Title 24-A: MAINE INSURANCE CODE
Chapter 33: HEALTH INSURANCE CONTRACTS
§2736-C. Individual health plans
4. Cessation of business. Carriers that provide individual health plans after the effective date of this section that plan to cease doing business in the individual health plan market must comply with the following requirements.
A. Notice of the decision to cease doing business in the individual health plan market must be provided to the bureau 3 months prior to the cessation unless a shorter notice period is approved by the superintendent. If existing contracts are nonrenewed, notice must be provided to the policyholder or contract holder 6 months prior to nonrenewal. [2001, c. 258, Pt. B, §1 (amd).]
B. Carriers that cease to write new business in the individual health plan market continue to be governed by this section. [1993, c. 477, Pt. C, §1 (new); Pt. F, §1 (aff).]
C. Carriers that cease to write new business in the individual health plan market are prohibited from writing new business in that market for a period of 5 years from the date of notice to the superintendent unless the superintendent waives this requirement for good cause shown. [2001, c. 258, Pt. B, §2 (amd).]
[2001, c. 258, Pt. B, §§1, 2 (amd).]
Title 24-A: MAINE INSURANCE CODE
Chapter 33: HEALTH INSURANCE CONTRACTS
3. Guaranteed issuance and guaranteed renewal. Carriers providing individual health plans must meet the following requirements on issuance and renewal.
A. Coverage must be guaranteed to all residents of this State other than those eligible without paying a premium for Medicare Part A. On or after January 1, 1998, coverage must be guaranteed to all legally domiciled federally eligible individuals, as defined in section 2848, regardless of the length of time they have been legally domiciled in this State. Except for federally eligible individuals, coverage need not be issued to an individual whose coverage was terminated for nonpayment of premiums during the previous 91 days or for fraud or intentional misrepresentation of material fact during the previous 12 months. When a managed care plan, as defined by section 4301-A, provides coverage a carrier may:
(1) Deny coverage to individuals who neither live nor reside within the approved service area of the plan for at least 6 months of each year; and
(2) Deny coverage to individuals 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 within all or a designated part of its service area 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 may not enroll individuals residing within the area subject to denial of coverage or groups or subgroups within that area for a period of 180 days after the date of the first denial of coverage.
[RR 2001, c. 1, §30 (cor).]
B. Renewal is guaranteed, pursuant to section 2850-B. [1997, c. 445, §10 (rpr); §32 (aff).]
C. A carrier is exempt from the guaranteed issuance requirements of paragraph A provided that the following requirements are met.
(1) The carrier does not issue or deliver any new individual health plans on or after the effective date of this section;
(2) If any individual health plans that were not issued on a guaranteed renewable basis are renewed on or after December 1, 1993, all such policies must be renewed by the carrier and renewal must be guaranteed after the first such renewal date; and
(3) The carrier complies with the rating practices requirements of subsection 2.
[1993, c. 477, Pt. C, §1 (new); Pt. F, §1 (aff).]
Arguments against Risk Pools ignore the overwhelming evidence to the contrary:
-Only 5 States in America still do business the expensive Guaranteed Issue Way. States that had Guaranteed Issue are getting rid of the Socialist-Style method or regulating health insurance....and are putting in Risk Pools.
-45 States in America regulate the business of health insurance another way then the Expensive Maine Guaranteed Issue Way....and most of those have Risk Pools...and individuals there pay far less for their health insurance.
-Can someone explain why defenders of Maine’s Expensive insurance laws want to impose such outrageously high rates of insurance on Maine citizens?
If Guaranteed Issue and Community rating are such a good deal -- and Risk Pools are so horrible:
1) Why do only 5 states in America use Guaranteed Issue and Community rating right now?
2) Why have 11 of the 16 states that originally adopted these rules, dropped them and put in Risk Pools?
3) Why are the 5 GI States so much more expensive for health insurance? ($300 vs. $150 mo.)
4) Why has the Federal Government put up $1,000,000 per state in grants to start Risk Pools?
5) Why did NH insurance rates drop by 30%+ and more when NH installed a Risk Pool?
6) Why did 10 out of 11 carriers leave Maine when the Legislature repealed our Risk Pool in 1993?
7) Why do most Americans buy $1000 deductible or less...and most Mainers buy $5000+ deductible?
8) Why did 30,000 NH citizens return to the NH individual market after the NH Risk Pool was implemented?
9) Why did 60,000 Maine citizens drop out of the Maine individual after GI and CR were implemented?
10) Why isn't Dirigo able to write policies for all Maine individuals and sole proprietors that can't buy an affordable product? Why is Dirigo enrollment capped? Why isn't enrollment in all individual and sole proprietor health insurance capped?
April 1 was the first effective date for all individuals with Dirigo. Gov. Baldacci announced on March 27.... 5 days prior to April 1....that all openings for individuals in Dirigo had been taken.
The Dirigo Health Authority CLOSED enrollment to these folks because they couldn't handle the ADVERSE SELECTION of the individual market. Isn't that interesting?
Question: If an organization with the auspices of the State of Maine and Anthem BCBS can't handle the high risk individuals in the individual market, then just who can?
ANSWER: THE MARKET IN 34 STATES DOES HANDLE IT WITH A RISK POOL.