An Act To Establish aHealth Cafe Bill of Rights .
Maine Legislature, Session 124, LD 1205
Committee: Insurance and Financial Services
Sponsors: TREAT, BOWMAN, ADAMS, BEAUDOIN, GOODE, PINGREE, PRIEST, RUSSELL, TRINWARD, MARRACHE
Amends: 24-A MRSA §2809-A, 24-A MRSA §4303, 24-A MRSA §4302, 24-A MRSA §423, 24-A MRSA §2735-A, 24-A MRSA §2736, 24-A MRSA §2736-A, 24-A MRSA §2839-A, 24-A MRSA §4224-B, 24-A MRSA §2736-C, 24-A MRSA §2, 24-A MRSA §280

124th MAINE LEGISLATURE' 
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Legislative Document 
No. 1205 
H.P.830 
House of Representatives, March 26, 2009 
An Act To Establish aHealth Cafe Bill of Rights 
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Reference to the Committee on Insurance and Financial Services suggested and ordered 
- printed. 
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Presented by Representative TREAT of Hallowell. 
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111· 7ll(;£~{ 
MILLICENT M. MacFARLAND 
Clerk 
Cosponsored by Senator BOWMAN of York and , 
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Representatives: ADAMS of Portland, BEAUDOIN of Biddeford, GOODE of Bangor, 
Speaker PINGREE of North Haven, PRIEST of Brunswick, RUSSELL of Portland, 
TRINWARD of Waterville; Senator: MARRACHE of Kennebec. 
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Printed on recycled pilpcr 
Be it enacted by the People of the State of Maine as follows: 
PART A 
Sec. A-I. 24-A MRSA §2809-A,sub-§1-A, ~-2 is enacted to read: 
B-2. All notices of cancellation sent to certificate holders pursuantto paragraph B-1 
must include a telephone number that certificate holders can call to determine if the 
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policy has been cancelled for nonpayrllent of premium or if the policy has been 
reinstated because the premium has been paid. If a notice of cancellation has been 
mailed to certificate holders 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 o~ noncancellation or reinstatement to certificate' holders by first 
class mail as expeditiously· as possible, but in no event more than 10 days after the 
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. A-2. 24-A MRSA§4302, sub-§l,'i{A, as enacted by PL 1995, c. 673, Pt. C, 
§ 1 and affected by §2, is amended to read: 
A. Coverage provisions, benefits and any exclusions by category of service, type of 
provider and, if applicable, by specific service, .including but not limited to the 
following types of exclusions and limitations: 
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(1) Health care services, excluded from coverage; 
(2) Health care services requiring copayments or deductibles paid by enrollees; 
(3) Restrictions on access to a particular provider type; ami . 
(4) Health care services that are or may be provided only by referral; and 
(5) Childhood immunizations as recommended by the United States Department 
of Health and Human Services, Centers for Disease Control and Prevention and 
the,American Academy of Pediatrics; 
. Sec. A-3. 24-A MRSA §4303, sub-§12 is enacted to read; 
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12. Publication of policies by carriers. A carrier must publish at least 5 individual 
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health plans with the highest level of enrollment and at least 5 small group health plans 
with the highest level of enrollment on the carrier's publicly accessible website in a 
. manner that will allow consumers to review the coverage offered under each policy. The 
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policies posted on the website must be updated when changes are made to the policies by 
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the carrier. The appearance of the policy on the website must duplicate the appearance of 
a paper· copy of the policy. The bureau shall provide a link from its website to each 
carrier's website. A carrier must review annually which policies to post and make any 
necessary changes on its website. A carrier must post the required policies on its website 
within 90 days after the effective date of this subsection~ 
Sec. A-4. 24-A MRS A §4303, sub-§13 is enacted to read: 
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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 t6 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: 
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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 copavrnent 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; 
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 standards for 
explanation of benefits forms used by carriers. At a minimum, the rules must require the 
information required by this subsection and miw require any additional information 
helpful to consumers in understanding how a carrier administers its policies. 
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. 
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UnB 
Sec. B-1. 24-:-A MRSA §4301-A, sub-§16-A is enacted to read: 
16-A. Provider profiling program. "Provider profiling program" means a program 
' that uses provider data in order to rate or rank provider quality or efficiency of care by the 
use of a grade, star, tier, rating or any other form of designation. 
