| | 9-C. Health maintenance organizations. A corporation subject | to this chapter is not required to maintain separate reserves or | surplus with respect to the operations of a health maintenance | organization that is not a separate legal entity. All assets of | the corporation must be available to pay claims arising from | corporate operations, other than with the exception of assets | supporting reserves set aside in accordance with a plan for the | continuation of benefits to health maintenance organization | members under Title 24-A, section 4204, subsection 7 and assets | supporting additional reserves as defined in Title 24-A, section | 921, must be available to pay claims arising from corporate | operations to the extent required by rules adopted by the | superintendent pursuant to Title 24-A, section 901-A. A hospital | or medical service corporation that establishes and maintains a | health maintenance organization not organized as a separate legal | entity shall maintain separate accounting for the health | maintenance organization; |
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| | Sec. 4. 24-A MRSA §222, sub-§2, ¶F, as amended by PL 1999, c. 113, §9, | is further amended to read: |
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| F. "Subsidiary" of a specified person means an affiliate | controlled by that person, directly or indirectly, through | one or more intermediaries. |
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| | Sec. 5. 24-A MRSA §222, sub-§8, ¶B, as enacted by PL 1975, c. 356, §1, | is amended to read: |
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| B. Every insurer subject to registration shall file a | registration statement on a form provided by the | superintendent, which shall must contain current information | about: |
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| (1) The capital structure, general financial condition, | ownership and management of the insurer and of any | person controlling the insurer; |
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| (2) The following transactions currently outstanding | between the insurer and its affiliates: |
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| (a) Loans and other investments, and purchases, sales | or exchanges of securities of the affiliate by the | insurer or of the insurer by its affiliates; |
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| (b) Purchases, sales or exchanges of assets; |
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| (c) Transactions not in the ordinary course of | business; |
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| (d) Guarantees or undertakings for the benefit of an | affiliate which that result in an actual | contingent exposure of the insurer's assets to | liability, other than insurance contracts entered | into in the ordinary course of the insurer's | business; |
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| (e) All management and service contracts and all | cost-sharing arrangements, other than cost | allocation arrangements based upon generally | accepted accounting principles; |
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| (f) Reinsurance agreements covering all or | substantially all of one or more lines of | insurance of the ceding insurer; and |
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| (3) Other matters concerning transactions between the | insurer and any affiliate as may be required by the | superintendent; |
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| | Sec. 6. 24-A MRSA §901, as amended by PL 1991, c. 828, §21, is | repealed. |
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| | Sec. 7. 24-A MRSA §901-A is enacted to read: |
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| §901-A.__Statutory accounting principles; reserves |
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| | 1.__Principles; admitted assets.__In evaluating the financial | condition of an insurer, the superintendent shall determine which | assets may be recognized as admitted assets, and shall value the | insurer's admitted assets and the insurer's liabilities in | accordance with recognized statutory accounting principles as | codified by the National Association of Insurance Commissioners | or its successor organization and reflected in the association's | accounting practices and procedures manual and its successor | publications and in any permitted accounting practices approved | by the superintendent. |
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| | 2.__Reserve required.__If the superintendent finds, in view of | the character of investments held by a domestic insurer, that it | would be prudent for the insurer to establish a special reserve | for possible losses or fluctuations in the value of its | investments, including realty holdings acquired by mortgage loan | default, the superintendent may permit or require the insurer to | establish such a reserve, reasonable in amount, and may require | that the reserve be maintained and reported in any statement or | report of the financial condition of the insurer. |
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| | 3.__Rules.__The superintendent may adopt rules to implement | the purposes of this chapter.__These rules are routine technical | rules pursuant to Title 5, chapter 375, subchapter II-A. |
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| | Sec. 8. 24-A MRSA §902, as amended by PL 1987, c. 399, §2, is | repealed. |
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| | Sec. 9. 24-A MRSA c. 11, sub-c. II, as amended, is repealed. |
