An Act To Create the Comprehensive Health Insurance Risk Pool Association LR0436(02)
Maine Legislature, Session 121, LD 1190
Committee Amendment CA_A_S384 (Senate)
Amends: 24-A MRSA §2736-C

COMMITTEE AMENDMENT ,,/Jr. to S.P. 394, L.D. 1190, 
To 
Create 
the 
Comprehensive 
Health 
Insurance 
Bill, "An 
Risk 
Pool 
Association" 
Amend the bill by striking out all of the emergency preamble. 
Further amend the bill by inserting before section 1 the 
following: 
. Sec. 1. 24-A MRS A §2736-C, sub-§2, ,B, as enacted by PL 1993, 
c. 477, Pt. C, §1 and affected by Pt. F, §1, is amended to read: 
B. 
A carrier may not vary the premium rate due to the 
gender, 
heal~A-5£a£QST claims experience or policy duration 
of the individual. 
A carrier may vary the premium rate 
based 
on 
health 
status, 
age 
and 
tobacco 
use 
only 
as 
permitted in paragraph D. 
Sec. 2. 24-A MRS A §2736·C, sub-§2, ,C, as amended by PL 2001, 
c. 410, Pt. A, §1 and affected by §10, is further amended to read: 
C. 
A carrier may vary the premium rate due to 
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Page l-LR0436(2) 
COMMITTEE AMENDMENT 
t" 
COMMITTEE AMENDMENT "A' to S.P. 394, L.D. 1190 
Sec. 3. 24-A MRSA §2736-C, sub-§2, ~D, as amended by PL 2001, 
c. 410, Pt. A, §2 and affected by §10, is further amended to-read: 
D. 
A carrier may vary the premium rate due to age, health 
status, occupation or industry anaL geographic area en:},}' 
~nae~--~~--~ellew4n~---~~--~e---wi&hin--~~--lis~ea 
pe~een~a~e--9anas and tobacco use in accordance with the 
following limitations. 
(1) 
For all policies, contracts or certificates that 
are executed, delivered, issued for delivery, continued 
or renewed in this State between December 1, 1993 and 
July 14, 1994, the premium rate may not deviate above 
or below the community rate filed by the carrier by 
more than 50"'0. 
(2) 
For all policies, contracts or certificates that 
are executed, delivered, issued for delivery, continued 
or renewed in this State between July 15, 1994 and July 
14, 1995, the premium rate may not deviate above or 
below the community rate filed by the carrier by more 
than 339-0 • 
(3) 
For all policies, contracts or certificates that 
are executed, delivered, issued for delivery, continued 
or renewed in this State after July 15, 
1995, 
the 
premium 
rate 
may 
not 
deviate 
above 
or 
below 
the 
community rate filed by the carrier by more than 20%. 
(4) 
For all policies, contracts or certificates that 
are executed, delivered, issued for delivery, continued 
or renewed in this State after February L 
2005, the 
maximum rate differential from the community rate filed 
by the carrier for age as determined by ratiQ is 4 to 
1. 
The limitation does not apply for determining rates 
for an attained age of less than 19 or more than 65 
years. 
(5) 
For all policies, contracts or certificates that 
are executed, delivered, issued for delivery, continued 
or renewed in this State after February 1, 2005, the 
maximum rate differential from the community rate filed 
by the carrier for health status as determined by ratio 
is 1.5 to 
and the maximum rate differential for 
tobacco use as determined by ratio is 1.5 to 1. 
Rate 
variations based on health status do not apply to rate 
variations based on an insured's status as a tobacco 
user. 
COMMITTEE AMENDMENT 
.f.'-
COMMITTEE AMENDMENT ,~ to S.P. 394, L.D. 1190 
(6) 
A variation in rate is not permitted on the basis 
of changes in health status after a policy, contract or 
certificate is issued or renewed. 
Sec.4. 24-A MRSA §2736-C, sub-§2, ,G is enacted to read: 
G. 
A carrier that offered individual health plans prior to 
February L 
2005 may close its individual book of business 
sold prior to February 1, 2005 and may establish a separate 
community rate for individuals applying for coverage under 
an individual health plan after February 1, 2005.' 