Sec. B-2. 24.;.A MRSA §4302, sub-§l, CfIJ, as enacted by PL 1999, c. 742, §5, is 
amended to read: 
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J. A description of the independent external review procedures and the circumstances 
under which an enrollee is entitled to independent external review as required by this 
chapter; aOO 
Sec. B-3. 24-A MRSA §4302, sub-§l, ~, as ,enacted by PL 1999, c. 742, §5, is 
amended to read: 
K. A description of the requirements for enrollees to obtain coverage of routine costs 
of clinical trials and information on the manner in which enrollees not eligible to 
participate in clinical trials may qualify for the compassionate use program of the 
federal Food and Drug Administration for use of investigational drugs pursuant to 21 
Code of Federal Regulations, Section 312.34, as amended7; and 
Sec. B-4. 24-A MRSA §4302, sub-§l, C!flL is enacted to read: 
. L. A description of a provider profiling program that may be a part of the health 
plan, includiIlg the location of provider performance· ratings in the plan materials or 
on a publicly accessible website, information explaining the provider rating system 
and the basis upon which provider performance is measured, the limitations of the 
data used to measure provider performance, the process for selecting providers and a 
conspicuous written disclaimer explaining the provider performance ratings should 
only be used as a guide for choosing a provide~ and that enrollees should consult their 
current provider before making a decision about their health care based on a provider 
rating. 
Sec. B-5. 24-A MRSA §4303, sUlb-§2, ~1E is enacted to read: 
E. A carrier. with a provider profilirig program shall: 
(1) Disclose to providers the methodologies, criteria, data and analysis used to 
evaluate provider quality, performance and cost-efficiency ratings; 
(2)· Create and share with providers their provider profile at least 60 days prior to . 
using or publicly disclosing the results of the provider profiling program; 
(3) 
Afford providers the opportunity to correct errors, submit additional 
information for consideration and seek review of data and performance ratings; 
and 
(4)' Afford providers due process appeal rights to challenge the profiling 
determination described. in this subsection and by Bureau of Insurance Rule 
Chapter 850, Health Plan Accountability: 
PART C 
Sec. C-l. 24-A MRSA §423-][), SUlb-§l, as enacted by PL 2003, c. 469, Pt. E, §2, 
is amended to read: 
1. 
Annual report supplement required. 
Each health insurer and health 
maintenance organization shall file an annual report supplement on or before' March 1 st 
of each year, or within any reasonable extension of time that the s.uperintendent for good 
cause may have granted on or before March 1 st. The superintendent shall adopt rules 
regarding specifications for.the alillual report supplement. The annual report supplements. 
must provide the public with general, understandable and comparable product offerings 
and financial information relative to the in-state operations and results of authorized 
insurers and health maiIltenance organizations. Such information must include, but is not 
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limited to, medical claims expense, administrative expense and underwriting gain for 
each line segment of the market in this State in which the insurer participates. 
Inforination regarding product offerings must include products described in section 
2736-C, subsection 6, paragraph A; section 2808-B,subsection 6, paragraph A; and' 
section 4303, subsection 12. The annual report supplements must contain sufficient detail 
for the public to understand the components of cost incurred by authorized health insurers 
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and health maintenance organizations as well as the' annual cost trends of these carriers. 
Information regarding product offerings must coritain sufficient detail" for the public to 
understand and. compare product· offerings of each 'insurer oi-health maintenance 
organization by price, services that are covered; services that are not covered or services 
that are excluded and out-of-pocket costs. The superintendent shall develop standardized 
defin.itions of each reported measure. Rules adopted pursuant to this section 'are routine 
technical rules as defined in Title 5, chapter 375, subc:h~pte~ 2-A. 
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PARTD 
Sec. D-1. 24-A MRSA §2735-A, sub-§l, 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 eG 90 days before the 
effective date of any proposed increase in premium rates or any proposed rating formula, 
classification of risks or rriodification of any formula or classificatiori 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, 
subs~ction 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 dna rate filing until 4G 
days after the date notice is mailed by an'insurer, ,An jncrease in prernjum rates may 
not be implemented until eG 90 days after thencitice is provided or until the effective date 
under section 2736, whichever is later. 