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| | Sec. 10. 24-A MRSA c. 11, sub-c. IV, as amended, is repealed. |
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| | Sec. 11. 24-A MRSA §1110, sub-§1-A, ¶¶A and B, as enacted by PL 1999, c. | 715, §4, are amended to read: |
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| A. "Admitted assets" has the same meaning as "assets" as | defined in section 901 means assets recognized by the | superintendent pursuant to section 901-A. |
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| B. "Aggregate amount of investments" means the aggregate | value of those investments as determined under sections 981 | to 984, except as provided in section 1157, subsection 5 in | accordance with statutory accounting principles pursuant to | section 901-A and any rules adopted under that section. |
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| | Sec. 12. 24-A MRSA §1131, sub-§1, ¶¶A and B, as repealed and replaced by | PL 1987, c. 399, §12, are amended to read: |
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| A. The loan or investment shall must fulfill the | requirements of section 1103 and otherwise qualify as a | sound investment. |
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| B. No such loan or investment may be represented by: |
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| (1) Any item described in section 902 asset determined to | be nonadmitted pursuant to section 901-A or rules | adopted under that section; |
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| (2) Any loan or investment expressly prohibited under | section 1136; or |
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| (3) Agents' balances, or amounts advanced to or owing by | agents, except as to mortgage loans and collateral | loans to those agents otherwise authorized under this | chapter. |
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| | Sec. 13. 24-A MRSA §1151-A, sub-§§2 and 3, as enacted by PL 1999, c. | 715, §8, are amended to read: |
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| | 2. Admitted assets. "Admitted assets" means assets that may | be allowed in determining the financial condition of an insurer | pursuant to sections 901 and 902 recognized by the superintendent | pursuant to section 901-A. |
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| | 3. Aggregate amount of investments. "Aggregate amount of | investments" means the aggregate value of those investments, as | determined under sections 981 to 984 in accordance with statutory | accounting principles pursuant to section 901-A and any rules | adopted under that section, except as provided in section 1157, | subsection 5. |
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| | Sec. 14. 24-A MRSA §1156, sub-§2, ¶H, as amended by PL 1993, c. 313, | §27, is further amended to read: |
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| H. Investments that do not qualify or are not permitted | under any other paragraph of this subsection; as long as: |
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| (1) After giving effect to any investment made under this | paragraph, the aggregate amount of those investments | does not exceed 14% of total admitted assets, except | that investments made under this paragraph in | institutions or property not located within the State | may not exceed 10% of total admitted assets; and, if | the insurer makes investments described in paragraphs A | to G and elects to charge those investments against the | quantitative limits in this paragraph instead of the | quantitative limits in paragraphs A to G, then the | aggregate amount invested under this paragraph in those | types of investments may not exceed 5% of total | admitted assets for any one of those types of | investments; |
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| (2) Investments that are neither interest bearing nor | income entitled, including the cost of outstanding bona | fide hedging transactions made under section 1153, | subsection 2, are subject to all of the provisions of | this paragraph; and the aggregate amount of those | investments held at any one time may not exceed 3% of | total admitted assets; |
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| (3) The investment limitations contained in this chapter, | qualitative or otherwise, may do not apply to loans or | investments made or acquired under this paragraph, | provided that no loan or investment made or acquired | under this paragraph may be represented by any item | described in section 902 asset determined to be | nonadmitted pursuant to section 901-A or rules adopted | under that section; any loan or investment expressly | prohibited under section 1160; or agents' balances, or | amounts advanced to or owing by agents, except as to | policy loans, mortgage loans and collateral loans to | those agents otherwise authorized under this chapter; | or |
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| (4) The insurer shall keep a separate record of all loans | and investments made or acquired under this paragraph. | Any such loan or investment that, subsequent to the | date of making or acquisition, has attained the | standard of eligibility and qualifies under any other | provision of this chapter may be considered to have | been made or acquired under and in compliance with | that provision and may no longer be considered to have | been made or acquired under this paragraph. |
