2.__Advocacy panel. In any proceeding regarding a rate filing affecting the interests of more than 100 policyholders or certificate holders or in any proceeding regarding an application for licensure by an insurer, nonprofit hospital and medical service organization, nonprofit health care service organization or health maintenance organization, the bureau shall impanel an advocacy panel to represent the interests of consumers and the public.__The bureau may contract for the services of an advocacy panel if existing staff resources are not adequate to represent the interests of consumers and the public.__The insurer, nonprofit hospital and medical service organization, nonprofit health care service organization or health maintenance organization making the rate filing or application for licensure shall pay the cost of participation of the advocacy panel.

3. Intervenor funding. Intervenor funding may be provided as follows.

A.__In any bureau proceeding regarding a rate filing or in any proceeding regarding an application for licensure by an insurer, nonprofit hospital and medical service organization, nonprofit health care service organization or health maintenance organization, the superintendent may order the insurer, nonprofit hospital and medical service organization, nonprofit health care service organization or health maintenance organization to compensate an intervenor in the proceeding for reasonable attorney's fees, expert witness fees or other reasonable costs incurred in preparation and advocacy of the intervenor's position.__The superintendent may order compensation to an intervenor if the superintendent finds that:

(1)__The position of the intervenor is not adequately represented by an advocacy panel;

(2)__The intervenor has substantially contributed to the approval, in whole or in part, of a position advocated by the intervenor in the proceeding, except that, if an advocacy panel is not appointed to a proceeding, the intervenor must have contributed substantially to the conduct of the proceeding and assisted in the resolution of the issues raised in the proceeding; and

(3)__The participation of the intervenor in the proceeding without compensation would impose a significant financial hardship on the intervenor.

B.__In any proceeding in which the bureau__significantly modified or denied a rate filing or application for licensure, the superintendent may compensate the intervenor for reasonable attorney's fees, expert witness fees and other reasonable costs incurred in preparation and advocacy of the intervenor's position whenever the superintendent finds that the requirements of paragraph A, subparagraphs (1) and (3) are satisfied.__Compensation may be provided from the bureau's regulatory fund, filing fees or assessments, subject to availability of funds.

C.__A determination that an intervenor is eligible for an award of compensation pending the outcome of a proceeding must be made by the superintendent at the earliest practicable time in the bureau proceeding.

4.__Rules.__The bureau, after notice and hearing, may adopt rules to implement this section. Rules adopted pursuant to this section are routine technical rules as defined in Title 5, chapter 375, subchapter II-A.

Sec. 3. 24-A MRSA §216, sub-§2, as amended by PL 1997, c. 314, §1, is further amended to read:

2. All records of the bureau are subject to public inspection, except as otherwise expressly provided by law as to particular matters; and except that records, correspondence and reports of investigation in connection with actual or claimed violations of this Title or prosecution or disciplinary action for those violations are confidential. The confidential nature of any such record, correspondence or report may not limit or affect use of the same by the superintendent in any such prosecution or action. This subsection does not preclude participation by the superintendent in the establishment of an interstate complaint handling system that may involve the sharing of information with insurance regulatory officials in other jurisdictions and with the National Association of Insurance Commissioners, as long as the names of the complainant and insured remain confidential. This subsection does not preclude the dissemination of aggregate ratios of substantiated consumer complaints to the public by the superintendent. Only complaints received in writing are included in the calculation of the complaint ratio. A complaint received by electronic means is considered a written complaint. A substantiated consumer complaint includes any matter in which the resolution results in a favorable outcome to the consumer, including, but not limited to, the recovery of premium refunds, additional amounts paid on claims or policy reinstatements. A matter in which the actions of an insurer are in violation of this Title is deemed a

substantiated complaint. The superintendent shall adopt rules necessary to define the method for calculating complaint ratios. Rules adopted pursuant to this subsection are major substantive rules as defined in Title 5, chapter 375, subchapter II-A.

Sec. 4. 24-A MRSA §221, sub-§5 is enacted to read:

5.__Market conduct examinations; reports. Notwithstanding any other provision of this section, the bureau shall conduct a minimum of 3 market conduct examinations at random per year, including at least one insurer writing coverage under each of the following bureau divisions:__property and casualty insurance; life and disability insurance; and health insurance.__The examined insurer shall pay the costs of the market conduct examination.__On an annual basis, the bureau shall report the number of complaints filed against insurers, the number of enforcement actions taken against insurers and the number of market conduct examinations completed.__The report must also include an overview of the issues underlying the complaints filed against insurers and the steps being taken by the bureau to address those issues.__On or before March 15th of each year, the bureau shall submit the report to the public and to the joint standing committee of the Legislature having jurisdiction over insurance matters.

Sec. 5. 24-A MRSA §2774, sub-§2, as enacted by PL 1989, c. 556, Pt. C, §2, is amended to read:

2. Action against licensee. The superintendent is authorized to take appropriate action against a licensee which that fails to meet the standards of this chapter or any rules adopted by the superintendent, or who fails to respond in a timely manner to corrective actions ordered by the superintendent. The superintendent may impose a civil penalty not to exceed $1,000 for each violation, as permitted by section 12-A, or may deny, suspend or revoke the license.

Sec. 6. 24-A MRSA §4321, sub-§4, ¶¶B and D, as enacted by PL 1997, c. 792, §3, are amended to read:

B. Providing information to consumers regarding health care plan options and obtaining health care coverage and services, including a chart comparing health plans offered by carriers. The division may contract with a 3rd party for the development of the comparison chart. The division may not make any specific recommendations regarding commercially offered products;

D. Providing information to consumers on health care plan performance, including information on complaints made against carriers, by distributing published materials and

utilizing existing resources relating to health care plan performance and complaints;

SUMMARY

This bill does the following.

1. It increases the maximum civil penalty for violations of the Maine Insurance Code by corporate entities to $25,000.

2. It describes the mission of the Department of Professional and Financial Regulation, Bureau of Insurance and requires that the bureau dedicate its resources to supporting its mission.

3. It requires that the bureau appoint an advocacy panel to represent the interests of consumers in any rate filing affecting the interests of more than 100 policyholders or certificate holders or in any proceeding regarding an application for licensure by an insurer, nonprofit hospital and medical service organization, nonprofit health care service organization or health maintenance organization.

4. It allows the Superintendent of Insurance to order an insurer, nonprofit hospital and medical service organization, nonprofit health care service organization or health maintenance organization to compensate an intervenor in a proceeding for reasonable attorney's fees, expert witness fees or other reasonable costs. The superintendent may order compensation upon a finding that the position of the intervenor is not adequately represented by an advocacy panel, that the intervenor has substantially contributed to the approval, in whole or in part, of a position advocated by the intervenor in the proceeding and that the participation of the intervenor in the proceeding without compensation would impose a significant financial burden on the intervenor. The bill also allows the Superintendent of Insurance to order compensation for an intervenor from Bureau of Insurance funds if the position of the intervenor is not adequately represented by an advocacy panel and if participation of the intervenor without compensation would impose a significant financial burden on the intervenor.

5. It requires the bureau to conduct on an annual basis at least one market conduct examination of insurers writing business in each of its divisions: property and casualty insurance; life and disability insurance; and health insurance.

6. It removes the requirement that only substantiated complaints are included in the complaint ratios compiled by the Bureau of Insurance.

7. It requires the Bureau of Insurance, Consumer Health Care Division to publish a chart comparing health plans offered by carriers and allows the division to contract for those services. It also requires the division to publish information relating to complaints against carriers.