An Act to Ensure Choices in Health Insurance Markets by Limiting the Requirement to Offer Clear Choice Design Health Plans
Maine Legislature, Session 131, LD 1252
Committee: Health Coverage, Insurance and Financial Services
Sponsors: MORRIS
Amends: 24-A MRSA §2793

Legislative Document
No. 1252
H.P. 800
House of Representatives, March 21, 2023
An Act to Ensure Choices in Health Insurance Markets by Limiting 
the Requirement to Offer Clear Choice Design Health Plans
Reference to the Committee on Health Coverage, Insurance and Financial Services 
suggested and ordered printed.
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 amended by PL 2021, c. 361, §3, is further amended 
to read:
§2793.  Clear choice designs
The superintendent shall develop clear choice designs for individual health plans 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 health plan subject to section 2736‑C or a pooled 
market health plan subject to section 2792 must conform to one of the clear choice designs 
developed pursuant to this section unless it is approved as an alternative plan 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 individual 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 health plans offered in 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 section 2792 through the federally facilitated marketplace 
pursuant to the federal Affordable Care Act or the Maine Health Insurance Marketplace 
established in Title 22, section 5403.
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 plan designs 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 Patient Protection and Affordable Care 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.