An Act To Establish a Health Care Bill of Rights
Maine Legislature, Session 123, LD 1294
Committee: Insurance and Financial Services
Sponsors: TREAT, PERRY, BABBIDGE, BRAUTIGAM, CANAVAN, CROCKETI, PINGREE, PRATI, MARRACHE, NUTIING
Amends: 24-A MRSA §205-A, 24-A MRSA §2735-A, 24-A MRSA §2736, 24-A MRSA §2736-C, 24-A MRSA §2, 24-A MRSA §2808-B, 24-A MRSA §2839-A

Legislative Document 
No. 1294 
H.P.912 
House of Representatives, March 9, 2007 
An Act To Establish a Health Care Bill of Rights 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
Presented by Representative TREAT of Farmingdale. 
Cosponsored by Senator PERRY of Penobscot and 
Il/~ 
/J7.17l~ 
MILLICENT M. MacFARLAND 
Clerk 
Representatives: BABBIDGE of Kennebunk, BRAUTIGAM of Falmouth, CANAVAN of 
Waterville, CROCKETI of Augusta, PINGREE of North Haven, PRATI of Eddington, 
Senators: MARRACHE of Kennebec, NUTIING of Androscoggin. 
Primet.l on recyded paper 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1. 24-A MRSA §205-A is enacted to read: 
§205-A. Rate bearings 
1. Hearing officer. In any proceeding regarding an individual or small group rate 
filing, the bureau shall contract for the services of an independent hearing officer to 
oversee the proceeding and may not utilize the services of existing bureau staff. An 
independent hearing officer must be an attorney in good standing licensed to practice law 
in this State. The insurer, nonprofit hospital and medical service organization, nonprofit 
health care service organization or health maintenance organization making the rate filing 
shall pay the cost of the hearing officer. 
The hearing officer shall make a recommended decision to the superintendent after the 
hearing. The superintendent shall issue a final decision in the matter but may not 
substitute the judgment of the superintendent for the judgment of the hearing officer on 
matters of fact-finding. The superintendent may: 
A. Affirm the decision of the hearing officer; 
B. Remand the matter for further proceedings, findings of fact or conclusions of law; 
or 
C. Reverse or modify the decision of the hearing officer, but only if the conclusions 
of law in the decision are arbitrary, capricious or not supported by substantial 
evidence on the record. 
2. Advocacy panel. In any proceeding regarding an individual or small group rate 
filing, the bureau shall impanel an advocacy panel to represent the interests of consumers 
and the public. The bureau may contract for the services of an advocacy panel if existing 
staff resources are not adequate to represent the interests of consumers and the public. 
The insurer, nonprofit hospital and medical service organization, nonprofit health care 
service organization or health maintenance organization making the rate filing shall pay 
the cost of participation of the advocacy panel. 
3. Rules. The bureau, after notice and hearing, may adopt rules to implement this 
section. Rules adopted pursuant to this subsection are routine technical rules as defined in 
Title 5, chapter 375, subchapter 2-A. 
Sec. 2. 24-A MRSA §2735-A, sub-§ 1, as enacted by PL 2001, c. 432, §4, is 
amended to read: 
1. Notice of rate filing or rate increase on existing policies. An insurer offering 
individual health plans as defined in section 2736-C must provide written notice by first 
class mail of a rate filing to all affected policyholders at least @ 90 days before the 
effective date of any proposed increase in premium rates or any proposed rating formula, 
classification of risks or modification of any formula or classification of risks. The notice 
must also inform policyholders of their right to request a hearing pursuant to section 229 
or a special rate hearing pursuant to section 2736, subsection 4 or Title 24, section 2321, 
Page I -123LR195S(OIH 
subsection 5. The notice must show the proposed rate and state that the rate is subj ect to 
regulatory approval. The superintendent may not take final action on a rate filing until 4() 
days after the date notice is mailed by an insurer. An increase in premium rates lay 
not be implemented until @ 90 days after the notice is provided or until the effective date 
under section 2736, whichever is later. 
