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USA Statutes : maine
Title : Title 24-A. MAINE INSURANCE CODE
Chapter : Chapter 18-A. PRIVATE PURCHASING ALLIANCES (HEADING. PL 1995, c. 673, Pt. A, @3 (new))
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Title 24-A - §1951. Definitions
Title 24-A: MAINE INSURANCE CODE
Chapter 18-A: PRIVATE PURCHASING ALLIANCES (HEADING: PL 1995, c. 673, Pt. A, @3 (new))
§1951. Definitions
As used in this chapter, unless the context otherwise indicates, the following terms have the following meanings.
[1995, c. 673, Pt. A, §3 (new).]
1. Carrier. "Carrier" means any insurance company, nonprofit hospital and medical service organization or health maintenance organization
authorized to issue health plans in this State. For the purposes of this chapter, carriers that are affiliated companies
or that are eligible to file consolidated tax returns are treated as one carrier and any restrictions or limitations imposed
by this chapter apply as if all health plans delivered or issued for delivery in this State by affiliated carriers were issued
by one carrier. For purposes of this chapter, health maintenance organizations are treated as separate organizations from
affiliated insurance companies and nonprofit hospital and medical service organizations.
[1995, c. 673, Pt. A, §3 (new).]
2. Private purchasing alliance. "Private purchasing alliance" or "alliance" means a corporation established under former Title 13-A, Title 13-B or Title
13-C to provide health insurance to its members through one or more participating carriers.
[2003, c. 428, Pt. H, §1 (amd).]
The Revisor's Office cannot provide legal advice or
interpretation of Maine law to the public. If you need legal
advice, please consult
a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007
This page created on: 2005-10-01
Title 24-A - §1952. Licensure
Title 24-A: MAINE INSURANCE CODE
Chapter 18-A: PRIVATE PURCHASING ALLIANCES (HEADING: PL 1995, c. 673, Pt. A, @3 (new))
§1952. Licensure
A private purchasing alliance may not market, sell, offer or arrange for a package of one or more health benefit plans underwritten
by one or more carriers without first being licensed by the superintendent. The superintendent shall specify by rule standards
and procedures for the issuance and renewal of licenses for private purchasing alliances. A rule may require an application
fee of not more than $400 and an annual license fee of not more than $100. A license may not be issued until the rulemaking
required by this chapter has been undertaken and all required rules are in effect. Dirigo Health, as established in chapter
87, is exempt from the licensure requirements of this section as an independent executive agency of the State.
[2003, c. 469, Pt. E, §8 (amd).]
The Revisor's Office cannot provide legal advice or
interpretation of Maine law to the public. If you need legal
advice, please consult
a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007
This page created on: 2005-10-01
Title 24-A - §1953. Powers
Title 24-A: MAINE INSURANCE CODE
Chapter 18-A: PRIVATE PURCHASING ALLIANCES (HEADING: PL 1995, c. 673, Pt. A, @3 (new))
§1953. Powers
In addition to the powers granted in Title 13-B or Title 13-C, an alliance may do any of the following:
[RR 2001, c. 2, Pt. B, §43 (cor); §58 (aff).]
1. Membership fees. Set reasonable fees for membership in the alliance for financing reasonable and necessary costs incurred in administering
the alliance;
[1995, c. 673, Pt. A, §3 (new).]
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;
[1995, c. 673, Pt. A, §3 (new).]
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;
[1995, c. 673, Pt. A, §3 (new).]
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;
[1995, c. 673, Pt. A, §3 (new).]
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;
[1995, c. 673, Pt. A, §3 (new).]
6. Negotiation. Negotiate with participating carriers the premium rates charged for coverage offered through the alliance, consistent with
rules adopted by the superintendent; or
[1995, c. 673, Pt. A, §3 (new).]
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.
[1995, c. 673, Pt. A, §3 (new).]
The Revisor's Office cannot provide legal advice or
interpretation of Maine law to the public. If you need legal
advice, please consult
a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007
This page created on: 2005-10-01
Title 24-A - §1954. Duties
Title 24-A: MAINE INSURANCE CODE
Chapter 18-A: PRIVATE PURCHASING ALLIANCES (HEADING: PL 1995, c. 673, Pt. A, @3 (new))
§1954. Duties
An alliance shall:
[1995, c. 673, Pt. A, §3 (new).]
1. Carrier eligibility. Develop and make available a list of objective criteria, subject to rules adopted by the superintendent, that participating
carriers must meet in order to be eligible to participate in the alliance;
[1995, c. 673, Pt. A, §3 (new).]
2. Enrollee choice. Ensure that enrollees have a choice among a reasonable number of competing carriers and types of health benefit plans.
A.
[2001, c. 369, §2 (rp).]
B.
[T. 24-A, §1954, sub-§2, paragraph B (rp).]
C.
[1997, c. 370, Pt. A, §2 (rp).]
[2001, c. 369, §2 (amd).]
3. Enrollment. Develop standard enrollment procedures in accordance with rules adopted by the superintendent;
[1995, c. 673, Pt. A, §3 (new).]
4. Plan descriptions. Publish educational materials, plan descriptions and comparison sheets describing participating carriers and the health
benefit plans available through the alliance for use in enrolling eligible members. The information may include an assessment
of utilization management procedures and the level of quality and cost-effective care;
[1995, c. 673, Pt. A, §3 (new).]
5. Enrollee eligibility. Establish eligibility standards for membership in accordance with rules adopted by the superintendent. Eligibility standards
may not relate to health status;
[1995, c. 673, Pt. A, §3 (new).]
