Better understand your plan and how to get the most out of it.
The latest state regulations, and how upcoming changes may affect your coverage:
Maine
An Act To Improve Access to Behavioral Health Services by Prohibiting Cost Sharing by Insurers
This coverage applies to fully insured commercial Maine plans.
In accordance with Maine state legislative changes effective January 1, 2023, Individual and Small Group plans will provide coverage for the first primary care office visit and behavioral health office visit in each plan year without cost sharing. The second and third primary care and behavioral health office visits will not apply a deductible or coinsurance. Any copayments for primary care office visits and behavioral health office visits in a plan year will count toward the deductible, except for Medicare Enhance plans that have a deductible.
In accordance with Maine state legislative changes effective January 1, 2023, Large Group plans will provide coverage for the first primary care office visit and behavioral health office visit in each plan year without cost sharing.
This does not apply to high-deductible health plans as defined in the federal Internal Revenue Code, Section 223(c)(2).
An Act To Clarify Health Insurance Coverage for Postpartum Care
This coverage applies to fully insured commercial Maine plans, excluding Medicare Enhance.
In accordance with Maine state legislative changes effective January 1, 2023, Harvard Pilgrim will cover unlimited physical therapy visits for the treatment of postpartum related pelvic floor disorders up to 12 months after the birth of the baby.
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At Harvard Pilgrim, our goal is to provide you with detailed plan information to help guide you toward making the very best health care decisions for you and your family. Log in to your account and click on Plan Details and then View My Plan Documents to view, download, save and print benefits and coverage documents — including your benefit handbook.