LD 1363
pg. 2
Page 1 of 3 An Act To Create Lower-cost Health Insurance Options Page 3 of 3
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LR 273
Item 1

 
annual out-of-pocket payments for covered health care
expenses reach $6,000. When the $6,000 annual limit is met,
the coinsurance amount must be reduced to 5% on any
additional expenses.

 
B.__A carrier may not enroll an employee or member in an
alternate plan as described in this section if the
employee or member has any other supplemental insurance
coverage for the payment of the deductibles and
coinsurance associated with the alternate plan except as
provided in section 2808-D, subsection 2.

 
C. The superintendent shall adopt rules to further define
the plan required by this subsection. Rules adopted
pursuant to this subsection are routine technical rules as
defined in Title 5, chapter 375, subchapter 2-A.

 
Sec. 3. 24-A MRSA §§2808-C and 2808-D are enacted to read:

 
§2808-C.__Mandatory options in all group health coverage plans

 
1.__Mandatory offer.__All carriers offering group health
plans in this State shall offer, at the time of offering and
renewing a health plan, an alternate version of that plan in
accordance with the requirements of this subsection and any
rules adopted by the superintendent pursuant to this section.__
The alternate version of each plan must provide the identical
coverages of the primary plan, except that additional
deductibles and coinsurance payments must be required in the
alternate plan as described in this subsection.

 
A.__The alternate plan must include an annual deductible
of $3,000.__The alternate plan must include a 20%
coinsurance payment on health care expenses above $3,000
until the annual out-of-pocket payments for covered health
care expenses reach $6,000.__When the $6,000 annual limit
is met, the coinsurance amount must be reduced to 5% on
any additional expenses.

 
B.__A carrier may not enroll an employee or member in an
alternate plan as described in this section if the
employee or member has any other supplemental insurance
coverage for the payment of the deductibles and
coinsurance associated with the alternate plan, except as
provided in section 2808-D, subsection 2.

 
2.__Rulemaking.__The superintendent shall adopt rules to
further define the plan required by subsection 1. Rules
adopted pursuant to this section are routine technical rules
as defined in Title 5, chapter 375, subchapter 2-A.


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