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_H186 (House)
Amends: 24-A MRSA §2736-C, 24-A MRSA §2, 5 MRSA §12004-G, 24-A MRSA §423-E, 24-A MRSA §405, 24-A MRSA §40, 24-A MRSA §405-B, 24-A MRSA §14, 24-A MRSA §4319, 24-A MRSA §2839-A, 24-A MRSA §2850-B, 24-A MRSA §4204, 24-A MRSA §4303, 24-A MRSA §6603, 24-A MRSA §2849-B, 24-A MRSA §6702, 24-A MRSA §6704, 24-A MRSA §6706, 24-A MRSA §6708, 24-A MRSA §671, 24-A MRSA §6719, 5 MRSA §12004, 22 MRSA §32, 22 MRSA §333-A, 22 MRSA §335, 22 MRSA §412, 22 MRSA §1844, 22 MRSA §1849, 22 MRSA §2061, 24-A MRSA §2694-A, 24-A MRSA §2752, 24-A MRSA §6904, 24-A MRSA §6951, 24-A MRSA §6952

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 bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'PART A 
Sec. A-I. 24-A MRSA §2736-C, sub-§2, ~C, as amended by PL 2001, c. 410, 
Pt. A, § 1 and affected by § 1 0, is further amended to read: 
C. A carrier may vary the premium rate due to smoking status geographic area and 
family membership. The superintendent may adopt rules setting forth appropriate 
methodologies regarding rate discounts rating based on smoking status geographic 
area. Rules adopted pursuant to this paragraph are routine technical rules as defined 
in Title 5, chapter 375, subchapter H-A 2-A. 
Sec. A-2. 24-A MRSA §2736-C, sub-§2, ~, as amended by PL 2007, c. 629, 
Pt. A, §4, is further amended to read: 
D. A carrier may vary the premium rate due to age and geographio area smoking 
status in accordance with the limitations set out in this paragraph. 
(1) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State between December 1, 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 
14, 1995, the premium rate may not deviate above or below the community rate 
filed by the carrier by more than 33%. 
COMMITTEE AMENDMENT 
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COMMITIEE AMENDMENT "A" to H.P. 979, L.D. 1333 
(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 June 
30,2-009 2012, 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 deli¥ery, continued or renevfed in this State on or after July 1, 2QQ9, for each 
health benefit plan offered by a carrier, the highest premium rate for each ratiflg 
tier may flOt exceed 2.5 times the premium rate that could be charged to afl 
eligible indi¥idual 'Nith the lowest premium rate for that ratiflg tier ifl a givefl 
ratiflg period. For purposes of this subparagraph, "rating tier" meaflS each 
category of ifldi¥idual or family compositiofl for \yhich a carrier charges separate 
rate57 
(a) In determining the rating factor for geographic area purSUaflt to this 
subparagraph, the ratio betweefl the highest afld lowest ratiflg factor used by a 
carrier for geographic area may flOt exceed 1.5 afld the ratio betvfeefl highest 
afld lovlest combined rating factors for age afld geographic area may not 
exceed 2.5. 
(b) Ifl determifliflg rating factors for age afld geographic area pursuant to this 
subparagraph, flO resulting rates, takiflg iflto account the saviflgs resulting 
from the reiRsuraflce program created by chapter 54, may exceed the rates 
that would have resulted from USiflg proj ected claims afld expeflses afld the 
ratiflg factors applicable prior to July 1, 2QQ9, as determifled without takiflg 
iflto account the sa¥iflgs resultiflg from the MaiRe Ifldi¥idual ReiflsuraflCe 
Associatiofl established ifl chapter 54. 
(c) The superifltefldeflt shall adopt rules settiflg forth appropriate 
methodologies regardiflg determiflatiofl of ratiflg factors pursuaflt to this 
subparagraph. Rules adopted pursuaflt to this di¥isiofl are routifle technical 
rules as defifled ifl Title 5, chapter 375, subchapter 2 A. 
(5) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State between July 1, 2012 and 
December 31, 2013, the maximum rate differential due to age filed by the carrier 
as determined by ratio is 3 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 filed by the carrier 
as determined by ratio is 4 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. 
(7) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State on or after January 1, 2015, the 
maximum rate differential due to age filed by the carrier as determined by ratio is 
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. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
(8) 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 
maximum rate differential due to smoking status filed by the carrier as 
determined by ratio is 1.5 to 1. 
Sec. A-3. 24-A MRSA §2736-C, sub-§2, ~H, as enacted by PL 2007, c. 629, Pt. 
A, §6, is repealed. 
Sec. A-4. 24-A MRSA §2736-C, sub-§2, ~ is enacted to read: 
1. A carrier that offered individual health plans prior to July 1, 2012 may close its 
individual book of business sold prior to July 1, 2012 and may establish a separate 
community rate for individuals applying for coverage under an individual health plan 
on or after July 1, 2012. If a carrier closes its individual book of business as 
permitted under this paragraph, the carrier may vary the premium rate for individuals 
in that closed book of business only as permitted in this paragraph. 
(1) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State between July 1, 2012 and 
December 31, 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 and 
December 31, 2013, the maximum rate differential due to age 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 filed by the carrier 
as determined by ratio is 3 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. 
(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 filed by the carrier 
as determined by ratio is 4 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 on or after January 1, 2016, the 
maximum rate differential due to age filed by the carrier as determined by ratio is 
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 on or after July 1, 2012, the 
maximum rate differential due to smoking status filed by the carrier as 
determined by ratio is 1.5 to 1. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
The superintendent shall establish by rule procedures and policies that facilitate the 
implementation of this paragraph, including, but not limited to, notice requirements 
for policyholders and experience pooling requirements of individual health products. 
When 
establishing 
rules 
regarding 
experience 
pooling 
requirements, 
the 
superintendent shall ensure, to the greatest extent possible, the availability of 
affordable options for individuals transitioning from the closed book of business. 
Rules adopted pursuant to this paragraph are routine technical rules as defined in 
Title 5, chapter 375. subchapter 2-A. The superintendent shall direct the Consumer 
Health Care Division, established in section 4321, to work with carriers and health 
advocacy organizations to provide information about comparable alternative 
insurance options to individuals in a· carrier's closed book of business and upon 
request to assist individuals to facilitate the transition to an individual health plan in 
that carrier's or another carrier's open book of business. 
Sec. A-S. 24-A MRSA §2S0S-B, sub-§2, ~C, as amended by PL 2001, c. 410, 
Pt. A, §3 and affected by § 10, is further amended to read: 
C. A carrier may vary the premium rate due to occupation and industry, geographic 
area, family membership, smoking status, participation in wellness programs and 
group size. 
The superintendent may adopt rules setting forth appropriate 
methodologies regarding rate discounts for participation in wellness programs and 
rating for geographic area, family membership and group size pursuant to this 
paragraph. Rules adopted pursuant to this paragraph are routine technical rules as 
defined in Title 5, chapter 375, subchapter II-A 2-A. 
Sec. A-6. 24-A MRSA §2S0S-B, sub-§2, ~, as amended by PL 2001, c. 410, 
Pt. A, §4 and affected by § 1 0, is further amended to read: 
D. A carrier may vary the premium rate due to age, oeeupation or industry and 
geographie area and smoking status 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 be.tween 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 
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 after 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%, exeept as provided in 
paragraph D 1. 
(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 
December 31, 2012, the maximum rate differential due to age filed by the carrier 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
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 and 
December 31, 2013, the maximum rate differential due to age 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 filed by the carrier 
as determined by ratio is 3 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. 
(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 filed by the carrier 
as determined by ratio is 4 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. 
(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 filed by the carrier as determined by ratio is 
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. 
(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 smoking status filed by the carrier as 
determined by ratio is 1.5 to 1. 
Sec. A-7. 24-A MRSA §2S0S-B, sub-§2, ~-1, as amended by PL 2001, c. 410, 
Pt. A, §5 and affected by § 10, is repealed. 
Sec. A-S. 24-A MRS A §2S0S-B, sub-§2, ~ 
is enacted to read: 
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. 
0) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State between October 1, 2011 and 
December 31, 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 and 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
December 31, 2013, the maximum rate differential due to age 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 filed by the carrier 
as determined by ratio is 3 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. 
(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 filed by the carrier 
as determined by ratio is 4 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 on or after January 1, 2016, the 
maximum rate differential due to age filed by the carrier as determined by ratio is 
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 on or after October 1, 2011, the 
maximum rate differential due to smoking status filed by the carrier as 
determined by ratio is 1.5 to 1. 
PARTB 
Sec. B-1. 5 MRSA §12004-G, sub-§14-F, as enacted by PL 2007, c. 629, Pt. A, 
§ 1, is repealed. 
Sec. B-2. 5 MRSA §12004-G, sub-§14-H is enacted to read: 
14-H. 
Health Care 
Board of Directors 
Expenses Only 
of the Maine 
Guaranteed Access 
Reinsurance 
Association 
24-A §3953 
Sec. B-3. 24-A MRSA §423-E, as enacted by PL 2007, c. 629, Pt. A, §2, is 
repealed. 
Sec. B-4. 24-A MRS A §2736-C, sub-§2, ,G, as enacted by PL 2007, c. 629, Pt. 
A, § 5, is repealed. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
Sec. B-S. 24-A MRSA §2736-C, sub-§2-A, as enacted by PL 2007, c. 629, Pt. 
A, § 7, is repealed. 
Sec. B-6. 24-A MRSA §2736-C, sub-§3, as corrected by RR 2001, c. 1, §30, is 
amended to read: 
3. Guaranteed issuance and guaranteed renewal. Carriers providing individual 
health plans must meet the following requirements on issuance and renewal. 
A. Coverage must be guaranteed to all residents of this State other than those eligible 
without paying a premium for Medicare Part A and may be reinsured through the 
Maine Guaranteed Access Reinsurance Association established pursuant to chapter 
54-A. On or after JaRaaT)' 1, 1998 July 1, 2012, coverage must be guaranteed to all 
legally domiciled federally eligible individuals, as defined in section 2848, regardless 
of the length of time they have been legally domiciled in this State. Except for 
federally eligible individuals, coverage need not be issued to an individual whose 
coverage was terminated for nonpayment of premiums during the previous 91 days or 
for fraud or intentional misrepresentation of material fact during the previous 12 
months. 
When a managed care plan, as defined by section 4301-A, provides 
coverage a carrier may: 
(1) Deny coverage to individuals who neither live nor reside within the approved 
service area of the plan for at least 6 months of each year; and 
(2) 
Deny coverage to individuals if the carrier has demonstrated to the 
superintendent's satisfaction that: 
(a) The carrier does not have the capacity to deliver services adequately to 
additional enrollees within all or a designated part of its service area because 
of its obligations to existing enrollees; and 
(b) The carrier is applying this provision uniformly to individuals and groups 
without regard to any health-related factor. 
