An Act To Amend the Laws Related to Health Insurance and Confidentiality of Property and Casualty Filings
Maine Legislature, Session 122, LD 1499
Committee: Insurance and Financial Services
Sponsors: SULLIVAN, PERRY, MAYO, BRAUTIGAM
Amends: 24-A MRSA §6603, 24-A MRSA §2701, 24-A MRSA §2304-A, 24-A MRSA §2412, 24 MRSA §2332-A, 24-A MRSA §2723-A, 24-A MRSA §2844, 24-A MRSA §4222-B, 24-A MRSA §2808-B, 24-A MRSA §2850-B, 24-A MRSA §2848, 24-A MRSA §2744, 24-A MRSA §283

Legislative Document 
No. 1499 
S.P.517 
In Senate, March 28, 2005 
An Act To Amend the Laws Related to Health Insurance and 
Confidentiality of Property and Casualty Filings 
Submitted by the Department of Professional and Financial Regulation pursuant to Joint 
Rule 204. 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
Presented by Senator SULLIVAN of York. 
Cosponsored by Representative PERRY of Calais and 
JOY J. O'BRIEN 
Secretary of the Senate 
Senator: MAYO of Sagadahoc, Representative: BRAUTIGAM of Falmouth. 
Printed on recycled paper 
Be it enacted by the People of the State of Maine as follows: 
PART A 
Sec. A-I. 24-A MRSA §6603. sub-§l.1fF-l is enacted to read: 
F-l. Must comply with the requirements of section 2809-A, 
subsection 11, concerning continued coverage in the event of 
an 
employee's 
being 
temporarily 
laid 
off 
or 
losing 
employment because of an injury or disease that the employee 
claims to be compensable under workers' compensation: 
PART B 
Sec. B-1. 24-A MRSA §2701. sub-§2, 1rC. as amended by PL 2001, 
c. 258, Pt. E, §1, is further amended to read: 
C. 
Sections 2736, 2736-A, 2736-B and 2736-C apply to: 
(1) 
Association groups as defined by section 2805-A, 
except associations of employers; aBe 
(I-A) 
Credit 
union 
groups 
as 
defined 
by 
section 
2807-A: and 
(2) 
Other groups as defined by section 2808, except 
employee leasing companies registered pursuant to Title 
32, chapter 125. 
PARTe 
Sec. e-l. 24-A MRSA §2304-A. sub-§7. as repealed and replaced 
by PL 1991, c. 377, §10, is amended to read: 
7. 
Except as provided in section 2304-C, a rate filing and 
its supporting data are confidential until the filing seeames 
eEEeesive is approved. 
Sec. e-2. 24-A MRSA §2412. sub-§8. as enacted by PL 1997, c. 
126, §4, is amended to read: 
8. 
Confidentiality 
of 
form 
filings. 
Forms 
filed 
as 
required by this section 
and 
any 
supporting information are 
confidential until the filing seeemes--e-t_t-eo-t.-i-IJ.e-..----±E--an--i:esQFeF 
eees-Be~-~~ey4Qe-~£-~~~~~y€-~~_t~-~~-~~~~~r-~~-feFms-aBe 
sQppeFsiB~--~~~~-seeeme-~~~-eB-~~-ea~e-~~-fi±iB~ is 
approved. 
Page l-LR0447(1) 
PARTD 
Sec. D-l. 24 MRSA §2332-A, sub-§3 is enacted to read: 
3. 
Credit toward deductible. When 
an insured is covered 
under more than one expenSf3 incurred health plan, payments made 
by the primary plan, payments made by the insured and payments 
made from a health savin_gs account or similar fund for benefits 
covered under the secondary plan must be credited toward the 
deductible of the secondary plan. This subsection does not apply 
if the secondary plan is designed to supplement the primary plan. 
Sec. D-2. 24-A MRSA §2723-A. sub-§3 is enacted to read: 
3. 
Credit 
towar~Qeductible. 
