1.1 A bill for an act
1.2 relating to insurance; regulating certain licenses,
1.3 fees, rates, practices, and coverages; providing for
1.4 health care administrative simplification; making
1.5 certain technical changes; amending Minnesota Statutes
1.6 2000, sections 60A.351; 60D.20, subdivision 2;
1.7 61A.092, subdivision 6; 62A.02, subdivision 2;
1.8 62A.021, subdivision 1; 62A.25, subdivision 2; 62A.31,
1.9 subdivision 1h; 62A.65, subdivision 5; 62E.11,
1.10 subdivision 6; 62E.14, subdivisions 4, 5, 6; 62H.01;
1.11 62H.04; 62J.51, subdivision 19; 62J.535, subdivision
1.12 2, by adding subdivisions; 62J.581; 62L.03,
1.13 subdivisions 1, 5; 62L.08, by adding a subdivision;
1.14 62Q.68, subdivision 1; 72A.08, subdivision 1; 79A.04,
1.15 subdivision 9; Minnesota Statutes 2001 Supplement,
1.16 sections 60A.14, subdivision 1; 60K.56, subdivisions
1.17 6, 8, 9; 62M.03, subdivision 2; Laws 2001, chapter
1.18 117, article 1, section 29; proposing coding for new
1.19 law in Minnesota Statutes, chapter 62Q; repealing
1.20 Minnesota Statutes 2000, section 62J.535, subdivision
1.21 1.
1.22 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.23 Section 1. Minnesota Statutes 2001 Supplement, section
1.24 60A.14, subdivision 1, is amended to read:
1.25 Subdivision 1. [FEES OTHER THAN EXAMINATION FEES.] In
1.26 addition to the fees and charges provided for examinations, the
1.27 following fees must be paid to the commissioner for deposit in
1.28 the general fund:
1.29 (a) by township mutual fire insurance companies:
1.30 (1) for filing certificate of incorporation $25 and
1.31 amendments thereto, $10;
1.32 (2) for filing annual statements, $15;
1.33 (3) for each annual certificate of authority, $15;
2.1 (4) for filing bylaws $25 and amendments thereto, $10.
2.2 (b) by other domestic and foreign companies including
2.3 fraternals and reciprocal exchanges:
2.4 (1) for filing certified copy of certificate of articles of
2.5 incorporation, $100;
2.6 (2) for filing annual statement, $225;
2.7 (3) for filing certified copy of amendment to certificate
2.8 or articles of incorporation, $100;
2.9 (4) for filing bylaws, $75 or amendments thereto, $75;
2.10 (5) for each company's certificate of authority, $575,
2.11 annually.
2.12 (c) the following general fees apply:
2.13 (1) for each certificate, including certified copy of
2.14 certificate of authority, renewal, valuation of life policies,
2.15 corporate condition or qualification, $25;
2.16 (2) for each copy of paper on file in the commissioner's
2.17 office 50 cents per page, and $2.50 for certifying the same;
2.18 (3) for license to procure insurance in unadmitted foreign
2.19 companies, $575;
2.20 (4) for valuing the policies of life insurance companies,
2.21 one cent per $1,000 of insurance so valued, provided that the
2.22 fee shall not exceed $13,000 per year for any company. The
2.23 commissioner may, in lieu of a valuation of the policies of any
2.24 foreign life insurance company admitted, or applying for
2.25 admission, to do business in this state, accept a certificate of
2.26 valuation from the company's own actuary or from the
2.27 commissioner of insurance of the state or territory in which the
2.28 company is domiciled;
2.29 (5) for receiving and filing certificates of policies by
2.30 the company's actuary, or by the commissioner of insurance of
2.31 any other state or territory, $50;
2.32 (6) for each appointment of an agent filed with the
2.33 commissioner, $10;
2.34 (7) for filing forms and rates, $75 per filing, to which
2.35 may be paid on a quarterly basis in response to an invoice.
2.36 Billing and payment may be made electronically;
3.1 (8) for annual renewal of surplus lines insurer license,
3.2 $300.
3.3 The commissioner shall adopt rules to define filings that
3.4 are subject to a fee.
3.5 Sec. 2. Minnesota Statutes 2000, section 60A.351, is
3.6 amended to read:
3.7 60A.351 [RENEWAL OF INSURANCE POLICY WITH ALTERED RATES.]
3.8 If an insurance company licensed to do business in this
3.9 state offers or purports to offer to renew any commercial
3.10 liability and/or property insurance policy at less favorable
3.11 terms as to the dollar amount of coverage or deductibles, higher
3.12 rates, and/or higher rating plan, the new terms, the new rates
3.13 and/or rating plan may take effect on the renewal date of the
3.14 policy if the insurer has sent to the policyholder notice of the
3.15 new terms, new rates and/or rating plan at least 60 days prior
3.16 to the expiration date. If the insurer has not so notified the
3.17 policyholder, the policyholder may elect to cancel the renewal
3.18 policy within the 60-day period after receipt of the notice.
3.19 Earned premium for the period of coverage, if any, shall be
3.20 calculated pro rata upon the prior rate. This subdivision does
3.21 not apply to ocean marine insurance, accident and health
3.22 insurance, and reinsurance.
3.23 This section does not apply if the change relates to guide
3.24 "a" rates or excess rates also known as "consent to rates" or if
3.25 there has been any change in the risk insured.
3.26 Sec. 3. Minnesota Statutes 2000, section 60D.20,
3.27 subdivision 2, is amended to read:
3.28 Subd. 2. [DIVIDENDS AND OTHER DISTRIBUTIONS.] (a) Subject
3.29 to the limitations and requirements of this subdivision, the
3.30 board of directors of any domestic insurer within an insurance
3.31 holding company system may authorize and cause the insurer to
3.32 declare and pay any dividend or distribution to its shareholders
3.33 as the directors deem prudent from the earned surplus of the
3.34 insurer. An insurer's earned surplus, also known as unassigned
3.35 funds, shall be determined in accordance with the accounting
3.36 procedures and practices governing preparation of its annual
4.1 statement. Dividends which are paid from sources other than an
4.2 insurer's earned surplus as of the end of the immediately
4.3 preceding quarter for which the insurer has filed a quarterly or
4.4 annual statement as appropriate, or are extraordinary dividends
4.5 or distributions may be paid only as provided in paragraphs (d),
4.6 (e), and (f).
4.7 (b) The insurer shall notify the commissioner within five
4.8 business days following declaration of a dividend declared
4.9 pursuant to paragraph (a) and at least ten days prior to its
4.10 payment. The commissioner shall promptly consider the
4.11 notification filed pursuant to this paragraph, taking into
4.12 consideration the factors described in subdivision 4.
