An Act To Implement Task Force Recommendations Relating to Parity and Portability of Benefits for Law Enforcement Officers and Firefighters and To Establish a High-risk Health Insurance Pool' , Further amend the amendment in the first paragraph after the title in the first line (page 1, line in amendment) by striking out the following: Amend" and inserting in its place the following: 'Further amend Further amend the amendment subsection ll-A in paragraph C in in amendment) by striking out the in its place the following: '60% in Part A in section in the 4th line (page 2, line 48 following: "4540" and inserting Further amend the amendment in Part A in section 3 in §286-M in subsection 6 in paragraph A in the 14th line (page 6, line 47 in amendment) by striking out the following: "45 40" and inserting in its place the following: '60% Page l-LR0263(9) SENATE AMENDMENT
Maine Legislature, Session 122, LD 1021
Committee Amendment CA_B-SA_B_S608 (Senate)
Amends: 24 MRSA §2317-B, 24 MRSA §2327, 24-A MRSA §2736-C, 24-A MRSA §2, 24-A MRSA §2848, 24-A MRSA §2850-B, 24-A MRSA §4202-A, 24-A MRSA §4207, 24-A MRSA §4210, 24-A MRSA §4212, 24-A MRSA §4222-B, 24-A MRSA §4346, 24-A MRSA §6603

SENATE 
AMENDMENT "(6,, to COMMITTEE 
AMENDMENT 
"B" to H.P. 
706, 
L.D. 
1021, 
Bill, 
"An 
Act 
To 
Implement 
Task 
Force 
Recommendations Relating to Parity and Portability of Benefits 
for Law Enforcement Officers and Firefighters" 
Amend 
the 
amendment 
by 
inserting 
after 
the 
title 
the 
following: 
'Amend the bill by striking out the title and substituting 
the following: 
'An Act To 
Implement Task Force Recommendations Relating to 
Parity and Portability of Benefits for Law Enforcement Officers 
and Firefighters and To Establish a High-risk Health Insurance 
Pool' , 
Further amend the amendment in the first paragraph after the 
title in the first line 
(page 
1, 
line 
in amendment) 
by 
striking out the following: 
"Amend" and inserting in its place 
the following: 'Further amend' 
Further 
amend 
the 
amendment 
subsection ll-A in paragraph C in 
in amendment) by striking out the 
in its place the following: '60%' 
in Part A in section 
in 
the 4th line (page 2, line 48 
following: "4540" and inserting 
Further amend the amendment in Part A in section 3 in §286-M 
in subsection 6 in paragraph A in the 14th line (page 6, line 47 
in amendment) by striking out the following: "45 40" and inserting 
in its place the following: '60%' 
Page l-LR0263(9) 
SENATE AMENDMENT 
SENATE AMENDMENT "/!;" to COMMITTEE AMENDMENT ('ef to H. P. 706, L.D. 
1021 
Further amend the amendment in Part A in section 3 in §286-M 
in subsection 6 in paragraph B in the 15th line (page 7, line 22 
in amendment) by striking out the following: "45'1-0" and inserting 
in its place the following: '60%' 
Further amend the amendment by inserting at the end before 
the summary the following: 
'Further 
amend 
the bill by inserting after Part 
B the 
following: 
'PARTe 
Sec. e-l. 24 MRSA §2317-B, sub-§14-A is enacted to read: 
14-A. 
Title 24-A. 
section 
2000-C. 
Small 
group 
health 
plans, Title 24-A, section 2808-C; 
Sec. e-2. 24 MRSA §2317-B, sub-§15, as enacted by PL 1999, c. 
256, Pt. M, §10, is repealed. 
Sec. C-3. 24 MRSA §2327, as amended by PL 2003, c. 469, Pt. 
E, §1, is further amended to read: 
§2321. 
Group rates 
A group 
health care 
contract 
may 
not 
be 
issued 
by 
a 
nonprofit hospital or medical service organization in this State 
until a copy of the group rates to be used in calculating the 
premium for these contracts has been filed for informational 
purposes with the superintendent. 
The filing must include the 
base rates and a description of any procedures to be used to 
adjust 
the 
base rates 
to reflect factors 
including but not 
limited to age, gender, health status, claims experience, group 
size and coverage of dependents. 
Notwithstanding this section, 
rates 
for 
group 
Medicare 
supplement, 
nursing 
home 
care 
or 
long-term care contracts and for certain group contracts included 
within the definition of "individual health plan" in Title 24-A, 
section 
2736-C, 
subsection 1, 
paragraph 
C must 
be 
filed In 
accordance with section 2321 and rates for small group health 
plans as defined by Title 24-A, section 6ggg-fl 2808-C must be 
filed in accordance with that section. 
Sec. C-4. 24-A MRSA §2736-C, sub-§2, 1[B, as enacted by PL 
1993, c. 477, Pt. C, §1 and affected by Pt. F, §l, is amended to 
read: 
B. 
A carrier may not vary the premium rate due to the 
gender, 
aeal~a-£~a~H6T claims experience or policy duration 
of the individual. 
A carrier may vary the premium rate 
SENATE AMENDMENT 
SENATE AMENDMENT "P)" to COMMITTEE AMENDMENT "8-to H. P. 706, L. D. 
1021 
based 
on 
health 
status, 
age 
and 
tobacco 
use 
only 
as 
permitted in paragraph D. 
Sec. C-5. 24-A MRSA §2736-C, sub-§2, ~C, 
2001, c. 410, Pt. A, §l and affected by §10, 
to read: 
as 
amended by PL 
is further amended 
C. 
A carr ier may vary the 
premium rate due to 
smekiB'3 
66a601:&-aBEl family membership. 
±ae--6~..,i-n-t~-...ffia-y--aElep6 
tQ±es-£e~~iR'3-~~~£-~~~~~~~~B&&-~~aFGi~-Fa6e 
Eli6eeQB6S-~-ea--6~~£~-&&&~&r--R~Je£-~~-PQtSQaB6 
6e-~~i£-~~~~r~-~e01:~iae-~e€aBi€a~-~~~~~~ia&G-iB 
±i6±e-eT-eaap6et-~+eT-6QBeaap6et-±±-AT 
Sec. C-6. 
2001, c. 410, 
to read: 
24-A MRSA §2736-C, sub-§2, ~D, 
Pt. A, §2 and affected by §10, 
as amended by 
PL 
is further amended 
D. 
A carrier may vary the premium rate due to age, health 
status, occupation or industry aBElL 
geographic area eB±Y 
QBElet--~~--~e~JewiR'3--~~--~---wi~aia--~~--±is6eE1 
peteeB~a'3e--BaBEls 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'l-o. 
(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 3 3'l-o. 
(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 
communi ty rate filed by the carrier by more than 20°0. 
(4) 
For all policies, contracts or certificates that 
are executed, delivered, issued for delivery, continued 
or renewed in this State after January 1, 
2008, 
the 
maximum rate differential from the community rate filed 
by the carrier for age as determined by ratio is 4 to 
one. 
The limitation does 
not apply for determining 
SENATE AMENDMENT 
SENATE AMENDMENT "S" to COMMITTEE AMENDMENT *'8" to H.P. 706, L.D. 
1021 
rates for an attained age of less than 19 or more than 
years. 
( 5) 
For all policies, contracts or certificates that 
are executed, delivered, issued for delivery, continued 
or renewed in this State after January 1, 
2008, 
the 
maximum rate differential from the community rate filed 
by the carrier for health status as determined by ratio 
is 1.5 to one and the maximum rate differential for 
tobacco use as determined by ratio is 1.5 to one. 
Rate 
variations based on health status do not apply to rate 
variations based on an insured's status as a tobacco 
~ 
(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. C-7. 24-A MRSA §2736-C, sub-§2, 1(G is enacted to read: 
G. 
A carrier that offered individual health plans prior to 
January 1, 2008 may close its individual book of business 
sold prior to January 1, 2008 and may establish a separate 
community rate for individuals applying for coverage under 
an individual health plan after January 1, 2008. 
Sec. C-S. 24-A MRSA §2736-C, sub-§3, 1(A, as corrected by RR 
2001, c. 1, §30, is repealed. 
Sec. C-9. 24-A MRSA §2736-C, sub-§3, 1(C, as enacted by PL 
1993, c. 477, Pt. C, §1 and affected by Pt. F, §1, is repealed. 
Sec. C-IO. 24-A MRSA §2736-C, sub-§3, 1rD, as enacted by PL 
1999, c. 256, Pt. D, §1, is amended to read: 
D. 
Netw,itRstaN.a,iN.~--pa-£~-aph---A-r-earr,ier6 Carriers offering 
supplemental coverage for the Civilian Health and Medical 
Program 
for 
the 
Uniformed 
Services, 
CHAMPUS, 
are 
not 
required 
to 
issue 
this 
coverage 
if the 
applicant 
for 
insurance does not have CHAMPUS coverage. 
Sec. C-ll. 24-A MRSA §2736-C, sub-§3, 1rE is enacted to read: 
E. 
An individual may not be denied health insurance due to 
age 
or gender. 
This paragraph may not be construed to 
reguire a carrier to actively market health insurance to an 
individual 65 years of age or older. 
Sec. C-12. 24-A MRSA §2736-C, sub-§9, as enacted by PL 1995, 
c. 570, §7, is amended to read: 
SENATE AMENDMENT 
SENATE AMENDMENT "13,, to COMMITTEE AMENDMENT"'8"to H.P. 706, L.D. 
1021 
9. 
Exemption for certain associations. 
The superintendent 
may exempt a group health insurance policy or group nonprofit 
hospital or medical service corporation contract issued to an 
association group, organized pursuant to section 2805-A, from the 
requirements 
of 
sliBseet:ieB--.J.,---pa-F-ag-r.:aph---Af 
subsection 
6, 
paragraph Af and subsection 8 if: 
A. 
Issuance and renewal of coverage under the policy or 
contract is guaranteed to all members of the association who 
are residents of this State and to their dependents; 
B. 
