An Act To Modify Rating Practices for Individual and Small Group Health Plans and To Encourage Value-based Purchasing of Health Care Services
Maine Legislature, Session 125, LD 1333
Committee Amendment CA_A-HA_G_H236 (House)
Amends: 24-A MRSA §2736-C

HOUSE AMENDMENT" G" to COMMITTEE AMENDMENT "A" to H.P. 979, 
L.D. 1333, Bill, "An Act To Modify Rating Practices for Individual and Small Group 
Health Plans and To Encourage Value-based Purchasing of Health Care Services" 
Amend the amendment in Part A in section 1 by striking out all of paragraph C (page 
1, lines 17 to 21 in amendment) and inserting the following: 
'e. 
A carrier may vary the premium rate due to smolting status and family 
membership. 
The sl:tperintendent may adopt rules setting forth appropriate 
methodologies regarding rate discoUilts based on smoking status. Rules adopted 
pursuant to this paragraph are routine technical rules as defined in Title 5, chapter 
375, subchapter II-A 2-A.' 
Amend the amendment in Part A by inserting after section 1 the following: 
'Sec. A-2. 24-A MRSA §2736-C, suh-§2, ~C-l is enacted to read: 
C-l. A carrier may vary the premium rate due to geographic area in accordance with 
the limitation set out in this paragraph. For all policies, contracts or certificates that 
are executed, delivered, issued for delivery, continued or renewed in this State on or 
after July 1, 2012, the rating factor used by a carrier for geographic area may not 
exceed 1.5.' 
Amend the amendment in Part A in section 2 in paragraph D in the first and 2nd lines 
(page 1, lines 24 and 25 in amendment) by striking out the following: "age and 
geographic area" and inserting the following: 'age aBEl .. geographic area and' 
Amend the amendment in Part A in section 2 in paragraph D in subparagraph (5) in 
the 3rd line (page 2, line 31 in amendment) by inserting after the following: "~" the 
following: 'and geographic area' 
Amend the amendment in Part A in section 2 in paragraph D in subparagraph (5) in 
the 5th line (page 2, line 33 in amendment) by inserting after the following: "65 years of 
age." the following: 'In determining the rating factor for geographic area pursuant to this 
subparagraph, the ratio between the highest and lowest rating factor used by a carrier for 
geographic area may not exceed 1.5 and the ratio between highest and lowest combined 
rating factors for age and geographic area may not exceed 3.' 
HOUSE AMENDMENT 
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HOUSE AMENDMENT ,if" to COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
Amend the amendment in Part A in section 2 in paragraph D in subparagraph (6) in 
the 3rd line (page 2, line 36 in amendment) by inserting after the following: "age" the 
following: 'and geographic area' 
Amend the amendment in Part A in section 2 in paragraph D in subparagraph (6) in 
the 5th line (page 2, line 38 in amendment) by inserting after the following: "65 years of 
age." the following: 'In determining the rating factor for geographic area pursuant to this 
subparagraph, the ratio between the highest and lowest rating factor used by a carrier for 
geographic area may not exceed 1.5 and the ratio between highest and lowest combined 
rating factors for age and geographic area may not exceed 4.' 
Amend the amendment in Part A in section 2 in paragraph D in subparagraph (7) in 
the 3rd line (page 2, line 41 in amendment) by inserting after the following: "age" the 
following: 'and geographic area' 
Amend the amendment in Part A in section 2 in paragraph D in subparagraph (7) in 
the 5th line (page 2, line 43 in amendment) by inserting after the following: "65 years of 
age." the following: 'In determining the rating factor for geographic area pursuant to this 
subparagraph, the ratio between the highest and lowest rating factor used by a carrier for 
geographic area may not exceed 1.5 and the ratio between highest and lowest combined 
rating factors for age and geographic area may not exceed 5.' 
Amend the amendment in Part A in section 4 in paragraph I in subparagraph (1) in 
the 3rd line (page 3, line 16 in amendment) by inserting after the following: "age" the 
following: 'and geographic area' 
Amend the amendment in Part A in section 4 in paragraph I in subparagraph (1) in 
the last line (page 3, line 18 in amendment) by inserting after the following: "65 years of 
age." the following: 'In determining the rating factor for geographic area pursuant to this 
subparagraph, the ratio between the highest and lowest rating factor used by a carrier for 
geographic area may not exceed 1.5 and the ratio between highest and lowest combined 
rating factors for age and geographic area may not exceed 2.' 
Amend the amendment in Part A in section 4 in paragraph I in subparagraph (2) in 
the 3rd line (page 3, line 21 in amendment) by inserting after the following: "age" the 
following: 'and geographic area' 
Amend the amendment in Part A in section 4 in paragraph I in subparagraph (2) in 
the last line (page 3, line 23 in amendment) by inserting after the following: "65 years of 
age." the following: 'In determining the rating factor for geographic area pursuant to this 
subparagraph, the ratio between the highest and lowest rating factor used by a carrier for 
geographic area may not exceed l.5 and the ratio between highest and lowest combined 
rating factors for age and geographic area may not exceed 2.5.' 
