1. Authorization. There may be a provision for coordination of benefits payable under the policy and under other plans of insurance or health care coverage, in conformance with rules adopted by the superintendent to establish uniformity in the permissive use of coordination of benefits provisions in order to avoid claim delays and misunderstandings that otherwise result from the use of inconsistent or incompatible provisions among the several insurers and nonprofit hospital or medical service organization plans and nonprofit health care organization plans. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter II?A.

[PL 1999, c. 256, Pt. N, §1 (NEW).]

Terms Used In Maine Revised Statutes Title 24-A Sec. 2723-A

  • Contract: A legal written agreement that becomes binding when signed.
  • health insurance: means insurance of human beings against bodily injury, disablement or death by accident or accidental means, or the expense thereof, or against disablement or expense resulting from sickness, and every insurance appertaining thereto, including provision for the mental and emotional welfare of human beings by defraying the costs of legal services only to the extent provided for in chapter 38. See Maine Revised Statutes Title 24-A Sec. 704
  • insured: as used in this chapter , shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under such a policy to any indemnities, benefits and rights provided therein. See Maine Revised Statutes Title 24-A Sec. 2731
2. Coordination with Medicare. Coordination of benefits with Medicare is governed by the following provisions.
A. The policy may not coordinate benefits with Medicare Part A unless:

(1) The insured is enrolled in Medicare Part A;
(2) The insured was previously enrolled in Medicare Part A and voluntarily disenrolled;
(3) The insured stated on an application or other document that the insured was enrolled in Medicare Part A; or
(4) The insured is eligible for Medicare Part A without paying a premium and the policy states that it will not pay benefits that would be payable under Medicare even if the insured fails to exercise the insured’s right to premium-free Medicare Part A coverage. [PL 1999, c. 256, Pt. N, §1 (NEW).]
B. The policy may not coordinate benefits with Medicare Part B unless:

(1) The insured is enrolled in Medicare Part B;
(2) The insured was previously enrolled in Medicare Part B and voluntarily disenrolled;
(3) The insured stated on an application or other document that the insured was enrolled in Medicare Part B; or
(4) The insured is eligible for Medicare Part A without paying a premium and the insurer provided prominent notification to the insured both when the policy was issued and, if applicable, when the insured becomes eligible for Medicare due to age. The content of the notification must be approved by the bureau. The notification must state that the policy will not pay benefits that would be payable under Medicare even if the insured fails to enroll in Medicare Part B and state that the insured may contact the bureau, the Health Insurance Consumer Assistance Program established in section 4326 or another relevant organization or agency for assistance in understanding coordination of benefits with Medicare Part B under the insured’s contract. [PL 2023, c. 104, §2 (AMD).]
C. Coordination is not permitted with Medicare coverage for which the insured is eligible but not enrolled except as provided in paragraphs A and B. [PL 1999, c. 256, Pt. N, §1 (NEW).]

[PL 2023, c. 104, §2 (AMD).]

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.

[PL 2005, c. 121, Pt. D, §2 (NEW).]

SECTION HISTORY

PL 1999, c. 256, §N1 (NEW). PL 1999, c. 790, §D7 (AMD). PL 2005, c. 121, §D2 (AMD). PL 2023, c. 104, §2 (AMD).
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