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avoid or reject high-risk policyholders, reduce the insured's | | benefits or increase cost-sharing. The superintendent may | | approve a plan only after the superintendent determines that the | | plan is in the public interest and is consistent with this | | section and Title 24-A, section 2808-B. Rules adopted pursuant | | to this section are major, substantive rules as defined in Title | | 5, chapter 375, subchapter 2-A. |
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| | | Sec. 16. Effective date. That section of this Act that amends the | | Maine Revised Statutes, Title 24-A, section 2736-C, subsection | | 5 takes effect October 15, 2003. |
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| | | Current law allows small group carriers to form a | | reinsurance pool for the purpose of reinsuring small group | | risks. To date, no small group carriers have not taken | | advantage of this authorization. |
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| | | This bill requires both individual and small group health | | plan carriers to participate in a reinsurance pool for their | | respective type of insurance. The Department of Human | | Services, Bureau of Medical Services and the Governor's Office | | of Health Policy and Finance, an office created by Executive | | Order on January 9, 2003, are required to work together to | | develop a plan creating the reinsurance pools. The | | requirement to participate in the reinsurance pools is | | contingent upon the approval of the plan by the Superintendent | | of Insurance. |
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| | | This bill also requires so-called "pure community rating" | | for both individual and small group health plan carriers, | | requires higher amounts of premium dollars to be used for | | direct medical care and removes statutory authority permitting | | high-deductible plans. |
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