An Act To Allow Maine Citizens To Buy Health Insurance across State Lines
Maine Legislature, Session 125, LD 0226
Committee: Insurance and Financial Services
Sponsors: SULLIVAN, KATZ, AYOTTE, COLLINS, HILL, RICHARDSON
Amends: 24-A MRSA §405, 24-A MRSA §405-A, 24-A MRSA §405-B

Legislative Document 
No. 226 
S.P. 77 
In Senate, February 1, 2011 
An Act To Allow Maine Citizens To Buy Health Insurance across 
State Lines 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
JOSEPH G. CARLETON, JR. 
Secretary of the Senate 
Presented by Senator SULLIVAN of York. 
Cosponsored by Senator KATZ of Kennebec, Representative AYOTTE of Caswell and 
Senators: COLLINS of York, HILL of York, Representative: RICHARDSON of Warren. 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  24-A MRSA §405, sub-§6, as enacted by PL 1969, c. 132, §1, is amended 
to read: 
6.    Any suit or action by the duly constituted receiver, rehabilitator or liquidator of 
the insurer, or of the insurer's assignee or successor, under laws similar to those contained 
in chapter 57 (delinquency proceedings; rehabilitation and liquidation).; or 
Sec. 2.  24-A MRSA §405, sub-§7 is enacted to read: 
7.  Transactions pursuant to individual or group health insurance covering residents 
of this State written by a regional insurer or health maintenance organization, as defined 
in section 405-A, duly authorized or qualified to transact individual or group health 
insurance in the state or country of its domicile if the superintendent certifies that the 
regional insurer or health maintenance organization meets the requirements of section 
405-A. 
Sec. 3.  24-A MRSA §405-A is enacted to read: 
§405-A.  Certification of regional insurers or health maintenance organizations to 
transact individual or group 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 
or group health insurance in one of the following states: Connecticut, Massachusetts, 
New Hampshire, Rhode Island and Vermont. 
2.  Certification of regional insurers or health maintenance organizations.  A 
regional insurer or health maintenance organization may not transact individual or group 
health insurance in this State by mail, the Internet or otherwise unless the superintendent 
has issued a certification that the 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.  In order to be certified, the regional 
insurer or health maintenance organization must meet the requirements of this subsection. 
A.  A policy, contract or certificate of individual or group health insurance offered for 
sale in this State by the regional insurer or health maintenance organization must 
comply with the applicable individual and group health insurance laws in the state or 
country of its domicile and must be actively marketed in that state or country. 
B.  The regional insurer or health maintenance organization shall maintain minimum 
capital and surplus requirements and maintain reserves as required by section 410; 
section 901-A; sections 951 to 958-A; section 4204, subsection 2-A, paragraph D; 
and section 4204-A, as applicable. 
C.  The regional insurer or health maintenance organization shall meet the 
requirements of section 4302 for reporting plan information with respect to individual 
and group health plans offered for sale in this State and disclose to prospective 
enrollees how the health plans differ from individual and group health plans offered 
by domestic insurers in a format approved by the superintendent within 90 days of 
the effective date of this section.  Health plan policies and applications for coverage 
must contain the following disclosure statement or a substantially similar statement:  
"This policy is issued by a regional insurer or health maintenance organization and is 
governed by the laws and rules of (regional insurer or health maintenance 
organization's state of domicile).  This policy may not be subject to all the insurance 
laws and rules of the State of Maine, including coverage of certain health care 
services or benefits mandated by Maine law.  Before purchasing this policy, you 
should carefully review the terms and conditions of coverage under this policy, 
including any exclusions or limitations of coverage." 
D.  The regional insurer or health maintenance organization shall meet the 
requirements of section 4303, subsection 4 for grievance procedures with respect to 
health plans offered for sale in this State. 
E.  The regional insurer or health maintenance organization shall designate an agent 
for receiving service of legal documents and process in the manner provided in this 
Title. 
