An Act To Prohibit Tobacco Use Surcharges in Small Group and Individual Health Insurance Products
Maine Legislature, Session 127, LD 0135
Committee: Insurance and Financial Services
Sponsors: SANBORN, GRATWICK, BECK, MELARAGNO, ROTUNDO
Amends: 24-A MRSA §2736-C, 24-A MRSA §2808-B

Legislative Document 
No. 135 
H.P. 93 
House of Representatives, January 22, 2015 
An Act To Prohibit Tobacco Use Surcharges in Small Group and 
Individual Health Insurance Products 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
ROBERT B. HUNT 
Clerk 
Presented by Representative SANBORN of Gorham. 
Cosponsored by Senator GRATWICK of Penobscot and 
Representatives: BECK of Waterville, MELARAGNO of Auburn, ROTUNDO of Lewiston. 
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 2007, c. 629, Pt. 
A, §3, is further amended to read: 
B.  A carrier may not vary the premium rate due to tobacco use or the gender, health 
status, occupation or industry, claims experience or policy duration of the individual. 
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. 
(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 July 1, 2012, 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, ¶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 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 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. 4.  24-A MRSA §2808-B, sub-§2, ¶B, as amended by PL 1993, c. 477, Pt. 
B, §1 and affected by Pt. F, §1, is further amended to read: 
B.  A carrier may not vary the premium rate due to tobacco use or the gender, health 
status, claims experience or policy duration of the eligible group or members of the 
group. 
Sec. 5.  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, and group size and tobacco use 
only 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 October 1, 2011, the 
maximum rate differential due to tobacco use filed by the carrier as determined 
by ratio is 1.5 to 1. 
Sec. 6.  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 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. 
(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 prohibits carriers providing individual health plans or small group health 
plans from adding a surcharge for tobacco use.