An Act To Strengthen Consumer Protections in Health Care
Maine Legislature, Session 129, LD 1650
Committee: Health Coverage, Insurance and Financial Services
Sponsors: TIPPING, SANBORN, BROOKS, FOLEY, MADIGAN, MARTIN, MELARAGNO, TEPLER, GRATWICK
Amends: 24-A MRSA §2735-A, 24-A MRSA §2736-C, 24-A MRSA §2808-B

Legislative Document
No. 1650
H.P. 1186
House of Representatives, April 30, 2019
An Act To Strengthen Consumer Protections in Health Care
Reference to the Committee on Health Coverage, Insurance and Financial Services 
suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative TIPPING of Orono.
Cosponsored by Senator SANBORN, L. of Cumberland and
Representatives: BROOKS of Lewiston, FOLEY of Biddeford, MADIGAN of Waterville, 
MARTIN of Eagle Lake, MELARAGNO of Auburn, TEPLER of Topsham, Senator: 
GRATWICK of Penobscot.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  24-A MRSA §2735-A, sub-§1, as amended by PL 2011, c. 364, §1, is 
further amended to read:
1.  Notice of rate filing or rate increase on existing policies.  An insurer offering 
individual health plans as defined in section 2736-C must provide written notice by first 
class mail of a rate filing to all affected policyholders at least 60 days before the effective 
date of any proposed increase in premium rates or any proposed rating formula, 
classification of risks or modification of any formula or classification of risks.  Except as 
otherwise provided in section 2736-C, subsection 2-B, the The notice must also inform 
policyholders of their right to request a hearing pursuant to section 229.  The notice must 
show the proposed rate and, unless otherwise provided in section 2736-C, subsection 2-B, 
state that the rate is subject to regulatory approval.  Except as otherwise provided in 
section 2736-C, subsection 2-B, the The superintendent may not take final action on a 
rate filing until 40 days after the date notice is mailed by an insurer.  An increase in 
premium rates may not be implemented until 60 days after the notice is provided or until 
the effective date under section 2736, whichever is later.
Sec. 2.  24-A MRSA §2736-C, sub-§2, ¶C-1, as enacted by PL 2011, c. 90, Pt. 
A, §2, is repealed.
Sec. 3.  24-A MRSA §2736-C, sub-§2, ¶D, as amended by PL 2019, c. 5, Pt. A, 
§3, is further amended to read:
D.  A carrier may vary the premium rate due to age, geographic area and tobacco use 
in accordance with the limitations set out in this paragraph.  A carrier that varies the 
premium rate due to age must vary the premium rate according to a uniform age 
curve.  The superintendent shall adopt rules establishing a uniform age curve that is 
substantially similar to the age curve in effect on January 1, 2019 under the federal 
Affordable Care Act.  Rules adopted under this paragraph are routine technical rules 
as defined in Title 5, chapter 375, subchapter 2-A.
(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, 
except as provided in subparagraph (9) (10), 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.
(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, except that the carrier may not apply a rate differential 
pursuant to this subparagraph when the covered individual is participating in an 
evidence-based tobacco cessation strategy approved by the United States 
Department of Health and Human Services, Food and Drug Administration.
(9)  For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State on or after the effective date of 
this subparagraph, the maximum rate differential due to age filed by the carrier as 
determined by ratio is 3 to 1 for individuals 21 years of age and older on the first 
day of coverage under the policy, contract or certificate.  The variation in rate due 
to age must be actuarially justified for individuals under 21 years of age 
consistent with the uniform age rating curve adopted under this paragraph.
(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, for 
each individual health plan offered by a carrier, the highest premium rate for each 
rating tier may not exceed 2.5 times the premium rate that could be charged to an 
eligible individual with the lowest premium rate for that rating tier in a given 
rating period. For purposes of this subparagraph, "rating tier" means each 
category of individual or family composition for which a carrier charges separate 
rates.
(a)  In determining the rating factor for geographic area pursuant to this 
subparagraph, the ratio between the highest and lowest rating factor used by a 
carrier for geographic area may not exceed 1.5 and the ratio between highest 
and lowest combined rating factors for age and geographic area may not 
exceed 2.5.
