An Act To Improve Transparency in the Health Insurance Markets
Maine Legislature, Session 124, LD 0323
Committee: Insurance and Financial Services
Sponsors: TREAT, BOWMAN, FOSSEL, GOODE, LEGG, PRIEST, RICHARDSON
Amends: 24-A MRSA §4303

FIRST P~GULAR SES~ION-2009 
Legislative Document 
No. 323 
H.P.259 
House of Representatives, Febmary 3, 2009 
An Act To Improve Transparency in the Health Insurance Markets 
Submitted by the Department ofPfofessional and Financial Regulation pursuant to Joint 
Rule 204. 
. 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
Presented by Representative TREAT of Hallowell. 
Cosponsored by Senator BOWMAN of York and' 
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1?1.11l(}£~{ 
MILLICENT M. MacFARLAND 
Clerk 
Representatives: FOSSEL of Alna, GOODE of Bangor, LEGG of Kellnebunk, PRIEST of 
Bmnswick, RICHARDSON of Warren. 
PrintcJ llO rcc)'C'kd purer 
Be it enacted by the People of the State of Maine as follows: 
Sec. ]. 24-A MRS A §2809-A, sub-§l-A, ~ 
is enacted to read: 
D. All notices of cancellation sent to certificate holders pursuant to paragraph B-1 
must include a 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. If a notice of cancellation has been 
mailed to a certificate holder pursuant to paragraph B-1 and the policy is not 
thereafter cancelled because the premium has been paid or the policy is reinstated, the 
insurer shall mail notice of noncancellation or reinstatement to the certificate holder 
by first class mail as expeditiously as possible, but in no event more than 10 days 
after premium for continued coverage or reinstatement has been received by the 
insurer. Notice pursuant to this paragraph must be provided in the same manner as 
notice provided pursuant to paragraph B-1. 
Sec. 2. 24-A MRSA §4303, sub-§12 is enacted to read: 
12. Publication of policies by carriers. A carrier shall publish on its publicly 
accessible website at least 5 individual policies offered by that carrier, or all individual 
policies offered by that carrier if the carrier offers fewer than 5 individual policies, having 
the highest levels of enrollment in the State and at least 5 small group policies offered by 
that carrier, or all small group policies offered by that carrier if the carrier offers fewer 
than 5 small group policies, having the highest levels of enrollment in the State. The 
caITier shall publish such policies in a manner that will allow consumers to review the 
coverage offered under each of these policies. The appearance of a policy published on 
the carrier's publicly accessible website must duplicate the actual policy an individual 
would receive if the individual were to request a paper copy of the policy. The carrier 
shall publish the required policies on its publicly accessible website within 90 days after 
the effective date of this subsection. After publishing the required policies in accordance 
with this subsection, the carrier must update its website within 14 days after making any 
changes to its published policies. 
Sec. 3. 24-A MRSA §4303, sub-§13 is enacted to read: 
13. Explanations of benefits. A carrier offering an expense-incurred individual 
health plan to Maine residents or an expense-incurred group health plan to a Maine 
employer shall provide individual policyholders and group certificate holders with a clear 
written explanation of benefit documents in response to the filing of any claim for 
coverage of hospital or medical expenses. In addition to any additional information 
required by rule, the explanation of benefits must include: 
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; 
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E. A telephone number and address where an insured may obtain clarification of the 
explanation of benefits; 
F. A notice of appeal rights; 
G. A notice of the right to file a complaint with the bureau; and 
H. Such other information as the superintendent may require by rule. 
The superintendent shall establish by rule the minimum information, and mInImum 
standards for the accuracy and clarity of the information presented, to appear in an 
explanation of benefits. The rule must require explanations of benefits to include at least 
the information required by this subsection and may require explanations of benefits to 
contain any additional information helpful to policyholders in understanding how their 
policies are being administered. Rules adopted pursuant to this subsection are routine 
technical rules as defined in Tide 5, chapter 375, subchapter 2-A. 
This subsection applies to all explanations of benefits issued after January 1, 2010. 
SUMMARY 
This bill amends the Maine Insurance Code to require that health insurers provide 
updated information to group enrollees regarding the status of their employer-sponsored 
insurance coverage when a notice of termination for nonpayment has been issued, post on 
their publicly accessible websites current versions of their individual and small group 
policies that have the most residents of the State enrolled and send clear explanations of 
benefits to explain the services and payments made by insurance companies on behalf of 
their policyholders.