Rates for the association comply with the premium rate 
requirements 
of 
subsection 
or 
are 
established 
on 
a 
nationwide basis and substantially comply with the purposes 
of this section, except that exempted associations may be 
rated separately from the carrier's other individual health 
plans, if any; 
C. 
The 
group's 
anticipated 
loss 
ratio, 
subsection 5, is at least 75%; 
as 
defined 
in 
D. 
The association's membership criteria do not include 
age, health status, medical utilization history or any other 
factor with a similar purpose or effect; 
E. 
The association's group health plan is not marketed to 
the general public; 
F. 
The 
association does 
not 
allow insurance 
agents 
or 
brokers 
to 
market 
association 
memberships, 
accept 
applications for memberships or enroll members, except when 
the association is an association of insurance agents or 
brokers organized under section 2805-A; 
G. 
Insurance 
is 
provided 
as 
an 
incidental benefit 
of 
association 
membership 
and 
the 
primary 
purposes 
of 
the 
association do not include group buying or mass marketing of 
insurance or other goods and services; and 
H. 
Granting 
an 
exemption 
to 
the 
association 
does 
not 
conflict with the purposes of this section. 
Sec. C-13. 24·A MRSA §2803-A, sub-§4, as amended by PL 2001, 
c. 410, Pt. B, §2, is further amended to read: 
4. 
Exception. 
An insurer is 
loss information described in this 
eligible for 
small group coverage 
2808-C. 
not required to provide the 
section for a group that is 
pursuant to 
section 68g8-g 
SENATE AMENDMENT 
SENATE AMENDMENT "13,, to COMMITTEE AMENDMENT ",(;11 to H.P. 706, L.D. 
1021 
Sec. C-14. 24-A MRSA §2S04, sub-§3, as amended by PL 1999, c. 
256, Pt. G, §1, is further amended to read: 
3. 
Except as provided in section 2736-C, section 
2ggg-J;! 
2808-C 
and chapter 
36, 
an lnsurer may 
exclude or limit the 
coverage 
on 
any 
person 
as 
to 
whom 
evidence 
of 
individual 
insurability is not satisfactory to the insurer. 
Sec. C-lS. 24-A MRSA §2S0S, sub-§3, as amended by PL 1999, c. 
256, Pt. G, §2, is further amended to read: 
3. 
Except as provided in section 2736-C, 
2808-C 
and chapter 
36, 
an insurer may exclude 
coverage 
on 
any 
person 
as 
to 
whom 
evidence 
insurability is not satisfactory to the insurer. 
section 
28g8-J;! 
or limit the 
of 
individual 
Sec. C-16. 24-A MRSA §2S0S-A, sub-§4, as amended by PL 1999, 
c. 256, Pt. G, §3, is further amended to read: 
4. 
Except as provided in section 2736-C, 
2808-C 
and chapter 
36, 
an insurer may exclude 
coverage 
on 
any 
person 
as 
to 
whom 
evidence 
insurability is not satisfactory to the insurer. 
section 28g8-B 
or limit the 
of 
individual 
Sec. C-17. 24-A MRSA §2S06, sub-§3, as amended by PL 1999, c. 
256, Pt. G, §4, is further amended to read: 
3. 
Except as provided in section 2736-C, 
2808-C 
and chapter 
36, 
an insurer 
may 
exclude 
coverage 
on 
any 
person 
as 
to 
whom 
evidence 
insurability is not satisfactory to the insurer. 
section 28g8-B 
or limit the 
of 
individual 
Sec. C-1S. 24-A MRSA §2S07-A, sub-§3, as amended by PL 1999, 
c. 256, Pt. G, §5, is further amended to read: 
3. 
Except as provided in section 2736-C, 
2808-C 
and chapter 
36, 
an insurer 
may 
exclude 
coverage 
on 
any 
member 
as 
to 
whom 
evidence 
insurability is not satisfactory to the insurer. 
section 28g8-B 
or limit the 
of 
individual 
Sec. C-19. 24-A MRSA §2S0S-B, as amended by PL 2005, c. 121, 
Pt. E, §§1 and 2, is repealed. 
Sec. C-20. 24-A MRSA §2S0S-C is enacted to read: 
§2808-C. 
Small group health plans 
1. 
Purpose. 
The purpose of this section is to promote the 
availability of health insurance coverage to small employers, to 
SENATE AMENDMENT 
4. 
~11" 
SENATE AMENDMENT "tI" to COMMITTEE AMENDMENT V to H.P. 706, L.D. 
1021 
prevent abusive rating practices, to require disclosure of rating 
practices to purchasers of small group health plans, to establish 
standards for continuity of coverage 
for small employers and 
their 
covered 
employees 
and 
to 
improve 
the 
efficiency 
and 
fairness of the small group market. 
2. 
Definitions. 
As 
used 
in this 
section, 
unless 
the 
context 
otherwise 
indicates, 
the 
following 
terms 
have 
the 
following meanings. 
A. 
"Actuarial certification" means a written statement by a 
member 
of 
the 
American 
Academy 
of 
Actuaries 
or 
other 
individual acceptable to the superintendent that a carrier 
offering small group health plans is in compliance with the 
provisions of subsection 4 based on the person's examination 
and review of the carrier's appropriate records 
and the 
actuarial assumptions and methods used by the carrier to 
establish premium rates for its small group health plans. 
B. 
"Base premium rate" means, for each class of business as 
to a rating period, the lowest premium rate charged or which 
could have been charged under a rating system for that class 
of business by a small group carrier to small employers with 
similar case characteristics for health plans with the same 
or similar coverage. 
C. 
"Carrier" 
means 
any 
insurance 
company, 
nonprofit 
hospital 
and 
medical 
service 
organization 
or 
health 
maintenance organization authorized to 
issue 
small group 
health plans 
in this State. 
For 
the 
purposes 
of this 
section, carriers that are affiliated companies or that are 
eligible to file consolidated tax returns are treated as one 
carrier and any restrictions or limitations imposed by this 
section apply as if all small group health plans delivered 
or issued for delivery in this State by affiliated carriers 
were issued by one carrier. 
For purposes of this section, 
health maintenance organizations are treated as 
separate 
organizations 
from 
affiliated 
insurance 
companies 
and 
nonprofit hospital and medical service organizations. 
D. 
"Case 
characteristics" 
means 
demographic 
or 
other 
relevant characteristics of a 
small employer as determined 
by 
a 
carrier that are considered by the carrier in the 
determination of the premium rates for the small employer. 
"Case characteristics" does not include claims experience, 
health status or duration of coverage. 
E. 
"Class of business" means all or a distinct grouping of 
small employers in accordance with this paragraph to whom 
SENATE AMENDMENT 
SENATE AMENDMENT "£,,, to COMMITTEE AMENDMENT ·'8" to H. P. 706, L. D. 
1021 
the 
carrier 
provides 
coverage 
as 
demonstrated 
by 
the 
carrier's records. 
(1) 
A distinct grouping may only be established by the 
small employer carrier on the basis that the applicable 
health benefit plans: 
(a) 
Are marketed and sold through individuals and 
organizations that are not participating in the 
marketing or sale of other distinct groupings of 
small employers for the carrier: 
(b) 
Have been acquired from another carrier as a 
distinct grouping of plans: 
( c) 
Are 
provided 
through 
an 
association with 
membership of not less than 50 
small employers 
that 
has 
been 
formed 
for 
purposes 
other 
than 
obtaining insurance: or 
(d) 
Are in a class of business that meets the 
requirements 
for 
exception 
to 
the 
restrictions 
related to premium rates provided in subsection 4. 
(2) 
A carrier may establish no more than 2 additional 
groupings 
under 
subparagraph 
(1) 
on 
the 
basis 
of 
underwriting criteria that 
are 
expected 
to 
produce 
substantial variation in the health care costs. 
(3) 
The superintendent may approve the establishment 
of additional distinct groupings upon application to 
the superintendent and a finding by the superintendent 
that 
such 
action would 
enhance 
the 
efficiency 
and 
fairness of the small group health plan market. 
F. 
"Index rate" means, for each class of business for small 
employers with similar case characteristics, the arithmetic 
average 
of 
the 
applicable 
base 
premium 
rate 
and 
the 
corresponding highest premium rate. 
G. 
"Late enrollee" means an eligible employee or dependent 
who 
requests 
enrollment 
in 
a 
small 
group 
health 
plan 
following 
the 
initial 
minimum 
30-day 
enrollment 
period 
provided 
under 
the 
terms 
of 
the 
plan, 
except 
that 
an 
eligible employee or dependent is not considered a 
late 
enrollee if the eligible employee or dependent meets the 
requirements of section 
2849~B, subsection 3, paragraph A, 
B, C-l or D. 
SENATE AMENDMENT 
SENATE AMENDMENT "e" to COMMITTEE AMENDMENT '8" to H.P. 706, L.D. 
1021 
H. 
"New business premium rate" means, 
for each class of 
business as to a rating period, the premium rate charged or 
offered by the carrier to small employers with similar case 
characteristics for newly issued health benefit plans with 
the same or similar coverage. 
I. 
"Rating period" means the calendar period for which the 
premium rates established by a carrier are assumed to be in 
effect as determined by the carrier. 
J. 
"Small employer" means any person, 
firm, corporation, 
partnership 
or 
association 
actively 
engaged 
in business 
that, 
on at least 
50% 
of its working 
days 
during 
the 
preceding year, employed no more than 50 eligible employees 
and at least 2 eligible employees. In determining the number 
of 
eligible 
employees, 
companies 
that 
are 
affiliated 
companies or that are eligible to file a combined tax return 
for 
purposes 
of 
state taxation must 
be 
considered 
one 
employer. 
K. 
"Small group health plan" means any hospital and medical 
expense-incurred policy; health, hospital or medical service 
corporation 
plan 
contract; 
or 
health 
maintenance 
organization 
subscriber 
contract 
covering 
an 
eligible 
group. 
