An Act To Extend the Scope of the Maine Guaranteed Access Reinsurance Association
Maine Legislature, Session 125, LD 1670
Committee Amendment CA_A_S522 (Senate)
Amends: 24-A MRSA §2

COMMITTEE AMENDMENT" A" to S.P. 569, L.D. 1670, Bill, "An Act To 
Extend the Scope of the Maine Guaranteed Access Reinsurance Association" 
Amend the bill by striking out the title and substituting the following: 
'An Act Relating to Rating on the Basis of Group Size in the Small Group Health 
Insurance Market' 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'Sec. 1. 24-A MRSA §2S0S-B, sub-§2, ,C, as amended by PL 2011, c. 364, §10, 
is further amended to read: 
C. A carrier may vary the premium rate due to occupation and industry, family 
membership, and participation in wellness programs aBe gF9tifl si>'5e to the extent 
permitted by the federal Affordable Care Act. The superintendent may adopt rules 
setting forth appropriate methodologies regarding rate discounts for participation in 
wellness programs and rating for occupation and industry aRe gF9tif! si>'5e pursuant to 
this paragraph. Rules adopted pursuant to this paragraph are routine technical rules 
as defined in Title 5, chapter 375, subchapter 2-A. 
Sec. 2. 24-A MRSA §2S0S-B, sub-§2,~, as amended by PL 2011, c. 364, §11, 
is further amended to read: 
D. A carrier may vary the premium rate due to age, group size and tobacco use only 
under the following schedule and within the listed percentage bands. 
(1) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State between July 15, 1993 and July 
14, 1994, the premium rate may not deviate above or below the community rate 
filed by the carrier by more than 50%. 
(2) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State between July 15, 1994 and July 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" A .. to S.P. 569, L.D. 1670 
14, 1995, the premium rate may not deviate above or below the community rate 
filed by the carrier by more than 33%. 
(3) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State between July 15, 1995 and 
September 30, 2011, the premium rate may not deviate above or below the 
community rate filed by the carrier by more than 20%. 
(4) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State between October 1, 2011 and 
Deoember 31 September 30, 2012, the maximum rate differential due to age filed 
by the carrier as determined by ratio is 2 to 1. The limitation does not apply for 
determining rates for an attained age of less than 19 years of age or more than 65 
years of age. 
(5) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State between January 1, 2013 October 
1, 2012 and December 31, 2013, the maximum rate differential due to age and 
group size filed by the carrier as determined by ratio is 2.5 to 1. The limitation 
does not apply for determining rates for an attained age of less than 19 years of 
age or more than 65 years of age. 
(6) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State between January 1, 2014 and 
December 31, 2014, the maximum rate differential due to age and group size 
filed by the carrier as determined by ratio is 3 to 1 to the extent permitted by the 
federal Affordable Care Act. The limitation does not apply for determining rates 
for an attained age of less than 19 years of age or more than 65 years of age. 
(7) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State between January 1, 2015 and 
December 31, 2015, the maximum rate differential due to age and group size 
filed by the carrier as determined by ratio is 4 to 1 to the extent permitted by the 
federal Mfordable Care Act. The limitation does not apply for determining rates 
for an attained age of less than 19 years of age or more than 65 years of age. 
(8) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State on or after January 1, 2016, the 
maximum rate differential due to age and group size filed by the carrier as 
determined by ratio is 5 to 1 to the extent permitted by the federal Affordable 
Care Act. The limitation does not apply for determining rates for an attained age 
of less than 19 years of age or more than 65 years of age. 
(9) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State on or after October 1,2011, the 
maximum rate differential due to tobacco use filed by the carrier as determined 
by ratio is 1.5 to l. 
Sec. 3. 24-A MRSA §2S0S-B, sub-§2, ~H, as amended by PL 2011, c. 364, §13, 
is further amended to read: 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" A" to S.P. 569, L.D. 1670 
H. A carrier that offered small group health plans prior to October 1, 2011 may close 
its small group book of business sold prior to October 1, 2011 and may establish a 
separate community rate for eligible groups applying for coverage under a small 
group health plan on or after October 1,2011. If a carrier closes its small group'book 
of business as permitted under this paragraph, the carrier may vary the premium rate 
for that closed book of business only as permitted in this paragraph and paragraphs C 
and C-l. 
(1) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State between October 1, 2011 and 
Deeember 31 September 30, 2012, the maximum rate differential due to age filed 
by the carrier as determined by ratio is 2 to 1. The limitation does not apply for 
determining rates for an attained age of less than 19 years of age or more than 65 
years of age. 
(2) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State between January 1,2013 October 
1, 2012 and December 31, 2013, the maximum rate differential due to age and 
group size filed by the carrier as determined by ratio is 2.5 to 1. The limitation 
does not apply for determining rates for an attained age of less than 19 years of 
age or more than 65 years of age. 
(3) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State between January 1, 2014 and 
December 31, 2014, the maximum rate differential due to age and group size 
filed by the carrier as determined by ratio is 3 to 1 to the extent permitted by the 
federal Affordable Care Act. The limitation does not apply for determining rates 
for an attained age of less than 19 years of age or more than 65 years of age. 
(4) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State between January 1, 2015 and 
December 31, 2015, the maximum rate differential due to age and group size 
filed by the carrier as determined by ratio is 4 to 1 to the extent permitted by the 
federal Affordable Care Act. The limitation does not apply for determining rates 
for an attained age of less than 19 years of age or more than 65 years of age. 
(5) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State on or after January 1,2016, the 
maximum rate differential due to age and group size filed by the carrier as 
determined by ratio is 5 to 1 to the extent permitted by the federal Affordable 
Care Act. The limitation does not apply for determining rates for an attained age 
of less than 19 years of age or more than 65 years of age. 
(6) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State on or after October 1,2011, the 
maximum rate differential due to tobacco use filed by the carrier as determined 
by ratio is l.5 to l.' 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" A" to S.P. 569, L.D. 1670 
SUMMARY 
This amendment replaces the bill. The amendment provides that, beginning October 
1, 2012, the rating factor used by small group health insurance carriers for group size 
must be combined within the maximum rate differential due to age of 2.5 to 1. The 
combined rating band for age and group size would be increased to 3 to 1 on January 1, 
2014 and, to the extent permitted by the federal Affordable Care Act, further increased 
each year by a factor of 1 up to a combined 5 to 1 rating band on January 1,2016. Under 
current law, the rating factor for group size falls outside of the rating bands. 
FISCAL :SOTE HEQURED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 03/26/12 
~a~ 
LD 1670 
LR 2369(02) 
An Act To Extend the Scope of the Maine Guaranteed Access Reinsurance Association 
Fiscal Detail and Notes 
Fiscal Note for Bill as Amended by Committee Amendment" A" ~ .. 5" 2-
Committee: Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - Other Special Revenue Funds 
Any additional costs to the Bureau of Insurance in the Department of Professional and Financial Regulation are 
expected to be minor and can be absorbed within existing budgeted resources. 
LR2369(02) - Fiscal Note - Page 1 of 1