Sec. A-1. 24-A MRSA §2735-A, sub-§§1-A and 3 are enacted to read:
1-A. Notice of rate filings or rate increase on existing policies renewed in calendar year 2006. Notwithstanding subsection 1, for existing policies renewed in calendar year 2006, an insurer offering individual health plans as defined in section 2736-C for plan years beginning in 2006 must provide written notice by first class mail of a rate filing to all affected policyholders at least 30 days before the effective date of any proposed increase in premium rates or any proposed rating formula or classification of risks or modification of any formula or classification of risks. The notice must also inform policyholders of their right to request a hearing pursuant to section 229 or a special rate hearing pursuant to section 2736, subsection 4 or Title 24, section 2321, subsection 5. The notice must show the proposed rate and state that the rate is subject to regulatory approval. An increase in premium rates may not be implemented until 30 days after the notice is provided.
This subsection is repealed January 1, 2007.
3. Notice of rate increase on new business for calendar year 2006. Notwithstanding subsection 2, for new business quoted in calendar year 2006 by an insurer offering individual health plans as defined in section 2736-C, the insurer must disclose any rate increase that the insurer anticipates implementing within the following 30 days. If the quote is in writing, the disclosure must also be in writing. If the increase is pending approval at the time of notice, the disclosure must include the proposed rate and state that it is subject to regulatory approval. If disclosure required by this subsection is not provided, an increase may not be implemented until at least 30 days after the date the quote is provided.
This subsection is repealed January 1, 2007.
Sec. A-2. 24-A MRSA §2839-A, sub-§§1-A and 3 are enacted to read:
1-A. Notice of rate increase on existing policies renewed in calendar year 2006. Notwithstanding subsection 1, for existing policies renewed in calendar year 2006, an insurer offering group health insurance for 2006 plan years, except for accidental injury, specified disease, hospital indemnity, disability income, Medicare supplement, long-term care or other limited benefit group health insurance, must provide written notice by first class mail of a rate increase to all affected policyholders or others who are directly billed for group coverage at least 30 days before the effective date of any increase in premium rates. An increase in premium rates may not be implemented until 30 days after the notice is provided.
This subsection is repealed January 1, 2007.
3. Notice of rate increase on new business for calendar year 2006. Notwithstanding subsection 2, for new business quoted in calendar year 2006 by an insurer offering group health insurance, except for accidental injury, specified disease, hospital indemnity, disability income, Medicare supplement, long-term care or other limited benefit group health insurance, quotes a rate for new business, the insurer must disclose any rate increase that the insurer anticipates implementing within the following 30 days. If the quote is in writing, the disclosure must also be in writing. If such disclosure is not provided, an increase may not be implemented until at least 30 days after the date the quote is provided.
This subsection is repealed January 1, 2007.
Sec. A-3. 24-A MRSA §6903, sub-§4, as enacted by PL 2003, c. 469, Pt. A, §8, is repealed.
Sec. A-4. 24-A MRSA §6903, sub-§4-A is enacted to read:
4-A. Dirigo Health Program. "Dirigo Health Program" means the program of services provided by Dirigo Health that includes comprehensive health benefits coverage, subsidies, wellness programs and quality improvement initiatives.
Sec. A-5. 24-A MRSA §6908, sub-§12 is enacted to read:
12. Report; jurisdiction. Dirigo Health shall report twice annually, once in January and once during the last month of the regular legislative session, to the joint standing committee of the Legislature having jurisdiction over insurance and financial services matters on the Dirigo Health Program and budget. Minutes of meetings of the Board of Directors of Dirigo Health must be provided to each member of the joint standing committees of the Legislature having jurisdiction over insurance and financial services matters, health and human services matters and appropriations and financial affairs.
Sec. A-6. 24-A MRSA §6911, as enacted by PL 2003, c. 469, Pt. A, §8 and amended by c. 689, Pt. B, §6, is further amended to read:
§6911. Coordination with MaineCare
The Department of Health and Human Services is the state agency responsible for the financing and administration of MaineCare. It shall pay for MaineCare benefits for MaineCare-eligible individuals, including those enrolled in health plans in MaineCare that are providing coverage under the Dirigo Health Insurance Program. An individual participating in the Dirigo Health Program who applies for and is determined eligible for MaineCare is enrolled directly in MaineCare.