Sec. 3. 24-A MRSA §2735-A, sub-§2, as enacted by PL 2001, c. 432, §4, is 
amended to read: 
2. Notice of rate increase on new business. When an insurer offering individual 
health plans as defined in section 2736-C quotes a rate for new business, it must disclose 
any rate increase that the insurer anticipates implementing within the following W 120 
days. If the quote is in writing, the disclosure must also be in writing. If the increase is 
pending approval' at the time of notice, the disclosure must include the proposed rate and 
state that it is subject to regulatory approval. If disclosure required by this subsection is 
not provided, an increase may not be implemented until at least W 120 days after the date 
the quote is provided or the effective date under section 2736, whichever is later. 
Sec. 4. 24-A MRSA §2736, sub-§l, as amended by PL 2003, c. 428, Pt. F, §2, is 
further amended to read: 
1. Filing of rate information. Every insurer shall file with the superintendent every 
rate, rating formula, classification of risks and every modification of any formula or 
classification that it proposes to use in connection with individual health insurance 
policies and certain group policies specified in section 2701. Every such filing must state 
the effective date of the filing. Every such filing must be made not less than @ 90 days 
in advance of the stated effective date, unless the 60 day 90-day requirement is waived by 
the superintendent, and the effective date may be suspended by the superintendent for a 
period of time not to exceed 30 days. In the case of a filing that meets the criteria in 
subsection 3, the superintendent may suspend the effective date for a longer period not to 
exceed 30 days from the date the organization satisfactorily responds to any reasonable 
discovery requests. 
Sec. 5. 24-A MRSA §2736, sub-§2, as amended by PL 1997, c. 344, §8, IS 
further amended to read: 
2. Filing; information. When a filing is not accompanied by the information upon 
which the insurer supports such filing, or the superintendent does not have sufficient 
information to determine whether such filing meets the requirements that rates be 
reasonable and necessary and not be exeessi't'e, inadequate or unfairly discriminatory, the 
superintendent shall require the insurer to furnish the information upon which it supports 
the filing. A filing and supporting information, including all accompanying rates, rating 
formulas, rating classifications, trend documentation and actuarial information used to 
support the filing, are public records within the meaning of Title 1, section 402, 
subsection 3 and become part of the official record of any hearing held pursuant to 
section 2736-A. 
Sec. 6. 24-A MRSA §2736, sub-§2-A is enacted to read: 
2-A. Approval of filing. A rate filing may not be approved by the superintendent 
unless the superintendent makes an affirmative finding that the standards contained in this 
section are met and supported by documented evidence in the record or filing. 
Sec. 7. 24-A MRS A §2736, sub-§3, as amended by PL 2003, c. 469, Pt. E, §9, is 
further amended to read: 
3. Criteria for special rate hearings. Any filing of rates, rating formulas and 
modifications for Medicare supplement contracts as defined in chapter 67 and for 
individual health plans as defined in section 2736-C, subsection 1, paragraph C that 
satisfies anyone of the criteria set forth in this subsection is subject to the provisions of 
subsection 4. 
A. 
The rate increase for any policyholder may not exceed exceeds the index of 
inflation multiplied by 1.5 excluding any approved rate differential based on age. For 
the purposes of this subsection, "index of inflation" means the rate of increase in 
medical costs for a section of the United States selected by the superintendent that 
includes Maine for the most recent 12-month period immediately preceding the date 
of the filing for which data are available. 
B. 
The insurer HH:lSt fails to demonstrate in accordance with generally accepted 
actuarial principles and practices consistently applied that, as of a date no more than 
days prior to the filing, the ratios of benefits incurred to premiums earned for 
those products average no less than 80% for the previous 12-month period. For the 
purposes of this calculation, any savings offset payments paid pursuant to section 
6913 must be treated as incurred claims. 
D. The insurer's surplus level exceeds the authorized control level as defined in 
section 6451, subsection 8, paragraph C by a factor of 3. 
E. The insurer's net underwriting gain expressed as a percentage of an after-tax basis 
for any line of insurance or for all lines of insurance combined in the previous year is 
at or above the Consumer Price Index multiplied by 2. 
Sec. 8. 24-A MRSA §2736, sub-§4, as amended by PL 2003, c. 469, Pt. E, § 10, 
is further amended to read: 
4. Special rate hearing. A rate hearing conducted with respect to filings that meet 
anyone of the criteria in subsection 3 is subject to this subsection. 
