Minnesota Legislature
HF 3169
as introduced - 91st Legislature (2019 - 2020) Posted on 02/11/2020 03:35pm
Current Version - as introduced
1.5 1.6 1.7 1.8 1.9 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 2.24 2.25 2.26 2.27 2.28 2.29 2.30 2.31 2.32 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 3.27 3.28 3.29 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 4.20 4.21
4.22 4.23
A bill for an act
relating to health insurance; clarifying certain health insurance provisions; amending
Minnesota Statutes 2018, section 62Q.81.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2018, section 62Q.81, is amended to read:
62Q.81 ESSENTIAL HEALTH BENEFIT PACKAGE REQUIREMENTS.
Subdivision 1.
Essential health benefits package.
(a) Health plan companies offering
individual and small group health plans must include the essential health benefits package
deleted text begin required under section 1302(a) of the Affordable Care Act and asdeleted text end described in this
subdivision.
(b) The essential health benefits package means new text begin insurance new text end coverage that:
(1) provides new text begin the new text end essential health benefits deleted text begin as outlined in the Affordable Care Actdeleted text end new text begin described
in subdivision 4new text end ;
(2) limits cost-sharing for deleted text begin suchdeleted text end new text begin thenew text end coverage deleted text begin in accordance with the Affordable Care
Act,deleted text end as described in subdivision 2; and
(3) deleted text begin subject to subdivision 3,deleted text end provides bronze, silver, gold, or platinum level of coverage
deleted text begin in accordance with the Affordable Care Actdeleted text end new text begin , as described in subdivision 3new text end .
Subd. 2.
new text begin Cost-sharing; new text end coverage for enrollees under the age of 21.
new text begin
(a) Cost-sharing
includes (1) deductibles, coinsurance, co-payments, or similar charges, and (2) qualified
medical expenses, as defined in section 223(d)(2) of the Internal Revenue Code of 1986,
as amended. Cost-sharing does not include premiums, balance billing from non-network
providers, or spending for noncovered services.
new text end
new text begin
(b) Cost-sharing per year for individual health plans is limited to the amount allowed
under section 223(c)(2)(A)(ii) of the Internal Revenue Code of 1986, as amended, increased
by an amount equal to the product of that amount and the premium adjustment percentage.
The premium adjustment percentage is the percentage that the average per capita premium
for health insurance coverage in the United States for the preceding calendar year exceeds
the average per capita premium for 2017. If the amount of the increase is not a multiple of
$50, the increases must be rounded to the next lowest multiple of $50.
new text end
new text begin
(c) Cost-sharing per year for small group health plans is limited to twice the amount
allowed under paragraph (b).
new text end
new text begin (d) new text end If a health plan company offers health plans in any level of coverage deleted text begin specified under
section 1302(d) of the Affordable Care Act, asdeleted text end described in subdivision deleted text begin 1, paragraph (b),
clause (3)deleted text end new text begin 3new text end , the health plan company shall also offer coverage in that level to individuals
who have not attained 21 years of age as of the beginning of a policy year.
Subd. 3.
new text begin Levels of coverage; new text end alternative compliance for catastrophic plans.
new text begin
(a) A
health plan in the bronze level must provide a level of coverage designed to provide benefits
that are actuarially equivalent to 60 percent of the full actuarial value of the benefits provided
under the plan.
new text end
new text begin
(b) A health plan in the silver level must provide a level of coverage designed to provide
benefits that are actuarially equivalent to 70 percent of the full actuarial value of the benefits
provided under the plan.
new text end
new text begin
(c) A health plan in the gold level must provide a level of coverage designed to provide
benefits that are actuarially equivalent to 80 percent of the full actuarial value of the benefits
provided under the plan.
new text end
new text begin
(d) A health plan in the platinum level must provide a level of coverage designed to
provide benefits that are actuarially equivalent to 90 percent of the full actuarial value of
the benefits provided under the plan.
new text end
new text begin (e) new text end A health plan company that does not provide an individual or small group health
plan in the bronze, silver, gold, or platinum level of coveragedeleted text begin , as described in subdivision
1, paragraph (b), clause (3),deleted text end shall be treated as meeting the requirements ofnew text begin thisnew text end section
deleted text begin 1302(d) of the Affordable Care Actdeleted text end with respect to any deleted text begin policydeleted text end new text begin plannew text end year if the health plan
company provides a catastrophic plan that meets thenew text begin followingnew text end requirements deleted text begin of section
1302(e) of the Affordable Care Act.deleted text end new text begin :
new text end
new text begin
(1) the only individuals to enroll in the health plan:
new text end
new text begin
(i) have not attained age 30 before the beginning of the plan year;
new text end
new text begin
(ii) have an inability to access affordable coverage; or
new text end
new text begin
(iii) are experiencing a hardship in reference to their capability to access coverage; and
new text end
new text begin
(2) the health plan provides:
new text end
new text begin
(i) essential health benefits, except that it does not provide benefits for any plan year
until the individual has incurred cost-sharing expenses in an amount equal to the limitation
in effect under subdivision 2; and
new text end
new text begin
(ii) coverage for at least three primary care visits.
new text end
Subd. 4.
Essential health benefits; definition.
new text begin (a) new text end For purposes of this section, "essential
health benefits" deleted text begin has the meaning given under section 1302(b) of the Affordable Care Act
and includesdeleted text end new text begin meansnew text end :
(1) ambulatory patient services;
(2) emergency services;
(3) hospitalization;
(4) laboratory services;
(5) maternity and newborn care;
(6) mental health and substance use disorder services, including behavioral health
treatment;
(7) pediatric services, including oral and vision care;
(8) prescription drugs;
(9) preventive and wellness services and chronic disease management;
(10) rehabilitative and habilitative services and devices; and
(11) additional essential health benefits included in the deleted text begin EHB-benchmark plan, as defined
under the Affordable Care Actdeleted text end new text begin health plan described in paragraph (c)new text end .
new text begin
(b) If a service provider does not have a contractual relationship with the health plan to
provide services, emergency services must be provided without imposing any prior
authorization requirement or limitation on coverage that is more restrictive than the
requirements or limitations that apply to emergency services received from providers who
have a contractual relationship with the health plan. If services are provided out-of-network,
the cost-sharing must be equivalent to services provided in-network.
new text end
new text begin
(c) The scope of essential health benefits under paragraph (a) must be equal to the scope
of benefits provided under a typical employer plan.
new text end
new text begin
(d) Essential health benefits must:
new text end
new text begin
(1) reflect an appropriate balance among the categories, to ensure benefits are not unduly
weighted toward any category;
new text end
new text begin
(2) not make coverage decisions, determine reimbursement rates, establish incentive
programs, or design benefits in a manner that discriminates against individuals on the basis
of age, disability, or expected length of life;
new text end
new text begin
(3) account for the health care needs of diverse segments of the population, including
women, children, persons with disabilities, and other groups; and
new text end
new text begin
(4) ensure that health benefits established as essential are not subject to denial to
individuals against their wishes on the basis of the individuals' age or expected length of
life or of the individuals' present or predicted disability, degree of medical dependency, or
quality of life.
new text end
Subd. 5.
Exception.
This section does not apply to a dental plan deleted text begin described in section
1311(d)(2)(B)(ii) of the Affordable Care Actdeleted text end new text begin that is limited in scope and provides pediatric
dental benefitsnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2020, for health plans offered,
issued, or renewed on or after that date.
new text end