Code of Maine Rules
02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
031 - BUREAU OF INSURANCE
Chapter 745 - INDIVIDUAL HEALTH INSURANCE PILOT PROJECTS FOR PERSONS UNDER 30 YEARS OF AGE
Section 031-745-8 - LOSS RATIO REQUIREMENTS
Current through 2024-38, September 18, 2024
To be eligible to market plans to persons under 30 years of age pursuant to this Rule, a carrier must offer Standardized Plan A and Standardized Plan B and have a medical loss ratio of at least 70% in the individual market. The loss ratio is determined by dividing individual incurred claims by individual earned premiums based on recent Rule 940 reports. The number of Rule 940 reports to be used will be based on the number of member months for the individual line on the carrier's Rule 945 reports reduced by any member months associated with short-term policies as defined by 24-A M.R.S.A. §2849-B.
1. The most recent Rule 940 report must be used if the number of member months for that year is at least 12,000.
2. The sum of incurred claims and the sum of earned premiums from the two most recent Rule 940 reports must be used if (1) does not apply and the number of member months for those two years is at least 12,000.
3. The sum of incurred claims and the sum of earned premiums from the three most recent Rule 940 reports must be used if (1) and (2) do not apply and the number of member months for those three years is at least 12,000.
4. The sum of incurred claims and the sum of earned premiums from the four most recent Rule 940 reports must be used if (1) , (2) , and (3) do not apply.
