An Act To Allow Maine Residents To Purchase Health Insurance from Out-of-state Insurers
Maine Legislature, Session 124, LD 0290
Committee: Insurance and Financial Services
Sponsors: McKANE, CROCKETT, DAVIS, COURTNEY, DIAMOND, SMITH, MARRACHE, BEAUDETTE, BEAUDOIN, PILON, RICHARDSON, McCORMICK
Amends: 24-A MRSA §405, 24-A MRSA §405-A

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Legislative Document 
No. 290 
H.P.230 
House of Representatives, February 2,2009 
An Act To Allow Maine Residents To Purchase Health Insurance 
from Out-of-state Insurers 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
plinted. 
Presented by Representative McKANE of Newcastle. 
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MILLICENT M. MacFARLAND 
Clerk 
Cosponsored by Representatives: CROCKETT of Bethel, DAVIS of Sangerville, Senators: 
COURTNEY of York, DIAMOND of Cumberland, SMITH of Piscataquis, Senator 
MARRACHE of Kennebec and Representatives: BEAUDETTE of Biddeford, BEAUDOIN of 
Biddeford, PILON of Sa co, RICHARDSON of Warren, Senator: McCORMICK of Kelmebec. 
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Be it enacted by the People of the State of Maine as follows: 
Sec. 1. 24-A MRSA §405, sub-§7 is enacted to read: 
7. Transactions pursuant to individual health insurance covering residents of this 
State written by a regional insurer or health maintenance organization duly authorized or 
qualified to transact such insurance in the state or country of its domicile if the 
superintendent certifies that the regional insurer or health maintenance organization meets 
the requirements of section 405-A. 
Sec. 2. 24-A MRSA §405-A is enacted to read: 
§405-A. Certification of regional insurers or health maintenance organizations to 
transact individual and group health insurance 
To qualify under this section and section 405, subsection 7, a regional insurer or 
health maintenance organization, as described in this section, may not transact individual 
or group health insurance in this State by mail, the Internet or otherwise unless the 
superintendent has issued a certification that the requirements of this section have been 
met. The superintendent shall issue a certification or deny certification within 30 days of 
a request. A regional insurer or health maintenance organization shall meet the following 
requirements. 
1. R.egional insurer; authority to transact individual or group health insurance 
in certain states. As used in this section, "regional insurer or health maintenance 
organization" means an insurer or health maintenance organization that holds a valid 
certificate of authority to transact individual or group health insurance in one of the 
following states: Connecticut, Massachusetts, New Hampshire, Rhode Island and 
Vermont. 
2. Compliance with laws of state. Any policy, contract or certificate of individual 
or group health insurance offered for sale in this State by a regional insurer or health 
maintenance organization must comply with the applicable individual and group health 
insurance laws in the state of its domicile, and any such policy must be actively marketed 
in that state. 
3. 
Minimum surplus and reserve levels. 
The regional insurer or health 
maintenance organization shall maintain minimum capital and surplus requirements and 
maintain reserves as required by section 410; section 90l-A; sections 951 to 958-A; 
section 4204, subsection 2-A, paragraph D; and section 4204-A, as applicable. 
4. 
Disclosure and reporting. 
The regional insurer or health maintenance 
organization shall meet the requirements of section 4302 for reporting plan information 
with respect to individual health plans offered for sale in this State and disclose to 
prospective enrollees how the health plans differ from individual and group health plans 
offered by domestic insurers in a format approved by the superintendent within 90 days 
of the effective date of this section. Health plan policies and applications for coverage 
must contain the following disclosure statement or a substantially similar statement: 
"This policy is issued by a regional insurer or health maintenance organization and is 
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governed by the laws and regulations of [state of regional insurer or health maintenance 
organization's state of domicile). This policy may not be subject to all the insurance laws 
and rules of the State of Maine, including coverage of certain health care services or 
benefits mandated by Maine law. Before purchasing this policy, you should carefully 
review the terms and conditions of coverage under this policy, including any exclusions 
or limitations of coverage. II 
5. Grievance procedures. The regional insurer or health maintenance organization 
shall meet the requirements of section 4303, subsection 4 for grievance procedures with 
respect to health plans offered for sale in this State. 
6. Unfair trade practices. The provisions of chapter 23 apply to the regional 
insurer or health maintenance organization permitted to transact health insurance under 
this section or section 405. 