4.13 (c) The commissioner shall review at least annually the
4.14 dividends paid by an insurer pursuant to paragraph (a) for the
4.15 purpose of determining if the dividends are reasonable based
4.16 upon (1) the adequacy of the level of surplus as regards
4.17 policyholders remaining after the dividend payments, and (2) the
4.18 quality of the insurer's earnings and extent to which the
4.19 reported earnings include extraordinary items, such as surplus
4.20 relief reinsurance transactions and reserve destrengthening.
4.21 (d) No domestic insurer shall pay any extraordinary
4.22 dividend or make any other extraordinary distribution to its
4.23 shareholders until: (1) 30 days after the commissioner has
4.24 received notice of the declaration of it and has not within the
4.25 period disapproved the payment; or (2) the commissioner has
4.26 approved the payment within the 30-day period.
4.27 (e) For purposes of this section, an extraordinary dividend
4.28 or distribution includes any dividend or distribution of cash or
4.29 other property, whose fair market value together with that of
4.30 other dividends or distributions made within the preceding 12
4.31 months exceeds the greater of (1) ten percent of the insurer's
4.32 surplus as regards policyholders on December 31 of the preceding
4.33 year; or (2) the net gain from operations of the insurer, if the
4.34 insurer is a life insurer, or the net income, if the insurer is
4.35 not a life insurer, not including realized capital gains, for
4.36 the 12-month period ending on December 31 of the preceding year,
5.1 but does not include pro rata distributions of any class of the
5.2 insurer's own securities.
5.3 (f) Notwithstanding any other provision of law, an insurer
5.4 may declare an extraordinary dividend or distribution that is
5.5 conditional upon the commissioner's approval, and the
5.6 declaration shall confer no rights upon shareholders until: (1)
5.7 the commissioner has approved the payment of such a dividend or
5.8 distribution; or (2) the commissioner has not disapproved the
5.9 payment within the 30-day period referred to above.
5.10 (g) For purposes of state law, dividends paid to an
5.11 insurer's parent company from an insurer, which is a member of
5.12 an insurance holding company system, are not considered income
5.13 to the parent company.
5.14 Sec. 4. Minnesota Statutes 2001 Supplement, section
5.15 60K.56, subdivision 6, is amended to read:
5.16 Subd. 6. [MINIMUM EDUCATION REQUIREMENT.] Each person
5.17 subject to this section shall complete a minimum of 30 credit
5.18 hours of courses accredited by the commissioner during each
5.19 24-month licensing period. Any person whose initial licensing
5.20 period extends more than six months shall complete 15 hours of
5.21 courses accredited by the commissioner during the initial
5.22 license period. Any person teaching or lecturing at an
5.23 accredited course qualifies for 1-1/2 three times the number of
5.24 credit hours that would be granted to a person completing the
5.25 accredited course. No more than 15 one-half of the credit hours
5.26 per licensing period required under this section may be credited
5.27 to a person for courses attending any combination of courses
5.28 either sponsored by, offered by, or affiliated with an insurance
5.29 company or its agents; or offered using new delivery technology,
5.30 including computer, interactive technology, and the Internet.
5.31 Courses sponsored by, offered by, or affiliated with an
5.32 insurance company or agent may restrict its students to agents
5.33 of the company or agency.
5.34 Sec. 5. Minnesota Statutes 2001 Supplement, section
5.35 60K.56, subdivision 8, is amended to read:
5.36 Subd. 8. [REPORTING.] (a) After completing the minimum
6.1 education requirement, each person subject to this section shall
6.2 file or cause to be filed a compliance report in accordance with
6.3 the procedures adopted by the commissioner. The compliance
6.4 report A producer must not claim credit for continuing education
6.5 not actually completed at the date of filing the report.
6.6 (b) An institution offering an accredited course shall
6.7 comply with the procedure for reporting compliance adopted by
6.8 the commissioner.
6.9 (c) If a person subject to this section completes a
6.10 nonaccredited course, that person may submit a written report to
6.11 the advisory committee an application of the commissioner for
6.12 approval of the course accompanied by a fee of not more than $10
6.13 payable to the state of Minnesota for deposit in the general
6.14 fund. This report must be accompanied by proof satisfactory to
6.15 the commissioner that the person has completed the minimum
6.16 education requirement for the annual period during which the
6.17 nonaccredited course was completed. Upon the recommendation of
6.18 the advisory committee a determination that the course satisfies
6.19 the criteria for course accreditation, the commissioner may
6.20 approve the nonaccredited course and shall so inform the
6.21 person. If the nonaccredited course is approved by the
6.22 commissioner, it may be used to satisfy the minimum education
6.23 requirement for the person's next annual compliance period.
6.24 Sec. 6. Minnesota Statutes 2001 Supplement, section
6.25 60K.56, subdivision 9, is amended to read:
6.26 Subd. 9. [ENFORCEMENT.] If a person subject to this
6.27 section fails to complete the minimum education or reporting
6.28 requirement or to pay the prescribed fees for any licensing
6.29 period, no license may be renewed or continued in force for that
6.30 person for any class of insurance beginning June November 1 of
6.31 the year due and that person may not act as an insurance
6.32 producer until the person has demonstrated to the satisfaction
6.33 of the commissioner that all requirements of this section have
6.34 been complied with or that a waiver or extension has been
6.35 obtained.
6.36 Sec. 7. Minnesota Statutes 2000, section 61A.092,
7.1 subdivision 6, is amended to read:
7.2 Subd. 6. [APPLICATION.] This section applies to a policy,
7.3 certificate of insurance, or similar evidence of coverage issued
7.4 to a Minnesota resident or issued to provide coverage to a
7.5 Minnesota resident. This section does not apply to: (1) a
7.6 certificate of insurance or similar evidence of coverage that
7.7 meets the conditions of section 61A.093, subdivision 2; or (2) a
7.8 group life insurance policy that contains a provision permitting
7.9 the certificate holder, upon termination or layoff from
7.10 employment, to retain the coverage provided under the group
7.11 policy by paying premiums directly to the insurer, provided that
7.12 the employer shall give the employee notice of the employee's
7.13 and each related certificate holder's right to continue the
7.14 insurance by paying premiums directly to the insurer. The
7.15 insurer may reserve the right to increase premium rates after
7.16 the first 18 months of continued coverage provided for under
7.17 clause (2). A related certificate holder is an insured spouse
7.18 or dependent child of the employee. Upon termination of this
7.19 group policy or at the option of the insured who has continued
7.20 coverage under clause (2), each covered employee, spouse, and
7.21 dependent child is entitled to have issued to them a life
7.22 conversion policy as prescribed in section 61A.09, subdivision
7.23 1, paragraph (h).
