An Act To Allow Maine Residents To Purchase Health Insurance from Out-of-state Insurers
Maine Legislature, Session 124, LD 0290
Committee Amendment CA_A_H169 (House)
Amends: 24-A MRSA §405-B

COMMITTEE AMENDMENT ,4" to H.P. 230, L.D. 290, Bill, "An Act To Allow 
Maine Residents To Purchase Health Insurance from Out-of-state Insurers" 
Amend the bill by striking out all of sections 2 and 3 and inserting the following: 
'Sec. 2. 24-A MRS A §405-A is enacted to read: 
§405-A. Certification of regional insurers or health maintenance organizations to 
transact individual 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 
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. Regional insurer; authority to transact individual health insurance in certain 
states. As used in this section, flregional insurer or health maintenance organization
ff 
means an insurer or health maintenance organization that is domiciled in and holds 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. Any policy, contract or certificate of individual 
health insurance offered for sale in this State by a regional insurer or health maintenance 
organization must comply with the applicable individual 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 901-A; sections 951 to 958-A; 
section 4204, subsection 2-A, paragraph D; and section 4204-A, as applicable. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT ,A .. to H.P. 230, L.D. 290 
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 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 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. " 
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. Complaint process. The regional insurer or health maintenance organization 
shall respond to inquiries from the bureau related to consumer complaints in accordance 
with section 220, subsection 2. 
7. 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. 
8. Taxes; assessments. The regional insurer or health maintenance organization is 
subject to applicable taxes or assessments imposed on insurers transacting individual 
health insurance in this State pursuant to this Title and Title 36. 
9. 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. 
10. Compliance with court orders. The regional insurer or health rriaintenance 
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. 
11. 
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 health insurance in this State is required to belong in accordance with this 
Title. The regional insurer or health maintenance organization is considered a "member 
insurer" as defined under section 4605-A for the purposes of participation in the 
insurance insolvency guaranty association. 
For the purposes of this section, "health insurance" does not include the following 
types of insurance or any combination of those types of insurance: accidental injury, 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to RP, 230, L.D, 290 
specified disease, hospital indemnity, dental, vision, disability income, long-term care, 
Medicare supplement or other limited benefit health insurance. 
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 MRSA §405-B is enacted to read: 
§405-B. Domestic insurers; individual 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 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 be domiciled in and 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 health insurance offered for sale in this State by a domestic insurer or health 
maintenance organization must comply with the applicable individual 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 health plans offered for sale in this State and disclose to 
prospective enrollees how the individual health plans of the parent or subsidiary differ 
from individual 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." 
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. 
Appropriations and allocations. 
The following appropriations and 
allocations are made. 
PROFESSIONAL AND FINANCIAL REGULATION, DEPARTMENT OF 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT 'A" to H.P. 230, L.D. 290 
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Insurance - Bureau of 0092 
Initiative: Allocates funds for the costs of implementing and administering the provisions 
permitting out-of-state carriers to offer health insurance policies to Maine residents, 
including the costs of one half-time Attorney position, one Insurance Claims Examiner 
position and one half-time Public Service Manager I position. 
OTHER SPECIAL REVENUE FUNDS 
POSITIONS - LEGISLATIVE COUNT 
Personal Services 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
2009-10 
2.000 
$75,417 
$49,253 
$124,670 
2010-11 
2.000 
$159,709 
$47,291 
$207,000 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or 
section number to read consecutively. 
SUMMARY 
This amendment is the minority report of the committee. This amendment: 
1. Removes language from the bill that would have authorized out-of-state health 
insurers to offer group health plans for sale in the State, and retains language that 
authorizes out-of-state health insurers to offer individual health plans for sale in the State; 
2. Clarifies that the out-of-state insurer must respond to any consumer complaints 
raised to the Department of Professional and Financial Regulation, Bureau ofinsurance; 
3. 
Clarifies that the term "health insurance" does not include accidental injury, 
specified disease, hospital indemnity, dental, vision, disability income, long-term care, 
Medicare supplement or other limited benefit health insurance; and 
4. Adds an appropriations and allocations section. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
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Approved: 04/03/09 MaC!. 
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LD290 
LR276(02) 
An Act To Allow Maine Residents To Purchase Health Insurance from Out-of-state Insurers 
Fiscal Note for Bill as Amended by Committee Amendment 'ft' 
Committee: Insurance and Financial Services 
Appropriations! Allocations 
Other Special Revenue Funds 
Fiscal Note Required: Yes 
Fiscal Note 
2009-10 
$124,670 
2010-11 
$207,000 
Projections 
2011-12 
$216,582 
Projections 
2012-13 
$226,740 
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"JJ Revenue 
Other Special Revenue Funds 
$127,231 
$212,122 
$221,705 
$231,862 
Fiscal Detail and Notes 
Provides an Other Special Revenue Funds allocation of $124,670 in 2009-10 and $207,000 in 2010-11 to the Bureau 
of Insurance in the Department of Professional and Financial Services for the costs of implementing and administering 
the bill's provisions permitting out-of-state carriers to offer health insurance policies to Maine residents including the 
costs of one half-time Attorney position, one Insurance Claims Examiner position, and one part-time Public Service 
Manager 1 position. Revenues will be generated through assessment of insurers and health maintenance 
organizations. 
The Department of the Attorney General will incur some minor additional costs. These costs can be supported 
utilizing existing budgeted resources. 
LR0276(02) - Fiscal Note - Page 1 of 1