An Act To Modify Rating Practices for Individual and Small Group Health Plans and To Encourage Value-based Purchasing of Health Care Services
Maine Legislature, Session 125, LD 1333
Committee Amendment CA_A-HA_F_H235 (House)
Amends: 24-A MRSA §2736-C, 24-A MRSA §2

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HOUSE AMENDMENT" V" to COMMITTEE AMENDMENT "A" to H.P. 979, 
L.D. 1333, Bill, "An Act To Modify Rating Practices for Individual and Small Group 
Health Plans and To Encourage Value-based Purchasing of Health Care Services" 
Amend the amendment in Part A in section 1 by striking out all of paragraph C (page 
1, lines 17 to 21 in amendment) and inserting the following: 
'e. 
A carrier may vary the premium rate due to smoking status and family 
membership. 
The superintendent may adopt rules setting forth appropriate 
methodologies regarding rate discounts based on smoking status. 
Rules adopted 
pursuant to this paragraph are routine teohnioal rules as defined in Title 5, chapter 
375, subchapter II A.' 
Amend the amendment in Part A by inserting after section 1 the following: 
'Sec. A-2. 24-A MRSA §2736-C, sub-§2, ~C-l is enacted to read: 
C-l. A carrier may vary the premium rate due to geographic area in accordance with 
the limitation set out in this paragraph. For all policies, contracts or certificates that 
are executed, delivered, issued for delivery, continued or renewed in this State on or 
after July 1, 2012, the rating factor used by a carrier for geographic area may not 
exceed 1.5.' 
Amend the amendment in Part A in section 2 in paragraph D in subparagraph (6) in 
the 4th line (page 2, line 37 in amendment) by inserting after the following: "I" the 
following: 'to the extent permitted by the federal Affordable Care Act' 
Amend the amendment in Part A in section 2 in paragraph D in subparagraph (7) in 
the 4th line (page 2, line 42 in amendment) by inserting after the following: "1" the 
following: 'to the extent permitted by the federal Affordable Care Act' 
Amend the amendment in Part A in section 4 in paragraph I in the 6th line (page 3, 
line 13 in amendment) by inserting after the following: "paragraph" the following: 'and 
paragraphs C and C-I' 
Amend the amendment in Part A in section 4 in paragraph I in subparagraph (4) in 
the 4th line (page 3, line 32 in amendment) by inserting after the following: "1" the 
following: 'to the extent permitted by the federal Affordable Care Act' 
HOUSE AMENDMENT 
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HOUSE AMENDMENT "r, to COMMITTEE AMENDMENT "A" to H.P. 979, L.D. 1333 
Amend the amendment in Part A in section 4 in paragraph I in subparagraph (5) in 
the 4th line (page 3, line 37 in amendment) by inserting after the following: "I" the 
following: 'to the extent permitted by the federal Affordable Care Act' 
Amend the amendment in Part A in section 5 by striking out all of paragraph C (page 
4, lines 16 to 22 in amendment) and inserting the following: 
'e. A carrier may vary the premium rate due to occupation and industry, 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 occupation and 
industry 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 
H-A2-A.' 
Amend the amendment in Part A by inserting after section 5 the following: 
'Sec. A-6. 24-A MRSA §2S0S-B, suh-§2, ~C-l is enacted to read: 
C-l. A carrier may vary the premium rate due to geographic area in accordance with 
the limitation set out in this paragraph. For all policies, contracts or certificates that 
are executed, delivered, issued for delivery, continued or renewed in this State on or 
after October I, 20 II, the rating factor used by a carrier for geographic area may not 
exceed 1.5.' 
Amend the amendment in Part A in section 6 in paragraph D in subparagraph (7) in 
the 4th line (page 5, line 16 in amendment) by inserting after the following: "I" the 
following: 'to the extent permitted by the federal Affordable Care Act' 
Amend the amendment in Part A in section 6 in paragraph D in subparagraph (8) in 
the 4th line (page 5, line 21 in amendment) by inserting after the following: "I" the 
following: 'to the extent permitted by the federal Affordable Care Act' 
Amend the amendment in Part A in section 8 in paragraph H in the 6th line (page 5, 
line 35 in amendment) by inserting after the following: "paragraph" the following: 'and 
paragraphs C and C-I ' 
Amend the amendment in Part A in section 8 in paragraph H in subparagraph (4) in 
the 4th line (page 6, line 12 in amendment) by inserting after the following: "I" the 
following: 'to the extent permitted by the federal Affordable Care Act' 
Amend the amendment in Part A in section 8 in paragraph H in subparagraph (5) in 
the 4th line (page 6, line 17 in amendment) by inserting after the following: "I" the 
following: 'to the extent permitted by the federal Affordable Care Act' 
Amend the amendment in Part B in section 6 in subsection 3 by striking out all of 
paragraph F (page 8, lines 15 to 17 in amendment) 
Amend the amendment in Part C in section 4 in §405-B in subsection 1 in the first 
line (page 19, line 1 in amendment) by striking out the following: "subsidiary" and 
inserting the following: 'corporate affiliate' 
HOUSE AMENDMENT 
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HOUSE AMENDMENT" (' 
to COMMITTEE AMENDMENT "A" to RP. 979, L.D. 1333' 
Amend the amendment in Part C in section 4 in §405-B in subsection 3 in the 4th line 
(page 19, line 13 in amendment) by striking out the following: "subsidiary" and inserting 
the following: 'corporate affiliate' 
Amend the amendment in Part D by striking out all of section 5. 
Amend the amendment in Part F by striking out all of sections 5, 7 and 8. 
Amend the amendment by relettering or renumbering any nonconsecutive Part letter 
or section number to read consecutively. 
SUMMARY 
The amendment incorporates the substance of Senate Amendment "H" to Committee 
Amendment "A" (S-96), except that this amendment retains current law pertaining to 
geographic acccss stan:a 
SPONSORED BY: 
o/t1? 
(Representative ~N, 
J.) 
TOWN: Eagle Lake 
HOUSE AMENDMENT