Sec. 7. 24-A MRSA §4222-B, sub-§21 is enacted to read:

21.__Sections 235-A, 2736 and 2839, relating to rate filings and hearings, apply to health maintenance organizations.

SUMMARY

This bill requires that a hearing be held before proposed changes in health insurance rates that exceed the Consumer Price Index by 100% or more are approved. It also changes the standard of review from whether the rates are excessive to whether the rates are unreasonable relative to the benefits and coverage offered. The bill requires that the hearing be held before an impartial administrative hearing officer who is not employed by the Department of Professional and Financial Regulation, Bureau of Insurance. The bill also requires that actuarial staff at the Bureau of Insurance prepare a report for use in the hearing.

The bill applies to both individual and group health insurance policies and to all carriers, including health maintenance organizations.