Amend the amendment in Part A in section 4 in paragraph I in subparagraph (3) in 
the 3rd line (page 3, line 26 in amendment) by inserting after the following: "age" the 
following: 'and geographic area' 
Amend the amendment in Part A in section 4 in paragraph I in subparagraph (3) in 
the 5th line (page 3, line 28 in amendment) by inserting after the following: "65 years of 
age." the following: 'In determining the rating factor for geographic area pursuant to this 
subparagraph, the ratio between the highest and lowest rating factor used by a carrier for 
HOUSE AMENDMENT 
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HOUSE AMENDMENT .(]-" to COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
geographic area may not exceed l.5 and the ratio between highest and lowest combined 
rating factors for age and geographic area may not exceed 3.' 
Amend the amendment in Part A in section 4 in paragraph I in subparagraph (4) in 
the 3rd line (page 3, line 31 in amendment) by inserting after the following: "age" the 
following: 'and geographic area' 
Amend the amendment in Part A in section 4 in paragraph I in subparagraph (4) in 
the 5th line (page 3, line 33 in amendment) by inserting after the following: "65 years of 
age." the following: 'In determining the rating factor for geographic area pursuant to this 
subparagraph, the ratio between the highest and lowest rating factor used by a carrier for 
geographic area may not exceed 1.5 and the ratio between highest and lowest combined 
rating factors for age and geographic area may not exceed 4.' 
Amend the amendment in Part A in section 4 in paragraph I in subparagraph (5) in 
the 3rd line (page 3, line 36 in amendment) by inserting after the following: "~" the 
following: 'and geographic area' 
Amend the amendment in Part A in section 4 in paragraph I in subparagraph (5) in 
the 5th line (page 3, line 38 in amendment) by inserting after the following: "65 years of 
age." the following: 'In determining the rating factor for geographic area pursuant to this 
subparagraph, the ratio between the highest and lowest rating factor used by a carrier for 
geographic area may not exceed 1.5 and the ratio between highest and lowest combined 
rating factors for age and geographic area may not exceed 5.' 
Amend the amendment in Part A in section 5 in paragraph C in the first and 2nd lines 
(page 4, lines 16 and 17 in amendment) by striking out the following: "geographic area," 
Amend the amendment in Part A in section 5 in paragraph C in the 5th line (page 4, 
line 20 in amendment) by striking out the following: "geographic area," 
Amend the amendment in Part A in section 6 in paragraph D in subparagraph (4) in 
the 3rd line (page 4, line 43 in amendment) by inserting after the following: "age" the 
following: 'and geographic area' 
Amend the amendment in Part A in section 6 in paragraph D in subparagraph (4) in 
the last line (page 5, line 2 in amendment) by inserting after the following: "65 years of 
age." the following: 'In determining the rating factor for geographic area pursuant to this 
subparagraph, the ratio between the highest and lowest rating factor used by a carrier for 
geographic area may not exceed 1.5 and the ratio between highest and lowest combined 
rating factors for age and geographic area may not exceed 2.' 
Amend the amendment in Part A in section 6 in paragraph D in subparagraph (5) in 
the 3rd line (page 5, line 5 in amendment) by inserting after the following: "age" the 
following: 'and geographic area' 
Amend the amendment in Part A in section 6 in paragraph D in subparagraph (5) in 
the last line (page 5, line 7 in amendment) by inserting after the following: "65 years of 
age." the following: 'In determining the rating factor for geographic area pursuant to this 
subparagraph, the ratio between the highest and lowest rating factor used by a carrier for 
geographic area may not exceed 1.5 and the ratio between highest and lowest combined 
rating factors for age and geographic area may not exceed 2.5.' 
HOUSE AMENDMENT 
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HOUSE AMENDMENT ,,(J-.' to COMMITIEE AMENDMENT "A" to H.P. 979, L.D. 1333 
Amend the amendment in Part A in section 6 in paragraph D in subparagraph (6) in 
the 3rd line (page 5, line 10 in amendment) by inserting after the following: "age" the 
following: 'and geographic area' 
Amend the amendment in Part A in section 6 in paragraph D in subparagraph (6) in 
the 5th line (page 5, line 12 in amendment) by inserting after the following: "65 years of 
age." the following: 'In determining the rating factor for geographic area pursuant to this 
subparagraph, the ratio between the highest and lowest rating factor used by a carrier for 
geographic area may not exceed 1.5 and the ratio between highest and lowest combined 
rating factors for age and geographic area may not exceed 3.' 
Amend the amendment in Part A in section 6 in paragraph D in subparagraph (7) in 
the 3rd line (page 5, line 15 in amendment) by inserting after the following: "~" the 
following: 'and geographic area' 
Amend the amendment in Part A in section 6 in paragraph D in subparagraph (7) in 
the 5th line (page 5, line 17 in amendment) by inserting after the following: "65 years of 
age." the following: 'In determining the rating factor for geographic area pursuant to this 
subparagraph, the ratio between the highest and lowest rating factor used by a carrier for 
geographic area may not exceed 1.5 and the ratio between highest and lowest combined 
rating factors for age and geographic area may not exceed 4.' 
