An Act Regarding Short-term, Limited-duration Health Plans
Maine Legislature, Session 129, LD 1260
Committee Amendment CA_A_H476 (House)
Amends: 24-A MRSA §2736-C, 24-A MRSA §2849-B

COMMITTEE AMENDMENT "A" to H.P. 921, L.D. 1260, Bill, "An Act 
Regarding Short-term, Limited-duration Health Plans" 
Amend the bill by striking out everything after the enacting clause and inserting the 
following: 
'Sec. 1. 24-A MRSA §2736-C, sub-§1, 1C, as amended by PL 2011, c. 238, Pt. 
D, §1, is further amended to read: 
C. "Individual health plan" means any hospital and medical expense-incurred policy 
or health, hospital or medical service corporation plan contract. It includes both 
individual contracts and certificates issued under group contracts specified in section 
2701, subsection 2, paragraph C. 
"Individual health plan" does not include the 
following types of insurance: 
(1) Accident; 
(2) Credit; 
(3) Disability; 
(4) Long-term care or nursing home care; 
(5) Medicare supplement; 
(6) Specified disease; 
(7) Dental or vision; 
(8) Coverage issued as a supplement to liability insurance; 
(9) Workers' compensation; 
(10) Automobile medical payment; 
COMMITTEE AMENDMENT 
COMMITIEE AMENDMENT .. ; 
"to H.P. 921, L.D. 1260 
(11) Insurance under which benefits are payable with or without regard to fault 
and that is required statutorily to be contained in any liability insurance policy or 
equivalent self-insurance; or 
(12) Short-term. limited-duration policies, as described in section 2849-B, 
subsection 1. 
Sec. 2. 24-A MRSA §2849-B, sub-§1, as amended by PL 2011, c. 90, Pt. G, §1, 
is further amended to read: 
1. Policies subject to this section. This section applies to all individual, group and 
blanket medical insurance policies except hospital indemnity, specified accident, 
specified disease, long-term care and short-term. limited-duration policies issued by 
insurers or health maintenance organizations. For purposes of this section, a short-term .. 
limited-duration policy is an individual, nonrenewable policy issued for a term that is--les-s 
than 12 months does not extend beyond December 31st of the calendar year in which the 
policy is issued. This section does not apply to Medicare supplement policies as defined 
in section 5001, subsection 4. 
Sec. 3. 24-A MRSA §2849-B, sub-§2, as amended by PL 2007, c. 199, Pt. D, §4, 
is further amended to read: 
2. Persons provided continuity of coverage. Except as provided in subsection 3, 
this section provides continuity of coverage for a person who seeks coverage under an 
individual, group or blanket insurance policy or health maintenance organization policy 
if: 
A. That person was covered under an individual, group or blanket contract or policy 
issued by a nonprofit hospital or medical service organization, insurer; or health 
maintenance organization or was covered under an uninsured employee benefit plan 
that provides payment for health services received by employees and their dependents 
or a governmental program, including, but not limited to, those listed in section 2848, 
subsection 1-B, paragraph A, subparagraphs (3) to (10). For purposes of this section, 
the individual, group or blanket policy under which the person is seeking coverage is 
the "succeeding policy." 
The group, blanket or individual contract or policy, 
uninsured employee benefit plan or governmental program that previously covered 
the person is the "prior contract or policy"; and 
·32 
B. Coverage under the prior contract or policy terminated: 
(1) Within 180 days before the date the person enrolls or is eligible to enroll in 
the succeeding contract if: 
(a) Coverage was terminated due to unemployment, as defined in Title 26, 
section 1043; 
(b) The person was eligible for and received unemployment compensation 
benefits for the period of unemployment, as provided under Title 26, chapter 
13;and 
( c) The person is employed at the time replacement coverage is sought under 
this provision; or 
COMMITTEE AMENDMENT 
~·"" 
COMMITTEE AMENDMENT "A" to H.P. 921, L.D. 1260 
(2) Within 90 days before the date the person enrolls or is eligible to enroll in the 
succeeding contract. 