"Small 
group health plan" 
does 
not 
include 
the 
following types of insurance: 
(1) 
Accident; 
(2) 
Credit; 
(3) 
Disability; 
(4) 
Long-term care or nursing home care; 
(5) 
Medicare supplement; 
(6) 
Specified disease; 
(7) 
Dental or vision; 
( 8 ) 
Coverage 
issued 
as 
a 
supplement 
to 
liability 
insurance; 
(9) 
Workers' compensation; 
(10) 
Automobile medical payment; or 
(11) 
Insurance under which benefits are payable with 
or 
without 
regard 
to 
fault 
and 
that 
is 
reguired 
SENATE AMENDMENT 
SENATE AMENDMENT" e 
. to COMMITTEE AMENDMENT 'tf to H.P. 706, L.D. 
1021 
statutorily to be contained in any liability insurance 
policy or eguivalent self-insurance. 
3. 
Small group health plans subject to this section. 
The 
following small group health plans are subject to this section. 
A. 
Except 
as 
provided in this paragraph, 
this 
section 
applies 
to 
any 
small 
group 
health 
plan 
that 
provides 
coverage to one or more employees of a small employer. 
B. 
This section does not apply to individual health plans 
that are subject to section 2736-C. 
4. 
Premium rates. 
Premium rates for small group health 
plans are subject to the following provisions. 
A. 
The index rate for a rating period for any class of 
business may not exceed the index rate for any other class 
of business by more than 20%. 
This paragraph does not apply 
to a class of business if any of the following apply: 
(1) 
The class of business is one for which the carrier 
does 
not 
reject. 
and 
never 
has 
rejected, 
small 
employers included wi thin the carrier's definition of 
employers 
eligible 
for 
the 
class 
of 
business 
or 
otherwise eligible employees and dependents who enroll 
on a timely basis, based upon their claims experience 
or health status; 
(2) 
The carrier does not involuntarily transfer, and 
never has involuntarily transferred, 
a health benefit 
plan into or out of the class of business: and 
(3) 
The class of business is available for purchase. 
B. 
For a class of business, the premium rate charged during 
a 
rating 
period 
to 
small 
employers 
with 
similar 
case 
characteristics for the same or similar coverage, 
or the 
rates that could be 
charged to such employers 
under the 
rating system for that class of business, may not vary from 
the index rate by more than 25% of the index rate. 
C. 
The percentage increase in the premium rate charged to a 
small employer for a 
new rating period may not exceed the 
sum of the following: 
(I) 
The percentage 
cha~ge in the new business premium 
rate measured from the first day of the prior rating 
~riod to the first day of the new rating period. In 
the case of a 
class of business for which the small 
Page lO-LR0263(9) 
SENATE AMENDMENT 
SENATE AMENDMENT "p>" to COMMITTEE AMENDMENT '~" to H.P. 706, L.D. 
1021 
group carrier is not issuing new policies, the carrier 
shall use the percentage change in the base premium 
rate; 
(2) 
An 
adjustment, 
not to exceed 
15% 
annually and 
adjusted pro rata for rating periods of less than one 
year, due to the claims experience, health status or 
duration of coverage or the employees or dependents of 
the small employer as 
determined 
from the carrier's 
rate manual for the class of business; and 
(3) 
Any adjustment due to change in coverage or change 
in the case characteristics of the small employer as 
determined from the carrier's rate manual for the class 
of business. 
D. 
In the case of health benefit plans issued prior to the 
effective date of this section, a premium rate for a rating 
period may exceed the ranges described in paragraphs A and B 
for a period of 5 years following the effective date of this 
section. 
In that case, 
the 
percentage 
increase 
in 
the 
premium rate charged to a small employer in such a class of 
business for a new rating period may not exceed the sum of 
the following: 
(1) 
The percentage change in the new business premium 
rate measured from the first day of the prior rating 
period to the first day of the new rating period. In 
the case of a class of business for which the small 
group carrier is not issuing new policies, the carrier 
shall use the percentage change in the base premium 
rate; and 
(2) 
Any adjustment due to change in coverage or change 
in the case characteristics of the small employer as 
determined from the carrier's rate manual for the class 
of business. 
E. 
A small group carrier may use any legitimate rating 
factor, 
including 
claims 
experience, 
health 
status 
or 
duration of coverage, in the determination of premium rates 
subject to this section, except that the maximum variation 
for all small employers in a class of business using all 
legitimate rating factors is 5 to one for the premium rate 
charged to any small employer in that class of business. 
F. 
A small group carrier may not transfer a small employer 
involuntarily into or out of a class of business. A small 
group carrier may not transfer a small employer into or out 
of a class of business unless such offer is made to transfer 
Page ll-LR0263(9) 
SENATE AMENDMENT 
SENATE AMENDMENT "e,,, to COMMITTEE AMENDMENT" B "to H.P. 706, L.D. 
1021 
all small employers in the class of business without regard 
to any changes in case characteristics, claims experience, 
health status or duration of coverage since the first date 
of coverage. 
5. 
Coverage for late enrollees. 
In providing coverage to 
late enrollees, small group health plan carriers are allowed to 
exclude or limit coverage for a late enrollee subject to the 
limitations set forth in section 2849-B, subsection 3. 
6. 
Guaranteed issuance and guaranteed renewal. 
Carriers 
providing 
small 
group health plans 
must 
meet 
the 
following 
reguirements on issuance and renewal. 
A. 
Any small group health plan offered to any eligible 
group or subgroup must be offered to all eligible groups 
that meet the carrier's minimum participation reguirements, 
which may not exceed 75°-0, 
to all eligible employees and 
their dependents in those groups. 
In determining compliance 
with minimum participation reguirements, eligible employees 
and their dependents that have existing health care coverage 
may not be considered in the calculation. 
If an employee 
declines coverage because the employee has other coverage, 
any dependents of that employee who are not eligible under 
the 
employee's other 
coverage are eligible for 
coverage 
un de r the small group health plan. 
B. 
A carrier may deny coverage under a managed care plan, 
as defined by section 4301-A: 
(1) 
To 
employers 
who 
have 
no 
employees 
who 
live, 
reside or work within the approved service area of the 
plan: and 
(2) 
To employers if the carrier has demonstrated to 
the superintendent's satisfaction that: 
(a) 
The carrier does not have the capacity to 
deliver 
services 
adeguately 
to 
additional 
enrollees wi thin all or a designated part of its 
service 
area 
because 
of 
its 
obligations 
to 
existing enrollees: and 
(b) 
The 
carrier 
is 
applying 
this 
provision 
uniformly to individuals and groups without regard 
to any health-related factor. 
A carrier that denies coverage in accordance with this 
subparagraph may not enroll individuals residing within 
the service area subject to denial of coverage, 
or 
Page l2-LR0263(9) 
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1021 
groups or subgroups wi thin that area for a period of 
days after the date of the first denial of coverage. 
7. 
Disc10sure 
of 
rating 
practices 
and 
renewabi1ity 
provisions. 
following in 
Each 
small 
the sales and 
group 
carrier 
shall 
disclose 
the 
marketing materials provided to small 
employers: 
A. 
The extent to which premium rates for a specific small 
employer 
are 
established or adjusted due 
to the 
claims 
experience, health status or duration of coverage of the 
employees and dependents of the small employer; 
B. 
The ability of the carrier to change premium rates and 
rating factors, 
including case characteristics, 
that may 
affect changes in premium rates; 
C. 
A description of the class of business in which the 
small 
employer 
is 
or 
will 
be 
included, 
including 
the 
applicable grouping of plans; and 
D. 
The small employer's rights regarding renewal of the 
small group health plan. 
8. 
Mainten~ of records. 
A small group carrier shall 
maintain at its principal place of business 
a 
complete 
and 
detailed 
description 
of 
its 
rating 
practices 
and 
renewal 
underwriting practices, including information and documentatiol1 
that demonstrate that its rating methods and practices are based 
upon 
commonly 
accepted 
actuarial 
assumptions 
and 
are 
in 
accordance with sound actuarial principles. On or before March 
1st annually, 
a 
carrier shall file with the superintendent an 
actuarial certification that the carrier is in compliance with 
this section and that the rating methods of the carrier are 
actuarially sound. A copy of the certification must be retained 
by the carrier at its principal place of business. 
A carrier 
shall also make the information and documentation required in 
this subsection available to the superintendent upon request. 
The information provided to the superintendent pursuant to this 
subsection is proprietary and must be kept confidential by the 
superintendent. The information may not be disclosed except as 
agreed to by the carrier or as ordered by a court of competent 
jurisdiction. 
9. 
Discretion of superintendent. 
The superintendent may 
suspend all or any part of subsection 4 as to the premium rates 
applicable to one or more small employers for one or more rating 
periods upon a filing by the small group carrier and a finding by 
the superintendent that either the suspension is reasonable ln 
light of the financial condition of the carrier or that the 
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suspension would enhance 
the efficiency and fairness 
of the 
marketplace for small group health plans. 
10. 
A2Plicability. 
This section applies to all small group 
health 
plan 
policies, 
contracts 
and 
certificates 
executed, 
delivered, 
issued for delivery, 
continued or renewed in this 
State on or after January 1, 2009. 
For purposes of this section, 
all contracts are deemed to be renewed no later than the next 
yearly anniversary of the contract date. 
Sec. C-21. 24-A MRSA §2848, sub-§l-B, 1[A, as amended by PL 
1999, c. 256, Pt. L, §2, is further amended to read: 
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, 29 United States Code, 
Section 
1001, 
or 
a 
plan that would be an employee welfare 
benefit 
plan 
but 
for 
the 
"governmental 
plan" 
or 
"none1ecting 
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 Medical Program for the 
Uniformed Services, 
CHAMPUS, 
United States Code, 
Chapter 55; 
(6) 
A medical 
care program of 
the federal 
Heal th Care 
Improvement Act, 
United States 
Section 1601 or of a tribal organization; 
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(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; e~ 
plan 
as 
defined 
in 
federal 
by the federal Public Health 
2701(c)(1)(I), 
as 
amended 
by 
(10) 
A heal th benef i t plan under Section 5 (e) of the 
Peace 
Corps 
Act, 
Uni ted 
States 
Code, 
Section 
2504(e)..- ..LQ£ 
( 11) 
Insurance coverage offered by the Comprehensive 
Health 
Insurance 
Risk 
Pool 
Association pursuant 
to 
chapter 54. 
