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-A

Current through 2024-29, July 17, 2024
2009 ANNUAL REPORT SUPPLEMENT and INSTRUCTIONS
HEALTH INSURERS and HEALTH MAINTENANCE ORGANIZATIONS WITH AT
				  LEAST $2,000,000 of DIRECT WRITTEN HEALTH INSURANCE PREMIUM IN MAINE (See
				  Section
				  5 of this Rule.)
1. Reports shall 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).
2. The reporting entity shall report the
				information (hereinafter referred to as "line items") indicated on the attached
				reporting forms. Statewide data is to be reported on Part 1. One copy of Part 2
				of the form must be completed for each region, as defined in item 3 below, in
				which the entity has health business. The majority of the line items listed
				correspond to line items from the Statement of Revenue and Expenses, the
				Underwriting and Investment Exhibit, Part 3 - Analysis of Expenses and the
				Exhibit of Premiums, Enrollment and Utilization, which are contained in the
				health annual statutory financial statements. For insurers completing life and
				accident and health (Life) or property and casualty (P&C) annual statutory
				financial statements, a portion of the information required is contained within
				Schedule H - Accident and Health Exhibit-of those annual statutory financial
				statements. Some line items may not tie directly to any exhibits in the Life or
				P&C statements. For these items, the reporting entity may look to the
				instructions for the health statement for guidance.
a. Member and Contract Information. The
				reporting entity shall report the indicated information on member months and on
				contracts in-force and covered lives as of December 31.
b. Revenue and Expense Information. The
				reporting entity shall report the indicated information on revenues and
				expenses and shall use 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.
i. Total cost containment expenses should be
				reported in the cost containment expense line item and should be equivalent to
				information contained in line 20 of the Statement of Revenue and Expenses if
				the insurer files a health annual statutory financial statement.
ii. Other claims adjustment expenses should
				be reported in total only and should be equivalent to information contained in
				line 20 of the Statement of Revenue and Expenses if the insurer files a health
				annual statutory financial statement.
iii. All other general and administrative
				expenses should be reported in the appropriate line items and should, in total,
				be equivalent to line 21 of the Statement of Revenue and Expenses if the
				insurer files a health annual statutory financial statement.
iv. Lobbying expenses are expenditures in
				connection with matters before legislative bodies or governmental officers or
				agencies, including general legislative lobbying and direct lobbying of pending
				and proposed statutes or regulations.
(A) All
				lobbying expenses should be included, whether paid directly by the reporting
				entity or paid by a parent, affiliate, or holding company on behalf of the
				reporting entity.
(B) Lobbying
				expenses paid by a parent, affiliate, or holding company on behalf of multiple
				entities within the corporate structure should be included in an amount
				reflective of an appropriate allocation to the reporting entity.
v. Investment expenses should not
				be included in any of the expense line items.
c. Utilization Statistics. The reporting
				entity shall report the indicated information on utilization and shall use 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.
d. The following definitions and guidance
				apply to items not found in the NAIC health annual statutory financial
				statements.
Line 2: "Number of contracts 12/31" means the number of
				  individual or group policies in force at the end of the reporting year. A
				  single group policy counts as one contract regardless of the number of
				  certificate holders.
Line 2a: "Number of contracts included in line 2 that were
				  issued during the year" means the number of individual or group policies issued
				  during the year and still in force at the end of the year.
Line 2b: "Number of contracts included in line 2a covering
				  policyholders that were uninsured for the prior 90 days" means the number of
				  individual policies issued to previously uninsured individuals and the number
				  issued to small groups that did not have a previous health plan in the prior 90
				  days.