Chapter 199
H.P. 1053 - L.D. 1503
PART D
Sec. D-1. 24-A MRSA §2849, sub-§1, as amended by PL 1995, c. 332, Pt. F, §3, is further amended to read:
1. Policies subject to this section.
Notwithstanding any other provision of law, this section applies to all group and blanket medical insurance policies issued by insurers or health maintenance organizations to policyholders who are obtaining coverage for a group or subgroup to replace coverage under a different contract or policy issued by any a nonprofit hospital or medical service organization, insurer or health maintenance organization, or to replace coverage under an uninsured employee benefit plan that provides payment for health services received by employees or their dependents if the policyholder has applied for coverage under the replacement policy within 90 days after termination of coverage under the contract or policy being replaced. For purposes of this section, the group or blanket policy issued to replace the prior contract or policy is the "replacement policy." The group or blanket contract or policy or uninsured employee benefit plan , or a number of individual contracts or policies if the premiums were paid by the employer or by payroll deduction, being replaced is the "replaced contract or policy."
Sec. D-2. 24-A MRSA §2849-A, sub-§2, as amended by PL 1999, c. 256, Pt. L, §6, is further amended to read:
2. Requirement.
Every group or blanket policy subject to this section must provide a reasonable extension of benefits for a person who is totally disabled on the date the group or blanket policy is discontinued, or on the date coverage for a subgroup in the policy is discontinued. A premium may not be charged during the period of extension. For a policy providing hospital or medical expense coverage, an extension of benefits provision is reasonable if it provides benefits for covered expenses directly relating to the condition causing total disability for at least 6 months following the effective date of discontinuance. For a policy providing specific indemnity during hospital confinement, "extension of benefits" means that discontinuance of the policy during a disability has no effect on benefits payable for that confinement.
Sec. D-3. 24-A MRSA §2849-A, sub-§4-A, as enacted by PL 1997, c. 604, Pt. H, §2, is amended to read:
4-A. Coordination of benefits.
If replacement coverage is secured by the group or blanket policyholder from any an insurer, nonprofit hospital or medical service organization or health maintenance organization and a totally disabled person is covered under such the replacement coverage, the replacement coverage must pay as primary coverage and the replaced coverage must pay as secondary coverage for the covered expenses directly relating to the condition causing total disability during the extension of benefits required under this section.
Sec. D-4. 24-A MRSA §2849-B, sub-§2, as amended by PL 2001, c. 258, Pt. E, §7, is further amended to read:
2. Persons provided continuity of coverage.
Except as provided in subsection 3, this section provides continuity of coverage for a person who seeks coverage under an individual or a , group or blanket insurance policy or health maintenance organization policy if:A. That person was covered under an individual or , group or blanket contract or policy issued by any a nonprofit hospital or medical service organization, insurer, health maintenance organization , or was covered under an uninsured employee benefit plan that provides payment for health services received by employees and their dependents or a governmental program, including, but not limited to, those listed in section 2848, subsection 1-B, paragraph A, subparagraphs (3) to (10). For purposes of this section, the individual or , group or blanket policy under which the person is seeking coverage is the "succeeding policy." The group , blanket or individual contract or policy, uninsured employee benefit plan or governmental program that previously covered the person is the "prior contract or policy"; and
B.
Coverage under the prior contract or policy terminated:
(1) Within 180 days before the date the person enrolls or is eligible to enroll in the succeeding contract if:
(a) Coverage was terminated due to unemployment, as defined in Title 26, section 1043;
(b) The person was eligible for and received unemployment compensation benefits for the period of unemployment, as provided under Title 26, chapter 13; and
(c) The person is employed at the time replacement coverage is sought under this provision; or
(2) Within 90 days before the date the person enrolls or is eligible to enroll in the succeeding contract.
A period of ineligibility for any a health plan imposed by terms of employment may not be considered in determining whether the coverage ended within a time period specified under this section.
This section does not apply to replacements of group or blanket coverage within the scope of section 2849 or if the succeeding policy is an individual policy and the prior contract or policy was a short-term policy.