Sec. C-22. 24-A MRS A §2849-B, sub-§2, 1fA, as amended by PL 
2001, c. 258, Pt. E, §7, is further amended to read: 
A. 
That person was covered under aB-~~~~~-eF Q group 
contract or policy issued 
by 
any nonprofit hospital 
or 
medical service organization, insurerT or health maintenance 
organization, or was covered under an uninsured employee 
benefit plan that provides 
payment 
for 
health services 
received by employees and their dependents or a governmental 
program, 
including, but not limited to, 
those listed In 
section 2848, subsection 1-B, paragraph A, subparagraphs (3) 
to (10). 
For purposes of this section, the individual or 
group policy under which the person is seeking coverage is 
the "succeeding policy." 
The group 
e~--i·nE1.,i,.,.,iE1Ha± contract 
or policy, uninsured employee benefit plan or governmental 
program that previously covered the person is the "prior 
contract or policy"; and 
Sec. C-23. 24-A MRSA §2850-B, sub-§2, 1f1fC and D, as enacted by 
PL 1997, c. 445, §30 and affected by §32, are amended to read: 
C. 
"Large group market" means groups not subject to section 
2736-C or 68G8-g 2808-C. 
D. 
"Small group market" means groups subject to section 
68G8-g 2808-C. 
Sec. C-24. 24-A MRSA §2850-B, sub-§3, 1fG, as amended by PL 
2003, c. 428, Pt. A, §l, is further amended to read: 
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G. 
When the carrier ceases offering a product and meets the 
following requirements: 
(1) 
In the large group market: 
(a) 
The 
carrier 
policyholder and to 
before termination; 
must 
provide 
notice 
to 
the 
the insureds at least 90 days 
(b) 
The carrier must offer to each policyholder 
the option to purchase any other product currently 
being offered in the large group market; and 
(c) 
In exercising the option to discontinue the 
product and in offering the option of coverage 
under division (b), the carrier must act uniformly 
without regard to the claims experience of the 
policyholders or the health status of the insureds 
or prospective insureds; 
(2) 
In the small group market: 
(a) 
The carrier shall replace the product with a 
product that complies with the 
requirements 
of 
this 
section, 
including 
renewability, 
and 
with 
section aggg-g 2808-C; 
(b) 
The 
superintendent 
shall 
find 
that 
the 
replacement 
is 
in 
the 
best 
interests 
of 
the 
policyholders; and 
(c) 
The 
carrier shall 
provide 
notice 
to 
the 
policyholder and to the insureds at least 90 days 
before replacement: or 
(3) 
In the individual market: 
(a) 
The carrier shall replace the product with a 
product that complies with the 
requirements 
of 
this 
section, 
including 
renewability, 
and 
with 
section 2736-C; 
(b) 
The 
superintendent 
shall 
find 
that 
the 
replacement 
is 
in 
the 
best 
interests 
of 
the 
policyholders; and 
(c) 
The 
carrier 
shall 
provide 
notice 
to 
policyholder 
and, 
if 
a 
group 
policy, 
to 
insureds at least 90 days before replacement; 
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Sec. C-25. 24-A MRS A §2850-B, sub-§4, 1IB, as amended by PL 
2001, c. 258, Pt. E, §ll, is further amended to read: 
B. 
Carriers that cease to write new small group business 
continue 
to 
be 
governed 
by 
section 6898-8 
2808-C 
with 
respect to small group contracts in force and their renewal 
or replacement contracts. 
Sec. C-26. 24-A MRSA c. 54 is enacted to read: 
CHAPTER 54 
CQMPREHKNSIVE HEALTH INSURANCE RISK POOL ASSQCIATION 
§390l. 
Short title 
This chapter may be known and cited as "the Comprehensive 
Health Insurance Risk Pool Association Act. " 
§390Z. 
Puepose 
It is the purpose of this chapter to establish a mechanism 
to distribute among all insurers doing business in this State the 
costs of providing health and accident insurance coverage to 
those residents of this State who because of health conditions 
consume unusually large amounts of health care and to ensure a 
competitive insurance market. 
§3903. 
Definitions 
As 
used 
in this 
chapter, 
unless 
the 
context 
otherwise 
indicates, the following terms have the following meanings. 
1. Association. "Association" means the Comprehensive Health 
Insurance Risk Pool Association established in section 3904. 
2. 
Board. 
"Board" 
means 
the board of directors of the 
association. 
3. 
Covered person. 
"Covered person" means an individual 
resident of this State, exclusive of dependents, who: 
A. Is eligible to receive benefits from an insurer; 
B. 
Is eligible 
for 
benefits 
under 
the 
federal 
Health 
Insurance Portability and Accountability Act of 1996; or 
C. 
Has 
been 
certified 
as 
eligible 
for 
federal 
trade 
adjustment 
assistance 
or 
for 
pension 
benefit 
guarantee 
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corporation assistance, 
as provided by the federal Trade 
Adjustment Assistance Reform Act of 2002. 
4. 
Dependent. 
"Dependent" 
means 
a 
resident 
spouse 
or 
resident unmarried child under 19 years of age. a child who is a 
student under 23 years of age and who is financially dependent 
upon the parent or 
a 
child of any age 
who is disabled and 
dependent upon the parent. 
5. 
Health maintenance organization. 
"Health maintenance 
organization" means an organization authorized under chapter 56 
to operate a health maintenance organization in this State. 
6. 
Insurer. 
"Insurer" means an entity that is authorized 
to write medical insurance or that provides medical insurance in 
this State. 
"Insurer" includes an insurance company. nonprofit 
hospital 
and 
medical 
service organization, 
fraternal 
benefit 
society, 
health 
maintenance 
organization, 
self-insurance 
arrangement that provides health care benefits in this State to 
the extent allowed under the federal Employee Retirement Income 
Security Act of 1974, 3rd-party administrator, multiple-employer 
welfare arrangement, any other entity providing medical insurance 
or health benefits subject to state insurance regulation or any 
reinsurer reissuing health insurance in this State. 
7. 
Medical insurance. 
"Medical insurance" means a hospital 
and 
medical 
expense-incurred 
policy, 
nonprofit 
hospital 
and 
medical service plan, health maintenance organization subscriber 
contract or other health care plan or arrangement that pays for 
or furnishes medical or health care services whether by insurance 
or otherwise, whether sold as an individual or group policy. 
"Medical insurance" does not include accidental injury, specified 
disease, hospital indemnity, dental, vision, disability income, 
Medicare 
supplement, 
long-term care or other limited benefit 
health 
insurance 
or credit insurance: 
coverage 
issued 
as 
a 
supplement 
to liability insurance; 
insurance arising 
out of 
workers' 
compensation or 
similar 
law; 
and 
automobile 
medical 
payment insurance or insurance under which benefits are payable 
with or without regard to fault and that is statutorily required 
to be contained in any liability insurance policy or equivalent 
self-insurance. 
8. 
Medicare. 
"Medicare" means coverage under both Parts A 
and B of Title XVIII of the Social Security Act, 42 United States 
Code. Section 1395 et seq., as amended. 
9. 
Plan. "Plan" means the health insurance plan adopted by 
the board pursuant to this chapter. 
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1021 
10. 
Producer. 
"Producer" means a person who is licensed to 
sell health insurance in this State. 
11. 
Resident. 
"Resident" means an individual who: 
A. 
Is legally located in the United States and has been 
legally domiciled in this State for a period established by 
the board and subject to the approval of the superintendent 
and not to exceed one year; 
B. 
Is legally domiciled in this State on the date of 
application to the plan and is eligible for enrollment in 
the risk pool under this chapter as a result of the federal 
Health Insurance Portability and Accountability Act of 1996; 
C. 
Is legally domiciled in this State on the date of 
application to the plan and has been certified as eligible 
for 
federal 
trade 
adjustment 
assistance 
or 
for 
pension 
benefit guarantee corporation assistance, as provided by the 
federal Trade Adjustment Assistance Reform Act of 2002. 
12. 
Reinsurer. 
"Reinsurer" means an insurer from whom 
a 
person 
providing 
health 
insurance 
for 
a 
resident 
procures 
insurance for itself with the insurer with respect to all or part 
of the medical insurance risk of the person. "Reinsurer" includes 
an insurer that provides employee benefits excess insurance. 
13. 
Third-party administrator. 
"Third-party administrator" 
means an entity that is paying or processing medical insurance 
claims for a resident. 
§3904. 
Comprehensive Health Insurance Risk Pool Association 
1. 
Risk 
pool 
established. 
The 
Comprehens i ve 
Heal th 
Insurance Risk Pool Association is established as 
a nonprofit 
legal entity. 
As 
a condition of doing business, every insurer 
that has sold medical insurance within the previous 12 months or 
is actively marketing a medical insurance policy in this State 
shall participate in the association. 
2. 
Board of directors. 
The association is governed by a 
board of directors in accordance with the following. 
A. 
The board consists of 11 members appointed as follows: 
(1) 
Six members appointed by the superintendent: 
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(a) 
Two members must be chosen from the general 
public and may not be associated with the medical 
profession. a hospital or an insurer; 
(c) 
One member must represent health insurance 
producers; and 
(d) 
One 
member 
must 
represent 
a 
statewide 
association 
representing 
small 
businesses 
that 
receives the majority of its funding from persons 
and businesses in the State. 
A board member appointed by the superintendent may be 
removed at any time without cause; and 
(2) 
Five members appointed by the member insurers, at 
least 2 of whom are domestic insurers and at least 2 of 
whom are self-insured or 3rd-party administrators. 
