Maine Revised Statutes Title 24-A Sec. 4240 – Coverage for diabetes supplies
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All health maintenance organization individual and group health contracts and certificates must provide coverage for the medically appropriate and necessary equipment, limited to insulin, oral hypoglycemic agents, monitors, test strips, syringes and lancets, and the out-patient self-management training and educational services used to treat diabetes, if: [PL 2003, c. 517, Pt. A, §10 (AMD); PL 2003, c. 517, Pt. A, §13 (AFF).]
1. Certification of medical necessity. The enrollee‘s treating physician or a physician who specializes in the treatment of diabetes certifies that the equipment and services are necessary; and
[PL 1995, c. 592, §4 (NEW).]
Terms Used In Maine Revised Statutes Title 24-A Sec. 4240
- 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 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:
2. Provision of medical services. The diabetes out-patient self-management training and educational services are provided through ambulatory diabetes education facilities authorized by the State’s Diabetes Control Project within the Bureau of Health.
[PL 1995, c. 592, §4 (NEW).]
The requirements of this section apply to all group policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date. [PL 2003, c. 517, Pt. A, §10 (NEW); PL 2003, c. 517, Pt. A, §13 (AFF).]
Revisor’s Note: §4240. Coverage for Pap tests (As enacted by PL 1995, c. 617, §5 is REALLOCATED TO TITLE 24-A, SECTION 4242)
SECTION HISTORY
RR 1995, c. 2, §53 (RAL). PL 1995, c. 592, §4 (NEW). PL 1995, c. 617, §5 (NEW). PL 1995, c. 617, §6 (AFF). PL 2003, c. 517, §A10 (AMD). PL 2003, c. 517, §A13 (AFF).