An Act To Return Affordable Health Insurance to the State
Maine Legislature, Session 123, LD 0912
Committee: Insurance and Financial Services
Sponsors: WALKER, BOWMAN, AUSTIN, FITTS, LEWIN, VAUGHAN, MARRACI-IE, RAYE, SULLIVAN
Amends: 24-A MRSA §2736-C, 24-A MRSA §2, 24-A MRSA §2849-B, 2 MRSA §6, 5 MRSA §286-M, 5 MRSA §934-B, 5 MRSA §1667-B, 5 MRSA §12004-G, 5 MRSA §12004-I, 22 MRSA §32, 22 MRSA §3174-V, 22 MRSA §3174-D, 24-A MRSA §1952, 24-A MRSA §2736, 24-A MRSA §2736-A, 24-A MRSA §2839

Legislative Document 
No. 912 
H.P.687 
House of Representati ves, March 1, 2007 
An Act To Return Affordable Health Insurance to the State 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
Presented by Representative WALKER of Lincolnville. 
Cosponsored by Senator BOWMAN of York and 
17/~ 
1J7.11k~ 
MILLICENT M. MacFARLAND 
Clerk 
Representatives: AUSTIN of Gray, FITTS of Pittsfield, LEWIN of Eliot, VAUGHAN of 
Durham, Senators: MARRACI-IE of Kennebec, RAYE of Washington, SULLIVAN of York. 
Printed on recycled paper 
Be if enacted by the People of the State of Maine- a'S follows: 
PART A 
Sec. A-I. 24-A MRSA §2736-C, sub-§l,~, as enacted by PL 1993, c. 477, Pt. 
C, § I and affected by Pt. F, § 1, is repealed. 
Sec. A-2. 24-A MRSA §2736-C, sub-§2, as amended by PL 2003, c. 469, Pt. E, 
§ 12, is repealed. 
Sec. A-3. 24-A MRSA §2736-C, sub-§3, ~A, as corrected by RR 2001, c. I, 
§30, is repealed. 
Sec. A-4. 24-A MRSA §2736-C, sub-§3, ~C, as enacted by PL 1993, c. 477, Pt. 
C, § 1 and affected by Pt. F, § 1, is repealed. 
Sec. A-S. 24-A MRSA §2736-C, sub-§3, ~, as enacted by PL 1999, c. 256, Pt. 
D, § 1, is amended to read: 
D. 
NotwithstaHdiHg paragraph A, carriers Carriers offering supplemental coverage 
for the Civilian Health and Medical Program for the Uniformed Services, 
CHAMPUS, are not required to issue this coverage ifthe applicant for insurance does 
not have CHAMPUS coverage. 
Sec. A-6. 24-A MRSA §2736-C, sub-§6, ~, as enacted by PL 1993, c. 477, Pt. 
C, §1 and affected by Pt. F, §1, is repealed. 
Sec. A-7. 24-A MRSA §2736-C, sub-§6, ~C, as enacted by PL 1993, c. 477, Pt. 
C, § 1 and affected by Pt. F, § 1, is amended to read: 
C. 
A carrier may Hot directly or iHdirectly eHter iHto aHY cOHtract, agreement or 
arrangemeHt with a represeHtative of the carrier that provides for or results in the 
compensation paid to the represeHtative for the sale of aH iHdividual health plan to be 
varied because of the ratiHg factors listed in subsection 2. A carrier may enter into a 
compensation arrangement that provides compensation to a representative of the 
carrier on the basis of percentage of premium, provided that the percentage does not 
vary because of the ratiHg factors listed in subsectioH 2. 
Sec. A-S. 24-A MRSA §2736-C, sub-§6,~, as enacted by PL 1993, c. 477, Pt. 
C, § 1 and affected by Pt. F, § 1, is repealed. 
Sec. A-9. 24-A MRSA §2736-C, sub-§9, as enacted by PL 1995, c. 570, §7, is 
amended to read: 
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 subsectioH 3, paragraph A; subsection 6, paragraph A"i- and subsection 8 
if: 
Page I - 123LR0587(Ol)-1 
.. 