B. 
Terms 
for initial appointments 
to the board are as 
follows. 
Of those members of the board appointed by the 
superintendent, 
members serve for a term of one year, 
members for a term of 2 years and 2 members for a term of 3 
years. 
Of those members appointed by the member insurers, 
one member serves for a term of one year, one member serves 
for a term of 2 years and one member serves for a term of 3 
years. 
The appointing authority shall designate the period 
of 
service 
of 
each 
initial 
appointee 
at 
the 
time 
of 
appointment. All terms after the initial terms must be for 3 
years. 
C. 
The board shall elect one of its members as chair. 
D. 
Board 
members 
may 
be 
reimbursed 
from 
funds 
of 
the 
association for actual and necessary expenses incurred by 
them as members but may not otherwise be compensated for 
their services. 
3. 
Plan of operation; rules. 
The association shall adopt a 
plan of operation in accordance with the requirements of this 
chapter and submit its articles, bylaws and operating rules to 
the superintendent for approval. 
If the association fails to 
adopt the plan of operation and sui table articles and bylaws 
within 
days 
after 
the 
appointment 
of 
the 
board, 
the 
superintendent shall adopt rules to effectuate the requirements 
of 
this 
chapter, 
and 
those 
rules 
remain 
in 
effect 
until 
superseded 
by 
a 
plan 
of 
operation 
and articles 
and 
bylaws 
submitted by the association and approved by the superintendent. 
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Rules adopted pursuant to this subsection by the superintendent 
are routine technical rules as defined in Title 5, chapter 375, 
subchapter 2-A. 
4. 
Immunity. 
A board member is not liable and is immune 
from suit at law or equity for any conduct performed in good 
faith that is within the subject matter over which the board has 
been given jurisdiction. 
§3905. 
Liability and indemnification 
1. 
Liability. 
The board and its employees may not be held 
liable for any obligations of the association. 
A cause of action 
may not arise against the association: the board, its agents or 
its employees: any member insurer or its agents, employees or 
producers: or the superintendent for any action or omission in 
the performance of powers and duties pursuant to this chapter. 
2. 
Indemnification. 
The board in its bylaws or rules may 
provide for indemnification of, and legal representation for, its 
members and employees. 
§3906. 
Duties and powers of association 
1. 
Duties. 
The association shall: 
A. 
Establish administrative and accounting procedures for 
the operation of the association: 
B. 
Establish 
procedures 
under 
which 
applicants 
and 
participants in the plan may have grievances reviewed by an 
impartial body and reported to the board: 
C. 
Select a plan administrator in accordance with section 
3907: 
D. 
Collect assessments as provided in section 3908. 
The 
level 
of 
payments 
must 
be 
established 
by 
the 
board. 
Assessments 
must 
be 
collected pursuant 
to 
the 
plan 
of 
operation 
approved 
by 
the 
board. 
In 
addition 
to 
the 
collection 
of 
such 
assessments, 
the 
association 
shall 
collect an organizational assessment or assessments from all 
insurers as necessary to provide for expenses that have been 
incurred or are estimated to be incurred prior to receipt of 
the 
first 
calendar 
year 
assessments. 
Organizational 
assessments must be equal in amount for all insurers but may 
not 
exceed 
$500 
per 
insurer 
for 
all 
such 
assessments. 
Assessments are due and payable within 30 days of receipt of 
the assessment notice by the insurer: 
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E. 
Require that all policy forms issued by the association 
conform to standard forms developed by the association. 
The 
forms must be approved by the superintendent and must comply 
with this Title: and 
F. 
Develop 
and 
implement 
a 
program 
to 
publicize 
the 
existence of the plan, the eligibility requirements for the 
plan and the procedures for enrollment in the plan and to 
maintain public awareness of the plan. 
2. 
Povers. The association may: 
A. 
Exercise powers granted to insurers under the laws of 
this State; 
B. 
Enter into contracts as necessary or proper to carry out 
the 
prov~s~ons and purposes of this chapter, including the 
authority, with the approval of the superintendent, to enter 
into contracts with similar organizations in other states 
for the joint performance of common administrative functions 
or with persons or other organizations for the performance 
of administrative functions; 
C. 
Sue or be 
sued, 
including taking any legal actions 
necessary or proper to recover or collect assessments due 
the association; 
D. 
Take any legal actions necessary to avoid the payment of 
improper 
claims 
against the 
association or 
the 
coverage 
provided by or 
through the 
association, 
to 
recover 
any 
amounts erroneously or improperly paid by the association, 
to recover any amounts paid by the association as a result 
of mistake of fact or law or to recover other amounts due 
the association; 
E. 
Establish 
a 
system to modify 
from 
time 
to 
time 
as 
appropriate rates, rate schedules, rate adjustments, expense 
allowances, producers' referral fees, claim reserve formulas 
and 
any 
other 
actuarial 
function 
appropriate 
to 
the 
operation of the association in accordance with section 3910; 
F. 
Issue policies 
of 
insurance 
in accordance 
with 
the 
requirements of this chapter; 
G. 
Appoint 
appropriate 
legal, 
actuarial 
and 
other 
commi ttees as necessary to provide technical assistance in 
the operation of the plan, policy or other contract design 
and 
any 
other 
function 
within 
the 
authority 
of 
the 
association; 
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H. 
Borrow money to effect the purposes of the association. 
Any 
notes 
or 
other 
evidence 
of 
indebtedness 
of 
the 
association not in default must be legal investments for 
insurers and may be carried as admitted assets: 
I. 
Establish 
rules, 
conditions 
and 
procedures 
for 
reinsuring risks of member insurers desiring to issue plan 
coverage to individuals otherwise eligible for plan coverage 
in their own names; 
J. 
Prepare and distribute application forms and enrollment 
instruction forms to producers and to the general public: 
K. 
Provide 
for 
reinsurance 
of 
risks 
incurred 
by 
the 
association. The provision of reinsurance may not subject 
the 
association 
to 
any 
of 
the 
capital 
or 
surplus 
requirements, if any, otherwise applicable to reinsurers; 
L. 
Issue additional types of health insurance policies to 
provide 
optional 
coverage, 
including Medicare 
supplement 
health insurance; 
M. 
Provide for and employ cost-containment measures 
and 
requirements, 
including, but not limited to, preadmission 
screening, 
2nd 
surgical 
opinions, 
concurrent utilization 
review and individual case management for the purpose of 
making the plan more cost-effective; 
N. 
Design, utilize, contract or otherwise arrange for the 
delivery of cost-effecti ve health care services, including 
establishing 
or 
contracting 
with 
preferred 
provider 
organizations, 
health maintenance organizations 
and other 
limited network provider arrangements; 
O. 
Apply 
for 
funds 
or 
grants 
from 
public 
or 
private 
sources, 
including federal 
grants 
provided 
to qualified 
high-risk pools; and 
P. 
Develop a plan to subsidize low-income individuals. 
The 
association shall submit that plan to the joint standing 
committee of the Legislature having jurisdiction over health 
insurance 
matters 
no 
later 
than 
February 
1, 
2008. 
If 
necessary, 
the 
joint standing 
committee 
may 
report out 
legislation to the 
Second 
Regular Session of 
the 123rd 
Legislature 
to 
implement 
the 
plan 
submitted 
by 
the 
association. 
3. 
Additional duties and powers. 
The superintendent may, 
by rule, establish additional powers and duties of the board and 
may adopt such rules as are necessary and proper to implement 
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this chapter. 
Rules 
adopted pursuant 
to this subsection are 
routine 
technical rules as defined in Title 5, 
chapter 
375, 
subchapter 2-A. 
4. 
Review for solvency. 
The superintendent shall review 
the ol?erations of the association at least every 3 years to 
determine its solvency. 
If the superintendent determines that 
the 
funds 
of 
the 
association 
are 
insufficient 
to 
support 
enrollment of additional persons, the superintendent may order 
the association to increase its assessments 
or 
increase its 
premium rates. 
If the superintendent determines that the funds 
of the association are insufficient to sUl?l?ort the enrollment of 
additional persons and that the cap of assessments in section 
3908 i§ too low to support the enrollment of additional persons, 
the 
superintendent 
may 
order 
the 
association 
to 
charge 
an 
assessment in excess of the cap for a period not to exceed 12 
months. 
5. 
Annual report. 
The association shall report annually to 
the 
joint 
standing 
committee 
of 
the 
Legislature 
having 
jurisdiction over health insurance matters by March 15th. 
The 
report 
must 
include 
information 
on 
the 
benefits 
and 
rate 
structure of coverage offered by the association, the financial 
solvency of the association and the administrative expenses of 
the plan. 
6. 
Audit. 
The association must be audited at least every 3 
years. A copy of the audit must be provided to the superintendent 
and to 
the joint standing committee of the Legislature having 
jurisdiction over health insurance matters. 
§3907. 
Selection of plan administrator 
1. 
Selection of plan administrator. 
The board shall select 
an insurer or 
3rd-l?arty administrator, 
through 
a 
competitive 
bidding 
process, 
to 
administer 
the 
plan. 
The 
board 
shall 
evaluate bids submitted under this subsection based on criteria 
established by the board, including: 
A. 
The insurer I s or the 3rd-l?arty administrator I s 
proven 
ability to handle large group accident and health insurance; 
B. 
The 
efficiency 
of 
the 
insurer's 
or 
the 
3rd-party 
administrator's claims-payment procedures; and 
C. 
An estimate of total charges for administering the plan. 
2. 
Contract 
with 
plan 
administrator. 
The 
pI an 
administrator selected pursuant to subsection 1 is contracted for 
a period of 3 years. 
At least one year prior to the expiration 
SENATE AMENDMENT 
SENATE AMENDMENT .. B .. to COMMITTEE AMENDMENT"~" to H.P. 706, L.D. 
