Maine § 24-A §2736-C Individual health plans

Maine Statutes

§ 24-A §2736-C — Individual health plans

Maine·Title 24-A MAINE INSURANCE CODE·Ch. 33 HEALTH INSURANCE CONTRACTS

1.Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings.

2.Rating practices. The following requirements apply to the rating practices of carriers providing individual health plans. 2-A. Reinsurance requirement. 2-B. Optional guaranteed loss ratio. Notwithstanding section 2736, subsection 1 and section 2736‑A, at the carrier's option, rate filings for a carrier's credible block of individual health plans may 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.

3.Guaranteed issuance and guaranteed renewal. Carriers providing individual health plans must meet the follow

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1.
Definitions.
As used in this section, unless the context otherwise indicates, the following terms have the following meanings.
2.
Rating practices.
The following requirements apply to the rating practices of carriers providing individual health plans.
2-A.
Reinsurance requirement.
2-B.
Optional guaranteed loss ratio.
Notwithstanding section 2736, subsection 1 and section 2736‑A, at the carrier's option, rate filings for a carrier's credible block of individual health plans may 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.
3.
Guaranteed issuance and guaranteed renewal.
Carriers providing individual health plans must meet the following requirements on issuance and renewal.
4.
Cessation of business.
Carriers that provide individual health plans after the effective date of this section that plan to cease doing business in the individual health plan market must comply with the following requirements.
5.
Loss ratios.
Except as provided in subsection 2‑B, 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 medical loss ratio calculated under section 4319 will be at least 80%.
6.
Fair marketing standards.
Carriers providing individual health plans must meet the following standards of fair marketing.
7.
Applicability.
This section applies to all policies, plans, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State on or after December 1, 1993 with the exception of short-term contracts, as defined in section 2849‑B. For purposes of this section, all contracts are deemed renewed no later than the next yearly anniversary of the contract date.
8.
Authority of the superintendent.
9.
Exemption for certain associations.
The superintendent may exempt a group health insurance policy or group nonprofit hospital or medical service corporation contract issued to an association group, organized pursuant to section 2805‑A, from the requirements of subsection 3, paragraph A and subsection 6, paragraph A if:
10.
Pilot projects; persons under 30 years of age.
The superintendent shall authorize pilot projects in accordance with this subsection that allow a health insurance carrier that offers individual insurance, is marketing an individual insurance policy in this State and has a medical-loss ratio of at least 70% in the individual market to offer individual medical insurance products to persons under 30 years of age beginning July 1, 2009.
11.
Open enrollment; rules.
Notwithstanding subsection 3, on or after January 1, 2014, a carrier may restrict enrollment in individual health plans to open enrollment periods and special enrollment periods to the extent not inconsistent with applicable federal law. The superintendent may adopt rules establishing minimum open enrollment dates and minimum criteria for special enrollment periods for all individual health plans offered in this State. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A.

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Legislative History

PL 1993, c. 477, Pt. C, §1 (NEW). PL 1993, c. 477, Pt. F, §1 (AFF). PL 1993, c. 546, §1 (AMD). PL 1993, c. 547, §3 (AMD). PL 1993, c. 645, §§A3, B2 (AMD). PL 1995, c. 177, §1 (AMD). PL 1995, c. 332, §§J2, K1 (AMD). PL 1995, c. 342, §§4, 5 (AMD). PL 1995, c. 570, §7 (AMD). PL 1997, c. 370, Pt. E, §§2-4 (AMD). PL 1997, c. 445, §§8-11 (AMD). PL 1997, c. 445, §32 (AFF). PL 1999, c. 44, §1 (AMD). PL 1999, c. 44, §2 (AFF). PL 1999, c. 256, §§C1, D1, 2 (AMD). RR 2001, c. 1, §30 (COR). PL 2001, c. 258, §§B1, 2, E2 (AMD). PL 2001, c. 410, Pt. A, §§1, 2 (AMD). PL 2001, c. 410, Pt. A, §10 (AFF). PL 2003, c. 428, Pt. H, §3 (AMD). PL 2003, c. 469, Pt. E, §§12, 13 (AMD). PL 2005, c. 493, §1 (AMD). PL 2007, c. 629, Pt. A, §§3-7 (AMD). PL 2007, c. 629, Pt. I, §1 (AMD). PL 2007, c. 629, Pt. M, §§4, 5 (AMD). PL 2011, c. 90, Pt. A, §§1-5 (AMD). PL 2011, c. 90, Pt. B, §§4-6 (AMD). PL 2011, c. 90, Pt. B, §10 (AFF). PL 2011, c. 90, Pt. D, §§2, 3 (AMD). PL 2011, c. 90, Pt. F, §1 (AMD). PL 2011, c. 238, Pt. D, §1 (AMD). PL 2011, c. 364, §§3-8 (AMD). PL 2011, c. 621, §1 (AMD). PL 2013, c. 271, §1 (AMD). PL 2019, c. 5, Pt. A, §§1-7 (AMD). PL 2019, c. 330, §1 (AMD). PL 2019, c. 330, §6 (AFF). PL 2021, c. 344, §1 (AMD). PL 2021, c. 655, §1 (AMD). PL 2023, c. 405, Pt. A, §§88, 89 (AMD).