Maine LD 243: An Act To Restore Consumer Rate Review for Health Insurance Plans in the Individual Market

LD 243 (subjects: INSURANCE , HEALTH )

Official bill page at mainelegislature.org: http://www.mainelegislature.org/legis/bills/display_ps.asp?ld=243&PID=1456&snum=127


Sponsors | Actions | Bill Text | Patterns of Support


Sponsors

Principal Sponsor: Rep. Gina Melaragno of Auburn: (D – District 62) — e-mail | Facebook

5 Cosponsors:

Actions

Chamber

Action
2/3/2015 House Committee on Insurance and Financial Services suggested and ordered printed.
The Bill was REFERRED to the Committee on INSURANCE AND FINANCIAL SERVICES.
Sent for concurrence. ORDERED SENT FORTHWITH.
2/3/2015 Senate On motion by Senator Whittemore of Somerset, REFERRED to the Committee on Insurance and Financial Services, in concurrence.
5/5/2015 House Reports READ.
On motion of Representative BECK of Waterville, the Majority Ought to Pass as Amended Report was ACCEPTED.
ROLL CALL NO. 55
(Yeas 81 – Nays 66 – Absent 4 – Excused 0)
The Bill was READ ONCE.
Committee Amendment “A” (H-104) was READ and ADOPTED.
Under suspension of the rules, the Bill was given its SECOND READING without REFERENCE to the Committee on Bills in the Second Reading.
The Bill was PASSED TO BE ENGROSSED as Amended by Committee Amendment “A” (H-104).
Sent for concurrence. ORDERED SENT FORTHWITH.
5/6/2015 Senate Reports READ
On motion by Senator WHITTEMORE of Somerset Tabled until Later in Today’s Session, pending ACCEPTANCE OF EITHER REPORT
Unfinished Business
5/7/2015 Senate Taken from the table by the President
On motion by Senator WHITTEMORE of Somerset the Minority Ought Not To Pass Report ACCEPTED , in NON-CONCURRENCE.
Roll Call Ordered Roll Call # 56 20 Yeas – 15 Nays- 0 Excused – 0 Absent PREVAILED
Ordered sent down forthwith for concurrence.
5/12/2015 House The House INSISTED on ACCEPTANCE of the Majority Ought to Pass as Amended Report and PASSAGE TO BE ENGROSSED as Amended by Committee Amendment “A” (H-104).
ORDERED SENT FORTHWITH.
5/13/2015 Senate On motion by Senator WHITTEMORE of Somerset The Senate INSISTED To ACCEPTANCE of Minority OUGHT NOT TO PASS Report , in NON-CONCURRENCE.
Placed in Legislative Files (DEAD).

Bill Text

.

An Act To Restore Consumer Rate Review for Health Insurance Plans in the Individual Market

Be it enacted by the People of the State of Maine as follows:

Sec. 1. 24-A MRSA 2735-A, sub- 1, as amended by PL 2011, c. 364, 1, is further amended to read:

1. Notice of rate filing or rate increase on existing policies. An insurer offering individual health plans as defined in section 2736-C must provide written notice by first class mail of a rate filing to all affected policyholders at least 60 days before the effective date of any proposed increase in premium rates or any proposed rating formula, classification of risks or modification of any formula or classification of risks. Except as otherwise provided in section 2736-C, subsection 2-B, the The notice must also inform policyholders of their right to request a hearing pursuant to section 229. The notice must show the proposed rate and , unless otherwise provided in section 2736-C, subsection 2-B, state that the rate is subject to regulatory approval. Except as otherwise provided in section 2736-C, subsection 2-B, the The superintendent may not take final action on a rate filing until 40 days after the date notice is mailed by an insurer. An increase in premium rates may not be implemented until 60 days after the notice is provided or until the effective date under section 2736, whichever is later.

Sec. 2. 24-A MRSA 2736-A, first , as amended by PL 2011, c. 364, 2, is further amended to read:

If at any time the superintendent has reason to believe that a filing does not meet the requirements that rates not be excessive, inadequate or unfairly discriminatory or that the filing violates any of the provisions of chapter 23, the superintendent shall cause a hearing to be held. If a filing proposes an increase in rates in an individual health plan as defined in section 2736-C, the superintendent shall cause a hearing to be held at the request of the Attorney General. In any hearing conducted under this section, the insurer has the burden of proving rates are not excessive, inadequate or unfairly discriminatory.