A period of ineligibility for a health plan imposed by terms of employment may not 
be considered in determining whether the coverage ended within a time period 
specified under this section. 
This section does not apply to replacements of group or blanket coverage within the 
scope of section 2849 or if the succeeding policy is an individual policy and the prior 
contract or policy was a short-term. limited-duration policy. 
Sec. 4. 24-A MRSA §2849-B, sub-§8, as amended by PL 2011, c. 90, Pt. G, §2, 
is further amended to read: 
8. Short-term, limited-duration insurance. A person eligible for continuity of 
coverage under subsection 2 may be allowed to purchase coverage under an individual, 
nonrenewable.. short-term. limited-duration policy. 
The issuance of a short-term .. 
limited-duration policy is subject to the following conditions. 
A. Upon offering an individual short-term, limited-duration policy for purchase, an 
insurer or the insurer's agent or broker ffitlSt shall provide written disclosure ef-the 
terms and benefits of the poliey as required in this paragraph in at least 14-point type. 
Speeifie diselosme that the short term poliey is not soojeet to any lim4tation on 
preexisting eondition exelusions or the provisions of gaaranteed renewal and 
eontin:tii-ty of eoverage is required. An insurer or the insurer's agent or broker shall 
specifically disclose: 
(1) A summary of plan benefits. limits and exclusions in a standardized format 
similar to the format required for a qualified health plan under the federal 
Affordable Care Act that is specific to the exact policy being offered for purchase 
in this State, including, but not limited to, information about the circumstances in 
which covered benefits may be subject to balance billing and examples of how 
charges may be applied toward any cost sharing under the policy and billed to the 
individual policyholder: and 
(2) A comparison of the short-term, limited-duration policy to a qualified health 
plan in the terms, benefits and conditions of the policy, any exclusions, medical 
loss ratio requirements or the provisions of guaranteed renewal and continuity of 
coverage. 
B. 
An insurer or the insurer's agent or broker may net issue a short-term .. 
limited-duration policy that replaces a prior short-term, limited-duration policy if as 
long as the combined term of the new policy and all prior sueeessive policies does not 
exceed 24 months and the individual has not been covered under any prior short-
term, limited-duration policy for at least 12 months. All individuals making an 
application for coverage under a short-term, limited-duration policy must disclose 
any prior coverage under a short-term, limited-duration policy and the policy 
duration. 
C. An insurer or the insurer's agent or broker may not issue a short-term, limited-
duration policy unless it has been sold through an in-person encounter. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A " 
to H.P. 921, L.D. 1260 
D. An insurer or the insurer's agent or broker may not actively market or sell any 
short-term, limited-duration policy during any open enrollment period, except for a 
short-term, limited-duration policy that terminates coverage on December 31st of the 
calendar year in which it is sold. 
E. Upon offering an individual short-term, limited-duration policy for purchase, an 
insurer or the insurer's agent or broker shall assess an individual making an 
application for eligibility for an advanced premium tax credit or cost-sharing 
reduction for coverage under a qualified health plan purchased on the exchange 
pursuant to the federal Affordable Care Act, as defined in section 2188, subsection 1, 
paragraph A, and shall provide an estimate of the cost for coverage under a qualified 
health plan after applying any advanced premium tax credit or cost-sharing reduction. 
F. 
An insurer or the insurer's agent or broker shall make the documents and 
information required to be disclosed under paragraph A upon offering an individual 
short-term. limited-duration policy for purchase available through the insurer's 
publicly accessible website. 
G. An insurer or the insurer's agent or broker shall provide, upon the purchase of a 
short-term, limited-duration policy; upon the expiration of the policy; and, if the 
policy is in effect during an open enrollment period, on November 1st of the calendar 
year in which the policy was sold, written notice of the following: 
(1) 
Disclosure that a short-term, limited-duration policy is not considered 
minimum essential coverage under the federal Affordable Care Act and that 
termination of a policy is not a qualifying event for a special enrollment period; 
and 
(2) The dates for the next open enrollment period, the website address for the 
publicly accessible website of the exchange, as defined in section 2188, 
subsection l, paragraph A, and the toll-free telephone number for the exchange. 
