Sec. E-1. 24-A MRSA §2808-B, sub-§2, ¶E, as enacted by PL 1991, c. 861, §2, is repealed and the following enacted in its place:
E. The superintendent may exempt from the requirements of this subsection an association group organized pursuant to section 2805-A or a trustee group organized pursuant to section 2806 that offers a small group health plan that:
(1) Complies with the premium rate requirements of this subsection; and
(2) Guarantees issuance and renewal to all persons and their dependents within the association or trustee group except that a professional association may require that a minimum percentage of the eligible professionals employed by a subgroup be members of the association in order for the subgroup to be eligible for issuance or renewal of coverage through the association. The minimum percentage must not exceed 90%. For purposes of this subparagraph, "professional association" means an association that:
(a) Serves a single profession that requires a significant amount of education, training or experience or a license or certificate from a state authority to practice that profession;
(b) Has been actively in existence for 5 years;
(c) Has a constitution and bylaws or other analogous governing documents;
(d) Has been formed and maintained in good faith for purposes other than obtaining insurance;
(e) Is not owned or controlled by a carrier or affiliated with a carrier;
(f) Does not make membership in the association conditional on health status or claims experience;
(g) Has a least 1,000 members if it is a national association; 200 members if it is a state or local association;
(h) All members and dependents of members are eligible for coverage regardless of health status or claims experience; and
(i) Is governed by a board of directors and sponsors annual meetings of its members.
Producers may only market association memberships, accept applications for membership or sign up members in the professional association where the individuals are actively engaged in or directly related to the profession represented by the professional association.
Sec. E-2. 24-A MRSA §2808-B, sub-§4, ¶A, as amended by PL 1997, c. 445, §16 and affected by §32, is further amended to read:
A. Coverage must be guaranteed to all eligible groups that meet the carrier's minimum participation requirements, which may not exceed 75%, to all eligible employees and their dependents in those groups. In determining compliance with minimum participation requirements, eligible employees and their dependents who have existing health care coverage may not be considered in the calculation. If an employee declines coverage because the employee has other coverage, any dependents of that employee who are not eligible under the employee's other coverage are eligible for coverage under the small group health plan. A carrier may deny coverage under a managed care plan, as defined by section 4301:
(1) To employers who have no employees who live, reside or work within the approved service area of the plan; and
(2) To employers if the carrier has demonstrated to the superintendent's satisfaction that:
(a) The carrier does not have the capacity to deliver services adequately to additional enrollees because of its obligations to existing enrollees; and
(b) The carrier is applying this provision uniformly to individuals and groups without regard to any health-related factor.
A carrier that denies coverage in accordance with this paragraph subparagraph may not enroll groups within the service area for a period of 180 days after the date of denial of coverage.
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