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| Home > Statutes > Usa Maine |
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USA Statutes : maine
Title : Title 24-A. MAINE INSURANCE CODE
Chapter : Chapter 56-B. MAINE CONSUMER CHOICE HEALTH PLAN (HEADING. PL 2001, c. 708, @3 (new))
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Title 24-A - §4346. Maine Consumer Choice Health Plan
Title 24-A: MAINE INSURANCE CODE
Chapter 56-B: MAINE CONSUMER CHOICE HEALTH PLAN (HEADING: PL 2001, c. 708, @3 (new))
§4346. Maine Consumer Choice Health Plan
1. Definitions. As used in this chapter, unless the context otherwise indicates, the following terms have the following meanings.
A. "Board" means the Board of Directors of the Maine Consumer Choice Health Plan established in Title 5, section 12004-G, subsection
21-B.
[2001, c. 708, §3 (new).]
B. "Carrier" means:
(1) An insurance company licensed in accordance with this Title to provide health insurance;
(2) A health maintenance organization licensed pursuant to chapter 56;
(3) A fraternal benefit society as defined by section 4101; or
(4) A nonprofit hospital and medical service organization or nonprofit health care service organization licensed pursuant
to Title 24.
[2001, c. 708, §3 (new).]
C. "Director" means the Executive Director of the Maine Consumer Choice Health Plan.
[2001, c. 708, §3 (new).]
D. "Eligible employee" or "employee" means an individual who:
(1) Meets the definition of "eligible employee" set forth in section 2808-B, subsection 1, paragraph C;
(2) Is a self-employed individual who:
(a) Works and resides in the State; and
(b) Is organized as a sole proprietorship or in any other legally recognized manner that a self-employed individual may organize,
a substantial part of whose income derives from a trade or business through which the individual has attempted to earn taxable
income, and who has filed the appropriate United States Internal Revenue Service form for the previous taxable year, and for
whom a copy of the appropriate United States Internal Revenue Service form or forms and schedule has been filed with the plan
or its administrator; or
(3) Is a sole employee of a nonprofit organization that has been determined by the Internal Revenue Service to be exempt
from taxation under the United States Internal Revenue Code, Section 501(c)(3),(4) or (6) and who has a normal work week of
at least 20 hours and is not covered under a public or private plan for health insurance or other health benefit arrangement.
[2001, c. 708, §3 (new).]
E. "Fund" means the Maine Consumer Choice Health Plan Fund.
[2001, c. 708, §3 (new).]
F. "Plan" means the Maine Consumer Choice Health Plan established in this section.
[2001, c. 708, §3 (new).]
G. "Small employer" means an eligible group as defined in section 2808-B, subsection 1, paragraph D.
[2001, c. 708, §3 (new).]
[2001, c. 708, §3 (new).]
2. Plan established. The Maine Consumer Choice Health Plan is established as an independent executive agency to negotiate and contract with carriers
to provide a board-authorized choice of health benefits coverage to eligible enrollees.
On or before January 1, 2006, the board shall initiate a request for proposal process seeking proposals from qualified nonprofit
organizations for assumption of the administrative and financial responsibility of the plan. If the board determines that
a qualified organization exists, the board, in conjunction with the Governor, shall submit any necessary legislation to accomplish
the transfer of the functions of the plan to a nonprofit organization.
[2001, c. 708, §3 (new).]
3. Board of directors. The plan operates under the supervision of the Board of Directors of the Maine Consumer Choice Health Plan, which consists
of 5 voting members.
A. The Governor shall appoint to the board one member representing large employers, 2 members representing small employers,
one member representing governmental entities and one member representing consumer health care organizations. Appointments
by the Governor are subject to review by the joint standing committee of the Legislature having jurisdiction over health insurance
matters and to confirmation by the Legislature.
[2001, c. 708, §3 (new).]
B. Initial terms of the members of the board are staggered: 3 members serve 3-year terms and 2 members serve 2-year terms.
After the initial terms, members serve full 2-year terms and continue to serve until their successors have been appointed.
Board members may serve up to 3 full terms consecutively.
