Code of Maine Rules
02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
031 - BUREAU OF INSURANCE
Chapter 840 - PRIVATE PURCHASING ALLIANCES
Section 031-840-6 - Participating Carriers
Current through 2024-13, March 27, 2024
A. To be eligible as a participating carrier, a carrier must demonstrate the following operating characteristics to the alliance board's satisfaction:
B. In evaluating which carriers may participate in the alliance, the board shall consider:
C. Contracts between the board and participating carriers shall specify how all premiums will be transmitted, grace periods for payments, and penalties for late payments.
D. Nothing in this Rule prohibits a participating carrier from contracting with particular health care providers or types, classes, or categories of health care providers, or from setting reimbursement methodology.
E. When filing rates with the Superintendent for use with alliance products offered to individuals or small employers, the carrier shall include a comparison of the alliance rates to the carrier's rates for the same or similar product offered outside the alliance. The filing must demonstrate that all rate differences are attributable to differences in administrative costs, marketing costs, profit margins, economies of scale, product design, or other factors unrelated to health status or perceived health risk. Differences in product design may include differences in benefits, provider networks, provider contracts, or case management provisions.