| | | A health maintenance organization authorized pursuant to | | chapter 56 may impose penalties in its 2 standardized small | | group health plans through its utilization review procedures | | that apply per admission or per encounter.__Those penalties | | must be consistent with the normal requirements applicable to | | benefits in that health maintenance organization. |
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| | | Sec. 11. 24-A MRSA §2808-B, sub-§9, as enacted by PL 1993, c. 325, | | §1, is repealed and the following enacted in its place: |
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| | | 9.__Reinsurance mechanism.__Small group carriers shall | | participate in a reinsurance pool for the purpose of | | reinsuring small group risks.__The participants in the plan of | | operation of the pool shall guarantee, without limitation, the | | solvency of the pool.__That guarantee constitutes a permanent | | financial obligation of each participant on a pro rata basis. |
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| | | Sec. 12. 24-A MRSA §2808-B, sub-§10 is enacted to read: |
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| | | 10.__Minimum return of aggregate premiums.__For all policies | | issued on or after October 15, 2003, the Superintendent of | | Insurance shall disapprove any premium rates filed by any | | carrier, whether initial or revised, for a small group health | | policy unless it is anticipated that the aggregate benefits | | estimated to be paid under all the health insurance policies | | maintained in force by the carrier for the period for which | | coverage is to be provided will return to policyholders at | | least 85% of the aggregate premiums collected for those | | policies, as determined in accordance with accepted actuarial | | principles and practices and on the basis of incurred claims | | experience and earned premiums. |
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| | | Sec. 13. 24-A MRSA §4202-A, sub-§1, as amended by PL 2001, c. 218, | | §1, is further amended to read: |
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| | | 1. Basic health care services. "Basic health care | | services" means health care services that an enrolled | | population might reasonably require in order to be maintained | | in good health and includes, at a minimum, emergency care, | | inpatient hospital care, inpatient physician services, | | outpatient physician services, ancillary services such as x- | | ray services and laboratory services and all benefits mandated | | by statute and mandated by rule applicable to health | | maintenance organizations. The superintendent may adopt rules | | defining "basic health care services" to be provided by health | maintenance organizations. In adopting such rules, the | superintendent shall consider the coverages that have | traditionally been provided by health maintenance | organizations; the need for flexibility in the marketplace; | and the importance of providing multiple options to employers | and consumers.may not |
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