(b)  In determining rating factors for age and geographic area pursuant to this 
subparagraph, rates must take into account the savings resulting from the 
reinsurance program created by chapter 54-A.
(c)  The superintendent shall adopt rules setting forth appropriate 
methodologies regarding determination of rating factors pursuant to this 
subparagraph.  Rules adopted pursuant to this division are routine technical 
rules as defined in Title 5, chapter 375, subchapter 2-A.
Sec. 4.  24-A MRSA §2736-C, sub-§2-B, as amended by PL 2011, c. 364, §7, is 
repealed.
Sec. 5.  24-A MRSA §2736-C, sub-§5, as amended by PL 2019, c. 5, Pt. A, §6, is 
further amended to read:
5.  Loss ratios.  Except as provided in subsection 2-B, for For all policies and 
certificates issued on or after the effective date of this section, the superintendent shall 
disapprove any premium rates filed by any carrier, whether initial or revised, for an 
individual health policy unless it is anticipated that the medical loss ratio calculated under 
section 4319 will be at least 80%.
Sec. 6.  24-A MRSA §2808-B, sub-§2, ¶C-1, as enacted by PL 2011, c. 90, Pt. 
A, §7, is repealed.
Sec. 7.  24-A MRSA §2808-B, sub-§2, ¶D, as amended by PL 2019, c. 5, Pt. A, 
§11, is further amended to read:
D.  A carrier may vary the premium rate due to age, geographic area and tobacco use 
in accordance with the limitations set out in this paragraph.  A carrier that varies the 
premium rate due to age must vary the premium rate according to a uniform age 
curve.  The superintendent shall adopt rules establishing a uniform age curve that is 
substantially similar to the age curve in effect on January 1, 2019 under the federal 
Affordable Care Act.  Rules adopted under this paragraph are routine technical rules 
as defined in Title 5, chapter 375, subchapter 2-A.
(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, 
except as provided in subparagraph (10) (11), 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, except that the carrier may not apply a rate differential 
pursuant to this subparagraph when the covered individual is participating in an 
evidence-based tobacco cessation strategy approved by the United States 
Department of Health and Human Services, Food and Drug Administration.
(10)  For all policies, contracts or certificates that are executed, delivered, issued 
for delivery, continued or renewed in this State on or after the effective date of 
this Act, the maximum rate differential due to age filed by the carrier as 
determined by ratio is 3 to 1 for individuals 21 years of age and older on the first 
day of coverage under the policy, contract or certificate.  The variation in rate due 
to age must be actuarially justified for individuals under 21 years of age 
consistent with the uniform age rating curve adopted under this paragraph.
(11) 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, for 
each small group health plan offered by a carrier, the highest premium rate for 
each rating tier may not exceed 2.5 times the premium rate that could be charged 
to an eligible individual with the lowest premium rate for that rating tier in a 
given rating period.  For purposes of this subparagraph, "rating tier" means each 
category of individual or family composition for which a carrier charges separate 
rates.
(a)  In determining the rating factor for geographic area pursuant to this 
subparagraph, the ratio between the highest and lowest rating factor used by a 
carrier for geographic area may not exceed 1.5 and the ratio between highest 
and lowest combined rating factors for age and geographic area may not 
exceed 2.5.
(b)  In determining rating factors for age and geographic area pursuant to this 
subparagraph, rates must take into account the savings resulting from the 
reinsurance program created by chapter 54-A.
(c)  The superintendent shall adopt rules setting forth appropriate 
methodologies regarding determination of rating factors pursuant to this 
subparagraph. Rules adopted pursuant to this division are routine technical 
rules as defined in Title 5, chapter 375, subchapter 2-A.
SUMMARY
This bill makes changes to the rating provisions for individual and small group health 
insurance plans to reduce the rating band for age and to require that the ratio on the basis 
of geographic area is 1.5 to 1 and that the ratio for age and geographic area may not 
exceed 2.5.  The changes in the bill reinstate the rating provisions in place before the 
enactment of Public Law 2011, chapter 90.