6. Acceptance of enrollees. Accept all applicants for membership that meet the alliance's eligibility standards;
[1995, c. 673, Pt. A, §3 (new).]
7. Risk pools. Develop standards for classifying groups of participating members into risk pools. The risk pools may include one or more
risk pools for enrolled employees and their dependents and a risk pool for enrolled individuals and their dependents;
[1995, c. 673, Pt. A, §3 (new).]
8. Annual report. Prepare an annual report on the operations of the alliance to the superintendent, which must include an accounting of all
outside revenues received by the alliance and internal and independent audits and any other information the superintendent
may require;
[1995, c. 673, Pt. A, §3 (new).]
9. Trust account. Maintain a trust account or accounts for deposit of all money received and collected for the operation of the alliance.
An alliance and its board members, employees and agents have a fiduciary duty with respect to all money received or owed
to it to ensure payments of its obligations and a full accounting to its members and the superintendent; and
[1995, c. 673, Pt. A, §3 (new).]
10. Violations. Report to the superintendent any suspected or alleged law violations.
[1995, c. 673, Pt. A, §3 (new).]
div>
The superintendent may specify further duties by rule.
[1995, c. 673, Pt. A, §3 (new).]
The Revisor's Office cannot provide legal advice or
interpretation of Maine law to the public. If you need legal
advice, please consult
a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007
This page created on: 2005-10-01
Title 24-A - §1955. Restrictions
Title 24-A: MAINE INSURANCE CODE
Chapter 18-A: PRIVATE PURCHASING ALLIANCES (HEADING: PL 1995, c. 673, Pt. A, @3 (new))
§1955. Restrictions
1. Restricted activities. An alliance may not purchase health care services, assume risk for the cost or provision of health care services or otherwise
contract with health care providers for the provision of health care services to enrollees without the prior approval of the
superintendent.
[1997, c. 616, §3 (amd).]
2. Licensing. A person who solicits applications for insurance, negotiates insurance contracts or takes applications for insurance from
enrollees on behalf of an alliance or on behalf of insurance carriers or health maintenance organizations that have contracted
with the alliance must be licensed with the bureau in compliance with chapter 16.
[1997, c. 457, §32 (amd); §55 (aff).]
3. Conflict of interest. A person may not be a board member, officer or employee of an alliance if that person is employed as or by, is a member
of the board of directors of, is an officer of, or has a material direct or indirect ownership interest in a carrier or health
care provider. A person may not be a board member or officer of an alliance if a member of that person's household is a member
of the board of directors of, is an officer of or has a material direct or indirect ownership interest in a carrier or health
care provider. An employee of an alliance who is licensed as an agent, broker or consultant may act under that license only
on behalf of the alliance and only within the scope of that person's duties as an employee.
[1997, c. 616, §3 (amd).]
4. Commissions. All commissions or other payments to the alliance from or on behalf of carriers must inure to the benefit of the alliance
and alliance members. An employee of an alliance may not receive compensation that is contingent upon the amount of coverage
sold or upon the health carrier that is chosen. This subsection does not prohibit an alliance from arranging coverage through
an unaffiliated agent or broker who is paid on a commission basis in the ordinary course of business.
[1995, c. 673, Pt. A, §3 (new).]
5. Rulemaking. The superintendent may specify further restrictions by rule.
[1995, c. 673, Pt. A, §3 (new).]
The Revisor's Office cannot provide legal advice or
interpretation of Maine law to the public. If you need legal
advice, please consult
a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007
This page created on: 2005-10-01
Title 24-A - §1956. Authority of superintendent
Title 24-A: MAINE INSURANCE CODE
Chapter 18-A: PRIVATE PURCHASING ALLIANCES (HEADING: PL 1995, c. 673, Pt. A, @3 (new))
§1956. Authority of superintendent
1. Alliance conduct. The superintendent has the authority to regulate the establishment and conduct of alliances as set forth in this chapter.
[1995, c. 673, Pt. A, §3 (new).]
2. Representations. A person or entity not licensed by the superintendent as a private purchasing alliance and engaged in the purchase, sale,
marketing or distribution of health insurance or health care benefit plans may not represent itself as an alliance, health
insurance purchasing alliance, purchasing alliance, health insurance purchasing cooperative or purchasing cooperative, or
otherwise use a confusingly similar name.
[1995, c. 673, Pt. A, §3 (new).]
3. Conflict. Nothing in this chapter may be considered in conflict with or limit the duties and powers granted to the superintendent
under the laws of this State.
[1995, c. 673, Pt. A, §3 (new).]
4. Penalties. Violations of this chapter are subject to the penalties contained in section 12-A.
[1995, c. 673, Pt. A, §3 (new).]
The Revisor's Office cannot provide legal advice or
interpretation of Maine law to the public. If you need legal
advice, please consult
a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007
This page created on: 2005-10-01
Title 24-A - §1957. Rulemaking
Title 24-A: MAINE INSURANCE CODE
Chapter 18-A: PRIVATE PURCHASING ALLIANCES (HEADING: PL 1995, c. 673, Pt. A, @3 (new))
§1957. Rulemaking
The superintendent shall adopt rules necessary to carry out the requirements of this chapter before January 1, 1997. All
rules adopted pursuant to this chapter are major substantive rules as defined in Title 5, chapter 375, subchapter II-A.
[1995, c. 673, Pt. A, §3 (new).]
The Revisor's Office cannot provide legal advice or
interpretation of Maine law to the public. If you need legal
advice, please consult
a qualified attorney.
Office of the Revisor of Statutes
7 State House Station
State House Room 108
Augusta, Maine 04333-0007
This page created on: 2005-10-01
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