An Act To Protect Health Insurance Ratepayers from Undocumented Rate Increases
Maine Legislature, Session 126, LD 0083
Committee: Insurance and Financial Services
Sponsors: PATRICK, PETERSON, ALFOND, GOODALL, JACKSON, JOHNSON, LACHOWICZ, BRIGGS, CAREY, HERBIG
Amends: 24-A MRSA §2736-C

Legislative Document 
No. 83 
S.P. 34 
In Senate, January 22, 2013 
An Act To Protect Health Insurance Ratepayers from 
Undocumented Rate Increases 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
DAREK M. GRANT 
Secretary of the Senate 
Presented by Senator PATRICK of Oxford. 
Cosponsored by Representative PETERSON of Rumford and 
Senators: President ALFOND of Cumberland, GOODALL of Sagadahoc, JACKSON of 
Aroostook, JOHNSON of Lincoln, LACHOWICZ of Kennebec, Representatives: BRIGGS of 
Mexico, CAREY of Lewiston, HERBIG of Belfast. 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  24-A MRSA §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.  Notwithstanding section 2736, subsection 
and section 2736-A, at the carrier's option, rate Rate filings for a carrier's credible block 
of individual health plans may must 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 
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 the 
superintendent determines that the number of members is likely to be less than 
needed to meet the credibility standard, the filing is subject to section 2736, 
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 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. 2.  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.  Except as provided in subsection 2-B, for 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. 
SUMMARY 
This bill 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.