A carrier that denies coverage in accordance with this paragraph may not enroll 
individuals residing within the area subject to denial of coverage or groups or 
subgroups within that area for a period of 180 days after the date of the first 
denial of coverage. 
B. Renewal is guaranteed, pursuant to section 2850-B. 
C. A carrier is exempt from the guaranteed issuance requirements of paragraph A 
provided that the following requirements are met. 
(1) The carrier does not issue or deliver any new individual health plans on or 
after the effective date of this section; 
(2) If any individual health plans that were not issued on a guaranteed renewable 
basis are renewed on or after December I, 1993, all such policies must be 
renewed by the carrier and renewal must be guaranteed after the first such 
renewal date; and 
(3) The carrier complies with the rating practices requirements of subsection 2. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 979, L.D. l333 
D. Notwithstanding paragraph A, carriers offering supplemental coverage for the 
Civilian Health and Medical Program for the Uniformed Services, CHAMPUS, are 
not required to issue this coverage if the applicant for insurance does not have 
CHAMPUS coverage. 
E. 
A carrier may evaluate the health status of an individual for purposes of 
designating that individual for reinsurance through the Maine Guaranteed Access 
Reinsurance Association established in chapter 54-A. For individual health plans 
issued on or after July 1, 2012, the carrier shall use the health statement developed by 
the Board of Directors of the Maine Guaranteed Access Reinsurance Association 
pursuant to section 3955, subsection 1, paragraph E to make a designation and may 
not use any other method to determine the health status of an individual. For purposes 
of this subsection, "health statement" means any information intended to inform the 
carrier or an insurance producer acting on behalf of a carrier of the health status of an 
enrollee or prospective enrollee in an individual health plan. 
F. An individual may not be denied health insurance due to age or gender. This 
paragraph may not be construed to require a carrier to actively market health 
insurance to an individual 65 years of age or older. 
Sec. B-7. 24-A MRSA c. 54, as amended, is repealed. 
Sec. B-8. 24-A MRSA c. 54-A is enacted to read: 
CHAPTER S4-A 
MAINE GUARANTEED ACCESS REINSURANCE ASSOCIATION ACT 
§39S1. Short title 
This chapter may be known and cited as "the Maine Guaranteed Access Reinsurance 
Association Act. " 
§39S2. Definitions 
As used in this chapter, unless the context otherwise indicates, the following terms 
have the following meanings. 
1. Association. "Association" means the Maine Guaranteed Access Reinsurance 
Association under section 3953. 
2. Board. "Board" means the Board of Directors of the Maine Guaranteed Access 
Reinsurance Association under section 3953, subsection 2. 
3. 
Covered person. 
"Covered person" means an individual covered as a 
policyholder, participant or dependent under a plan, policy or contract. of medical 
insurance. 
4. Dependent. "Dependent" means a spouse, a domestic partner as defined in 
section 2832-A, subsection 1 or a child under 26 years of age. 
S. Health maintenance organization. "Health maintenance organization" means an 
organization authorized under chapter 56 to operate a health maintenance organization in 
this State. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
6. Insurer. "Insurer" means an entity that is authorized to write medical insurance 
or that provides medical insurance in this State. 
For the purposes of this chapter, 
"insurer" includes an insurance company, a nonprofit hospital and medical service 
organization, a fraternal benefit society, a health maintenance organization, a self-insured 
employer subject to state regulation as described in section 2848-A, a 3rd-party 
administrator, a multiple-employer welfare arrangement, a reinsurer that reinsures health 
insurance in this State, a captive insurance company established pursuant to chapter 83 
that insures the health coverage risks of its members, the Dirigo Health Program 
established in chapter 87 or any other state-sponsored health benefit program whether 
fully insured or self-funded. 
7. Medical insurance. "Medical insurance" means a hospital and medical expense-
incurred policy, nonprofit hospital and medical service plan, health maintenance 
organization subscriber contract or other health care plan or arrangement that pays for or 
furnishes medical or health care services whether by insurance or otherwise, whether sold 
as an individual or group policy. "Medical insurance" does not include accidental injury, 
specified disease, hospital indemnity, dental, vision, disability income, Medicare 
supplement, long-term care or other limited benefit health insurance or credit insurance; 
coverage issued as a supplement to liability insurance; insurance arising out of workers' 
compensation or similar law; automobile medical payment insurance; or insurance under 
which benefits are payable with or without regard to fault and that is statutorily required 
to be contained in any liability insurance policy or equivalent self-insurance. 
8. Medicare. "Medicare" means coverage under both Parts A and B of Title XVIII 
of the federal Social Security Act, 42 United States Code, Section 1395 et seq., as 
amended. 
9. Member insurer. "Member insurer" means an insurer that offers individual 
health plans and is actively marketing individual health plans in this State. 
10. Producer. "Producer" means a person who is licensed to sell health insurance in 
this State. 
11. Reinsurer. "Reinsurer" means an insurer from whom a person providing health 
insurance for a resident procures insurance for itself with the insurer with respect to all or 
part of the medical insurance risk of the person. "Reinsurer" includes an insurer that 
provides employee benefits excess insurance. 
12. Resident. "Resident" has the same meaning as in section 2736-C, subsection 1, 
paragraph C-2. 
13. Third-party administrator. "Third-party administrator" means an entity that is 
paying or processing medical insurance claims for a resident. 
§3953. Maine Guaranteed Access Reinsurance Association 
1. 
Guaranteed access reinsurance mechanism established. 
The Maine 
Guaranteed Access Reinsurance Association is established as a nonprofit legal entity. As 
a condition of doing business in the State, an insurer that has issued or administered 
medical insurance within the previous 12 months or is actively marketing a medical 
insurance policy or medical insurance administrative services in this State must 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
participate in the association. The Dirigo Health Program established in chapter 87 and 
any other state-sponsored health benefit program shall also participate in the association. 
2. Board of directors. The association is governed by the Board of Directors of the 
Maine Guaranteed Access Reinsurance Association established under Title 5, section 
12004-G, subsection 14-H. 
A. The board consists of 11 members appointed as described in this paragraph: 
(1) Six members appointed by the superintendent: 2 members chosen from the 
general public and who are not associated with the medical profession, a hospital 
or an insurer; 2 members who represent medical providers; one member who 
represents a statewide organization that represents small businesses; and one 
member who represents producers. 
A board member appointed by the 
superintendent may not be removed without cause; and 
(2) Five members appointed by the member insurers, at least one of whom is a 
domestic insurer and at least one of whom is a 3rd-party administrator. 
B. Members of the board serve for 3-year terms. Members of the board may serve 
up to 3 consecutive terms. 
C. The board shall elect one of its members as chair. 
D. Board members may be reimbursed from funds of the association for actual and 
necessary expenses incurred by them as members but may not otherwise be 
compensated for their services. 
3. Plan of operation; rules. The board shall adopt a plan of operation in accordance 
with the requirements of this chapter and submit its articles, bylaws and operating rules to 
the superintendent for approval. If the board fails to adopt the plan of operation and 
suitable articles and bylaws within 90 days after the appointment of the board, the 
superintendent shall adopt rules to effectuate the requirements of this chapter and those 
rules remain in effect until superseded by a plan of operation and articles and bylaws 
submitted by the board and approved by the superintendent. 
Rules adopted by the 
superintendent pursuant to this subsection are routine technical rules as defined in Title 5, 
chapter 375, subchapter 2-A. 
4. Immunity. A board member is not liable and is immune from suit at law or 
equity for any conduct performed in good faith that is within the scope of the board's 
jurisdiction. 
§39S4. Liability and indemnification 
1. Liability. The board and its employees may not be held liable for any obligations 
of the association. A cause of action may not arise against the association; the board, its 
agents or its employees; a member insurer or its agents, employees or producers; or the 
superintendent for any action or omission in the performance of powers and duties 
pursuant to this chapter. 
2. 
Indemnification. 
The board mav provide in its bylaws or rules for 
indemnification of, and legal representation for, its members and employees. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
§3955. Duties and powers of association 
1. Duties. The association shall: 
A. 
Establish administrative and accounting procedures for the operation of the 
association; 
B. Select an association administrator in accordance with section 3956; 
C. Collect the assessments provided in section 3957. The level of payments must be 
established by the board. Assessments must be collected pursuant to the plan of 
operation approved by the board and adopted pursuant to section 3953, subsection 3. 
In addition to the collection of such assessments, the association shall collect an 
organizational assessment or assessments from all insurers as necessary to provide for 
expenses that have been incurred or are estimated to be incurred before receipt of the 
first calendar year assessments; 
D. Establish procedures for the handling and accounting of association assets; 
E. Develop a health statement to be used by a member insurer to designate a resident 
for reinsurance pursuant to section 3959; and 
F. Provide for reinsurance for member insurers pursuant to section 3958. 
2. Powers. The association may: 
A. Exercise powers granted to nonprofit corporations under the laws of this State; 
B. 
Enter into contracts as necessary or proper to carry out the provisions and 
purposes of this chapter and may, with the approval of the superintendent, enter into 
contracts with similar organizations of other states for the joint performance of 
common administrative functions or with persons or other organizations for the 
performance of administrative functions; 
C. Sue or be sued and may take legal actions necessary or proper to recover or 
collect assessments provided in section 3957 due the association; 
D. Take legal actions necessary to avoid the payment of improper claims against the 
association or the coverage provided by or through the association, to recover any 
amounts erroneously or improperly paid by the association, to recover amounts paid 
by the association as a result of mistake of fact or law or to recover other amounts 
due the association; 
E. Appoint appropriate legal, actuarial and other committees as necessary to provide 
technical assistance and any other function within the authority of the association; 
F. Borrow money to effect the purposes of the association. Notes or other evidence 
of indebtedness of the association not in default must be legal investments for 
insurers and may be carried as admitted assets; 
G. 
Provide for reinsurance of risks incurred by members of the association and 
purchase reinsurance retroceding those risks to the extent the board determines 
appropriate. The provision of reinsurance may not subject the association to any of 
the capital or surplus requirements, if any, otherwise applicable to reinsurers; and 
H. Apply for funds or grants from public or private sources, including federal grants. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
3. Additional duties and powers. 
The superintendent may, by rule, establish 
additional powers and duties of the board and may adopt such rules as are necessary and 
proper to implement this chapter. Rules adopted pursuant to this subsection are routine 
technical rules as defined in Title 5, chapter 375, subchapter 2-A. 
4. Review for solvency. An annual review of the association for solvency must be 
performed by an independent certified public accountant using generally accepted 
accounting principles. 
The association shall submit the annual review to the 
superintendent. If the superintendent determines that the funds of the association are 
insufficient to support the need for reinsurance, the superintendent may order the 
association to increase its assessments. If the superintendent determines that the funds of 
the association are insufficient, the superintendent may order the association to charge 
additional assessments. 
5. 
Annual report. 
The association shall report annually to the joint standing 
committee of the Legislature having jurisdiction over health insurance matters by March 
15th. The report must include information on the financial solvency of the association 
and the administrative expenses of the association. 