When an insured is covered 
under more than one expense incurred health plan, payments made 
by the primary plan, pay-ments made by the insured and payments 
made from a health savings account or similar fund for benefits 
covered under the secondary plan must be credited toward the 
deductible of the secondary plan. This subsection does not apply 
if the secondary plan is designed to supplement the primary plan. 
Sec. D-3. 24-A MRSA §2844, sub-§3 is enacted to read: 
3. 
Credit toward 
Q~Q]~ctible. 
When an insured is covered 
under more than one eXPSl-Qse-incurred health plan, payments made 
by the primary plan, payments made by the insured and payments 
ffigde from a heaJ th savi_tlgs 
accQJJnL~imilar fund for benefits 
covered under the secondary plan must be credited toward the 
deductible of the seconda~_plan. 
This subsection does not apply 
if the secondary plan is designed to supplement the primary plan. 
Sec. D-4. 24-A MRSA §4222-B, sub-§21 is enacted to read: 
21. 
Section 
2723-A, 
sLtbsection 
and 
section 
2844, 
subsection 3 apply to health maintenance organizations. 
PARTE 
Sec. E-1. 24-A MRSA §2808-B. sub-§2-C 1fA. as enacted by PL 
2003, c. 469, Pt. E, §16, is amended to read: 
A. 
A block 
of 
small 
group 
health plans 
is 
considered 
credible if the anticipated avera~ number of ~e~ger-~eB~Rs 
members during the period for which the rates will be in 
effect 
is 
at 
least 
1,000 
or 
if it meets 
credibility 
standards adopted by the superintendent by rule. The rate 
filing must state the anticipated average number of ~e~geF 
maRtHs members during the period for which the rates will be 
in 
effect 
and 
the 
basis 
for 
the 
estimate. 
If 
the 
superintendent determines that the number of ffieffi&e-F-maBt.R6 
members is likely to be less than 1,000 and the block does 
not satisfy any alternative credibility standards adopted by 
rule, the filing is subject to subsection 2-B, 
except as 
provided in paragraph A 1. 
Sec. E-2. 24-A MRSA §2808-B, sub-§2-C, ~A-l is enacted to read: 
A-I. A carrier that elected to file rates in accordance with 
this subsection prior to September 1, 2004 may continue to 
file rates in accordance with this subsection as long as the 
anticipated number of member months for a l2-month period is 
at least 1, 000. 
PARTF 
Sec.F-l. 24-AMRSA§2839-A, as enacted by PL 2001, c. 432, 
§7, is amended to read: 
§2839-A. Notice of rate increase 
1. 
Notice of rate increase 
on existing policies. 
An 
insurer offering group health insurance, except for accidental 
injury, specified disease, hospital indemnity, disability income, 
Medicare 
supplement, 
long-term care or other limited benefit 
group health insurance, 
must provide written notice by first 
class mail of a rate increase to all affected policyholders or 
others who are directly billed for group coverage at least 60 
d~ys before the effective date of any increase in premium rates. 
An increase in premium rates may not'be implemented until 60 days 
af~er the notice is provided. 
For small group health plan rates 
subject to section 2808 B, 
subsection 2 B, if the increase is 
pending approval at the time of notice, the disclosure must state 
that the increase is subject to regulatory approval. 
2. 
Notice of rate increase on new business. 
When 
an 
insurer offering group health insurance, except for accidental 
injury, specified disease, hospital indemnity, disability income, 
Medicare 
supplement, 
long-term care or other limited benefit 
group health insurance, quotes a rate for new business, it must 
disclose 
any 
rate 
increase 
that 
the 
insurer 
anticipates 
implementing within the following 90 days. 
If the quote is in 
writing, 
the 
disclosure 
must 
also 
be 
in writing. 
If 
such 
disclosure is not provided, an increase may not be implemented 
until at least 90 days after the date the quote is provided. 