7.24 Sec. 8. Minnesota Statutes 2000, section 62A.02,
7.25 subdivision 2, is amended to read:
7.26 Subd. 2. [APPROVAL.] (a) The health plan form shall not be
7.27 issued, nor shall any application, rider, endorsement, or rate
7.28 be used in connection with it, until the expiration of 60 days
7.29 after it has been filed unless the commissioner approves it
7.30 before that time.
7.31 (b) Notwithstanding paragraph (a), a rate filed with
7.32 respect to a policy of accident and sickness insurance as
7.33 defined in section 62A.01 by an insurer licensed under chapter
7.34 60A, may be used on or after the date of filing with the
7.35 commissioner. Rates that are not approved or disapproved within
7.36 the 60-day time period are deemed approved.
8.1 Sec. 9. Minnesota Statutes 2000, section 62A.021,
8.2 subdivision 1, is amended to read:
8.3 Subdivision 1. [LOSS RATIO STANDARDS.] (a) Notwithstanding
8.4 section 62A.02, subdivision 3, relating to loss ratios, health
8.5 care policies or certificates shall not be delivered or issued
8.6 for delivery to an individual or to a small employer as defined
8.7 in section 62L.02, unless the policies or certificates can be
8.8 expected, as estimated for the entire period for which rates are
8.9 computed to provide coverage, to return to Minnesota
8.10 policyholders and certificate holders in the form of aggregate
8.11 benefits not including anticipated refunds or credits, provided
8.12 under the policies or certificates, (1) at least 75 percent of
8.13 the aggregate amount of premiums earned in the case of policies
8.14 issued in the small employer market, as defined in section
8.15 62L.02, subdivision 27, calculated on an aggregate basis; and
8.16 (2) at least 65 percent of the aggregate amount of premiums
8.17 earned in the case of each policy form or certificate form
8.18 issued in the individual market; calculated on the basis of
8.19 incurred claims experience or incurred health care expenses
8.20 where coverage is provided by a health maintenance organization
8.21 on a service rather than reimbursement basis and earned premiums
8.22 for the period and according to accepted actuarial principles
8.23 and practices. Assessments by the reinsurance association
8.24 created in chapter 62L and all types of taxes, surcharges, or
8.25 assessments created by Laws 1992, chapter 549, or created on or
8.26 after April 23, 1992, are included in the calculation of
8.27 incurred claims experience or incurred health care expenses.
8.28 The applicable percentage for policies and certificates issued
8.29 in the small employer market, as defined in section 62L.02,
8.30 increases by one percentage point on July 1 of each year,
8.31 beginning on July 1, 1994, until an 82 percent loss ratio is
8.32 reached on July 1, 2000. The applicable percentage for policy
8.33 forms and certificate forms issued in the individual market
8.34 increases by one percentage point on July 1 of each year,
8.35 beginning on July 1, 1994, until a 72 percent loss ratio is
8.36 reached on July 1, 2000. A health carrier that enters a market
9.1 after July 1, 1993, does not start at the beginning of the
9.2 phase-in schedule and must instead comply with the loss ratio
9.3 requirements applicable to other health carriers in that market
9.4 for each time period. Premiums earned and claims incurred in
9.5 markets other than the small employer and individual markets are
9.6 not relevant for purposes of this section.
9.7 (b) All filings of rates and rating schedules shall
9.8 demonstrate that actual expected claims in relation to premiums
9.9 comply with the requirements of this section when combined with
9.10 actual experience to date. Filings of rate revisions shall also
9.11 demonstrate that the anticipated loss ratio over the entire
9.12 future period for which the revised rates are computed to
9.13 provide coverage can be expected to meet the appropriate loss
9.14 ratio standards, and aggregate loss ratio from inception of the
9.15 policy form or certificate form shall equal or exceed the
9.16 appropriate loss ratio standards.
9.17 (c) A health carrier that issues health care policies and
9.18 certificates to individuals or to small employers, as defined in
9.19 section 62L.02, in this state shall file annually its rates,
9.20 rating schedule, and supporting documentation including ratios
9.21 of incurred losses to earned premiums by policy form or
9.22 certificate form duration for approval by the commissioner
9.23 according to the filing requirements and procedures prescribed
9.24 by the commissioner. The supporting documentation shall also
9.25 demonstrate in accordance with actuarial standards of practice
9.26 using reasonable assumptions that the appropriate loss ratio
9.27 standards can be expected to be met over the entire period for
9.28 which rates are computed. The demonstration shall exclude
9.29 active life reserves. If the data submitted does not confirm
9.30 that the health carrier has satisfied the loss ratio
9.31 requirements of this section, the commissioner shall notify the
9.32 health carrier in writing of the deficiency. The health carrier
9.33 shall have 30 days from the date of the commissioner's notice to
9.34 file amended rates that comply with this section. If the health
9.35 carrier fails to file amended rates within the prescribed time,
9.36 the commissioner shall order that the health carrier's filed
10.1 rates for the nonconforming policy form or certificate form be
10.2 reduced to an amount that would have resulted in a loss ratio
10.3 that complied with this section had it been in effect for the
10.4 reporting period of the supplement. The health carrier's
10.5 failure to file amended rates within the specified time or the
10.6 issuance of the commissioner's order amending the rates does not
10.7 preclude the health carrier from filing an amendment of its
10.8 rates at a later time. The commissioner shall annually make the
10.9 submitted data available to the public at a cost not to exceed
10.10 the cost of copying. The data must be compiled in a form useful
10.11 for consumers who wish to compare premium charges and loss
10.12 ratios.
10.13 (d) Each sale of a policy or certificate that does not
10.14 comply with the loss ratio requirements of this section is an
10.15 unfair or deceptive act or practice in the business of insurance
10.16 and is subject to the penalties in sections 72A.17 to 72A.32.
10.17 (e)(1) For purposes of this section, health care policies
10.18 issued as a result of solicitations of individuals through the
10.19 mail or mass media advertising, including both print and
10.20 broadcast advertising, shall be treated as individual policies.
10.21 (2) For purposes of this section, (i) "health care policy"
10.22 or "health care certificate" is a health plan as defined in
10.23 section 62A.011; and (ii) "health carrier" has the meaning given
10.24 in section 62A.011 and includes all health carriers delivering
10.25 or issuing for delivery health care policies or certificates in
10.26 this state or offering these policies or certificates to
10.27 residents of this state.
