An Act To Prohibit Tobacco Use Surcharges in Small Group and Individual Health Insurance Products
Maine Legislature, Session 127, LD 0135
Committee Amendment CA_A_H26 (House)
Amends: 24-A MRSA §2736-C, 24-A MRSA §2

COMMITTEE AMENDMENT "A "to H.P. 93, L.D. 135, Bill, "An Act To Prohibit 
Tobacco Use Surcharges in Small Group and Individual Health Insurance Products" 
Amend the bill by striking out the title and substituting the following; 
'An Act To Reduce Tobacco Use Surcharges in Small Group and Individual Health 
Insurance Products' 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'Sec. 1. 24-A MRSA §2736-C, sub-§2, ~, 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. 
(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 
COMMITTEE AMENDMENT 
.f) 
u.. 
,.-, 
''''' 
r}:' 
COMMITTEE AMENDMENT"~" to H.P. 93, L.D. 135 
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 agl;: 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, 2016, the maximum rate differential due to tobacco use filed 
by the carrier as detennined by ratio is 1.5 to I. 
(2l. For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State on or after January 1, 2017, the 
maximum rate differential due to tobacco use filed by the carrier as determined 
!rr..ratio is 1.2 to 1. 
Sec. 2. 24-A MRSA §2736-C, sub-§2,~, as amended by PL 2011, c. 364, §5, is 
Dllrther 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-l. 
(1) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State between July I, 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 deli very, 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. 
COMMITTEE AMENDMENT 
~ 
\,J) 
ik 
• .J 
!X' 
COMMITTEE AMENDMENT "A" to H.P. 93, L.D. 135 
(3) 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 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 I 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 between July 1, 2012 
and December 31, 2016, the maximum rate differential due to tobacco use filed 
by the carrier as detennined by ratio is 1.5 to 1. 
(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, 2017, the 
maximum rate differential due to tobacco use filed by the carrier as determined 
by ratio is 1.2 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. 3. 24-A MRSA §2S0S-B, sub-§2, ~, 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 
under the following schedule and within the listed percentage bands. 
(l) 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%. 
COMMITTEE AMENDMENT 
.. ~i ~J 
!...c 
!) 
il; 
COMMITTEE AMENDMENT "A" to H.P. 93, L.D. 135 
(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 I, 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 I 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 I, 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 I, 
II and December 31, 2016, the maximum rate differential due to tobacco use 
filed by the carrier as determined by ratio is 1.5 to 1. 
(10) For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State on or after January 1, 2017, the 
maximum rate differential due to tobacco use filed by the carrier as determined 
by ratio is 1.2 to 1. 
COMMITTEE ,AMENDMENT 
v) 
L&.-
I Ie 
COMMITTEE AMENDMENT"~ "to H.P. 93, L.D. 135 
Sec. 4. 24-A MRS A §2S0S-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-l. 
(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 I, 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 detennining 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 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 pennitted 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 between October 1, 
2011 and December 31, 2016, the maximum rate differential due to tobacco use 
filed by the carrier as determined by ratio is 1.5 to 1. 
COMMITTEE AMENDMENT 
,,~) 
l.t. 
r!" 
COMMITTEE AMENDMENT" A" to H.P. 93, L.D. 135 
ill For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State on or after January 1, 2017, the 
maximum rate differential due to tobacco use filed by the carrier as determined 
QY..Jatio is 1.2 to 1.' 
SUMMARY 
The amendment replaces the bill, which proposed to prohibit carriers providing 
individual health plans or small group health plans from adding a surcharge for tobacco 
use. The amendment reduces the maximum rate differential that may be applied by a 
carrier for tobacco use in individual and small group health insurance policies from 1.5 to 
to 1.2 to 1 and makes the changed rate differential apply to all policies, contracts and 
certificates issued or renewed on or after January 1,2017. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
":-;.,', 
~\f~l 
~~t!. 
~,~~\;:J 
Approved: 03/17115 
.::wac 
LD 135 
LR 781(02) 
An Act To Prohibit Tobacco Use Surcharges in Small Group and Individual Health Insurance 
Fiscal Detail and Notes 
Products 
Fiscal Note for Bill as Amended by Committee Amendment '~'I 
Committee: Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - Other Special Revenue Funds 
CH-d~ 
Any additional costs to the Department of Professional and Financial Regulation to adopt the changes in this bill are 
expected to be minor and can be absorbed within existing budgeted resources. 
LR0781(02) - Fiscal Note - Page 1 of 1