An Act To Establish a Health Care Bill of Rights
Maine Legislature, Session 124, LD 1205
Committee Amendment CA_A-SA_B_S332 (Senate)
Amends: 24-A MRSA §2809-A

SENATE AMENDMENT ,\13 " to COMMITTEE AMENDMENT "A" to H.P. 830, 
L.D. 1205, Bill, "An Act To Establish a Health Care Bill of Rights" 
Amend the amendment by striking out all of the first paragraph after the title (page 1, 
lines 11 to 14 in amendment) and inserting the following: 
'Amend the bill in Part A by striking out all of section 1 (page 1, lines 3 to 14 in L.D.) 
and inserting the following: 
'Sec. A-I. 24-A MRSA §2809-A, sub-§l-A, ~-2 is enacted to read: 
B-2. All notices of cancellation sent to certificate holders pursuant to paragraph B-1 
must include a toll-free telephone number that certificate holders can call to 
determine if the policy has been cancelled for nonpayment of premium or if the 
policy has been reinstated because the premium has been paid.' 
Amend the bill in Part A by striking out all of section 4 (page 1, line 38 and page 2, 
lines 1 to 23 in L.D.) and inserting the following: 
'Sec. A-4. 24-A MRS A §4303, sub-§13 is enacted to read: 
13. 
Explanation of benefits. A carrier offering an individual expense-incurred 
health plan to residents of this State or an expense-incurred group health plan to an 
employer in this State shall provide individual policyholders and group certificate holders 
with clear written explanations of benefit documents in response to the filing of any claim 
providing for coverage of hospital or medical expenses. The explanation of benefits must 
include all of the following information: 
A. The date of service; 
B. The provider of the service; 
C. An identification of the service for which the claim is made; 
D. Any amount the insured is obligated to pay under the policy for copayment or 
coinsurance; 
E. A telephone number and address where the insured may obtain clarification of the 
explanation of benefits; 
F. A notice of appeal rights; and 
SENATE AMENDMENT 
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SENATE AMENDMENT·:8" to COMMITTEE AMENDMENT "A" to H.P. 830, L.D. 1205 
G. A notice of the right to file a complaint with the bureau after exhausting any 
appeals under a carrier's internal appeals process. 
The superintendent shall establish by rule the minimum information and standards for 
explanation of benefits forms used by carriers, taking into consideration any input from 
stakeholders and any national standards for explanation of benefits forms. Rules adopted 
pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, 
subchapter 2-A. This subsection applies to any explanation of benefits form issued on or 
after January 1, 2010.' ' 
Amend the amendment in Part C by striking out all of section 1 and inserting the 
following: 
'Sec. C-l. 24-A MRS A §2736, sub-§l, as amended by PL 2009, c. 14, §4 and c. 
244, Pt. G, § 1, is repealed and the following enacted in its place: 
1. 
Filing of rate information. 
Every insurer shall file for approval by 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 celiain group policies specified in section 2701. If the filing 
applies to individual health plans as defined in section 2736-C, the insurer shall 
simultaneously file a copy with the Attorney General. Every such filing must state the 
effective date of the filing. Every such filing must be made not less than 60 days in 
advance of the stated effective date, unless the 60-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. A filing required under this section must be made 
electronically in a format required by the superintendent unless exempted by rule adopted 
by the superintendent. Rules adopted pursuant to this subsection are routine technical 
rules as defined in Title 5, chapter 375, subchapter 2-A.' 
Amend the amendment in Pali 0 by striking out all of sections 2 and 3. 
Amend the amendment in Part F in section 1 in subsection 7-A in the 9th line (page 
5, line 11 in amendment) by inserting after the following: "authorization" the following: 
'for a period not to exceed 6 months' 
SUMMARY 
This amendment makes the following changes. 
1. It removes the requirement that carriers provide written notice of reinstatement of 
a group policy following a cancellation notice for nonpayment of premium. In place of 
the written notice requirement, this amendment requires carriers to provide a toll-free 
telephone number that certificate holders can call to determine if the policy has been 
cancelled or reinstated after payment of the premium. 
2. It removes requirements of the bill that the Superintendent of Insurance establish 
additional requirements for explanation of benefits forms through rulemaking. 
3. It removes the provisions that increase the minimum loss ratio for small group 
health plans. 
SENATE AMENDMENT 
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SENATE AMENDMENT 'J?" to COMMITTEE AMENDMENT "A" to H.P. 830, L.D. 1205 
4. It limits the requirement that a carrier replacing a previous carrier honor any prior 
authorizations for prescription drugs to a period not to exceed 6 months. 
5. It corrects a conflict involving the section concerning the subject of the filing of 
rate information created by Public Law 2009, chapters 14 and 244 by incorporating the 
changes made in those laws with the changes proposed in Committee Amendment "A." 
SPONSOREDB~ 
__ 
(Senator BOWMAN) 
COUNTY: Yorl{ 
SENATE AMENDMENT