Sec. A-7. 24-A MRSA §6912, first ¶, as enacted by PL 2003, c. 469, Pt. A, §8, is amended to read:
Dirigo Health may establish sliding-scale subsidies for the purchase of Dirigo Health Insurance Program coverage paid by eligible individuals or employees whose income is under 300% of the federal poverty level and who are not eligible for MaineCare. Dirigo Health may also establish sliding-scale subsidies for the purchase of employer-sponsored health coverage paid by employees of businesses with more than 50 employees, whose income is under 300% of the federal poverty level and who are not eligible for MaineCare.
Sec. A-8. 24-A MRSA §6912, sub-§2, as enacted by PL 2003, c. 469, Pt. A, §8, is amended to read:
2. Eligibility for subsidy. Individuals To be eligible for a subsidy an individual or employee must:
A. Have Be enrolled in the Dirigo Health Program, have an income under 300% of the federal poverty level, and be a resident of the State, be ineligible for MaineCare coverage and be enrolled in Dirigo Health Insurance; or
B. Be enrolled in a health plan of an employer with more than 50 employees and have an income under 300% of the federal poverty level. The health plan must meet any criteria established by Dirigo Health. The individual must meet other eligibility criteria established by Dirigo Health.
Sec. A-9. 24-A MRSA §6912, sub-§6, as enacted by PL 2003, c. 469, Pt. A, §8, is amended to read:
6. Report. Within 30 days after any subsidies are established pursuant to this section, the board shall report on the amount of the subsidies, the funding required for the subsidies and the estimated number of Dirigo Health Program enrollees eligible for the subsidies and submit the report to the joint standing committee of the Legislature having jurisdiction over appropriations and financial affairs, the joint standing committee of the Legislature having jurisdiction over insurance and financial services matters and the joint standing committee of the Legislature having jurisdiction over health and human services matters.
Sec. A-10. 24-A MRSA §6913, sub-§1, as enacted by PL 2003, c. 469, Pt. A, §8, is repealed and the following enacted in its place:
1. Determination of cost savings. The following are the procedures for determining cost savings.
A. After an opportunity for a hearing conducted pursuant to Title 5, chapter 375, subchapter 4, the board shall determine annually not later than April 1st the aggregate measurable cost savings, including any reduction or avoidance of bad debt and charity care costs to health care providers in this State as a result of the operation of Dirigo Health and any increased MaineCare enrollment due to an expansion in MaineCare eligibility occurring after June 30, 2004.
B. Within 30 days of the board's determination pursuant to paragraph A, the board shall file with the superintendent its determination as well as the supporting information for that determination. The filing constitutes a public record.
C. Following a public hearing held in accordance with the Maine Administrative Procedure Act and no later than 6 weeks following the receipt of the board's determination, the superintendent shall issue an order approving, in whole or in part, or disapproving the filing made under paragraph B. The board is designated a party to the hearing. The superintendent shall approve the filing upon a determination that the aggregate measurable cost savings filed by the board are reasonably supported by the evidence in the record.
Sec. A-11. 24-A MRSA §6913, sub-§§2 and 3, as enacted by PL 2003, c. 469, Pt. A, §8, are repealed and the following enacted in their place:
2. Determination of savings offset amount. The board shall determine annually a savings offset amount to be paid by health insurance carriers, employee benefit excess insurance carriers and 3rd-party administrators, not including carriers and 3rd-party administrators with respect to accidental injury, specified disease, hospital indemnity, dental, vision, disability income, long-term care, Medicare supplement or other limited benefit health insurance. The board shall determine the savings offset amount in accordance with the following:
A. Not later than April of each year, the board shall prospectively determine the savings offset amount to be applied during each 12-month calendar year period;
B. To determine the savings offset amount, the board shall use the criteria and reports described in subsections 7 and 8;
C. The savings offset amount must reflect and may not exceed aggregate measurable cost savings, as determined by the board pursuant to subsection 1; and
D. The savings offset amount calculation is limited to the amount of funds necessary to provide subsidies pursuant to section 6912 and to support the Maine Quality Forum established in section 6951 and may not include general administrative expenses of Dirigo Health, except for general administrative expenses of the Maine Quality Forum.