[2001, c. 708, §3 (new).]
C. Board members shall elect a chair. All meetings of the board are public proceedings within the meaning of Title 1, chapter
13, subchapter I.
[2001, c. 708, §3 (new).]
D. Board members are entitled to reimbursement for necessary expenses according to the provisions of Title 5, chapter 379.
[2001, c. 708, §3 (new).]
[2001, c. 708, §3 (new).]
4. Executive director. The Executive Director of the Maine Consumer Choice Health Plan is the administrator of the plan. The director is appointed
by the board and serves at the pleasure of the board.
[2001, c. 708, §3 (new).]
5. Powers. The board may:
A. Enter into contracts with qualified 3rd parties for any service necessary to carry out the purposes of this chapter;
[2001, c. 708, §3 (new).]
B. Employ necessary staff;
[2001, c. 708, §3 (new).]
C. Authorize benefit plan designs offered by participating carriers in accordance with subsection 7 and all applicable statutes
and rules;
[2001, c. 708, §3 (new).]
D. Establish membership fees in accordance with subsection 9 to support the administrative expenses of the plan;
[2001, c. 708, §3 (new).]
E. Provide, if approved by the board, premium collection services for participating carriers with respect to health benefit
plans offered through the plan if the carrier offering the health benefit plan gives express written authorization to the
board or any other entity acting on behalf of the board to act as the carrier's agent for that purpose;
[2001, c. 708, §3 (new).]
F. Establish procedures for adjusting payments within each risk pool to participating carriers if the board finds that some
participating carriers have a significantly disproportionate share of high-risk or low-risk enrollees;
[2001, c. 708, §3 (new).]
G. Establish a financial relationship directly with producers licensed pursuant to chapter 16 to market health benefit plans
offered through the plan;
[2001, c. 708, §3 (new).]
H.
[2001, c. 714, Pt. II, §2 (rp).]
I. Accept grant funding from any public or private sources identified by the board;
[2001, c. 708, §3 (new).]
J. Perform all lawful acts necessary or convenient in the exercise of any power, authority or jurisdiction over the plan, either
in the administration of the plan or to fulfill the purpose of the plan as set forth in this chapter;
[2001, c. 708, §3 (new).]
K. Undertake activities necessary to administer the plan, including marketing and publicizing the plan and ensuring carrier
and enrollee compliance with plan requirements; and
[2001, c. 708, §3 (new).]
L. Adopt rules as necessary to administer the plan. Rules adopted pursuant to this paragraph are routine technical rules as
defined in Title 5, chapter 375, subchapter II-A, except that rules adopted relating to the establishment of a risk adjustment
mechanism or risk pools pursuant to paragraph F and subsection 10 are major substantive rules as defined in Title 5, chapter
375, subchapter II-A and must be submitted to the Legislature on or before January 1, 2004.
[2001, c. 708, §3 (new).]
[2001, c. 714, Pt. II, §2 (amd).]
6. Participating carriers; contracts. The board shall develop objective criteria for the selection of participating carriers and provide adequate notice of the
application process to permit all carriers a reasonable and fair opportunity to participate. The selection of participating
carriers must be based on the criteria developed by the board.
[2001, c. 708, §3 (new).]
7. Selection of health plans. The board shall require carriers to offer multiple health plans to ensure that enrollees have a choice among carriers and
types of health benefit plans in accordance with this subsection.
A. The plan must offer, at a minimum, a fee-for-service plan, a managed care plan and a point-of-service plan. These health
benefit plans may offer a range of deductibles, and must include at least one plan with a high deductible. The plan may offer
other health plans in accordance with applicable state or federal law.
[2001, c. 708, §3 (new).]
B. To the extent possible, the plan must ensure that at least one plan offered pursuant to this subsection is available to
enrollees in all geographic areas of the State.
[2001, c. 708, §3 (new).]
[2001, c. 708, §3 (new).]
8. Enrollee eligibility. The board may establish conditions for enrollment and participation for enrollees in accordance with this subsection.
A. Small employers are eligible. Employers that choose to participate in the plan shall offer enrollment to all employees
and their dependents who are not enrolled in another health plan.