7. Taxes; assessments. The regional insurer or health maintenance organization is 
subject to applicable taxes or assessments imposed on insurers transacting individual and 
group health insurance in this State pursuant to this Title and Title 36. 
8. Service of process. The regional insurer or health maintenance organization shall 
designate an agent for receiving service of legal documents and process in the manner 
provided in this Title. 
9. 
Compliance with court orders. The regional insurer or health maintenance 
organization shall comply with lawful orders from courts of competent jurisdiction issued 
on a voluntary dissolution proceeding or in response to a petition for an injunction by the 
superintendent asserting that the regional insurer or health maintenance organization is in 
a hazardous financial condition. 
10. 
Participation in guaranty association. 
The regional insurer or health 
maintenance organization shall participate in an insurance insolvency guaranty 
association to which a domestic insurer or health maintenance organization that transacts 
individual and group health insurance in this State is required to belong in accordance 
with this Title. 
Except as expressly provided. in this section, the requirements of this Title do not 
apply to a regional insurer or health maintenance organization permitted to transact health 
insurance under this section or section 405. 
Sec. 3. 24-A MRS A §405-B is enacted to read: 
§405-B. Domestic insurers; individual and group health insurance approved in 
other states 
Notwithstanding any other provision of this Title except as expressly provided, a 
domestic insurer or health maintenance organization may offer for sale in this State an 
individual or group health plan duly authorized for sale in another state by a parent or 
subsidiary of the domestic insurer if the following requirements are met. 
1. Certificate of authority from state of domicile. The parent or subsidiary of the 
domestic insurer or health maintenance organization must hold a valid certificate of 
authority to transact individual health insurance in one of the following states: 
Connecticut, Massachusetts, New Hampshire, Rhode Island and Vermont. 
2. Compliance with laws of state of domicile. Any policy, contract or certificate of 
individual or grOUp health insurance offered for sale in this State by a domestic insurer or 
health maintenance organization must comply with the applicable individual and grOUp 
health insurance laws in the state of domicile of the parent or subsidiary, and any such 
policy must be actively marketed in that state. 
3. 
Disclosure and reporting. 
The domestic insurer or health maintenance 
organization shall meet the requirements of section 4302 for reporting plan information 
with respect to individual and grOUp health plans offered for sale in this State and disclose 
to prospective enrollees how the individual and grOUp health plans of the parent or 
subsidiary differ from individual and grOUp health plans offered by domestic insurers in a 
format approved by the superintendent within 90 days of the effective date of this section. 
Health plan policies and applications for coverage must contain the following disclosure 
statement or a substantially similar statement: "This policy is issued by a domestic insurer 
or health maintenance organization but is governed by the laws and rules of [state of 
domicile of parent or subsidiary of domestic insurer], which is the state of domicile of the 
parent or subsidiary of the domestic insurer or health maintenance organization. This 
policy may not be subject to all the insurance laws and rules of the State of Maine, 
including coverage of certain health care services or benefits mandated by Maine law. 
Before purchasing this policy, you should carefully review the terms and conditions of 
coverage under this policy, including any exclusions or limitations of coverage. II 
4. Grievance procedures. The domestic insurer or health maintenance organization 
shall meet the requirements of section 4303, subsection 4 for grievance procedures with 
respect to health plans offered for sale in this State. 
Sec. 4. Effective date. This Act takes effect January 1, 2010. 
SUMMARY 
This bill permits out-of-state health insurers, which are referred to as regional 
insurers in the bill, to offer their individual and group health plans for sale in this State if 
certain requirements of Maine law are met, including minimum capital and surplus and 
reserve requirements, disclosure and reporting requirements and grievance procedures. 
The bill defines regional insurers as those insurers authorized to transact individual or 
group health insurance in one of the following states: Connecticut, Massachusetts, New 
Hampshire, Rhode Island and Vermont. It also permits Maine health insurers to offer 
individual health plans of out-of-state parent or subsidiary health insurers if similar 
requirements are met. If out-of-state health plans are offered for sale in this State, the bill 
requires that prospective enrollees be provided adequate disclosure of how the plans 
differ from Maine health plans in a format approved by the Superintendent of Insurance. 
The bill takes effect January 1,2010. 
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