An Act To Enable Maine Residents To Purchase Health Insurance over State Lines
Maine Legislature, Session 125, LD 0473
Committee: Insurance and Financial Services
Sponsors: HARMON, ESPLING, MALABY, McCORMICK, CHASE, FOSTER, GILLWAY, GUERIN, JOHNSON, KNIGHT, OLSEN, WINTLE
Amends: 24-A MRSA §405, 24-A MRSA §405-A, 24-A MRSA §405-B, 24-A MRSA §405-C

Legislative Document 
No. 473 
H.P. 366 
House of Representatives, February 10, 2011 
An Act To Enable Maine Residents To Purchase Health Insurance 
over State Lines 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
HEATHER J.R. PRIEST 
Clerk 
Presented by Representative HARMON of Palermo. 
Cosponsored by Representatives: ESPLING of New Gloucester, MALABY of Hancock, 
Senator McCORMICK of Kennebec and 
Representatives: CHASE of Wells, FOSTER of Augusta, GILLWAY of Searsport, GUERIN 
of Glenburn, JOHNSON of Greenville, KNIGHT of Livermore Falls, OLSEN of Phippsburg, 
WINTLE of Garland. 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  24-A MRSA §405, sub-§6, as enacted by PL 1969, c. 132, §1, is amended 
to read: 
6.    Any suit or action by the duly constituted receiver, rehabilitator or liquidator of 
the insurer, or of the insurer's assignee or successor, under laws similar to those contained 
in chapter 57 (delinquency proceedings; rehabilitation and liquidation).; or 
Sec. 2.  24-A MRSA §405, sub-§7 is enacted to read: 
7.  Transactions pursuant to individual or group health insurance covering residents 
of this State written by an insurer or health maintenance organization, as defined in 
section 405-A, subsection 1, duly authorized or qualified to transact individual or group 
health insurance in the state or country of its domicile if the superintendent certifies that 
the insurer or health maintenance organization meets the requirements of section 405-A. 
Sec. 3.  24-A MRSA §405-A is enacted to read: 
§405-A.  Certification of insurers or health maintenance organizations to transact 
individual or group health insurance 
1.  Insurer or health maintenance organization defined.  As used in this section, 
"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 any state. 
2.  Certification of insurers or health maintenance organizations.  An insurer or 
health maintenance organization 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 insurer or health maintenance organization has met the requirements 
of this subsection.  The superintendent shall issue a certification or deny certification 
within 30 days of a request.  In order to be certified, the insurer or health maintenance 
organization must meet the requirements of this subsection. 
A.  A policy, contract or certificate of individual or group health insurance offered for 
sale in this State by the insurer or health maintenance organization must comply with 
the applicable individual and group health insurance laws in the state or country of its 
domicile and must be actively marketed in that state or country. 
B.  The insurer or health maintenance organization must maintain minimum capital 
and surplus requirements and maintain reserves as required by section 410; section 
901-A; chapter 11, subchapter 3; section 4204, subsection 2-A, paragraph D; and 
section 4204-A, as applicable. 
C.  The insurer or health maintenance organization must 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 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 an insurer or health maintenance organization governed by the laws and 
rules of (insurer's 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." 
D.  The insurer or health maintenance organization must meet the requirements of 
section 4303, subsection 4 for grievance procedures with respect to health plans 
offered for sale in this State. 
E.  The insurer or health maintenance organization must designate an agent for 
receiving service of legal documents and process in the manner provided in this Title. 
F.  The insurer or health maintenance organization must participate in an insurance 
insolvency guaranty association to which a domestic insurer or health maintenance 
organization that transacts individual or group health insurance in this State is 
required to belong in accordance with this Title. 
3.  Unfair trade practices.  The provisions of chapter 23 apply to an insurer or 
health maintenance organization permitted to transact individual or group health 
insurance under this section or section 405. 
4.  Taxes; assessments.  An insurer or health maintenance organization is subject to 
applicable taxes or assessments imposed on insurers transacting individual or group 
health insurance in this State pursuant to this Title and Title 36. 
5.  Compliance with court orders.  An insurer or health maintenance organization 
shall comply with lawful orders from courts of competent jurisdiction issued in a 
voluntary dissolution proceeding or in response to a petition for an injunction by the 
superintendent asserting that the insurer or health maintenance organization is in a 
hazardous financial condition. 
Except as expressly provided in this section, the requirements of this Title do not 
apply to an insurer or health maintenance organization permitted to transact individual or 
group health insurance under this section or section 405. 
Sec. 4.  24-A MRSA §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, 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 or health maintenance organization 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 or group health insurance in any state; 
2.  Compliance with laws of state of domicile.  The policy, contract or certificate of 
individual or group health insurance offered for sale in this State by the 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 must be 
actively marketed in that state; 
3.  Disclosure and reporting.  The domestic insurer or health maintenance 
organization must 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 other 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 or health 
maintenance organization), 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."; and 
4.  Grievance procedures.  The domestic insurer or health maintenance organization 
must meet the requirements of section 4303, subsection 4 for grievance procedures with 
respect to health plans offered for sale in this State. 
Sec. 5.  24-A MRSA §405-C is enacted to read: 
§405-C.  Waiver 
A person who purchases individual or group health insurance from an insurer or 
health maintenance organization pursuant to section 405-A or from a domestic insurer or 
health maintenance organization pursuant to section 405-B must sign a waiver indicating 
that the person knows that the insurance policy does not include coverage of certain 
health care services or benefits mandated by this Title. 
Sec. 6.  Effective date.  This Act takes effect January 1, 2012. 
SUMMARY 
This bill permits insurers authorized to transact individual or group health insurance 
in any state 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.  It also 
permits Maine health insurers to offer individual and group 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 in a format approved by the Superintendent of Insurance of 
how the plans differ from Maine health plans.  This bill also requires a person purchasing 
such insurance to sign a waiver acknowledging that the insurance policy does not 
necessarily fully adhere to Maine law.  The bill includes an effective date of January 1, 
2012.