1021 
of each 3 year period of service by a plan administrator, the 
board shall invite all insurers, 
including the current plan 
administrator, to submit bids to serve as the plan administrator 
for the succeeding 3-year period. 
The selection of the plan 
administrator for the succeeding period must be made at least 6 
months prior to the expiration of the 3-year period. 
3. 
Duties of plan 
administr~t...!o~r"-.!... __ 
T",-h~e~J;ip,-,!l,JiaaJn~--.!a~d~mi!.!.=.i.!Jnl.,!i,...,;s~t~r,--a~t.),,!o~r 
selected pursuant to subsection 1 shall: 
A. 
Perform 
all 
eligibility 
and 
administrative 
Claims-payment functions relating to the plan: 
B. 
Pay 
a 
producer's referral fee 
as established by the 
board to each producer who refers an applicant to the plan, 
if the applicant's application is accepted. 
The selling or 
marketing 
of 
the 
plan 
is 
not 
limited 
to 
the 
plan 
administrator 
or 
its producers. 
The 
plan administrator 
shall pay the referral fees from funds received as premiums 
for the plan; 
C. 
Establish a premium billing procedure for collection of 
premiums 
from 
insured 
persons. 
Billings 
must 
be 
made 
periodically as determined by the board; 
D. 
Perform all necessary functions to ensure timely payment 
of benefits to covered persons under the plan, including: 
(1) 
Making 
available 
information 
relating 
to 
the 
proper manner of submitting a claim for benefits under 
the plan and distributing forms upon which submissions 
must be made; 
(2) 
Evaluating 
the 
eligibility of 
each 
claim 
for 
payment under the plan; and 
(3) 
Notifying 
each 
claimant within 
days 
after 
receiving a properly completed and executed proof of 
loss 
of whether the claim is accepted, 
rejected or 
compromised. 
The 
board 
shall 
establish 
reasonable 
reimbursement amounts for 
any services covered under 
the benefit plans; 
E. 
Submit 
regular 
reports 
to 
the 
board 
regarding 
the 
operation of the plan. 
The freguency, content and form of 
the reports must be as determined by the board; 
F. 
Following the close of each calendar year, determine net 
premiums, 
reinsurance premiums less administrative expense 
allowance, the expenses of administration pertaining to the 
SENATE AMENDMENT 
SENATE AMENDMENT J?>" to COMMITTEE AMENDMENT" S· to H.P. 706, L.D. 
1021 
reinsurance operations of the association and the incurred 
losses of the year 
and 
report this 
information 
to 
the 
superintendent; and 
G. 
Pay claims expenses from the premium payments received 
from or on behalf of covered persons under the plan. 
If the 
payments 
by 
the 
plan administrator 
for 
claims 
expenses 
exceed the portion of premiums allocated by the board for 
payment of claims expenses, the board shall provide the plan 
administrator with additional funds for payment of claims 
expenses. 
4. 
Payment to plan administrator. 
The plan administrator 
selected pursuant to subsection 1 must be paid, as provided in 
the contract of the association under subsection 2, for the plan 
administrator's direct 
and indirect expenses 
incurred in the 
performance of plan administrator's services. 
As 
used in this 
subsection, "direct and indirect expenses" includes that portion 
of the audited administrative costs, printing expenses, claims 
administration expenses, 
management expenses, building overhead 
expenses and other actual operating and administrative expenses 
of the plan administrator that are approved by the board as 
allocable to the administration of the plan and included in the 
specifications of a bid under subsection 2. 
§3908. 
Assessments against insurers 
1. 
Assessments. 
For the purpose of providing the funds 
necessary to carry out the powers and duties of the association, 
the board shall assess member insurers at such a time and for 
such amounts as the board finds necessary. Assessments are due 
not less than 30 days after receipt of written notice by member 
insurers and accrue interest at 12°-0 per annum on and after the 
due date. 
2. 
Maximum assessment. 
The board shall assess each insurer 
an amount not to exceed $3 per person insured or reinsured by 
each insurer per month for medical insurance. 
A member insurer 
may not be assessed on policies or contracts insuring federal or 
state employees. 
This assessment begins January 1, 2007. 
3. 
Determination of assessment. 
The 
board 
shall 
make 
reasonable efforts to ensure that each covered person is counted 
only once with respect to any assessment. 
For that purpose, the 
board shall require each insurer that obtains excess or stop loss 
insurance 
to 
include 
in its 
count 
of 
covered 
persons 
all 
individuals whose coverage is insured, 
in whole or 
~n part, 
through excess or stop loss coverage. 
The board shall allow a 
reinsurer to exclude from its number of covered persons those who 
have 
been counted by 
the primary insurer or 
by 
the primary 
SENATE AMENDMENT 
(l 
" 
t 
SENATE AMENDMENT "V" to COMMITTEE AMENDMENT 15 to H.P. 706, L.D. 
1021 
reinsurer or primary excess or stop loss insurer for the purpose 
of determining its assessment under this subsection. The board 
may verify each insurer' s assessment based on annual statements 
and other reports determined to be necessary by the board. 
The 
board may use anY--.reasonable method of estimating the number of 
covered persons of an insurer if the specific number is unknown. 
4. 
Excess funds. 
If assessments and other receipts by the 
association, board or plan administrator exceed the actual losses 
and administrative expenses of the plan, the board shall hold the 
excess as interest and may 
use those excess 
funds 
to offset 
future 
losses 
or 
to 
reduce 
plan premiums. 
As 
used in this 
subsection, "future losses" includes reserves for claims incurred 
but not reported. 
5. 
Failure 
to 
pay assessment. 
The 
superintendent 
may 
suspend or revoke, after notice and hearing, the certificate of 
authority to transact insurance in this State of any member 
insurer that fails to pay an assessment. 
As an alternative, the 
superintendent may levy a penalty on any member insurer that 
fails 
to 
pay 
an 
assessment 
when 
due. 
In 
addition, 
the 
superintendent may use any power granted to the superintendent by 
this Title to collect any unpaid assessment. 
§3909. 
Availability of coverage 
The association shall offer a choice of 2 or more coverage 
options through the plan. The requirements of this plan become 
effective 
January 
L 
2007. 
Policies 
offered 
through 
the 
association must be available for sale beginning on January 1, 
2008. The association shall directly insure the coverage provided 
by the plan, and the policies must be issued through the plan 
administrator. 
At 
least 
one 
coverage 
option 
must 
be 
a 
standardized health plan as defined in Chapter 750 of the rules 
of the bureau. 
§39l0. 
Reguirements for coverage 
1. 
CoVerage offered. 
The plan must offer in an annually 
renewable policy the coverage specified in this section for each 
eligible person. 
If an eligible person is also eligible for 
Medicare coverage, the plan may not payor reimburse any person 
for expenses paid by Medicare. 
Any person whose health insurance 
coverage is involuntarily terminated for any reason other than 
nonpayment of premiums may apply for coverage under the plan. 
If 
such coverage is applied for within 90 days after the involuntary 
termination and if premiums are paid for the entire period of 
coverage, 
the effective date of the coverage is the date of 
termination of the previous coverage. 
SENATE AMENDMENT 
SENATE AMENDMENT "E" to COMMITTEE AMENDMENT,t,g"to H.P. 706, L.D. 
1021 
2. 
Major medical expense coverage. 
The plan must offer 
major medical expense coverage to every eligible person who is 
not eligible for Medicare. 
The coverage to be issued by the 
plan, 
its 
schedule 
of 
benefits 
and 
exclusions 
and 
other 
limitations must be established by the board and may be amended 
from time to time subject to the approval of the superintendent. 
In establishing the plan coverage, 
the board shall take intQ 
consideration the levels of health insurance provided in the 
State and medical and economic factors as determined appropriate. 
3. 
Rates. 
Rates for coverage issued by the association 
must meet the reguirements of this subsection. 
A. 
Rates 
may 
not 
be 
unreasonable 
in 
relation 
to 
the 
benefits provided, the risk experience and the reasonable 
expenses of providing the coverage. 
B. 
Rate schedules must comply with section 2736-C and are 
subject to approval by the superintendent. 
C. 
Standard 
risk 
rates 
for 
coverage 
issued 
by 
the 
association must be established by the association, subject 
to 
approval 
by 
the 
superintendent, 
usino 
reasonable 
actuarial 
technigues 
and 
must 
reflect 
anticipated 
experiences 
and 
expenses 
of 
such 
coverage 
for 
standard 
risks. The premium for the standard risk rates must range 
from a minimum of 125°b to a maximum of 150°-0 of the weighted 
average 
of 
rates 
charged 
by 
those 
insurers 
and 
health 
maintenance 
organizations 
with 
individuals 
enrolled 
ln 
similar medical insurance plans. 
4. 
Compliance with state law. 
Products offered by the 
association must comply with all relevant reguirements of this 
Title 
applicable 
to 
individual 
health 
insurance 
policies, 
including reguirements for mandated coverage for specific health 
services, 
for specific diseases and for certain providers of 
health care services. 
5. 
Other sources primary. 
The association must be payer of 
last resort of benefits whenever any other benefit or source of 
3rd-party payment is available. 
The 
coverage provided by the 
association must 
be 
considered excess 
coverage, 
and benefits 
otherwise payable under association coverage must be reduced by 
all amounts paid or payable through any other health insurance 
and by all hospital and medical expense benefits paid or payable 
under any short-term, accident, dental-only, vision-only, fixed 
indemnity, limited benefit or credit insurance; coverage issued 
as 
a 
supplement to liability insurance; workers' 
compensation 
coverage; 
automobile 
medical 
payment; 
or 
liability insurance 
whether 
or not provided on the basis of fault, 
and by 
any 
SENATE AMENDMENT 
() 
\1 
" 
SENATE AMENDMENT "..," to COMMITTEE AMENDMENT Rj to H.P. 706, L.D. 
1021 
hospital or medical benefits paid or payable by any insurer or 
insurance arrangement or any hospital or medical benefits paid or 
payable under or provided pursuant to any state or federal law or 
program. 
6. 
