L.D.899, “An Act to Strengthen the Requirements for Medical Payments Coverage,” (P.L. Ch. 102), amends the process for the assignment of Medical Payments Coverage under 24-A M.R.S. § 2910-A(4). The amendment adds the requirement that the agreement to assign this coverage must be “written” and “on a form prescribed or approved by the superintendent.”
The Bureau proposed a change to 24-A M.R.S. § 2910-A(4) after receiving complaints from consumers who had assigned their medical payments benefit to a provider and had later been billed by the provider for cost sharing due under their health insurance, even though the medical payments coverage paid to the provider was greater than the cost sharing due under the consumer’s health insurance. One intent of the form is to allow an option for insureds with the applicable commercial health insurance coverage (not Medicare, Mainecare, etc.), to direct the casualty insurer to pay a provider after the health insurer has paid its contracted amount for the service.
Attached is a draft form for this purpose. The Bureau seeks comments and suggestions regarding the form. Following the review of comments, the Bureau will provide further guidance to insurers regarding requirements for an acceptable form.
The law’s effective date is September 24th, 2025. However, the Bureau will not enforce this provision prior to December 1, 2025, to allow insurers adequate time to develop the necessary forms and procedures. In the interim, insurers are encouraged to use a form that is substantially similar to the attached draft form. The form should include an option for insureds with appropriate commercial health insurance to request medical payments to providers upon receipt of a bill from the medical provider indicating the amount owed by the insured after the health insurer pays its contracted amount (option 3 in the attached draft form). An electronic form will be acceptable. The form need not be filed with the Bureau at the current time.
Please submit comments on or before August 29, 2025 to InsuranceComment.PFR@maine.gov.
Draft Form: Directions to Pay Medical Benefits - State of Maine (PDF)