Previous PageTable Of ContentsNext Page

PUBLIC LAWS OF MAINE
First Regular Session of the 121st

PART E

     Sec. E-1. 24 MRSA §2327, as amended by PL 2003, c. 428, Pt. E, §1, is further amended to read:

§2327. Group rates

     A group health care contract may not be issued by a nonprofit hospital or medical service organization in this State until a copy of the group rates to be used in calculating the premium for these contracts has been filed for informational purposes with the superintendent. The filing must include the base rates and a description of any procedures to be used to adjust the base rates to reflect factors including but not limited to age, gender, health status, claims experience, group size and coverage of dependents. Notwithstanding this section, rates for group Medicare supplement, nursing home care or long-term care contracts and for certain group contracts included within the definition of "individual health plan" in Title 24-A, section 2736-C, subsection 1, paragraph C must be filed in accordance with section 2321 and rates for small group health plans as defined by Title 24-A, section 2808-B must be filed in accordance with that section.

     Sec. E-2. 24-A MRSA §423-D is enacted to read:

§423-D. Annual report supplement

     1. Annual report supplement required. Each health insurer and health maintenance organization shall file an annual report supplement on or before March 1st of each year, or within any reasonable extension of time that the superintendent for good cause may have granted on or before March 1st. The superintendent shall adopt rules regarding specifications for the annual report supplement. The annual report supplements must provide the public with general, understandable and comparable financial information relative to the in-state operations and results of authorized insurers and health maintenance organizations. Such information must include, but is not limited to, medical claims expense, administrative expense and underwriting gain for each line segment of the market in this State in which the insurer participates. The annual report supplements must contain sufficient detail for the public to understand the components of cost incurred by authorized health insurers and health maintenance organizations as well as the annual cost trends of these carriers. The superintendent shall develop standardized definitions of each reported measure. Rules adopted pursuant to this section are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.

     2. Exemption. If an insurer is engaged in the type of health insurance business identified as an exception to the definition of health insurance in section 704, subsection 2 and is not engaged in health insurance in this State as defined in that section, then the insurer is not subject to the requirements of this section for the filing of annual report supplements.

     Sec. E-3. 24-A MRSA §1902, as enacted by PL 1989, c. 846, Pt. D, §2 and affected by Pt. E, §4, is amended to read:

§1902. License required

     A person may not act as or profess to be an administrator after August 1, 1990, unless licensed under this chapter. An administrator doing business in this State on August 1, 1990, shall apply for a license by November 1, 1990. In addition to any other penalty that may be imposed for violation of this Title, any person violating this section shall, upon conviction, be punished by a fine of not less than $100 nor more than $1,000 or by imprisonment for less than one year, or both.

     An administrator licensed under this chapter on or before December 31, 2003 shall submit information by March 21, 2004 as to the types of business conducted by that administrator in this State on a form prescribed by the superintendent.

     Sec. E-4. 24-A MRSA §1903, sub-§§1 and 2, as enacted by PL 1989, c. 846, Pt. D, §2 and affected by Pt. E, §4, are amended to read:

     1. The names, addresses and official positions of the individuals who are responsible for the conduct of the affairs of the administrator, including, but not limited to, all members of the board of directors, board of trustees, executive committee, or other governing board or committee, the principal officers in the case of a corporation or the partners in the case of a partnership; and

     2. An application fee, as specified in section 601, that the superintendent shall apply toward the initial administrator annual fee if an administrator's license is granted to the applicant. ; and

     Sec. E-5. 24-A MRSA §1903, sub-§3 is enacted to read:

     3. The specific type of business in which the 3rd-party administrator will or intends to engage.

     Sec. E-6. 24-A MRSA §1905, sub-§2, as enacted by PL 1989, c. 846, Pt. D, §2 and affected by Pt. E, §4, is amended to read:

     2. If the superintendent finds that the applicant is qualified for an administrator license, the superintendent shall promptly issue the license, which identifies the types of business in which the applicant may engage; otherwise the superintendent shall refuse to issue the license and promptly notify the applicant.

