HF 364

as introduced - 81st Legislature (1999 - 2000) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to insurance; requiring health plans to allow 
  1.3             their enrollees to obtain health care outside of a 
  1.4             designated network of providers and to reimburse 
  1.5             licensed health care providers who provide services to 
  1.6             enrollees without regard to whether the provider 
  1.7             belongs to a particular health plan network; amending 
  1.8             Minnesota Statutes 1998, section 62Q.51. 
  1.9   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.10     Section 1.  Minnesota Statutes 1998, section 62Q.51, is 
  1.11  amended to read: 
  1.12     62Q.51 [POINT-OF-SERVICE OPTION.] 
  1.13     Subdivision 1.  [DEFINITION.] For purposes for this 
  1.14  section, "point-of-service option" means a health plan coverage 
  1.15  under which the health plan company will reimburse an 
  1.16  appropriately licensed or registered provider for providing 
  1.17  covered services to an enrollee, without regard to whether the 
  1.18  provider belongs to a particular network and without regard to 
  1.19  whether the enrollee was referred to the provider by another 
  1.20  provider.  
  1.21     Subd. 2.  [REQUIRED POINT-OF-SERVICE OPTION.] Each health 
  1.22  plan company operating in the small group or large group market 
  1.23  shall offer at least one a point-of-service option in each such 
  1.24  market in which it operates to every enrollee enrolled in its 
  1.25  health plan.  The option must allow the enrollee to obtain 
  1.26  health care treatment and services from a licensed health care 
  1.27  provider who is not a member of the health plan's designated 
  2.1   provider network.  Health plan companies may require different 
  2.2   levels of cost-sharing for enrollees who choose to exercise the 
  2.3   point-of-service option as long as these different levels of 
  2.4   cost-sharing are actuarially sound and justified. 
  2.5      Subd. 3.  [RATE APPROVAL.] The premium rates and cost 
  2.6   sharing requirements for each option must be submitted to the 
  2.7   commissioner of health or the commissioner of commerce as 
  2.8   required by law.  A health plan that includes lower enrollee 
  2.9   cost sharing for services provided by network providers than for 
  2.10  services provided by out-of-network providers, or lower enrollee 
  2.11  cost sharing for services provided with prior authorization or 
  2.12  second opinion than for services provided without prior 
  2.13  authorization or second opinion, qualifies as a point-of-service 
  2.14  option so long as enrollees may seek services from 
  2.15  out-of-network providers without other restrictions.  Any lower 
  2.16  cost sharing for services provided by out-of-network providers 
  2.17  must be actuarially sound and justified and not designed solely 
  2.18  to deter enrollees from seeking health care outside of a plan's 
  2.19  network. 
  2.20     Subd. 4.  [EXEMPTION NONDISCRIMINATORY COVERAGE OF MENTAL 
  2.21  HEALTH AND CHEMICAL DEPENDENCY SERVICES.] This section does not 
  2.22  apply to a health plan company with fewer than 50,000 
  2.23  enrollees A point-of-service option that is offered by a health 
  2.24  plan pursuant to this section must comply with the cost-sharing 
  2.25  requirements and benefit or service limitations for mental 
  2.26  health and chemical dependency services provided under section 
  2.27  62Q.47. 
  2.28     Sec. 2.  [EFFECTIVE DATE; APPLICATION.] 
  2.29     Section 1 is effective January 1, 2000, and applies to 
  2.30  health plans issued or renewed to provide coverage to Minnesota 
  2.31  residents on or after that date.