4. Grievance procedures. The domestic insurer or health maintenance organization meets the requirements of section 4303, subsection 4 for grievance procedures with respect to health plans offered for sale in this State.

Sec. 4. 24-A MRSA §1420-M, sub-§1, as enacted by PL 2001, c. 259, §24, is amended to read:

1. Appointment. An insurance producer may not act as an agent of an insurer unless the insurance producer becomes an appointed agent of that insurer. An insurance producer may not act as an agent of a foreign insurer or health maintenance organization certified to transact individual health insurance pursuant to section 405-A unless the producer holds a valid producer license from the state or country of domicile of the foreign insurer or health maintenance organization. An insurance producer who is not acting as an agent of an insurer is not required to become appointed.

Sec. 5. Effective date. This Act takes effect January 1, 2006.

SUMMARY

Beginning January 1, 2006, this bill permits out-of-state health insurers, which are referred to as foreign insurers in the Maine Insurance Code, to offer their individual health plans for sale in this State if certain requirements of Maine law are met, including minimum capital and surplus and reserve requirements, disclosure and reporting requirements and grievance procedures. It also permits Maine health insurers to offer individual health plans of out-of-state parent or subsidiary health insurers if similar requirements are met. If out-of-state health plans are offered for sale in this State, the bill requires that prospective enrollees be provided adequate disclosure of how the plans differ from Maine health plans in a format approved by the Superintendent of Insurance.