LD 1496
pg. 34
Page 33 of 41 An Act To Reduce Maine's Health Insurance Rates and Expand Consumer Choice ... Page 35 of 41
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LR 541
Item 1

 
(4) Dirigo Health shall require participating
employers to certify that at least 75% of their
employees that work 30 hours or more per week and who
do not have other creditable coverage are enrolled in
Dirigo Health Insurance and that the employer group
otherwise meets the minimum participation requirements
specified by section 2808-B, subsection 4, paragraph A.

 
(5) Dirigo Health shall reduce the payment amounts for
plan enrollees eligible for a subsidy under section
6912 accordingly. Dirigo Health shall return any
payments made by plan enrollees also enrolled in
MaineCare to those enrollees.

 
(6) Dirigo Health shall require participating
employers to pass on any subsidy in section 6912 to the
plan enrollee qualifying for the subsidy, up to the
amount of payments made by the plan enrollee.

 
(7) Dirigo Health may establish other criteria for
participation.

 
(8) Dirigo Health may limit the number of
participating employers.

 
Sec. B-26. 24-A MRSA §6913, sub-§9, as enacted by PL 2003, c. 469, Pt.
A, §8, is amended to read:

 
9. Demonstration of offset. As provided in sections 2736-C,
2808-B 2808-C and 2839-B, the claims experience used to determine
any filed premiums or rating formula must reasonably reflect, in
accordance with accepted actuarial standards, known changes and
offsets in payments by the carrier to health care providers in
this State, including any reduction or avoidance of bad debt and
charity care costs to health care providers in this State as a
result of the operation of Dirigo Health and any increased
enrollment due to an expansion in MaineCare eligibility occurring
after June 30, 2004 as determined by the board consistent with
subsection 1.

 
Sec. B-27. Effective date. This Part takes effect January 1, 2007.

 
PART C

 
Sec. C-1. 24-A MRSA §4205, sub-§1, śC, as enacted by PL 1975, c. 503,
is amended to read:

 
C. The furnishing of health care services through providers
which that are under contract with or employed by the health


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