" 
II 
"7 
j, 
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 'Nith the premium rate requiremeFlts of 
subsectioFl 2 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, as defined in subsection 5, is at least 75%; 
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. A-IO. 24-A MRSA §2S0S-B, sub-§l,~, as enacted by PL 1991, c. 861, 
§2, is repealed. 
Sec. A-It. 24-A MRSA §2S0S-B, sub-§2, as amended by PL 2003, c. 469, Pt. 
E, §§14 and 15, is repealed. 
Sec. A-12. 24-A MRSA §2S0S-B, sub-§2-B, ~, as enacted by PL 2003, c. 
469, Pt. E, § 16, is repealed. 
Sec. A-l3. 24-A MRSA §2S0S-B, sub-§4, as corrected by RR 2001, c. 1. §32, is 
amended to read: 
4. Guaranteed renewal. Carriers providing small group health plans must meet the 
following requirements on issuance aFld 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 participatioFl 
requirements, 'which may FlOt exceed 75%, to all eligible employees and their 
ElependeFlts in those groups. In determtning compltance with miFlimum participation 
feEj'LttfCments, eligible employees aFld their dependents ''lho have existiFlg health care 
coverage may Flot be c'BFISidered iFl the calculation. If an employee declines coverage 
because the employee has other coverage, aFl)' depeFldeFlts of that employee who are 
not eligible under the employee's other coverage are eligible for coverage under the 
srnatl- group health plan. A carrier may deFly coverage under a managed care plaFl, as 
defined by sectioFl 430 I A: 
(1) To employers \",'ho ha·ve no employees who live, reside or work 'Nithin the 
approved service area ofthe plarr,--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 adequately to 
additional enrollees within 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 area subject to denial of coverage, or 
groups or subgroups within that area for a period of 180 days after the date of 
the first denial of coverage. 
B. Renewal is guaranteed under section 2850-B. 
Sec. A-14. 24-A MRSA §2S0S-B, sub-§6,~, as enacted by PL 1991, c. 861, 
§2, is repealed. 
Sec. A-IS. 24-A MRSA §2S0S-B, sub-§6, ,C, as enacted by PL 1991, c. 861, 
§2, is amended to read: 
C. 
A carrier may not directly or indirectly enter into any contract, agreement or 
arrangement with a representative of the carrier that provides for or results in the 
compensation paid to the representative for the sale of a small group health plan to be 
varied because of the rating factors listed in subsection 2. A carrier may enter into a 
compensation arrangement that provides compensation to a representative of the 
carrier on the basis of percentage of premium, provided that the percentage does not 
vary because of the rating factors listed in subsection 2. 
Sec. A-16. 24-A MRSA §2S0S-B, sub-§6, ~, as enacted by PL 1991, c. 861, 
§2, is repealed. 
Sec. A-17. 24-A MRSA §2S4S, sub-§I-B, ,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 "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 Medical Program for the Uniformed Services, 
CHAMPUS, 10 United States Code, Chapter 55; 
(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, 5 United States Code, Chapter 89; 
(9) A public health plan as defined in federal regulations authorized by the 
federal Public Health Service Act, Section 2701(c)(l)(l), as amended by Public 
8 
Law 104-191; 6f 
(10) A health benefit plan under Section 5( e) of the Peace Corps Act, 22 United 
States Code, Section 2504(e}.-~ 
(11) 
The plan. offered by the Comprehensive Health Insurance Risk Pool 
Association pursuant to chapter 54. 
Sec. A-18. 24-A MRSA §2849-B, sub-§2, ~A, as amended by PL 2001, c. 258, 
Pt. E, §7, is further amended to read: 
A. 
That person was covered under an indiyidl:lal or ~ group contract or policy issued 
by any nonprofit hospital or medical service organization, insurer, 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 I-B, paragraph A, subparagraphs (3) to fl-Qj .olJ For purposes of this 
section, the individual or group policy under which the person is seeking coverage is 
the "succeeding policy." 
The group or ifldiyidl:lal contract or policy, uninsured 
employee benefit plan or governmental program that previously covered the person is 
the "prior contract or policy"; and 
Sec. A-19. 24-A MRSA c. 54 is enacted to read: 
CHAPTER 54 
COMPREHENSIVE HEALTH INSURANCE RISK POOL ASSOCIATION 
§3901. Short title 
This chapter may be known and cited as "the Comprehensive Health Insurance Risk 
Pool Association Act." 