A. 
Any person requesting a hearing shall provide the superintendent with a written 
statement detailing the circumstances that justify a· hearing notwithstanding the 
satisfaction of the criteria in subsection 3. 
B. 
If the superintendent decides to hold a hearing, the supelintendent shall issue a 
written statement detailing the circumstances that justify a hearing not\yithstanding 
the satisfaction of the criteria in subsection 3. 
C. 
In any hearing conducted under this subsection, the Bureau of Insurance and any 
party asserting burden of proving that the rates are excessive have the burden of 
establishing' that the rates are eJwessive. 
The burden of proying that rates are 
reasonable and necessary, adequate, not unfairly discriminatory and in compliance 
with the requirements of section 6913 remains with the insurer. 
Sec. 9. 24-A MRS A §2736, sub-§5 is enacted to read: 
5. Standard for approval. The following standards apply to the making and use of 
rates pursuant to this section. 
A. Rates are determined not to be reasonable and necessary if the rates are likely to 
produce a profit from business in this State that is unreasonably high in relation to the 
benefits provided, the surplus requirements and the surplus available, or if expenses 
are unreasonably high in relation to the benefits provided. 
B. Rates are determined not to be reasonable and necessary if the rate structure 
established by a stock insurance company provides for replenishment of surpluses 
from premiums when replenishment is attributable to investment losses. 
C. Rates are determined to be inadequate if the rates are clearly insufficient, together 
with investment income attributable to the rates, to sustain projected losses and 
expenses for the benefits provided. 
D. Rates are determined to be unfairly discriminatory if price differentials fail to 
equitably reflect the differences in expected losses and expenses or the rates fail to 
clearly and equitably reflect consideration of the policyholder'S participation in a 
wellness program or clinically accepted course of preventive care. 
Sec. 10. 24-A MRSA §2736, sub-§6 is enacted to read: 
6. Factors to be considered. In determining whether the standards in subsection 5 
have been met, the factors considered by the superintendent may include but are not 
limited to: 
A. The past and prospective net underwriting gains of the insurer from the line of 
insurance for which the insurer seeks rate approval and from all of its lines of 
insurance; 
B. The past, current and reasonably expected surplus levels of the carrier anticipated 
in the filing; 
C. Investment income reasonably expected by the carrier from premiums anticipated 
in the filing, plus any other expected income from currently invested assets 
representing the amount expected on unearned premium reserves and loss reserves; 
D. The degree of competition in the market for which the rate approval is sought and 
in the overall health insurance market; 
E. The degree to which testimony offered by the carrier in support of the components 
of its requested rates is supported by written evidence such as analyses, reports or 
studies; and 
F. The profit and risk charge included in the previous year's rate filing and the profit 
actually achieved. 
Sec. 11. 24-A MRS A §2736-A, first ~, as amended by PL 2003, c. 469, Pt. E, 
§ 11, is further amended to read: 
If a filing proposes an increase in rates or at any time the superintendent has reason to 
believe that a filing does not meet the requirements that rates Bet be exoessive, reasonable 
and necessary, and not inadequate, unfairly discriminatory or not in compliance with 
section 6913 or that the filing violates any of the provisions of chapter 23, the 
superintendent shall cause a hearing to be held. In any hearing conducted under this 
section, the burden of proving that rates are reasonable and necessary, adequate, not 
unfairly discriminatory and in compliance with the requirements of section 6913 remains 
with the insurer. 
Sec. 12. 24-A MRSA §2736-C, sub-§2, ~F, as enacted by PL 2003, c. 469, Pt. 
E, § 12, is amended to read: 
l3 
F. 
A carrier that adjusts its rate shall account for the savings offset payment or any 
recovery in that offset payment in its experience consistent with this section and 
section 69l3. With regard to accounting for any recovery of the savings offset 
payment, a carrier shall provide demonstrable proof and quantify the total amount 
negotiated and saved by the carrier. 
Sec. 13. 24-A MRS A §2736-C, sub-§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 ~ 
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. 
