Maine Revised Statutes Title 24-A Sec. 4210 – Open enrollment
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1. After a health maintenance organization has been in operation 24 months, it shall have an annual open enrollment period of at least one month during which it accepts enrollees up to the limits of its capacity, as determined by the health maintenance organization, in the order in which they apply for enrollment. To the extent not inconsistent with the requirements of chapter 36 and sections 2736?C and 2808?B as qualified by section 4222?B, subsection 3, a health maintenance organization may apply to the superintendent for authorization to impose such underwriting restrictions upon enrollment as are necessary to preserve its financial stability, to prevent excessive adverse selection by prospective enrollees or to avoid unreasonably high or unmarketable charges for enrollee coverage for health care services. The superintendent shall approve or deny the application within 10 days of the receipt of that application from the health maintenance organization.
[PL 1995, c. 332, Pt. O, §4 (AMD).]
Terms Used In Maine Revised Statutes Title 24-A Sec. 4210
- 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
- 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-AMonth: means a calendar month. See Maine Revised Statutes Title 1 Sec. 72 Superintendent: means the Superintendent of Insurance. See Maine Revised Statutes Title 24-A Sec. 4202-A
2. Health maintenance organizations providing or arranging for services exclusively on a group contract basis may limit the open enrollment provided for in this section to all members of the group or groups covered by such contracts.
[PL 1975, c. 503 (NEW).]
SECTION HISTORY
PL 1975, c. 503 (NEW). PL 1995, c. 332, §O4 (AMD).