§3902. 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 3903. 
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 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. 
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; or 
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 of2002. 
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 
lli!1Jng or processing medical insurance claims for a resident. 
§3903. Comprehensive Health Insurance Risk Pool Association 
1. 
Risk pool established. 
The Comprehensive Health Insurance Risk Pool 
Association is established as a nonprofit legal entity. As a condition of doing busin~ 
every insurer that has sold medical insurance within the previous 12 months or is actively 
marketinKiJ medical insurance policy in this State shall participate in the association. 
2. Board of directors. The association IS governed by a board of directors III 
accordance with the following. 
A. The board consists of 11 members as follows. 
(1) Six members appointed by the superintendent: 
(a) Two members must be chosen from the general public and may not be 
associated with the medical profession, a hospital or an insurer; 
(b) Two members must represent medical providers; 
(c) One member must represent 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. 
B. 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 suitable articles and bylaws within 90 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. 
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. 
§3904. 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. 
P:!ge '7 - !23LR0587(O!H 
II 
§3905. 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 3906; 
D. Collect assessments as provided in section 3907. The level of payments must be 
established bv 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 mav not exceed $500 per 
insurer for all such assessments. Assessments are due and lli!)1tble within 30 days of 
receipt of the assessment notice by the insurer; 
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. Powers. 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 prOVISIOns and 
purposes of this chapter, including the authority, with the approval of the 
~erintendent, to enter into contracts with similar organizations in other statcj for 
the joint performance of common administrative functions or with persons QLpther 
organizations far the performance of administrative functjo~ 
~._5j!e or be sued, including takin-8..1!ny legal a~tions necessa!YQLP[9J~~L to_xccaver 
QX co!J~ct a~sessments dut;Cthe as§ociatiol!~ 
Q: __ Iake3n}:'L~al actionj necessary to av(]jil~~<!YJl1ellU)f impro~r claims against 
tJ1S;.J1,'isociati()n_9l:the_~~~r:~t;:.J2IQyjded bv_oLthI.:ou£-hthe a~socj~tion, to recover ai'll. 
.i!J1!ol![H!LelTQl_leO_l!~Y_Qr improperly paidJJ."Lxhe associatiQIh~!:.eCO\~r any aIDQunts 
p_,ticLbi'_Jhe _ assoc iatiQn __ i1_~J!.Jesu ItQLillj_~r1!\(~.-0iJacL.9L _t~~Y __ QL to recover ~ther 
amounts due the associ'Hi.Q!h 
F 
ut:_~J~blish __ ~Jem_~~D(ldify from time to time aSiillPLopria!'~~<!J~s, rat~ 
~c:hedJ,!l~!,ate adjl~~!.ment~expense allowances,--12roducers' referral f~es~laim 
re5~-~~_ forJ1}l!l~~_<!!lQjlllY_QJh~L ~I::tuarial [unctiQD_?1;propriEli;:~9~LQ~x'!!L()t:LO[ lh~ 
~~Q£iaJi91LiD3CCorda~~ \vitlLsection 32(22.; 
F. Issue policies of insurance in accordance with the requirements ofthis chapter; 
G. Appoint appropriate legal, actuarial and other committees 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; 
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, use, contract or otherwise arrange for the delivery of high-quality and 
cost-effective health care services, including establishing or contracting with 
preferred provider organizations, health maintenance organizations and limited 
network provider arrangements for the management of chronic diseases and high-risk 
conditions; 
O. Apply for funds or grants from public or private sources, including federal grants 
provided to qualified high-risk pools; and 
P. 
Develop a subsidy program for low-income individuals who receive coverage 
under the plan. 
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 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 operations 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 support the enrollment of additional persons and that 
the cap of assessments in section 3907 is too low to support the enrollment of additional 
I 
.. 
II 
IS 
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. 
§3906. Selection of plan administrator 
1. Selection of plan administrator. The board shall select an insurer or 3rd-party 
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's or the 3rd-party administrator'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 plan administrator selected pursuant to 
subsection I is contracted for a period of 3 years. At least one year prior to the expiration 
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 administrator. 
