Maine Code § 24-A-4231

Insolvency or withdrawal; alternative coverage
Open in Lexace · Ask the AI about this section
1. Continuation of coverage by other carriers. In the event of an insolvency of a health
maintenance organization and if satisfactory arrangements for the performance of its obligations have
not been made as provided for in section 4214, all other carriers that made an offer of coverage to any

group contract holder of the insolvent health maintenance organization at the most recent purchase or
renewal of coverage, upon order of the superintendent, shall offer the enrollees in the group covered by
that contract a 30-day enrollment period that begins on the date of insolvency.
Each carrier shall offer the group's enrollees the same coverage and rates that the carrier had offered to
those enrollees at the most recent purchase or renewal of coverage prior to the insolvency, except that
a successor health maintenance organization may increase the group's rate to the extent justified by
including the new enrollees in a recalculation of rates using the existing method of rate calculation of
the successor carrier or, if the group was covered under a multiple-year contract, to the extent justified
to take into account increased health care costs, as approved by the superintendent.
[PL 2001, c. 88, §8 (AMD).]
2. Allocation of enrollees. If no other carrier had offered coverage to a group contract holder in
the insolvent health maintenance organization, or if the superintendent determines that the other health
benefit plan or plans lack sufficient health care delivery resources to ensure that health care services
will be available and reasonably accessible to all of that group's enrollees in the insolvent health
maintenance organization, then the superintendent shall allocate equitably the insolvent health
maintenance organization's group contracts among all health maintenance organizations that operate
within a portion of the insolvent health maintenance organization's service area, taking into
consideration the health care delivery resources of each health maintenance organization. Each health
maintenance organization to which a group or groups are so allocated shall offer such group or groups
the health maintenance organization's existing coverage that is most similar to each group's coverage
with the insolvent health maintenance organization at rates determined in accordance with the successor
health maintenance organization's existing rating methodology.
[PL 1989, c. 842, §18 (NEW).]
3. Nongroup enrollees.
[PL 1995, c. 332, Pt. O, §10 (RP).]
4. Allocation upon withdrawal. If any group contract holder of a withdrawing health
maintenance organization is unable to obtain replacement coverage subsequent to a withdrawal
pursuant to section 415-A, the superintendent may allocate equitably the withdrawing health
maintenance organization's group contract holders among all health maintenance organizations that
operate within a portion of the withdrawing health maintenance organization's service area in
accordance with subsection 2.
[PL 2001, c. 88, §9 (NEW).]

‹ Prev All Maine sections Next ›


Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.