6. Audit. The association must be audited at least annually by an independent 
certified public auditor. A copy of the audit must be provided to the superintendent and 
to the joint standing committee of the Legislature having jurisdiction over health 
insurance matters. 
§3956. Selection of administrator 
1. 
Selection of administrator. 
The board shall select an insurer or 3rd-party 
administrator through a competitive bidding process to administer the reinsurance 
provided by the association. 
2. Contract with administrator. The administrator selected pursuant to subsection 
serves for a period of 3 years pursuant to a contract with the association. At least one 
year prior to the expiration of that 3-year period of service, the board shall invite all 
insurers, including the current administrator, to submit bids to serve as the administrator 
for the succeeding 3-year period. 
The board shall select the administrator for the 
succeeding period at least 6 months prior to the ending of the 3-year period. 
3. Duties of administrator. The administrator selected pursuant to subsection 
shall: 
A. Perform all administrative functions relating to the association; 
B. Submit regular reports to the board regarding the operation of the association. 
The frequency. content and form of the reports must be as determined by the board; 
C. Following the close of each calendar year, determine reinsurance premiums less 
any administrative expense allowance. the expense of administration pertaining to the 
reinsurance operations of the association and the incurred losses of the year, and 
report this information to the superintendent; and 
D. Pay reinsurance amounts as provided for in the plan of operation under section 
3953, subsection 3. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
4. Payment to administrator. The administrator selected pursuant to subsection 1 
must be paid, as provided in the contract of the association under subsection 2, for its 
direct and indirect expenses incurred in the performance of its services. As used in this 
subsection, "direct and indirect expenses" includes that portion of the audited 
administrative costs, printing expenses, claims administration expenses, management 
expenses, building overhead expenses and other actual operating and administrative 
expenses of the administrator that are approved by the board as allocable to the 
administration of the association and included in the bid specifications pursuant to 
subsection 1. 
§3957. Assessments against insurers 
1. Assessments. For the purpose of providing the funds necessary to carry out the 
powers and duties of the association under section 3955, the board shall assess insurers at 
such a time and for such amounts as the board finds necessary. Assessments are due not 
less than 30 days after written notice to the insurers and accrue interest at 12% per annum 
on and after the due date. 
2. Maximum assessment. The board shall assess each insurer an amount not to 
exceed $4 per month per covered person enrolled in medical insurance insured, reinsured 
or administered by the insurer. An insurer may not be assessed on policies or contracts 
insuring federal or state employees. 
3. Determination of assessment. The board shall make reasonable efforts to ensure 
that each covered person is counted only once with respect to an assessment. For that 
purpose, the board shall require each insurer that obtains excess or stop loss insurance to 
include in its count of covered persons all persons whose coverage is insured, in whole or 
in part, through excess or stop loss coverage. The board shall allow a reinsurer to exclude 
from its number of covered persons those who have been counted by the primary insurer 
or by the primary reinsurer or primary excess or stop loss insurer for the purpose of 
determining its assessment under this subsection. The board may verify the amount of 
each insurer's assessment based on annual statements and other reports determined to be 
necessary by the board. The board may use any reasonable method of estimating the 
number of covered persons of an insurer if the specific number is not reported. 
4. Organizational assessments. The board may assess insurers for the purpose of 
organizing the association. Organizational assessments must be equal in amount for all 
insurers but may not exceed $500 per insurer for all such assessments. 
5. Assessments to cover net losses. In addition to the assessment described in 
subsections 1 to 3, the board shall assess insurers at such a time and for such amounts as 
the board finds necessary to cover any net loss in accordance with this subsection. 
A. Before April 1 st of each year, the association shall determine and report to the 
superintendent the association's net losses for the previous calendar year, including 
administrative expenses and incurred losses for the year, taking into account 
investment income and other appropriate gains and losses and an estimate of the 
assessments needed to cover the losses incurred by the association in the previous 
calendar year. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
B. Individual assessments of each insurer are determined by multiplying the absolute 
value of net losses, if net earnings are negative, by a fraction, the numerator of which 
is the insurer's total premiums earned in the preceding calendar year from all health 
benefit plans, including excess or stop loss coverage, and the denominator of which is 
the total premiums earned in the preceding calendar year from all health benefit 
plans. 
C. The association shall impose a penalty of interest on insurers for late payment of 
assessments. 
6. Deferral of assessment. An insurer may apply to the superintendent for a deferral 
of all or part of an assessment imposed by the association under this section. The 
superintendent may defer all or part of the assessment if the superintendent determines 
that the payment of the assessment would place the insurer in a financially impaired 
condition. If all or part of the assessment is deferred, the amount deferred must be 
assessed against other insurers in a proportionate manner consistent with this section. 
The insurer that receives a deferral remains liable to the association for the amount 
deferred and is prohibited from reinsuring any person through the association until such 
time as the insurer pays the assessments. 
7. Excess funds. If assessments and other receipts by the association, board or 
administrator selected pursuant to section 3956 exceed the actual losses and 
administrative expenses of the association, the board shall hold the excess as interest and 
shall use those excess funds to offset future losses or to reduce reinsurance premiums. As 
used in this subsection, "future losses" includes reserves for claims incurred but not 
reported. 
8. Failure to pay assessment. The superintendent may suspend or revoke, after 
notice and hearing, the certificate of authority to transact insurance in this State of any 
member insurer that fails to pay an assessment. As an alternative, the superintendent may 
levy a penalty on any insurer that fails to pay an assessment when due. In addition, the 
superintendent ~ay use any power granted to the superintendent by this Title to collect 
any unpaid assessment. 
9. Federal funding; reduction of assessment. The board shall work collaboratively 
with the Dirigo Health Program established pursuant to chapter 87 to develop a proposal 
to access unused funds from the State's allocation from the federal preexisting condition 
insurance plan established pursuant to the federal Affordable Care Act to be used to fund, 
in part, the operations of the association. Any federal funding obtained by the association 
must be used to reduce the assessment of member insurers required under this section. In 
developing the proposal, funds necessary for the federal preexisting condition insurance 
plan as currently administered by Dirigo Health have priority over any funds transferred 
to the association. 
§3958. Reinsurance; premium rates 
1. Reinsurance amount. A member insurer offering an individual health plan must 
be reinsured by the association to the level of coverage provided in this subsection and is 
liable to the association for the reinsurance premium rate established in accordance with 
subsection 2. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
A. The association may not reimburse a member insurer with respect to claims of a 
person designated for reinsurance by the member insurer pursuant to section 3959 
until the insurer has incurred an initial level of claims for that person of $7,500 for 
covered benefits in a calendar year. In addition, the insurer is responsible for 10% of 
the next $25,000 of claims paid during a calendar year. 
The association shall 
reimburse insurers for claims paid in excess of $32,500. 
The association may 
annually adjust the initial level of claims and the maximum limit to be retained by the 
insurer to reflect increases in costs and utilization within the standard market for 
individual health plans within the State. The adjustments may not be less than the 
annual change in the' Consumer Price Index for medical care services unless the 
superintendent approves a lower adjustment factor as requested by the association. 
B. An insurer shall apply all managed care, utilization review, case management, 
preferred provider arrangements, claims processing and other methods of operation 
without regard to whether claims paid for coverage are reinsured under this 
subsection. 
2. Premium rates. The association, as part of the plan of operation under section 
3953, subsection 3, shall establish a methodology for determining premium rates to be 
charged member insurers to reinsure persons eligible for coverage under this chapter. 
The methodology must include a system for classification of persons eligible for coverage 
that reflects the types of case characteristics used by insurers for individual health plans 
pursuant to section 2736-C. The methodology must provide for the development of base 
reinsurance premium rates, subject to approval of the superintendent, set at levels that 
reasonably approximate gross premiums charged for individual health plans and that are 
adjusted to reflect retention levels required under this Title. 
The association shall 
periodically review the methodology established under this subsection and may make 
changes to the methodology as needed with the approval of the superintendent. The 
association may consider adjustments to the premium rates charged for reinsurance to 
reflect the use of effective cost containment and managed care arrangements by a insurer. 
§3959. Designation for reinsurance 
1. Designation. The association shall provide reinsurance to a member insurer for 
persons designated by a member insurer using the health statement developed by the 
board pursuant to section 3955, subsection 1, paragraph F. 
2. Designation without application. The board shall develop a list of medical or 
health conditions for which a person is automatically designated for reinsurance. 
A 
person who demonstrates the existence or history of any medical or health conditions on 
the list developed by the board may not be required to complete the health statement 
specified in subsection 1. The board may amend the list from time to time as appropriate. 
§3960. Actions against association or insurers based upon joint or collective actions 
Participation in the association, the establishment of reinsurance rates, forms or 
procedures or any other joint or collective action required by this chapter may not be the 
basis of any legal action or criminal or civil liability or penalty against the association or 
an insurer. 
COMMITTEE AMENDMENT 
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.~. 
COMMITIEE AMENDMENT "A" to H.P. 979, L.D. 1333 
§3961. Reimbursement of member insurer 
1. 
Reimbursement. 
A member insurer may seek reimbursement from the 
association and the association shall reimburse the member insurer to the extent claims 
made by a covered person on a calendar year basis after July 1,2012 exceed the amounts 
otherwise eligible for reimbursement pursuant to section 3958, subsection 1, paragraph A, 
if: 
A. The member insurer sold an individual health plan to the covered person between 
December 1, 1993 and July 1, 2012, the individual health plan that was sold has been 
continuously renewed by the covered person and the member insurer has closed its 
book of business for individual health plans sold between December 1, 1993 and July 
1, 2012; and 
B. The member insurer is able to determine through the use of individual health 
statements, claims history, risk scores or any reasonable means that, between 
December 1, 1993 and July 1, 2012, while the person received coverage under an 
individual health plan issued by the member insurer, the covered person would have 
been designated by the member insurer pursuant to section 3959, subsection 1. 
2. Rules. The superintendent may adopt rules to facilitate payment to a member 
insurer pursuant to this section. Rules adopted pursuant to this subsection are routine 
technical rules as defined in Title 5, chapter 375, subchapter 2-A, 
Sec. B-9. Maine Guaranteed Access Reinsurance Association staggered 
terms. 
Notwithstanding the Maine Revised Statutes, Title 24-A, section 3953, 
subsection 2, of the members of the Board of Directors of the Maine Guaranteed Access 
Reinsurance Association initially appointed by the Superintendent of Insurance, 2 
members serve for terms of one year, 2 members for terms of 2 years and 2 members for 
terms of 3 years and, of those members initially appointed by the member insurers, one 
member serves for a term of one year, 2 members serve for terms of 2 years and 2 
members serve for terms of 3 years. The appointing authority shall designate the period 
of service of each initial appointee at the time of appointment. 
Sec. B-I0. Effective date. Those sections of this Part that repeal the Maine 
Revised Statutes, Title 5, section 12004-G, subsection 14-F, Title 24-A, section 423-E, 
Title 24-A, section 2736-C, subsection 2, paragraph G, Title 24-A, section 2736-C, 
subsection 2-A and Title 24-A, chapter 54 and that section of this Part that amends Title 
24-A, section 2736-C, subsection 3 take effect July 1,2012. 
