherwise becomes covered under a COBRA continuation provision;
(2) In the case of an individual becoming covered under a COBRA continuation provision, at the time the individual ceases to be covered under that provision; and
(3) On the request on behalf of an individual made not later than 24 months after the date of cessation of the coverage described in subparagraph (1) or (2), whichever is later. The certification under subparagraph (1) may be provided, to the extent practicable, at a time consistent with notices required under any applicable COBRA continuation provision. [PL 2001, c. 258, Pt. C, §1 (NEW).]
B. The certification described in this paragraph is a written certification of:
(1) The period of federally creditable coverage of the individual under the plan and the coverage, if any, under the COBRA continuation provision;
(2) The waiting period, if any, imposed with respect to the individual for any coverage under the plan; and
(3) An educational statement regarding the federal Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, consistent with federal law. [PL 2007, c. 199, Pt. A, §6 (AMD).]
[PL 2007, c. 199, Pt. A, §6 (AMD).]
3. Alternative evidence of prior coverage. A carrier may not deny continuity rights as required by section 2849?B solely because the individual does not provide a certification described in subsection 2. The carrier must accept alternative evidence of prior coverage provided by the individual. If the individual asserts the existence of prior coverage but is unable to provide evidence, the carrier must make reasonable efforts to verify the existence of the prior coverage. The carrier may deny continuity rights if the individual refuses to cooperate in the carrier’s efforts to verify prior coverage, such as if the individual refuses to provide needed authorization for the release of information to the carrier when requested by the carrier.
[PL 2001, c. 258, Pt. C, §1 (NEW).]
4. Notice. A carrier may not impose a preexisting condition exclusion before providing the individual with notice consistent with federal law of the individual’s continuity rights and giving the individual an opportunity to provide a certification as described in subsection 2 or alternative evidence of prior coverage as described in subsection 3.
[PL 2007, c. 199, Pt. A, §7 (AMD).]
5. Rules. The superintendent may issue rules specifying the contents of certifications or other requirements consistent with this section. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter II?A.
[PL 2001, c. 258, Pt. C, §1 (NEW).]
SECTION HISTORY
PL 2001, c. 258, §C1 (NEW). PL 2007, c. 199, Pt. A, §§6, 7 (AMD).