HISTORY OF MANDATED HEALTH INSURANCE BENEFITS

Year Enacted	Benefit	Contracts Affected	Type of Mandate	Statutory Reference		ET*
Year Enacted	Benefit	Contracts Affected	Type of Mandate	Title 24	Title 24-A	ET*
1975	Maternity benefits provided to married women must also be provided to unmarried women.	All Contracts	Mandated Coverage	§2318	§2741 §2832, §4234	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	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 excluding HMOs	Mandated Coverage	§2319	§2743 §2834	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 Provider	§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	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.	Groups of more than 20	Mandated Coverage	§2325-A	§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	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 Offer	§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
1995	Must make available coverage for listed mental illnesses at levels not less expensive than for physical illnesses.	Individual Small Groups	Mandated Offer	§2325-A	§2843 §4234-A §2749-C	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.	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	Coverage of prosthetic devices to replace an arm or leg. Effective 1/04	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	Coverage for $1,400 per hearing aid for each ear every 36 months. Effective from birth to age 5 on 1/08, age 6-13 on 1/09, age 14-18 on 1/10.	All Contracts	Mandated Coverage		§2762, §2847-M, §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		§2763, §2847-N, §4254, Public Law 595	Y
2008	Coverage for colorectal cancer screening in accordance with American Cancer Society guidelines. Effective 1/09	All Contracts	Mandated Coverage		§2763, §2847-N, §4254, Public Law 516	Y

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

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