Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 630 - RURAL MEDICAL ACCESS PROGRAM › Section 031-630-4 - Assessments

Current through 2024-29, July 17, 2024
1. The assessment base for insured
				policyholders (including holders of excess policies) shall be the actual
				premium paid for policies issued or renewed with an effective date during July
				1 to June 30 of the following calendar year; except that if a policy insuring
				physicians includes a deductible of less than $100,000 for the physician's
				exposure, then the assessment base for insuring physicians shall be the
				calculated premium by the insurer for an equivalent risk without any
				deductible. The assessment base on a policy or portion of a policy insuring
				hospitals that includes a deductible of less than $1,000,000 shall be the
				calculated premium by the insurer for an equivalent risk without any
				deductible.
2. Each year, not later
				than May 1, for purposes of assessments on self-insureds, the Superintendent
				shall identify the principal writer of physicians' malpractice insurance and
				the principal writer of hospital malpractice insurance based on direct written
				premium in the prior calendar year, or the most recent year for which
				information is available as of May 1.
3. The assessment base for self-insured
				physicians shall be determined for each physician by using the filed and
				approved rates and rating rules as of July 1 of each year of the principal
				writer of physicians' malpractice insurance in Maine. A physician carrying a
				deductible coverage of $100,000 or more per claim from an insurer shall be
				considered self-insured to the extent of his or her self-insured retention. The
				assessment base shall use the number of years licensed in Maine (unless the
				physician provides evidence of more recent occurrence-based coverage or
				extended reporting coverage), appropriate classification as defined by the
				principal writer, and maximum coverage limits of $1,000,000 per claim,
				$3,000,000 aggregate per year; except that if the physician retains excess
				coverage with an underlying retention other than $1,000,000 per claim,
				$3,000,000 aggregate per year, then the assessment base shall be adjusted based
				on the principal writer's increased or reduced limits factors to the attachment
				point of the excess coverage.
4.
				The assessment base for self-insured hospitals shall be determined for each
				hospital by using the filed and approved rates and rating rules as of July 1
				for the principal writer of hospital malpractice insurance in Maine. A hospital
				is considered self-insured if its self-insured retention is at least
				$1,000,000. The assessment base shall use the claims made years of exposure,
				appropriate classification as defined by the principal writer, coverage of
				$1,000,000 per claim, $3,000,000 aggregate per year, no schedule rating, and
				the number of beds and outpatient visits applicable to each hospital; except
				that if the hospital retains excess coverage with an underlying retention
				greater than $1,000,000 per claim, $3,000,000 aggregate per year, then the
				assessment base shall be adjusted based on the principal writer's increased or
				reduced limits factors to the attachment point of the excess
				coverage.
5. If the assessment
				amount is less than $5, then it shall be waived.
6. If a physician is licensed in Maine, but
				does not currently practice in Maine, then he or she is not to be charged an
				assessment. If a Maine licensed physician practices medicine part of the time
				in Maine and part of the time elsewhere, the physician is allowed to pro-rate
				the annual assessment owed to be equal to the pro-rated amount of time
				practiced in Maine. For purposes of this section, telemedicine and
				radiology/film consultation performed from outside Maine is not considered
				practicing medicine in Maine.
7. Up
				to the coverage limits established in this section, the assessment base applies
				to all premiums, regardless of whether coverage is by a single policy or
				multiple policies.
8. Physicians,
				physicians' employers, and hospitals covered by a policy issued by an insurer
				shall remit, after billing by the insurer, the assessment ordered by the
				Superintendent pursuant to
				24-A M.R.S.A.
				§6305 and this Rule. The insurer shall
				hold collected funds and invest those funds until premium assistance credits or
				refunds are authorized or intercompany transfers are ordered. Any interest
				earned on collected funds shall be credited to the Program. The insurer shall
				report to the Superintendent, within 60 days after billing, the name and
				address of any physician, hospital, or physician's employer that fails to pay
				the required assessment when due.
9. Self-insured physicians, physicians'
				employers, and hospitals shall remit the assessment to the principal writer of
				physicians' malpractice insurance in Maine. The Superintendent shall develop a
				form to be used by reporting self-insureds. Upon receipt on or before July 1 of
				lists of physicians, physicians' employers, hospitals, and the last known
				insurer, if any, from the Board of Licensure in Medicine, the Board of
				Osteopathic Examination and Registration, and the Department of Health &
				Human Services' Division of Licensure and Certification, the Superintendent
				shall notify all self-insureds of the assessment and the procedure for
				calculating the assessment base.
10. The principal writer of physicians' and
				hospitals' malpractice insurance shall receive and maintain funds collected,
				shall invest funds held and credit interest earned to the Program, shall review
				the calculation on the prescribed submission form, and shall report quarterly
				to the Superintendent the receipts, earnings, disbursements, and balance of the
				fund. The principal writer shall report quarterly to the Superintendent a
				listing of all self-insureds remitting the assessment and the amount
				paid.
11. The Superintendent shall
				review the Program fund balance each year after collecting substantially all of
				the assessments for the current policy year. The purpose of this review is to
				determine the Program assessment rate consistent with the statutory
				requirements to provide an adequate and reliable funding source for the Program
				and to allow for the orderly and prudent drawdown of any long-term Program fund
				balance. The Superintendent may include in this review, without limitation,
				such considerations as the then-current condition of and reasonably anticipated
				trends in the medical malpractice insurance market in Maine, the size of this
				market's assessment base, and recent and expected requests for assistance from
				the Program.
When the Superintendent identifies the principal writer of
				  physicians' and hospital malpractice insurance pursuant to Subsection
				  2, the Superintendent shall notify the
				  principal writer and other affected parties of the assessment rate for the
				  upcoming policy year.
When the Program fund balance is above $50,000, the
				  Superintend shall select an assessment rate at three-fourths of one percent
				  (0.75%) or less, or may waive the assessment entirely. For the policy year
				  starting July 1, 2014 and each policy year thereafter until the Superintendent
				  selects a different rate, the assessment rate is two-tenths of one percent of
				  premium (0.2%).
When the Program fund balance is $50,000 or less, the
				  Superintendent shall select an assessment rate no less than three-fourths of
				  one percent (0.75%) but not to exceed one percent (1.0%).
The Superintendent may in no event select an assessment rate
				  expected to result in collections exceeding $500,000 for the upcoming policy
				  year.