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HF 2009

1st Engrossment - 89th Legislature (2015 - 2016) Posted on 05/04/2015 03:46pm

KEY: stricken = removed, old language.
underscored = added, new language.

Bill Text Versions

Engrossments
Introduction Posted on 03/18/2015
1st Engrossment Posted on 04/07/2015

Current Version - 1st Engrossment

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A bill for an act
relating to commerce; regulating health coverages; modifying coverages;
amending Minnesota Statutes 2014, sections 62A.3075; 62A.65, subdivision
3; 62L.05, subdivision 9; 62L.08, by adding a subdivision; 62Q.18; 62Q.73,
subdivision 3.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2014, section 62A.3075, is amended to read:


62A.3075 CANCER CHEMOTHERAPY TREATMENT COVERAGE.

(a) A health plan company that provides coverage under a health plan for cancer
chemotherapy treatment shall not require a higher co-payment, deductible, or coinsurance
amount for a prescribed, orally administered anticancer medication that is used to kill or
slow the growth of cancerous cells than what the health plan requires for an intravenously
administered or injected cancer medication that is provided, regardless of formulation or
benefit category determination by the health plan company.

(b) A health plan company must not achieve compliance with this section by imposing
an increase in co-payment, deductible, or coinsurance amount for an intravenously
administered or injected cancer chemotherapy agent covered under the health plan.

(c) Nothing in this section shall be interpreted to prohibit a health plan company
from requiring prior authorization or imposing other appropriate utilization controls in
approving coverage for any chemotherapy.

(d) A plan offered by the commissioner of management and budget under section
43A.23 is deemed to be at parity and in compliance with this section.

(e) A health plan company is in compliance with this section if it does not include
orally administered anticancer medication in the fourth tier of its pharmacy benefit.

new text begin (f) A health plan company that provides coverage under a health plan for cancer
chemotherapy treatment shall indicate the level of coverage for orally administered
anticancer medication within its pharmacy benefit filing with the commissioner.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2017, and applies to
coverage offered, sold, issued, or renewed on or after that date.
new text end

Sec. 2.

Minnesota Statutes 2014, section 62A.65, subdivision 3, is amended to read:


Subd. 3.

Premium rate restrictions.

No individual health plan may be offered,
sold, issued, or renewed to a Minnesota resident unless the premium rate charged is
determined in accordance with the following requirements:

(a) Premium rates may vary based upon the ages of covered persons in accordance
with the provisions of the Affordable Care Act.

(b) Premium rates may vary based upon geographic rating area. The commissioner
shall grant approval if the following conditions are met:

(1) the areas are established in accordance with the Affordable Care Act;

(2) each geographic region must be composed of no fewer than seven counties that
create a contiguous region; and

(3) the health carrier provides actuarial justification acceptable to the commissioner
for the proposed geographic variations in premium rates for each area, establishing that the
variations are based upon differences in the cost to the health carrier of providing coverage.

(c) Premium rates may vary based upon tobacco use, in accordance with the
provisions of the Affordable Care Act.

(d) In developing its premiums for a health plan, a health carrier shall take into
account only the following factors:

(1) actuarially valid differences in rating factors permitted under paragraphs (a)
and (c); and

(2) actuarially valid geographic variations if approved by the commissioner as
provided in paragraph (b).

(e) The premium charged with respect to any particular individual health plan shall
not be adjusted more frequently than annually or January 1 of the year following initial
enrollment, except that the premium rates may be changed to reflect:

(1) changes to the family composition of the policyholder;

(2) changes in geographic rating area of the policyholder, as provided in paragraph
(b);

(3) changes in age, as provided in paragraph (a);

(4) changes in tobacco use, as provided in paragraph (c);

(5) transfer to a new health plan requested by the policyholder; or

(6) other changes required by or otherwise expressly permitted by state or federal
law or regulations.

(f) All premium variations must be justified in initial rate filings and upon request of
the commissioner in rate revision filings. All rate variations are subject to approval by
the commissioner.

(g) The loss ratio must comply with the section 62A.021 requirements for individual
health plans.

(h) The rates must not be approved, unless the commissioner has determined that the
rates are reasonable. In determining reasonableness, the commissioner shall consider the
growth rates applied under section 62J.04, subdivision 1, paragraph (b), to the calendar
year or years that the proposed premium rate would be in effect and actuarially valid
changes in risks associated with the enrollee populations.

(i) A health carrier may, as part of a minimum lifetime loss ratio guarantee filing
under section 62A.02, subdivision 3a, include a rating practices guarantee as provided in
this paragraph. The rating practices guarantee must be in writing and must guarantee that
the policy form will be offered, sold, issued, and renewed only with premium rates and
premium rating practices that comply with subdivisions 2, 3, 4, and 5. The rating practices
guarantee must be accompanied by an actuarial memorandum that demonstrates that the
premium rates and premium rating system used in connection with the policy form will
satisfy the guarantee. The guarantee must guarantee refunds of any excess premiums to
policyholders charged premiums that exceed those permitted under subdivision 2, 3, 4, or
5. A health carrier that complies with this paragraph in connection with a policy form is
exempt from the requirement of prior approval by the commissioner under paragraphs
(b), (f), and (h).