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Sec. D-2. 24-A MRS A §2'736, sub-§l~ as ain~nded byPL2003, ~" 428, Pt. F, §2, 
is further amen~ed to read: 
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, 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 
poilcies and certain group policies specified in section 2701. 'If the filing applies to 
individual health plans as defiried 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, or 90 days in the case of a 
filing that applies to individual health plans as defined in section 2736-C, in advance of 
the stated' effective date, unless' the 60-day or' 90-day requirement is waived by the. 
supe~ntendent, and the effectiv~ date may be suspended by. the superintendent for a 
period of time not to ,exceed 30 days. In the case of a filing that rrieets 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. D-3~ 24-A MRSA §2736; sub';§2, as amended by PL 1997, c. 344, §8, is 
further amended to read: 
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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 todetennine whethe~ such filing meets the requirements that rates not be 
excessive, inadequate or unfairly discriminatory, the superintendent shall require the 
insurer to furnish the information upon which it supports the filing. For any rate filing, 
the superintendent shall consider revenues and expenses. from all line segments of the 
filing insurer. A filing and all supporting information. except for descriptions of the 
amount and terms or conditions or reimbursement in a contract between an insurer and a 
3rd party. are public reCords within the meaning of Title 1, section 402, subsection 3 and 
become part ofthe official record of any hearing held pursuant to section 2736-A. 
Sec. D-4. 24-A MRSA §2736-A, first CU, as amended by PL 2007, c. 629, Pt. M, 
§3, is further amended to read: 
If at any time the superintendent has reason to believe that a filing does not meet the 
requiremertts that rates not be excessive, inadequate, unfairly discriminatory or not in 
compliance with femleF section 6913 or that the filing violates any of the provisions of 
chapter 23, the superintendent shall cause a hearing to be held. If a filing proposes an 
increase in rates in. an individual health plan as defined in section 2736-C, the 
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superintendent shall cause a hearing to be held at the request of the Attorney General. In 
any hearing conducted under this section, the burden of proving rates are reasonable, 
adequate, not unfairly discriminatory and in compliance with section 6913 remains with 
the insurer.· 
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Sec. D-S. 24-A MRSA §2839-A, as amended by PL 2005, c. 121, Pt. F, §1 and c. 
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400, Pt. A, §2, is furthef amended to read: 
. §2839-A. Notice of rate inlcrease 
1. Notice of rate increase on existing policies. An insurer offering group health 
insurance, except for small group health plans as defined in section 2808-B and 
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 
W):l0 are directly blned for group coverage at least 60 days before the effective date of any 
increase in premium rates. An increase in.premium rates may not be implemented until 
60·days after the notice is provided. For small group health plan rates subject to section 
2808 13, subsection 2 13, if the increase. is pending appro .... al at. the time of notice, the 
disclosure must state that the increase is subiect to regulator,r ai:JProval. 
2.;Notice of rate increase on new business. When an insurer offering group health 
insurance, except for small group health plans as defined in section 2808-B and 
accidental injury, specified disease, hospital indemnity, disability income, Medicare 
supplement, long-term care or other limited benefit group health insurance, quotes a rate 
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. for new business, it must disclose any rate increase that the insurer anticipates 
implementing within the following 90 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 90 days after the date the quote is provided. For small group 
health plan rates subject to section 280813, subsection 213, if the increase is pending 
approval at the time of notice, the disclosure must state that the increase is subject to 
regulatory approval. 
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4. 
Notice of rate increase on existing small group health plans. An insurer 
offering small group health plans as defined in section 2808-B shall provide writteri 
notice by first class mail ora rate increase to all affected policyholders or others who are 
directly billed for· group coverage at least 90, days before the effective date of any 
increase in preinium rates. The notice must also inform policyholders' of their right to 
request a hearing pursuant to section 229.' The notice must state that the Attorney 
General is authorized to represent small· employers in rate proceedings and must include 
inforniation about how to contact the Office of the Attorney General. The notice must 
show tb;e; piroposoo Iiat.e and s~ate that the rate is subject to regulatory approval. The 
supeIliiIMlemdeml may not take final action on a rate filing until 70 days after the date notice 
iis; maiil!ecl! by 3:]] insurer. An increase in premium rates may not be implemented until 90 
. clIaiys; after the notice is provided or until the effective date under section 2808-B, 
s:ubsecuon 2-A, whichever is later. 
