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Medical Loss Ratio

Maine Request for an Adjustment of the Medical Loss Ratio Standard

The Affordable Care Act allows the Secretary to adjust the medical loss ratio (MLR) standard for a State if it is determined that meeting the 80 percent medical loss ratio standard may destabilize the individual market. In order to qualify for this adjustment, a State must demonstrate that requiring insurers in its individual market to meet the 80 percent MLR has a likelihood of destabilizing the individual market and could result in fewer choices for consumers. This page contains materials related to this State’s application for an adjustment to the MLR standard for the individual market.

A State’s request for an adjustment to the MLR standard is a public document. The Secretary invites public comment regarding a State’s request. All public comments must be submitted electronically by midnight on the 10th calendar day after the posting of a complete State request. When the application is deemed complete, the webpage will be updated to reflect the deadline for public comment on the State’s application.

To submit a comment regarding this adjustment application, please email MLRAdjustments@hhs.gov. Please include Maine in the email subject line.

State: Maine

Application Status: Complete 

Comments Due: February 5, 2011

Application Materials:

Persons using assistive technology may not be able to fully access information in this file. For assistance, please email MLRAdjustments@hhs.gov.

  • MLR Adjustment Request
    This file contains Maine’s request for an adjustment to MLR standard to 65 percent excluding Federal adjustments for quality improvement expenses and taxes (received by HHS on 12/16/10).
  • HHS MML Adjustment Request
    This file contains data on issuers in Maine’s individual market pursuant to §158.321(d) (received by HHS on 12/16/10).
  • Appendix A July Letter
    This document is a July 1, 2010 letter from Maine Superintendent of Insurance to the Secretary requesting an adjustment to MLR standard to 65 percent excluding Federal adjustments for quality improvement expenses and taxes (received as part of the 12/16/10 package, but originally submitted on July 1, 2010).
  • Appendix B1 Anthem Rates
    This file contains premium data on Anthem products (received by HHS on 12/16/10).
  • Appendix B2 MEGA Rates
    This file contains premium data on MEGA products (received by HHS on 12/16/10).
  • Appendix B3 HPHC DirigoChoice
    This file contains premium data on DirigoChoice products (received by HHS on 12/16/10).
  • Appendix B4 Anthem HMO Rates
    This file contains premium data on Anthem HMO products (received by HHS on 12/16/10).
  • Appendix B5 Aetna HMO Rates
    This file contains premium data on Aetna HMO products (received by HHS on 12/16/10).
  • Appendix B6 Harvard Pilgrim HMO Rates
    This file contains premium data on Harvard Pilgrim HMO products (received by HHS on 12/16/10).
  • Appendix C Benefit Chart
    This file contains charts comparing benefits offered under Maine's Standard plans and other select plans offered in the Maine individual market (received by HHS on 12/16/10).
  • HHS Request for Additional Information
    This document is a January 4, 2011 letter from the Director of the Office of Oversight to Maine requesting additional information in order for Maine’s application to be deemed complete.
  • Maine Response to HHS Request for Additional Information
    This document is a response letter from Maine to the Director of the Office of Oversight with responses to the requests in the Office of Oversight’s January 4, 2011 letter (received by HHS on 01/11/11).
  • MEGA policies
    This file contains a sample MEGA rate calculation (received by HHS on 01/11/11).
  • MEGA Rate Calculation
    This file contains a sample MEGA rate calculation (received by HHS on 01/11/11).
  • Revision of HHS MML Request
    This file is a revision of the file labeled “HHS MML Adjustment Request” that was initially received by HHS on 12/16/10 (received by HHS on 01/11/11).
  • HHS Follow-up Letter
    This document is a January 12, 2011 letter from the Director of the Office of Oversight to Maine requesting additional information regarding Maine’s application, which is separate and distinct from requests for information for completeness.
  • Maine Response to HHS Request for Supplemental Information
    This document is a response letter from Maine to the Director of the Office of Oversight with responses to the requests in the Office of Oversight’s January 12, 2011 letter (received by HHS on 01/21/11).
  • Senator Snowe Letter
    This document is a November 8, 2010 letter from Senator Olympia Snowe to the Secretary requesting an adjustment to the MLR standard for the State of Maine (received as part of the 01/21/11 package, but originally submitted on November 8, 2010).
  • DirigoChoice Worksheet
    This file is a worksheet used to estimate discounts under the DirigoChoice program (received by HHS on 01/21/11).
  • Anthem and MEGA Rate Comparison
    This file is a spreadsheet comparing premium rates for Anthem and MEGA policies with $10,000 deductibles (received by HHS on 01/21/11).
  • MEGA Member Distribution by Income
    This file is a slide showing the distribution of MEGA’s members in Maine based on income bracket (received by HHS on 01/21/11)
  • HHS Letter Deeming Maine’s Application Complete
    This document is a January 25, 2011 letter from the Director of the Office of Oversight to Maine deeming
    Maine’s application complete and indicating the start of the HHS review period.
  • Maine Response to Second HHS Request for Supplemental Information
    This document is a response letter from Maine to the Director of the Office of Oversight with responses to the requests in the Office of Oversight’s January 25, 2011 letter (received by HHS on 01/31/11).
  • Revision of MEGA Policies
    This document is a revision of the file labeled “Mega policies,” which was initially received by HHS on 01/11/11, to include information on the number of MEGA enrollees (received by HHS on 01/31/11).
  • Supplement to Revision of HHS MML Request
    This document contains data that supplements the file labeled “Revision of HHS MML Request” that was initially received by HHS on 01/11/11 (received by HHS on 01/31/11).
  • HHS Letter to Maine Extending the 30 Day Review Period for an Additional 30 days
    This document is a February 24, 2011 letter from the Director of the Office of Oversight to Maine exercising the Secretary’s discretion to extend the 30-day review period for an additional 30 days.
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    Public Comments:

    • UniteHere Public Comment
      This file is a public comment from UniteHere regarding Maine’s request for an adjustment to the MLR standard (received by HHS on 12/27/2010).
    • UniteHere Second Public Comment
      This file is a second public comment from UniteHere regarding Maine’s request for an adjustment to the MLR standard (received by HHS on 01/31/2011).
    • Timothy Jost Public Comment
      This file is a public comment from Timothy Jost regarding Maine’s request for an adjustment to the MLR standard (received by HHS on 02/04/2011).