An Act to Ensure Choices in Health Insurance Markets by
Maine Legislature, Session 132, LD 0520
Sponsors: MORRIS
Amends: 24-A MRSA §2792, 24-A MRSA §2793

Legislative Document
No. 520
H.P. 338
House of Representatives, February 11, 2025
An Act to Ensure Choices in Health Insurance Markets by 
Modifying the Provisions of Law Governing Clear Choice Design 
Health Plans
Received by the Clerk of the House on February 7, 2025.  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.
Cosponsored by Representatives: CIMINO of Bridgton, FLYNN of Albion, FOLEY of Wells, 
OLSEN of Raymond, Senator: HAGGAN of Penobscot.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  24-A MRSA §2792, sub-§1, as amended by PL 2021, c. 361, §1, is further 
amended to read:
1.  Pooled market established.  Subject to the requirements of subsection 5, all 
individual 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 health insurance 
carrier offering an individual health plan subject to this section shall make the plan 
available to all eligible small employers within the plan's approved service area, and a 
health insurance carrier offering a small group health plan subject to this section shall make 
the plan available to all eligible individuals residing within the plan's approved service area.  
This subsection does not require the Maine Health Insurance Marketplace established in 
Title 22, chapter 1479 to offer identical choices of health plans to individuals and to small 
employers under Title 22, chapter 1479.
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.  Premium rates for a health plan offered in the pooled market 
described in subsection 1 may not vary based on whether the plan is issued to an individual 
or to a small employer.  Rate filings and review for the pooled market are subject to the 
provisions of sections 2736 to 2736‑C.  For health plans that are issued on other than a 
calendar year basis, rates applicable on and after January 1st of any plan year must be the 
approved rates for the most similar plan offered during the new calendar year, adjusted by 
a factor, approved by the superintendent as part of the rating plan, that appropriately 
accounts for any differences in plan design.
Sec. 3.  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 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.  The 
superintendent shall develop separate clear choice designs for individual and small group 
health plans.
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 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 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.  No later than January 31st of each year, the superintendent 
shall release the proposed clear choice designs to be used in the following plan year for 
review and comment by stakeholders.
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 individual health plan designs and up to 3 small group 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 amends the provisions of the Maine Insurance Code related to pooled market 
and clear choice design. 
The bill eliminates the requirement that health insurance carriers offering individual 
health plans must make those plans available to all eligible small employers within the 
plan's approved service area. It also eliminates the requirement that health insurance 
carriers offering small group health plans make those plans available to all eligible 
individuals residing within the plan's approved service area. 
The bill eliminates requirements related to premium rate adjustments for health plans 
that are issued on other than a calendar year basis. 
The bill requires the Superintendent of Insurance to develop separate clear choice 
designs for individual health plans and small group health plans and requires that on 
January 31st of each year, the superintendent must release the proposed clear choice 
designs to be used in the following plan year for review and comment by stakeholders. The 
bill modifies provisions related to alternative designs to allow carriers to offer up to 3 
alternative individual health plan designs and up to 3 alternative small group health plan 
designs.