10.28 (f) The loss ratio phase-in as described in paragraph (a)
10.29 does not apply to individual policies and small employer
10.30 policies issued by a health plan company that is assessed less
10.31 than three percent of the total annual amount assessed by the
10.32 Minnesota comprehensive health association. These policies must
10.33 meet a 68 percent loss ratio for individual policies, a 71
10.34 percent loss ratio for small employer policies with fewer than
10.35 ten employees, and a 75 percent loss ratio for all other small
10.36 employer policies.
11.1 (g) Notwithstanding paragraphs (a) and (f), the loss ratio
11.2 shall be 60 percent for a policy or certificate of accident and
11.3 sickness insurance as defined in section 62A.01, offered by an
11.4 insurance company licensed under chapter 60A that is assessed
11.5 less than ten percent of the total annual amount assessed by the
11.6 Minnesota Comprehensive Health Association. For purposes of the
11.7 percentage calculation of the association's assessments, an
11.8 insurance company's assessments include those of its affiliates.
11.9 (h) The commissioners of commerce and health shall each
11.10 annually issue a public report listing, by health plan company,
11.11 the actual loss ratios experienced in the individual and small
11.12 employer markets in this state by the health plan companies that
11.13 the commissioners respectively regulate. The commissioners
11.14 shall coordinate release of these reports so as to release them
11.15 as a joint report or as separate reports issued the same day.
11.16 The report or reports shall be released no later than June 1 for
11.17 loss ratios experienced for the preceding calendar year. Health
11.18 plan companies shall provide to the commissioners any
11.19 information requested by the commissioners for purposes of this
11.20 paragraph.
11.21 Sec. 10. Minnesota Statutes 2000, section 62A.25,
11.22 subdivision 2, is amended to read:
11.23 Subd. 2. (a) Every policy, plan, certificate or contract to
11.24 which this section applies shall provide benefits for
11.25 reconstructive surgery when such service is incidental to or
11.26 follows surgery resulting from injury, sickness or other
11.27 diseases of the involved part or when such service is performed
11.28 on a covered dependent child because of congenital disease or
11.29 anomaly which has resulted in a functional defect as determined
11.30 by the attending physician.
11.31 (b) The coverage limitations on reconstructive surgery in
11.32 paragraph (a) do not apply to reconstructive breast surgery
11.33 following mastectomies. In these cases, coverage for
11.34 reconstructive surgery must be provided if the mastectomy is
11.35 medically necessary as determined by the attending physician.
11.36 (c) Reconstructive surgery benefits include all stages of
12.1 reconstruction of the breast on which the mastectomy has been
12.2 performed, surgery and reconstruction of the other breast to
12.3 produce a symmetrical appearance, and prosthesis and physical
12.4 complications at all stages of a mastectomy, including
12.5 lymphedemas, in a manner determined in consultation with the
12.6 attending physician and patient. Coverage may be subject to
12.7 annual deductible, copayment, and coinsurance provisions as may
12.8 be deemed appropriate and as are consistent with those
12.9 established for other benefits under the plan or coverage.
12.10 Coverage may not:
12.11 (1) deny to a patient eligibility, or continued
12.12 eligibility, to enroll or to renew coverage under the terms of
12.13 the plan, solely for the purpose of avoiding the requirements of
12.14 this section; and
12.15 (2) penalize or otherwise reduce or limit the reimbursement
12.16 of an attending provider, or provide monetary or other
12.17 incentives to an attending provider to induce the provider to
12.18 provide care to an individual participant or beneficiary in a
12.19 manner inconsistent with this section.
12.20 Written notice of the availability of the coverage must be
12.21 delivered to the participant upon enrollment and annually
12.22 thereafter.
12.23 Sec. 11. Minnesota Statutes 2000, section 62A.31,
12.24 subdivision 1h, is amended to read:
12.25 Subd. 1h. [LIMITATIONS ON DENIALS, CONDITIONS, AND PRICING
12.26 OF COVERAGE.] No health carrier issuing Medicare-related
12.27 coverage in this state may impose preexisting condition
12.28 limitations or otherwise deny or condition the issuance or
12.29 effectiveness of any such coverage available for sale in this
12.30 state, nor may it discriminate in the pricing of such coverage,
12.31 because of the health status, claims experience, receipt of
12.32 health care, medical condition, or age of an applicant where an
12.33 application for such coverage is submitted prior to or during
12.34 the six-month period beginning with the first day of the month
12.35 in which an individual first enrolled for benefits under
12.36 Medicare Part B. This subdivision applies to each
13.1 Medicare-related coverage offered by a health carrier regardless
13.2 of whether the individual has attained the age of 65 years. If
13.3 an individual who is enrolled in Medicare Part B due to
13.4 disability status is involuntarily disenrolled due to loss of
13.5 disability status, the individual is eligible for another
13.6 six-month enrollment period provided under this subdivision
13.7 beginning the first day of the month in which the individual
13.8 later becomes eligible for and enrolls again in Medicare Part
13.9 B. An individual who is or was previously enrolled in Medicare
13.10 Part B due to disability status is eligible for another
13.11 six-month enrollment period under this subdivision beginning the
13.12 first day of the month in which the individual has attained the
13.13 age of 65 years and either maintains enrollment in, or enrolls
13.14 again in, Medicare Part B. If an individual enrolled in
13.15 Medicare Part B voluntarily disenrolls from Medicare Part B
13.16 because the individual becomes reemployed and is enrolled under
13.17 an employee welfare benefit plan, the individual is eligible for
13.18 another six-month enrollment period, as provided in this
13.19 subdivision, beginning the first day of the month in which the
13.20 individual later becomes eligible for and enrolls again in
13.21 Medicare Part B.
13.22 Sec. 12. Minnesota Statutes 2000, section 62A.65,
13.23 subdivision 5, is amended to read:
13.24 Subd. 5. [PORTABILITY AND CONVERSION OF COVERAGE.] (a) No
13.25 individual health plan may be offered, sold, issued, or with
13.26 respect to children age 18 or under renewed, to a Minnesota
13.27 resident that contains a preexisting condition limitation,
13.28 preexisting condition exclusion, or exclusionary rider, unless
13.29 the limitation or exclusion is permitted under this subdivision
13.30 and under chapter 62L, provided that, except for children age 18
13.31 or under, underwriting restrictions may be retained on
13.32 individual contracts that are issued without evidence of
13.33 insurability as a replacement for prior individual coverage that
13.34 was sold before May 17, 1993. The individual may be subjected
13.35 to an 18-month preexisting condition limitation, unless the
13.36 individual has maintained continuous coverage as defined in
14.1 section 62L.02. The individual must not be subjected to an
14.2 exclusionary rider. An individual who has maintained continuous
14.3 coverage may be subjected to a one-time preexisting condition
14.4 limitation of up to 12 months, with credit for time covered
14.5 under qualifying coverage as defined in section 62L.02, at the
14.6 time that the individual first is covered under an individual
14.7 health plan by any health carrier. Credit must be given for all
14.8 qualifying coverage with respect to all preexisting conditions,
14.9 regardless of whether the conditions were preexisting with
14.10 respect to any previous qualifying coverage. The individual
14.11 must not be subjected to an exclusionary rider. Thereafter, the
14.12 individual must not be subject to any preexisting condition
14.13 limitation, preexisting condition exclusion, or exclusionary
14.14 rider under an individual health plan by any health carrier,
14.15 except an unexpired portion of a limitation under prior
14.16 coverage, so long as the individual maintains continuous
14.17 coverage as defined in section 62L.02.
