§ 24-A §4320-C — Emergency services

If a carrier offering a health plan provides or covers any benefits with respect to services in an emergency facility or setting, the plan must cover emergency services without prior authorization. Cost-sharing requirements, such as a deductible, copayment amount or coinsurance rate, for out-of-network services are the same as requirements that would apply if such services were provided in network, and any payment made by an enrollee pursuant to this section must be applied to the enrollee's in-network cost-sharing limit. The enrollee's responsibility for payment for covered out-of-network emergency services must be limited so that if the enrollee has paid the enrollee's share of the charge as specified in the plan for in-network services, the carrier shall hold the enrollee harmless from any additional amount owed to an out-of-network provider for covered emergency services and make payment to the out-of-network provider in accordance with section 4303‑C or, if there is a dispute, in accordance with section 4303‑E. A carrier offering a health plan in this State shall also comply with the requirements of section 4304, subsection 5.

Legislative History

PL 2011, c. 364, §34 (NEW). PL 2019, c. 238, §3 (AMD). PL 2019, c. 668, §4 (AMD).