02-031 C.M.R. ch. 840, § 9 - Additional Duties

In addition to the duties set forth in 24-A M.R.S.A. §1954, an alliance shall:

A. Provide that each eligible employee of any member employer is permitted to enroll in any health benefit plan offered to the applicable risk pool by any participating carrier that provides coverage where he or she works or lives;

B. Ensure that contracts with member individuals or employers meet the following requirements:

(1) For administrative purposes, the alliance will be the policyholder or contract holder of the health benefit plan on behalf of member individuals and employers, their eligible employees, and dependents;

(2) The contracts shall provide that the participating carrier will issue a certificate of coverage specifying the essential features of the health benefit plan's coverage to each individual member and eligible employee; and

(3) The contract shall provide that health benefit plans offered by the employer must be procured through the alliance.

C. Receive, review, and act, as appropriate, on grievances by member individuals, employers, or enrollees;

D. Establish administrative and accounting procedures for operating the alliance and for providing services to member individuals, employers, and employee enrollees;

E. Establish procedures for billing and collection of premiums from members (including any share of the premium paid by employee enrollees);

F. Establish procedures for annual or rolling open enrollment periods during which:

(1) Individuals or employees enrolled in health benefit plans through the alliance may elect to enroll in any health benefit plan that is available to the applicable risk pool through the alliance and that provides health coverage where they live or, if coverage is through a participating employer, where they work; and

(2) Late enrollees may elect to enroll in any health benefit plan that is available through the alliance and that provides health coverage where they live or, if coverage is through a participating employer, where they work;

G. Provide that in the event a member terminates coverage purchased through the alliance, the former member shall be ineligible to purchase a health benefit plan through the alliance for a period of twelve months; and

H. Treat all members within a risk pool equally with regard to membership fees, administrative fees, and benefits of membership.

Notes

02-031 C.M.R. ch. 840, § 9