An Act To Protect Health Insurance Consumers Amend the amendment in Part A by striking out all of sections 1 to 3 and inserting in their place the following: Sec. A-I. 24-A MRSA §2736-C, sub-§2, V, as enacted by PL 2003, c. 469, Pt. E, §12, is amended to read: F. A carrier that adjusts its rate shall account for t;ae SaviB'3S--e-f.f-s.e-t-~-et any recovery in t;aat; the savings offset payment in its experience consistent with this section and section 6913, but the carrier may not adjust its rate to reflect the savings offset payment amount paid by the carrier. Sec. A-2. 24-A MRSA §2808-B, sub-§2-B, 1fD, as enacted by PL 2003, c. 469, Pt. E, §16, is amended to read: D. A carrier that adjusts its rate shall account for t;ae SaViB'36--e-f.f~-~ym&~~-et any recovery of t;aat; the savings offset payment in its experience consistent with this section and section 6913, but the carrier may not adjust its rate to reflect the savings offset payment amount paid by the carrier. Sec. A-3. 24-A MRSA §2839-B, sub-§2, as enacted by PL 2003, c. 469, Pt. E, §17, is amended to read: Page 1-LR2809(6) HOUSE AMENDMENT
Maine Legislature, Session 122, LD 1935
Committee Amendment CA_A-HA_H_H1100 (House)
Amends: 24-A MRSA §2736-C, 24-A MRSA §2808-B, 24-A MRSA §2839-B, 24-A MRSA §6913

HOUSE AMENDMENT .. /I;, to COMMITTEE AMENDMENT "A" to S. P. 736, 
L.D. 1935, Bill, "An Act To Protect Health Insurance Consumers" 
Amend 
the 
amendment in Part 
A by striking out all 
of 
sections 1 to 3 and inserting in their place the following: 
'Sec. A-I. 24-A MRSA §2736-C, sub-§2, V, as enacted by PL 
2003, c. 469, Pt. E, §12, is amended to read: 
F. 
A carrier that adjusts its rate shall account for t;ae 
SaviB'3S--e-f.f-s.e-t-~-et any recovery in t;aat; the savings 
offset 
payment 
in 
its 
experience 
consistent 
with 
this 
section and section 6913, but the carrier may not adjust its 
rate to reflect the savings offset payment amount paid by 
the carrier. 
Sec. A-2. 24-A MRSA §2808-B, sub-§2-B, 1fD, as enacted by PL 
2003, c. 469, Pt. E, §16, is amended to read: 
D. 
A carrier that adjusts its rate shall account for t;ae 
SaViB'36--e-f.f~-~ym&~~-et any recovery of t;aat; the 
savings 
offset 
payment 
in 
its 
experience 
consistent 
with 
this 
section and section 6913, but the carrier may not adjust its 
rate to reflect the savings offset payment amount paid by 
the carrier. 
Sec. A-3. 24-A MRSA §2839-B, sub-§2, as enacted by PL 2003, c. 
469, Pt. E, §17, is amended to read: 
HOUSE AMENDMENT 
HOUSE AMENDMENT "i £" to COMMITTEE AMENDMENT "A" to S. P. 736, L . D . 
1935 
n 
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 I 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 certify that the carrier has not included in its 
experience any sayings offset payments paid in accordance with 
section 6913. 
The filing must also certify that the carrier has 
included 
in its 
experience 
any 
saviR~s--e{{se~--FaymeREs--eF 
recovery of ~aese 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. 
Sec. A-4. 24-A MRSA §6913, sub-§2, as repealed and replaced by 
PL 2005, c. 400, Pt. A, §ll, is amended to read: 
2. 
Determination of savings offset amount. The board shall 
determine annually a savings offset amount to be paid by health 
insurance carriers, employee benefit excess insurance carriers 
and 
3rd-party 
administrators, 
not 
including 
carriers 
and 
3rd-party 
administrators 
with 
respect 
to 
accidental 
injury, 
specified disease, hospital indemnity, dental, vision, disability 
income, 
long-term care, 
Medicare 
supplement or other limited 
benefit health insurance. 
The board shall determine the savings 
offset amount in accordance with the following: 
A. 
Not later than April of each year, 
the board 
prospectively determine the 
savings offset amount 
applied during each l2-month calendar year period; 
shall 
to be 
B. To determine the savings offset amount, the board shall 
use the criteria and reports described in subsections 7 and 
8; 
C. The savings offset amount must reflect and may not exceed 
aggregate measurable cost savings, 
as 
determined by the 
board pursuant to subsection 1; and 
D. The savings offset amount calculation is limited to the 
amount of funds necessary to provide subsidies pursuant to 
section 
6912 
and 
to 
support 
the 
Maine 
Quality 
Forum 
established in section 6951 
and may not include general 
HOUSE AMENDMENT 
HOUSE AMENDMENT "lj" to COMMITTEE AMENDMENT "A" to S.P. 736, L.D. 
1935 
rt 
administrative expenses of Dirigo Health, except for general 
administrative expenses of the Maine Quality Forum. 
~Re-~~~-~~f~-ame~B~-~~~mi£~~-~Re-~~-~-aeeeFaaBee 
wa,~R--thl-s-~t;.~-a,s--t-he--de-t;e.RA-~1ng--faeteF-.f-EH:--inG-1us-~-ef 
sava,B~s-~.f~-~ym&&t;.&-~R-~~~-~h~e~~h-~~~€-~~1ng--Feva,ew 
BY-~Re-B~Fea~T 
Sec. A-5. 24-A MRSA §6913, sub-§9, as enacted by PL 2003, c. 
469, Pt. A, §8, is amended to read: 
9. 
Demonstration of recovery of savings offset payments. 
As provided in sections 2736-C, 
2808-8 and 2839-8, the claims 
experience used to determine any filed premiums or rating formula 
may not reflect the sayings offset payment amount determined in 
accordance with subsection 2, but must reasonably reflect, in 
accordance with accepted actuarial standards, known changes and 
effse~&-a,R recovery of savings offset payments by the carrier to 
health care providers in this State, including any reduction or 
avoidance of bad debt and charity care costs to health care 
providers in this State as a result of the operation of Dirigo 
Health 
and 
any 
increased enrollment due 
to 
an expansion in 
MaineCare eligibility occurring after June 30, 2004 as determined 
by the board consistent with subsection 1. I 
Further amend the 
nonconsecutive 
consecutively. 
Part 
bill by relettering 
letter 
or 
section 
SUMMARY 
or renumbering any 
number 
to 
read 
This amendment prohibits insurance carriers from including 
the costs of the savings offset payment used to support the 
Dirigo Health Program in health insurance premium rates. 
SPONSORED BY, ~ 
(Representative GLYNN) 
TOWN: 
South Portland 
HOUSE AMENDMENT