2025-11-11T13:13:30-06:00 2024-12-31 450250958 Eide Bailly LLP 877 W Main St Ste 800 Boise ID 837025858 990 2024-01-01 454331075 Maine Guaranteed Access Reinsurance Association MAIN 2077911335 254 Commercial Street Portland ME 04101 Jolan Ippolito Chair 2077911335 2025-11-10 1 1 Kimberly C Nelson CPA P01887713 2083447150 2025-11-10 2024 2025-03-06 01:10:19Z Jolan Ippolito 254 Commercial Street Portland ME 04101 176496044 0 X www.mgara.org X 2012 ME A reinsurance program for the high risk segment of Maine's individual health insurance market. 12 12 0 13 0 0 63478674 45726151 28889529 29141368 2533509 4891874 0 0 94901712 79759393 0 0 0 0 0 0 0 0 0 122907117 61102268 122907117 61102268 -28005405 18657125 98613951 86951138 61994173 33434953 36619778 53516185 X To operate the reinsurance program described in the Enabling Act in such manner as to maximize the impact of the Association in lowering the cost of health insurance in Maine's individual market; and to do so without jeopardizing the solvency of the Association. 0 0 60283091 29141368 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. In the normal course of business, the Member Insurers seek to limit their exposure to loss on any single insured and to recover a portion of losses paid by ceding reinsurance to the Association. In 2021 and 2022, 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 of amounts (Continued on Sch O)(Continued from Page 2) recoverable from a federal highcost risk pool. In 2023, the Association covered 100% of claims paid in excess of $90,000 (up to $275,000). In 2024, the Association covered 75% of claims paid in excess of $135,000 (up to $275,000).The Association officially commenced operations on January 1, 2012. Premium collections and claims processing began on July 1, 2012. The Association suspended its operations effective January 1, 2014, and the final assessment was assessed in October of 2013. The Association reinitiated its reinsurance program effective January 1, 2019, in accordance with its Amended and Restated Plan of Operation dated January 1, 2019, approved by the Maine Bureau of Insurance in late December 2018. The Association amended its reinsurance program effective January 1, 2022, in accordance with its Amended and Restated Plan of Operation dated January 1, 2022, approved by the Maine Bureau of Insurance, to shift from a prospective to a retrospective model. Effective January 1, 2023, the Plan of Operations was amended and restated for the Association's program to be extended to a merged Individual Market and Small Group Market, referred to as the "Pooled Market". This extended the Association's coverage to small group health plans as well as individual health insurance plans. Effective January 1, 2024, the Plan of Operations was amended and restated for the Association to implement Maine's High-Priced Items and Services (HPIS) statutory regime on a pilot program basis, which requires MGARA to publish, based on carriers' reporting, a list of providers that receive insurance payments in excess of a statutory threshold for certain identified services. Reporting commences in 2025 for the 2024 year. 60283091 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 1 0 0 1 1 1 1 0 0 0 1 1 1 1 0 0 0 0 0 X River 9 Consulting 2087948840 301 Meadow Ridge Lane Eagle ID 83616 X Jolan F Ippolito Chair 2.00 X X 0 0 0 Ben Johnston Treasurer (from 04/2024) 2.00 X X 0 0 0 David Reagan Treasurer (left 04/2024) 2.00 X X 0 0 0 Dr David Howes Director 2.00 X 0 0 0 Bruce Nicholson Director 2.00 X 0 0 0 Kevin Lewis Director 2.00 X 0 0 0 James Lyon Director 2.00 X 0 0 0 Ellen Schneiter Director 2.00 X 0 0 0 Terry Brann Director 2.00 X 0 0 0 Eric Jermyn Director 2.00 X 0 0 0 Scott Cremens Director 2.00 X 0 0 0 Kate Skouteris Director (from 10/2024) 2.00 X 0 0 0 Dan Demeritt Director 2.00 X 0 0 0 Christopher Howard Secretary/Clerk 2.00 X 0 0 0 0 0 0 0 0 0 0 River 9 Consulting Inc 301 Meadow Ridge Eagle ID 83616 Administrative Services 350500 Milliman 80 Lamberton Road Windsor CT 06095 Actuarial Services 218802 Pierce Atwood LLP 254 Commercial St Portland ME 04101 Legal Services 135700 3 45726151 45726151 Regular Assessments 524130 29141368 29141368 29141368 3307774 3307774 98320751 96736651 1584100 1584100 1584100 79759393 29141368 0 4891874 350500 350500 135700 135700 45675 45675 218802 218802 1703 1703 66797 66797 Claims Incurred 60283091 60283091 61102268 60283091 819177 0 4118190 1032509 0 3600930 7264310 8026311 86642400 73501412 589051 789976 98613951 86951138 318984 101295 61675189 33333658 61994173 33434953 X 36619778 53516185 36619778 53516185 98613951 86951138 18657125 -1760718 0 X X 0 1 X 1 1 1 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 Claims Payable 24633658 Estimate for Claims IBNR 8700000 33333658 X 17715584 -1760718 -60283091 -62043809 79759393 0 79759393 819177 0 819177 60283091 60283091 61102268 Part X, Line 2: Management believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. Management would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 2d - Other Adjustments: Claims Incurred -60,283,091. Part XII, Line 4b - Other Adjustments: Claims Incurred 60,283,091. Form 990, Part VI, Section A, line 1a The Board of Directors by resolution adopted by a majority of the full Board of Directors then in office may create and appoint an Executive Committee consisting of three or more Directors and may delegate to it some or all of the Board's authority in the management of the corporation's business and affairs except as limited by Section 709 of the Maine Nonprofit Corporations Act, the resolution establishing such executive authority or any other resolutions thereafter adopted by the Board of Directors. The Executive Committee shall keep regular minutes of its proceedings and report the same to the Board of Directors. Members of the Executive Committee may be removed, with or without cause, and vacancies may be filled by resolution adopted by a majority of the full Board of Directors then in office. Form 990, Part VI, Section A, line 3 Effective January 1, 2022, the Association entered into an administrative agreement with River 9 Consulting, Inc. (River 9). This agreement stipulates a flat monthly fee of $15,000 per month and $50 quarterly per individual claims processing fee. This fee applies to each person for which a claim reimbursement payment is made to a participating carrier related to that individual during the relevant calendar quarter. There is a total annual fee cap of $400,000 for individual market. The management service expense for the years ended December 31, 2024 and 2023, was $350,500 and $377,000, respectively, of which $49,750 and $68,300, was payable at December 31, 2024 and 2023, respectively. Form 990, Part VI, Section A, line 6 Members are "Member Insurers" that offer individual health plans and are actively marketing individual health plans in the State of Maine. Form 990, Part VI, Section A, line 7a The Board of Directors consists of 12 members, comprised of 5 Insurer Member Directors and 7 Public Interest Directors. Member Directors are elected by Member Insurers, at least one of whom is an officer, employee, director manager, shareholder, partner, member or designee of a domestic insurer and at least one of whom is an officer, employee, director, manager, shareholder, partner, member or designee of a third party administrator. Public Interest Directors are appointed by the Superintendent of Insurance. The Public Interest Directors consist of: 1. 2 members chosen from the general public who are not associated with the medical profession, a hospital or an insurer; 2. 2 members who represent medical providers; 3. 1 member who represents a statewide organization that represents small businesses; 4. 1 member who represents producers; and, 5. 1 member who represents individual health insurance consumers who is not associated or formerly associated with the medical profession, a hospital, an insurer or a producer. Form 990, Part VI, Section A, line 7b Members have no right to vote except with respect to the election of Member Directors, for which each Member has one vote. The Board of Directors shall have the exclusive power to alter, amend, or repeal the Articles of Incorporation, subject to the approval of the Superintendent of Insurance of the State of Maine. Form 990, Part VI, Section A, line 8b The association did not utilize an Executive Committee during the fiscal year. Form 990, Part VI, Section B, line 11b A copy of the Form 990 is provided to the board for review prior to filing. Form 990, Part VI, Section B, line 12c The board of the organization has adopted a conflict of interest policy. The conflict of interest policy covers the Board of Directors and specifies the procedures for handling all conflicts that arise. The policy is reviewed on an annual basis by the governing board. Determinations of whether a conflict exists are made by the officers of the board. The officers of the board determine appropriate responses and actions to take when actual conflicts arise. Form 990, Part VI, Section C, line 19 The Association's organizational documents are available upon request. Form 990, Part XII, Line 1: Modified Cash Basis of Accounting. Form 990, Part XII, Line 2c: The Board of Directors assumes the responsiblity for oversight of the audit and selection of an independent accountant. State of Maine Department of Professional and Financial Regulation 76 Northern Avenue Gardiner ME 04345 016000001 Bureau of Insurance ME Government N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0