Further amend the bill in section 3 in paragraph E in the 
2nd line 
(page 1, 
line 
in L.D.) 
by inserting after the 
following: 
"gender." the following: 
'This paragraph may not be 
construed 
to 
require 
a 
carrier 
to 
actively 
market 
health 
insurance to an individual 65 years of age or older.' 
Further amend the bill in section 6 in that part designated 
"§3903." in subsection 7 in the 9th line (page 4, line 37 in 
L.D.) 
by 
inserting 
after 
the 
following: 
"income," 
the 
following: 
'Medicare supplement,' 
Further amend the bill in section 6 in that part designated 
"§3904." in subsection 2 in paragraph A in subparagraph (1) in 
the first line (page 5, line 49 in L.D.) by striking out the 
following: 
".f..Q.ID;:" 
and inserting in its place the following: 
'Six' 
Further amend the bill in section 6 in that part designated 
"§3904." in subsection 2 in paragraph A in subparagraph (1) in 
the 4th line (page 6, 
line 2 in L.D.) 
by striking out the 
following: 
"one 
member" 
and 
inserting 
in 
its 
place 
the 
following: 
'2 members' 
Further amend the bill in section 6 in that part designated 
"§3904." in subsection 2 in paragraph A in subparagraph (1) in 
the 5th line (page 6, line 3 in L.D.) by inserting after the 
following: 
"providers;" 
the 
following: 
'one 
member 
must 
represent a statewide organization that represents the interests 
of small businesses and that receives a majority of its funding 
from small businesses located in this State' 
Further amend the bill in section 6 in that part designated 
"§3904." in subsection 2 in paragraph A in subparagraph (1) in 
the last line (page 6, line 5 in L.D.) by inserting after the 
following: 
"1.." the following: 
'and' 
COMMITTEE AMENDMENT 
, .... 
( 
\ 
COMMITTEE AMENDMENT ~' to S.P. 394, L.D. 1190 
Further amend the bill in section 6 in that part designated 
"§3904." in subsection 2 in paragraph A in subparagraph (2) in 
the last line (page 6, 
line 8 in L.D.) by striking out the 
following: 
"; and" and inserting in its place the following: 
'-,-' 
Further amend the bill in section 6 in that part designated 
"§3904." in subsection 2 in paragraph A by striking out all of 
subparagraph (3). 
Further amend the bill in section 6 in that part designated 
"§3909." in the first paragraph in the 3rd line (page 13, line 14 
in L.D.) 
by striking out the following: 
"April 1. 
2003" and 
inserting in its place the following: 
'October 1, 2004' 
Further amend the bill in section 6 in that part designated 
"§3909." in the first paragraph in the 4th line (page 13, line 15 
in L.D.) by striking out the following: 
"August 1. 2003" and 
inserting in its place the following: 
'February 1, 2005' 
Further amend the bill in section 6 in that part designated 
"§3910." by striking out all of subsection 4 and inserting in its 
place the following: 
'4. 
Compliance with state law. 
Products offered by the 
association must comply with all relevant requirements of this 
Title 
applicable 
to 
individual 
health 
insurance 
policies, 
including requirements for mandated coverage for specific health 
services 
and specific diseases and for certain providers of 
health care services.' 
Further amend the bill in section 6 in that part designated 
"§3911." in subsection 4 in paragraph D in the 2nd line (page 16, 
line 13 in L.D.) by striking out the following: 
"$1.000,000" and 
inserting in its place the following: 
'$3,000,000' 
Further amend the bill in section 6 by inserting after that 
part designated "§3912." the following: 
'§3913. 
Reimbursement of carrier 
1. 
Reimbursement. 
A carrier may seek reimbursement from 
the association and the association shall reimburse the carrier 
to the extent claims made by a covered person after February I, 
2005 exceed premiums paid on a calendar year basis by the covered 
person 
to 
the carrier 
for 
a 
covered person 
who 
meets 
the 
following criteria: 
A. The carrier sold an individual health plan to the covered 
person between December 1, 1993 and February 1, 2005 and the 
COMMITTEE AMENDMENT 
.t'· 
COMMITTEE AMENDMENT 'A' to S.P. 394, L.D. 1190 
policy that was sold has been continuously renewed by the 
covered person; and 
B. 