5. Notice of rate increase on new small group business. When an insurer offering 
small group health plans as dermed in section 2808-B quotes a rate for new business, the 
insurer must disclose any rate increase that the insurer anticipates implementing within 
the following 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 the increase is subj ect to regulatory approvaL If such 
disclosure is not provided, an increase may not be implemented until at least 120 days 
atler the date the quote is provided OF until the effective ,date under section 2808-B, 
subsection 2-A, whichever is later. 
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Sec. D-6. 24-A MRSA §4224-B is enacted to read: 
§4224-B. Loss information 
1. Definitions. As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings. 
A. "Contract" means the health maintenance organization contract relating to the loss 
information requested purSuant to this section. ' 
B. "Loss information" means the aggregate claims experience of the group insurance 
policy health maintenance organization contract. "Loss information" includes the 
amount of premium received, the amount of claims paid and the loss ratio. "Loss 
information" does not include any information or data pertaining to the medical 
. diagnosis, treatment or health status that identifies an individual covered under the' 
group contract. 
C. "Loss ratio"· means the ratio between the amount 'of premium received and the 
amount of claims paid by the insurer under the health maintenance organization 
contract. 
2. . Disclosure of basic loss information. 
Upon written request, every health 
maintenance organization shall provide loss information concerning a group contract to 
its contract holder or former contract holder within 21 business days of the date of the 
,request. This subsection does not apply to a former contract holder whose coverage 
terminated more than 18 months prior to the date of a request. 
, 3. "Transmittal of request .. ' An" insurance' producer ot" another authorized 
r~presentative of a health maintenance organization who receives a request for loss 
information in accorda'nce with this section shan transmit the request for loss information 
to the heaith'maintenance organizatiorlwithin 4. busine,ss days. 
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Sec. E-L 24-A MRSA §2736-C; sub-:§5, as amended by PL 2007, c. 629,Pt. M, 
'§5, isfurtheramendeci to read:' 
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5. Loss ratios. For all policies and certificates issued on or after the effective qate of 
this section, the superintendent shall disapprove any premium rates filed by any carrier, 
whetheriniii!il ot revised, for an individual health policy urness itis antiCipated that the 
aggregate benefits estimated to be paid under all the individual health policies maintained 
in force by thecamer for the period for which coverage is to be provided will return to 
policyholders at'least ~ 
85% of the aggregate premiums collected for those policies, as 
determined in accordance with aC,cepted actuarial principles and practices and on the 
, basis' of incurred claims experience and earned premiums. For the purposes' of this 
calculation, any payments paid pursuant to ·feFmeF section 6913 must be treated as 
'incurred claims. If incurred claims were less than 85% 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 exc,ess premium is the amount of preinium 
above that amount ne'cessafy to achieve an 85% iossratio for all dfthe carrier's individual 
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 exces's prermums. 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 subsection are routine technical rules as defined in Title 5, chapter 375, 
subchapter 2-A. 
Sec.E-2. 24-A MRSA §2S03-A, sub-§4, as amendedby PL 2001, c. 410, Pt. B, 
§2, is repealed. 
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Sec. E-3. 24-A MRSA §280S-B, suh: .. §2-A, CffB, as enacted by PL 2003, c. 469, 
Pt. E, § 16, is amend,ed to read: 
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B. A filing imd all supporting information, except for descriptions of the amount and 
terms or conditions or reimbursement in a contract between an insurer and a 3rd 
lli!1!Y" are public records 6]Wept as provided by notwithstanding Title 1, section 402, 
subsection3 and become part of the official record of any hearing. held pursuant to 
subsection 2-B; paragraphs B or F. 
'Sec. E-4. 24-A MRSA §2S0S-:-:B, sub-§2-B, '\fA, asamend~d by PL 2007, c. 629, 
Pt. M, §7, is further amended to read: 
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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 +.§.% 85% of the aggregate premiums collected for 
those policies, as detennined 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 payments paid pursuant to feF.I:B:et: section 6913 
must be treated as incurred claims. 
Sec. E-S. 24-A MRS A §2S0S-B, sub-§2-B, ~, as enacted by PL 2003, C. 469, 
Pt. E, § 16, is amended to read: 
B. 
