An Act To Prohibit a Health Insurance Carrier from Establishing a Separate Premium Rate Based on Geographic Area
Maine Legislature, Session 126, LD 0161
Committee: Insurance and Financial Services
Sponsors: LUCHINI, GOODE, HUBBELL, PETERSON, PATRICK
Amends: 24-A MRSA §2736-C, 24-A MRSA §2808-B

Legislative Document 
No. 161 
H.P. 136 
House of Representatives, January 31, 2013 
An Act To Prohibit a Health Insurance Carrier from Establishing a 
Separate Premium Rate Based on Geographic Area 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
MILLICENT M. MacFARLAND 
Clerk 
Presented by Representative LUCHINI of Ellsworth. 
Cosponsored by Representatives: GOODE of Bangor, HUBBELL of Bar Harbor, PETERSON 
of Rumford, Senator: PATRICK of Oxford. 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  24-A MRSA §2736-C, sub-§2, ¶C-1, as enacted by PL 2011, c. 90, Pt. 
A, §2, is amended to read: 
C-1.  A carrier may vary the premium rate due to geographic area in accordance with 
the limitation set out in this paragraph and paragraph D-1.  For all policies, contracts 
or certificates that are executed, delivered, issued for delivery, continued or renewed 
in this State on or after between July 1, 2012 and December 31, 2013, the rating 
factor used by a carrier for geographic area may not exceed 1.5. 
Sec. 2.  24-A MRSA §2736-C, sub-§2, ¶D, as amended by PL 2011, c. 364, §4, 
is further amended to read: 
D.  A carrier may vary the premium rate due to age and tobacco use in accordance 
with the limitations set out in this paragraph and paragraph D-1. 
(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%. 
(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, 2012, the premium rate may not deviate above or below the community rate 
filed by the carrier by more than 20%. 
(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 to the extent permitted by the federal Affordable 
Care Act.  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 to the extent permitted by the federal Affordable Care Act.  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 between July 1, 2012 
and December 31, 2013, the maximum rate differential due to tobacco use filed 
by the carrier as determined by ratio is 1.5 to 1. 
Sec. 3.  24-A MRSA §2736-C, sub-§2, ¶D-1 is enacted to read: 
D-1.  A carrier may vary the premium rate due to age, geographic area and tobacco 
use in accordance with the limitations set out in paragraphs C-1 and D and this 
paragraph. 
(1)  For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State on or after January 1, 2014, the 
maximum rate differential due to age and geographic area 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. 
(2)  For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State on or after  January 1, 2014,  the 
maximum rate differential due to tobacco use filed by the carrier as determined 
by ratio is 1.5 to 1. 
Sec. 4.  24-A MRSA §2736-C, sub-§2, ¶I, as amended by PL 2011, c. 364, §5, is 
further amended to read: 
I.  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 and paragraphs C 
and C-1. 
(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 on or after January 1, 
2014 and December 31, 2014, the maximum rate differential due to age and 
geographic area 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 to the extent permitted by the federal Affordable 
Care Act.  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 to the extent permitted by the federal Affordable Care Act.  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 tobacco use filed by the carrier as determined 
by ratio is 1.5 to 1. 
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. 
Sec. 5.  24-A MRSA §2808-B, sub-§2, ¶C-1, as enacted by PL 2011, c. 90, Pt. 
A, §7, is amended to read: 
C-1.  A carrier may vary the premium rate due to geographic area in accordance with 
the limitation set out in this paragraph and paragraph D-3.  For all policies, contracts 
or certificates that are executed, delivered, issued for delivery, continued or renewed 
in this State on or after between October 1, 2011 and December 31, 2013, the rating 
factor used by a carrier for geographic area may not exceed 1.5. 
Sec. 6.  24-A MRSA §2808-B, sub-§2, ¶D, as amended by PL 2011, c. 638, §2, 
is further amended to read: 
D.  A carrier may vary the premium rate due to age, group size and tobacco use only 
as provided in paragraph D-3 and 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 between 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 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%. 
(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 
September 30, 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. 
(5)  For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State between October 1, 2012 and 
December 31, 2013, the maximum rate differential due to age and group size 
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 and group size 
filed by the carrier as determined by ratio is 3 to 1 to the extent permitted by the 
federal Affordable Care Act. 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 and group size 
filed by the carrier as determined by ratio is 4 to 1 to the extent permitted by the 
federal Affordable Care Act.  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 and group size filed by the carrier as 
determined by ratio is 5 to 1 to the extent permitted by the federal Affordable 
Care Act.  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 between October 1, 
2011 and December 31, 2013, the maximum rate differential due to tobacco use 
filed by the carrier as determined by ratio is 1.5 to 1. 
Sec. 7.  24-A MRSA §2808-B, sub-§2, ¶D-3 is enacted to read: 
D-3.  A carrier may vary the premium rate due to age, group size, geographic area 
and tobacco use in accordance with the limitations set out in paragraph D and this 
paragraph. 
(1) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State on or after January 1, 2014, the 
maximum rate differential due to age, group size and geographic area 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. 
(2)  For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State on or after January 1, 2014,  the 
maximum rate differential due to tobacco use filed by the carrier as determined 
by ratio is 1.5 to 1. 
Sec. 8.  24-A MRSA §2808-B, sub-§2, ¶H, as amended by PL 2011, c. 638, §3, 
is further amended 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 and paragraphs C 
and C-1. 
(1)  For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State between October 1, 2011 and 
September 30, 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 October 1, 2012 and 
December 31, 2013, the maximum rate differential due to age and group size 
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 on or after January 1, 
2014 and December 31, 2014, the maximum rate differential due to age, 
geographic area and group size filed by the carrier as determined by ratio is 3 to 1 
to the extent permitted by the federal Affordable Care Act.  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 and group size 
filed by the carrier as determined by ratio is 4 to 1 to the extent permitted by the 
federal Affordable Care Act.  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 and group size filed by the carrier as 
determined by ratio is 5 to 1 to the extent permitted by the federal Affordable 
Care Act.  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 tobacco use filed by the carrier as determined 
by ratio is 1.5 to 1. 
SUMMARY 
This bill eliminates the ability of health insurers to establish a separate premium rate 
variation on the basis of geographic area, which was enacted as part of Public Law 2011, 
chapter 90.  The bill merges the rating bands for age and geographic area so that the 
combined rate differential due to age and geographic area may not exceed a ratio of 3 to 1 
beginning January 1, 2014 for all individual and small group health insurance policies.