The savings offset amount determined by the board in accordance with this subsection is the determining factor for inclusion of savings offset payments in premiums through rate setting review by the bureau.
3. Savings offset payments required from health insurance carriers, 3rd-party administrators and employee benefit excess insurance carriers. Except for the carriers and 3rd-party administrators that are specifically excluded in subsection 2, each health insurance carrier, 3rd-party administrator and employee benefit excess insurance carrier shall pay a savings offset payment. The following provisions govern savings offset payments.
A. The board shall calculate savings offset payments as a percentage of paid claims, as defined by the board pursuant to subsection 10. The board shall make reasonable efforts to ensure that paid claims are counted only once with respect to any savings offset payment. The board may verify each health insurance carrier's, 3rd-party administrator's and employee benefit excess insurance carrier's savings offset payment based on annual statements and other reports the board determines to be necessary.
B. Maximum savings offset payments are as follows:
(1) For health insurance carriers, the savings offset payment may not exceed 4.0% of annual paid claims for health care on policies issued pursuant to the laws of this State that insure residents of this State;
(2) For 3rd-party administrators, the savings offset payment may not exceed 4.0% of annual paid claims for health care for residents of this State; and
(3) For employee benefit excess insurance carriers, the savings offset payment may not exceed 4.0% of annual paid claims on employee benefit excess insurance policies, as defined in section 707, subsection 1, paragraph C-1, issued pursuant to the laws of this State that insure residents of this State.
C. A health insurance and employee benefit excess insurance carrier may not be required to pay a savings offset payment on policies or contracts insuring federal employees.
D. Savings offset payments apply to claims paid for plan years beginning on or after January 1, 2006.
E. Savings offset payments may not begin until 12 months after Dirigo Health begins providing health insurance coverage;
F. Savings offset payments must be made quarterly and are due not less than 60 days after the close of the quarter and with a minimum of 30 days' written notice by Dirigo Health to health insurance carriers, employee benefit excess insurance carriers and 3rd-party administrators and must accrue interest at 12% per annum on or after the due date, except that:
(1) For plan years beginning between January 1, 2006 and March 31, 2006, both days inclusive, savings offset payments must be made monthly for January 2006, February 2006 and March 2006 and are due not less than 60 days after the close of each of those calendar months; and
(2) Savings offset payments for 3rd-party administrators for groups of 500 or fewer members may be made annually not less than 60 days after the close of the plan year.
G. Savings offset payments received by Dirigo Health must be pooled with other revenues of the agency in the Dirigo Health Fund established in section 6915; and
H. Annual savings offset payments received must be reconciled by Dirigo Health. Any unused payments must reduce the next savings offset payment charged to health insurance carriers, 3rd-party administrators and employee benefit excess insurance carriers according to a formula developed by the board.
Sec. A-12. 24-A MRSA §6913, sub-§§4 and 6, as enacted by PL 2003, c. 469, Pt. A, §8, are repealed.
Sec. A-13. 24-A MRSA §6913, sub-§10 is enacted to read:
10. Definition of paid claims; rulemaking. The board shall adopt rules regarding the definition of paid claims for the purposes of calculating savings offset payments for health insurance carriers, 3rd-party administrators and employee benefit excess insurance carriers due on or after January 1, 2007. Rules adopted pursuant to this subsection are major substantive rules as defined in Title 5, chapter 375, subchapter 2-A.
Sec. A-14. 24-A MRSA §6914, as enacted by PL 2003, c. 469, Pt. A, §8, is amended to read:
§6914. Intragovernmental transfer
Starting July 1, 2004, Dirigo Health shall transfer funds, as necessary, to a special dedicated, nonlapsing revenue account administered by the agency of State Government that administers MaineCare for the purpose of providing a state match for federal Medicaid dollars. Dirigo Health shall annually set the amount of contribution. The transfer may not include money collected as a savings payment offset pursuant to section 6913.
| Revisor of Statutes Homepage | Subject Index | Search | 122nd Laws of Maine | Maine Legislature |
About the 1st Regular & 1st Special Session Laws Of Maine