PARTC 
Sec. C-l. 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 }3receedings; rehabilitatien and liquidatien).,;",Q! 
Sec. C-2. 24-A MRS A §405, sub-§7 is enacted to read: 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
7. Transactions pursuant to individual health insurance covering residents of this 
State written by a regional insurer or health maintenance organization, as defined in 
section 405-A, duly authorized or qualified to transact individual health 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. C-3. 24-A MRSA §40S-A is enacted to read: 
§405-A. Certification of regional insurers or health maintenance organizations to 
transact individual health insurance 
1. Regional insurer or health maintenance organization defined. 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 
health insurance in Connecticut, Massachusetts, New Hampshire or Rhode Island. 
2. Certification of regional insurers or health maintenance organizations. A 
regional insurer or health maintenance organization may not transact individual health 
insurance in this State by mail, the Internet or otherwise unless the superintendent has 
issued a certification that the regional 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. 
A. A 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 domicile of that 
regional insurer and must be actively marketed in that state. 
B. A 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. 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 rules of (regional 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. " 
c.. A 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. 
D. A regional insurer or health maintenance organization shall meet the requirements 
of chapter 56-A for provider network adequacy with respect to health plans offered 
for sale in this State. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
E. A regional insurer or health maintenance organization shall meet the requirements 
of chapter 33 with respect to rates for individual health plans offered for sale in this 
State. 
F. A regional insurer or health maintenance organization shall designate an agent for 
receiving service of legal documents or process in the manner provided in this Title. 
G. A regional insurer or health maintenance organization shall meet the requirements 
of this Title with respect to allowing the superintendent access to records of the 
regional insurer or health maintenance organization. 
3. Unfair trade practices. The provisions of chapter 23 apply to a regional insurer 
or health maintenance organization permitted to transact individual health insurance 
under this section or section 405. 
4. 
Taxes; assessments. A regional insurer or health maintenance organization 
transacting individual health insurance in this State under this section is subject to 
applicable taxes or assessments imposed on insurers transacting individual health 
insurance in this State pursuant to this Title and Title 36. 
5. 
Compliance with court orders. 
A regional insurer or health maintenance 
organization transacting individual health insurance in this State under this section 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 regional insurer or health maintenance organization is in a hazardous 
financial condition. 
6. Exemption from other requirements. 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 individual health insurance under this 
section. 
7. Agreement with insurance regulators in other state. The superintendent shall 
enter into a memorandum of understanding or other agreement with the insurance 
department of the state of domicile of a regional insurer or health maintenance 
organization permitted to transact individual health insurance in this State under this 
section with respect to enforcement of the provisions of this section. 
8. Sale of policies. An individual health insurance policy, contract or certificate may 
not be offered for sale in this State pursuant to this section before January 1, 2014. 
Sec. C-4. 24-A MRSA §405-B is enacted to read: 
§405-B. Domestic insurers or licensed health maintenance organization; individual 
health insurance approved in other states 
Notwithstanding any other provision of this Title, a domestic insurer or licensed 
health maintenance organization authorized to transact individual health insurance in this 
State may offer for sale in this State an individual health plan duly authorized for sale in 
Connecticut, Massachusetts, New Hampshire or Rhode Island by a parent or corporate 
affiliate of the domestic insurer or licensed health maintenance organization if the 
following requirements are met. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
1. Certificate of authority from state of domicile. The parent or subsidiary of the 
domestic insurer or licensed health maintenance organization must hold a valid certificate 
of authority to transact individual health insurance in the state of domicile of the parent or 
corporate affiliate. 
2. Compliance with laws of state of domicile. A policy, contract or certificate of 
individual health insurance offered for sale in this State by the domestic insurer or 
licensed health maintenance organization must comply with the applicable individual 
health insurance laws in the state of domicile of the parent or corporate affiliate and must 
be actively marketed in that state. 
3. Disclosure and reporting. The domestic insurer or licensed 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 other domestic insurers or licensed health 
maintenance organizations in a format approved by the superintendent. 
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 licensed 
health maintenance organization but is governed by the laws and rules of (state of 
domicile of parent or corporate affiliate of domestic insurer or licensed health 
maintenance organization), which is the state of domicile of the parent or corporate 
affiliate of the domestic insurer or licensed 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 licensed 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. 
5. Sale of policies. A domestic insurer or licensed health maintenance organization 
may not offer an individual health plan for sale in this State pursuant to this section 
before January 1, 2014. 
Sec. C-S. 24-A MRSA §40S-C is enacted to read: 
§405-C. Domestic insurers or licensed health maintenance organizations; parity 
with regional insurers 
Notwithstanding any other provision of this Title, a domestic insurer or licensed 
health maintenance organization authorized to transact individual health insurance in this 
State may offer for sale in this State an individual health plan equivalent to any plan 
offered for sale in this State by a regional insurer or health maintenance organization 
pursuant to section 405-A. An individual health plan may not be offered for sale pursuant 
to this section before January 1, 2014. 
PARTD 
Sec. D-l. 24-A MRSA §14 is enacted to read: 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
§14. Affordable Care Act defined 
As used in this Title, "federal Affordable Care Act" means the federal Patient 
Protection and Affordable Care Act, Public Law 111-148, as amended by the federal 
Health Care and Education Reconciliation Act of 2010, Public Law 111-152, and any 
amendments to or regulations or guidance issued under those acts. 
Sec. D-2. 24-A MRSA §2736-C, sub-§2-B is enacted to read: 
2-B. Optional guaranteed loss ratio. Notwithstanding section 2736, subsection 1 
and section 2736-A, at the carrier's option, rate filings for a carrier's individual health 
plans may be filed in accordance with this subsection. Rates filed in accordance with this 
subsection are filed for informational purposes unless rate review is required pursuant to 
the federal Affordable Care Act. 
A. 
A carrier's individual health plans are considered credible if the anticipated 
average number of members during the period for which the rates will be in effect is 
at least 1,000 in the aggregate or if the individual health plans in the aggregate meet 
credibility standards adopted by the superintendent by rule. The rate filing must state 
the anticipated average number of members during the period for which the rates will 
be in effect and the basis for the estimate. If the superintendent determines that the 
number of members is likely to be less than 1,000 and the carrier does not satisfy any 
alternative credibility standards adopted by the superintendent by rule, the filing is 
subject to subsection 1 and section 2736-A. 
B. On an annual schedule as determined by the superintendent, the carrier shall file a 
report with the superintendent showing aggregate earned premiums and incurred 
claims for the period the rates were in effect. Incurred claims must include claims 
paid to a date after the end of the annual reporting period and an estimate of unpaid 
claims. The report must state how the unpaid claims estimate was determined. The 
superintendent shall determine the reporting period and the paid-to date; beginning 
January 1, 2011, both the reporting period and the paid-to date must be consistent 
with those for the rebates required pursuant to the federal Affordable Care Act and 
federal regulations adopted pursuant to the federal Affordable Care Act. 
Sec. D-3. 24-A MRSA §2736-C, sub-§5, as amended by PL 2007, c. 629, Pt. M, 
§5, is further amended to read: 
5. Loss ratios. FeF Except as provided in subsection 2-B, for all policies and 
certificates issued on or after the effective date of this section, the superintendent shall 
disapprove any premium rates filed by any carrier, whether initial or revised, for an 
individual health policy unless it is anticipated that the aggregate benefits estimated to be 
paid under all the individual health policies maintained in force by the carrier for the 
period for which coverage is to be provided will return to policyholders at least 65% of 
the aggregate premiums collected for those policies, as determined in accordance with 
accepted actuarial principles and practices and on the basis of incurred claims experience 
and earned premiums. For the purposes of this calculation, any payments paid pursuant 
to former section 6913 must be treated as incurred claims. 
Sec. D-4. 24-A MRSA §2S0S-B, sub-§2-C, ~B, as enacted by PL 2003, c. 469, 
Pt. E, §16, is amended to read: 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
B. 
On an annual schedule as determined by the superintendent, the carrier shall file 
a report with the superintendent showing aggregate earned premiums and incurred 
claims for the period the rates were in effect. Incurred claims must include claims 
paid to a date 6 months after the end of the annual reporting period determined by the 
superintendent and an estimate of unpaid claims. The report must state how the 
unpaid claims estimate was determined. 
The superintendent shall determine the 
reporting period and the paid-to date; beginning January 1, 2011, both the reporting 
period and the paid-to date must be consistent with those for the rebates required 
pursuant to section 4319 and to the federal Affordable Care Act and federal 
regulations adopted pursuant to the federal Affordable Care Act. 
Sec. D-S. 24-A MRSA §2S0S-B, sub-§2-C, ,C, as amended by PL 2007, c. 
629, Pt. M, § 10, is further amended to read: 
C. If incurred claims were less than 78% of aggregate earned premiums over a 
continuous 36 mOflth 12-month period, the carrier shall refund a percentage of the 
premium to the eurrent in foree polieyholder. For the purposes of ealeulating this 
loss ratio pereentage, any payments paid pursuant to former seetion 6913 llliist be 
treated as ineurred elaims. The exeess premium is the amount of premium above that 
amoUHt fleeessary to aehieve a 78% loss ratio for all of the earrier's small group 
polieies during the same 36 month period. 
The refund must be distributed to 
polieyholders in an amoUHt reasonably ealeulated to eorrespond to the aggregate 
experienee of all polieyholders holding polieies having similar benefits. The total of 
all refunds must equal the exeess premiums. The refund must be paid on a basis 
consistent with requirements for rebates pursuant to section 4319 and to the federal 
Affordable Care Act and federal regulations adopted pursuant to the federal 
Affordable Care Act. The superintendent may adopt rules modifying the formula for 
calculation of refunds attributable to periods that are affected by the transition to 
calendar year reporting beginning with experience for 2011. Rules adopted pursuant 
to this paragraph are routine technical rules as defined in Title 5, chapter 375, 
subchapter 2-A. 
(1) For determination ofloss-ratio percentages in 2005, actual aggregate incurred 
claims expenses include expenses incurred in 2005 and projected expenses for 
2006 and 2007. 
For determination of loss-ratio percentages in 2006, actual 
incurred claims expenses include expenses in 2005 and 2006 and projected 
expenses for 2007. 
(2) The superintendent may waive the requiremeflt for refunds during the first 3 
years after the effective date of this subsectiofl. 
Sec. D-6. 24-A MRSA §4319 is enacted to read: 
§4319. Rebates 
1. Rebates required. Carriers must provide rebates in the large group, small group 
and individual markets to the extent required by the federal Affordable Care Act and 
federal regulations adopted pursuant thereto if the medical loss ratio under subsection 2 is 
less than the minimum medical loss ratio under subsection 3. 
COMMITTEE AMENDMENT 
, ..a! 
