02-031 C.M.R. ch. 940, § 15 - MEWAs and Captives

Current through 2022-14, April 6, 2022

A. For purposes of this section, the following definitions apply:

1. "Captive" means a captive insurance company licensed pursuant to Title 24-A M.R.S.A. Chapter 83.

2. "MEWA" means a multiple-employer welfare arrangement licensed pursuant to Title 24-A M.R.S.A. Chapter 81.

B. When a rate increase has been identified as "potentially unreasonable" in accordance with the ACA, the following provisions of this Rule apply to MEWAs and captives:

1. Section 5, General Rate Submission Requirements, applies.

2. Section 9, Small Group Health Plans, applies with respect to coverage of small employers, except that Subsection E does not apply and Subsection D applies regardless of whether the average number of members covered meets credibility standards pursuant to the ACA.

3. Section 12, Review Pursuant to the ACA, applies.

3-A. Section 13, Policies Subject to the ACA Rating Requirements, applies.

4. Notwithstanding the requirement for separate large group and small group filings in Sections 5 and 9, a MEWA or captive may make a combined large and small group rate filing if the rates do not differ between large and small groups. However, separate ACA Preliminary Justifications must be included for small groups and, if required, for large groups.

C. When a rate increase is subject to the ACA and has not been identified as "potentially unreasonable" in accordance with the ACA, the MEWA or captive shall provide an informational filing at least 60 days before the effective date of the rate increase explaining why the increase is not "potentially unreasonable" as defined under the ACA.

D. Section 14, Rebates and Medical Loss Ratio Reporting, applies to MEWAs and captives to the extent required by the ACA.

E. Notwithstanding Paragraph 5(C)(6), MEWAs and captives may prepare filings in a manner that protects the confidentiality of information that is confidential under Maine law, including in the case of captives any information that is protected by Title 24-A M.R.S.A. § 6715, by following the confidentiality protocol available on the Bureau of Insurance web site.

F. No other provisions of this rule apply to MEWAs and captives, except that the general provisions set forth in Sections 1 through 4 and Section 15 apply to the extent relevant.

Notes

02-031 C.M.R. ch. 940, § 15