§4209. Information to enrollees

1.  Information provided annually.  Every health maintenance organization must annually provide to its enrollees:

A. The most recent annual statement of financial condition including a balance sheet and a statement of operations;   [PL 1989, c. 842, §15 (NEW).]

B. A description of the organizational structure and operation of the health maintenance organization, including the kind and extent of enrollee participation and a summary of any material changes since the issuance of the last report; and   [PL 1995, c. 673, Pt. D, §4 (AMD).]

C.   [PL 1995, c. 673, Pt. D, §5 (RP).]

D.   [PL 1995, c. 673, Pt. D, §5 (RP).]

E. A description of the plan as required under section 4302, subsection 1.   [PL 1995, c. 673, Pt. D, §6 (NEW).]

[PL 1995, c. 673, Pt. D, §4-6 (AMD).]

2.  List of providers.  The health maintenance organization must provide to its subscribers, upon enrollment and reenrollment, a list of providers.

[PL 1989, c. 842, §15 (RPR).]

3.  Notice of material change.  Every health maintenance organization must provide 30 days' advance notice to its subscribers of any material change in the operation of the organization that will directly affect the subscribers.

[PL 1989, c. 842, §15 (RPR).]

4.  Notice of termination of primary care provider.  An enrollee must be notified in writing by the health maintenance organization of the termination of the primary care provider that provided health care services to that enrollee. The health maintenance organization must provide assistance to the enrollee in transferring to another participating primary care provider.

[PL 1989, c. 842, §15 (RPR).]

5.  Access to services.  The health maintenance organization shall provide to its subscribers information on how services may be obtained, where additional information on access to services is obtained and a toll free telephone number for calls within the service area of the health maintenance organization.

[PL 1989, c. 842, §15 (NEW).]

6.  Notification of cancellation.  A health maintenance organization may not cancel or refuse to renew any group contract until it has provided by first class mail at least 10 days' prior notification according to this section. The notice must include the date of cancellation of coverage and the time period for exercising contract conversion rights. The notice also must include an explanation of any applicable grace period. Notification is not required when the health maintenance organization has received written notice from the group contract holder that replacement coverage has been obtained.

A. Notice must be mailed to the group contract holder or subgroup sponsor.   [PL 1995, c. 189, §3 (NEW); PL 1995, c. 189, §4 (AFF).]

B.   [PL 2003, c. 156, §5 (RP).]

B-1. At the time of notification under paragraph A, notice must be mailed to the individual enrollee at the last address provided to the health maintenance organization by the subgroup sponsor, the group contract holder or the individual enrollee. If the health maintenance organization does not have an address on file for the individual enrollee, the notice must be mailed to the office of the subgroup sponsor, if any, or the group contract holder. The notice must also include information to the individual enrollee about the availability of individual coverage as described in section 2809-A, subsection 1-B.   [PL 2003, c. 428, Pt. B, §3 (AMD).]

C.   [PL 2003, c. 428, Pt. B, §3 (RP).]

[PL 2003, c. 428, Pt. B, §3 (AMD).]

SECTION HISTORY

PL 1975, c. 503 (NEW). PL 1989, c. 842, §15 (RPR). PL 1995, c. 189, §3 (AMD). PL 1995, c. 189, §4 (AFF). PL 1995, c. 673, §§D4-6 (AMD). PL 2003, c. 156, §5 (AMD). PL 2003, c. 428, §B3 (AMD).