An Act To Ensure Choices in Health Insurance Markets
Maine Legislature, Session 130, LD 0443
Committee: Health Coverage, Insurance and Financial Services
Sponsors: MORRIS
Amends: 24-A MRSA §2793

Legislative Document
No. 443
H.P. 319
House of Representatives, February 16, 2021
An Act To Ensure Choices in Health Insurance Markets
Received by the Clerk of the House on February 11, 2021.  Referred to the Committee on 
Health Coverage, Insurance and Financial Services pursuant to Joint Rule 308.2 and ordered 
printed pursuant to Joint Rule 401.
ROBERT B. HUNT
Clerk
Presented by Representative MORRIS of Turner.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  24-A MRSA §2793, as enacted by PL 2019, c. 653, Pt. B, §2, is amended to 
read:
§2793.  Clear choice designs
The superintendent shall develop clear choice designs for the individual and small 
group health insurance markets market in order to reduce consumer confusion and provide 
meaningful choices for consumers by promoting a level playing field on which carriers 
compete on the basis of price and quality.
1.  Clear choice design.  For the purposes of this section, "clear choice design" means 
a set of annual copayments, coinsurance and deductibles for all or a designated subset of 
the essential health benefits.  An individual or small group health plan subject to section 
2792 must conform to one of the clear choice designs developed pursuant to this section 
unless an opt-out request is granted under subsection 4.
2.  Development of clear choice designs.  The superintendent shall develop clear 
choice designs in consultation with working groups consisting of consumers, carriers, 
health policy experts and other interested persons.  The superintendent shall adopt rules for 
clear choice designs, taking into consideration the ability of plans to conform to actuarial 
value ranges, consumer needs and promotion of benefits with high value and return on 
investment.  The superintendent shall develop at least one clear choice design for each tier 
of health insurance plan designated as bronze, silver, gold and platinum in accordance with 
the federal Affordable Care Act.  Rules adopted pursuant to this subsection are routine 
technical rules as defined in Title 5, chapter 375, subchapter 2‑A.  Clear choice designs 
apply only to all individual and small group health plans offered in this State with effective 
dates of coverage on or after January 1, 2022 through the federally facilitated marketplace 
pursuant to the federal Affordable Care Act or the Maine Health Insurance Marketplace 
established in Title 22, chapter 1479.
3.  Annual review.  The superintendent shall consider annually whether to revise, 
discontinue or add any clear choice designs for use by carriers in the following calendar 
year, including but not limited to considering whether deductible and copayment levels 
should be changed to reflect medical inflation and conform with actuarial value and annual 
maximum out-of-pocket limits.
4.  Alternative plan designs.  In addition to one or more health plans that include cost-
sharing parameters consistent with a clear choice design developed pursuant to this section, 
a carrier may offer up to 3 health plans that modify one or more specific cost-sharing 
parameters in a clear choice design if the carrier submits an actuarial certification to the 
satisfaction of the superintendent that the alternative plan design offers significant 
consumer benefits and does not result in adverse selection.  An alternative plan design may 
be offered only in a service area where the carrier offers at least one clear choice design 
plan at the same tier.
SUMMARY
This bill limits the requirement for health insurance carriers to offer so-called clear 
choice design plans to individual health plans offered through the federally facilitated 
marketplace pursuant to the federal Affordable Care and Patient Protection Act or the 
Maine Health Insurance Marketplace.  The bill also expands the ability of carriers to offer 
alternative plans to a clear choice design plan.