LD 854
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Page 1 of 2 An Act to Amend the Maine Insurance Code to Adopt Statutory Insurance Accountin... LD 854 Title Page
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LR 747
Item 1

 
9-C. Health maintenance organizations. A corporation subject
to this chapter is not required to maintain separate reserves or
surplus with respect to the operations of a health maintenance
organization that is not a separate legal entity. All assets of
the corporation must be available to pay claims arising from
corporate operations, other than with the exception of assets
supporting reserves set aside in accordance with a plan for the
continuation of benefits to health maintenance organization
members under Title 24-A, section 4204, subsection 7 and assets
supporting additional reserves as defined in Title 24-A, section
921, must be available to pay claims arising from corporate
operations to the extent required by rules adopted by the
superintendent pursuant to Title 24-A, section 901-A. A hospital
or medical service corporation that establishes and maintains a
health maintenance organization not organized as a separate legal
entity shall maintain separate accounting for the health
maintenance organization;

 
Sec. 4. 24-A MRSA §222, sub-§2, ¶F, as amended by PL 1999, c. 113, §9,
is further amended to read:

 
F. "Subsidiary" of a specified person means an affiliate
controlled by that person, directly or indirectly, through
one or more intermediaries.

 
Sec. 5. 24-A MRSA §222, sub-§8, ¶B, as enacted by PL 1975, c. 356, §1,
is amended to read:

 
B. Every insurer subject to registration shall file a
registration statement on a form provided by the
superintendent, which shall must contain current information
about:

 
(1) The capital structure, general financial condition,
ownership and management of the insurer and of any
person controlling the insurer;

 
(2) The following transactions currently outstanding
between the insurer and its affiliates:

 
(a) Loans and other investments, and purchases, sales
or exchanges of securities of the affiliate by the
insurer or of the insurer by its affiliates;

 
(b) Purchases, sales or exchanges of assets;

 
(c) Transactions not in the ordinary course of
business;

 
(d) Guarantees or undertakings for the benefit of an
affiliate which that result in an actual
contingent exposure of the insurer's assets to
liability, other than insurance contracts entered
into in the ordinary course of the insurer's
business;

 
(e) All management and service contracts and all
cost-sharing arrangements, other than cost
allocation arrangements based upon generally
accepted accounting principles;

 
(f) Reinsurance agreements covering all or
substantially all of one or more lines of
insurance of the ceding insurer; and

 
(3) Other matters concerning transactions between the
insurer and any affiliate as may be required by the
superintendent;

 
Sec. 6. 24-A MRSA §901, as amended by PL 1991, c. 828, §21, is
repealed.

 
Sec. 7. 24-A MRSA §901-A is enacted to read:

 
§901-A.__Statutory accounting principles; reserves

 
1.__Principles; admitted assets.__In evaluating the financial
condition of an insurer, the superintendent shall determine which
assets may be recognized as admitted assets, and shall value the
insurer's admitted assets and the insurer's liabilities in
accordance with recognized statutory accounting principles as
codified by the National Association of Insurance Commissioners
or its successor organization and reflected in the association's
accounting practices and procedures manual and its successor
publications and in any permitted accounting practices approved
by the superintendent.

 
2.__Reserve required.__If the superintendent finds, in view of
the character of investments held by a domestic insurer, that it
would be prudent for the insurer to establish a special reserve
for possible losses or fluctuations in the value of its
investments, including realty holdings acquired by mortgage loan
default, the superintendent may permit or require the insurer to
establish such a reserve, reasonable in amount, and may require
that the reserve be maintained and reported in any statement or
report of the financial condition of the insurer.

 
3.__Rules.__The superintendent may adopt rules to implement
the purposes of this chapter.__These rules are routine technical
rules pursuant to Title 5, chapter 375, subchapter II-A.

 
Sec. 8. 24-A MRSA §902, as amended by PL 1987, c. 399, §2, is
repealed.