Recovery of claims paid. 
An amount paid or payable by 
Medicare or any other government program or any other insurance, 
or self-insurance maintained in lieu of otherwise statutorily 
required insurance, may not be made or recognized as claims under 
such a policy or be recognized as or towards satisfaction of 
applicable deductibles or out-of-pocket maximums or to reduce the 
limits of benefits available. 
The association has a 
cause of 
action against a participant for the recovery of the amount of 
any benefits paid to the participant that should not have been 
claimed or recognized as claims because of the provisions of this 
subsection or because the benefits are otherwise not covered. 
Benefits due from the association may be reduced or refused as a 
setoff against any amount recoverable under this subsection. 
§3911. 
E1igibi1ity for coverage 
1. 
Eligibility; application for coverage. 
A resident is 
eligible for coverage under the plan if evidence is provided of 
rejection, a requirement of restrictive riders, a rate increase 
or a preexisting conditions limitation on a qualified plan, the 
effect of which is to substantially reduce coverage from that 
received by a person considered a standard risk by at least one 
association 
member 
within 
months 
of 
the 
date 
of 
the 
certificate, 
or 
if 
the 
resident 
meets 
other 
eligibility 
requirements adopted by rule by the superintendent that are not 
inconsistent with this chapter and that indicate that a person is 
unable to obtain coverage substantially similar to that which may 
be obtained by a person who is considered a standard risk. 
Rules 
adopted pursuant to this subsection are routine technical rules 
as defined in Title 5, chapter 375, subchapter 2-A. 
2. 
Change of domicile. 
The board shall develop standards 
for eligibility for coverage by the association for any natural 
person who changes that person's domicile to this State and who 
at the time domicile is established in this State is insured by 
an organization similar to the association. 
The eligible maximum 
lifetime benefits for that covered person may not exceed the 
lifetime benefits available through the association, 
less any 
benefits 
received 
from 
a 
similar organization in the 
former 
domiciliary state. 
3. 
Eligibili~withoy~plication. 
The 
board 
develop a list of medical or health conditions for which a 
is 
eligible 
for 
plan 
coverage 
without 
applying 
for 
shall 
person 
health 
insurance under subsection 1. 
A person who can demonstrate the 
SENATE AMENDMENT 
SENATE AMENDMENT oof!:>oo to COMMITTEE AMENDMENT""; to H.P. 706, L.D. 
1021 
existence or history of a medical or health condition on the list 
developed 
by 
the board 
may 
not 
be 
required to 
provide the 
evidence specified in subsection 1. The board may amend the list 
from time to time as appropriate. 
4. 
Exclusions from eligibility. 
A person is not eligible 
for coverage under the plan if: 
A. 
The person has or obtains health insurance 
coverage 
substantially similar to or more comprehensive than a plan 
policy or would be eligible to have coverage if the person 
elected to obtain it, except that: 
(1) 
A person 
may maintain other coverage 
for 
the 
period of time the person is satisfying a preexisting 
condition waiting period under a plan policy; and 
(2) 
A person may maintain plan coverage for the period 
of 
time 
the 
person 
is 
satisfying 
a 
preexisting 
condition waiting period under another health insurance 
policy intended to replace the plan policy; 
B. 
The 
person 
is 
determined eligible 
for 
health care 
benefits under the MaineCare program pursuant to Title 22; 
C. 
The person previously terminated plan coverage, unless 
months have elapsed since the person's last termination; 
D. 
The person has met the lifetime maximum benefit amount 
under the plan of $3,000,000; 
E. 
The 
person 
is 
an 
inmate 
or 
resident 
of 
a 
public 
institution; or 
F. 
The person's premiums are paid for or reimbursed under 
any government-sponsored program or by any government agency 
or health care provider, except as an otherwise qualifying 
full-time employee, 
or dependent thereof, of a 
government 
agency or health care provider. 
5. 
Termination of coverage. 
The coverage of any person 
ceases: 
A. 
On the date a person is no longer a resident; 
B. 
Upon the death of the covered person; 
C. 
On 
the date 
state law requires cancellation of the 
policy; or 
SENATE AMENDMENT 
n 
"~sIt 
SENATE AMENDMENT "1.::>" to COMMITTEE AMENDMENT 
to H.P. 706, L.D. 
1021 
D. 
At the option of the association, 
days after the 
association 
makes 
any 
inquiry 
concerning 
the 
person's 
eligibili ty or place of residence to which the person does 
not reP-lY....-
The coverage of 
anY-IL~rson who 
c~ases to meet the eligibility 
requirements of this section may be terminated immediately. 
6. 
Unfair trade practice. 
It constitutes an unfair trade 
practice 
for 
any 
insurer, 
producer, 
employer 
or 
3rd-party 
administrator to refer an individual employee or a dependent of 
an individual employee to the association or to arrange for an 
individual employee or a dependent of an individual employee to 
gpply to the plan for the purpose of separating such an employee 
or 
dependent 
from 
a 
group 
health benefits plan provided in 
connection with the employee's employment. 
§39l2. 
Actions against association or members based upon joint 
or collective actions 
Participation 
in 
the 
association, 
the 
establishment 
of 
rates, 
forms 
or procedures or 
any other joint or collective 
action required by this chapter may not be the basis of any legal 
action or criminal or civil liability or penalty against the 
association or any member insurer. 
§39l3. 
Reimbursement of carriers 
1. 
Reimbursement. A carrier may seek reimbursement from the 
association and the association shall reimburse the carrier to 
the extent claims made by a member after January 1, 2008 exceed 
premiums paid on a calendar year basis by the member to the 
carrier for a member who meets the following criteria: 
A. 
The carrier sold an individual health plan to the member 
between December 1, 1993 and January 1, 2008, and the policy 
that was sold has been continuously renewed by the member; 
B. 
The carrier is able to determine through the use of 
individual 
health 
statements, 
claims 
history 
or 
any 
reasonable means that at any time while the policy was In 
effect, the member 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 
requiring 
open-heart surgery, Parkinson's disease, pOlycystic kidney 
SENATE AMENDMENT 
i) 
" 
• 
SENATE AMENDMENT "0" to COMMITTEE AMENDMENT B to H.P. 706, L.D. 
1021 
disease, 
psychotic 
disorders, 
quadriplegia, 
stroke, 
syringomyelia or Wilson's disease; and 
C. 
The 
carrier 
has 
closed 
its 
book 
of 
business 
for 
individual health plans sold prior to January I, 2008. 
~ 
.. __ 
~J,lles 
__ ~he S1!P_exj.nJ~_eJl!;leltt----'l.l.Qy._ado--1>-t 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. 
Sec. C-27. 24-A MRSA §4202-A, sub-§10, ,B, as amended by PL 
1993, c. 645, Pt. A, §5, is further amended to read: 
B. 
Is compensated, except for reasonable copayments, for 
basic health care services to enrolled participants solely 
on 
a 
predetermined periodic rate basis, 
except that the 
organization is not prohibited from having a provision in a 
group contract allowing an adjustment of premiums based upon 
the actual health services 'utilization of 
the enrollees 
covered under the contract, and except that such a contract 
may 
not 
be 
sold 
to 
an eligible group 
subject 
to 
the 
eemm~Bi~y rating requirements of section &898-8 2808-C; 
Sec. C-28. 24-A MRSA §4207, sub-§5, as amended by PL 2003, c. 
469, Pt. E, §19, is further amended to read: 
5. 
A schedule or an amendment to a schedule of charge for 
enrollee health coverage for health care services may not be used 
by any health maintenance organization unless it complies with 
section 2736, &898-8 2808-C or 2839, whichever is applicable. 
Sec. C-29. 24-A MRSA §4210, sub-§l, as amended by PL 1995, c. 
332, Pt. 0, §4, is further amended to read: 
1. 
After 
a 
health maintenance organization has been in 
operation 24 months, it shall have an annual open enrollment 
period of at least one month during which it accepts enrollees up 
to the limits of its capacity, 
as 
determined by the health 
maintenance organization, in the order in which they apply for 
enrollment. 
To the extent not inconsistent with the requirements 
of chapter 36 and sections 2736-C and 6898-8 2808-C as qualified 
by 
section 
4222-B, 
subsection 
3, 
a 
health 
maintenance 
organization may apply to the superintendent for authorization to 
impose 
such underwriting restrictions 
upon enrollment 
as 
are 
necessary 
to 
preserve 
its 
financial 
stability, 
to 
prevent 
excessive adverse selection by prospective enrollees or to avoid 
unreasonably high or unmarketable charges for enrollee coverage 
for health care services. The superintendent shall approve or 
SENATE AMENDMENT 
SENATE AMENDMENT "8,, to COMMITTEE AMENDMEN;'£' to H.P. 706, L.D. 
1021 
deny the application within 10 
days of the 
receipt of that 
application from the health maintenance organization. 
Sec. C-30. 24-A MRSA §4212, sub-§2, ~C, as enacted by PL 1995, 
c. 332, Pt. 0, §6, is amended to read: 
C. 
When the provisions of the State's community rating law 
are applicable, as provided by section 2736-C, subsection 3, 
paragraph B aRQ-seetieR-6SQS-BT-s~bseetieR-4T-Fa~a~~aFR-B; or 
Sec. C-31. 24-A MRSA §4222-B, sub-§3, as enacted by PL 1995, 
c. 332, Pt. 0, §8, is amended to read: 
3. 
The 
requirements 
of 
sections 
2736-C 
and 
6SQS-BT 
eeJ'RJ'R~!!.4.-ty---r-a-t.-:i,.ng---lawT 
2808 -C 
apply 
to 
heal th 
maintenance 
organizations, except that a health maintenance organization is 
not required to offer coverage or accept appl ications from an 
eligible 
group 
or 
individual 
located 
outside 
the 
health 
maintenance organization's approved service area. 
