Code of Maine Rules
02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
031 - BUREAU OF INSURANCE
Chapter 857 - Small Business Health Insurance Premium Support Program
Section 031-857-4 - Premium Relief Credit Amounts and Requirement that Credits be Shared with Employees

Universal Citation: 02 ME Code Rules ยง 031-857-4

Current through 2024-38, September 18, 2024

1. Throughout the duration of the program, small group health insurance carriers shall provide premium relief credits to eligible small businesses based on the number of enrolled eligible employees and covered beneficiaries. The program shall reimburse small group health insurance carriers for those premium relief credits and for their reasonable expenses in administering the program.

2. Premium relief credits shall be based upon the following four subscriber types: Employee Only; Employee and Spouse or Partner; Employee with One or More Children; and Employee and Spouse or Partner with One or More Children. "Children" includes adult children covered by the employee's plan. Premium relief payments will be provided based upon subscriber type and will not vary based upon the number of children included in a subscriber's enrollment. Small group health insurance carriers are permitted to use different terminology for these four subscriber types so long as the terminology corresponds to the family compositions specified by this rule. If more than one member of the same household is employed by the same employer, credits shall be allocated in a manner consistent with the premium billing and employee contributions.

3. The amounts of the premium relief credits may be adjusted by the Superintendent throughout the duration of the program based upon available funding. Changes to the credit amounts, if any, will be communicated through a bulletin.

4. The initial monthly credit amounts are $50 per employee, $50 per covered spouse or domestic partner, and an additional $30 for any subscriber type that includes child coverage, based upon the following subscriber types:

Employee: $50

Employee and Spouse or Partner: $100

Employee + Child(ren): $80

Employee and Spouse or Partner + Child(ren): $130

5. Monthly premium relief credits may not be prorated by the carrier. The full monthly credit specified by this subsection shall be provided if an employee or beneficiary was enrolled in the plan during all or any part of the month, but not to exceed the total premium charged for that employee and any beneficiaries.

6. Eligible small businesses are required to divide the premium relief credits each month with each enrolled eligible employee in at least the same proportion as the premium contributions by the employer and employee.

A. This subsection does not prohibit an employer from passing through the full amount of the premium relief credit to its employees, or some other amount that is higher than the minimum required by this subsection.

B. If employee contributions are paid through weekly or biweekly payroll deductions, or some other basis that does not coincide with a calendar month, the employee's share of the credit may be prorated accordingly so long as the employee receives the full amount of the credit due for each month.

Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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