HP0979, LD 1333, item 18, Document Text

Amend the amendment in Part A in section 1 by striking out all of paragraph C (page 1, lines 17 to 21 in amendment) and inserting the following:

‘C. A carrier may vary the premium rate due to smoking status and family membership. The superintendent may adopt rules setting forth appropriate methodologies regarding rate discounts based on smoking status. Rules adopted pursuant to this paragraph are routine technical rules as defined in Title 5, chapter 375, subchapter II-A.’

Amend the amendment in Part A by inserting after section 1 the following:

‘Sec. A-2. 24-A MRSA §2736-C, sub-§2, ¶C-1 is enacted to read:

C-1. A carrier may vary the premium rate due to geographic area in accordance with the limitation set out in this paragraph. For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State on or after July 1, 2012, the rating factor used by a carrier for geographic area may not exceed 1.5.’

Amend the amendment in Part A in section 2 in paragraph D in subparagraph (6) in the 4th line (page 2, line 37 in amendment) by inserting after the following: " 1" the following: ' to the extent permitted by the federal Affordable Care Act'

Amend the amendment in Part A in section 2 in paragraph D in subparagraph (7) in the 4th line (page 2, line 42 in amendment) by inserting after the following: " 1" the following: ' to the extent permitted by the federal Affordable Care Act'

Amend the amendment in Part A in section 4 in paragraph I in the 6th line (page 3, line 13 in amendment) by inserting after the following: " paragraph" the following: ' and paragraphs C and C-1'

Amend the amendment in Part A in section 4 in paragraph I in subparagraph (4) in the 4th line (page 3, line 32 in amendment) by inserting after the following: " 1" the following: ' to the extent permitted by the federal Affordable Care Act'

Amend the amendment in Part A in section 4 in paragraph I in subparagraph (5) in the 4th line (page 3, line 37 in amendment) by inserting after the following: " 1" the following: ' to the extent permitted by the federal Affordable Care Act'

Amend the amendment in Part A in section 5 by striking out all of paragraph C (page 4, lines 16 to 22 in amendment) and inserting the following:

‘C. A carrier may vary the premium rate due to occupation and industry, family membership, smoking status, participation in wellness programs and group size. The superintendent may adopt rules setting forth appropriate methodologies regarding rate discounts for participation in wellness programs and rating for occupation and industry and group size pursuant to this paragraph. Rules adopted pursuant to this paragraph are routine technical rules as defined in Title 5, chapter 375, subchapter II-A 2-A.’

Amend the amendment in Part A by inserting after section 5 the following:

‘Sec. A-6. 24-A MRSA §2808-B, sub-§2, ¶C-1 is enacted to read:

C-1. A carrier may vary the premium rate due to geographic area in accordance with the limitation set out in this paragraph. For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State on or after October 1, 2011, the rating factor used by a carrier for geographic area may not exceed 1.5.’

Amend the amendment in Part A in section 6 in paragraph D in subparagraph (7) in the 4th line (page 5, line 16 in amendment) by inserting after the following: " 1" the following: ' to the extent permitted by the federal Affordable Care Act'

Amend the amendment in Part A in section 6 in paragraph D in subparagraph (8) in the 4th line (page 5, line 21 in amendment) by inserting after the following: " 1" the following: ' to the extent permitted by the federal Affordable Care Act'

Amend the amendment in Part A in section 8 in paragraph H in the 6th line (page 5, line 35 in amendment) by inserting after the following: " paragraph" the following: ' and paragraphs C and C-1'

Amend the amendment in Part A in section 8 in paragraph H in subparagraph (4) in the 4th line (page 6, line 12 in amendment) by inserting after the following: " 1" the following: ' to the extent permitted by the federal Affordable Care Act'

Amend the amendment in Part A in section 8 in paragraph H in subparagraph (5) in the 4th line (page 6, line 17 in amendment) by inserting after the following: " 1" the following: ' to the extent permitted by the federal Affordable Care Act'

Amend the amendment in Part B in section 6 in subsection 3 by striking out all of paragraph F (page 8, lines 15 to 17 in amendment)

Amend the amendment in Part C in section 4 in §405-B in subsection 1 in the first line (page 19, line 1 in amendment) by striking out the following: " subsidiary" and inserting the following: ' corporate affiliate'

Amend the amendment in Part C in section 4 in §405-B in subsection 3 in the 4th line (page 19, line 13 in amendment) by striking out the following: " subsidiary" and inserting the following: ' corporate affiliate'

Amend the amendment in Part D by striking out all of section 5.

Amend the amendment in Part F in section 7 by striking out all of subsection 1 (page 24, lines 31 to 35 in amendment) and inserting the following:

‘ 1. Demonstration of adequate access to providers. A carrier offering or renewing a managed care plan shall provide to its members reasonable access to health care services. A carrier may provide incentives to members to use designated providers based on cost or quality, but may not require members to use designated providers of health care services.’

Amend the amendment by relettering or renumbering any nonconsecutive Part letter or section number to read consecutively.

summary

This amendment makes changes to Committee Amendment "A" as follows.

1. The amendment restricts rating in the individual and small group market on the basis of geographic area using language previously enacted to a rating factor of 1.5 instead of allowing rating on the basis of geographic area outside of the age rating band.

2. The amendment clarifies that the expansion of the rating bands in the individual and small group market to 4 to 1 and 5 to 1 is allowed to the extent permitted by the federal Patient Protection and Affordable Care Act.

3. The amendment clarifies that carriers offering managed care plans may provide incentives to members to use designated providers based on cost or quality, but may not require members to use designated providers of health care services.

4. The amendment makes technical changes and corrections.

HP0979 LD 1333	First Regular Session - 125th Maine Legislature S "H" to C "A", Filing Number S-96, Sponsored by DIAMOND		LR 1371 Item 18
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