An Act To Eliminate Insurance Rating Based on Age, Geographic Location or Smoking History and To Reduce Rate Variability Due to Group Size
Maine Legislature, Session 129, LD 0132
Committee: Health Coverage, Insurance and Financial Services
Sponsors: BROOKS, FARNSWORTH, FAY, HANDY, HOBBS, MELARAGNO, SYLVESTER, TALBOT ROSS
Amends: 24-A MRSA §2736-C, 24-A MRSA §2808-B

Legislative Document
No. 132
H.P. 114
House of Representatives, January 17, 2019
An Act To Eliminate Insurance Rating Based on Age, Geographic 
Location or Smoking History and To Reduce Rate Variability Due 
to Group Size
Reference to the Committee on Health Coverage, Insurance and Financial Services 
suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative BROOKS of Lewiston.
Cosponsored by Representatives: FARNSWORTH of Portland, FAY of Raymond, HANDY of 
Lewiston, HOBBS of Wells, MELARAGNO of Auburn, SYLVESTER of Portland, TALBOT 
ROSS of Portland.
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.  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, 2019, the rating factor used by a carrier 
for geographic area may not exceed 1.5.  For all policies, contracts or certificates that 
are executed, delivered, issued for delivery, continued or renewed in this State on or 
after January 1, 2020, a carrier may not vary the premium rate due to geographic 
area.
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 between January 1, 
2015 and December 31, 2019, the maximum rate differential due to age 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.  For all 
policies, contracts or certificates that are executed, delivered, issued for delivery, 
continued or renewed in this State on or after January 1, 2020, a carrier may not 
vary the premium rate due to 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, 2019, the maximum rate differential due to tobacco use filed 
by the carrier as determined by ratio is 1.5 to 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, 2020, a carrier may not vary the premium rate 
due to tobacco use.
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 between January 1, 
2016 and December 31, 2019, the maximum rate differential due to age 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.  For all 
policies, contracts or certificates that are executed, delivered, issued for delivery, 
continued or renewed in this State on or after January 1, 2020, a carrier may not 
vary the premium rate due to 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, 2019, the maximum rate differential due to tobacco use filed 
by the carrier as determined by ratio is 1.5 to 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, 2020, a carrier may not vary the premium rate 
due to tobacco use.
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, ¶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.  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, 2019, the rating factor used by a 
carrier for geographic area may not exceed 1.5.  For all policies, contracts or 
certificates that are executed, delivered, issued for delivery, continued or renewed in 
this State on or after January 1, 2020, a carrier may not vary the premium rate due to 
geographic area.
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, 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 between January 1, 
2016 and December 31, 2019, 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, 2019, the maximum rate differential due to tobacco use 
filed by the carrier as determined by ratio is 1.5 to 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, 2020, a carrier may not vary the premium rate 
due to tobacco use.
(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, 2020, a 
carrier may not vary the premium rate due to age.
(11)  For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State between January 1, 2020 and 
December 31, 2020, the maximum rate differential due to group size filed by the 
carrier as determined by ratio is 3 to 1.
(12)  For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State between January 1, 2021 and 
December 31, 2021, the maximum rate differential due to group size filed by the 
carrier as determined by ratio is 2 to 1.
(13)  For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State on or after January 1, 2022, the 
maximum rate differential due to group size 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 between January 1, 
2016 and December 31, 2019, 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, 2019, the maximum rate differential due to tobacco use 
filed by the carrier as determined by ratio is 1.5 to 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, 2020, a carrier may not vary the premium rate 
due to tobacco use.
(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, 2020, a 
carrier may not vary the premium rate due to age.
(8)  For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State between January 1, 2020 and 
December 31, 2020, the maximum rate differential due to group size filed by the 
carrier as determined by ratio is 3 to 1.
(9)  For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State between January 1, 2021 and 
December 31, 2021, the maximum rate differential due to group size filed by the 
carrier as determined by ratio is 2 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, 2022, the 
maximum rate differential due to group size filed by the carrier as determined by 
ratio is 1.5 to 1.
SUMMARY
This bill prohibits insurance carriers providing individual health plans or small group 
health plans from varying premium rates based on age, geographic location or tobacco 
use on or after January 1, 2020.  The bill also reduces the variation based on group size to 
1.5 to 1 for small group plans over time.