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Anthem Health Plans of Maine v. Superintendent of Insurance

40 A.3d 380 (2012)

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Anthem Health Plans of Maine v. Superintendent of Insurance

Maine Supreme Judicial Court

40 A.3d 380 (2012)

Facts

Anthem Health Plans of Maine (Anthem) (plaintiff) filed a proposal with the state superintendent of insurance (defendant) to increase rates for individual health insurance plans by 9.2 percent, which built in a 3 percent profit and risk margin. The superintendent held hearings, and nearly 40 existing Anthem individual subscribers testified the increase would impose a hardship. The superintendent interpreted Maine law to require balancing between rates that would not be excessive, yet not threaten insurers’ financial integrity. Anthem’s Maine individual product lines earned it pre-tax operating gains of over $15.5 million in the two previous years, averaging 2.1 percent of total revenue. On the other hand, the superintendent found it necessary to protect the public interest in keeping individual health insurance affordable and noted concern that Anthem’s rising rates had caused adverse selection. The superintendent found the proposed increase excessive and unfairly discriminatory and approved only a 5.2 percent rate increase, with a 1 percent built-in margin. Anthem challenged the decision, arguing that a 5.2 percent increase was inadequate, and that it was entitled to a fair and reasonable return rate matching 3 percent industry-wide average margins.

Rule of Law

Issue

Holding and Reasoning (Jabar, J.)

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