Maine Guaranteed Access Reinsurance Association

A REINSURANCE PROGRAM FOR THE HIGH RISK SEGMENT OF MAINE'S INDIVIDUAL HEALTH INSURANCE MARKET.

THE ASSOCIATION WAS CREATED FOR THE PURPOSE OF PROVIDING A REINSURANCE PROGRAM FOR THE HIGHER RISK SEGMENT OF MAINE'S INDIVIDUAL HEALTH INSURANCE MARKET IN ORDER TO REDUCE INSURANCE COSTS IN THAT MARKET AND ASSURE AVAILABILITY OF AFFORDABLE HEALTH INSURANCE TO RESIDENTS OF THE STATE OF MAINE BY PROVIDING REINSURANCE OF A SIGNIFICANT PORTION OF THE COVERAGE PROVIDED THROUGH INDIVIDUAL HEALTH INSURANCE POLICIES OFFERED BY ITS MEMBER INSURERS. THE ASSOCIATION WAS ESTABLISHED PURSUANT TO AN ACT OF THE MAINE STATE LEGISLATURE. THE ASSOCIATION'S ORIGINAL PLAN OF OPERATION WAS ADOPTED EFFECTIVE JUNE 12, 2012 (ORIGINAL PLAN") AND THE ASSOCIATION OPERATED (CONTINUED ON SCH O)(CONTINUED FROM PAGE 2) ITS REINSURANCE PROGRAM DURING THE PERIOD JULY 1, 2012 THROUGH DECEMBER 31, 2013. PURSUANT TO LEGISLATIVE ACTION, EFFECTIVE JANUARY 1, 2014, THE ASSOCIATION'S OPERATIONS WERE SUSPENDED DURING THE PENDENCY OF THE TRANSITIONAL REINSURANCE PROGRAM INSTITUTED PURSUANT TO SECTION 1341 OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT ("FEDERAL PROGRAM") IN ORDER TO AVOID REDUNDANCY WITH THE FEDERAL PROGRAM. PURSUANT TO SUCH SUSPENSION, THE ASSOCIATION FILED AN AMENDED PLAN OF OPERATION WITH THE SUPERINTENDENT OF INSURANCE ON JUNE 5, 2014 PURSUANT TO 24-A M.R.S. SECTION 3962, WHICH REQUIRED THE ASSOCIATION TO FILE WITH THE SUPERINTENDENT FOR APPROVAL OF AN AMENDED PLAN OF OPERATION ("SUSPENSION PLAN") WITHIN 6 MONTHS FOLLOWING THE IMPLEMENTATION OF THE FEDERAL PROGRAM.ON JULY 30, 2018, THE STATE OF MAINE RECEIVED APPROVAL FROM THE UNITED STATES DEPARTMENT OF HEALTH & HUMAN SERVICES, CENTERS FOR MEDICARE & MEDICAID SERVICES ("CMS") OF ITS APPLICATION FOR STATE INNOVATION WAIVER UNDER SECTION 1332 OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT ("SECTION 1332 WAIVER APPLICATION"). ON AUGUST 21, 2018 THE STATE OF MAINE ACCEPTED THE SECTION 1332 WAIVER BY EXECUTING AND DELIVERING TO CMS THE SPECIFIC TERMS AND CONDITIONS OF THE SECTION 1332 WAIVER ("STCS"). THE SECTION 1332 WAIVER APPLICATION AND THE STCS ARE COLLECTIVELY REFERRED TO AS THE "SECTION 1332 WAIVER."ON AUGUST 18, 2018, THE ASSOCIATION'S BOARD APPROVED THE RE-INITIATION OF ASSOCIATION OPERATIONS AS OF JANUARY 1, 2019, AND THE SUBMISSION OF AN AMENDED AND RESTATED PLAN OF OPERATION FOR APPROVAL BY THE MAINE SUPERINTENDENT OF INSURANCE. ON NOVEMBER 30, 2018, CMS CONFIRMED IN A LETTER TO THE MAINE SUPERINTENDENT OF INSURANCE THE ESTIMATED AMOUNT OF SECTION 1332 PASS-THROUGH FUNDING TO THE STATE OF MAINE FOR USE IN OPERATING THE ASSOCIATION'S REINSURANCE PROGRAM AT $65,270,675. THE ASSOCIATION'S AMENDED AND RESTATED PLAN OF OPERATION WAS SUBMITTED TO AND APPROVED BY THE SUPERINTENDENT OF INSURANCE IN DECEMBER 2018. THE ASSOCIATION RECEIVED $39,315,869 AND $26,291,971 AS OF DECEMBER 31, 2021 AND 2020, RESPECTIVELY.IN 2021 AND 2020, THE ASSOCIATION COVERED LOSSES AT 90% OF CLAIMS PAID AT $65,000 OF LOSS, AND AT 100% OF CLAIMS PAID IN EXCESS OF $95,000 OF LOSS, NET AMOUNTS RECOVERABLE FROM A FEDERAL HIGH COST RISK POOL.