Amend the amendment in Part A in section 6 in paragraph D in subparagraph (8) in 
the 3rd line (page 5, line 20 in amendment) by inserting after the following: "~" the 
following: 'and geographic area' 
Amend the amendment in Part A in section 6 in paragraph D in subparagraph (8) in 
the 5th line (page 5, line 22 in amendment) by inserting after the following: "65 years of 
age." the following: 'In determining the rating factor for geographic area pursuant to this 
subparagraph, the ratio between the highest and lowest rating factor used by a carrier for 
geographic area may not exceed 1.5 and the ratio between highest and lowest combined 
rating factors for age and geographic area may not exceed 5.' 
Amend the amendment in Part A in section 8 in paragraph H in subparagraph (1) in 
the 3rd line (page 5, line 38 in amendment) by inserting after the following: "~" the 
following: 'and geographic area' 
Amend the amendment in Part A in section 8 in paragraph H in subparagraph (1) in 
the last line (page 5, line 40 in amendment) by inserting after the following: "65 years of 
age." the following: 'In determining the rating factor for geographic area pursuant to this 
subparagraph, the ratio between the highest and lowest rating factor used by a carrier for 
geographic area may not exceed 1.5 and the ratio between highest and lowest combined 
rating factors for age and geographic area may not exceed 2.' 
Amend the amendment in Part A in section 8 in paragraph H in subparagraph (2) in 
the 3rd line (page 6, line 1 in amendment) by inserting after the following: "age" the 
following: 'and geographic area' 
Amend the amendment in Part A in section 8 in paragraph H in subparagraph (2) in 
the last line (page 6, line 3 in amendment) by inserting after the following: "65 years of 
age." the following: 'In determining the rating factor for geographic area pursuant to this 
subparagraph, the ratio between the highest and lowest rating factor used by a carrier for 
HOUSE AMENDMENT 
t-,. .,. 
HOUSE AMENDMENT "6-" to COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
geographic area may not exceed 1.5 and the ratio between highest and lowest combined 
rating factors for age and geographic area may not exceed 2.5.' 
Amend the amendment in Part A in section 8 in paragraph H in subparagraph (3) in 
the 3rd line (page 6, line 6 in amendment) by inserting after the following: "~" the 
following: 'and geographic area' 
Amend the amendment in Part A in section 8 in paragraph H in subparagraph (3) in 
the 5th line (page 6, line 8 in amendment) by inserting after the following: "65 years of 
age." the following: 'In determining the rating factor for geographic area pursuant to this 
subparagraph, the ratio between the highest and lowest rating factor used by a carrier for 
geographic area may not exceed 1.5 and the ratio between highest and lowest combined 
rating factors for age and geographic area may not exceed 3.' 
Amend the amendment in Part A in section 8 in paragraph H in subparagraph (4) in 
the 3rd line (page 6, line 11 in amendment) by inserting after the following: "~" the 
following: 'and geographic area' 
Amend the amendment in Part A in section 8 in paragraph H in subparagraph (4) in 
the 5th line (page 6, line 13 in amendment) by inserting after the following: "65 years of 
age." the following: 'In determining the rating factor for geographic area pursuant to this 
subparagraph, the ratio between the highest and lowest rating factor used by a carrier for 
geographic area may not exceed 1.5 and the ratio between highest and lowest combined 
rating factors for age and geographic area may not exceed 4.' 
Amend the amendment in Part A in section 8 in paragraph H in subparagraph (5) in 
the 3rd line (page 6, line 16 in amendment) by inserting after the following: "age" the 
following: 'and geographic area' 
Amend the amendment in Part A in section 8 in paragraph H in subparagraph (5) in 
the 5th line (page 6, line 18 in amendment) by inserting after the following: "65 years of 
age." the following: 'In determining the rating factor for geographic area pursuant to this 
subparagraph, the ratio between the highest and lowest rating factor used by a carrier for 
geographic area may not exceed 1.5 and the ratio between highest and lowest combined 
rating factors for age and geographic area may not exceed 5.' 
Amend the amendment by relettering or renumbering any nonconsecutive Part letter 
or section number to read consecutively. 
SUMMARY 
Committee Amendment "A" changes the laws governing community rating for 
individual and small group health insurance as they relate to age, smoking status and 
geographic area. This amendment eliminates the changes relating to geographic area, 
thus including rating on the basis of geographic area inside of the rating bands for age 
HOUSE AMENDMENT 
HOUSE AMENDMENT "r;., to COMMITTEE AMENDMENT "An to H.P. 979, L.D. 1333 
instead of allowing rating outside of the bands. 
This amendment further restricts rating on the basis of geographic area within the 
bandstoafactorofl.~~ /l;; L /_ 
SPONSOREDBY:~~~ 
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.~ ________ __ 
(Representative GOODE) 
TOWN: Bangor 
HOUSE AMENDMENT