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Me. Rev. Stat. tit. 24-A, § 4261

Fees for covered dental services

Known as the Health Maintenance Organization Act

The act spans §§ 4201–4261 (80 sections).

PL 2025, c. 298, §4 (NEW).

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings.

A. "Covered dental service" means a dental service for which reimbursement is available under an individual or group contract or for which reimbursement would be available but for the application of contractual limitations such as a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative benefit payment or any other similar limitation.

B. "Dental provider" means a person licensed under Title 32, chapter 143, subchapter 3.

2. Prohibition of required fees for dental services not covered. A health maintenance organization that issues individual or group dental insurance or individual or group contracts that include coverage for dental services may not require, directly or indirectly, that a participating dental provider provide dental services at a fee set by, or subject to the approval of, the health maintenance organization for a service that is not a covered dental service.

3. Fees for covered dental services. A fee for a covered dental service must be set by the health maintenance organization in good faith and may not be nominal.

Official source: Maine Legislature. Reproduced from public-domain Maine statutes; confirm against the official source for the current text. Not legal advice.