     Sec. E-7. 24-A MRSA §1905, sub-§5 is enacted to read:

     5. An administrator shall submit an application to amend its license if the administrator desires to amend the types of business on its then-current license.

     Sec. E-8. 24-A MRSA §1952, as amended by PL 2003, c. 428, Pt. H, §2, is further amended to read:

§1952. Licensure

     A private purchasing alliance may not market, sell, offer or arrange for a package of one or more health benefit plans underwritten by one or more carriers without first being licensed by the superintendent. The superintendent shall specify by rule standards and procedures for the issuance and renewal of licenses for private purchasing alliances. A rule may require an application fee of not more than $400 and an annual license fee of not more than $100. A license may not be issued until the rulemaking required by this chapter has been undertaken and all required rules are in effect. Dirigo Health, as established in chapter 87, is exempt from the licensure requirements of this section as an independent executive agency of the State.

     Sec. E-9. 24-A MRSA §2736, sub-§3, ¶B, as enacted by PL 1997, c. 344, §8, is amended to read:

     Sec. E-10. 24-A MRSA §2736, sub-§4, ¶C, as enacted by PL 1997, c. 344, §8, is amended to read:

     Sec. E-11. 24-A MRSA §2736-A, as repealed and replaced by PL 1979, c. 558, §8, is amended to read:

§2736-A. Hearing

     If at any time the superintendent has reason to believe that a filing does not meet the requirements that rates shall not be excessive, inadequate or, unfairly discriminatory or not in compliance with section 6913 or that the filing violates any of the provisions of chapter 23, he the superintendent shall cause a hearing to be held.

     Hearings held under this section shall must conform to the procedural requirements set forth in the Maine Administrative Procedure Act, Title 5, chapter 375, subchapter IV 4.

     Sec. E-12. 24-A MRSA §2736-C, sub-§2, ¶F is enacted to read:

     Sec. E-13. 24-A MRSA §2736-C, sub-§5, as amended by PL 2003, c. 428, Pt. H, §3, is further amended to read:

     5. Loss ratios. For all policies and certificates issued on or after the effective date of this section, the superintendent shall disapprove any premium rates filed by any carrier, whether initial or revised, for an individual health policy unless it is anticipated that the aggregate benefits estimated to be paid under all the individual health policies maintained in force by the carrier for the period for which coverage is to be provided will return to policyholders at least 65% of the aggregate premiums collected for those policies, as determined in accordance with accepted actuarial principles and practices and on the basis of incurred claims experience and earned premiums. For the purposes of this calculation, any savings offset payments paid pursuant to section 6913 must be treated as incurred claims.

     Sec. E-14. 24-A MRSA §2808-B, sub-§2, ¶A, as amended by PL 2003, c. 313, §1, is repealed.

     Sec. E-15. 24-A MRSA §2808-B, sub-§2, ¶G, as enacted by PL 2003, c. 313, §2, is repealed.

     Sec. E-16. 24-A MRSA §2808-B, sub-§§2-A to 2-C are enacted to read:

     2-A. Rate filings. A carrier offering small group health plans shall file with the superintendent the community rates for each plan and every rate, rating formula and classification of risks and every modification of any formula or classification that it proposes to use.

     2-B. Rate review and hearings. Except as provided in subsection 2-C, rate filings are subject to this subsection.

     2-C. Optional guaranteed loss ratio. Notwithstanding subsection 2-B, at the carrier's option, rate filings for a credible block of small group health plans may be filed in accordance with this subsection instead of subsection 2-B. Rates filed in accordance with this subsection are filed for informational purposes.

     Sec. E-17. 24-A MRSA §2839-B is enacted to read:

§2839-B. Large group rates

     1. Application. This section applies to group health insurance offered in the large group market as defined in section 2850-B, except insurance covering only accidental injury, specified disease, hospital indemnity, dental, vision, disability income, long-term care, Medicare supplement or other limited benefit health insurance.