For the purposes of this 
calculation, any savings offset payments paid pursuant to section 6913 must be treated as 
incurred claims. If incurred claims were less than 75% of aggregate earned premiums 
over a continuous 12-month period, the carrier shall refund a percentage of the premium 
to the current in-force policyholder. The excess premium is the amount of premium 
above that amount necessary to achieve a 75% loss ratio for all of the carrier's small 
group policies during the same 12-month period. The refund must be distributed to 
policyholders in an amount reasonably calculated to correspond to the aggregate 
experience of all policyholders holding policies having siniilar benefits. The total of all 
refunds must equal the excess premiums. The superintendent may require further support 
for the unpaid claims estimate and may require refunds to be recalculated if the estimate 
is found to be unreasonably large. 
The superintendent may adopt rules sctting forth 
appropriate methodologies regarding refunds pursuant to this subsection. Rules adopted 
pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, 
subchapter 2-A. 
For each successive full calendar year period after this subsection 
becomes effective, the loss ratio required in this subsection must increase by one full 
percentage point until the maximum loss ratio required is 80%. 
PRge 5 - 123LR19!\5(OJ)-t 
Sec. 14. 24-A MRSA §2S0S-B, sub-§2-A, as enacted by PL 2003, c. 469, Pt. E, 
§ 16, is amended to read: 
2-A. Rate filings. A carrier offering small group health plans shall file with the 
superintendent the community rates for each plan and every rate, rating formula and 
classification of risks and every modification of any formula or classification that it 
proposes to use. 
A. 
Every filing must state the effective date of the filing. Every filing must be 
made not less than @ 90 days in advance of the stated effective date, unless the 6G-
6ay 90-day requirement is waived by the superintendent. The effective date may be 
suspended by the superintendent for a period of time not to exceed 30 days. In the 
1 
case of a filing that meets the criteria in subsection 2-B, paragraph E, the 
superintendent may suspend the effective date for a longer period not to exceed 30 
days from the date the carrier satisfactorily responds to any reasonable discovery 
requests. 
B. 
A filing and supporting information, including all accompanying rates, rating 
formulas, rating classifications, trend documentation and actuarial information used 
to support the filiDg, are public records eJwept as provided by within the meaning of 
Title 1, section 402, subsection 3 and become part of the official record of any 
hearing held pursuant to subsection 2-B, paragraphs B or F. 
C. 
Rates for small group health plans must be filed in accordance with this section 
and subsections subsection 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. 15. 24-A MRS A §2S0S-B, sub-§2-B, as enacted by PL 2003, c. 469, Pt. E, 
§ 16, is amended to read: 
2-B. Rate review and hearings. Except as provided in subsection 2 C, rate Rate 
filings are subject to this subsection. 
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. For 
the purposes of this calculation, any savings offset payments paid pursuant to section 
6913 must be treated as incurred claims. A rate filing or rate increase may not be 
approved without an affirmative finding that the standards described in paragraphs G 
and H are met and are supported by documented evidence. 
B. 
If a filing proposes an increase in rates or at any time the superintendent has 
reason to believe that a filing does not meet the requirements that rates be reasonable 
and necessary and not be excessive, inadequate or unfairly discriminatory or that the 
filing violates any of the provisions of chapter 23, the superintendent shall cause a 
hearing to be held. 
Hearings held under this subsection must conform to the 
procedural requirements set forth in Title 5, chapter 375, subchapter 4. 
The 
superintendent shall issue an order or decision within 30 days after the close of the 
hearing or of any rehearing or reargument or within such other period as the 
superintendent for good cause may require, but not to exceed an additional 30 days. 
In the order or decision, the superintendent shall either approve or disapprove the rate 
filing. 
If the superintendent disapproves the rate filing, the superintendent shall 
establish the date on which the filing is no longer effective, specify the filing the 
superintendent would approve and authorize the insurer to submit a new filing in 
accordance with the terms of the order or decision. 
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 be reasonable and 
necessary and not be excessive, inadequate, unfairly discriminatory or not in 
compliance with section 6913, the superintendent shall require the carrier to furnish 
the information upon which it supports the filing. 
D. 
