An Act To Strengthen Consumer Protections in Health Care”
Maine Legislature, Session 129, LD 1650
Committee Amendment CA_A_H814 (House)
Amends: 24-A MRSA §2735-A, 24-A MRSA §2736-A, 24-A MRSA §2736-C, 24-A MRSA §2808-B

COMMITTEE AMENDMENT “      ” to H.P. 1186, L.D. 1650, Bill, “An Act To 
Strengthen Consumer Protections in Health Care”
Amend the bill by striking out everything after the enacting clause and inserting the 
following:
'PART A
Sec. A-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. A-2.  24-A MRSA §2736-A, first ¶, as amended by PL 2011, c. 364, §2, is 
further amended to read:
If at any time the superintendent has reason to believe that a filing does not meet the 
requirements that rates not be excessive, inadequate or unfairly discriminatory or that the 
filing violates any of the provisions of chapter 23, the superintendent shall cause a 
hearing to be held.  If a filing proposes an increase in rates in an individual health plan as 
defined in section 2736-C, the superintendent shall cause a hearing to be held at the 
Date: 
(Filing No. H-          )
COMMITTEE AMENDMENT “      ” to H.P. 1186, L.D. 1650
COMMITTEE AMENDMENT
request of the Attorney General. In any hearing conducted under this section, the insurer 
has the burden of proving rates are not excessive, inadequate or unfairly discriminatory.
Sec. A-3.  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. A-4.  Application.  Those sections of this Part that amend the Maine Revised 
Statutes, Title 24-A, sections 2735-A, 2736-A and 2736-C apply to individual health plan 
rate filings submitted by an insurer or a carrier to the Department of Professional and 
Financial Regulation, Bureau of Insurance pursuant to Title 24-A, sections 2736 and 
2736-C for the 2022 plan or policy year and thereafter.
PART B
Sec. B-1.  24-A MRSA §2736-C, sub-§2, ¶C-1, as enacted by PL 2011, c. 90, 
Pt. A, §2, is repealed.
Sec. B-2.  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 
COMMITTEE AMENDMENT “      ” to H.P. 1186, L.D. 1650
COMMITTEE AMENDMENT
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 between July 1, 2012 
and December 31, 2021, 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, 2022, 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.
COMMITTEE AMENDMENT “      ” to H.P. 1186, L.D. 1650
COMMITTEE AMENDMENT
(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.
(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, 2022, a 
carrier may not vary the premium rate based on tobacco use as a rating factor.
Sec. B-3.  24-A MRSA §2736-C, sub-§2-B, as amended by PL 2011, c. 364, §7, 
is repealed.
Sec. B-4.  24-A MRSA §2808-B, sub-§2, ¶C-1, as enacted by PL 2011, c. 90, 
Pt. A, §7, is repealed.
Sec. B-5.  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.
COMMITTEE AMENDMENT “      ” to H.P. 1186, L.D. 1650
COMMITTEE AMENDMENT
(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 between October 1, 
2011 and December 31, 2021, 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, 2022, 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 
COMMITTEE AMENDMENT “      ” to H.P. 1186, L.D. 1650
COMMITTEE AMENDMENT
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.
(12)  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, a 
carrier may not vary the premium rate based on tobacco use as a rating factor.' 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or 
section number to read consecutively.
SUMMARY
This amendment replaces the bill and is the minority report of the committee.
Part A amends the rate review process for individual health insurance.  It requires 
advance review and prior approval of individual health insurance rates.  It requires the 
Superintendent of Insurance to hold a hearing if a filing proposes an increase in rates in 
individual health insurance plans.  It requires the Superintendent of Insurance to 
disapprove premium rates unless the minimum medical loss ratio satisfies the statutory 
requirements for individual health plans.  The changes apply to individual health plan rate 
filings submitted to the Department of Professional and Financial Regulation, Bureau of 
Insurance beginning with the 2022 plan or policy year.
Part B 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.  These changes reinstate the rating provisions in place before the enactment 
of Public Law 2011, chapter 90. Part B also prohibits the use of tobacco as a rating factor.  
The changes apply to all individual and small group policies issued or renewed on or after 
January 1, 2022.
Revised: 07/13/20
LD 1650
LR 243(02)
FY 2019-20
FY 2020-21
Projections 
FY 2021-22
Projections 
FY 2022-23
Appropriations/Allocations
Other Special Revenue Funds
$0
$0
$11,100
$11,100
Fiscal Detail and Notes
The bill requires the Superintendent of Insurance to hold a hearing when an individual health insurance plan proposes 
an increase in rates for plan rate filings beginning with the 2022 plan year. It is anticipated that the Bureau will need 
to hold three hearings a year, beginning in fiscal year 2021-22.  These three hearings are estimated to cost $11,100, 
with any future allocation funded by existing resources within the Bureau of Insurance.
Fiscal Note
An Act To Strengthen Consumer Protections in Health Care
Fiscal Note for Bill as Amended by Committee Amendment " "
Committee: Health Coverage, Insurance and Financial Services
Fiscal Note Required: Yes
LR0243(02) - Fiscal Note - Page 1 of 1