§ 24-A §1953 — Powers

Maine § 24-A §1953

• Jurisdiction: Maine
• Title 24-A: MAINE INSURANCE CODE
• Ch. 18-A: PRIVATE PURCHASING ALLIANCES

Text

In addition to the powers granted in Title 13‑B or Title 13‑C, an alliance may do any of the following:
1.
Membership fees.
Set reasonable fees for membership in the alliance for financing reasonable and necessary costs incurred in administering the alliance;
2.
Premium collection.
Provide premium collection services for health benefit plans offered through the alliance if the insurer or health maintenance organization offering the plan gives express written authorization to the alliance or any other person or entity acting on behalf of the alliance to act as the insurer's or the health maintenance organization's agent for that purpose;
3.
Contracts.
Contract with qualified independent 3rd parties for any service necessary to carry out the powers and duties authorized or required by this chapter;
4.
Standards.
Exclude a carrier or freeze enrollment in a carrier for failure to achieve established quality, access or information reporting standards of the alliance;
5.
Data collection.
Develop uniform standards for data to be provided by participating carriers and providers. The alliance may collect data necessary for evaluation of the performance of participating carriers and their provider networks by consumers, providers, employers and the superintendent;
6.
Negotiation.
Negotiate with participating carriers the premium rates charged for coverage offered through the alliance, consistent with rules adopted by the superintendent; or
7.
Risk adjustment.
Establish procedures, subject to approval by the superintendent, for adjusting payments within each risk pool to participating carriers if the alliance finds that some carriers have a significantly disproportionate share of high-risk or low-risk enrollees.

Legislative History

PL 1995, c. 673, §A3 (NEW). PL 1997, c. 616, §2 (AMD). RR 2001, c. 2, §B43 (COR). RR 2001, c. 2, §B58 (AFF).