Sec. A-1. 24-A MRSA §2850-B, sub-§3, ¶¶G and H, as enacted by PL 1997, c. 445, §30 and affected by §32, are amended to read:
G. When the carrier ceases offering a product and meets the following requirements:
(1) In the large group market:
(a) The carrier must provide notice to the policyholder and to the insureds at least 90 days before termination;
(b) The carrier must offer to each policyholder the option to purchase any other product currently being offered in the large group market; and
(c) In exercising the option to discontinue the product and in offering the option of coverage under division (b), the carrier must act uniformly without regard to the claims experience of the policyholders or the health status of the insureds or prospective insureds;
(2) In the small group market:
(a) The carrier shall replace the product with a product that complies with the requirements of this section, including renewability, and with section 2808-B;
(b) The superintendent shall find that the replacement is in the best interests of the policyholders; and
(c) The carrier shall provide notice to the policyholder and to the insureds at least 90 days before replacement; or
(3) In the individual market:
(a) The carrier shall replace the product with a product that complies with the requirements of this section, including renewability, and with section 2736-C;
(b) The superintendent shall find that the replacement is in the best interests of the policyholders; and
(c) The carrier shall provide notice to the policyholder and, if a group policy, to the insureds at least 90 days before replacement; or
H. In renewing a large group policy in accordance with this section, a carrier may modify the coverage, terms and conditions of the policy consistent with other applicable provisions of state and federal laws as long as the modifications are applied uniformly to all policyholders of the same product. This paragraph does not apply to individual or small group policies.; or
Sec. A-2. 24-A MRSA §2850-B, sub-§3, ¶I is enacted to read:
I. In renewing an individual or small group policy in accordance with this section, a carrier may make minor modifications to the coverage, terms and conditions of the policy consistent with other applicable provisions of state and federal laws as long as the modifications meet the conditions specified in this paragraph and are applied uniformly to all policyholders of the same product. Modifications not meeting the requirements in this paragraph are considered a discontinuance of the product pursuant to paragraph G.
(1) A modification pursuant to this paragraph must be approved by the superintendent. The superintendent shall approve the modification if it meets the requirements of this section.
(2) A change in a requirement for eligibility is not a minor modification pursuant to this paragraph if the change results in the exclusion of a class or category of enrollees currently covered.
(3) Benefit modifications required by law are deemed minor modifications for purposes of this paragraph.
(4) Benefit modifications other than modifications required by law are minor modifications only if they meet the requirements of this subparagraph. For purposes of this subparagraph, changes in conditions or requirements specified in the policy, such as preauthorization requirements, are considered benefit modifications.
(a) The total of any increases in benefits may not increase the actuarial value of the total benefit package by more than 5%.
(b) The total of any decreases in benefits may not decrease the actuarial value of the total benefit package by more than 5%.
(c) For purposes of the calculations in divisions (a) and (b), increases and decreases must be considered separately and may not offset one another.
(5) A carrier must give 60 days' notice of any modification pursuant to this paragraph to all affected policyholders and certificate holders.
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