The plan administrator selected pursuant to 
subsection I 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 45 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 
frequency, 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 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 
the 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. 
§3907. 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 no later 
than 30 days after receipt of written notice by member insurers and accrue interest at 12% 
per annum on and after the due date. 
2. Maximum assessment. The board shall assess each insurer an amount not to 
exceed $2 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, 2008. 
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 in 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 reinsurer or primary excess or stop loss insurer for the 
purpose of determining its assessment under this section. 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 ifthe 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 pav 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 
I 
addition, the superintendent may use any power granted to the superintendent by this 
Title to collect any unpaid assessment. 
§3908. Availability of coverage 
The association shall offer a choice of 2 or more coverage options through the plan. 
The requirements ofthis plan become effective January 1, 2008. Policies offered through 
the association must be available for sale beginning on July 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. 
§3909. Requirements 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 ofthe previous coverage. 
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 into 
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 requirements 
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 
I I 
the association, subject to approval by the superintendent, using reasonable actuarial 
techniques 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% to a maximum of 150% of the weighted average of rates charged 
by those insurers and health maintenance organizations with individuals enrolled in 
similar medical insurance plans. 
4. Compliance with state law. Products offered by the association must comply 
with all relevant requirements of this Title applicable to individual health insurance 
policies, including requirements 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 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 
I 
recoverable under this subsection. 
§3910. Eligibility for coverage 
1. Eligibility; application for coverage. A resident i~ ~!igi.ble to~_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 6 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 
II 
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 anv 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. Eligibility without application. The board shall develop a list of medical or 
health conditions for which a person is eligible for plan coverage without applying for 
health insurance under subsection I. A person who can demonstrate the 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: 
(I) 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 12 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 Of resident of a public institution; or 
pr;ge 14·· !23LR(J58i(Ol)-l 
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 ofthe policy; or 
D. At the option of the association, 30 days after the association makes any inquiry 
concerning the person's eligibility or place of residence to which the person does not 
~ 
The coverage of any person who ceases 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 apply 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. 
§3911. 
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 mav not be the basis of anv legal 
action or criminal or civil liability or penalty against the association or any member 
\11 surer. 
§3912. Reimbursement of carriers 
1. Reimbursement. A carrier may seek reimbursement from the assllciation and the 
association shall reimburse the carrier to the extent claims made bv a member aftcx 
January I, 2008 exceed premiums paid on a calen_(t~yeaL12asisJ~y-.1h~ melllbeL19-.Jhe 
carrier for a carrier who meets the following criteria: 
A. The carrier sold an individual health plan tothe member betwe~n December 1, 
1993 and January 1, 2008, and the policy that was sold ha~ __ Q~J;.n cQ!ltinuou~h 
renewed by the member; 
B. The carrier is able to determine through the use o[jI}~i.Yidual h.~1!.Lth statemenl~, 
claims historY or any reasonable means that at anv tim~ while the policy was in 
effect, the member was diagnosed with one of the following_JJl.(;'9ical_s;orgijtions: 
acquired 
immune 
deficiency 
syndrome, ----'!!!gina 
pectoUh_3scites, 
chemical 
dependency cirrhosis of the liver, coronary occllJ.siot!L~vstjc_ fibl:osis,.J~I!~_9Jeich's 
ataxia, hemophilia. Hodgkin's diseasuiunting1on's 
chor:.e~iu~nil~ __ ~!.i3betc;i, 
leukemia, metastatic cancer, motor or sensory aphasia, multiple sclerosis, muscular 
g~{~!roJ2hhmyasthenia gravis, myotonia, heart di§~ase J:~qJlj[i!!g...91~l!:.-ht;:~rullS~J}" 
Parkinson's disease, polycystic kidney 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 l, 2009. 
2. Rules. The superintendent may adopt 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. A-20. 
Comprehensive Health Insurance Risk Pool Association; 
II 
staggered terms for board of directors. 
Notwithstanding the Main~ Revised 
Statutes, Title 24-A, section 6903, the terms for initial appointments to the board of 
directors of the Comprehensive Health Insurance Risk Pool Association are as follows. 
Of those members of the board appointed by the Superintendent of Insurance, 2 members 
IS 
serve for a term of one year, 2 members for a term of 2 years and 2 members for a term of 
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. 
