Mandated Health Insurance Benefits: A mandated benefit is coverage that your health insurance company is required by Maine law to provide. These benefits typically pertain to a specific disease or condition. For example, coverage for diabetes supplies and services. A health policy that provides coverage for the mandate as required may contain provisions for maximum benefits and coinsurance and limitations, deductibles and exclusions to the same extent that these provisions are applicable to all coverage and are not inconsistent with the requirements of the particular mandate.

 

History of Mandated Benefits for Health Insurance
Year Enacted
Benefit
Contracts
Affected
Type of
Mandate
Statutory Reference
ET*
Title 24
Title 24-A
1975 Maternity benefits provided to married women must also be provided to unmarried women. All Contracts excluding HMOs Mandated Coverage §2318 §2741,
§2832,
Y
1975 Coverage of children must be made available to unmarried women on the same basis as married women All Contracts excluding HMOs Mandated Offer §2318 §2742,
§2833,
§4234
Y
1975 Must include benefits for dentists' services to the extent that the same services would be covered if performed by a physician. All Contracts excluding HMOs Mandated Provider   §2437 N
1975 Family Coverage must cover any children born while coverage is in force from the moment of birth, including treatment of congenital defects. All Contracts Mandated Coverage §2319 §2743,
§2834 §4234-C
Y
1975 Must include benefits for psychologists' services to the extent that the same services would be covered if performed by a physician. All Contracts excluding HMOs Mandated Provider   §2744,
§2835
Y
1977 Benefits must be made available for home health care services. All Contracts excluding HMOs Mandated Offer §2320 §2745,
§2837
N
1979 Benefits must be made available for outpatient health care services of certified rural health clinics. Nonprofit Hospital & Medical Service Organizations Mandated Offer §2324   N
1981 Benefits must be made available for the services of optometrists if the same services would be covered if performed by a physician. All Groups excluding HMOs Mandated Offer §2331 §2841 N
1981 Benefits must be made available for treatment of alcoholism by licensed or certified treatment facilities subject "reasonable limitations". All Groups excluding HMOs Mandated Offer §2329 §2842 Y
1983 Benefits must include for treatment of alcoholism and drug dependency, subject to "reasonable limitations". Groups of more than 20 excluding HMOs Mandated Coverage §2329 §2842 Y
1983
1995
2003
2019
Benefits must be included for Mental Health Services, subject to "reasonable limitations".
Requires coverage of listed conditions at levels not less extensive than for physical illnesses.
All Contracts Mandated Coverage §2325-A §2749-C, §2843, §4234-A
Y
1983 Benefits must be included for the services of social workers and psychiatric nurses to the extent that the same services would be covered if performed by a physician. All Contracts excluding HMOs Mandated Provider   §2744,
§2835
Y
1986 Benefits must be included for the services of chiropractors to the extent that the same services would be covered by a physician. Benefits must be included for therapeutic, adjustive and manipulative services. All Contracts Mandated Provider and Coverage   §2840-A,
§2748§4236
N
1987 Benefits must be made available for cardiac rehabilitation expenses. Groups of 20 or more Mandated Offer   §2845 N
1990 Benefits must be included for AIDS, AIDS Related Complex (ARC) or HIV related diseases to the extent that any other sickness or disabling condition is covered. All Contracts Mandated Coverage§2332-B §2750,
§2846,
§4229
Y
1990
1997
Benefits must be made available for screening mammography. All Contracts Mandated Coverage §2320-A §2837-A,
§2745-A,
§4237-A
Y
1992 Benefits must be made available for the services of acupuncturist if comparable services would be covered if performed by a physician. All Contracts Mandated Provider §2320-B §2837-B,
§2745-B
Y
1994
1995
1997
Provide benefits for care by chiropractors at least equal to benefit paid to other providers treating similar neuro-musculoskeletal conditions. Requires treatment for acute care for a limited self referred for chiropractic benefits. HMO Only Mandated Provider
and Coverage
  §4236 N
1995 Must provide coverage for reconstruction of both breasts to produce symmetrical appearance according to patient and physician wishes. All Contracts Mandated Coverage §2320-C §2745-C,
§2837-C,
§4237
Y**
1995 Must provide coverage for metabolic formula and up to $3,000 per year for prescribed modified low-protein food products. All Contracts Mandated Coverage §2320-D §2745-D,
§2837-D,
§4238
Y
1996 Benefits must be provided for maternity (length of stay) and newborn care, in accordance with "Guidelines for Perinatal Care" as determined by attending provider and mother. All Contracts including HMOs Mandated Coverage §2318-A §2743-A,
§2834-A,
§4234-B
Y**
1996 Benefits must be provided for medically necessary equipment and supplies used to treat diabetes (insulin, oral hypoglycemic agents, monitors, test strips, syringes and lancets) and approved self-management and education training. All Contracts Mandated Coverage §2332-F §2754,
§2847-E,
§4240
Y
1996 Benefits must be provided for screening Pap tests. Group, and all HMO contracts Mandated Coverage §2320-E §2837-E,
§4242
Y
1996 Benefits must be provided for annual gynecological exam without prior approval of primary care physician. Group managed care Mandated Coverage §2332-G §2847-F,
§4241
Y
1996 Benefits must be made available for mental health services provided by licensed counselors. All Contracts Mandated Offer   §2744(3),
§2835(3),
§4234-A(8-A)
N
1997 Benefits provided for breast cancer treatment for a medically appropriate period of time determined by the physician in consultation with the patient. All Contracts Mandated Coverage §2320-C §2745-C,
§2837-C,
§4237
Y
1998 Coverage required for off-label use of prescription drugs for treatment of cancer, HIV, or AIDS. All Contracts Mandated Coverage §2320-F,
§2320-G
§2745-E,
§2745-F,
§2837-F,
§2837-G,
§4234-D,
§4234-E
Y
1998 Coverage required for prostate cancer screening: Digital rectal examinations and prostate-specific antigen tests covered if recommended by a physician, at least once a year for men 50 years of age or older until age 72. All Contracts Mandated Coverage §2325-C §2745-G,
§2837-H,
§4244
Y
1999 Coverage of nurse practitioners and nurse midwives and allows nurse practitioners to serve as primary care providers. All Contracts Mandated Provider §2332-K §2757,
§2847-H,
§4248
Y
1999 Prescription drug coverage must include contraceptives. Effective 2019 coverage must be provided without any deductible, coinsurance, copay or other cost-sharing requirement. Coverage must be provided for dispensing of prescribed coverage for 12 months. All Contracts Mandated Coverage §2332-J §2756,
§2847-G,
§4247
Y
1999 Coverage of registered nurse first assistants. All Contracts Mandated Provider and Coverage §2332-L §2758,
§2847-I,
§4246
Y
2000 Access to clinical trials. All Contracts Mandated Coverage   §4310 Y
2000 Access to prescription drugs for contracts that provide coverage for prescription drugs and medical devices. All Managed Care Contracts Mandated Coverage   §4311 Y
2001 Coverage of hospice care services All Contracts Mandated Coverage   §2759,
§2847-J,
§4250
Y
2001 Coverage of general anesthesia for dentistry. Effective 1/02 All Contracts Mandated Coverage §2332-M §2760,
§2847-K,
§4251
Y
2001 Access to eye care providers. Effective 1/02 All Managed Care Contracts Mandated Coverage   §4314 Y
2003, 2010 Coverage of prosthetic devices to replace an arm or leg. Effective 1/2004. Exclusion for micro-processors removed effective 1/2011. All Contracts Mandated Coverage   §4315 Y
2003 Coverage of licensed clinical professional counselors. Effective 1/04
See Bulletin 335
All Contracts Mandated Provider   §2744, §2835, §4234-A (8) Y
2005 Coverage of licensed pastoral counselors and marriage & family therapists.
Effective 1/06
See Bulletin 335
All Contracts Mandated Provider   §2744, §2835, §4234-A (8) Y
2005 Benefits must be made available for breast reduction and symptomatic varicose vein surgery.
Effective 1/06
All Contracts Mandated Offer §2332-N §2761, §2847-L, §4252 Y