14.18 (b) A health carrier must offer an individual health plan
14.19 to any individual previously covered under a group health plan
14.20 issued by that health carrier, regardless of the size of the
14.21 group, so long as the individual maintained continuous coverage
14.22 as defined in section 62L.02. If the individual has available
14.23 any continuation coverage provided under sections 62A.146;
14.24 62A.148; 62A.17, subdivisions 1 and 2; 62A.20; 62A.21; 62C.142;
14.25 62D.101; or 62D.105, or continuation coverage provided under
14.26 federal law, the health carrier need not offer coverage under
14.27 this paragraph until the individual has exhausted the
14.28 continuation coverage. The offer must not be subject to
14.29 underwriting, except as permitted under this paragraph. A
14.30 health plan issued under this paragraph must be a qualified plan
14.31 as defined in section 62E.02 and must not contain any
14.32 preexisting condition limitation, preexisting condition
14.33 exclusion, or exclusionary rider, except for any unexpired
14.34 limitation or exclusion under the previous coverage. The
14.35 individual health plan must cover pregnancy on the same basis as
14.36 any other covered illness under the individual health plan. The
15.1 initial premium rate for the individual health plan must comply
15.2 with subdivision 3. The premium rate upon renewal must comply
15.3 with subdivision 2. In no event shall the premium rate exceed
15.4 90 100 percent of the premium charged for comparable individual
15.5 coverage by the Minnesota comprehensive health association, and
15.6 the premium rate must be less than that amount if necessary to
15.7 otherwise comply with this section. An individual health plan
15.8 offered under this paragraph to a person satisfies the health
15.9 carrier's obligation to offer conversion coverage under section
15.10 62E.16, with respect to that person. Coverage issued under this
15.11 paragraph must provide that it cannot be canceled or nonrenewed
15.12 as a result of the health carrier's subsequent decision to leave
15.13 the individual, small employer, or other group market. Section
15.14 72A.20, subdivision 28, applies to this paragraph.
15.15 Sec. 13. Minnesota Statutes 2000, section 62E.11,
15.16 subdivision 6, is amended to read:
15.17 Subd. 6. [MEMBER ASSESSMENTS.] The association shall make
15.18 an annual determination of each contributing member's liability,
15.19 if any, and may make an annual fiscal year end assessment if
15.20 necessary. The association may also, subject to the approval of
15.21 the commissioner, provide for interim assessments against the
15.22 contributing members whose aggregate assessments comprised a
15.23 minimum of 90 percent of the most recent prior annual
15.24 assessment, in the event that the association deems that
15.25 methodology to be the most administratively efficient and cost
15.26 effective means of assessment, and as may be necessary to assure
15.27 the financial capability of the association in meeting the
15.28 incurred or estimated claims expenses of the state plan and
15.29 operating and administrative expenses of the association until
15.30 the association's next annual fiscal year end assessment.
15.31 Payment of an assessment shall be due within 30 days of receipt
15.32 by a contributing member of a written notice of a fiscal year
15.33 end or interim assessment. Failure by a contributing member to
15.34 tender to the association the assessment within 30 days shall be
15.35 grounds for termination of the contributing member's
15.36 membership. A contributing member which ceases to do accident
16.1 and health insurance business within the state shall remain
16.2 liable for assessments through the calendar year during which
16.3 accident and health insurance business ceased. The association
16.4 may decline to levy an assessment against a contributing member
16.5 if the assessment, as determined herein, would not exceed ten
16.6 dollars.
16.7 Sec. 14. Minnesota Statutes 2000, section 62E.14,
16.8 subdivision 4, is amended to read:
16.9 Subd. 4. [WAIVER OF PREEXISTING CONDITIONS FOR MEDICARE
16.10 SUPPLEMENT PLAN ENROLLEES.] Notwithstanding the above, any
16.11 Minnesota resident holder of a policy or certificate of Medicare
16.12 supplement coverages pursuant to sections 62A.315 and 62A.316,
16.13 or Medicare supplement plans previously approved by the
16.14 commissioner, may enroll in the comprehensive health insurance
16.15 plan as described in section 62E.07, with a waiver of the
16.16 preexisting condition as described in subdivision 3, without
16.17 interruption in coverage, provided, the policy or certificate
16.18 has been terminated by the insurer for reasons other than
16.19 nonpayment of premium and, provided further, that the option to
16.20 enroll in the plan is exercised within 30 90 days of termination
16.21 of the existing contract.
16.22 Coverage in the state plan for purposes of this section
16.23 shall be effective on the date of termination upon completion of
16.24 the proper application and payment of the required premium. The
16.25 application must include evidence of termination of the existing
16.26 policy or certificate.
16.27 Sec. 15. Minnesota Statutes 2000, section 62E.14,
16.28 subdivision 5, is amended to read:
16.29 Subd. 5. [TERMINATED EMPLOYEES.] An employee who is
16.30 voluntarily or involuntarily terminated or laid off from
16.31 employment and unable to exercise the option to continue
16.32 coverage under section 62A.17 may enroll, within 60 90 days of
16.33 termination or layoff, with a waiver of the preexisting
16.34 condition limitation set forth in subdivision 3 and a waiver of
16.35 the evidence of rejection set forth in subdivision 1, paragraph
16.36 (c).
17.1 Sec. 16. Minnesota Statutes 2000, section 62E.14,
17.2 subdivision 6, is amended to read:
17.3 Subd. 6. [TERMINATION OF INDIVIDUAL POLICY OR CONTRACT.] A
17.4 Minnesota resident who holds an individual health maintenance
17.5 contract, individual nonprofit health service corporation
17.6 contract, or an individual insurance policy previously approved
17.7 by the commissioners of health or commerce, may enroll in the
17.8 comprehensive health insurance plan with a waiver of the
17.9 preexisting condition as described in subdivision 3, without
17.10 interruption in coverage, provided (1) no replacement coverage
17.11 that meets the requirements of section 62D.121 was offered by
17.12 the contributing member, and (2) the policy or contract has been
17.13 terminated for reasons other than (a) nonpayment of premium; (b)
17.14 failure to make copayments required by the health care plan; (c)
17.15 moving out of the area served; or (d) a materially false
17.16 statement or misrepresentation by the enrollee in the
17.17 application for membership; and, provided further, that the
17.18 option to enroll in the plan is exercised within 30 90 days of
17.19 termination of the existing policy or contract.
