Terms Used In Maine Revised Statutes Title 24-A Sec. 4234-B

  • Deductible: means the amount an enrollee is responsible to pay out of pocket before a health maintenance organization begins to pay the costs associated with treatment. 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-A
  • Person: means an individual, firm, partnership, corporation, association, syndicate, organization, society, business trust, attorney-in-fact or any legal entity. See Maine Revised Statutes Title 24-A Sec. 4202-A
  • Individual and group contracts and certificates issued by a health maintenance organization that provide maternity benefits, including benefits for childbirth, shall provide coverage for services related to maternity and routine newborn care, including coverage for hospital stay, in accordance with the attending physician’s or attending certified nurse midwife’s determination in conjunction with the mother that the mother and newborn meet the criteria outlined in the “Guidelines for Perinatal Care,” published by the American Academy of Pediatrics and the American College of Obstetrics and Gynecology. For the purposes of this section, “routine newborn care” does not include any services provided after the mother has been discharged from the hospital. For the purposes of this section, “attending physician” includes the obstetrician, pediatrician or other physician attending the mother and newborn. Benefits for routine newborn care required by this section are part of the mother’s benefit. The mother and the newborn are treated as one person in calculating the deductible, coinsurance and copayments for coverage required by this section. [PL 2003, c. 517, Pt. B, §23 (AMD).]
    SECTION HISTORY

    PL 1995, c. 615, §4 (NEW). PL 2001, c. 258, §A4 (AMD). PL 2003, c. 517, §B23 (AMD).