Sec. A-21. Application for funds. The Superintendent of Insurance shall apply 
for all available federal funds for the purpose of operating a high-risk health insurance 
pool. 
Sec. A-22. Subsidy program. No later than January 1, 2009, the Comprehensive 
Health Insurance Risk Pool Association Board of Directors shall develop a subsidy 
program for low-income individuals who receive coverage under the plan as authorized 
under the Maine Revised Statutes, Title 24-A, section 3905, subsection 2, paragraph P. 
The association shall also determine whether the subsidy program could be expanded 
within the limitations of available funding to all low-income individuals who would 
otherwise not be eligible for coverage pursuant to Title 24-A, section 3910. 
The 
association shall submit a report on the subsidy program and any recommendations for 
expanding eligibility to the Joint Standing Committee on Insurance and Financial 
Services on or before February 15, 2008. The Joint Standing Committee on Insurance 
and Financial Services may summit any necessary legislation to the Second Regular 
Session of the 123rd Legislature to implement the subsidy program. 
Sec. A-23. Effective date. Those sections of this Part that repeal the Maine 
Revised Statutes, Title 24-A, section 2736-C, subsection 2; section 2736-C, subsection 3, 
paragraphs A and C; section 2808-B, subsection 2; and section 2808-B, subsection 4, 
paragraph A take effect January 1, 2010. Those sections of this Part that amend Title 
24-A, section 2848, subsection I-B, paragraph A and section 2849-B, subsection 2, 
paragraph A take effect January 1, 2010. 
P{lgc J6 - 123UW587{Ol)-1 
PARTB 
Sec. B-1. 2 MRSA §6, sub-§l, as repealed and replaced by PL 2005, c. 397, Pt. 
A, § I, is amended to read: 
1. Range 91. The salaries of the following state officials and employees are within 
salary range 91: 
Commissioner of Transportation; 
Commissioner of Conservation; 
Commissioner of Administrative and Financial Services; 
Commissioner of Education; 
Commissioner of Environmental Protection; 
I I 
Exeeutive Direetor of Dirigo Health; 
Commissioner of Public Safety; 
Commissioner of Professional and Financial Regulation; 
Commissioner of Labor; 
Commissioner of Agriculture, Food and Rural Resources; 
Commissioner of Inland Fisheries and Wildlife; 
Commissioner of Marine Resources; 
Commissioner of Corrections; 
Commissioner of Economic and Community Development; 
Commissioner of Defense, Veterans and Emergency Management; and 
Executive Director, Workers' Compensation Board. 
Sec. B-2. 2 MRS A §103, sub-§2, as amended by PL 2005, c. 369, §2, is further 
amended to read: 
2. Input. In developing the plan, the Govemor shall, at a minimum, review the 
process for the development of the plan with the joint standing committee of the 
Legislature having jurisdiction over health and human services matters and seek input 
from the Advisory Council on Health Systems Development, pursuant to section 104; the 
Maine Quality Forum and the Maine Quality Forum Advisory Council, pursuant to Title 
/\, chapter 87, subchapter 2; a statewide health performance council; and other 
agencies and organizations. 
I< 
Sec. B-3. 5 MRSA §286-M, sub-§l1, as enacted by PL 2005, c. 636, Pt. A, §3, is 
repealed. 
Sec. B-4. 5 MRSA §934-B, as enacted by PL 2003, c. 469, Pt. A, §2, is repealed. 
Sec. B-S. 5 MRSA §1667-B, first~, as amended by PL 2005, c. 386, Pt. 0, §2, is 
further amended to read: 
Allotments in Other Special Revenue funds accounts, internal service fund accounts 
and enterprise funds, except the State Lottery Fund aRd the Dirigo Health ERterprise 
FttOO, may exceed current year allocations and the unused balance of allocations 
authorized to carry forward by law under the following conditions, except that funds in 
Other Special Revenue funds accounts, internal service fund accounts and enterprise 
funds must be expended in accordance with the statutes that establish the accounts and for 
no other purpose: 
Sec. B-6. 5 MRSA §12004-G, sub-§14-D, as enacted by PL 2003, c. 469, Pt. A, 
I 
§3, is repealed. 