,,~ 1 
COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
2. Medical loss ratio. For pU!p0ses of this section, the medical loss ratio is the ratio 
of the numerator to the denominator as described in paragraphs A and B, respectively, 
plus any credibility adjustment. The period for which the medical loss ratio is determined 
and the meaning of all terms used in this subsection must be in accordance with the 
federal Affordable Care Act and federal regulations adopted pursuant thereto. For the 
purposes of this subsection: 
A. The numerator is the amount expended on reimbursement for clinical services 
provided to enrollees and activities that improve health care quality; and 
B. The denominator is the total amount of premium revenue excluding federal and 
state taxes and licensing and regulatory fees paid and after accounting for payments 
or receipts for risk adjustment, risk corridors and reinsurance pursuant to federal law. 
3. Minimum medical loss ratio. The minimum medical loss ratio is: 
A. In the large group market, 85%; 
B. In the small group market, 80%; and 
C. In the individual market, 80% or such lower minimum medical loss ratio as the 
Secretary of the United States Department of Health and Human Services determines 
based on a finding, pursuant to the federal Affordable Care Act and federal 
regulations adopted pursuant thereto, that an 80% minimum medical loss ratio might 
destabilize the individual market in this State. 
PARTE 
Sec. E-l. 2 MRSA §lOl, as amended by PL 2005, c. 369, §1 and amended by c. 
397, Pt. C, § 1 and affected by §2, is repealed. 
Sec. E-2. 2 MRSA §l03, as amended by PL 2009, c. 355, §§1 to 3, is repealed. 
Sec. E-3. 2 MRSA §l04, as amended by PL 2009, c. 609, §§ 1 to 3, is repealed. 
PARTF 
Sec. F-l. 24-A MRS A §2736-C, sub-§8, as amended by PL 1999, c. 256, Pt. D, 
§2, is repealed. 
Sec. F-2. 24-A MRSA §2839-A, sub-§l, as amended by PL 2005, c. 121, Pt. F, 
§ 1, is further amended to read: 
1. Notice of rate increase on existing policies. An insurer offering group health 
insurance, except for accidental injury, specified disease, hospital indemnity, disability 
income, Medicare supplement, long-term care or other limited benefit group health 
insurance, must provide written notice by first class mail or electronically of a rate 
increase to all affected policyholders or others who are directly billed for group coverage 
at least 60 days before the effective date of any increase in premium rates. An increase in 
premium rates may not be implemented until 60 days after the notice is provided. For 
small group health plan rates subject to section 2808-B, subsection 2-B, if the increase is 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
pending approval at the time of notice, the disclosure must state that the increase is 
subject to regulatory approval. 
Sec. F-3. 24-A MRSA §2850-B, sub-§3, ~, as enacted by PL 2003, c. 428, Pt. 
A, §2, is amended to read: 
1. In renewing an individual or small group policy in accordance with this section, a 
carrier may make minor modifications to the coverage, terms and conditions of the 
policy consistent with other applicable provisions of state and federal laws as long as 
the modifications meet the conditions specified in this paragraph and are applied 
uniformly to all policyholders of the same product. Modifications not meeting the 
requirements in this paragraph are considered a discontinuance of the product 
pursuant to paragraph G. 
(1) 
A modification pursuant to this paragraph must be approved by the 
superintendent. The superintendent shall approve the modification if it meets the 
requirements of this section. 
(2) A change in a requirement for eligibility is not a minor modification pursuant 
to this paragraph if the change results in the exclusion of a class or category of 
enrollees currently covered. 
(3) Benefit modifications required by law are deemed minor modifications for 
purposes of this paragraph. 
(4) Benefit modifications other than modifications required by law are minor 
modifications only if they meet the requirements of this subparagraph. For 
purposes of this subparagraph, changes in administrative conditions or 
requirements specified in the policy, such as preauthorization requirements, are 
not considered benefit modifications. 
(a) The total of any increases in benefits may not increase the actuarial value 
of the total benefit package by more than 5%. 
(b) The total of any decreases in benefits may not decrease the actuarial 
value of the total benefit package by more than 5%. 
(c) For purposes of the calculations in divisions (a) and (b), increases and 
decreases must be considered separately and may not offset one another. 
(5) A carrier must give 60 days' notice of any modification pursuant to this 
paragraph to all affected policyholders and certificate holders. 
Sec. F-4. 24-A MRSA§4202-A, sub-§l, as amended by PL 2001, c. 218, §1, is 
further amended to read: 
1. 
Basic health care services. 
"Basic health care services" means health care 
services that an enrolled population might reasonably require in order to be maintained in 
good health and includes, at a minimum, emergency care, inpatient hospital care, 
inpatient physician services, outpatient physician services, ancillary services such as x-
ray services and laboratory services and all benefits mandated by statute and mandated by 
rule applicable to health maintenance organizations. The superintendent may adopt rules 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
defining "basic health care services" to be provided by health maintenance organizations. 
In adopting such rules, the superintendent shall consider the coverages that have 
traditionally been provided by health maintenance organizations; the need for flexibility 
in the marketplace; and the importance of providing multiple options to employers and 
consumers. The superiBteBdeBt may Bot require that all health beBefit plaBs offered by 
health maiBteBaBee orgaBii'iatioBs meet or eJ(eeed eaeh of the partieular requiremeBts of 
staBdard or basie health plaBs speeified iB Bureau of IBsuraBee Rule, Chapter 750. The 
superintendent may seleet required serviees from amoBg those set forth iB Bureau of 
IBsuraBce Rule, Chapter 750 aBd shall permit reasonable, but not excessive or unfairly 
discriminatory, variations in the copayment, coinsurance, deductible and other features of 
sueh coverage, except that these features must meet or exceed those required in benefits 
mandated by statute. 
The superintendent shall permit deductible, coinsurance and 
copayment levels consistent with the deductible levels permitted for policies issued 
pursuant to chapter 33 or 35. Rules adopted pursuant to this subsection are major 
substantive rules as defined in Title 5, chapter 375, subchapter II-A 2-A. 
Sec. F-S. 24-A MRS A §4203, sub-§3, ~S, as amended by PL 2003, c. 469, Pt. E, 
§ 18, is further amended to read: 
S. 
A list of the names and addresses of all physicians and facilities with which the 
health maintenance organization has or will have agreements. If products are offered 
that pay full benefits only when providers within a subset of the contracted physicians 
or facilities are utilized, a list of the providers in that limited network must be 
included, as well as a list of the geographic areas where the products are offered. 
This paragraph may Bot be eOBstrued to prohibit a health maiBteBaBee orgaBii'iatioB 
from offeriBg a health plaB that iBeludes fiBaBeial provisioBs desigaed to eBeourage 
members to use desigaated providers iB a Betwork iB aeeordaBee vlitH seotioB 4303, 
subseetioB 1, paragrapH A. 
Sec. F-6. 24-A MRSA §4204, sub-§2-A, ~, as amended by PL 1995, c. 332, 
Pt. I, §2, is repealed. 
Sec. F-7. 24-A MRSA §4303, sub-§l, as amended by PL 2009, c. 652, Pt. A, 
§33, is repealed and the following enacted in its place: 
1. Demonstration of adequate access to providers. A carrier offering or renewing 
a managed care plan shall provide to its members reasonable access to health care 
services in accordance with standards developed by rule by the superintendent. These 
standards may not require access to services based on specific travel times of members 
enrolled in a managed care plan. 
Sec. F-8. 24-A MRSA §6603, sub-§9, as enacted by PL 2007, c. 278, §1, is 
repealed. 
PARTG 
Sec. G-l. 24-A MRSA §2849-B, sub-§l, as amended by PL 1999, c. 36, §1, is 
further amended to read: 
1. Policies subject to this section. This section applies to all individual, group and 
blanket medical insurance policies except hospital indemnity, specified accident, 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
specified disease, long-term care and short-term policies issued by insurers or health 
maintenance organizations. 
For purposes of this section, a short-term policy is an 
individual, nonrenewable policy issued for a term that does not eJEeeed is less than 12 
months. 
This section does not apply to Medicare supplement policies as defined in 
section 5001, subsection 4. 
Sec. G-2. 24-A MRSA §2849-B, sub-§8, ,n, as enacted by PL 1995, c. 342, §8, 
is amended to read: 
B. An insurer or the insurer's agent or broker may not issue a short-term policy that 
replaces a prior short-term policy if the combined term of the new policy and all prior 
successive policies exceed ~ 24 months. All individuals making an application for 
coverage under a short-term policy must disclose any prior coverage under a 
short-term policy and the policy duration. 
PARTH 
Sec. H-l. 36 MRSA §S122, sub-§l, ~CC, as enacted by PL 2009, c. 213, Pt. 
BBBB, §5, is amended to read: 
Cc. For tax years beginning on or after January 1,2009 but before January 1,2011, 
an amount equal to the gross income during the taxable year from the discharge of 
indebtedness deferred under the Code, Section 108(i); and 
Sec. H-2. 36 MRSA §S122, sub-§l, ~D, as enacted by PL 2009, c. 213, Pt. 
ZZZ, § 1, is amended to read: 
DD. For any taxable year beginning in 2009, 2010 or 2011, an amount equal to the 
absolute value of any net operating loss carry-forward claimed for purposes of the 
federal income tax~; and 
Sec. H-3. 36 MRSA §S122, sub-§l, ~E is enacted to read: 
EE. 
The amount claimed as a deduction in determining federal adjusted gross 
income that is included in the credit for wellness programs under section 5219-FF. 
Sec. H-4. 36 MRSA §S200-A, sub-§l, ~, as amended by PL 2009, c. 652, Pt. 
A, §54, is further amended to read: 
V. For any taxable year beginning in 2009, 2010 or 2011, an amount equal to the 
absolute value of any net operating loss carry-forward claimed for purposes of the 
federal income tax; and 
Sec. H-S. 36 MRSA §S200-A, sub-§l, ~, as reallocated by PL 2009, c. 652, 
Pt. A, §55, is amended to read: 
W. For tax years beginning on or after January 1,2009 but before January 1,2011, 
an amount equal to the gross income during the taxable year from the discharge of 
indebtedness deferred under the Code, Section 1 08(i)~; and 
Sec. H-6. 36 MRSA §S200-A, sub-§l, ~X is enacted to read: 
X. The amount claimed as a deduction in determining federal taxable income that is 
included in the credit for wellness programs under section 5219-FF. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
Sec. H-7. 36 MRS A §5219-FF is enacted to read: 
§5219-FF. Credit for wellness programs 
1. Definitions. As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings. 
A. "Employee" means an individual who performs services for an employing unit. 
B. "Employing unit" has the same meaning as in Title 26, section 1043, subsection 
1ll 
C. 
"Qualified wellness program expenditure" means an expenditure made by an 
employing unit to develop, institute and maintain a wellness program. 
D. 