F.  The regional insurer or health maintenance organization shall participate in an 
insurance insolvency guaranty association to which a domestic insurer or health 
maintenance organization that transacts individual or group health insurance in this 
State is required to belong in accordance with this Title. 
3.  Unfair trade practices.  The provisions of chapter 23 apply to a regional insurer 
or health maintenance organization permitted to transact individual or group health 
insurance under this section or section 405. 
4.  Taxes; assessments.  A regional insurer or health maintenance organization is 
subject to applicable taxes or assessments imposed on insurers transacting individual or 
group health insurance in this State pursuant to this Title and Title 36. 
5.  Compliance with court orders.  A regional insurer or health maintenance 
organization shall comply with lawful orders from courts of competent jurisdiction issued 
in a voluntary dissolution proceeding or in response to a petition for an injunction by the 
superintendent asserting that the regional insurer or health maintenance organization is in 
a hazardous financial condition. 
Except as expressly provided in this section, the requirements of this Title do not 
apply to a regional insurer or health maintenance organization permitted to transact 
individual or group health insurance under this section or section 405. 
Sec. 4.  24-A MRSA §405-B is enacted to read: 
§405-B.  Domestic insurers; individual and group health insurance approved in 
other states 
Notwithstanding any other provision of this Title, a domestic insurer or health 
maintenance organization may offer for sale in this State an individual or group health 
plan duly authorized for sale in another state by a parent or subsidiary of the domestic 
insurer if the following requirements are met: 
1.  Certificate of authority from state of domicile.  The parent or subsidiary of the 
domestic insurer or health maintenance organization must hold a valid certificate of 
authority to transact individual health insurance in one of the following states:  
Connecticut, Massachusetts, New Hampshire, Rhode Island and Vermont; 
2.  Compliance with laws of state of domicile.  A policy, contract or certificate of 
individual or group health insurance offered for sale in this State by the domestic insurer 
or health maintenance organization must comply with the applicable individual and group 
health insurance laws in the state of domicile of the parent or subsidiary and must be 
actively marketed in that state; 
3.  Disclosure and reporting.  The domestic insurer or health maintenance 
organization shall meet the requirements of section 4302 for reporting plan information 
with respect to individual and group health plans offered for sale in this State and disclose 
to prospective enrollees how the individual and group health plans of the parent or 
subsidiary differ from individual and group health plans offered by other domestic 
insurers in a format approved by the superintendent within 90 days of the effective date 
of this section. Health plan policies and applications for coverage must contain the 
following disclosure statement or a substantially similar statement: "This policy is issued 
by a domestic insurer or health maintenance organization but is governed by the laws and 
rules of (state of domicile of parent or subsidiary of domestic insurer), which is the state 
of domicile of the parent or subsidiary of the domestic insurer or health maintenance 
organization.  This policy may not be subject to all the insurance laws and rules of the 
Maine law.  Before purchasing this policy, you should carefully review the terms and 
conditions of coverage under this policy, including any exclusions or limitations of 
coverage."; and 
4.  Grievance procedures.  The domestic insurer or health maintenance organization 
shall meet the requirements of section 4303, subsection 4 for grievance procedures with 
respect to health plans offered for sale in this State. 
Sec. 5.  Effective date.  This Act takes effect January 1, 2012. 
SUMMARY 
This bill permits insurers authorized to transact individual or group health insurance 
in Connecticut, Massachusetts, New Hampshire, Rhode Island and Vermont to offer their 
individual and group health plans for sale in this State if certain requirements of Maine 
law are met, including minimum capital and surplus and reserve requirements, disclosure 
and reporting requirements and grievance procedures.  It also permits Maine health 
insurers to offer individual health plans of out-of-state parent or subsidiary health insurers 
if similar requirements are met. If out-of-state health plans are offered for sale in this 
State, the bill requires that prospective enrollees be provided adequate disclosure in a 
format approved by the Superintendent of Insurance of how the plans differ from Maine 
health plans.  The bill includes an effective date of January 1, 2012.