17.20 Coverage allowed under this section is effective when the
17.21 contract or policy is terminated and the enrollee has completed
17.22 the proper application and paid the required premium or fee.
17.23 Expenses incurred from the preexisting conditions of
17.24 individuals enrolled in the state plan under this subdivision
17.25 must be paid by the contributing member canceling coverage as
17.26 set forth in section 62E.11, subdivision 10.
17.27 The application must include evidence of termination of the
17.28 existing policy or certificate as required in subdivision 1.
17.29 Sec. 17. Minnesota Statutes 2000, section 62H.01, is
17.30 amended to read:
17.31 62H.01 [AUTHORITY TO JOINTLY SELF-INSURE.]
17.32 Any two or more employers, excluding the state and its
17.33 political subdivisions as described in section 471.617,
17.34 subdivision 1, who are authorized to transact business in
17.35 Minnesota may jointly self-insure employee health, dental,
17.36 short-term disability benefits, or other benefits permitted
18.1 under the Employee Retirement Income Security Act of 1974,
18.2 United States Code, title 29, sections 1001 et seq. If an
18.3 employer chooses to jointly self-insure in accordance with this
18.4 chapter, the employer must participate in the joint plan for at
18.5 least three consecutive years. If an employer terminates
18.6 participation in the joint plan before the conclusion of this
18.7 three-year period, a financial penalty may be assessed under the
18.8 joint plan, not to exceed the amount contributed by the employer
18.9 to the plan's reserves as determined under Minnesota Rules, part
18.10 2765.1200. Joint plans must have a minimum of 100 1,000 covered
18.11 employees and meet all conditions and terms of sections 62H.01
18.12 to 62H.08. Joint plans covering employers not resident in
18.13 Minnesota must meet the requirements of sections 62H.01 to
18.14 62H.08 as if the portion of the plan covering Minnesota resident
18.15 employees was treated as a separate plan. A plan may cover
18.16 employees resident in other states only if the plan complies
18.17 with the applicable laws of that state.
18.18 A multiple employer welfare arrangement as defined in
18.19 United States Code, title 29, section 1002(40)(a), is subject to
18.20 this chapter to the extent authorized by the Employee Retirement
18.21 Income Security Act of 1974, United States Code, title 29,
18.22 sections 1001 et seq. The commissioner of commerce may, on
18.23 behalf of the state, enter into an agreement with the United
18.24 States Secretary of Labor for delegation to the state of some or
18.25 all of the secretary's enforcement authority with respect to
18.26 multiple employer welfare arrangements, as described in United
18.27 States Code, title 29, section 1136(c).
18.28 Sec. 18. Minnesota Statutes 2000, section 62H.04, is
18.29 amended to read:
18.30 62H.04 [COMPLIANCE WITH OTHER LAWS.]
18.31 (a) A joint self-insurance plan is subject to the
18.32 requirements of chapters 62A, 62E, and 62L, and 62Q, and
18.33 sections 72A.17 to 72A.32 unless otherwise specifically exempt.
18.34 A joint self-insurance plan must not offer less than a number
18.35 two qualified plan or its actuarial equivalent. A joint
18.36 self-insurance plan must pay assessments made by the Minnesota
19.1 Comprehensive Health Association, as required under section
19.2 62E.11.
19.3 (b) A joint self-insurance plan is exempt from providing
19.4 the mandated health benefits described in chapters 62A, 62E,
19.5 62L, and 62Q if it otherwise provides the benefits required
19.6 under the Employee Retirement Income Security Act of 1974,
19.7 United States Code, title 29, sections 1001, et seq., for all
19.8 employers and not just for the employers with 50 or more
19.9 employees who are covered by that federal law.
19.10 (c) A joint self-insurance plan is exempt from section
19.11 62L.03, subdivision 1, if the plan offers an annual open
19.12 enrollment period of no less than 15 days during which all
19.13 employers that qualify for membership may enter the plan without
19.14 preexisting condition limitations or exclusions except those
19.15 permitted under chapter 62L.
19.16 (d) A joint self-insurance plan is exempt from sections
19.17 62A.16, 62A.17, 62A.20, and 62A.21 if the joint self-insurance
19.18 plan complies with the continuation requirements under the
19.19 Employee Retirement Income Security Act of 1974, United States
19.20 Code, title 29, sections 1001, et seq., for all employers and
19.21 not just for the employers with 20 or more employees who are
19.22 covered by that federal law.
19.23 (e) A joint self-insurance plan must provide to all
19.24 employers the maternity coverage required by federal law for
19.25 employers with 15 or more employees.
19.26 Sec. 19. Minnesota Statutes 2000, section 62J.51,
19.27 subdivision 19, is amended to read:
19.28 Subd. 19. [UNIFORM DENTAL BILLING FORM.] "Uniform dental
19.29 billing form" means the 1990 most current version uniform dental
19.30 claim form developed by the American Dental Association.
19.31 Sec. 20. Minnesota Statutes 2000, section 62J.535, is
19.32 amended by adding a subdivision to read:
19.33 Subd. 1a. [ELECTRONIC CLAIM TRANSACTIONS.] Group
19.34 purchasers, including government programs, not defined as
19.35 covered entities under United States Code, title 42, sections
19.36 1320d to 1320d-8, as amended from time to time, and the
20.1 regulations promulgated under those sections, that voluntarily
20.2 agree with providers to accept electronic claim transactions,
20.3 must accept them in the ANSI X12N 837 standard electronic format
20.4 as established by federal law. Nothing in this section requires
20.5 acceptance of electronic claim transactions by entities not
20.6 covered under United States Code, title 42, sections 1320d to
20.7 1320d-8, as amended from time to time, and the regulations
20.8 promulgated under those sections. Notwithstanding the above,
20.9 nothing in this section or other state law prohibits group
20.10 purchasers not defined as covered entities under United States
20.11 Code, title 42, sections 1320d to 1320d-8, as amended from time
20.12 to time, and the regulations promulgated under those sections,
20.13 from requiring, as authorized by Minnesota law or rule,
20.14 additional information associated with a claim submitted by a
20.15 provider.