2007

2019

Hearing Aids - Children currently mandated. Adults effective 1/2020. The dollar limit changes to $3,000 effective 1/2020. All Contracts Mandated Coverage   §2762, §2847-O, §4253 Y
2008 Coverage for amino acid-based elemental infant formulas for children 2 years and under, regardless of delivery method. Effective 1/09. All Contracts Mandated Coverage   §2764, §2847-P, §4256 Y

2008

2019

Coverage for colorectal cancer screening - Colorectal cancer examinations and laboratory tests recommended by a health care provider in accordance with the most recently published colorectal cancer screening guidelines of a national cancer society or at high risk for colorectal cancer. All Contracts Mandated Coverage   §2763, §2847-N, §4254 Y
2009 An insurer that issues individual dental insurance or health insurance that includes coverage for dental services shall provide coverage for dental services performed by an independent practice dental hygienist. Effective 1/2010. All Contracts Mandated Provider   §2765, §2847-Q, §4257 Y
2010 Coverage for autism spectrum disorders for individuals 5 years of age or under. May be limited for applied behavior analysis to $36,000 per year. Effective 1/2011 All Contracts Mandated Coverage   §2768, §2847-T, §4259 Y
2010 Coverage for children’s early intervention services from birth to 36 months for a child identified with a developmental disability or delay. May be limited to $3,200 per year. Effective 1/2011 All Contracts Mandated Coverage   §2767, §2847-S, §4258 Y
2014 Coverage for autism spectrum disorders expanded to age 10. Effective 1/2015 All Contracts Mandated Coverage   §2768, §2847-T, §4259 Y
2014 Policies that provide chemotherapy treatment must provide coverage for prescribed orally administered anticancer medications equivalent to the coverage for IV or injected anticancer medication. Effective 1/2015 All Contracts Mandated Coverage   §4317-B Y
2014 Reimbursement for human leukocyte antigen testing to register as a bone marrow donor. Limited to $150 per lifetime. May not be applied to any deductible or other cost share. Effective 1/2015 All Contracts Mandated Coverage   §4320-I Y
2014 Coverage for services provided by a dental hygiene therapist for policies with dental coverage. Effective 1/2015 All Contracts Mandated Provider   §2847-U, §2765-A Y
2015 Coverage for abuse-deterrent opioid analgesic drugs on a basis not less favorable than that for opioid analgesic drugs that are not abuse-deterrent and are covered by the health plan. All Contracts Mandated Coverage   §4320-J N
2018 Coverage for preventive health services including evidence-based items or services with a rating of A or B in the United States Preventive Services Task Force or equivalent, preventive care and screenings and immunizations supported by the federal DHHS. All Contracts Mandated Coverage   §4320-A Y
2018 Coverage for services provided by a naturopathic doctor when those services are covered when provided by any other health care provided and within the lawful scope of practice of the naturopathic doctor. All Contracts Mandated Provider  

§4320-K

Y
2019 Coverage for Telehealth provided for any medically necessary health care service delivered through telehealth including telemonitoring and telephonic services. All Contracts effective 1/2020 Mandated Coverage   §4316  
2019 Abortion Services - A carrier offering a health plan in this State that provides coverage for maternity services shall provide coverage for abortion services. Effective 1/2020 Mandated Coverage    4320-M  

*ET (Extra-territorial) This column states whether the mandate applies to certificates issued in Maine through group policies that are issued outside of Maine.