ME| Bulletin 494, issued by the Maine Bureau of Insurtance, outlines seven enacted laws affecting Maine health insurance, most effective July 29, 2026 (with specific provisions effective earlier or for policies issued/renewed on or after January 1, 2027).
Basic Overview:
- LD 378 – Plan sponsor audit rights: Broadens the definition of “administrator” so that insurance companies acting as TPAs must honor plan sponsors’ statutory rights to audit claims and related data, extending the LD 1906 audit regime to carrier-administered plans; effective April 13, 2026.
- LD 582 – PFAS blood testing coverage: Requires health insurance carriers to cover medically necessary PFAS blood testing, as determined under National Academies (or comparable) clinical guidelines, for policies issued or renewed on or after January 1, 2027.
- LD 1502 – Prostate cancer screening coverage: Expands required coverage for prostate cancer screening by tying eligibility to current nationally recognized clinical guidelines rather than age thresholds, and bans all cost‑sharing (deductibles, copays, coinsurance) for these screenings on contracts issued or renewed on or after January 1, 2027.
- LD 1970 – Consent for HIV testing and disclosure: Requires informed patient consent before HIV testing, while allowing HIV‑related information to appear in medical records for purposes such as seeking insurance reimbursement.
- LD 2005 – Mail‑order prescription delivery failures: Allows a covered person to obtain a prescription at an in‑network brick‑and‑mortar pharmacy, at no greater out‑of‑pocket cost than the original mail order, if mail‑order medication is delayed more than one day beyond the expected delivery date or arrives unusable.
- LD 2011 – MaineCare exclusion from “carrier”: Removes MaineCare from the definition of “carrier” for prescription‑drug‑benefit regulation purposes, effectively excluding the MaineCare program from those health plan prescription drug provisions in the Maine Insurance Code.
- LD 2071 – Expanded vaccine access and pharmacist authority: Extends zero cost‑sharing coverage to FDA‑licensed vaccines that are recommended by specified national professional organizations, not just those recommended by ACIP, and authorizes pharmacists (and supervised interns) to prescribe, dispense, and administer vaccines within expanded age parameters while eliminating separate PCP notification requirements.