Sec. C-32. 24-A MRSA §4346, sub-§l, ~D, as enacted by PL 2001, 
c. 708, §3, is amended to read: 
D. 
who: 
"Eligible employee" or "employee" means an individual 
(1) 
Meets--the-- -de-f-i-ni-t-i-€ffi--e;E--'!.e-1-ig-ili1€--~-f>Y~'-- set 
;Ee~tR--ia-~~~-~r-~-i~-~7--FaFa~FaFB--~ 
Works on a fUll-time basis, with a normal work week of 
hours or more. 
"Eligible employee" includes a sole 
propr ietor, 
a 
partner 
of 
a 
partnership 
or 
an 
independent contractor, but does not include employees 
who 
work 
on 
a 
temporary 
or 
substitute basis. 
An 
employer 
may 
elect 
to 
treat 
as 
eligible 
employees 
part-time employees who work a normal work week of 10 
hours or more as long as at least one employee works a 
normal work week of 30 hours or more. 
An employer may 
elect to treat as eligible employees 
employees 
who 
retire from the employer's employment; 
(2) Is a self-employed individual who: 
(a) Works and resides in the State; and 
(b) Is organized as a sole proprietorship or in 
any 
other 
legally 
recognized 
manner 
that 
a 
self-employed 
individual 
may 
organize, 
a 
substantial part of whose income derives from a 
trade or business through which the individual has 
attempted to earn taxable 
income, 
and 
who 
has 
SENATE AMENDMENT 
SENATE AMENDMENT "S" to COMMITTEE AMENDMENT"g to H.P. 706, L.D. 
1021 
filed 
the 
appropriate 
United 
States 
Internal 
Revenue 
Service 
form 
for 
the previous 
taxable 
year, 
and 
for 
whom 
a 
copy of the 
appropriate 
United States Internal 
Revenue Service 
form or 
forms and schedule has been filed with the plan or 
its administrator; or 
(3) Is a sole employee of a nonprofit organization that 
has been determined by the Internal Revenue Service to 
be 
exempt 
from 
taxation 
under 
the 
United 
States 
Internal Revenue Code, Section 501(c)(3),(4) or (6) and 
who has a normal work week of at least 20 hours and is 
not covered under a public or private plan for health 
insurance or other health benefit arrangement. 
Sec. C-33. 24-A MRSA §4346, sub-§l, ~G, as enacted by PL 200L 
c. 708, §3, is amended to read: 
G. 
"Small employer" means an eligible group as defined in 
section 68g8-g 2808-C, subsection 1 ~, paragraph g 
~. 
Sec. C-34. 24-A MRSA §6603, sub-§l, ~H, as amended by PL 2001, 
c. 410, Pt. A, §9, is further amended to read: 
H. 
May issue only health care benefit plans that comply 
with the requirements of section 68g8-g 2808-C with regard 
to 
rating 
practices, 
coverage 
for 
late 
enrollees 
and 
guaranteed renewal. 
An arrangement may not provide health 
care benefits that do not meet or exceed the requirements 
for mandated benefits applicable to comparable insured plans. 
Sec. C-35. Study of reinsurance. 
The 
Comprehens i ve 
Health 
Insurance Risk Pool Association established pursuant to the Maine 
Revised Statutes, Title 24-A,' section 3904 shall conduct a study 
of the possibility of offering a reinsurance pool for the small 
group medical insurance market in order to spread the cost of 
high-risk 
individuals 
for 
the 
small 
group 
medical 
insurance 
market. 
The study must address the costs, potential funding 
mechanisms 
and 
effectiveness 
of 
a 
reinsurance 
pool. 
The 
association may address any other issues regarding a reinsurance 
pool 
that it determines 
are 
relevant 
in 
the 
study. 
The 
association 
shall 
submit its 
report 
to 
the 
joint 
standing 
committee 
of the Legislature having jurisdiction over health 
insurance matters by March 1, 2008. 
Sec. C-36. 
Application for 
Insurance shall apply for all 
purpose of operating a high-risk 
funds. 
The 
Superintendent 
available federal funds for 
health insurance pool. 
SENATE AMENDMENT 
of 
the 
SENATE AMENDMENT 'J~" to COMMITTEE AMENDMENT' BIf to H.P. 706, L.D. 
1021 
Sec. C-37. Department of Professional and Financial Regulation, 
Bureau of Insurance review of health insurance rate and form filing 
requirements. 
The 
Department 
of 
Professional 
and 
Financial 
Regulation, Bureau of Insurance shall review the State's health 
insurance 
rate 
and 
form 
filing 
requirements 
and 
make 
recommendations for changes in the requirements to reduce the 
costs and 
resources 
expended 
for 
insurers 
seeking regulatory 
approval of new health insurance products. 
In its review, the 
bureau 
shall 
identify 
the 
typical 
costs 
and 
resources 
for 
insurers seeking regulatory approval for 
new health insurance 
products in this State and, to the extent possible, compare those 
to the costs and resources for the regulatory approval of new 
health insurance products in other states. 
The bureau shall 
submit a report with its review and recommendations to the joint 
standing committee of the Legislature having jurisdiction over 
insurance and financial services matters by January 15, 2007. 
In 
its report, the bureau shall include draft legislation to move 
the State to a file-and-use standard for health insurance rate 
and 
form 
filings. 
The 
joint 
standing 
committee 
of 
the 
Legislature 
having 
jurisdiction over 
insurance 
and 
financial 
services matters shall submit a bill to the First Regular Session 
of the l23rd Legislature based on the recommendations from the 
bureau's report. 
Sec. 
C-38. 
Appropriations 
and 
allocations. 
The 
following 
appropriations and allocations are made. 
PROFESSIONAL AND FINANCIAL REGULATION, 
DEPARTMENT OF 
Bureau of Insurance 
0092 
Initiative: 
Allocates funds for contracting 
grant application to secure federal funds 
operating a high-risk health insurance pool. 
the preparation of a 
for the purpose of 
OTHER SPECIAL REVENUE FUNDS 
All Other 
2005-06 
$0 
2006-07 
$15,000 
OTHER SPECIAL REVENUE FUNDS TOTAL 
$0 
$15,000 
Sec. C-39. Effective date. 
Those sections of this Part that 
repeal the Maine Revised Statutes, Title 24-A, section 2736-C, 
subsection 3, paragraphs A and C and amend Title 24-A, section 
2848, subsection 1-B, paragraph A and section 2849-B, subsection 
2, paragraph A take effect January 1, 2008. 
Those sections of 
this Part that amend Title 24-A, section 2736-C, subsection 2, 
paragraphs B to D and section 2736-C, subsection 9 and enact 
Title 
24-A, 
section 
2736-C, 
subsection 
2, 
paragraph 
G 
SENATE AMENDMENT 
SENATE AMENDMENT .. ~. to COMMITTEE AMENDMENT"g"tO H.P. 706, L.D. 
1021 
and section 2736-C, subsection 3, paragraph E take effect January 
1,2008. 
Sec. C-40. Effective date. 
Those sections of this Part that 
amend the Maine Revised Statutes, Title 24, sections 23l7-B and 
2327 and Title 24-A, sections 2803-A, 
2804, 2805, 2805-A, 2806, 
2807-A, 
2850-B, 4202-A, 4207, 4210, 4212, 4222-B, 4346 and 6603 
take effect January 1, 
2009. 
That section of this Part that 
repeals Title 24-A, section 2808-B takes effect January 1, 2009. 
That section of this Part that enacts Title 24-A, section 2808-C 
takes effect January 1, 2009.' • 
Further amend 
any 
nonconsecutive 
consecutively. 
the amendment 
Part 
letter 
by 
or 
relettering or renumbering 
section 
number 
to 
read 
SUMMARY 
This amendment increases the state subsidy from 45<).0 to 60 90. 
The amendment also requires the Department of Professional 
and 
Financial 
Regulation, 
Bureau 
of 
Insurance 
to 
apply 
for 
federal 
funds 
that 
Congress 
is 
offering 
states 
to 
create 
high-r isk 
insurance 
pools. 
It 
repeals 
the 
requirement 
of 
guaranteed issue for individual health insurance and enacts the 
Comprehensi ve Health Insurance Risk Pool Association Act. 
The 
amendment also creates a 
study of 
a 
reinsurance pool for the 
small group market. 
SPONSORED BY: 
(Senator COUR 
COUNTY: 
York 
FISCAL :\OTL lH:tJLlaE.D 
(See attllched) 
SENATE AMENDMENT 
Approved: 04112/06 hac:.. 
LD 1021 
LR 0263(09) 
An Act To Implement Task Force Recommendations Relating to Parity and Portability of Benefits for 
Law Enforcement Officers and Firefighters 
Fiscal Note for Senate Amendment ,5" to Committee Amendment"~" 
Sponsor: Sen. Courtney 
Net Cost (Savings) 
General Fund 
Appropriations/Allocations 
General Fund 
Other Special Revenue Funds 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
2005-06 
2006-07 
$0 
$0 
$15,000 
Projections 
2007-08 
$998,154 
$998,154 
$0 
Projections 
2008-09 
$1,097,970 
$1,097,970 
$0 
The amounts above are the incremental differences between the committee amendment and this amendment. The 
amendment changes the State's health insurance subsidy from 45% to 60%, thereby increasing the 2008-2009 General 
Fund costs of the subsidy. The amendment also adds a FY 2006-07 Other Special Revenue Funds allocation of 
$15,000 for additional requirements for the Bureau of Insurance in the Department of Professional and Financial 
Regulation related to high-risk health insurance pools. 
Total Estimated Subsidy 
Estimated Administrative Costs 
Total Estimated Costs 
Funding Summary - as Amended 
Estimated Collections from 1.5% Assessment 
General Fund Subsidy Net of Assessments 
LR0263(9) - Fiscal Note - Page 1 of 1 
Projections 
2007-08 
$5,532,893 
$109,392 
$5,642,285 
($1,230,876) 
$4,4] 1,409 
Projections 
2008-09 
$6,086,182 
$111,894 
$6,198,076 
($],289,958) 
$4,908,] 18