For 
small 
group 
health 
plan 
rates 
subject 
to 
section 
2808 B, 
subsection 2 B, if the increase is pending approval at the time 
of notice, the disclosure must state that the increase is subject 
to regulatory approval. 
PARTG 
Sec. G-l. 24-A MRSA §2850-B. sub-§5 is enacted to read: 
5. Association plans. 
The requirements of this subsection 
apply to group contracts that are subject to this section and 
that 
are 
issued 
to 
association 
groups 
pursuant 
to 
section 
2805 A. 
Carriers shall renew coverage for association members if 
coverage 
through 
an 
association 
is 
terminated 
because 
the 
association ceases to exist. changes its membership eligibility 
criteria, 
fails 
to 
pay 
premiums, 
commits 
fraud 
or 
misrepresentation or voluntarily terminates the group policy. 
A. 
If coverage to an employer through an association is 
terminated, 
the carrier shall renew the coverage with the 
employer becoming the policyholder. 
B. 
If coverage to an individual member of an association is 
terminated, the carrier shall renew the coverage with the 
individual becoming the policyholder. 
A carrier that has 
been 
granted 
an 
exemption 
pursuant 
to 
section 
2736-C, 
subsection 9 does not lose that exemption simply by virtue 
of renewing coverage to individuals under this paragraph. 
The requirements of this subsection do not apply if the employer 
or 
individual 
fails 
to 
pay 
premiums, 
commits 
fraud 
or 
misrepresentation, 
voluntarily 
terminates 
membership 
in 
the 
association or ceases to qualify for membership for reasons other 
than 
a 
change 
in 
the 
association's 
membership 
eligibility 
criteria. 
PARTH 
Sec. H-l. 24-A MRSA §2848. sub-§l-B. as amended by PL 2001, c. 
258, Pt. E, §5, is further amended to read: 
I-B. 
Federally creditable coverage. 
coverage" is defined as follows. 
"Federally creditable 
A. 
"Federally creditable coverage" means health benefits or 
coverage provided under any of the following: 
(1) 
An 
employee welfare benefit plan as defined in 
Section 3(1) of the federal Employee Retirement Income 
Security Act of 1974, 
United States Code, Section 
1001, 
or 
a 
plan that would be 
an employee welfare 
benefit 
plan 
but 
for 
the 
"governmental 
plan" 
or 
"nonelecting 
church 
plan" 
exceptions, 
if 
the 
plan 
provides medical care as defined in subsection 2-A, and 
includes items and services paid for as medical care 
directly 
or 
through 
insurance, 
reimbursement 
or 
otherwise; 
(2) 
Benefits 
consisting 
of 
medical 
care 
provided 
directly, 
through 
insurance 
or 
reimbursement 
and 
including items and services paid for as medical care 
under a policy, contract or certificate offered by a 
carrier; 
( 3 ) 
Part A or Part B of Title XVIII of the Social 
Security Act, Medicare; 
(4) 
Title XIX of the Social Security Act, Medicaid, 
other than coverage consisting solely of benefits under 
Section 1928 of the Social Security Act or 
a state 
children's health insurance program under Title XXI of 
the Social Security Act; 
(5) 
The Civilian Health and 
Uniformed Services, 
CHAMPUS, 
Chapter 55; 
Medical Program for the 
United States Code, 
(6) 
A medical 
care program of 
the 
federal 
Indian 
Health Care 
Improvement Act, 
United States Code, 
Section 1601 or of a tribal organization; 
(7) 
A state health benefits risk pool; 
(8) 
A health plan offered under the federal Employees 
Health Benefits Amendments Act, 
United States Code, 
Chapter 89; 
(9) 
A public 
health 
regulations authorized 
Service 
Act, 
Section 
Public Law 104-191; or 
plan 
as 
defined 
in 
federal 
by the federal 
Public Health 
2701(c)(1)(I), 
as 
amended 
by 
(10) 
A health benefit plan under Section 5(e) of the 
Peace Corps Act, 22 United States Code, Section 2504(e). 
