02-031 C.M.R. ch. 840, § 7 - Risk Pools

A. If the alliance is designed to include individuals unaffiliated with an employer, all such individuals shall constitute a separate risk pool. Participating carriers may vary rates within this risk class only as would be permitted for an individual health plan subject to 24-A M.R.S.A. §2736-C. A carrier may offer coverage to individuals through the alliance even if the carrier does not offer the same coverage, or any coverage, through individual health plans outside the alliance.

B. If the alliance is to include small employers, all such employers shall constitute a separate risk pool. Participating carriers may vary rates within this risk class only as permitted pursuant to 24-A M.R.S.A. §2808-B.

C. The alliance and any participating carrier may negotiate rates for the individual or small employer risk pool which are less than the carrier's otherwise applicable individual or small group rates, but only if the reductions reflect savings derived from administrative costs, marketing costs, profit margins, economies of scale, or other factors unrelated to the pool's health status or perceived health risk. Reductions may not be based on any of the rating factors expressly prohibited or limited by 24-A M.R.S.A. §§2736-C(2) and 2808-B(2).

Notes

02-031 C.M.R. ch. 840, § 7