"Wellness program" means a program instituted by an employing unit that 
improves employee health, morale and productivity, including, without limitation: 
(1) Health education programs; 
(2) Behavioral change programs, such as counseling or seminars or classes on 
nutrition, stress management or smoking cessation; and 
(3) Incentive awards to employees who engage in regular physical activity. 
2. Credit allowed. A taxpayer constituting an employing unit with 20 or fewer 
employees, on an average monthly basis during the taxable year, is allowed a credit 
against the tax imposed by this Part for each taxable year beginning on or after January 1, 
2014 for a qualified wellness program expenditure made during the taxable year. 
3. Record keeping. An employing unit seeking a credit under subsection 2 is 
responsible for recording the amount of time employees engage in wellness programs for 
which the employing unit is claiming an expense. 
4. Limit; carry-over. The total credit for each taxpayer under this section is limited 
to $100 per employee or $2,000, whichever is less, per tax year. The credit may not 
reduce the tax otherwise due under this Part to less than zero. A taxpayer entitled to a 
credit under this section for any taxable year may carry over the portion, as reduced from 
year to year, of any unused credit and apply it to the tax liability for anyone or more of 
the next succeeding 5 taxable years. 
Sec. H-8. Application. This Part applies to tax years beginning on or after 
January 1,2014. 
PART I 
Sec. 1-1. 24-A MRS A §6702, sub-§4, as amended by PL 2009, c. 335, §9, is 
further amended to read: 
4. License. If the superintendent is satisfied that the documents and statements filed 
by the captive insurance company under subsections 2 and 3 comply with this chapter, 
the superintendent may grant a license authorizing it to do insurance business in 
accordance with this subsection. 
i"L captive insltfance company shall comply with all 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
applicable federal and state lav/s relating to the risks insl:l£ed p'l:lrs'I:lant to the license 
granted ay the s'I:lperintendent. 
A. A captive insurance company shall comply with all applicable federal laws. A 
captive insurance company, other than an association captive insurance company 
preliminarily conditionally approved for a license before January 1, 2012 and that 
elects to secure coverage in accordance with section 6706, subsection 2-A, shall 
comply with state and federal laws relating to the risks insured pursuant to the license 
granted by the superintendent to the extent provided in rules adopted pursuant to this 
chapter. 
B. An association captive insurance company insuring the health coverage risks of 
its members shall comply with the requirements for community rating and guaranteed 
issuance and renewal for association members pursuant to section 2808-B and any 
requirements for mandated benefits that apply to small group health plans. 
C. 
The superintendent shall grant a license to an association captive insurance 
company that files an application in accordance with this section and satisfies the 
following requirements: 
(1) The association captive insurance company insures only health risks and 
requires participating association members to be jointly and severally liable in 
accordance with section 6706, subsection 2-A; 
(2) The association captive insurance company's plan of operation is fiscally 
sound and establishes dispute resolution mechanisms acceptable to the 
superintendent in accordance with this section and designates a 3rd-party 
administrator approved by the superintendent; and 
(3) 
The superintendent determines that the association members have an 
aggregate net worth of at least $100,000,000. 
Sec. 1-2. 24-A MRSA §6702, sub-§7, ~D, as amended by PL 2009, c. 335, §9, is 
further amended to read: 
D. 
A captive insurance company may not provide personal motor vehicle or 
homeowner's insurance coverage or individual health Insurance coverage or any 
component thereof; 
Sec. 1-3. 24-A MRSA §6704, sub-§l, as amended by PL 2009, c. 335, §10, is 
further amended to read: 
1. Minimum capital and surplus. A captive insurance company may not be issued 
a license unless the company has and maintains unimpaired paid-in capital and surplus of: 
A. In the case of a pure captive insurance company, not less than $250,000; 
B. In the case of an association captive insurance company, not less than $750,000, 
except for an association captive insurance company insuring only health risks that 
elects to secure coverage in accordance with section 6706, subsection 2-A, maintains 
adequate reserve funds and has reinsurance unless the superintendent waives or 
modifies the reinsurance requirement. Reserve funds are presumed adequate if the 
association members have an aggregate net worth of at least $100,000,000 and the 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P, 979, L.D, 1333 
superintendent detennines that the funds are adequate to cover at least 3 months of 
claims and expenses; 
C. In the case of an industrial insured captive insurance company, not less than 
$500,000; 
D. In the case of a sponsored captive insurance company, not less than $500,000; 
and 
E. In the case of a risk retention group, not less than $1,000,000. 
The superintendent may prescribe additional capital based upon the type, volume and 
nature of insurance business transacted, except for an association captive health insurance 
company insuring only health risks that elects to secure coverage in accordance with 
section 6706, subsection 2-A. 
Sec. 1-4. 24-A MRSA §6706, sub-§2-A is enacted to read: 
2-A. Association captive insurance company providing health insurance. An 
association captive insurance company that provides health insurance may elect to 
require, in its plan of operation, that all association members who participate in the health 
insurance be jointly and severally liable for the health insurance obligations of the 
association captive insurance company and meet the financial criteria and employer 
required wellness criteria established in the plan of operation. The wellness criteria may 
not have the effect of making health status a condition of eligibility for any association 
member. The superintendent may not require joint and several liability as a condition of 
approval of an application. 
Sec. 1-5. 24-A MRSA §6706, sub-§4, as amended by PL 2009, c. 335, § 12, is 
further amended to read: 
4. Applicability of chapter 47. To the extent not inoonsistent consistent with this 
chapter, a captive insurance company is subject to the procedures applicable to domestic 
insurers pursuant to chapter 47 except that, if the surviving entity after a merger, 
consolidation, conversion or mutualization is a captive insurance company, a captive 
insurance company is subject to this chapter. With respect to mergers, consolidations, 
conversions and mutualizations, the superintendent, in the superintendent's discretion, 
may: 
A. Waive any public hearing requirement; 
B. Pennit an alien insurer as a party to a merger as long as the requirements for a 
merger between a captive insurance company and a foreign insurer apply. For the 
purposes of this paragraph, an alien insurer must be treated as a foreign insurer and 
the jurisdiction of the alien insurer is considered a state; or 
C. Approve the conversion of a captive insurance company organized as a stock 
insurer to a nonprofit corporation with one or more members or a limited liability 
company. 
Sec. 1-6. 24-A MRSA §6708, sub-§l, as enacted by PL 1997, c. 435, §1, is 
amended to read: 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
1. Powers, authorities and duties of superintendent. The powers, authorities and 
duties relating to examinations and investigations are vested in and imposed upon the 
superintendent pursuant to chapter 3 are extended to and imposed upon the 
superintendent in respect to examinations of captive insurance companies to the same 
extent they would otherwise be applicable with respect to domestic insurers in order for 
the superintendent to verify that all captive insurance companies operate in accordance 
with the provisions of this chapter. 
Sec. 1-7. 24-A MRSA §671S, as enacted by PL 1997, c. 435, §1, is amended to 
read: 
§6718. Rules 
The superintendent may adopt rules to implement this chapter. 
Rules adopted 
pursuant to this chapter section are routine technical major substantive rules as defined in 
Title 5, chapter 375, subchapter II-A 2-A. 
Sec. I-B. 24-A MRSA §6719, as enacted by PL 1997, c. 435, § 1, is amended to 
read: 
§6719. Laws applicable 
An insurance law of this State, other than described or referenced in this chapter, 
does not apply to a captive insurance company. This exclusion must be strictly construed 
so as to further the public policy in favor of providing alternative means for providing 
Insurance coverage. 
PART J 
Sec. J-1. 5 MRSA §12004-1, sub-§31-A, as enacted by PL 2003, c. 469, Pt. B, 
§2, is repealed. 
Sec. J-2. 22 MRSA §32S, sub-§3-A, as enacted by PL 2003, c. 469, Pt. C, §2, is 
amended to read: 
3-A. 
Capital investment fund. 
"Capital investment fund" means that fund 
established by the Governor pursuant to described in Title 2, section 101, subsection 1, 
paragraph D 102. 
Sec. J-3. 22 MRSA §32S, sub-§27, as enacted by PL 2003, c. 469, Pt. C, §6, is 
repealed. 
Sec. J-4. 22 MRSA §333-A, sub-§3, ~A, as enacted by PL 2007, c. 681, §5, is 
amended to read: 
A. The department may approve a nursing facility certificate of need application 
when the applicant proposes capital expenditures for renovations and improvements 
that are necessary: 
(1) To achieve compliance with code and related regulatory requirements; 
(2) To comply with the federal Health Insurance Portability and Accountability 
Act of 1996 and related patient privacy standards; 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
(3) To address other patient safety requirements and standards, eoasisteat v/ith 
the priorities set forth ia the earreat State Health Plaa; or 
(4) To address other necessary and time-sensitive patient safety or compliance 
Issues. 
Sec. J-5. 22 MRSA §335, sub-§l, ~, as amended by PL 2005, c. 369, §7, is 
repealed. 
Sec. J-6. 22 MRS A §335, sub-§7, as amended by PL 2005, c. 369, §8, is further 
amended to read: 
7. Review; approval. Except as provided in section 336, the commissioner shall 
issue a certificate of need if the commissioner determines and makes specific written 
findings regarding that determination that: 
A. The applicant is fit, willing and able to provide the proposed services at the 
proper standard of care as demonstrated by, among other factors, whether the quality 
of any health care provided in the past by the applicant or a related party under the 
applicant's control meets industry standards; 
B. The economic feasibility of the proposed services is demonstrated in terms of the: 
(1) Capacity of the applicant to support the project financially over its useful life, 
in light of the rates the applicant expects to be able to charge for the services to 
be provided by the project; and 
(2) Applicant's ability to establish and operate the project in accordance with 
existing and reasonably anticipated future changes in federal, state and local 
licensure and other applicable or potentially applicable rules; 
C. 
There is a public need for the proposed services as demonstrated by certain 
factors, including, but not limited to: 
(1) 
Whether, and the extent to which, the project will substantially address 
specific health problems as measured by health needs in the area to be served by 
the project; 
(2) Whether the project will have a positive impact on the health status indicators 
of the population to be served; 
(3) Whether the services affected by the project will be accessible to all residents 
of the area proposed to be served; and 
(4) Whether the project will provide demonstrable improvements in quality and 
outcome measures applicable to the services proposed in the project; 
D. The proposed services are consistent with the orderly and economic development 
of health facilities and health resources for the State as demonstrated by: 
(1) The impact of the project on total health care expenditures after taking into 
account, to the extent practical, both the costs and benefits of the project and the 
competing demands in the local service area and statewide for available resources 
for health care; 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
(2) The availability of state funds to cover any increase in state costs associated 
with utilization of the project's services; and 
(3) The likelihood that more effective, more accessible or less costly alternative 
technologies or methods of service delivery may become available; and 
E. The project meets the criteria set forth in subsection 1. 
In making a determination under this subsection, the commissioner shall use data 
a¥ailable in the State Health Plan under Title 2, section 103, including demographic, 
health care service and health care cost data, data from the Maine Health Data 
Organization established in chapter 1683 and other information available to the 
commissioner. Particular weight must be given to information that indicates that the 
proposed health services are innovations in high-quality health care delivery, that the 
proposed health services are not reasonably available in the proposed area and that the 
facility proposing the new health services is designed to provide excellent quality health 
care. 
