Maine seeks waiver from medical-loss ratio requirements

While the health insurance industry still is waiting to learn exactly what components will comprise the federally mandated medical-loss ratios under health reform, the state of Maine has already asked for an exemption for its insurers in the individual market, reports the Bangor Daily News. "It's really important to make sure that the options that Mainers currently have stay in place," said Maine Insurance Superintendent Mila Kofman. "That's why I sought the waiver."

While the federal government will require 80 percent of premiums go directly to patient care, Maine only requires a 65 percent ratio. The change could lead at least one insurer participating in the state's individual market to pull out--and Maine only has three insurers in the market to begin with, noted Kofman.

"In its filings with the Securities and Exchange Commission, one insurer [HealthMarkets Inc. doing business as MegaLife Insurance] has indicated its intent to pull out of individual insurance markets," she wrote in her waiver request. "Based on preliminary discussions I had with the insurer, the company could continue to operate in the Maine market in compliance with our current MLR standard, but would probably need to withdraw from this market if the minimum loss ratio requirement were increased."

To learn more:
- read this Bangor Daily News article