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| | Sec. 15. 24-A MRSA §1157, sub-§5, ¶D, as enacted by PL 1987, c. 399, | §14, is amended to read: |
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| D. Investments made or acquired by subsidiaries referred to | in paragraph B, subparagraph (1), shall be are considered to | be made or acquired directly by the insurer, pro rata, in | the case of a subsidiary not wholly owned, and shall, to | such extent, be are subject to all the provisions and | limitations on the making of investments specified in this | chapter with respect to investments by the insurer; shall | must be valued in accordance with the provisions of sections | 981 to 984 section 901-A and any other applicable provisions | of this Title and any applicable rules adopted by the | superintendent; and shall must be located pursuant to | section 3408. Those subsidiaries shall be are subject to | examination by the superintendent under section 221, | subsection 1, and section 222, subsection 1. |
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| | Sec. 16. 24-A MRSA §1157, sub-§6, as enacted by PL 1987, c. 399, §14, | is amended to read: |
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| | 6. Valuation of subsidiary stock. In determining the | financial condition of an insurer, all investments made directly | or indirectly in the stock of its subsidiaries shall must be | valued in accordance with section 982, subsection 3, and | regulations promulgated 901-A and any rules adopted under that | section. |
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| | Sec. 17. 24-A MRSA §3629, sub-§6, as enacted by PL 1969, c. 132, §1, | is repealed. |
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| | Sec. 18. 24-A MRSA §3629, sub-§6-A is enacted to read: |
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| | 6-A.__Section 901-A (statutory accounting principles); |
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| | Sec. 19. 24-A MRSA §4204, sub-§2-A, ¶D, as corrected by RR 1993, c. 1, | §67, is amended to read: |
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| D. The health maintenance organization is financially | responsible, complies with the minimum surplus requirements | of this section and, among other factors, can reasonably be | expected to meet its obligations to enrollees and | prospective enrollees. |
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| (1) In a determination of minimum surplus | requirements, the following terms have the following | meanings. |
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| (a) "Admitted assets" means assets as defined in | section 901 recognized by the superintendent | pursuant to section 901-A. For purposes of this | chapter, the asset value is that contained in the | annual statement of the corporation as of December | 31st of the year preceding the making of the | investment or contained in any audited financial | report, as defined in section 221-A, of more | current origin. |
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| (b) "Reserves" means those reserves held by | corporations subject to this chapter for the | protection of subscribers. For purposes of this | chapter, the reserve value is that contained in | the annual statement of the corporation as of | December 31st of the preceding year or any audited | financial report, as defined in section 221-A, of | more current origin. |
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| (2) In making the determination whether the health | maintenance organization is financially responsible, | the superintendent may also consider: |
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| (a) The financial soundness of the health maintenance | organization's arrangements for health care | services and the schedule of charges used; |
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| (b) The adequacy of working capital; |
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| (c) Any agreement with an insurer, a nonprofit | hospital or medical service corporation, a | government or any other organization for insuring | or providing the payment of the cost of health | care services or the provision for automatic | applicability of an alternative coverage in the | event of discontinuance of the plan; |
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| (d) Any agreement with providers for the provision of | health care services that contains a covenant | consistent with subsection 6; and |
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| (e) Any arrangements for insurance coverage or an | adequate plan for self-insurance to respond to | claims for injuries arising out of the furnishing | of health care services. |
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| | This bill modernizes the laws governing accounting standards | for insurers by adopting the statutory insurance accounting | practices that have been codified by the National Association of | Insurance Commissioners, or NAIC, on a nationwide basis effective | January 1, 2001. This bill repeals conflicting or superfluous | provisions of the chapter of the Maine Insurance Code relating to | valuation of insurers' assets and liabilities and updates the | pertinent cross-references. The bill also corrects an error in | the definition of "subsidiary" in the holding company law and | incorporates a change to the transactions-with-affiliates section | that was inadvertently omitted from prior accreditation | legislation. |
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