Legislative Document No. 1650 H.P. 1186 House of Representatives, April 30, 2019
An Act To Strengthen Consumer Protections in Health Care
Reference to the Committee on Health Coverage, Insurance and Financial Services suggested and ordered printed.
ROBERT B. HUNT Clerk
Presented by Representative TIPPING of Orono. Cosponsored by Senator SANBORN, L. of Cumberland and Representatives: BROOKS of Lewiston, FOLEY of Biddeford, MADIGAN of Waterville, MARTIN of Eagle Lake, MELARAGNO of Auburn, TEPLER of Topsham, Senator: GRATWICK of Penobscot.
Printed on recycled paper 1 Be it enacted by the People of the State of Maine as follows:
2 Sec. 1. 24-A MRSA §2735-A, sub-§1, as amended by PL 2011, c. 364, §1, is 3 further amended to read:
4 1. Notice of rate filing or rate increase on existing policies. An insurer offering 5 individual health plans as defined in section 2736-C must provide written notice by first 6 class mail of a rate filing to all affected policyholders at least 60 days before the effective 7 date of any proposed increase in premium rates or any proposed rating formula, 8 classification of risks or modification of any formula or classification of risks. Except as 9 otherwise provided in section 2736-C, subsection 2-B, the The notice must also inform 10 policyholders of their right to request a hearing pursuant to section 229. The notice must 11 show the proposed rate and, unless otherwise provided in section 2736-C, subsection 2-B, 12 state that the rate is subject to regulatory approval. Except as otherwise provided in 13 section 2736-C, subsection 2-B, the The superintendent may not take final action on a 14 rate filing until 40 days after the date notice is mailed by an insurer. An increase in 15 premium rates may not be implemented until 60 days after the notice is provided or until 16 the effective date under section 2736, whichever is later.
17 Sec. 2. 24-A MRSA §2736-C, sub-§2, ¶C-1, as enacted by PL 2011, c. 90, Pt. 18 A, §2, is repealed.
19 Sec. 3. 24-A MRSA §2736-C, sub-§2, ¶D, as amended by PL 2019, c. 5, Pt. A, 20 §3, is further amended to read: 21 D. A carrier may vary the premium rate due to age, geographic area and tobacco use 22 in accordance with the limitations set out in this paragraph. A carrier that varies the 23 premium rate due to age must vary the premium rate according to a uniform age 24 curve. The superintendent shall adopt rules establishing a uniform age curve that is 25 substantially similar to the age curve in effect on January 1, 2019 under the federal 26 Affordable Care Act. Rules adopted under this paragraph are routine technical rules 27 as defined in Title 5, chapter 375, subchapter 2-A. 28 (1) For all policies, contracts or certificates that are executed, delivered, issued 29 for delivery, continued or renewed in this State between December 1, 1993 and 30 July 14, 1994, the premium rate may not deviate above or below the community 31 rate filed by the carrier by more than 50%. 32 (2) For all policies, contracts or certificates that are executed, delivered, issued 33 for delivery, continued or renewed in this State between July 15, 1994 and July 34 14, 1995, the premium rate may not deviate above or below the community rate 35 filed by the carrier by more than 33%. 36 (3) For all policies, contracts or certificates that are executed, delivered, issued 37 for delivery, continued or renewed in this State between July 15, 1995 and June 38 30, 2012, the premium rate may not deviate above or below the community rate 39 filed by the carrier by more than 20%. 40 (5) For all policies, contracts or certificates that are executed, delivered, issued 41 for delivery, continued or renewed in this State between July 1, 2012 and
Page 1 - 129LR0243(01)-1 1 December 31, 2013, the maximum rate differential due to age filed by the carrier 2 as determined by ratio is 3 to 1. The limitation does not apply for determining 3 rates for an attained age of less than 19 years of age or more than 65 years of age. 4 (6) For all policies, contracts or certificates that are executed, delivered, issued 5 for delivery, continued or renewed in this State between January 1, 2014 and 6 December 31, 2014, the maximum rate differential due to age filed by the carrier 7 as determined by ratio is 4 to 1 to the extent permitted by the federal Affordable 8 Care Act. The limitation does not apply for determining rates for an attained age 9 of less than 19 years of age or more than 65 years of age. 10 (7) For all policies, contracts or certificates that are executed, delivered, issued 11 for delivery, continued or renewed in this State on or after January 1, 2015, 12 except as provided in subparagraph (9) (10), the maximum rate differential due to 13 age filed by the carrier as determined by ratio is 5 to 1 to the extent permitted by 14 the federal Affordable Care Act. The limitation does not apply for determining 15 rates for an attained age of less than 19 years of age or more than 65 years of age. 16 (8) For all policies, contracts or certificates that are executed, delivered, issued 17 for delivery, continued or renewed in this State on or after July 1, 2012, the 18 maximum rate differential due to tobacco use filed by the carrier as determined 19 by ratio is 1.5 to 1, except that the carrier may not apply a rate differential 20 pursuant to this subparagraph when the covered individual is participating in an 21 evidence-based tobacco cessation strategy approved by the United States 22 Department of Health and Human Services, Food and Drug Administration. 23 (9) For all policies, contracts or certificates that are executed, delivered, issued 24 for delivery, continued or renewed in this State on or after the effective date of 25 this subparagraph, the maximum rate differential due to age filed by the carrier as 26 determined by ratio is 3 to 1 for individuals 21 years of age and older on the first 27 day of coverage under the policy, contract or certificate. The variation in rate due 28 to age must be actuarially justified for individuals under 21 years of age 29 consistent with the uniform age rating curve adopted under this paragraph. 30 (10) For all policies, contracts or certificates that are executed, delivered, issued 31 for delivery, continued or renewed in this State on or after January 1, 2020, for 32 each individual health plan offered by a carrier, the highest premium rate for each 33 rating tier may not exceed 2.5 times the premium rate that could be charged to an 34 eligible individual with the lowest premium rate for that rating tier in a given 35 rating period. For purposes of this subparagraph, "rating tier" means each 36 category of individual or family composition for which a carrier charges separate 37 rates. 38 (a) In determining the rating factor for geographic area pursuant to this 39 subparagraph, the ratio between the highest and lowest rating factor used by a 40 carrier for geographic area may not exceed 1.5 and the ratio between highest 41 and lowest combined rating factors for age and geographic area may not 42 exceed 2.5.
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