A carrier that adjusts its rate shall account for the savings offset payment or any 
recovery of that savings offset payment in its experience consistent with this section 
and section 6913. With regard to accounting for any recovery of the savings offset 
payment, a carrier shall provide demonstrable proof and quantify the total amount 
negotiated and saved by the carrier. 
E. 
Any filing of rates, rating formulas and modifications that satisfies anyone of 
the criteria set forth in this paragraph is subject to the provisions of paragraph F: 
(1) The proposed rate for any group or subgroup does not include a unit cost 
change that exceeds the index of inflation multiplied by 1.5, excluding any 
approved rate differential based on age. For the purposes of this subparagraph, 
"index of inflation" means the rate of increase in medical costs for a section of 
the United States selected by the superintendent that includes this State for the 
most recent 12-month period immediately preceding the date of the filing for 
which data are available; ana 
(2) The carrier demonstrates fails to 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 ratio of benefits incurred to 
premiums earned averages no less than ~ 
75% for the previous 39 month.lk 
month period,.~ 
(3) The carrier's surplus level exceeds the authorized control level as defined in 
section 6451, subsection 8, paragraph C by a factor of 3; and 
( 4) The carrier's net underwriting gain expressed as a percentage on an after-tax 
basis for any line of insurance or for all lines of insurance combined in the 
previous year is at or above the Consumer Price Index multiplied by 2. 
F. 
Any rate hearing conducted with respect to filings that meet anyone of the 
criteria in 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 justify 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 burden of proving that the rates are excessive have the burden of 
establishing that the rates are excessive. The burden of proving that rates are 
reasonable and necessary, adequate, not unfairly discriminatory and in 
compliance with the requirements of section 6913 remains with the carrier. 
G. The following standards apply to the making and use of rates pursuant to this 
section. 
(1) Rates are determined not to be reasonable and necessary if the rates are likely 
to produce a profit from business in this State that is unreasonably high in 
relation to the benefits provided, the surplus requirements and the surplus 
available, or if expenses are unreasonably high in relation to the benefits 
provided. 
(2) Rates are determined not to be reasonable and necessary if the rate structure 
established by a stock insurance company provides for replenishment of 
surpluses from premiums when replenishment is attributable to investment losses. 
(3) Rates are determined to be inadequate if the rates are clearly insufficient, 
together with investment income attributable to the rates, to sustain projected 
losses and expenses for the benefits provided. 
(4) Rates are determined to be unfairly discriminatory if price differentials fail to 
equitably reflect the differences in expected losses and expenses or the rates fail 
to clearly and equitably reflect consideration of the policyholder's participation in 
a wellness program or clinically accepted course of preventive care. 
H. In determining whether the standards in subsection 5 have been met, the factors 
considered by the superintendent may include but are not limited to: 
(1) The past and prospective net underwriting gains of the insurer from the line 
of insurance for which the insurer seeks rate approval and from all of its lines of 
Insurance; 
(2) 
The past, current and reasonably expected surplus levels of the carner 
anticipated in the filing; 
(3) 
Investment income reasonably expected by the carrier from premiums 
anticipated in the filing plus any other expected income from currently invested 
assets representing the amount expected on unearned premium reserves and loss 
reserves; 
(4) The degree of competition in the market for which the rate approval is sought 
and in the overall health insurance market; 
?dgC 8·· l23LRloJS5(Ol)--l 
(5) 
The degree to which testimony offered by the carrier in support of the 
components of its requested rates is supported by written evidence such as 
analyses, reports or studies; and 
(6) The profit and risk charge included in the previous year's rate filing and the 
profit actually achieved. 
I. 
If incurred claims were less than 75% of aggregate earned premiums over a 
continuous 12-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 75% loss ratio for all of the carrier's small group 
policies during the same 12-month period. 
The refund must be distributed to 
policyholders in an amount reasonably calculated to correspond to the aggregate 
experience of all policyholders holding policies having similar benefits. The total of 
all refunds must equal the excess premiums. The superintendent may require further 
support for the unpaid claims estimate and may require refunds to be recalculated if 
the estimate is found to be unreasonably large. The superintendent may adopt rules 
setting forth appropriate methodologies regarding refunds pursuant to this subsection. 
