Maine § 24 §2332-A Coordination of benefits

Maine Statutes

§ 24 §2332-A — Coordination of benefits

Maine·Title 24 INSURANCE·Ch. 19 NONPROFIT HOSPITAL OR MEDICAL SERVICE ORGANIZATIONS

1.Authorization. Provisions contained in group and nongroup nonprofit hospital, medical service or health care subscriber contracts relating to coordination of benefits payable under the contract and under other plans of insurance or of health care coverage under which the subscriber or the subscriber's dependents may be covered must conform to rules adopted by the superintendent. The rules may establish uniformity in the permissive use of coordination of benefits provisions to ensure that the subscriber receives full benefits for covered medical services, to enhance cost containment through avoidance of windfall payments and to avoid claim delays and misunderstandings that otherwise result from the use of inconsistent or incompatible provisions among the several insurers and nonprofit ho

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1.
Authorization.
Provisions contained in group and nongroup nonprofit hospital, medical service or health care subscriber contracts relating to coordination of benefits payable under the contract and under other plans of insurance or of health care coverage under which the subscriber or the subscriber's dependents may be covered must conform to rules adopted by the superintendent. The rules may establish uniformity in the permissive use of coordination of benefits provisions to ensure that the subscriber receives full benefits for covered medical services, to enhance cost containment through avoidance of windfall payments and to avoid claim delays and misunderstandings that otherwise result from the use of inconsistent or incompatible provisions among the several insurers and nonprofit hospital, medical service and health care plans.
1-A.
Coordination with Medicare.
Coordination of benefits is governed by the following provisions.
2.
Medicaid and Children's Health Insurance Program.
Nonprofit service organizations may not consider the availability or eligibility for medical assistance under 42 United States Code, Section 13969, referred to as "Medicaid," or Title 22, section 3174‑T, referred to as the "Children's Health Insurance Program," when considering coverage eligibility or benefit calculations for subscribers and covered family members.
3.
Credit toward deductible.
When an insured is covered under more than one expense-incurred health plan, payments made by the primary plan, payments made by the insured and payments made from a health savings account or similar fund for benefits covered under the secondary plan must be credited toward the deductible of the secondary plan. This subsection does not apply if the secondary plan is designed to supplement the primary plan.

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Legislative History

PL 1987, c. 402, §A149 (NEW). PL 1991, c. 200, §B2 (AMD). PL 1993, c. 666, §B1 (RPR). PL 1997, c. 604, §G1 (AMD). PL 1997, c. 777, §B1 (AMD). PL 2005, c. 121, §D1 (AMD). PL 2005, c. 683, §A38 (AMD). PL 2023, c. 104, §1 (AMD). PL 2023, c. 597, §16 (AMD).