MHDO Premium Compilation Form

In accordance with its statutory authority, 22 M.R.S.A. §8706 sub-§2(C), the Maine Health Data Organization (MHDO) is authorized to assess health insurance entities licensed by the Maine Bureau of Insurance under 24 and 24-A M.R.S.A. for a percentage of its operational costs. Hospitals are assessed an equal percentage of these costs.

The process for determining individual assessments for all entities required to support the Organization is defined in the MHDO Rule, Chapter 10: Determination of Assessments. An assessment is levied upon insurers that have written $500,000 or more of adjusted health care premiums in Maine. It is based only upon health care premiums written and does not include the total dollar amount of claims processed on behalf of self-insured plan sponsors.

According to Chapter 10 Section 1-C, “health care premiums” means the dollar amount charged for any policies offered by health insurance entities, which partially or fully cover the cost of health care services, but does not include policies issued for specified disease, accident, injury, hospital indemnity, disability, long-term care, student comprehensive health, vision coverage of durable medical equipment, medical stop loss, certain other limited benefit health insurance policies and tax-exempt federal plans.

The calculation of the actual assessment is based on the total amount of health care premiums less the health care premiums for the exempted policies listed above.

In order to assist you in providing the MHDO with accurate adjusted premium information, download the Premium Compilation Form for calendar year 2023. Completed forms are required only for entities that have $500,000 or more in Maine resident health care premiums. Please complete, sign and return the survey via e-mail attachment ( no later than April 30, 2024. If applicable, you will receive a separate mailing indicating the actual amount assessed on your adjusted health care premiums.