In making all determinations under this subsection, the commissioner must be guided by 
the State Health Plan as described in Title 2, section 103. 
Sec. J-7. 22 MRS A §412, sub-§4, ,A, as enacted by PL 2009, c. 355, §5, is 
amended to read: 
A. A district coordinating council for public health shall: 
(1) Participate as appropriate in district-level activities to help ensure the state 
public health system in each district is ready and maintained for accreditation; 
and 
(2) Pro¥ide a mechanism for districtwide input to the state health plan under 
Title 2, section 103; 
(3) Ensme that the goals and strategies of the state health plan are addressed in 
the district; and 
(4) Ensure that the essential public health services and resources are provided for 
in each district in the most efficient, effective and evidence-based manner 
possible. 
Sec. J-S. 22 MRS A §412, sub-§6, "A and B, as enacted by PL 2009, c. 355, 
§5, are amended to read: 
A. The Statewide Coordinating Council for Public Health shall: 
(1) Participate as appropriate to help ensure the state public health system is 
ready and maintained for accreditation; and 
(2) 
Pro¥ide a mechanism for the Ad¥isory Council on Health Systems 
Development under Title 2, section 104 to obtain state'i'lide input for the state 
health plan under Title 2, section 103; 
(3) Pro¥ide a mechanism for disseminating and implementing the state health 
plan; and 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "An to H.P. 979, L.D. 1333 
(4) Assist the Maine Center for Disease Control and Prevention in planning for 
the essential public health services and resources to be provided in each district 
and across the State in the most efficient, effective and evidence-based manner 
possible. 
The Maine Center for Disease Control and Prevention shall provide staff support to 
the Statewide Coordinating Council for Public Health as resources permit. Other 
agencies of State Government as necessary and appropriate shall provide additional 
staff support or assistance to the Statewide Coordinating Council for Public Health as 
resources permit. 
B. Members of the Statewide Coordinating Council for Public Health are appointed 
as follows. 
(1) 
Each district coordinating council for public health shall appoint one 
member. 
(2) The Director of the Maine Center for Disease Control and Prevention or the 
director's designee shall serve as a member. 
(3) The commissioner shall appoint an expert in behavioral health from the 
department to serve as a member. 
(4) 
The Commissioner of Education shall appoint a health expert from the 
Department of Education to serve as a member. 
(5) 
The Commissioner of Environmental Protection shall appoint an 
environmental health expert from the Department of Environmental Protection to 
serve as a member. 
(6) The Director of the Maine Center for Disease Control and Prevention, in 
collaboration with the cochairs of the Statewide Coordinating Council for Public 
Health, shall convene a membership committee. 
After evaluation of the 
appointments to the Statewide Coordinating Council for Public Health, the 
membership committee shall appoint no more than 10 additional members and 
ensure that the total membership has at least one member who is a recognized 
content expert in each of the essential public health services, and has 
representation from populations in the State facing health disparities and has at 
least 2 mel'l'l:l:lers from the Advisory Council on Health Systems Development 
under Title 2, section 104. The membership committee shall also strive to ensure 
diverse representation on the Statewide Coordinating Council for Public Health 
from county governments, municipal governments, tribal governments, city 
health departments, local health officers, hospitals, health systems, emergency 
management agencies, emergency medical services, Healthy Maine Partnerships, 
school districts, institutions of higher education, physicians and other health care 
providers, clinics and community health centers, voluntary health organizations, 
family planning organizations, area agencies on aging, mental health services, 
substance abuse services, organizations seeking to improve environmental health 
and other community-based organizations. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to H.P. 979, LD. 1333 
Sec. J-9. 22 MRSA §412, sub-§6, ~F, as enacted by PL 2009, c. 355, §5, is 
repealed and the following enacted in its place: 
F. The Statewide Coordinating Council for Public Health shall report annually to the 
joint standing committee ofthe Legislature having jurisdiction over health and human 
services matters and the Governor's office on progress made toward achieving and 
maintaining accreditation of the state public health system and on districtwide and 
statewide streamlining and other strategies leading to improved efficiencies and 
effectiveness in the delivery of essential public health services. 
Sec. J-I0. 22 MRS A §1711-E, sub-§5, as enacted by PL 2007, c. 460, §1, is 
amended to read: 
5. Rules. The department, after cOftsultatioft '.vith the Governor's Office of Health 
Policy aftd Fiftaftce, shall adopt rules to implement this section. Rules adopted pursuant 
to this subsection are routine technical rules as defined by Title 5, chapter 375, subchapter 
2-A. 
Sec. J-11. 22 MRSA §1844, sub-§2, ~A, as enacted by PL 2005, c. 670, §1 and 
affected by §4, is amended to read: 
A. At least 45 days prior to filing an application for a certificate of public advantage 
for a merger, the parties to a merger agreement shall file a letter of intent with the 
department describing the proposed merger. Copies of the letter of intent and all 
accompanying materials must be submitted to the Attorney General aftd to the 
Governor's Office of Health Policy aftd Fiftaftce at the time the letter of intent is filed 
with the department. 
Sec. J-12. 22 MRSA §1844, sub-§2,~, as enacted by PL 2005, c. 670, §1 and 
affected by §4, is amended to read: 
D. The parties to a cooperative agreement shall submit copies of the application and 
all the accompanying materials to the Attorney General and the Governor's Office of 
Health Policy aftd Fiftaftce at the time they file the application with the department. 
Sec. J-13. 22 MRSA §1844, sub-§4, ~C, as enacted by PL 2005, c. 670, §1 and 
affected by §4, is amended to read: 
C. The department shall provide the Attorney General and the Governor's Office of 
Health Policy aftd Fiftaftce with copies of all comments from persons submitted under 
paragraph B. 
Sec. J-14. 22 MRSA §1844, sub-§4, ~F, as enacted by PL 2005, c. 670, §1 and 
affected by §4, is amended to read: 
F. The department shall issue a final decision to grant or deny an application for a 
certificate of public advantage under this section no less than 40 days and no more 
than 90 days after the filing of the application. The department shall issue a 
preliminary decision at least 5 days prior to issuing the final decision. The 
preliminary and final decisions must be in writing and set forth the basis for the 
decisions. The department shall provide copies of the preliminary and final decisions 
to the applicants, the Office of the Attorney General, the Governor's Office of Health 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "An to RP. 979, L.D. 1333 
Poliey and Finanee and all persons who requested notification from the department 
under subsection 3, paragraph B. 
Sec. J-15. 22 MRSA §1844, sub-§6, as enacted by PL 2005, c. 670, § 1 and 
affected by §4, is amended to read: 
6. Intervention. The Attorney General and the Governor's Offiee of Health Poliey 
and Finanee may intervene as a right in any proceeding under this chapter before the 
department. 
Except as provided in this subsection, intervention is governed by the 
provisions of Title 5, section 9054. 
Sec. J-16. 22 MRS A §1845, sub-§1, as enacted by PL 2005, c. 670, §1 and 
affected by §4, is amended to read: 
1. Periodic report and supervisory review. With regard to a certificate of public 
advantage approved under this chapter, the certificate holder shall report periodically to 
the department on the extent of the benefits realized and compliance with other terms and 
conditions of the certificate. The certificate holder shall submit copies of the report to the 
Attorney General and to the Governor's Offiee of Health Poliey and Finanee at the time 
the report is filed with the department. The Attorney General and the Governor's Offiee 
of Health Poliey and Finanee may submit to the department comments on the report filed 
under this subsection. The department shall consider any comments on the report from 
the Attorney General and the Governor's Offiee of Health Poliey and Finanee in the 
course of its evaluation of the certificate holder's report. Within 60 days of receipt of the 
certificate holder's report, the department shall make findings regarding the report, 
including responses to any comments from the Attorney General and the Governor's 
Offiee of Health Poliey and Finanee, determine whether to institute additional 
supervisory activities under this section and notify the certificate holder. 
Sec. J-17. 22 MRS A §1845, sub-§2, "A and B, as enacted by PL 2005, c. 
670, § 1 and affected by §4, are amended to read: 
A. 
The department shall conduct additional supervisory activities whenever 
requested by the Attorney General or the Governor's Offiee of Health Poliey and 
Finanee, or whenever the department, in its discretion, determines those activities 
appropriate, and: 
(1) For certificates of public advantage not involving mergers, at least once in the 
first 18 months after the transaction described in the cooperative agreement has 
closed; and 
(2) For certificates of public advantage involving mergers, at least once between 
and 30 months after the transaction described in the cooperative agreement 
has closed. 
B. In its discretion, the department may conduct additional supervisory activities by: 
(1) Soliciting and reviewing written submissions from the certificate holders, the 
Attorney General, the Governor's Offiee of Health Poliey and Finanee or the 
public; 
(2) Conducting a hearing in accordance with Title 5, chapter 375, subchapter 4 
and the department's administrative hearings rules; or 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
(3) Using any alternative procedures appropriate under the circumstances. 
Sec. J-18. 22 MRSA §1849, sub-§5, as enacted by PL 2005, c. 670, § 1 and 
affected by §4, is amended to read: 
5. Termination; surrender. This chapter does not prohibit certificate holders from 
terminating their cooperative agreement by mutual agreement, consent decree or court 
determination or by surrendering their certificate of public advantage to the department. 
Any certificate holder that terminates the agreement shall file a notice of termination with 
the department within 30 days after termination, surrender the certificate of public 
advantage and submit copies to the Attorney General and the Governor's Offiee of Health 
Poliey and Finaflee at the time the notice of termination is submitted to the department. 
Sec. J-19. 22 MRSA §2061, sub-§2, as corrected by RR 2003, c. 2, §71, is 
amended to read: 
2. Review. Each project for a health care facility has been reviewed and approved to 
the extent required by the agency of the State that serves as the designated planning 
agency of the State or by the Department of Health and Human Services in accordance 
with the provisions of the Maine Certificate of Need Act of 2002, as amended, and is 
eonsisteflt with the eost eontaiflment provisions for health eare afld health eoverage of the 
State Mealth Plan adopted pursuant to Title 2, seetion 101, subseetion 1, paragraph A; 
Sec. J-20. 24-A MRSA §2694-A, sub-§3, as enacted by PL 2009, c. 350, Pt. B, 
§ 1, is repealed. 