Rules adopted pursuant to this paragraph are routine technical rules as defined in 
Title 5, chapter 375, subchapter 2-A. For each successive full calendar year period 
after this subsection becomes effective, the loss ratio required by this subsection must 
increase by one full percentage point until the maximum loss ratio is 80%. 
Sec. 16. 24-A MRSA §2808-B, sub-§2-C, as amended by PL 2005, c. 121, Pt. 
E, §§ 1 and 2, is repealed. 
Sec. 17. 24-A MRS A §2839-A, sub-§I, as amended by PL 2005, c. 121, Pt. F, 
§ 1, is further amended to read: 
1. Notice of rate increase on existing policies. An insurer offering group health 
insurance, except for accidental injury, specified disease, hospital indemnity, disability 
income, Medicare supplement, long-term care or other limited benefit group health 
insurance, must provide written notice by first class mail of a rate increase to all affected 
policyholders or others who are directly billed for group coverage at least eg 90 days 
before the effective date of any increase in premium rates. An increase in premium rates 
may not be implemented until eg 90 days after the notice is provided. For small group 
health plan rates subject to section 2808-B, subsection 2-B, if the increase is pending 
approval at the time of notice, the disclosure must state that the increase is subject to 
regulatory approval. 
Sec. 18. 24-A MRSA §2839-A, sub-§2, as amended by PL 2005, c. 121, Pt. F, 
§ 1, is further amended to read: 
2. Notice of rate increase on new business. When an insurer offering group health 
insurance, except for accidental injury, specified disease, hospital indemnity, disability 
income, Medicare supplement, long-term care or other limited benefit group health 
insurance, quotes a rate for new business, it must disclose any rate increase that the 
insurer anticipates implementing within the following W 120 days. If the quote is in 
writing, the disclosure must also be in writing. If such disclosure is not provided, an 
increase may not be implemented until at least 9G 120 days after the date the quote is 
provided. For small group health plan rates subject to section 2S0S-B, subsection 2-B, if 
the increase is pending approval at the time of notice, the disclosure must state that the 
increase is subject to regulatory approval. 
Sec. 19. 24-A MRS A §4313, sub-§13, as enacted by PL 1999, c. 742, §19, is 
repealed. 
S 
Sec. 20. 24-A MRS A §4313, sub-§14, as enacted by PL 1999, c. 742, §19, is 
amended to read: 
14. \Vrongful death action. Notwithstanding subsection 13, an An enrollee or an 
enrollee's authorized representative may bring a cause of action against a carrier for its 
health care treatment decisions to seek a remedy under either this section or under Title 
I8-A, section 2-804, but may not seek remedies under both this section and Title 18-A, 
section 2-S04. 
SUMMARY 
This bill makes the following changes to the laws regulating individual and small 
group health plans. 
1. It increases the time period for advance notice of rate increases and rate changes to 
policyholders. 
2. It requires the Department of Professional and Financial Regulation, Bureau of 
Insurance to hold public hearings when a rate increase is proposed. 
3. It requires the Department of Professional and Financial Regulation, Bureau of 
Insurance to contract with an independent hearing officer to conduct rate hearings and to 
appoint an advocacy panel in those proceedings to represent the interests of consumers 
and the public. 
4. It clarifies that all rate filings and information and documentation used to support 
the filings are public records and may be disclosed to the public. 
5. It changes the standard of review that rates not be excessive to the standard that 
rates be reasonable and necessary. 
6. 
It requires that rates not be approved unless certain standards are met and 
supported by evidence in the record. 
7. It requires that carriers provide demonstrable proof and quantify the amount of 
any recovery of the savings offset payment through negotiations with health care 
providers as part of rate filings. 
8. It increases the minimum loss ratios for individual and small group health plans 
and requires carriers to refund to policyholders the difference between the required loss 
-P8ge 10 - l:t3LR1955{OlH 
ratio and the achieved loss ratio in instances when the carrier does not meet the minimum 
standards. 
9. It repeals the exclusivity provision regarding an enrollee's right to sue under the 
Maine Revised Statutes, Title 24-A, chapter 56-A. 
Page II - 123LR19S5(OI)-1