AUGUSTA, Maine ? The state insurance bureau has greenlighted a key component of a new insurance product that would be sold on Maine?s health insurance exchange next year under a controversial deal between insurer Anthem and health system MaineHealth.
The Maine Bureau of Insurance issued a decision Thursday that largely approved one piece of the health plans, the proposed network of doctors and hospitals that would serve consumers who buy the policies.
The network was the subject of a public hearing in late June, in which some health providers excluded from the network and several Anthem customers raised concerns that patients may have to travel farther for care and find new doctors.
The bureau approved the provider network on several conditions, including that Anthem submit more information about how the plans would affect access to health care based on where consumers live, and that Anthem contract with additional specialists in some areas and report on consumers? future experience with the plans.
The plans still need further approvals before they can be sold on Maine?s insurance exchange. The state insurance bureau will issue a broader report by the end of July detailing whether the plans comply with the federal health reform law. That report also will include one other carrier that plans to offer health insurance on Maine?s exchange, the nonprofit Maine Community Health Options.
The federal government will have the final say about whether plans from both organizations meet standards to be sold on the exchange.
The insurance exchanges are a key component of the health reform law, the federal Affordable Care Act, which aims to widen health coverage to 30 million people.The exchanges will operate as online markets where consumers and small businesses can shop for coverage beginning in October 2013. The plans would take effect in January 2014.
Plans sold on the exchanges will be available to individuals who buy their own insurance, small businesses and the uninsured. Most workers who have health insurance through a large employer aren?t eligible to shop for plans on the exchange and wouldn?t be affected by the Anthem-MaineHealth deal.
About 257,000 Mainers are expected to be eligible to shop for insurance on Maine?s exchange, which will be run by the federal government.
The Anthem-MaineHealth plans include 32 of Maine?s 38 hospitals, but exclude Central Maine Healthcare, which operates Central Maine Medical Center in Lewiston, Bridgton Hospital and Rumford Hospital, as well as Parkview Adventist Medical Center in Brunswick, York Hospital, and Portland?s Mercy Hospital.
Central Maine Healthcare officials have denounced the plan as a ?backroom deal? that allows MaineHealth to undercut hospitals that compete with its health system, undermining the intent of the reform law to improve access to affordable health care.
Anthem and MaineHealth contend that their collaboration will lead to lower health insurance premiums for consumers and allow policyholders plenty of choice in who they see for care.
Watch bangordailynews.com for updates.
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