Maine § 24-A §2808-B Small group health plans

Maine Statutes

§ 24-A §2808-B — Small group health plans

Maine·Title 24-A MAINE INSURANCE CODE·Ch. 35 GROUP AND BLANKET HEALTH INSURANCE

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 small group health plans. This subsection does not apply to policies issued before January 1, 1998 to eligible groups that employed, on average, 25 to 50 eligible employees until their first renewal date on or after January 1, 1998. 2-A. Rate filings. A carrier offering small group health plans shall file with the superintendent the community rates for each plan and every rate, rating formula and classification of risks and every modification of any formula or classification that it proposes to use. 2-B. Rate review and hearings. Except as provided in subsection 2

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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 small group health plans. This subsection does not apply to policies issued before January 1, 1998 to eligible groups that employed, on average, 25 to 50 eligible employees until their first renewal date on or after January 1, 1998.
2-A.
Rate filings.
A carrier offering small group health plans shall file with the superintendent the community rates for each plan and every rate, rating formula and classification of risks and every modification of any formula or classification that it proposes to use.
2-B.
Rate review and hearings.
Except as provided in subsection 2‑C and section 2792, rate filings are subject to this subsection.
2-C.
Guaranteed loss ratio.
Notwithstanding subsection 2‑B, rate filings for a credible block of small group health plans may be filed in accordance with this subsection instead of subsection 2‑B, except as otherwise provided in section 2792. Rates filed in accordance with this subsection are filed for informational purposes.
3.
Coverage for late enrollees.
In providing coverage to late enrollees, small group health plan carriers are allowed to exclude or limit coverage for a late enrollee subject to the limitations set forth in section 2849‑B, subsection 3.
4.
Guaranteed issuance and guaranteed renewal.
Carriers providing small group health plans must meet the following requirements on issuance and renewal.
5.
Cessation of business.
6.
Fair marketing standards.
Carriers providing small group 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 July 15, 1993. For purposes of this section, all contracts are deemed renewed no later than the next yearly anniversary date of the policy, plan, contract or certificate.
8.
Standardized plans.
8-A.
Authority of the superintendent.
The superintendent may by rule define one or more standardized small group health plans that must be offered by all carriers offering small group health plans in the State. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A.
9.
Reinsurance mechanism.
Small group carriers, except nonprofit hospital and medical service organizations, may form a reinsurance pool for the purpose of reinsuring small group risks. This pool may not become operative until the superintendent has approved a plan of operation. The superintendent may approve a plan only after the superintendent determines that the plan is in the public interest and is consistent with this section. The participants in the plan of operation of the pool shall guarantee, without limitation, the solvency of the pool. That guarantee constitutes a permanent financial obligation of each participant on a pro rata basis.

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Legislative History

PL 1991, c. 861, §2 (NEW). PL 1993, c. 325, §1 (AMD). PL 1993, c. 477, §§B1-3 (AMD). PL 1993, c. 477, §F1 (AFF). PL 1993, c. 546, §2 (AMD). PL 1993, c. 588, §§1,2 (AMD). PL 1993, c. 645, §A4 (AMD). PL 1995, c. 177, §2 (AMD). PL 1995, c. 332, §§D1-4,K2 (AMD). PL 1995, c. 673, §§A5,6 (AMD). RR 1997, c. 1, §22 (COR). PL 1997, c. 370, §E6 (AMD). PL 1997, c. 445, §§12-18 (AMD). PL 1997, c. 445, §32 (AFF). PL 1997, c. 777, §B2 (AMD). PL 1999, c. 256, §§E1,2,L1,P1 (AMD). RR 2001, c. 1, §32 (COR). PL 2001, c. 258, §§D1,E3,4 (AMD). PL 2001, c. 400, §1 (AMD). PL 2001, c. 400, §2 (AFF). PL 2001, c. 410, §§A3-7 (AMD). PL 2001, c. 410, §A10 (AFF). PL 2003, c. 313, §§1,2 (AMD). PL 2003, c. 428, §H5 (AMD). PL 2003, c. 469, §§E14-16 (AMD). PL 2005, c. 121, §§E1,2 (AMD). PL 2007, c. 629, Pt. M, §§6-10 (AMD). PL 2009, c. 244, Pt. C, §§7-9 (AMD). PL 2009, c. 244, Pt. F, §2 (AMD). PL 2009, c. 244, Pt. G, §2 (AMD). PL 2009, c. 439, Pt. D, §§1-3 (AMD). RR 2011, c. 1, §40 (COR). PL 2011, c. 90, Pt. A, §§6-10 (AMD). PL 2011, c. 90, Pt. D, §4 (AMD). PL 2011, c. 364, §§9-17 (AMD). PL 2011, c. 638, §§1-3 (AMD). PL 2019, c. 5, Pt. A, §§9-12 (AMD). PL 2019, c. 96, §1 (AMD). PL 2019, c. 653, Pt. B, §§3-7 (AMD). PL 2021, c. 344, §2 (AMD). PL 2021, c. 655, §2 (AMD). PL 2023, c. 59, §§5-7 (AMD).