Sec. B-7. 5 MRSA §12004-I, sub-§30-A, as enacted by PL 2003, c. 469, Pt. A, 
§4, is repealed. 
Sec. B-S. 22 MRSA §32S, sub-§17-A, ~C, as corrected by RR 2003, c. 1, § 15, is 
amended to read: 
C. 
The addition in the private office of a health care practitioner, as defined in Title 
24, section 2502, subsection I-A, of new technology that costs $1,200,000 or more. 
The department shall consult with the MaiRe Quality Forum Advisory CouRcil 
established pursuaRt to Title 24 A, sectioR 6952, prior to determiniRg ,,,,,hether a 
project qualifies as a Rev,' techRology iR the office of a private practitioner. 
Beginning September 30, 2004 and annually thereafter, the threshold amount for 
review must be updated by the commissioner to reflect the change in the Consumer 
Price Index medical index, 
With regard to the private office of a health care 
practitioner, "new health service" does not include the location of a new practitioner 
in a geographic area. 
Sec. B-9. 22 MRS A §33S, sub-§l, ~, as enacted by PL 2003, c. 469, Pt. C, §8, 
is amended to read: 
D. 
Does not result in inappropriate increases in service utilization, accordiRg to the 
principles of evideRce based medicine adopted by the Maine Quality Forum, as 
established in Title 24 A, section 6951; and 
Sec. B-I0. 22 MRSA §3174-V, sub-§2, as amended by PL 2005, c. 400, Pt. C, 
§ I, is further amended to read: 
2. Contracted services. When a federally qualified health center otherwise meeting 
the requirements of subsection 1 contracts with a managed care plan or the Dirigo Health 
Program for the provision of MaineCare services, the department shall reimburse that 
center the difference between the payment received by the center from the managed care 
plan or the Dirigo Health Program and 100% of the reasonable cost, reduced by the total 
copayments for which members are responsible, incurred in providing services within the 
scope of service approved by the federal Health Resources and Services Administration 
or the commissioner. Any such managed care contract must provide payments for the 
services of a center that are. not less than the level and amount of payment that the 
managed care plan or the Dirigo Health Program would make for services provided by an 
entity not defined as a federally qualified health center. 
Sec. B-l1. 22 MRSA §3174-DD, as amended by PL 2005, c. 400, Pt. C, §2, is 
repealed. 
Sec. B-12. 22 MRSA §S70S-A, as enacted by PL 2003, c. 469, Pt. C, §28, is 
amended to read: 
§8708-A. Quality data 
The board shall adopt rules regarding the collection of quality data. The board shall 
work with the Maine Quality Forum and the Maine Quality Forum Advisory Council 
established in Title 24 A, chapter 87, subchapter 2 to develop the rules. The rules must be 
based on the quality measures adopted by the Maine Qualit)' Forum pursuant to Title 24 
A, section 6951, subsection 2. The rules must specify the content, form, med ium and 
frequency of quality data to be submitted to the organization. In the collection of quality 
data, the organization must minimize duplication of effort, minimize the burden on those 
required to provide data and focus on data that may be retrieved in electronic format from 
within a health care practitioner's office or health care facility. As specified by the rules, 
health care practitioners and health care facilities shall submit quality data to the 
organization. 
Rules adopted pursuant to this section are major substantive rules as 
defined in Title 5, chapter 375, subchapter 2-A. 
Sec. B-13. 22 MRSA §S712, suh-§I, as enacted by PL 2003, c. 469, Pt. C, §29, 
is amended to read: 
1. Quality. At a minimum, the organization, in conjunction ,<"lith the Maine Quality 
Forum, established in Title 24 A, section 6951, shall develop and produce annual quality 
reports. 
Sec. B-14. 24-A MRSA §1952, as amended by PL 2003, c. 469, Pt. E, §8, is 
further amended to read: 
§1952. Licensure 
A private purchasing alliance may not market, sell, offer or arrange for a package of 
one or more health benefit plans underwritten by one or more carriers without first being 
licensed by the superintendent. The superintendent shall specify by rule standards and 
procedures for the issuance and renewal of licenses for private purchasing alliances. A 
rule may require an application fee of not more than $400 and an annual license fee of not 
more than $100. A license may not be issued until the rulemaking required by this 
chapter has been undertaken and all required rules are in effect. 
