An Act To Restore Consumer Rate Review for Health Insurance Plans in the Individual and Small Group Markets
Maine Legislature, Session 126, LD 0225
Committee Amendment CA_A_H314 (House)
Amends: 24-A MRSA §2735-A, 24-A MRSA §2736-C

COMMITTEE AMENDMENT "A" to H.P. 186, L.D. 225, Bill, "An Act To 
Restore Consumer Rate Review for Health Insurance Plans in the Individual and Small 
Group Markets" 
Amend the bill by striking out the title and substituting the following: 
'An Act To Restore Consumer Rate Review for Health Insurance Plans in the 
Individual Market' 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'Sec. 1. 24-A MRSA §2735-A, sub-§l, as amended by PL 2011, c. 364, §1, is 
further amended to read: 
1. Notice of rate filing or rate increase on existing policies. An insurer offering 
individual health plans as defined in section 2736-C must provide written notice by first 
class mail of a rate filing to all affected policyholders at least 60 days before the effective 
date of any proposed increase in premium rates or any proposed rating formula, 
classification of risks or modification of any formula or classification of risks. exeept as 
otherwise provided iB seetioB 2736 C, s1:lbseetioB 2.8, the The notice must also inform 
policyholders of their right to request a hearing pursuant to section 229. The notice must 
show the proposed rate and, 1:lBless otherwise provided iB seetioB 2736 C, s1:lbseetioB 2 .8, 
state that the rate is subject to regulatory approval. exeept as otherwise provided iB 
seetioB 2736 C, s1:lbseetioB 2 .8, the The superintendent may not take final action on a 
rate filing until 40 days after the date notice is mailed by an insurer. An increase in 
premium rates may not be implemented until 60 days after the notice is provided or until 
the effective date under section 2736, whichever is later. 
Sec. 2. 24-A MRS A §2736-A, first ~, as amended by PL 2011, c. 364, §2, is 
further amended to read: 
If at any time the superintendent has reason to believe that a filing does not meet the 
requirements that rates not be excessive, inadequate or unfairly discriminatory or that the 
filing violates any of the provisions of chapter 23, the superintendent shall cause a 
COMMITTEE AMENDMENT 
ROFS 
COMMITfEE AMENDMENT ·A .. to H.P. 186, L.D. 225 
hearing to be held. If a filing proposes an increase in rates in an individual health plan as 
defined in section 2736-C, the superintendent shall cause a hearing to be held at--the 
reqliest ef tHe "'tterney General. In any hearing conducted under this section, the insurer 
has the burden of proving rates are not excessive, inadequate or unfairly discriminatory. 
Sec. 3. 24-A MRS A §2736-C, sub-§2-B, as amended by PL 2011, c. 364, §7, is 
further amended to read: 
2-B. Rate filings; credible health plans. NetwitHstanding seetien 2736, sliaseetien 
and seetien 2736 A, at the earrier's eptien, rate Rate filings for a earrier's erediale aleek 
ef individual health plans may must be filed in accordance with this subsection. FdNes 
filed in aeeerdanee 'lAth tHis slihseetien are filed fer infermatienal plirpeses linless rate 
review is reQliired plirsliant te the federal Afferdaele Care Aet. 
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 
meets standards for full or partial credibility pursuant to the federal Affordable Care 
Act. 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.-tRe 
s1:lperintendent determines tHat the Rlimaer ef members is likely te ae less than 
needed te meet tHe crediaility standard, the filing is subjeet te seetien 2736, 
slibseetien 1 and seetiefl 2736 A. 
B. On an annual schedule as determined by the superintendent, the carrier shall file a 
report with the superintendent showing the calculation of rebates as required pursuant 
to the federal Affordable Care Act, except that the calculation must be based on a 
minimum medical loss ratio of 80% if the applicable federal minimum for the 
individual market in this State is lower. If the calculation indicates that rebates must 
be paid, the carrier must pay the rebates in the same manner as is required for rebates 
pursuant to the federal Affordable Care Act. 
Sec.4. 24-A MRSA §2736-C, sub-§5, as amended by PL 2011, c. 90, Pt. D, §3, 
is further amended to read: 
5. 
Loss ratios. BKeept as previded in slihseetien 2 B, fer 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 aenefits estimated te ae 
paid Wider all the individlJal health pelieies maifttainsd in feree ay tHe carrier fer the 
peried fer '.vhieH eeverage is te ae previded will remm te pelieyhelders at least 65% ef 
tHe aggregate prefBiliffiS eelleeted fer these pelieies the minimum medical loss ratio 
satisfies the requirements for individual health plans in section 4319, 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. 5. 
Application. 
This Act applies to individual health plan rate filings 
submitted by a carrier to the Department of Professional and Financial Regulation, 
Bureau of Insurance pursuant to the Maine Revised Statutes, Title 24-A, sections 2736 
and 2736-C for the 2015 plan year and thereafter. 
COMMITTEE AMENDMENT 
ROFS 
COMMITTEE AMENDMENT ,A" to H.P. 186, L.D. 225 
Sec. 6. Appropriations and allocations. The following appropriations and 
allocations are made. 
PROFESSIONAL AND FINANCIAL REGULATION, DEPARTMENT OF 
Insurance - Bureau of 0092 
Initiative: Allocates funds for the costs of conducting hearings, including advertising, 
reporting services, room rentals, travel reimbursement and contractual actuarial services. 
OTHER SPECIAL REVENUE FUNDS 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
SUMMARY 
2013-14 
$17,000 
$17,000 
2014-15 
$17,000 
$17,000 
This amendment is the majority report of the committee and replaces the bill. The 
amendment does the following. 
1. 
The amendment restores the statutory process for advance review and prior 
approval of individual health insurance rates and rescinds the changes to the rate review 
process for individual health insurance made by Public Law 2011, chapter 90. 
2. The amendment requires the Superintendent of Insurance to hold a hearing if a 
filing proposes an increase in rates in individual health insurance plans. 
3. The amendment removes the provisions in the bill that relate to small group health 
insurance and the provision that requires the superintendent to hold meetings in at least 3 
locations to allow public comment as part of any hearing. 
4. 
The amendment makes references to the minimum medical loss ratio for 
individual health plans consistent with federal law. 
5. The amendment removes cross-references to reflect the changes to the rate review 
process. 
6. The amendment also clarifies that the changes apply to individual health plan rate 
filings submitted to the Department of Professional and Financial Regulation, Bureau of 
Insurance beginning with the 2015 plan year. 
7. This amendment adds an appropriations and allocations section. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: OS/28/13 
~ac:.. 
LD225 
LR 721(02) 
An Act To Restore Consumer Rate Review for Health Insurance Plans in the Individual and Small 
Group Markets 
Fiscal Notefor Bill as Amended by Committee Amendment~' (H -j 14-) 
Committee: Insurance and Financial Services 
Appropriations/Allocations 
Other Special Revenue Funds 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2013-14 
FY2014-15 
$17,000 
$17,000 
Projections 
FY 2015-16 
$17,000 
Projections 
FY2016-17 
$17,000 
Provides an Other Special Revenue Funds allocation for the Bureau of Insurance in the Department of Professional 
and Financial Regulation for the costs of conducting hearings, including advertising, reporting services, room rentals, 
travel reimbursement and contractual actuarial services. 
LR0721(02) - Fiscal Note - Page 1 of 1