An Act To Protect Health Care Consumers from Catastrophic Debt
Maine Legislature, Session 124, LD 1620
Committee Amendment CA_A_H664 (House)
Amends: 24-A MRSA §4317

COMMITTEE AMENDMENT oj} " to H.P. 1148, L.D. 1620, Bill, "An Act To 
Protect Health Care Consumers from Catastrophic Debt" 
Amend the bill by striking out everything after the enacting clause and before the 
summary and insel1ing the following: 
'Sec. 1. 24-A MRSA §4317 is enacted to read: 
§4317. Prohibition against maximum aggregate benefit pl'ovisions 
1. Prohibition. An individual or group health plan issued or renewed by a carrier on 
or after the effective date of this section may not include a provision in a policy, contract, 
certificate or agreement that purp0l1s to terminate payment of any additional claims for 
coverage of health care services after a defined maximum aggregate dollar amount of 
claims for coverage of health care services on an annual, lifetime or other basis has been 
paid under the health plan for coverage of an insured individual, family 91' group. 
2. Specific benefits. This section may not be construed to limit the ability of a 
carrier to offer a health plan that limits benefits under the health plan for specified health 
care services on an annual basis. 
3. Exceptions. This section does not apply to: 
A. An individual health plan in effect on the effective date of this section with an 
annual or lifetime maximum aggregate benefit limit of less than $1,000,000; 
B. A health plan designed for an employee who works on a part-time, tempormy or 
seasonal basis or designed as sh0l1-term coverage for an employee who is fulfilling a 
waiting period for coverage under another employer-sponsored benefit plan; 
C. An individual health plan in effect on the effective date of this section issued 
pursuant to a conversion privilege in a group health insurance policy subject to 
section 2809-A; 
D. A pilot project to offer an individual health plan to a person under 30 years of age 
pursuant to section 2736-C, subsection 10; and 
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COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "n "to I-J.P. 1148, L.D. 1620 
E. Blanket health insurance as defined in section 2813 . 
4. Disclosure. A health plan issued after the effective date of this section that 
includes an annual or lifetime maximum aggregate benefit limit as permitted under 
subsection 3 must include a disclosure of the applicable limit on the face page of the 
individual policy or group certificate. The disclosure must be printed in a font that is 
larger or bolder than the font used in the body of the face page~ 
Sec. 2. Rulemaking. The Superintendent of Insurance shall undertake rulemaking 
in accordance with the Maine Revised Statutes, Title 5, chapter 375 to amend any rule 
adopted by the Department of Professional and Financial Regulation, Bureau ofInsurance 
that conflicts with this Act. Rules adopted pursuant to this section are routine technical 
rules as defined in Title 5, chapter 375, subchapter 2-A. 
Sec. 3. Application. The requirements of this Act apply to all policies, contracts 
and certificates subject to this Act that are executed, delivered, issued for delivery, 
continued or renewed in this State on or after January 1, 2011. For purposes of this Act, 
all contracts are deemed to be renewed no later than the next yearly anniversary of the 
contract date.' 
SUMMARY 
This amendment replaces the bill. The amendment prohibits individual or group 
health plans covering Maine residents from including provisions that terminate payment 
of further claims after a defined maximum specified aggregate doIlar amount of health 
care claims has been paid on an annual, ·Iifetime or other basis on behalf of an individual, 
family or group. The amendment adds exceptions to the prohibition on limits for several 
specific types of health plans and requires a health plan issued after the effective date of 
the provision to include a disclosure of a permitted limit. The amendment applies the 
provisions to health plans issued or renewed on or after January I, 20 II. 
FISCAL :SOTE RE(Jl'IH,f,1J 
(See attached) 
COMMITTEE AMENDMENT 
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Approved: 02/23110 wac.. 
LD 1620 
LR 2237(02) 
An Act To Protect Health Care Consumers from Catastrophic Debt 
Fiscal N~te for Bill as Amended by Committee Amendment ,fi" 
Committee: Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - General Fund 
Fiscal Detail and Notes 
Additional costs to the Bureau ofInsurance in the Department of Professional and Financial Regulation are expected 
to be minor and can be absorbed utilizing existing budgeted resources. Any fiscal impact to the State Employee 
Health Plan is also expected to be minor and could be absorbed within existing budget resources. 
LR2237(02) - Fiscal Note - Page 1 of I