20.16 Sec. 21. Minnesota Statutes 2000, section 62J.535, is
20.17 amended by adding a subdivision to read:
20.18 Subd. 1b. [PAPER CLAIM TRANSACTIONS.] All group purchasers
20.19 that accept paper claim transactions must accept, and health
20.20 care providers submitting paper claim transactions must submit,
20.21 these transactions with use of the applicable medical and
20.22 nonmedical data code sets specified in the federal electronic
20.23 claim transaction standards adopted under United States Code,
20.24 title 42, sections 1320d to 1320d-8, as amended from time to
20.25 time, and the regulations promulgated under those sections. The
20.26 paper claim transaction must also be conducted using the uniform
20.27 billing forms as specified in section 62J.52 and the identifiers
20.28 specified in section 62J.54, on and after the compliance date
20.29 required by law. Notwithstanding the above, nothing in this
20.30 section or other state law prohibits group purchasers not
20.31 defined as covered entities under United States Code, title 42,
20.32 sections 1320d to 1320d-8, as amended from time to time, and the
20.33 regulations promulgated under those sections, from requiring, as
20.34 authorized by Minnesota law or rule, additional information
20.35 associated with a claim submitted by a provider.
20.36 Sec. 22. Minnesota Statutes 2000, section 62J.535,
21.1 subdivision 2, is amended to read:
21.2 Subd. 2. [COMPLIANCE.] (a) Subdivision 1a is effective
21.3 concurrent with the date of required compliance for covered
21.4 entities established under United States Code, title 42,
21.5 sections 1320d to 1320d-8, as amended from time to time, for
21.6 uniform electronic billing standards, all health care providers
21.7 must conform to the uniform billing standards developed under
21.8 subdivision 1.
21.9 (b) Notwithstanding paragraph (a), the requirements for the
21.10 uniform remittance advice report shall be effective 12 months
21.11 after the date of the required compliance of the standards for
21.12 the electronic remittance advice transaction are effective under
21.13 United States Code, title 42, sections 1320d to 1320d-8, as
21.14 amended from time to time.
21.15 Sec. 23. Minnesota Statutes 2000, section 62J.581, is
21.16 amended to read:
21.17 62J.581 [STANDARDS FOR MINNESOTA UNIFORM HEALTH CARE
21.18 REIMBURSEMENT DOCUMENTS.]
21.19 Subdivision 1. [MINNESOTA UNIFORM REMITTANCE ADVICE
21.20 REPORT.] (a) All group purchasers and payers shall provide a
21.21 uniform remittance advice report to health care providers when a
21.22 claim is adjudicated. The uniform remittance advice report
21.23 shall comply with the standards prescribed in this section.
21.24 (b) Notwithstanding paragraph (a), this section does not
21.25 apply to group purchasers not included as covered entities under
21.26 United States Code, title 42, sections 1320d to 1320d-8, as
21.27 amended from time to time, and the regulations promulgated under
21.28 those sections.
21.29 Subd. 2. [MINNESOTA UNIFORM EXPLANATION OF BENEFITS
21.30 DOCUMENT.] (a) All group purchasers and payers shall provide a
21.31 uniform explanation of benefits document to health care patients
21.32 when a claim is adjudicated an explanation of benefits document
21.33 is provided as otherwise required or permitted by law. The
21.34 uniform explanation of benefits document shall comply with the
21.35 standards prescribed in this section.
21.36 (b) Notwithstanding paragraph (a), this section does not
22.1 apply to group purchasers not included as covered entities under
22.2 United States Code, title 42, sections 1320d to 1320d-8, as
22.3 amended from time to time, and the regulations promulgated under
22.4 those sections.
22.5 Subd. 3. [SCOPE.] For purposes of sections 62J.50 to
22.6 62J.61, the uniform remittance advice report and the uniform
22.7 explanation of benefits document format specified in subdivision
22.8 4 shall apply to all health care services delivered by a health
22.9 care provider or health care provider organization in Minnesota,
22.10 regardless of the location of the payer. Health care services
22.11 not paid on an individual claims basis, such as capitated
22.12 payments, are not included in this section. A health plan
22.13 company is excluded from the requirements in subdivisions 1 and
22.14 2 if they comply with section 62A.01, subdivisions 2 and 3.
22.15 Subd. 4. [SPECIFICATIONS.] The uniform remittance advice
22.16 report and the uniform explanation of benefits document shall be
22.17 provided by use of a paper document conforming to the
22.18 specifications in this section or by use of the ANSI X12N 835
22.19 standard electronic format as established under United States
22.20 Code, title 42, sections 1320d to 1320d-8, and as amended from
22.21 time to time for the remittance advice. The commissioner, after
22.22 consulting with the administrative uniformity committee, shall
22.23 specify the data elements and definitions for the uniform
22.24 remittance advice report and the uniform explanation of benefits
22.25 document. The commissioner and the administrative uniformity
22.26 committee must consult with the Minnesota Dental Association and
22.27 Delta Dental Plan of Minnesota before requiring under this
22.28 section the use of a paper document for the uniform explanation
22.29 of benefits document or the uniform remittance advice report for
22.30 dental care services.
22.31 Subd. 5. [EFFECTIVE DATE.] The requirements in
22.32 subdivisions 1 and 2 are effective 12 months after the date of
22.33 required compliance with the standards for the electronic
22.34 remittance advice transaction under United States Code, title
22.35 42, sections 1320d to 1320d-8, and as amended from time to
22.36 time October 16, 2004. The requirements in subdivisions 1 and 2
23.1 apply regardless of when the health care service was provided to
23.2 the patient.
23.3 Sec. 24. Minnesota Statutes 2000, section 62L.03,
23.4 subdivision 1, is amended to read:
23.5 Subdivision 1. [GUARANTEED ISSUE AND REISSUE.] (a) Every
23.6 health carrier shall, as a condition of authority to transact
23.7 business in this state in the small employer market,
23.8 affirmatively market, offer, sell, issue, and renew any of its
23.9 health benefit plans, on a guaranteed issue basis, to any small
23.10 employer, including a small employer covered by paragraph (b),
23.11 that meets the participation and contribution requirements of
23.12 subdivision 3, as provided in this chapter.
23.13 (b) A small employer that has its workforce reduced to one
23.14 employee may continue coverage as a small employer for 12 months
23.15 from the date the group is reduced to one employee.
23.16 (c) Notwithstanding paragraph (a), a health carrier may, at
23.17 the time of coverage renewal, modify the health coverage for a
23.18 product offered in the small employer market if the modification
23.19 is consistent with state law, approved by the commissioner, and
23.20 effective on a uniform basis for all small employers purchasing
23.21 that product other than through a qualified association in
23.22 compliance with section 62L.045, subdivision 2.