B. 
"Federally 
creditable 
coverage" 
does 
not 
include 
coverage consisting solely of one or more of the following: 
(1) 
Coverage 
for 
accident 
or 
disability 
insurance or any combination of those coverages; 
income 
(2) 
Liability insurance, 
including general liability 
insurance and automobile liability insurance; 
(3) 
Coverage 
issued 
as 
a 
supplement 
to 
liability 
insurance; 
(4) 
Workers' compensation or similar insurance; 
(5) 
Automobile medical payment insurance; 
(6) 
Credit insurance; 
(7) 
Coverage for on-site medical clinics; or 
(8) 
Other similar 
insurance coverage, 
specified in 
federal 
regulations 
issued 
pursuant 
to 
Public 
Law 
104-191, 
under 
which benefits 
for 
medical 
care are 
secondary or incidental to other insurance benefits. 
C. 
"Federally creditable coverage" 
does not include the 
following benefits if those benefits are provided under a 
separate policy, certificate or contract of insurance or are 
otherwise not an integral part of the plan: 
(1) 
Limited scope dental or vision benefits; 
(2) 
Benefits for long-term care, nursing home care, 
home 
health 
care, 
community-based 
care 
or 
any 
combination of those benefits; and 
(3) 
Other similar, 
federal 
regulations 
104-191. 
limited benefits as specified in 
issued 
pursuant 
to 
Public 
Law 
D. 
"Federally creditable coverage" 
does not include the 
following benefits if the benefits are provided under 
a 
separate policy, certificate or contract of insurance, and 
if 
no 
coordination exists 
between 
the provision of 
the 
benefits and any exclusion of benefits under a group health 
plan maintained by the same plan sponsor and those benefits 
are paid for an event without regard to whether benefits are 
provided for that event under a group health plan maintained 
by the same plan sponsor: 
( 1 ) 
and 
Coverage only for a specified disease or illness; 
( 2 ) 
Hospital 
indemnity 
or 
other 
fixed 
indemnity 
insurance. 
E. 
"Federally creditable coverage" does not include the 
following if it is offered as a separate policy, certificate 
or contract of insurance: 
(1) 
Medicare supplemental health insurance under the 
Social Security Act, Section l882(g)(1); 
(2) 
Coverage 
supplemental 
to 
the coverage provided 
under the Civilian Health and Medical Program of the 
Uniformed Services, 
CHAMPUS, 
United States Code, 
Chapter 55; and 
(3) 
Similar supplemental coverage under a group health 
plan. 
For 
purposes 
of 
this 
subsection, 
a 
"period 
of 
continuing 
federally 
creditable 
coverage" 
means 
a 
period 
in 
which 
an 
individual has maintained federally creditable coverage through 
one 
or 
more 
plans 
or 
programs, 
with 
no 
break 
in 
coverage 
exceeding 63 days. 
In calculating the aggregate length of a 
period of continuing federally creditable coverage that includes 
one or more breaks in coverage, only the time actually covered is 
counted. 
A waiting period is not counted as a break in coverage 
if, but is not counted as a period of actual coverage unless the 
individual has other federally creditable coverage during this 
period. 
For purposes of this subsection and subsection l-C, 
"group health plan" has the same meaning as specified in the 
federal Public Health Service Act, Title XXVII, Section 279l(a). 
PART I 
Sec. I-I. 24-A MRSA §2744, sub-§§1 and 2. as amended by PL 
2003, c. 65, §l and affected by §5, are further amended to read: 
1. 
Notwithstanding 
any provision of 
a 
health insurance 
policy subject to this chapter, whenever the policy provides for 
payment or reimbursement for services that are within the lawful 
scope of practice of a 
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eAila-~~~--~syeAia&Fie-aBa-~~--bea~~a-B~FsiB~ or a 
professional listed in subsection 2-A. 
