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that all health benefit plans offered by health maintenance | | organizations meet or exceed each of the particular requirements | | of standard or basic health plans specified in Bureau of | Insurance Rule, Chapter 750. The superintendent may select | required services from among those set forth in Bureau of | Insurance Rule, Chapter 750 and shall permit reasonable, but not | excessive or unfairly discriminatory, variations in the | copayment, coinsurance, deductible and other features of such | coverage, except that these features must meet or exceed those | required in benefits mandated by statute. | | pursuant to this subsection are major substantive rules as | defined in Title 5, chapter 375, subchapter II-A |
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| | | Sec. 14. Reinsurance mechanism plan; individual health plans. That section of | | this Act that enacts the Maine Revised Statutes, Title 24-A, | | section 2736-C, subsection 10 does not take effect until the | | Superintendent of Insurance has approved a plan developed by | | the Governor's Office of Health Policy and Finance, created by | | Executive Order 6 FY 02/03, pursuant to rules adopted by the | | Department of Human Services, Bureau of Medical Services. The | | plan may permit spreading individual risks evenly over the | | entire health insurance market through a risk adjustment | | mechanism that assesses carriers with lower-than-average risks | | to fund the excess costs of carriers with higher-than-average | | risks. The plan may allow partial integration of these | | individual risks with a cap on the increment to group | | premiums. The plan may not establish a separate health | | insurance plan, allow carriers to avoid or reject high-risk | | policyholders, reduce the insured's benefits or increase cost- | | sharing. 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 and Title 24-A, | | section 2736-C. Rules adopted pursuant to this section are | | major, substantive rules as defined in Title 5, chapter 375, | | subchapter 2-A. |
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| | | Sec. 15. Reinsurance mechanism plan, small group health plans. That section of | | this Act that repeals and replaces the Maine Revised Statutes, | | Title 24-A, section 2808-B, sub-section 9 does not take effect | | until the Superintendent of Insurance has approved a plan | | developed by the Governor's Office of Health Policy and | | Finance, created by Executive Order 6 FY 02/03, pursuant to | | rules adopted by the Department of Human Services, Bureau of | | Medical Services. The plan may permit spreading the risks | | evenly over the entire health insurance market through a risk | | adjustment mechanism that assesses carriers with lower-than- | | average risks to fund the excess costs of carriers with | | higher-than-average risks. The plan may allow partial | | integration of these small group risks with a cap on the | | increment to group premiums. The plan may not establish a | | separate health insurance plan, allow carriers to |
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