The carrier is able to determine through the use of 
individual 
health 
statements, 
claims 
history 
or 
any 
reasonable means that at the time the person applied for 
insurance coverage with the carrier, the covered person was 
diagnosed with one 
of the following medical conditions: 
acquired 
immune 
deficiency 
syndrome, 
angina 
pectoris, 
ascites, 
chemical 
dependency 
cirrhosis 
of 
the 
liver, 
coronary occlusion, 
cystic fibrosis, Friedreich's ataxia, 
hemophilia, Hodgkin's disease, Huntington's chorea, juvenile 
diabetes, 
leukemia, 
metastatic 
cancer, 
motor 
or 
sensory 
aphasia, multiple sclerosis, muscular dystrophy, myasthenia 
gravis, myotonia, heart disease causing open heart surgery, 
Parkinson's disease, polcystic kidney, psychotic disorders, 
quadriplegia, stroke, syringomyelia or Wilson's disease. 
2. Rules. 
The superintendent may adopt rules to facilitate 
payment to a 
carrier pursuant to this section. Rules adopted 
pursuant 
to 
this 
subsection 
are 
routine technical 
rules 
as 
defined in Title 5, chapter 375, subchapter 2-A.' 
Further amend the bill in section 8 in the last line (page 
17, line 32 in L.D.) by striking out the following: 
"March 1, 
2005" and inserting in its place the following: 
'March 1, 2006' 
Further amend the bill in section 9 in the last line (page 
17, line 36 in L.D.) by striking out the following: 
"October 1, 
2004" and inserting in its place the following: 
'February 1, 
2005' 
Further amend the bill by striking out all of the emergency 
clause. 
Further amend the 
nonconsecutive 
consecutively. 
Part 
bill by relettering 
letter 
or 
section 
SUMMARY 
or renumbering 
number 
to 
any 
read 
This amendment is the minority report of the committee. 
The 
amendment retains the Comprehensive Health Insurance Risk Pool 
Association to provide coverage for high-risk individuals and 
spread the cost of that coverage 
among all health insurance 
carriers doing business in the State. 
The amendment partially 
funds the high-risk pool by requiring health insurance carriers 
to pay an assessment based on the number of persons covered by 
that carrier. 
An individual insured through the high-risk pool 
COMMITTEE AMENDMENT 
ft" 
COMMITTEE AMENDMENT ,A, to S.P. 394, L.D. 1190 
may be charged a premium up to 150~ of the average premium rates 
charged by carriers for similar health insurance plans. 
The amendment repeals the guaranteed issuance requirement in 
the 
individual 
health 
insurance 
market. 
The 
amendment 
also 
broadens the community rating laws to allow carriers to vary 
premiums on the basis of age within a maximum rate differential 
on a ratio of 4 to 1 and on the basis of health status and 
tobacco use within a maximum rate differential on a ratio of 1.5 
to 
1. 
The 
prov1s1ons 
relating 
to 
guaranteed 
issuance 
and 
community rating take effect February 1, 2005. 
The 
amendment 
also 
removes 
the 
emergency 
preamble 
and 
emergency clause. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
l 
• 
Fiscal Detail and Notes 
Revised: 02/04/04 ;'t?ac:.. 
Office of Fiscal and Program Review 
LD 1190 
An Act To Create the Comprehensive Health Insurance Risk Pool 
Association 
LR0436(02) 
Fiscal Note for Bill as Amended by Committee Amendment ,it, 
Committee: Insurance and Financial Services 
~ 
Fiscal Note Required: Yes 
Minority Report 
Fiscal Note 
Minor cost increase - Other Special Revenue Funds 
The fiscal note assumes the Comprehensive Health Insurance Risk Pool Association would not require any additional 
appropriation or allocation of resources and would not result in transactions on the state's books because the 
Association would be established as an independent non-profit legal entity. Any additional cost to the Department of 
Professional and Financial Regulation in implementing this legislation can be absorbed by the department utilizing 
existing budgetary resources. 
LR0436(2) - Fiscal Note - Page 1 of 1