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 
that the filing violates any of the provisions of chapter 23, the superintendent shall 
.cause a hearing to be held. For any rate filing, notwithstanding subsection 2-C, the 
superintendent shall consider revenues and expenses from all line segments of the 
filing insurer. Hearings held under this subsection must confonn to the procedural 
requirements set fOl1h in Title 5, chapter 375, subchapter 4. The superintendent shall 
issue an order ordeGision within 30 days after the close of the hearing or of any 
reheapng or reargument or within such other period a$ 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 ten11S 
of the order or decision. 
Sec. K·6'. 24-A MRSA §Z808-B, sub-§2-C, ~C, as amended by PL 2007, c, 
629, Pt. M, § 10, is further amended to read: 
C. If incurred claims were less than +&% 88% of aggregate earned premiums over a 
continuous 36~month period, the carrier shall refund a perce1).tage of the premium to 
the current in-force policyholder. 
For the purposes of calculating this loss-ratio 
percentage, any payments paid pursuant to femlef section' 691 ~ must be treated as . 
incurred claims. The excess premium is the amount of premium above that amount 
necessary to achieve ~ 
an 88% loss ratio 'for all of the carrier's small group 
policies during the same 36-month period. 
The refund must be distributed to 
p0licyholders 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 prelniums. 
(1) 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, a.ctual 
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. E-7. 24-A MRSA §2S0S-B, sub-§6, Gf[A, as amended by PL 2001, c. 410, 
Pt. A, §6, is further amended to read: 
A. Each carrier must actively market small group health plan coverage, including 
any standardized plans required to be offered pursuant to subsection 8-A, to eligible 
groups in this State. 
Sec. E-S. 24-A MRSA §2S0S-B, sub-§S-A is enacted to read: 
8-A. Authority of the superintendent. The superintendent may by rule define one 
or more standardized small group health plans that must be offered by all carriers offering 
small' group health plans in the State. 'Rules adopted pursuant to th{s subsection are 
routine technical rules as defined in Title 5, chapter 375, subchapter 2-A. 
PART F 
Sec. F-1. 
Market conduct exams. 
The Superintendent of Insurance shall 
undertake market conduct exams of health insurance companies no less frequently than 
once every 3 years, beginning in 2010. 
PART G 
Sec. G-l. 24-A MRS A §4303, sub-§7-A is enacted toread: 
7-A. Continuity of prescriptions. If an enrollee has been undergoing a course of 
treatment with a prescription drug by prior authorization of a carrier and the enrollee's 
coverage with one carrier is ,replaced with coverage from another carrier pursuant to 
section 2849-B, the replacement carrier shall honor the prior authorization for that 
prescription drug and provide coverage in the same manner as the previous carrier until 
the replacement carrier conducts a review of the prior authorization for that prescription' 
drug, with the enrollee's prescribing provider. 
SUMMARY 
This bill does the following. 
1. Part A requires carriers to provide notice to policyholders when. a policy has been 
reinstated and the premium paid following a cancellation notice for nonpayment of 
premium. It requires carriers to provide notice to plan enrollees regarding any exclusions 
or limits of coverage for childhood immunizations. Part A also requires carriers to post at 
least 5 individual and 5 small group health plans on its publicly accessible website for 
comparison purposes and sets minimum standards for explanation of benefits documents 
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used by carriers. 
2. Part B establishes standards for provid~r profiling programs used by carriers. 
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3. Part C requires carriers and health maintenance organi?ations to include certain 
information about product offerings in the annual report supplement to the Dt;partment of 
Professional and Financial Regulation, Bureau of Insurance. 
4. Part D extends the notice period for carriers to notify policyholders of proposed 
,rate increases. It also permits the Attorney General· to request a rate hearing regarding 
proposed rate increases for individual health plans. 
5. Part E increases the minimum loss ratio fof individual and small group health 
plans to 85%. Part E also requires health maintenance organizations. to disclose loss 
information upon request from contract holders in the same manner as insurance 
companies. 
Part E also authorizes the Superintendent of Insurance to adopt rules 
requiring small group health carriers to offer standardized small group health plans. 
6. 
Part F requires the Superintendent of Insurance to undertake market conduct 
exams of health insurance companies no less frequently than once every 3 years, 
beginning in 2010. 
7. 
Part G requires a carrier replacing a previous camer to honor any prior 
. authorizations for prescription drugs for an enrollee undergoing a course of treatment 
until the replacement carrier conducts a review of that prior aitthorization with the 
enrollee's prescribing pJ.Dvider.