An Act to Ensme Choices m Health Insurance Markets by L1mitmg the Requirement to Offe1 Clear Choice Design Health Plans
Maine Legislature, Session 131, LD 1252
Committee Amendment CA_A_H210 (House)
Amends: 24-A MRSA §2792, 24-A MRSA §2793

COMMITTEE AMENDMENT "A" to HP 800, L D 1252, "An Act to Ensme 
Choices m Health Insurance Markets by L1mitmg the Requirement to Offe1 Clear Choice 
Design Health Plans" 
Amend the bill by stnkmg out everythmg after the enactmg clause and msertmg the 
followmg 
'Sec. l. 24-A MRSA §2792, sub-§1, as amended by PL 2021, c 361, §1, 1s further 
amended to read 
1. Pooled market established. Subject to the reqmrements of subsect10n 5, all 
mdiv1dual and small group health plans offered in this State with effective dates of coverage 
on or after January 1, 2023 must be offered through a pooled market. A .. heal-th ms\:lfance 
ca-rr1er offering an 1ndmdual health ploo sabjeot to this section shall make the plan 
ava1la-ble to all ehg1ble small employers w:t:tlun the plan's approved service area, and a 
health ms\¼fanee carrier offurmg a small group health f)lan subjeot to this seetioB shall make 
the plaB avatla-ble to all eltg1ble mdividuals residing withiB the plan's approved serviee area 
This subsection does Bot require the Mame Health lBs\¼faBee Marketplace esta-bhshed m 
T:t:tle 22, chapter 14 79 to offer 1den-t1cal eho1ees of health f)loos to mdtv1duals and to small 
effif)loyers under Title 22, chapter 14 79 
Sec. 2. 24-A MRSA §2792, sub-§2, as enacted by PL 2019, c 653, Pt B, §2, is 
amended to read 
2. Premium rates. Premmm rates for a health plan offered m the pooled market 
described m subsect10n 1 may not vary based on whether the plan is issued to an md1Vidual 
or to a small employer Rate filmgs and review for the pooled market are subject to the 
provisions of sections 2736 to 2736-C For heal-th plans that are issued OB other than a 
ealendar year basis, rates a.:ppheable OB and after January 1st of any plan yea-r mast be the 
approved rates for the most s1mtla-r plan offered durn1g the 11e'+Y ealeBdar year, adjusted by 
a faetor, appro:ved by the supermtenden-t as pa-rt of the ratmg f)lan, that appropimtely 
aeeoun-ts for any diffurenees 1B f)lan design 
Page I • 131LR1300(02) 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" ,4-,, to HP 800, L D 1252 
Sec. 3. 24-A MRSA §2793, as amended by PL 2021, c 361, §3, is further amended 
to read 
§2-793. Clear choice designs 
The supermtendent shall develop clear choice designs for health plans m order to 
reduce consumer confusion and provide meamngful choices for consumers by promotmg 
a level playmg field on which earners compete on the basis of price and quahty The 
supermtendent shall develop separate clear choice designs for md1vidual health plans and 
small group health plans 
1. Clear ch01ce design. For the purposes of this section, "clear choice design" means 
a set of annual copayments, comsmance and deductibles for all or a designated subset of 
the essential health benefits An mdividual health plan subJect to section 2736-C or a pooled 
market health plan subject to section 2792 must conform to one of the clear ch01ce designs 
developed pursuant to this section unless 1t 1s approved as an alternative plan under 
subsection 4 
2. Development of clear choice designs. The supermtendent shall develop clear 
choice designs m consultat10n with workmg groups cons1stmg of consumers, cainei s, 
health policy experts and other mterested persons The supermtendent shall adopt rules for 
clear ch01ce designs, taking mto consideration the ability of plans to conf01m to actua11al 
value ranges, consumer needs and promot10n of benefits with high value and 1 eturn on 
mvestment The supermtendent shall develop at least one clear ch01ce design for each tier 
of health msurance plan designated as bronze, silver, gold and platinum m accordance with 
the federal Affordable Care Act Rules adopted pursuant to this subsection are routme 
techmcal rules as defined m Title 5, chapter 375, subchapter 2-A Clear chmce designs 
apply to all md1v1dual health plans offered m this State with effective dates of coverage on 
or after January 1, 2022 and to all small group health plans offered through the pooled 
market under sect10n 2792 No late1 than January 31st of each year, the supermtendent shall 
release the proposed clear choice plan designs to be used m the following plan year fo1 
review and comment by stakeholders 
3. Annual review. The supermtendent shall conside1 annually whether to revise, 
d1scontmue or add any clear ch01ce designs for use by earners m the followmg calendar 
year, mcludmg but not hm1ted to considermg whether deductible and copayment levels 
should be changed to reflect medical mflat1on and conform with actuarial value and annual 
maxrmum out-of-pocket hm1ts 
4. Alternative plan designs. In add1t1on to one or more health plans that mclude cost-
sharmg parameters consistent with a clear choice design developed pursuant to this section, 
a earner may offer up to 3 mdividual health plan designs and up to 3 small group health 
plans that modify one or more specific cost-sharmg paramete1s ma clear ch01ce design 1f 
the earner submits an actuarial certification to the satisfaction of the supe1 mtendent that 
the alternative plan design offers sigmficant consumer benefits and does not result m 
adverse selection An alternative plan design may be offei ed only m a service a1 ea where 
the carrier offers at least one clear ch01ce design plan at the same tier 
Sec. 4. 
Appropriations and allocations. The followmg appropr1at10ns and 
allocat1ons are made 
PROFESSIONAL AND FINANCIAL REGULATION, DEPARTMENT OF 
COMMITTEE AMENDMENT 
ROS 
COMMITTEE AMENDMENT" Pr to HP 800, L D 1252 
Insurance - Bureau of 0092 
Initiative Provides a one-tune allocation to allow expenditures for consulting services to 
develop separate clear choice plan designs for individual health plans and small group 
health plans 
OTHER SPECIAL REVENUE FUNDS 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
2023-24 
$45,000 
$45,000 
2024-25 
$0 
$0 
Amend the bill by relettenng or renumbering any nonconsecutive Part letter or section 
number to read consecutively. 
SUMMARY 
This amendment, which is the minority report of the committee, replaces the bill The 
amendment ehmmates the requirement that health insurance canters offer the same plans 
m the mdividual and small group markets It also allows camers to offei up to 3 alternative 
md1v1dual health plans and 3 alternative small group plans 
Fmally, 1t requires the 
Supermtendent of Insurance to release the proposed plan designs for stakeholder review 
and comment by January 31st of the year m which the plans must be filed 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved 05/13/23 .$'a<:!-
LD 1252 
LR 1300(02) 
An Act to Ensure Choices in Health Insurance Markets by Limiting the Requirement to Offer Clear 
Choice Design Health Plans 
Fiscal Note for Bill as Amended by Committee Amendment •;4, ( H-'Z./0) 
Committee: Health Coverage, Insurance and Financial Services 
Appropriations/ Allocations 
Other Special Revenue Funds 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2023-24 
FY 2024-25 
$45,000 
$0 
Projections 
FY 2025-26 
$0 
Projections 
FY 2026-27 
This bill mcludes a one-tune allocation to the Bureau of Insurance withm the Department of Professional and 
Fmancrnl Regulation of $45,000 111 fiscal year 2023-24 to allow expenditures for consultmg services to develop 
separate clear choice plan designs for 111d1v1dual health plans and small group health plans 
LR1300(02) - Fiscal Note - Page 1 of 1