An Act To Continue Maine's Leadership in Covering the Uninsured
Maine Legislature, Session 123, LD 2247
Committee Amendment CA_A-HA_A_H1012 (House)
Amends: 24-A MRSA §405, 24-A MRSA §405-A, 24-A MRSA §405-B

HOUSE AMENDMENT" J to COMMITTEE AMENDMENT "A" to H.P. 1608, 
L.D. 2247, Bill, "An Act To Continue Maine's Leadership in Covering the Uninsured" 
Amend the amendment by inserting after Part F the following: 
'Amend the bill by inserting after Part G the following: 
'PARTH 
Sec. H-l. 24-A MRSA §405, sub-§7 is enacted to read: 
7. 
Transactions pursuant to an individual health plan as defined in section 2736-C 
or a small group health plan as defined in section 2808-B covering residents of this State 
written by a regional insurer or health maintenance organization duly authorized or 
qualified to transact such insurance in the state or country of its domicile if the 
superintendent certifies that the regional insurer or health maintenance organization meets 
the requirements of section 405-A. 
Sec. H-2. 24-A MRSA §405-A is enacted to read: 
§405-A. Certification of regional insurers or health maintenance organizations to 
transact individual and small group health insurance 
To qualify under this section and section 405, subsection 7, a regional insurer or 
health maintenance organization, as described in this section, may not transact individual 
or small group health insurance in this State by mail, the Internet or otherwise unless the 
superintendent has issued a certification that the requirements of this section have been 
met. The superintendent shall issue a certification or deny certification within 30 days of 
a request. A regional insurer or health maintenance organization shall meet the following 
requirements. 
1. Regional insurer; authority to transact individual or group health insurance 
in certain states. As used in this section, "regional insurer or health maintenance 
organization" means an insurer or health maintenance organization that is domiciled in 
and holds a valid certificate of authority to transact individual or group health insurance 
in one of the following states or jurisdictions: Connecticut, Massachusetts, New 
HOUSE AMENDMENT 
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HOUSE AMENDMENT '.ff" to COMMITTEE AMENDMENT "A" to H.P. 1608, L.D. 2247 
Hampshire, Rhode Island, Vermont, Delaware, Maryland, New Jersey, New York, 
Pennsylvania or the District of Columbia. 
2. Compliance with laws of state. Any policy, contract or certificate of individual 
or group health insurance offered for sale in this State by a regional insurer or health 
maintenance organization must comply with the applicable individual and group health 
insurance laws in the state of its domicile and the policy must be actively marketed in that 
state. 
3. 
Minimum surplus and reserve levels. 
The regional insurer or health 
maintenance organization shall maintain minimum capital and surplus requirements and 
maintain reserves as required by section 410; sections 901 to 984; section 4204, 
subsection 2-A, paragraph D; and section 4204-A as applicable. 
4. 
Disclosure and reporting. 
The regional insurer or health maintenance 
organization shall meet the requirements of section 4302 for reporting plan information 
with respect to individual health plans or small group health plans offered for sale in this 
State and disclose to prospective enrollees how the health plans differ from individual 
and small group health plans offered by domestic insurers in a format approved by the 
superintendent within 90 days of the effective date of this section. Health plan policies 
and applications for coverage must contain the following disclosure statement or a 
substantially similar statement: "This policy is issued by a regional insurer or health 
maintenance organization and is governed by the laws and regulations of [state of 
regional insurer or health maintenance organization's state of domicile]. This policy may 
not be subject to all the insurance laws and rules of the State of Maine, including 
coverage of certain health care services or benefits mandated by Maine law. Before 
purchasing this policy, you should carefully review the terms and conditions of coverage 
under this policy, including any exclusions or limitations of coverage. II 
5. Grievance procedures. The regional insurer or health maintenance organization 
shall meet the requirements of section 4303, subsection 4 for grievance procedures with 
respect to health plans offered for sale in this State. 
6. Unfair trade practices. The provisions of chapter 23 apply to the regional 
insurer or health maintenance organization permitted to transact health insurance under 
this section or section 405. 
7. Taxes; assessments. The regional insurer or health maintenance organization is 
subject to applicable taxes or assessments imposed on insurers transacting individual and 
small group health insurance in this State pursuant to this Title and Title 36. 
8. Service of process. The regional insurer or health maintenance organization shall 
designate an agent for receiving service of legal documents and process in the manner 
provided in this Title. 
9. 
Compliance with court orders. The regional insurer or health maintenance 
organization shall comply with lawful orders from courts of competent jurisdiction issued 
on a voluntary dissolution proceeding or in response to a petition for an injunction by the 
superintendent asserting that the regional insurer or health maintenance organization is in 
a hazardous financial condition. 
HOUSE AMENDMENT 
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HOUSE AMENDMENT .if:. to COMMITTEE AMENDMENT "A" to H.P. 1608, L.D. 2247 
10. 