(j) The commissioner may establish regulations to implement the provisions of
this subdivision.

new text begin (k) The provisions of Minnesota Statutes 2012, section 62A.65, subdivision 3,
apply to grandfathered plans.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective retroactively from January 1, 2014.
new text end

Sec. 3.

Minnesota Statutes 2014, section 62L.05, subdivision 9, is amended to read:


Subd. 9.

Dependent coverage.

Other state law and rules applicable to health plan
coverage of newborn infants, dependent children deleted text begin who do not reside with the eligible
employee
deleted text end , disabled new text begin dependent new text end children deleted text begin and dependentsdeleted text end , and adopted children apply to a
small employer plan. Health benefit plans that provide dependent coverage must define
"dependent" no more restrictively than the definition provided in section 62L.02.

Sec. 4.

Minnesota Statutes 2014, section 62L.08, is amended by adding a subdivision
to read:


new text begin Subd. 12. new text end

new text begin Grandfathered plans. new text end

new text begin The provisions of Minnesota Statutes 2012,
section 62L.08, apply to grandfathered plans.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective retroactively from January 1, 2014.
new text end

Sec. 5.

Minnesota Statutes 2014, section 62Q.18, is amended to read:


62Q.18 PORTABILITY OF COVERAGE.

Subdivision 1.

Definition.

For purposes of this section,

(1) "continuous coverage" has the meaning given in section 62L.02, subdivision 9;

(2) "guaranteed issue" means:

(i) for individual health plans, that a health plan company shall not decline an
application by an individual for any individual health plan offered by that health plan
company, including coverage for a dependent of the individual to whom the health plan
has been or would be issued; and

(ii) for group health plans, that a health plan company shall not decline an
application by a group for any group health plan offered by that health plan company and
shall not decline to cover under the group health plan any person eligible for coverage
under the group's eligibility requirements, including persons who become eligible after
initial issuance of the group health plan;

(3) "large employer" means an entity that would be a small employer, as defined in
section 62L.02, subdivision 26, except that the entity has more than 50 current employees,
based upon the method provided in that subdivision for determining the number of
current employees;

(4) "preexisting condition" has the meaning given in section 62L.02, subdivision
23
; and

(5) "qualifying coverage" has the meaning given in section 62L.02, subdivision 24.

Subd. 7.

Portability of coverage.

Effective July 1, 1994, no health plan company
shall offer, sell, issue, or renew any group health plan that does not, with respect to
individuals who maintain continuous coverage and who qualify under the group's
eligibility requirements:

(1) make coverage available on a guaranteed issue basis;

(2) give full credit for previous continuous coverage against any applicable
preexisting condition limitation or preexisting condition exclusion; and

(3) with respect to a group health plan offered, sold, issued, or renewed to a large
employer, impose preexisting condition limitations or preexisting condition exclusions
except to the extent that would be permitted under chapter 62L if the group sponsor were a
small employer as defined in section 62L.02, subdivision 26.

To the extent that this subdivision conflicts with chapter 62L, chapter 62L governs,
regardless of whether the group sponsor is a small employer as defined in section 62L.02,
except that for group health plans issued to groups that are not small employers, this
subdivision's requirement that the individual have maintained continuous coverage
applies. deleted text begin An individual who has maintained continuous coverage, but would be considered
a late entrant under chapter 62L, may be treated as a late entrant in the same manner under
this subdivision as permitted under chapter 62L.
deleted text end

Subd. 10.

Guaranteed issue.

No health plan company shall offer, sell, or issue
any health plan that does not make coverage available on a guaranteed issue basis in
accordance with the Affordable Care Act.

Sec. 6.

Minnesota Statutes 2014, section 62Q.73, subdivision 3, is amended to read:


Subd. 3.

Right to external review.

(a) Any enrollee or anyone acting on behalf
of an enrollee who has received an adverse determination may submit a written request
for an external review of the adverse determination, if applicable under section 62Q.68,
subdivision 1
, or 62M.06, to the commissioner of health if the request involves a health
plan company regulated by that commissioner or to the commissioner of commerce if the
request involves a health plan company regulated by that commissioner. Notification of
the enrollee's right to external review must accompany the denial issued by the insurer.
The written request must be accompanied by a filing fee of $25. The fee may be waived
by the commissioner of health or commerce in cases of financial hardship and must be
refunded if the adverse determination is completely reversed. No enrollee may be subject
to filing fees totaling more than $75 during a plan year for group coverage or policy year
for individual coverage.

(b) Nothing in this section requires the commissioner of health or commerce to
independently investigate an adverse determination referred for independent external
review.

(c) If an enrollee requests an external review, the health plan company must
participate in the external review. The cost of the external review in excess of the filing
fee described in paragraph (a) shall be borne by the health plan company.

(d) The enrollee must request external review within deleted text begin sixdeleted text end new text begin ninenew text end months from the
date of the adverse determination.