An Act To Create Lower-cost Health Insurance Options
Maine Legislature, Session 121, LD 1363
Committee: Insurance and Financial Services
Sponsors: WOODBURY, MAYO, BREAULT, CANAVAN, GLYNN, O'NEIL, PERRY, SNOWE-MELLO, YOUNG, LaFOUNTAIN
Amends: 24-A MRSA §2736-C, 24-A MRSA §2, 24-A MRSA §4222-B

12lst MAINE LEGISLATURE 
Legislative Document 
No. 1363 
H.P.998 
House of Representatives, March 18, 2003 
An Act To Create Lower-cost Health Insurance Options 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
plinted. 
Presented by Representative WOODBURY of Yarmouth. 
Cosponsored by Senator MAYO of Sagadahoc and 
17/~ 
/J7.1Jld£~ 
MILLICENT M. MacFARLAND 
Clerk 
Representatives: BREAULT of Buxton, CANAVAN of Waterville, GLYNN of South 
Portland, O'NEIL of Saco, PERRY of Bangor, SNOWE-MELLO of Poland, YOUNG of 
Li mestone, Senator: LaFOUNTAIN of York. 
Printt:d on rel.:"ydeJ p<.lpt'r 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1. 24-A MRSA §2736-C, sub-§10 is enacted to read: 
10. Options included in all health coverage plans. 
All 
carriers offering individual health plans in this State shall 
offer, at the time of offering and renewing a health plan, an 
alternate 
version 
of 
that 
plan 
in 
accordance 
with 
the 
requirements of this subsection and any rules adopted by the 
superintendent 
pursuant 
to 
this 
subsection. 
The 
alternate 
version of each plan must provide the identical coverages of the 
primary plan except that additional deductibles and coinsurance 
payments must be required in the alternate plan as described in 
this subsection. 
A. 
The alternate plan must include an annual deductible of 
$3,000. The alternate plan must include a 
0/0 coinsurance 
payment 
on health care expenses 
above 
$3,000 until 
the 
annual 
out-of-pocket 
payments 
for 
covered 
health 
care 
expenses reach $6,000. When the $6,000 annual limit is met, 
the 
coinsurance 
amount 
must 
be 
reduced 
to 
5% 
on 
any 
additional expenses. 
B. 
A carrier may not enroll an individual in an alternate 
plan as described in this section if the individual has any 
other supplemental insurance coverage for the payment of the 
deductibles and coinsurance associated with the alternate 
plan. 
C. 
The superintendent shall adopt rules to further define 
the 
options 
required 
by 
this 
subsection. 
Rules 
adopted 
pursuant to this subsection are routine technical rules as 
defined in Title 5, chapter 375, subchapter 2-A. 
Sec. 2. 24-A MRSA §2S0S-B, sub-§10 is enacted to read: 
10. 
ORtions included in all health coverage plans. 
All 
carriers offering small group health plans in this State shall 
offer, at the time of offering and renewing a health plan, an 
alternate 
version 
of 
that 
plan 
in 
accordance 
with 
the 
requirements of this subsection and any rules adopted by the 
superintendent 
pursuant 
to 
this 
subsection. 
The 
alternate 
version of each plan must provide the identical coverages of the 
primary plan except that additional deductibles and coinsurance 
payments must be required in the alternate plan as described in 
this subsection. 
A. 
The alternate plan must include an annual deductible of 
$3,000. 
The alternate plan must include a 20% coinsurance 
payment 
on health care expenses 
above 
$3,000 until the 
Page l-LR0273 (1) 
annual 
out-of-pocket 
payments 
for 
covered 
health 
care 
expenses reach $6,000. When the $6,000 annual limi t is met, 
the 
coinsurance 
amount 
must 
be 
reduced 
to 
additional expenses. 
B. 
A carrier may not enroll an employee or member in an 
alternate plan as described in this section if the employee 
or member has any other supplemental insurance coverage for 
the payment of the deductibles and coinsurance associated 
with 
the 
alternate 
plan 
except 
as 
provided 
in section 
2808-D, subsection 2. 
