24-A §2677-A. Payment for nonpreferred providers - Maine Statutes

Title 24-A: MAINE INSURANCE CODE

Chapter 32: PREFERRED PROVIDER ARRANGEMENT ACT HEADING: PL 1999, C. 609, §3 (RPR)

§2677-A. Payment for nonpreferred providers

1. Nonpreferred providers. A carrier incorporating a preferred provider arrangement into a health plan shall provide for payment of covered health care services rendered by providers that are not preferred providers.

[ 1999, c. 609, §14 (NEW) .]

2. Benefit level. The benefit level differential between services rendered by preferred providers and nonpreferred providers may not exceed 20% of the allowable charge for the service rendered, except that the superintendent may waive this requirement for a given benefit plan. Compliance with this requirement for a given benefit plan may be demonstrated on an aggregate basis. This demonstration of compliance must be based on a reasonably anticipated mix of claims certified by a qualified actuary who is a member of the American Academy of Actuaries or a successor organization. As used in this subsection, "allowable charge" means the amount that would be payable for services under the preferred provider arrangement including deductible and coinsurance amounts.

[ 2001, c. 369, §3 (AMD) .]

SECTION HISTORY

1999, c. 609, §14 (NEW). 2001, c. 369, §3 (AMD).