Sec. 3. 24-A MRSA 2736-C, sub- 2-B, as amended by PL 2011, c. 364, 7, is further amended to read:

2-B. Rate filings; credible health plans. Notwithstanding section 2736, subsection 1 and section 2736-A, at the carrier’s option, rate Rate filings for a carrier’s credible block of individual health plans may must be filed in accordance with this subsection. Rates filed in accordance with this subsection are filed for informational purposes unless rate review is required pursuant to the federal Affordable Care Act.

A. A carrier’s individual health plans are considered credible if the anticipated average number of members during the period for which the rates will be in effect meets standards for full or partial credibility pursuant to the federal Affordable Care Act. The rate filing must state the anticipated average number of members during the period for which the rates will be in effect and the basis for the estimate. If the superintendent determines that the number of members is likely to be less than needed to meet the credibility standard, the filing is subject to section 2736, subsection 1 and section 2736-A.
B. On an annual schedule as determined by the superintendent, the carrier shall file a report with the superintendent showing the calculation of rebates as required pursuant to the federal Affordable Care Act, except that the calculation must be based on a minimum medical loss ratio of 80% if the applicable federal minimum for the individual market in this State is lower. If the calculation indicates that rebates must be paid, the carrier must pay the rebates in the same manner as is required for rebates pursuant to the federal Affordable Care Act.

Sec. 4. 24-A MRSA 2736-C, sub- 5, as amended by PL 2011, c. 90, Pt. D, 3, is further amended to read:

5. Loss ratios. Except as provided in subsection 2-B, for For all policies and certificates issued on or after the effective date of this section, the superintendent shall disapprove any premium rates filed by any carrier, whether initial or revised, for an individual health policy unless it is anticipated that the aggregate benefits estimated to be paid under all the individual health policies maintained in force by the carrier for the period for which coverage is to be provided will return to policyholders at least 65% of the aggregate premiums collected for those policies the minimum medical loss ratio satisfies the requirements for individual health plans in section 4319, as determined in accordance with accepted actuarial principles and practices and on the basis of incurred claims experience and earned premiums. For the purposes of this calculation, any payments paid pursuant to former section 6913 must be treated as incurred claims.

Sec. 5. 24-A MRSA 3953, sub- 2, E and G, as enacted by PL 2013, c. 273, 3, are amended to read:

E. The board shall establish regular places and times for meetings and may meet at other times at the call of the chair. Meetings of the board must be open to the public and otherwise in compliance with Title 1, section 403. The board shall post notice of scheduled meetings, meeting agendas and minutes of meetings on a publicly accessible website maintained by the association.
G. The board shall establish a process for taking public comment at selected board meetings to be held at such time and place as the board may determine. The opportunity for public comment must be made available not less often than quarterly. Except as specified in this paragraph, meetings of the board are not open to the public.

Sec. 6. Application. Those sections of this Act that amend the Maine Revised Statutes, Title 24-A, sections 2735-A, 2736-A and 2736-C apply to individual health plan rate filings submitted by an insurer or a carrier to the Department of Professional and Financial Regulation, Bureau of Insurance pursuant to Title 24-A, sections 2736 and 2736-C for the 2016 plan or policy year and thereafter.

summary

This bill amends the rate review process for individual health insurance. It requires advance review and prior approval of individual health insurance rates. It requires the Superintendent of Insurance to hold a hearing if a filing proposes an increase in rates in individual health insurance plans. It requires the Superintendent of Insurance to disapprove premium rates unless the minimum medical loss ratio satisfies the statutory requirements for individual health plans. The changes apply to individual health plan rate filings submitted to the Department of Professional and Financial Regulation, Bureau of Insurance beginning with the 2016 plan or policy year. The bill also requires meetings of the Board of Directors of the Maine Guaranteed Access Reinsurance Association to be open to the public.

Patterns of Support

Pattern of Cosponsorship by Region:

Pattern of Cosponsorship by Gender:

Pattern of Cosponsorship by Party:

Pattern of Cosponsorship by Campaign Finance Classification:

Note: Maine Clean Elections Act (MCEA) Qualified candidates only accept a small dollar value of initial contributions early in their campaigns, pledge not to accept further campaign contributions from private sources, and receive public funding for their campaigns. MCEA Non-Qualified candidates choose not to obtain public funding and instead are free to accept campaign contributions from individuals, party committees, political action committees and business sources.


This information about LD 243 was last updated on 2016-05-12.
The Open Maine Politics website is in a beta release and results should not be taken as definitive. Please visit the official website of the Maine State Legislature for entirely verifiable information.

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