LD 1611
pg. 40
Page 39 of 47 An Act To Provide Affordable Health Insurance to Small Businesses and Individua... Page 41 of 47
Download Bill Text
LR 2137
Item 1

 
for private purchasing alliances. A rule may require an
application fee of not more than $400 and an annual license fee
of not more than $100. A license may not be issued until the
rulemaking required by this chapter has been undertaken and all
required rules are in effect. Dirigo Health, as established in
chapter 87, is exempt from the licensure requirements of this
section as an instrumentality of the State.

 
Sec. D-6. 24-A MRSA §2436, sub-§2-A, as enacted by PL 2001, c. 569,
§1, is amended to read:

 
2-A. For purposes of this section, an "undisputed claim"
means a timely claim for payment of covered health care expenses
under a policy or certificate providing health care coverage that
is submitted to an insurer on in the insurer's standard claim
form electronic data format using the most current published
procedural codes with all the required fields completed with
correct and complete information in accordance with the insurer's
published claims filing requirements. This subsection applies
only to a policy or certificate of a health plan as defined in
section 4301-A, subsection 7.

 
Sec. D-7. 24-A MRSA §2736-C, sub-§2, ¶B-1 is enacted to read:

 
B-1.__In no instance may a rate reflect the cost to the
individual health carrier of the recovery amount applied in
accordance with section 6920.

 
Sec. D-8. 24-A MRSA §2808-B, sub-§§2-A to 2-C are enacted to read:

 
2-A.__Rate filings.__A carrier offering small group health
plans shall file with the superintendent every rate, rating
formula and classification of risks and every modification of any
formula or classification that it proposes to use.__Every filing
must state the effective date of the filing.__Every filing must
be made not less than 60 days in advance of the stated effective
date, unless the 60-day requirement is waived by the
superintendent.

 
2-B.__Rate review and hearings.__Except as provided in
subsection 2-C, rate filings are subject to this subsection.

 
A.__The effective date may be suspended by the
superintendent for a period of time not to exceed 30 days.__
In the case of a filing that meets the criteria in paragraph
E, the superintendent may suspend the effective date for a
longer period not to exceed 30 days from the date the


Page 39 of 47 Top of Page Page 41 of 47