     2. Annual filing. Every carrier offering group health insurance specified in subsection 1 shall annually file with the superintendent on or before April 30th a certification signed by a member in good standing of the American Academy of Actuaries or a successor organization that the carrier's rating methods and practices are in accordance with generally accepted actuarial principles and with the applicable actuarial standards of practice as promulgated by an actuarial standards board. The filing must also certify that the carrier has included in its experience any savings offset payments or recovery of those savings offset payments consistent with section 6913. The filing also must state the number of policyholders, certificate holders and dependents, as of the close of the preceding calendar year, enrolled in large group health insurance plans offered by the carrier. A filing and supporting information are public records except as provided by Title 1, section 402, subsection 3.

     3. Documentation. Every carrier shall maintain at its principal place of business a complete and detailed description of its rating practices, including information and documentation that demonstrates that its rating methods and practices are in accordance with generally accepted actuarial principles and with the applicable actuarial standards of practice as promulgated by an actuarial standards board.

     Sec. E-18. 24-A MRSA §4203, sub-§3, ¶S, as amended by PL 1997, c. 370, Pt. F, §1, is further amended to read:

     Sec. E-19. 24-A MRSA §4207, sub-§5, as repealed and replaced by PL 1993, c. 645, Pt. A, §6, is amended to read:

     5. A schedule or an amendment to a schedule of charge for enrollee health coverage for health care services may not be used by any health maintenance organization unless it complies with section 2736, 2808-B or 2839, whichever is applicable.

     Sec. E-20. 24-A MRSA §4303, sub-§1, as amended by PL 1999, c. 742, §6, is further amended to read:

     1. Demonstration of adequate access to providers. A Except as provided in paragraph A, a carrier offering a managed care plan shall provide to its members reasonable access to health care services in accordance with standards developed by rule by the superintendent. These standards must consider the geographical and transportational problems in rural areas. All managed care plans covering residents of this State must provide reasonable access to providers consistent with the access-to-services requirements of any applicable bureau rule.

     Sec. E-21. Report by Superintendent of Insurance. The Superintendent of Insurance shall submit a report no later than January 1, 2007 to the joint standing committee of the Legislature having jurisdiction over insurance and financial services matters on any decisions by the superintendent to allow health insurance carriers to offer health plans in accordance with the Maine Revised Statutes, Title 24-A, section 4303, subsection 1, paragraph A. The report must include information on the number of enrollees covered under these plans, the financial provisions used in the plans and the designated providers that enrollees are encouraged to use under the plans, including their locations. The joint standing committee of the Legislature having jurisdiction over insurance and financial services matters may report out legislation to the First Regular Session of the 123rd Legislature to remove the repeal date of Title 24-A, section 4303, subsection 1, paragraph A.

     Sec. E-22. Report on medical malpractice awards. The Superintendent of Insurance shall submit a report, no later than January 1, 2005, to the joint standing committee of the Legislature having jurisdiction over insurance and financial services matters regarding medical malpractice lawsuits, damage awards for noneconomic damages in those lawsuits and the cost and availability of medical malpractice insurance in this State. As part of its review, the superintendent shall consult with representatives of the medical community, legal community and medical malpractice insurance industry regarding these issues. At a minimum, the report must address the impact on the cost of malpractice insurance of a cap on noneconomic damages of $250,000 in malpractice lawsuits. The joint standing committee of the Legislature having jurisdiction over insurance and financial services matters may report out legislation to the First Regular Session of the 122nd Legislature in response to the report.

Revisor of Statutes Homepage Subject Index Search 121st Laws of Maine Maine Legislature

About the 2003 Laws Of Maine

Previous PageTop Of PageTable Of ContentsNext Page

Office of the Revisor of Statutes
State House, Room 108
Augusta, Maine 04333

Contact the Office of the Revisor of Statutes