Maine Legislature, Session 121, LD 1043
Committee Amendment CA_A_H346 (House)
Amends: 24-A MRSA §2809-A, 24-A MRSA §4222-B

COMMITTEE AMENDMENT ,,//. to 
To Provide Continued Access 
H.P. 760, L.D. 1043, 
to Health Insurance 
Bill, "An 
for Small 
Business Employees" 
Amend the bill by striking out everything after the enacting 
clause and before the summary and inserting in its place the 
following: 
'Sec. 1. 24-A MRSA §2809-A, sub-§II, as amended by PL 1991, c. 
885, Pt. E, §30 and affected by §47, is repealed. 
Sec. 2. 24-A MRSA §2809-A, sub-§II-A is enacted to read: 
A. 
Continued group coverage: groups with fever than 20 
employees. 
Notwithstanding any other provision of this section. 
if the termination of a member's or employee's coverage under a 
group policy with 
or 
fewer 
members 
is 
a 
result of the 
termination or reduction of hours of the covered employee's 
employment. 
other 
than 
termination 
of 
employment 
for 
gross 
misconduct. the insurer shall allow the member or employee to 
elect. within the time period prescribed by paragraph C. 
to 
continue coverage under the group policy at the same level of 
benefits or coverage offered to employees whose employment has 
not been terminated and at the member's or employee's expense or. 
at the member's or employee's option. to convert to a policy of 
individual 
coverage 
without 
evidence 
of 
insurability 
in 
accordance with this section. 
If the level of benefits or 
coverage offered to employees whose 
employment has not been 
terminated is modified. the level of benefits or coverage offered 
to a member or employee pursuant to this subsection must be 
modified in the Same manner. 
COMMITTEE AMENDMENT 
tit at I. 
COMMITTEE AMENDMENT .. if. to H. p. 760. L. D. 1043 
A. 
For 
the 
purposes 
of 
this 
subsection, 
"member 
or 
employee" includes only a person who has been a member or 
employee for at least 6 months. 
B. 
The employer's decision to terminate an employee for 
gross 
misconduct 
is 
conclusive 
as 
to ineligibility for 
continued coverage under this subsection. 
C. 
Within 14 days of a member's or employee's termination 
of employment or reduction of hours of employment, other 
than for gross misconduct, 
the employer shall give the 
insurer written notice on a form provided by the insurer of 
a 
member's or employee's eligibility for an election to 
continue coverage under this subsection. 
D. 
Within 14 days of the receipt of written notice from the 
employer pursuant to paragraph C, the insurer shall send the 
member 
or employee 
an election and 
premium notice 
form 
approved by the superintendent. 
The form must provide the 
member or employee an opportunity to elect or decline to 
elect continued coverage under the group policy and notify 
the member or employee of the applicable premium amount due 
after the election to continue coverage. 
The notice must be 
sent by first class mail to the last known mailing address 
of the member or employee. 
E. 
The member or employee has 31 days from the receipt of 
the election and premium notice form under paragraph D from 
the insurer in which to elect continued coverage in writing 
to the insurer and make the initial premium payment to the 
insurer. 
After the election, the insurer shall bill the 
member or employee for premiums once each month with a due 
date on the first of the month of coverage subject to any 
grace period for payment pursuant to this Title. 
F. 
An insurer is not required to continue coverage under a 
group policy if the member or employee meets the conditions 
set out in subsection 3, paragraph A. 
G. 
The payment amount for continued group coverage under 
this subsection may not exceed 
102~ of the group rate in 
effect for a group member in the employer's group policy, 
including an employer's contribution, if any. 
H. 
At the option of the member or employee, the continued 
group coverage may cover the member or employee, the member 
or employee and any dependents or only the dependents of the 
member or employee. 
In the latter 2 cases, the dependents 
must have been covered for a period of at least 3 months 
COMMITTEE AMENDMENT 
l~ 
, 
,!I.." 
COMMITTEE AMENDMENT .. {Jf to H.P. 760, L.D. 1043 
under the group policy, 
unless the dependents 
were not 
eligible for 
coverage until after the beginning of the 
3-month period. 
1. 
Except as provided in paragraph J, coverage provided 
under this subsection continues for a maximum of 18 months 
from the date of termination of the prior coverage. 
J. 
Coverage 
provided 
under 
this 
subsection 
may 
be 
terminated sooner than provided under paragraph I if: 
(1) 
The 
member 
or 
employee 
fails 
to 
make 
timely 
payment of a reguired premium amount: 
(2) 
The 
member 
or 
employee 
becomes 
eligible 
for 
coverage under another groUp policy or becomes entitled 
to benefits under Title XVIII of the federal Social 
Security Act: or 
(3) 
The group health policy is terminated. 
K. 
At 
the expiration of 
any 
continued group 
coverage 
obtained under this subsection, the member or employee has 
the same conversion privileges as otherwise granted under 
this section. 
L. 
This subsection may not be construed to: 
(1) 
Prevent members or employees from negotiating for 
or 
rece~v~ng greater 
continued 
coverage 
of· group 
insurance than is provided in this subsection: 
(2) 
Reguire coverage beyond the time limit set in 
paragraph I: or 
(3) 
Permit a member or employee to increase the level 
of benefits or coverage that the member or employee 
received 
immediately before 
the 
termination of the 
employee's coverage under the employer's group policy. 
M. 
This subsection does not apply to any group policy 
subject to the United States Consolidated Omnibus Budget 
Reconciliation Act, 
Public 
Law 
99-272, Title X, 
Private 
Health Insurance Coverage, Sections 10001 to 10003. 
N. 
The 
superintendent may 
adopt rules as necessary to 
implement the reguirements of this subsection. Rules adopted 
pursuant to this subsection are routine technical rules as 
defined in Title 5, chapter 375, subchapter 2-A. 
COMMITTEE AMENDMENT 
~,.I. 
COMMIITEE AMENDMENT .. fj. to H.P. 760. L.D. 1043 
Sec. 3. 24-A MRSA §4222-B, sub-§lS, as enacted by PL 2001, c. 
410, Pt. B, §3, is amended to read: 
18. 
The 
FeEf\:l~FemeBt: 
reg;uirements 
of 
section 
2809-A, 
subsection 11 l1-A to continue group coverage under certain 
circumstances a~~l~es apply to health maintenance organizations.' 
SUMMARY 
This amendment is the minority report of the committee and 
replaces the bill. 
The amendment gives employees whose coverage 
under a group policy is terminated the right to maintain coverage 
under that group policy at the employee's expense for 18 months. 
The amendment applies to group policies covering fewer than 20 
employees. 
The amendment clarifies that the conversion privilege 
is not available if the employee's employment is terminated for 
gross misconduct. 
COMMITTEE AMENDMENT