Sec. 5. Bureau of Insurance bulletin. No later than 30 days following the 
effective date of this Act, the Department of Professional and Financial Regulation, 
Bureau of Insurance shall issue a bulletin related to short-term, limited-duration health 
insurance policies describing the statutory requirements for the policies, including the 
requirements enacted in this Act and the required mandated benefits applicable to all 
short-term, limited-duration policies. 
Sec. 6. Application. The requirements of this Act apply to all short-term, limited-
duration health insurance policies, contracts and certificates executed, delivered, issued 
for delivery, continued or renewed in this State on or after January 1, 2020. For purposes 
of this Act, all contracts are deemed to be renewed no later than the next yearly 
anniversary of the contract date.' 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or 
section number to read consecutively. 
SUMMARY 
This amendment replaces the bill. The amendment does the following. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT ·/J "to H.P. 921, L.D. 1260 
1. It limits the issuance of short-term, limited-duration individual health insurance 
policies in this State to policies with a term that ends on December 31st of the calendar 
year in which they are issued and allows an insurer or the insurer's agent or broker to 
issue a short-term, limited-duration policy that replaces a prior short-term, limited-
s 
duration policy only if the combined term of the new policy and all prior policies does not 
exceed 24 months and as long as the individual has not been covered under any short-
term, limited-duration policy for at least 12 months prior to the issuance of a policy. 
2. It requires that insurers make specific written disclosures related to the terms and 
benefits of policies in at least 14-point type, including the types of benefits and consumer 
protections that are and are not included in the policies, a summary of plan benefits, 
limits and exclusions in a standardized format, information about the circumstances in 
which covered benefits may be subject to balance billing and examples of how charges 
may be applied toward any cost sharing under the policy and billed to the individual 
policyholder, and a comparison of the short-term, limited-duration policy to a qualified 
health plan in the terms, benefits and conditions of the policy, any exclusions, medical 
loss ratio requirements or the provisions of guaranteed renewal and continuity of 
covel'age. It also requires an insurer to make the documents and information required to 
be disclosed to be made available on the insurer's publicly accessible website. 
3. It prohibits a short-term, limited-duration policy from being actively marketed or 
sold during any open enrollment period except for a policy that terminates coverage on 
December 31st. 
4. It restricts the sale of sho1t-term, limited-duration policies to in-person encounters 
with an insurer or an insurer's agent or broker. 
5. It requires that an insurer or an insurer's agent or broker, upon offering an 
individual short-term, limited-duration policy for purchase, assess an individual making 
an application for eligibility for an advanced premium tax credit or cost-sharing reduction 
for coverage under a qualified health plan purchased on the exchange pursuant to the 
federal Patient Protection and Affordable Care Act and provide an estimate of the cost for 
coverage under a qualified health plan after applying any advanced premium tax credit or 
cost-sharing reduction. 
6. It requires the Department of Professional and Financial Regulation, Bureau of 
Insurance to issue, no later than 30 days following the effective date of this legislation, a 
bulletin related to short-term, limited-duration health insurance policies describing the 
statutory requirements for the policies, including the requirements enacted in this 
legislation and the required mandated benefits applicable to all short-term, limited-
duration policies. 
7. It makes the requirements of this legislation apply to policies issued or renewed in 
this State on or after January 1, 2020. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Fiscal Detail and Notes 
Revised: 05/30/19 feac.. 
LD 1260 
LR 2034(02) 
An Act Regarding Short-term, Limited-duration Health Plans 
Fiscal Note for Bill as Amended by Committee Amendment{/, ( H-'l lio) 
Committee: Health Coverage, Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - Other Special Revenue Funds 
Any additional costs to the Bureau of Insurance within the Depmiment of Professional and Financial Regulation to 
issue a bulletin related to short-tem1, limited-duration health insurance policies describing the statutory requirements 
for the policies are expected to be minor and can be absorbed within existing budgeted resources. 
LR2034(02) - Fiscal Note - Page 1 of 1