Maine Revised Statutes Title 24-A Sec. 4241 – Gynecological and obstetrical services
Current as of: 2023 | Check for updates
|
Other versions
1. Coverage in managed care plans. With respect to managed care plans that require enrollees to select primary care physicians, a health maintenance organization that issues group policies, contracts and certificates must meet the following requirements.
A. The health maintenance organization must permit a physician who specializes in obstetrics and gynecology to serve as a primary care physician if the physician qualifies under the organization’s credentialling policy. [PL 1995, c. 617, §5 (NEW); PL 1995, c. 617, §6 (AFF).]
B. All group plan contracts must provide coverage for an annual gynecological examination, including routine pelvic and clinical breast examinations, performed by a physician, certified nurse practitioner or certified nurse midwife participating in the plan, without requiring the prior approval of the primary care physician. [PL 1995, c. 617, §5 (NEW); PL 1995, c. 617, §6 (AFF).]
C. If the examination specified in paragraph B reveals a gynecological condition for which another visit to the physician participating in the plan is medically required and appropriate, or for any gynecological care beyond the annual examination, the carrier may require the patient or the examining physician, certified nurse practitioner or certified nurse midwife to secure from the patient’s primary care physician a referral to the participating physician, certified nurse practitioner or certified nurse midwife from whom such care may be obtained. [PL 1995, c. 617, §5 (NEW); PL 1995, c. 617, §6 (AFF).]
[PL 2003, c. 517, Pt. A, §11 (AMD); PL 2003, c. 517, Pt. A, §13 (AFF).]
Terms Used In Maine Revised Statutes Title 24-A Sec. 4241
- Carrier: means a health maintenance organization, an insurer, a nonprofit hospital, a medical service corporation or any other entity responsible for the payment of benefits or provision of services under a group contract. See Maine Revised Statutes Title 24-A Sec. 4202-A
- Contract: A legal written agreement that becomes binding when signed.
- 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. Application. This section applies to all 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, §11 (AMD); PL 2003, c. 517, Pt. A, §13 (AFF).]
This section does not prohibit a carrier from requiring a physician, certified nurse practitioner or certified nurse midwife participating in the plan to inform a woman’s primary care physician prior to each treatment pursuant to this section. [PL 1995, c. 617, §5 (NEW); PL 1995, c. 617, §6 (AFF).]
SECTION HISTORY
PL 1995, c. 617, §5 (NEW). PL 1995, c. 617, §6 (AFF). PL 2003, c. 517, §A11 (AMD). PL 2003, c. 517, §A13 (AFF).