Participation in guaranty association. 
The regional insurer or health 
maintenance organization shall participate in an insurance insolvency guaranty 
association to which a domestic insurer or health maintenance organization that transacts 
individual and small group health insurance is required to belong in accordance with this 
Title. The regional insurer is considered a member insurer as defined in section 4605-A 
for purposes of participation in the Maine Life and Health Guaranty Association. 
Except as expressly provided in this section, the requirements of this Title do not 
apply to a regional insurer or health maintenance organization permitted to transact health 
insurance under this section or section 405. 
Sec. H-3. 24-A MRSA §405-B is enacted to read: 
§405-B. Domestic insurers; individual and small group health insurance approved 
in other states 
Notwithstanding any other provision of this Title except as expressly provided, a 
domestic insurer or health maintenance organization may offer for sale in this State an 
individual health plan as defined in section 2736-C or small group health plan as defined 
in section 2808-B duly authorized for sale in another state by a parent or subsidiary of the 
domestic insurer if the following requirements are met. 
1. Certificate of authority from state of domicile. The parent or subsidiary of the 
domestic insurer or health maintenance organization must be domiciled in and hold a 
valid certificate of authority to transact individual health insurance in one the following 
states or jurisdictions: 
Connecticut, Massachusetts, New Hampshire, Rhode Island, 
Vermont, Delaware, Maryland, New Jersey, New York, Pennsylvania or the District of 
Columbia. 
2. Compliance with laws of state of domicile. Any policy, contract or certificate of 
individual or small group health insurance offered for sale in this State by a domestic 
insurer or health maintenance organization must comply with the applicable individual 
and group health insurance laws in the state of domicile of the parent or subsidiary and 
the policy must be actively marketed in that state. 
3. 
Disclosure and reporting. The domestic insurer or health maintenance 
organization shall meet the requirements of section 4302 for reporting plan information 
with respect to individual and small group health plans offered for sale in this State and 
disclose to prospective enrollees how the individual and small group health plans of the 
parent or subsidiary differ from individual and small group health plans offered by 
domestic insurers in a format approved by the superintendent within 90 days of the 
effective date of this section. Health plan policies and applications for coverage must 
contain the following disclosure statement or a substantially similar statement: "This 
policy is issued by a domestic insurer or health maintenance organization but is governed 
by the laws and rules of [state of domicile of parent or subsidiary of domestic insurer], 
which is the state of domicile of the parent or subsidiary of the domestic insurer or health 
maintenance organization. This policy may not be subject to all the insurance laws and 
rules of the State of Maine, including coverage of certain health care services or benefits 
mandated by Maine law. Before purchasing this policy, you should carefully review the 
terms and conditions of coverage under this policy, including any exclusions or 
limitations of coverage." 
HOUSE AMENDMENT 
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HOUSE AMENDMENT .. fl, to COMMITTEE AMENDMENT "A" to H.P. 1608, L.D. 2247 
4. Grievance procedures. The domestic insurer or health maintenance organization 
shall meet the requirements of section 4303, subsection 4 for grievance procedures with 
respect to health plans offered for sale in this State. 
Sec. H-4. Effective date. This Part takes effect January 1,2009.' ' 
SUMMARY 
This amendment permits out -of-state health insurers, which are referred to as regional 
insurers in the amendment, to offer their individual or group health plans for sale in this 
State if certain requirements of Maine law are met, including minimum capital and 
surplus and reserve, disclosure and reporting and grievance procedures. The amendment 
defines the out-of-state health insurers as those insurers authorized to transact individual 
or small group health insurance in one of the following states or jurisdictions: 
Connecticut, Massachusetts, New Hampshire, Rhode Island, Vermont, Delaware, 
Maryland, New Jersey, New York, Pennsylvania or the District of Columbia. 
It also 
permits Maine health insurers to offer individual health plans of out-of-state parent or 
subsidiary health insurers if similar requirements are met. If out-of-state health plans are 
offered for sale in this State, the amendment requires that prospective enrollees be 
provided adequate disclosure of how the plans differ from Maine health plans in a format 
approved by the Superintendent oflnsurance. . 
SPONSORED BY: 
/id 112h-
(Representative W ALdR) 
TOWN: Lincolnville 
FISCAL XOTE REQr) lU:U 
(Seea!!ached) 
HOUSE AMENDMENT 
Approved: 04/15/08 MaC! 
LD 2247 
LR 3143(15) 
An Act To Continue Maine's Leadership in Covering the Uninsured 
Fiscal Note for House Amendment ".(I., to Committee Amendment "A" 
Sponsor: Rep. Walker of Lincolnville 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - Other Special Revenue Funds 
Fiscal Detail and Notes 
Any additional costs to the Bureau of Insurance in the Department of Professional and Financial Regulation can be 
absorbed by the bureau utilizing existing budget resources. 
LR3143(15) - Fiscal Note - Page 1 of 1