Payment or reimbursement 
for services rendered by e*iBi€al-6~£4~-~~~-~~-i&-tAis 
StateT-*i€eB6ea-£~4£~£~~-~~~~-~~~-~~-ia-tAis 
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aa9*eseeB1::-~~~~£--aaG-meB~al--he-a-l-t-h--BQFSiB~ a professional 
listed in subsection 
2-A, 
paragraph 
B, 
C or 
D may 
not 
be 
condi tioned upon prior diagnosis or referral by a physician or 
other health care professional, except in cases where diagnosis 
of the condition for which the services are rendered is beyond 
the scope of their licensure. 
2. 
Nothing in subsection 1 may be construed to require a 
heal th insurance policy subject to this chapter to provide for 
reimbursement of services that are within the lawful scope of 
practice of a 
~syeA91e~is1::-lieeBsea-~e-~~~~£€-~-~~-S&a~r-a 
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ee~tifiea-~~-lieeBsea-~~~~~~-iB-~-h-~-State professional 
listed in subsection 2-A. 
Sec.I-2. 24-A MRSA §2744, sub-§2-A is enacted to read: 
2-A. Subsections 1 and 2 apply with respect to the following 
types of professionals: 
A. A psychologist licensed to practice in this State; 
B. 
A certified social worker licensed for the independent 
practice of social work in this State who has at least a 
master's 
degree 
in 
social 
work 
from 
an 
accredited 
educational institution, 
who has 
been employed in social 
work for at least 2 years and who, after January 1, 1985, 1S 
licensed as a clinical social worker in this State; 
c. 
A lic.ensed clinical professional counselor licensed for 
the independent practice of counseling who has at least a 
master's degree in counseling from an accredited educational 
institution, 
who 
has been employed in counseling for at 
least 2 years and who, after January 1, 2002, is licensed as 
a clinical professional counselor in this State; and 
D. 
A 
licensed nurse 
who 
is certified by 
the 
American 
in 
adult 
Nurses' 
Association 
as 
psychiatric 
and mental 
specialist in child and 
health nursing. 
a 
clinical 
specialist 
health nursing or 
as 
adolescent psychiatr ic 
a 
clinical 
and mental 
Sec. 1-3. 24-A MRS A §2835. sub-§l. as amended by PL 2003, c. 
517, Pt. B, §13, is further amended to read: 
1. 
Notwithstanding 
any 
provision of 
a 
health 
insurance 
policy or certificate issued under a group policy subject to this 
chapter, 
whenever 
the 
policy 
provides 
for 
payment 
or 
reimbursement for services that are wi thin the lawful scope o[ 
practice of a 
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meR~a±-Rea±Eb-R~£siR~ professional listed in subsection 2-A, any 
person covered by the policy is entitled to reimbursement for 
these services if the services are performed by a physicianr-a 
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aQe±eseea~---~syeh~&~i&--~--~~---£ea~~h---R~FSiR~ 
or 
a 
professional listed in subsection 2-A. 
Payment or reimbursement 
for services rendered by e±iRiea~-se€4a~-~~~~~~-ia-~his 
StateT-Ji€eHSeQ-€~~~€~-~~~~-~~~-~iGe&seG-ia-this 
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aQeleSeeR~--psyclH.~~~~-aaG-meH~a~-...fie.a-l-t.-h--R~FsiR~ a professional 
listed in subsection 
2-A, 
paragraph S, 
C or D may 
not 
be 
conditioned upon prior diagnosis or referral by a physician or 
other health care professional, except in cases where diagnosis 
of the condition for which the services are rendered is beyond 
the scope of their licensure. 
Sec. 1-4. 24-A MRSA §283S, sub-§2, as amended by PL 2003, c. 
65, §2 and affected by §5, is further amended to read: 
2. 