Sec. J-21. 24-A MRSA §2752, sub-§3, ~A, as amended by PL 1997, c. 616, §5, 
is further amended to read: 
A. The social impact of mandating the benefit, including: 
(1) The extent to which the treatment or service is utilized by a significant 
portion of the population; 
(2) The extent to which the treatment or service is available to the population; 
(3) 
The extent to which insurance coverage for this treatment or service is 
already available; 
(4) 
If coverage is not generally available, the extent to which the lack of 
coverage results in persons being unable to obtain necessary health care 
treatment; 
(5) If the coverage is not generally available, the extent to which the lack of 
coverage results in unreasonable financial hardship on those persons needing 
treatment; 
(6) The level of public demand and the level of demand from providers for the 
treatment or service; 
(7) The level of public demand and the level of demand from the providers for 
individual or group insurance coverage of the treatment or service; 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
(8) 
The level of interest in and the extent to which collective bargaining 
organizations are negotiating privately for inclusion of this coverage in group 
contracts; 
(9) The likelihood of achieving the objectives of meeting a consumer need as 
evidenced by the experience of other states; 
(10) The relevant findings of tHe state HealtH planning ageney or the appropriate 
health system agency relating to the social impact of the mandated benefit; 
(11) The alternatives to meeting the identified need; 
(12) Whether the benefit is a medical or a broader social need and whether it is 
consistent with the role of health insurance and the concept of managed care; 
(l3) The impact of any social stigma attached to the benefit upon the market; 
(14) The impact of this benefit on the availability of other benefits currently 
being offered; 
(15) The impact of the benefit as it relates to employers shifting to self-insured 
plans and the extent to which the benefit is currently being offered by employers 
with self-insured plans; and 
(16) The impact of making the benefit applicable to the state employee health 
insurance program; 
Sec. J-22. 24-A MRSA §6904, sub-§l, as amended by PL 2007, c. 447, §4, is 
further amended to read: 
1. Appointments. The board consists of 9 voting members and 4 1 ex officio, 
nonvoting members as follows. 
A. The 9 voting members of the board are appointed by the Governor, subject to 
review by the joint standing committee of the Legislature having jurisdiction over 
health insurance matters and confirmation by the Senate in accordance with this 
paragraph. 
(1) Five members qualified in accordance with subsection 2-A, paragraph A are 
appointed by the Governor. 
(2) One member qualified in accordance with subsection 2-A, paragraph A is 
appointed by the Governor and must be selected from candidates nominated by 
the President of the Senate. 
(3) One member qualified in accordance with subsection 2-A, paragraph B is 
appointed by the Governor and must be selected from candidates nominated by 
the Speaker of the House. 
(4) One member qualified in accordance with subsection 2-A, paragraph B is 
appointed by the Governor and must be selected from the candidates nominated 
by the Senate Minority Leader. 
COMMITTEE AMENDMENT 
--;'} 
v 
COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
(5) One member qualified in accordance with subsection 2-A, paragraph B is 
appointed by the Governor and must be selected from candidates nominated by 
the House Minority Leader. 
B. The 4 J. ex officio, nonvoting members of the board are: 
(1) The Commissioner of Professional and Financial Regulation or the 
commissioner's designee; 
(2) The director of the Governor's Office of Health Policy afl:d Finance or the 
director of a successor agency; 
(3) 
The Commissioner of Administrative and Financial Services or the 
commissioner's designee; and 
(4) The Treasurer of State or the treasurer's designee. 
Sec. J-23. 24-A MRSA §6951, sub-§8, as enacted by PL 2003, c. 469, Pt. A, §8, 
is repealed. 
Sec. J-24. 24-A MRSA §6952, sub-§7, ~, as enacted by PL 2003, c. 469, Pt. 
A, §8, is amended to read: 
D. Make recommendations regarding quality assurance and quality improvement 
priorities for inclusion in the State Health Plan described in Title 2, chapter 5; and 
PARTK 
Sec. K-l. Appropriations and allocations. The following appropriations and 
allocations are made. 
PROFESSIONAL AND FINANCIAL REGULATION, DEPARTMENT OF 
Insurance - Bureau of 0092 
Initiative: Allocates funds for a part-time (0.5) Actuary position and a part-time (0.5) 
Actuary Assistant position and related costs for the Bureau of Insurance to analyze an 
expected increase in insurance rate filings as a result of changes that will affect health 
care premiums. 
OTHER SPECIAL REVENUE FUNDS 
POSITIONS - FTE COUNT 
Personal Services 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
SUMMARY 
2011-12 
2012-13 
1.000 
1.000 
$68,607 
$93,191 
$17,933 
$11,249 
$86,540 
$104,440 
This amendment is the majority report of the committee and replaces the bill. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
Part A makes the following changes to the community rating laws for individual and 
small group health insurance: 
1. It changes the maximum rate differential for individual health plans on the basis of 
age from 1.5: 1 to 5: 1. The changes in rating for individual health plans are phased in 
over a period of 4 years; 
2. It changes the maximum rate differential for small group health plans on the basis 
of age from 1.5: 1 to 5: 1. The changes in rating for small group health plans are phased in 
over a period of 4 years; 
3. It authorizes a maximum rate differential on the basis of smoking status from 
1.5:1; and 
4. It allows rating on the basis of geographic area outside of the rating bands for age. 
Part B modifies the laws relating to guaranteed issuance in the individual health 
insurance market to permit carriers to reinsure coverage offered to certain individuals 
identified using a health statement. Carriers are prohibited from using health status for 
any other purpose. 
Part B also creates the Maine Guaranteed Access Reinsurance 
Association. The purpose of the association is to provide reinsurance to spread the cost 
of certain individuals among all health insurers. The amendment funds the guaranteed 
access reinsurance through an assessment on insurers. 
Part C permits insurers authorized to transact individual health insurance in 
Connecticut, Massachusetts, New Hampshire or Rhode Island to offer their individual 
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. If out-of-state health plans are offered for sale in 
this State, the amendment 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. Part C also permits domestic insurers or licensed health 
maintenance organizations to offer individual health plans of a parent or corporate 
affiliate licensed to transact individual health insurance in Connecticut, Massachusetts, 
New Hampshire or Rhode Island if similar requirements are met. 
It also permits 
domestic insurers and licensed health maintenance organizations to offer plans equivalent 
to any plans offered by a regional insurer. Individual health insurance policies, contracts 
and certificates may not be offered for sale in this State pursuant to these provisions 
before January 1,2014. 
Part D adopts the definition of medical loss ratio in federal law and the minimum 
medical loss ratio requirements of federal law. Part D also allows individual health 
insurance rates to be filed for informational purposes without prior approval by the 
Department of Professional and Financial Regulation, Bureau of Insurance if the insurer 
maintains a minimum 80% medical loss ratio. 
Part E repeals the State Health Plan and the Advisory Council on Health Systems 
Development. 
Part F repeals the geographic access standards. Part F repeals the authorization for 
the Superintendent of Insurance to establish standardized individual health plans by rule. 
Part F also permits insurers offering group health insurance to notify affected 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
policyholders of a rate increase electronically as well as by mail. Part F clarifies that 
preauthorizations are not benefit modifications requiring prior approval of the Bureau of 
Insurance and authorizes health maintenance organizations to offer deductibles in excess 
of $1,000. Part F also clarifies that participation in the individual market is voluntary by 
removing the requirement that health maintenance organizations offering group coverage 
also offer individual coverage. 
Part G authorizes the renewal of short-term health insurance policies for a period not 
to exceed 24 months instead of the current 12 months. 
Part H provides a tax credit to employers of 20 or fewer employees for the expense of 
developing, instituting and maintaining wellness programs for their employees in the 
amount of $1 00 per employee, up to a maximum of $2,000. A wellness program includes 
programs for behavior modification, such as smoking cessation programs, equipping and 
maintaining an exercise facility and providing incentive awards to employees who 
exercise regularly. 
Part I amends the chapter of the Maine Insurance Code governing captive insurance 
companies. 
The amendment clarifies that, in the event of any conflict between the 
provisions of other state insurance laws and the provisions of the laws governing captive 
insurance companies, the provisions of the captive insurance company laws control, 
except that a captive insurance company insuring health risks may not provide individual 
health insurance and, if it insures health risks of employers, a captive insurance company 
must comply with the same requirements of community rating, guaranteed issuance and 
renewal and mandated benefit laws applicable to small group health insurers. Part I 
permits an association captive insurance company to require its members to be jointly and 
severally liable for its health insurance obligations and to meet financial obligations and 
wellness criteria established in a plan of operation and provides solvency standards 
applicable to such captives. 
The amendment would require the Superintendent of 
Insurance to issue a license to an association captive insuring health risks for an 
association captive insurance company that requires its members to be jointly and 
severally liable and has an aggregate net worth of more than $100,000,000 and meets the 
requirements of the captive insurance law. Part I also specifies that rules related to 
captive insurance companies are major substantive rules. 
Part J corrects cross-references and deletes references in statute to the Governor's 
Office of Health Policy and Finance, originally established in 2003 by executive order. 
Part K adds an appropriations and allocations section. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Revised: 05/04111 
~aC! 
LD 1333 
LR 1371(02) 
An Act To Modify Rating Practices for Individual and Small Group Health Plans and To Encourage 
Value-based Purchasing of Health Care Services 
Fiscal Note for Bill as Amended by Committee Amendment" A" 
Committee: Insurance and Financial Services 
Net Cost (Savings) 
General Fund 
Appropriations/Allocations 
Other Special Revenue Funds 
Revenue 
General Fund 
Other Special Revenue Funds 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2011-12 
$0 
$86,540 
$0 
$0 
FY 2012-13 
$0 
$104,440 
$0 
$0 
Projections 
FY 2013-14 
$75,148 
$110,071 
($75,148) 
($3,955) 
Projections 
FY 2014-15 
$302,686 
$116,040 
($302,686) 
($15,931) 
Providing an income tax credit in the amount of $1 00 per employee up to a total maximum credit of $2,000 per 
employer for tax years beginning on or after January 1,2014 to employers of20 or fewer employees for wellness 
programs such as smoking cessation programs, exercise facilities and incentives to exercise regularly will reduce 
General Fund revenue and reduce revenue sharing starting in fiscal year 2013-14. 
Provides an Other Special Revenue Funds allocation of $86,540 in 2011-12 and $104,440 in 2012-13 for a part-time 
Actuary position and a part-time Actuary Assistant position and related costs for the Bureau ofInsurance to analyze an 
expected increase in insurance rate filings as a result of changes that will affect health care premiums. The Bureau 
believes it can fund these positions within existing budgetary resources but should this not be the case, the Bureau has 
assessment authority under existing law to support the costs of the Bureau. 
The Maine Guaranteed Access Reinsurance Association is established as a nonprofit legal entity and would therefore 
have no direct fiscal impact on State agencies or programs. Also assumes any Association assessment on member 
insurers would have no direct fiscal impact on State agencies or programs. 
Assumes a number of provisions in the bill could have a fiscal impact on the Dirigo Health program. The net fiscal 
impact of these provisions on the Dirigo Health program can not be determined at this time. 
Assumes eliminating the Governor's Office of Health Policy and Finance will not have a fiscal impact on the Office o. 
'the Governor. That Office no longer exists and the positions have already been assigned to other duties. 
LR1371(02) - Fiscal Note - Page 1 of 1