C. 
The superintendent shall adopt rules to further define 
the plan reguired by this subsection. Rules adopted pursuant 
to this subsection are routine technical rules as defined in 
Title 5, chapter 375, subchapter 2-A. 
Sec. 3. 24·A MRSA §§2S0S·C and 2S0S·D are enacted to read: 
§2808-C. 
Mandatory options in all group health coverage plans 
1. 
Mandatory offer. 
All carriers offering group health 
plans in this State shall offer, at the time of offering and 
renewing a health plan, 
an alternate version of that plan in 
accordance with the requirements of this subsection and any rules 
adopted by the superintendent pursuant to this section. 
The 
alternate 
version 
of 
each 
plan 
must 
provide 
the 
identical 
coverages of the primary plan, except that additional deductibles 
and coinsurance payments must be required in the alternate plan 
as described in this subsection. 
A. 
The alternate plan must include an annual deductible of 
$3,000. 
The alternate plan must include a 
20°-0 coinsurance 
payment 
on health care 
expenses 
above 
$3,000 until 
the 
annual 
out-of-pocket 
payments 
for 
covered 
health 
care 
expenses reach $6,000. 
When the $6,000 annual limit is met, 
the 
coinsurance 
amount 
must 
be 
reduced 
to 
5% 
on 
any 
additional expenses. 
B. 
A carrier may not enroll an employee or member in an 
alternate plan as described in this section if the employee 
or member has any other supplemental insurance coverage for 
the payment of the deductibles and coinsurance associated 
with the alternate plan, 
except 
as 
provided in section 
2808-D, subsection 2. 
2. 
Rulemaking. 
The superintendent shall adopt rules to 
further define the plan required by subsection 1. Rules adopted 
pursuant to this section are routine technical rules as defined 
in Title 5, chapter 375, subchapter 2-A. 
§2808-D. 
Emplqyee choice of alternate plans 
An employer who offers coverage under a group plan to its 
employees, 
including a 
small group plan as defined in section 
2808-B, 
subsection 
It 
paragraph 
G, 
shall 
also 
offer 
its 
employees, at the time of offering and renewal of the health 
plan, the option of selecting the alternate plan or plans offered 
by a carrier pursuant to section 2808-B, subsection 10 or section 
2808-C. 
1. 
Employer contributions. 
An employer that contributes to 
the premium cost of any health plan for its employees shall 
contribute 
the 
same 
amount 
to 
the 
premium 
cost 
of 
the 
corresponding alternate plan or the total premium cost of the 
alternate plan, 
whichever 
is less. 
An 
employer 
may 
not 
be 
required to pay more for health benefits as 
a 
result of the 
application of this section than would otherwise be paid. 
2. 
Medical savings accounts. 
To 
the extent allowed by 
federal and state law, an employer may establish medical savings 
accounts for its employees in conjunction with an alternate plan 
for the purposes of supporting the deductible and coinsurance 
costs to plan enrollees. 
Sec. 4. 24-A MRSA §4222-B, sub-§21 is enacted to read: 
21. Section 2736-C, subsection 10, 2808-B, subsection 10 and 
2808-C, 
relating to the health coverage plan, apply to heal th 
maintenance organizations. 
SUMMARY 
This bill requires health insurance carriers to create an 
alternate version of each individual and group health coverage 
plan. 
The 
alternate 
version 
of 
each 
plan 
would 
have 
the 
identical coverages of the primary plan except that additional 
deductibles and patient cost-sharing would be required. 
The bill 
also requires that employers providing health insurance coverage 
to their employees offer their employees the option of choosing 
either the primary plan or the alternate plan. 
To the extent 
allowed by federal and state law, the bill allows employers to 
establish 
medical 
savings 
accounts 
in 
conjunction 
with 
the 
alternate plan for the purposes of supporting the deductible and 
coinsurance costs to employees.