[2001, c. 708, §3 (new).]
B. Governmental and municipal employers are eligible.
[2001, c. 708, §3 (new).]
C. Individuals not enrolled in another health plan may participate.
[2001, c. 708, §3 (new).]
D. Conditions for eligibility may not be based on health status.
[2001, c. 708, §3 (new).]
E. Eligibility may be extended at the board's discretion to employers with 51 or more employees with the approval of the Legislature.
In the event that the board seeks to extend eligibility to employers with 51 or more employees, the board shall notify the
joint standing committee of the Legislature having jurisdiction over health insurance matters. The joint standing committee
of the Legislature having jurisdiction over health insurance matters may submit legislation to extend eligibility to employers
with 51 or more employees under this chapter.
[2001, c. 708, §3 (new).]
[2001, c. 708, §3 (new).]
9. Contributions. The board shall establish contributions for participation in the plan, including any membership fees and premiums for health
coverage. Enrolled employers shall determine the annual amount, if any, contributed by the employer toward the premium cost
of health coverage under the plan for employees and their dependents. The board may establish a mechanism to collect contributions
from enrolled employers, including remittance of the share of any premium paid by an employee. The board may coordinate with
Maine Revenue Services to develop a mechanism for collection of contributions.
[2001, c. 708, §3 (new).]
10. Risk pools. The board shall develop standards for classifying groups of participating enrollees into risk pools. The board may establish
one or more risk pools consistent with rules adopted by the superintendent for private purchasing alliances pursuant to chapter
18-A.
[2001, c. 708, §3 (new).]
11. Cost, quality and value measures. The board shall develop and publish objective cost, quality and value measures. The board shall also consider such measures
in adopting authorization criteria for health plans.
[2001, c. 708, §3 (new).]
12. Licensing; regulation. Notwithstanding any other provision of law, the plan is not subject to licensure as an insurer pursuant to this Title.
Carriers that contract with the plan must be licensed pursuant to Title 24 or this Title. Health plans offered by participating
carriers must comply with all applicable requirements of statutes and rules. Except to the extent inconsistent with this
chapter, producers and carriers engaged in activities pursuant to this chapter are subject to all provisions of Title 24 and
this Title. Rates for health benefit plans provided to enrollees in the plan by participating carriers are not subject to
sections 2736, 2736-A and 2736-B.
[2001, c. 708, §3 (new).]
13. Marketing. The board shall approve and make available to potential enrollees educational and marketing materials, health benefit plan
descriptions, enrollee satisfaction survey results and comparison sheets that accurately summarize the requirements for eligibility
and the health benefit plans and premiums offered by participating carriers in the plan. The information provided must enable
enrollees and potential enrollees to make informed decisions regarding their enrollment in the plan and their choice of a
health benefit plan. Participating carriers may not provide any marketing materials to potential enrollees relating to benefits
and premiums for the plan unless authorized by the board.
[2001, c. 708, §3 (new).]
14. Enrollee satisfaction survey. On an annual basis, the board shall develop a survey to monitor the satisfaction of enrollees participating in the plan.
The results of the survey must be made available to enrollees and the public.
[2001, c. 708, §3 (new).]
15. Fund. The Maine Consumer Choice Health Plan Fund is created as a dedicated fund for the deposit of any funds advanced for initial
operating expenses and fees paid by enrollees for administration of the plan. The fund may not lapse, but remains in a continuing
carrying account to carry out the purposes of this chapter.
[2001, c. 708, §3 (new).]
16. Annual report. Beginning February 1, 2003 and annually on or before February 1st thereafter, the board shall submit a report on the operation
of the plan to the joint standing committee of the Legislature having jurisdiction over health insurance matters. The report
must include information relating to the carriers participating in the plan; the health benefit plans offered through the
plan and their premium rates; the total number of enrollees participating in the plan and sorted as to employer size; and
the administrative and operating expenses of the plan.
[2001, c. 708, §3 (new).]
17. Board-approved plans; report.
[2001, c. 708, §3 (new); T. 24-A, §4346, sub-§17 (rp).]
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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