LD 1496
pg. 23
Page 22 of 41 An Act To Reduce Maine's Health Insurance Rates and Expand Consumer Choice ... Page 24 of 41
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LR 541
Item 1

 
D.__"Case characteristics" means demographic or other
relevant characteristics of a small employer as determined
by a carrier that are considered by the carrier in the
determination of the premium rates for the small employer.
"Case characteristics" does not include claims experience,
health status or duration of coverage.

 
E.__"Class of business" means all or a distinct grouping of
small employers in accordance with this paragraph to whom
the carrier provides coverage as demonstrated by the
carrier's records:

 
(1)__A distinct grouping may only be established by the
small employer carrier on the basis that the applicable
health benefit plans:

 
(a)__Are marketed and sold through individuals and
organizations that are not participating in the
marketing or sale of other distinct groupings of
small employers for the carrier;

 
(b)__Have been acquired from another carrier as a
distinct grouping of plans;

 
(c)__Are provided through an association with
membership of not less than 50 small employers
that has been formed for purposes other than
obtaining insurance; or

 
(d)__Are in a class of business that meets the
requirements for exception to the restrictions
related to premium rates provided in subsection 4.

 
(2)__A carrier may establish no more than 2 additional
groupings under subparagraph (1) on the basis of
underwriting criteria that are expected to produce
substantial variation in the health care costs.

 
(3)__The superintendent may approve the establishment
of additional distinct groupings upon application to
the superintendent and a finding by the superintendent
that such action would enhance the efficiency and
fairness of the small group health plan market.

 
F.__"Index rate" means, for each class of business for small
employers with similar case characteristics, the arithmetic
average of the applicable base premium rate and the
corresponding highest premium rate.


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