(REALLOCATED FROM TITLE 24, SECTION 2332-J)

(REALLOCATED FROM TITLE 24, SECTION 2332-J)
1. Required coverage for services upon referral of primary care provider. A nonprofit hospital or a medical service organization that issues individual and group health care contracts shall provide coverage under those contracts for services performed by a certified nurse practitioner, certified midwife or certified nurse midwife to a patient who is referred to the certified nurse practitioner, certified midwife or certified nurse midwife by a primary care provider when those services are within the lawful scope of practice of the certified nurse practitioner, certified midwife or certified nurse midwife.

[PL 2021, c. 79, §1 (AMD).]

Terms Used In Maine Revised Statutes Title 24 Sec. 2332-K

  • Contract: A legal written agreement that becomes binding when signed.
  • organization: means a corporation or other entity authorized by the superintendent or organized pursuant to this chapter for the purpose of providing nonprofit hospital service plans within the meaning of subsection 1, nonprofit medical service plans within the meaning of subsection 2 and any organization that provides only nonprofit health care plans within the meaning of subsection 3. See Maine Revised Statutes Title 24 Sec. 2301
2. Required coverage for self-referred services. With respect to individual and group health care contracts that do not require the selection of a primary care provider, a nonprofit hospital or medical service organization shall provide coverage under those contracts for services performed by a certified nurse practitioner, certified midwife or certified nurse midwife when those services are covered services and when they are within the lawful scope of practice of the certified nurse practitioner, certified midwife or certified nurse midwife.

[PL 2021, c. 79, §1 (AMD).]

3. Limits; coinsurance; deductibles. Any contract that provides coverage for services under this section may contain provisions for maximum benefits and coinsurance and reasonable limitations, deductibles and exclusions to the extent that these provisions are not inconsistent with the requirements of this section.

[RR 1999, c. 1, §30 (RAL).]

4. Application. The requirements of this section apply 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. B, §8 (NEW).]

SECTION HISTORY

RR 1999, c. 1, §30 (RAL). PL 2003, c. 517, §B8 (AMD). PL 2021, c. 79, §1 (AMD).