Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 945 - ANNUAL REPORT SUPPLEMENT FOR HEALTH INSURERS › Appendix 031-945-B

Current through 2024-29, July 17, 2024
2009 ANNUAL REPORT SUPPLEMENT and INSTRUCTIONS HEALTH
				  INSURERS and HEALTH MAINTENANCE ORGANIZATIONS WITH LESS THAN $2,000,000 of
				  DIRECT WRITTEN HEALTH INSURANCE PREMIUM IN MAINE (See Section
				  5 of this Rule.)
Reports must not include data for accidental injury,
				  specified disease, hospital indemnity, dental, vision, disability income,
				  long-term care, Medicare supplement, or other limited benefit health insurance
				  as defined in Rule 755, Section 9. The filing requirements do apply to employee
				  benefit excess (stop-loss) insurance as defined in
				   24-A M.R.S.A.
				  §707(1) (C-1) with
				  respect to health benefit plans. The filing requirements also apply coverage
				  issued under the Federal Employees Health Benefits Program and to short-term
				  medical coverage as defined in
				   24-A M.R.S.A.
				  §2849-B(1).
The reporting entity shall report the information
				  (hereinafter referred to as "line items") indicated on the attached reporting
				  form on a statewide basis. The reporting entity shall report the indicated
				  information using the definitions and guidance found in the National
				  Association of Insurance Commissioner's Annual Statement Instructions and
				  Accounting Practices and Procedures Manual or their successor publications. The
				  information should be on a basis consistent with the annual statement line
				  indicated in the following table:
Health Blank:
Life Blank or P&C Blank
Source Exhibit:
Statement of Revenue and Expenses
Schedule H Part 1
1
Net premium income
Line 2
Line 2
2
Total revenues
Line 8
Line 2
3
Total medical and hospital expenses
Line 18
Line 3
4
Total claims adjustment and administrative expenses
Lines 20+21
Lines 4+7+8+9+10+11
5
Increase in reserves
Line 22
Line 6
6
Net underwriting gain or (loss) (line 2 less line 3
							 less line 4 less line(5)
Line 24
Line 12
Since all of the items on this "short form" are net of
				  reinsurance ceded, companies having less than $2,000,000 of direct written
				  health insurance premium in Maine
and
having 100% of the business
				  reinsured should file blank reports providing only their contact
				  information.
The six categories of policyholders are:
(a) Fully insured large groups, meaning all
				group and blanket policies, including Federal Employees Health Benefits
				Program, other than small groups and Dirigo groups
(b) Fully insured small groups (1-50
				employees) as defined by
				 24-A M.R.S.A.
				§2808-B, excluding Dirigo
				groups
(c) Fully insured
				individuals, including short-term coverage and excluding Medicare Advantage
				plans and Dirigo individuals
(d)
				Dirigo groups (issued pursuant to 24-A M.R.S.A. Chapter 87)
(e) Dirigo individuals (issued pursuant to
				24-A M.R.S.A. Chapter 87)
(f)
				Stop-loss (employee benefit excess insurance as defined in
				 24-A M.R.S.A.
				§707(1) (C-1) )
MAINE ANNUAL REPORT SUPPLEMENT for Year ____
This form is for companies with less than $2 million of
				  premium - see Rule 945, section
				  5.
Statewide Data
Company
				  ______________________________________________________ NAIC Code _____
Name of person completing this form
				  _______________________________
Telephone Number ____________ Email
				  ____________________________________
Large Groups
Small Groups
Individuals
Dirigo Groups
Dirigo Individuals
Stop-loss
TOTAL
1
Net premium income
2
Total revenues
3
Total medical and hospital expenses
4
Total claims adjustment and administrative expenses
5
Increase in reserves
6
Net underwriting gain or (loss) (line 2 less line 3
							 less line 4 less line(5)