Nothing in subsection 1 may be construed to require a 
health insurance policy subject to this chapter to provide for 
reimbursement of services that are wi thin the lawful scope of 
practice of a 
~syeRele~i&&-li€eRseQ-~e-~~~~€~-~-~~-S&a&er-a 
eliRiea±--se€ial--we~~e~--~~~-~~-~~~-~&a&&r--a--eliRieal 
~FeEessieRal-€eHHSe~e£-J4€e£Ge4-~~~~~~~~r-a-eeF&iEiee-seeial 
weF*eF-~~€~~~~-~Fae&iee-4R-~~~-S&a&&r-eF-~-&~~~-eeF~iEiea 
aRa--J.-icJ.e.ns.e.d---&e-~-a<J.t.-i~-iR--t-h-i-s--State professional listed in 
subsection 2-A. 
Sec.l-S. 24-A MRSA §283S, sub-§2-A is enacted to read: 
2-A. Subsections 1 and 2 apply with respect to the following 
types of professionals: 
A. 
A psychologist licensed to practice in this State; 
B. 
A certified social worker licensed for the independent 
practice of social work in this State who has at least a 
master's 
degree 
in 
social 
work 
from 
an 
accredited 
educational institution, 
who 
has been employed in social 
work for at least 2 years and who, after January 1, 1985, is 
licensed as a clinical social worker in this State; 
C. 
A licensed clinical professional counselor licensed for 
the independent practice of counseling who has at least a 
master's degree in counseling from an accredited educational 
institution, 
who 
has been employed in counseling for at 
least 2 years and who, 
aft~r January 1, 2002, is licensed as 
a clinical professional counselor in this State; and 
D. 
A licensed nurse 
who 
is certified by 
the 
American 
Nurses' 
Association 
as 
a 
clinical 
specialist 
in 
adult 
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n u r sing 
r 
as 
a 
clinical 
s p e cia Ii s t 
i n"'-_c"'-h.....,.i~l'-"d"---"a ... 
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y--'c~h",~",-' a",-",t..,r..."i,....,c"----"a...,n",d",---,m,-,-e",-="n-"tc=a,-,,,l 
health nursing. 
SUMMARY 
This bill does the following. 
1. 
It gives 
employees 
of 
employers 
with 
fewer 
than 
employees who have health coverage through a multiple employer 
welfare arrangement the same protection currently available to 
employees of employers with fewer 
than 
employees 
who 
are 
covered by insurance carriers. 
This limited protection allows 
the employee to stay on the employer's health plan for up to a 
year only in the event of a workers' 
compensation claim or a 
temporary layoff. 
2. 
It makes credit union groups subject to the 
concerning 
guaranteed 
issue, 
rating 
and 
rate 
currently 
apply 
to 
individual 
health 
insurance 
association group health insurance. 
requirements 
filing 
that 
and 
certain 
3. 
It amends the law concerning filing of insurance forms, 
rates and rating rules to provide that forms and any supporting 
information become public on the date the filing is approved. 
Under current law, 
filings are confidential until the filing 
becomes effective. 
4. 
It provides that when someone is covered under more than 
one health insurance policy, payments by the primary insurer must 
be counted toward the deductible by the secondary insurer. 
5. 
It amends the law concerning the guaranteed loss ratio 
option for small group health insurers to change the minimum 
threshold for eligibility from 
1,000 
member 
months 
to 
1,000 
members. 
This change does not apply to carriers already using 
this option. 
6. 
It amends the law that requires group health carriers to 
notify policyholders 60 days in advance of any rate increase to 
specify that the notice must state that the increase is subject 
to regulatory approval when that is the case. 
7. 
It amends 
the 
laws 
concerning 
health insurance to 
comply with federal 
coverage through associations. 
guaranteed 
law with 
renewal 
respect 
of 
to 
8. 
It amends the continuity of coverage law to clarify that 
a waiting period is not counted as a break in coverage nor is it 
counted 
as 
a 
period 
of 
actual 
coverage 
except 
in 
limited 
circumstances, consistent with federal law. 
9. 
It clarifies the laws concerning categories of mental 
health providers that must be covered to the same extent as 
physicians for services within the scope of their licenses.