LD 1496
pg. 27
Page 26 of 41 An Act To Reduce Maine's Health Insurance Rates and Expand Consumer Choice ... Page 28 of 41
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LR 541
Item 1

 
F.__A small group carrier may not transfer a small employer
involuntarily into or out of a class of business. A small
group carrier may not transfer a small employer into or out
of a class of business unless such offer is made to transfer
all small employers in the class of business without regard
to any changes in case characteristics, claims experience,
health status or duration of coverage since the first date
of coverage.

 
5.__Coverage for late enrollees.__In providing coverage to
late enrollees, small group health plan carriers are allowed to
exclude or limit coverage for a late enrollee subject to the
limitations set forth in section 2849-B, subsection 3.

 
6.__Guaranteed issuance and guaranteed renewal.__Carriers
providing small group health plans must meet the following
requirements on issuance and renewal.

 
A.__Any small group health plan offered to any eligible
group or subgroup must be offered to all eligible groups
that meet the carrier's minimum participation requirements,
which may not exceed 75%, to all eligible employees and
their dependents in those groups.__In determining compliance
with minimum participation requirements, eligible employees
and their dependents that have existing health care coverage
may not be considered in the calculation.__If an employee
declines coverage because the employee has other coverage,
any dependents of that employee who are not eligible under
the employee's other coverage are eligible for coverage
under the small group health plan.

 
B.__A carrier may deny coverage under a managed care plan,
as defined by section 4301-A:

 
(1)__To employers who have no employees who live,
reside or work within the approved service area of the
plan; and

 
(2)__To employers if the carrier has demonstrated to
the superintendent's satisfaction that:

 
(a)__The carrier does not have the capacity to
deliver services adequately to additional
enrollees within all or a designated part of its
service area because of its obligations to
existing enrollees; and

 
(b)__The carrier is applying this provision
uniformly to individuals and groups without regard
to any health-related factor.


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