Dirigo Health, as 
established in chapter 87, is exempt from the licensure requirements of this section as an 
independent executive agency of the State. 
Sec. B-15. 24-A MRSA §2736, suh-§3, ,0, as amended by PL 2003, c. 469, Pt. 
E, §9, is further amended to read: 
B. 
The insurer must demonstrate in accordance with generally accepted actuarial 
principles and practices consistently applied that, as of a date no more than 210 days 
prior to the filing, the ratios of benefits incurred to premiums earned for those 
products average no less than 80% for the previous I2-month period. 
For the 
purposes of this calculatioFl, aFt)' saviFlgs offset payments paid pursuant to section 
6913 must be treated as incurred claims. 
Sec. B-16. 24-A MRSA §2736, suh-§4, ~C, as amended by PL 2003, c. 469, Pt. 
E, § 1 0, is further amended to read: 
C. 
In any hearing conducted under this subsection, the Bureau of Insurance and any 
party asserting that the rates are excessive have the burden of establishing that the 
rates are excessive. The burden of proving that rates are adequate, and not unfairly 
discriminatory and in compliance with the requirements of section 6913 remains with 
the insurer. 
Sec. B-17. 24-A MRSA §2736-A, first ~, as amended by PL 2003, c. 469, Pt. E, 
§ 11, is further amended to read: 
If at any time the superintendent has reason to believe that a filing does not meet the 
requirements that rates not be excessive, inadequate, or unfairly discriminatory or not in 
compliance ·,."ith section 6913 or that the filing violates any of the provisions of chapter 
23, the superintendent shall cause a hearing to be held. 
Sec. B-1S. 24-A MRSA §2736-C, suh-§5, as amended by PL 2003, c. 469, Pt. 
E, § 13, is further amended to read: 
5. Loss ratios. For all policies and certificates issued on or after the effective date of 
this section, the superintendent shall disapprove any premium rates filed by any carrier, 
whether initial or revised, for an individual health policy unless it is anticipated that the 
aggregate benefits estimated to be paid under all the individual health policies maintained 
in force by the carrier for the period for which coverage is to be provided will return to 
policyholders at least 65% of the aggregate premiums collected for those policies, as 
determined in accordance with accepted actuarial principles and practices and on the 
basis of incurred claims experience and earned premiums. 
For the purposes of this 
calculation, any savings offset payments paid pursuant to section 6913 must be treated as 
I 
incurred claims. 
Sec. B-19. 24-A MRSA §2S0S-B, sub-§2-A, ~C, as enacted by PL 2003, c. 
469, Pt. E, § 16, is amended to read: 
C. 
Rates for small group health plans must be filed in accordance with this section 
and subsections 2-B and 2-C for premium rates effective on or after July 1, 2004, 
except that the filing of rates for small group health plans are not required to account 
for any savings offset payment or any recovery of that offset payment pursuant to 
subsection 2-B, paragraph D and section 6913 for rates effective before July 1,2005. 
Sec. B-20. 24-A MRSA §2S0S-B, suh-§2-B, ~A, as enacted by PL 2003, c. 469, 
Pt. E, § 16, is amended to read: 
Pag;;; 20 - 123LR0:587(Ol)-l 
A. 
The superintendent shall disapprove any premium rates filed by any carrier, 
whether initial or revised, for a small group health plan unless it is anticipated that the 
aggregate benefits estimated to be paid under all the small group health plans 
maintained in force by the carrier for the period for which coverage is to be provided 
will return to policyholders at least 75% of the aggregate premiums collected for 
those policies, as determined in accordance with accepted actuarial principles and 
practices and on the basis of incurred claims experience and earned premiums. Fef 
the purposes of this calculation, any sa't'ings offset payments paid pursuant to section 
6913 must be treated as incurred claims. 
Sec. B-21. 24-A MRSA §2S0S-B, sub-§2-B, ~C, as enacted by PL 2003, c. 469, 
II 
Pt. E, § 16, is amended to read: 
C. 