 
Sec. 9. 24-A MRSA c. 11, sub-c. II, as amended, is repealed.

 
Sec. 10. 24-A MRSA c. 11, sub-c. IV, as amended, is repealed.

 
Sec. 11. 24-A MRSA §1110, sub-§1-A, ¶¶A and B, as enacted by PL 1999, c.
715, §4, are amended to read:

 
A. "Admitted assets" has the same meaning as "assets" as
defined in section 901 means assets recognized by the
superintendent pursuant to section 901-A.

 
B. "Aggregate amount of investments" means the aggregate
value of those investments as determined under sections 981
to 984, except as provided in section 1157, subsection 5 in
accordance with statutory accounting principles pursuant to
section 901-A and any rules adopted under that section.

 
Sec. 12. 24-A MRSA §1131, sub-§1, ¶¶A and B, as repealed and replaced by
PL 1987, c. 399, §12, are amended to read:

 
A. The loan or investment shall must fulfill the
requirements of section 1103 and otherwise qualify as a
sound investment.

 
B. No such loan or investment may be represented by:

 
(1) Any item described in section 902 asset determined to
be nonadmitted pursuant to section 901-A or rules
adopted under that section;

 
(2) Any loan or investment expressly prohibited under
section 1136; or

 
(3) Agents' balances, or amounts advanced to or owing by
agents, except as to mortgage loans and collateral
loans to those agents otherwise authorized under this
chapter.

 
Sec. 13. 24-A MRSA §1151-A, sub-§§2 and 3, as enacted by PL 1999, c.
715, §8, are amended to read:

 
2. Admitted assets. "Admitted assets" means assets that may
be allowed in determining the financial condition of an insurer
pursuant to sections 901 and 902 recognized by the superintendent
pursuant to section 901-A.

 
3. Aggregate amount of investments. "Aggregate amount of
investments" means the aggregate value of those investments, as
determined under sections 981 to 984 in accordance with statutory
accounting principles pursuant to section 901-A and any rules
adopted under that section, except as provided in section 1157,
subsection 5.

 
Sec. 14. 24-A MRSA §1156, sub-§2, ¶H, as amended by PL 1993, c. 313,
§27, is further amended to read:

 
H. Investments that do not qualify or are not permitted
under any other paragraph of this subsection; as long as:

 
(1) After giving effect to any investment made under this
paragraph, the aggregate amount of those investments
does not exceed 14% of total admitted assets, except
that investments made under this paragraph in
institutions or property not located within the State
may not exceed 10% of total admitted assets; and, if
the insurer makes investments described in paragraphs A
to G and elects to charge those investments against the
quantitative limits in this paragraph instead of the
quantitative limits in paragraphs A to G, then the
aggregate amount invested under this paragraph in those
types of investments may not exceed 5% of total
admitted assets for any one of those types of
investments;

 
(2) Investments that are neither interest bearing nor
income entitled, including the cost of outstanding bona
fide hedging transactions made under section 1153,
subsection 2, are subject to all of the provisions of
this paragraph; and the aggregate amount of those
investments held at any one time may not exceed 3% of
total admitted assets;

 
(3) The investment limitations contained in this chapter,
qualitative or otherwise, may do not apply to loans or
investments made or acquired under this paragraph,
provided that no loan or investment made or acquired
under this paragraph may be represented by any item
described in section 902 asset determined to be
nonadmitted pursuant to section 901-A or rules adopted
under that section; any loan or investment expressly
prohibited under section 1160; or agents' balances, or
amounts advanced to or owing by agents, except as to
policy loans, mortgage loans and collateral loans to
those agents otherwise authorized under this chapter;
or

 
(4) The insurer shall keep a separate record of all loans
and investments made or acquired under this paragraph.
Any such loan or investment that, subsequent to the
date of making or acquisition, has attained the
standard of eligibility and qualifies under any other
provision of this chapter may be considered to have
been made or acquired under and in compliance with
that provision and may no longer be considered to have
been made or acquired under this paragraph.

