§ 24 §2301 — Purposes

Maine § 24 §2301

• Jurisdiction: Maine
• Title 24: INSURANCE
• Ch. 19: NONPROFIT HOSPITAL OR MEDICAL SERVICE ORGANIZATIONS

Text

Any corporation organized under special Act of the Legislature, under Title 13, chapter 81 or as a public benefit corporation under Title 13‑B for the following purposes may be authorized by the superintendent on the terms and conditions provided for in this chapter, except that when such a corporation was previously organized by special Act of the Legislature, this chapter does not apply when inconsistent with that Act as previously amended:
1.
Nonprofit hospital service plans.
To establish, maintain and operate nonprofit hospital service plans whereby hospital care may be provided by hospitals or groups of hospitals with which such a corporation has a contract for that purpose to those persons or groups of persons who become subscribers to that plan under a contract that entitles each subscriber to certain hospital care, and the hospital or hospitals contracting with such a corporation are governed by this chapter and by the provisions of Title 24‑A that are applicable as provided in this chapter;
2.
Nonprofit medical service plans.
To establish, maintain and operate nonprofit medical service plans whereby medical or surgical service is provided to those persons or groups of persons who become subscribers to such a plan under contracts with such a corporation, either in the capacity of principal or in the capacity of agent of other nonprofit medical service corporations or insurance companies authorized to do business in this State, and the physician or physicians contracting with such a corporation are governed by this chapter and by the provisions of Title 24‑A that are applicable as provided in this chapter;
3.
Nonprofit health care plans.
To establish, maintain and operate nonprofit health care plans whereby health care services not covered under subsections 1 and 2 may be provided, by institutions or persons licensed for that purpose by the State, when licensure is required, with which such a corporation has a contract for that purpose, to those persons or groups of persons who become subscribers to such a plan under a contract that entitles each subscriber to certain specific health care, and the institution or persons contracting with such a corporation are governed by this chapter and by the provisions of Title 24‑A that are applicable as provided in this chapter;
3-A.
Integrated medical service plans; indemnity health care contracts; health care plan administration.
A corporation subject to this chapter that maintains a nonprofit hospital service plan, a nonprofit medical service plan or a nonprofit health care plan in accordance with subsections 1, 2 or 3 may, in addition:
3-B.
Hospital and medical service business exclusive.
A hospital or medical service corporation may not engage in a business other than the business of hospital or medical service corporations as set forth in this section and in business activities reasonably and necessarily related to that business, except that:
3-C.
Nonprofit purposes.
A nonprofit hospital and medical service organization that is authorized to provide nonprofit hospital service plans under subsection 1, nonprofit medical service plans pursuant to subsection 2 or nonprofit health care plans pursuant to subsection 3 is a charitable and benevolent institution, in accordance with Title 5, section 194‑A, and a public charity and its assets are held for the purpose of fulfilling the charitable purposes of the organization, which purposes may include, but are not limited to, the following: providing access to medical care through affordable health insurance and affordable managed care products for persons of all incomes; identifying and addressing the State's unmet health care needs, particularly with respect to medically uninsured and underserved populations; making services and care available through participating providers; and improving the quality of care for medically uninsured and underserved populations.
4.
Inadvertent payments.
If direct payment is inadvertently made to a hospital, physician or other provider of medical services or health care by or on behalf of a subscriber or member, a corporation may reimburse the subscriber up to the amount payable under the plan to a hospital, a physician or other provider of medical services or health care;
5.
Principal or agent.
In order to maintain and operate such plans, contracts, facilities and services, a corporation may act either in the capacity of principal or agent of other nonprofit hospital service corporations, insurers, health maintenance organizations, health care services plans, employee benefit plans, health care and employee benefit plan sponsors and health care providers authorized to do business in this State;
6.
Contracts and agreements.
To contract with any similar corporations in other states for the joint administration of their business and to enter into reciprocal arrangements for the mutual benefit of their subscribers;
7.
Administrative services.
A corporation has the right to utilize its organization and facilities, either directly or through another legal entity owned by it and similar corporations located in other states, to perform services for the United States or State or the units or agencies of either; or any public charity involved in health care;
8.
Right to contract.
The State or any county, city, town or other quasi-municipal corporation has the same right to contract with a corporation subject to this chapter as it has under Title 24‑A, section 4501 with respect to insurers;
8-A.
Managed care plans.
With respect to managed care plans that require subscribers to select primary care physicians, a corporation subject to this chapter must meet the following requirements:
9.
Indemnity health care contracts.
9-A.
Investments.
Investments by corporations subject to this chapter are governed by this paragraph.
9-B.
Conversion to mutual insurer.
9-C.
Health maintenance organizations.
A corporation subject to this chapter is not required to maintain separate reserves or surplus with respect to the operations of a health maintenance organization that is not a separate legal entity. All assets of the corporation must be available to pay claims arising from corporate operations, with the exception of assets supporting reserves set aside in accordance with a plan for the continuation of benefits to health maintenance organization members under Title 24‑A, section 4204, subsection 7 and assets supporting additional reserves to the extent required by rules adopted by the superintendent pursuant to Title 24‑A, section 901‑A. A hospital or medical service corporation that establishes and maintains a health maintenance organization not organized as a separate legal entity shall maintain separate accounting for the health maintenance organization;
9-D.
Conversion to a domestic stock insurer.
Conversion of a nonprofit hospital and medical service organization as defined in paragraph B, subparagraph (8) to a domestic stock insurer is governed by this subsection.
10.
Superintendent defined.
As used in this chapter "superintendent" means the Superintendent of Insurance of this State; and
11.
Separate accounts.
A hospital or medical services corporation that issues indemnity contracts, contracts pursuant to hospital, medical or health care service plans or integrated medical service plans shall maintain separate accounting for each of these lines of business.

Legislative History

PL 1965, c. 458, §1 (RPR). PL 1965, c. 513, §44 (AMD). PL 1967, c. 114, §§1,2 (AMD). PL 1967, c. 494, §19 (RPR). PL 1969, c. 132, §§5,6 (AMD). PL 1969, c. 419, §1 (RPR). PL 1969, c. 590, §§36-39 (AMD). PL 1971, c. 444, §1 (RPR). PL 1973, c. 585, §12 (AMD). PL 1977, c. 141 (AMD). PL 1979, c. 377 (AMD). PL 1993, c. 702, §A1 (AMD). PL 1997, c. 344, §§2-4 (AMD). PL 1999, c. 256, §M1 (AMD). PL 1999, c. 715, §1 (AMD). PL 2001, c. 72, §§1-3 (AMD). PL 2001, c. 550, §B2 (AMD). PL 2003, c. 171, §§9-16 (AMD).