Maine Revised Statutes Title 24-A Sec. 4209 – Information to enrollees
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1. Information provided annually. Every health maintenance organization must annually provide to its enrollees:
A. The most recent annual statement of financial condition including a balance sheet and a statement of operations; [PL 1989, c. 842, §15 (NEW).]
B. A description of the organizational structure and operation of the health maintenance organization, including the kind and extent of enrollee participation and a summary of any material changes since the issuance of the last report; and [PL 1995, c. 673, Pt. D, §4 (AMD).]
C. [PL 1995, c. 673, Pt. D, §5 (RP).]
D. [PL 1995, c. 673, Pt. D, §5 (RP).]
E. A description of the plan as required under section 4302, subsection 1. [PL 1995, c. 673, Pt. D, §6 (NEW).]
[PL 1995, c. 673, Pt. D, §4-6 (AMD).]
Terms Used In Maine Revised Statutes Title 24-A Sec. 4209
- Contract: A legal written agreement that becomes binding when signed.
- Enrollee: means an individual who is enrolled in a health maintenance organization. See Maine Revised Statutes Title 24-A Sec. 4202-A
- Grace period: The number of days you'll have to pay your bill for purchases in full without triggering a finance charge. Source: Federal Reserve
- Group contract holder: means an entity or person that has purchased coverage from a health maintenance organization that provides, at a minimum, basic health care services to enrollees. See Maine Revised Statutes Title 24-A Sec. 4202-A
- Health care services: means any services included in the furnishing of medical care, dental care or hospitalization to an individual, or any services incident to the furnishing of that care or hospitalization, as well as the furnishing of any other services to an individual to prevent, alleviate, cure or heal human illness or injury. See Maine Revised Statutes Title 24-A Sec. 4202-A
- Health maintenance organization: means a public or private organization that is organized under the laws of the Federal Government, this State, another state or the District of Columbia or a component of such an organization, and that:
A. See Maine Revised Statutes Title 24-A Sec. 4202-Ain writing: include printing and other modes of making legible words. See Maine Revised Statutes Title 1 Sec. 72 Provider: means a physician, hospital or person that is licensed or otherwise authorized in this State to furnish health care services. See Maine Revised Statutes Title 24-A Sec. 4202-A
2. List of providers. The health maintenance organization must provide to its subscribers, upon enrollment and reenrollment, a list of providers.
[PL 1989, c. 842, §15 (RPR).]
3. Notice of material change. Every health maintenance organization must provide 30 days’ advance notice to its subscribers of any material change in the operation of the organization that will directly affect the subscribers.
[PL 1989, c. 842, §15 (RPR).]
4. Notice of termination of primary care provider. An enrollee must be notified in writing by the health maintenance organization of the termination of the primary care provider that provided health care services to that enrollee. The health maintenance organization must provide assistance to the enrollee in transferring to another participating primary care provider.
[PL 1989, c. 842, §15 (RPR).]
5. Access to services. The health maintenance organization shall provide to its subscribers information on how services may be obtained, where additional information on access to services is obtained and a toll free telephone number for calls within the service area of the health maintenance organization.
[PL 1989, c. 842, §15 (NEW).]
6. Notification of cancellation. A health maintenance organization may not cancel or refuse to renew any group contract until it has provided by first class mail at least 10 days’ prior notification according to this section. The notice must include the date of cancellation of coverage and the time period for exercising contract conversion rights. The notice also must include an explanation of any applicable grace period. Notification is not required when the health maintenance organization has received written notice from the group contract holder that replacement coverage has been obtained.
A. Notice must be mailed to the group contract holder or subgroup sponsor. [PL 1995, c. 189, §3 (NEW); PL 1995, c. 189, §4 (AFF).]
B. [PL 2003, c. 156, §5 (RP).]
B-1. At the time of notification under paragraph A, notice must be mailed to the individual enrollee at the last address provided to the health maintenance organization by the subgroup sponsor, the group contract holder or the individual enrollee. If the health maintenance organization does not have an address on file for the individual enrollee, the notice must be mailed to the office of the subgroup sponsor, if any, or the group contract holder. The notice must also include information to the individual enrollee about the availability of individual coverage as described in section 2809?A, subsection 1?B. [PL 2003, c. 428, Pt. B, §3 (AMD).]
C. [PL 2003, c. 428, Pt. B, §3 (RP).]
[PL 2003, c. 428, Pt. B, §3 (AMD).]
SECTION HISTORY
PL 1975, c. 503 (NEW). PL 1989, c. 842, §15 (RPR). PL 1995, c. 189, §3 (AMD). PL 1995, c. 189, §4 (AFF). PL 1995, c. 673, §§D4-6 (AMD). PL 2003, c. 156, §5 (AMD). PL 2003, c. 428, §B3 (AMD).