When a filing is not accompanied by the information upon which the carrier 
supports the filing or the superintendent does not have sufficient information to 
determine whether the filing meets the requirements that rates not be excessive, 
inadequate, or unfairly discriminatory or not in compliance ',>,Iith [;ection 6913, the 
superintendent shall require the carrier to furnish the information upon which it 
supports the filing. 
Sec. B-22. 24-A MRSA §2S0S-B, sub-§2-B,~, as enacted by PL 2003, c. 469, 
Pt. E, § 16, is amended to read: 
F. 
Any rate hearing conducted with respect to filings that meet the criteria \0 
paragraph E is subject to this paragraph. 
( 1) A person requesting a hearing shall provide the superintendent with a written 
statement detailing the circumstances that justity a hearing, notwithstanding the 
satisfaction of the criteria in paragraph E. 
(2) If the superintendent decides to hold a hearing, the superintendent shall issue 
a written statement detailing the circumstances that justify a hearing, 
notwithstanding the satisfaction of the criteria in paragraph E. 
(3) In any hearing conducted under this paragraph, the bureau and any party 
asserting that the rates are excessive have the burden of establishing that the rates 
are excessive. The burden of proving that rates are adequate, and not unfairly 
discriminatory and in compliance with the requirements of section 6913 remains 
with the carrier. 
Sec. B-23. 24-A MRSA §2S08-B, sub-§2-C, ~C, as enacted by PL 2003, c. 
469, Pt. E, § 16, is amended to read: 
C. 
If incurred claims were less than 78% of aggregate earned premiums over a 
continuous 36-month period, the carrier shall refund a percentage of the premium to 
the current in-force policyholder. 
For the purposes of calculating this loss ratio 
percentage, any savings offset payments paid pursuant to section 6913 must be 
treated as incurred claims. The excess premium is the amount of premium above that 
amount necessary to achieve a 78% loss ratio for all of the carrier's small group 
policies during the same 36-month period. 
The refund must be distributed to 
policyholders in an amount reasonably calculated to correspond to the aggregate 
I 
II 
.. 
experience of all policyholders holding policies having similar benefits. The total of 
all refunds must equal the excess premiums. 
(I) 
For determination of loss-ratio percentages in 2005, actual aggregate 
incurred claims expenses include expenses incurred in 2005 and projected 
expenses for 2006 and 2007. For determination of loss-ratio percentages in 2006, 
actual incurred claims expenses include expenses in 2005 and 2006 and projected 
expenses for 2007. 
(2) The superintendent may waive the requirement for refunds during the first 3 
years after the effective date of this subsection. 
Sec. 8-24. 24-A MRSA §2839-8, sub-§2, as enacted by PL 2003, c. 469, Pt. E, 
§ 17, is amended to read: 
2. 
Annual filing. 
Every carrier offering group health insurance specified in 
subsection I shall annually file with the superintendent on or before April 30th a 
certification signed by a member in good standing of the American Academy of 
Actuaries or a successor organization that the carrier's rating methods and practices are in 
accordance with generally accepted actuarial principles and with the applicable actuarial 
standards of practice as promulgated by an actuarial standards board. The filing must 
also certify that the carrier has included in its experience an)' savings offset payments or 
recovery of those savings offset payments consistent 'Nith section 6913. The filing also 
must state the number of policyholders, certificate holders and dependents, as of the close 
of the preceding calendar year, enrolled in large group health insurance plans offered by 
the carrier. A filing and supporting information are public records except as provided by 
Title 1, section 402, subsection 3. 
Sec. 8-25. 24-A MRSA c. 87, as amended, is repealed. 
Sec. 8-26. Effective date. This Part takes effect January I, 2009. 
SUMMARY 
Part A of this bill repeals the guaranteed issue and community rating laws for the 
individual and small group health insurance markets effective January I, 20 I O. The bill 
enacts the Comprehensive Health Insurance Risk Pool Association Act, which will 
operate as an alternative to guaranteed issuance laws in the individual health insurance 
market. 
The bill requires that the Comprehensive Health Insurance Risk Pool 
Association begin offering coverage for sale on July 1, 2008. The bill also requires the 
Department of Professional and Financial Regulation, Bureau of Insurance to apply for 
federal funds that Congress is offering to states to create high-risk insurance pools. 
Part B repeals the Dirigo Health Act effective January I, 2009. Part B also corrects 
cross-references.