 
Sec. 15. 24-A MRSA §1157, sub-§5, ¶D, as enacted by PL 1987, c. 399,
§14, is amended to read:

 
D. Investments made or acquired by subsidiaries referred to
in paragraph B, subparagraph (1), shall be are considered to
be made or acquired directly by the insurer, pro rata, in
the case of a subsidiary not wholly owned, and shall, to
such extent, be are subject to all the provisions and
limitations on the making of investments specified in this
chapter with respect to investments by the insurer; shall
must be valued in accordance with the provisions of sections
981 to 984 section 901-A and any other applicable provisions
of this Title and any applicable rules adopted by the
superintendent; and shall must be located pursuant to
section 3408. Those subsidiaries shall be are subject to
examination by the superintendent under section 221,
subsection 1, and section 222, subsection 1.

 
Sec. 16. 24-A MRSA §1157, sub-§6, as enacted by PL 1987, c. 399, §14,
is amended to read:

 
6. Valuation of subsidiary stock. In determining the
financial condition of an insurer, all investments made directly
or indirectly in the stock of its subsidiaries shall must be
valued in accordance with section 982, subsection 3, and
regulations promulgated 901-A and any rules adopted under that
section.

 
Sec. 17. 24-A MRSA §3629, sub-§6, as enacted by PL 1969, c. 132, §1,
is repealed.

 
Sec. 18. 24-A MRSA §3629, sub-§6-A is enacted to read:

 
6-A.__Section 901-A (statutory accounting principles);

 
Sec. 19. 24-A MRSA §4204, sub-§2-A, ¶D, as corrected by RR 1993, c. 1,
§67, is amended to read:

 
D. The health maintenance organization is financially
responsible, complies with the minimum surplus requirements
of this section and, among other factors, can reasonably be
expected to meet its obligations to enrollees and
prospective enrollees.

 
(1) In a determination of minimum surplus
requirements, the following terms have the following
meanings.

 
(a) "Admitted assets" means assets as defined in
section 901 recognized by the superintendent
pursuant to section 901-A. For purposes of this
chapter, the asset value is that contained in the
annual statement of the corporation as of December
31st of the year preceding the making of the
investment or contained in any audited financial
report, as defined in section 221-A, of more
current origin.

 
(b) "Reserves" means those reserves held by
corporations subject to this chapter for the
protection of subscribers. For purposes of this
chapter, the reserve value is that contained in
the annual statement of the corporation as of
December 31st of the preceding year or any audited
financial report, as defined in section 221-A, of
more current origin.

 
(2) In making the determination whether the health
maintenance organization is financially responsible,
the superintendent may also consider:

 
(a) The financial soundness of the health maintenance
organization's arrangements for health care
services and the schedule of charges used;

 
(b) The adequacy of working capital;

 
(c) Any agreement with an insurer, a nonprofit
hospital or medical service corporation, a
government or any other organization for insuring
or providing the payment of the cost of health
care services or the provision for automatic
applicability of an alternative coverage in the
event of discontinuance of the plan;

 
(d) Any agreement with providers for the provision of
health care services that contains a covenant
consistent with subsection 6; and

 
(e) Any arrangements for insurance coverage or an
adequate plan for self-insurance to respond to
claims for injuries arising out of the furnishing
of health care services.

 
SUMMARY

 
This bill modernizes the laws governing accounting standards
for insurers by adopting the statutory insurance accounting
practices that have been codified by the National Association of
Insurance Commissioners, or NAIC, on a nationwide basis effective
January 1, 2001. This bill repeals conflicting or superfluous
provisions of the chapter of the Maine Insurance Code relating to
valuation of insurers' assets and liabilities and updates the
pertinent cross-references. The bill also corrects an error in
the definition of "subsidiary" in the holding company law and
incorporates a change to the transactions-with-affiliates section
that was inadvertently omitted from prior accreditation
legislation.


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