An Act To Prohibit Discriminatory Practices in Certain Health Insurance Policies
Maine Legislature, Session 130, LD 1281
Committee: Health Coverage, Insurance and Financial Services
Sponsors: COLLINGS
Amends: 24-A MRSA §2452

Legislative Document
No. 1281
H.P. 941
House of Representatives, March 29, 2021
An Act To Prohibit Discriminatory Practices in Certain Health 
Insurance Policies
Received by the Clerk of the House on March 25, 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 COLLINGS of Portland.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  24-A MRSA §2452, sub-§1, as enacted by PL 1991, c. 385, §11, is repealed 
and the following enacted in its place:
1.  Discrimination prohibited; rating practices.  A policy of employee benefit excess 
insurance may not discriminate unfairly among or against beneficiaries of the underlying 
benefit plan, or treat conditions related to the Human Immunodeficiency Virus, or HIV, 
more restrictively than other sicknesses or disabling conditions.
The following requirements apply to the rating practices of carriers providing employee 
excess benefit insurance to small group health plans.
A.  A carrier may not vary the premium rate due to the gender, health status, claims 
experience or policy duration of the eligible group or members of the group or any 
other rating factor not specified in this subsection.
B.  A carrier may vary the premium rate due to family membership and participation 
in wellness programs.  The premium rate for a family must equal the sum of the 
premiums for each individual in the family, except that it may not be based on more 
than 3 dependent children who are less than 21 years of age.  The superintendent may 
adopt rules setting forth appropriate methodologies regarding rate discounts for 
participation in wellness programs.  Rules adopted pursuant to this paragraph are 
routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.
C.  A carrier may vary the premium rate due to geographic area in accordance with the 
limitation 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 October 1, 
2021, the rating factor used by a carrier for geographic area may not exceed 1.5.
D.  A carrier may vary the premium rate due to age, group size 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.
(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, 2022, except as 
provided in subparagraph (3), 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.
(2)  For all policies, contracts or certificates that are executed, delivered, issued for 
delivery, continued or renewed in this State on or after October 1, 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.
(3)  For all policies, contracts or certificates that are executed, delivered, issued for 
delivery, continued or renewed in this State on or after October 1, 2021, the 
maximum rate differential due to age filed by the carrier as determined by ratio is 
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 curve adopted under this paragraph.
Sec. 2.  24-A MRSA §2452, sub-§3, as enacted by PL 1991, c. 385, §11, is repealed 
and the following enacted in its place:
3.  Review.  The review of employee benefit excess insurance forms, rates and filings 
is subject to this subsection.
A.  An employee benefit excess insurance form is not exempt from the review 
provisions otherwise applicable under section 2412 on the ground that the form is 
designed for insurance on a particular subject.
B.  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.  Hearings held under this subsection must conform to the 
procedural requirements set forth in Title 5, chapter 375, subchapter 4.  The 
superintendent shall issue an order or decision within 30 days after the close of the 
hearing or of any rehearing or reargument or within such other period as the 
superintendent for good cause may require, but not to exceed an additional 30 days. In 
the order or decision, the superintendent shall either approve or disapprove the rate 
filing.  If the superintendent disapproves the rate filing, the superintendent shall 
establish the date on which the filing is no longer effective, specify the filing the 
superintendent would approve and authorize the insurer to submit a new filing in 
accordance with the terms of the order or decision.
C.  When a filing is not accompanied by the information upon which the carrier 
supports the filing or the superintendent does not have sufficient information to 
determine whether the filing meets the requirements that rates not be excessive, 
inadequate or unfairly discriminatory, the superintendent shall require the carrier to 
furnish the information upon which it supports the filing.
SUMMARY
This bill establishes rating practices for employee benefit excess insurance, including 
maximum rate differentials for age, group size and tobacco use.  This bill requires the 
Superintendent of Insurance to hold a hearing if the superintendent finds that a filing does 
not meet the requirement that rates not be excessive, inadequate or discriminatory or that it 
violates a prohibited trade practice or is fraudulent and establishes the procedure and 
consequences for the hearing.  This bill also requires the superintendent to require a carrier 
to provide more information if the superintendent finds that the filing does not have 
sufficient information to determine whether the filing meets the requirements.