23.23 Paragraph (a) does not apply to a health benefit plan
23.24 designed for a small employer to comply with a collective
23.25 bargaining agreement, provided that the health benefit plan
23.26 otherwise complies with this chapter and is not offered to other
23.27 small employers, except for other small employers that need it
23.28 for the same reason. This paragraph applies only with respect
23.29 to collective bargaining agreements entered into prior to August
23.30 21, 1996, and only with respect to plan years beginning before
23.31 the later of July 1, 1997, or the date upon which the last of
23.32 the collective bargaining agreements relating to the plan
23.33 terminates determined without regard to any extension agreed to
23.34 after August 21, 1996.
23.35 (c) (d) Every health carrier participating in the small
23.36 employer market shall make available both of the plans described
24.1 in section 62L.05 to small employers and shall fully comply with
24.2 the underwriting and the rate restrictions specified in this
24.3 chapter for all health benefit plans issued to small employers.
24.4 (d) (e) A health carrier may cease to transact business in
24.5 the small employer market as provided under section 62L.09.
24.6 Sec. 25. Minnesota Statutes 2000, section 62L.03,
24.7 subdivision 5, is amended to read:
24.8 Subd. 5. [CANCELLATIONS AND FAILURES TO RENEW.] (a) No
24.9 health carrier shall cancel, decline to issue, or fail to renew
24.10 a health benefit plan as a result of the claim experience or
24.11 health status of the persons covered or to be covered by the
24.12 health benefit plan. For purposes of this subdivision, a
24.13 failure to renew does not include a uniform modification of
24.14 coverage at time of renewal, as described in subdivision 1.
24.15 (b) A health carrier may cancel or fail to renew a health
24.16 benefit plan:
24.17 (1) for nonpayment of the required premium;
24.18 (2) for fraud or misrepresentation by the small employer
24.19 with respect to eligibility for coverage or any other material
24.20 fact;
24.21 (3) if the employer fails to comply with the minimum
24.22 contribution percentage required under subdivision 3; or
24.23 (4) for any other reasons or grounds expressly permitted by
24.24 the respective licensing laws and regulations governing a health
24.25 carrier, including, but not limited to, service area
24.26 restrictions imposed on health maintenance organizations under
24.27 section 62D.03, subdivision 4, paragraph (m), to the extent that
24.28 these grounds are not expressly inconsistent with this chapter.
24.29 (c) A health carrier may fail to renew a health benefit
24.30 plan:
24.31 (1) if eligible employee participation during the preceding
24.32 calendar year declines to less than 75 percent, subject to the
24.33 waiver of coverage provision in subdivision 3;
24.34 (2) if the health carrier ceases to do business in the
24.35 small employer market under section 62L.09; or
24.36 (3) if a failure to renew is based upon the health
25.1 carrier's decision to discontinue the health benefit plan form
25.2 previously issued to the small employer, but only if the health
25.3 carrier permits each small employer covered under the prior form
25.4 to switch to its choice of any other health benefit plan offered
25.5 by the health carrier, without any underwriting restrictions
25.6 that would not have been permitted for renewal purposes.
25.7 (d) A health carrier need not renew a health benefit plan,
25.8 and shall not renew a small employer plan, if an employer ceases
25.9 to qualify as a small employer as defined in section 62L.02,
25.10 except as provided in subdivision 1, paragraph (b). If a health
25.11 benefit plan, other than a small employer plan, provides terms
25.12 of renewal that do not exclude an employer that is no longer a
25.13 small employer, the health benefit plan may be renewed according
25.14 to its own terms. If a health carrier issues or renews a health
25.15 plan to an employer that is no longer a small employer, without
25.16 interruption of coverage, the health plan is subject to section
25.17 60A.082.
25.18 (e) A health carrier may cancel or fail to renew the
25.19 coverage of an individual employee or dependent under a health
25.20 benefit plan for fraud or misrepresentation by the eligible
25.21 employee or dependent with respect to eligibility for coverage
25.22 or any other material fact.
25.23 Sec. 26. Minnesota Statutes 2000, section 62L.08, is
25.24 amended by adding a subdivision to read:
25.25 Subd. 2a. [RENEWAL PREMIUM INCREASES LIMITED.] (a)
25.26 Beginning January 1, 2003, the percentage increase in the
25.27 premium rate charged to a small employer for a new rating period
25.28 must not exceed the sum of the following:
25.29 (1) the percentage change in the index rate measured from
25.30 the first day of the prior rating period to the first day of the
25.31 new rating period;
25.32 (2) an adjustment, not to exceed 15 percent annually and
25.33 adjusted pro rata for rating periods of less than one year, due
25.34 to the claims experience, health status, or duration of coverage
25.35 of the employees or dependents of the employer; and
25.36 (3) any adjustment due to change in coverage or in the case
26.1 characteristics of the employer.
26.2 (b) This subdivision does not apply if the employer,
26.3 employee, or any applicant provides the health carrier with
26.4 false, incomplete, or misleading information.
26.5 Sec. 27. Minnesota Statutes 2001 Supplement, section
26.6 62M.03, subdivision 2, is amended to read:
26.7 Subd. 2. [NONLICENSED UTILIZATION REVIEW ORGANIZATION.] An
26.8 organization that meets the definition of a utilization review
26.9 organization under section 62M.02, subdivision 21, that is not
26.10 licensed in this state that performs utilization review services
26.11 for Minnesota residents must register with the commissioner of
26.12 commerce and must certify compliance with sections 62M.01 to
26.13 62M.16.
26.14 Initial registration must occur no later than January 1,
26.15 1993. The registration is effective for two years and may be
26.16 renewed for another two years by written request. Applications
26.17 for initial and renewal registrations must be made on forms
26.18 prescribed by the commissioner. Each utilization review
26.19 organization registered under this chapter shall notify the
26.20 commissioner of commerce within 30 days of any change in the
26.21 name, address, or ownership of the organization. The
26.22 organization shall pay to the commissioner of commerce a fee of
26.23 $1,000 for the initial registration application and $1,000 for
26.24 each two-year renewal.
26.25 Sec. 28. Minnesota Statutes 2000, section 62Q.68,
26.26 subdivision 1, is amended to read:
26.27 Subdivision 1. [APPLICATION.] For purposes of sections
26.28 62Q.68 to 62Q.72, the terms defined in this section have the
26.29 meanings given them. For purposes of sections 62Q.69 and
26.30 62Q.70, the term "health plan company" does not include an
26.31 insurance company licensed under chapter 60A to offer, sell, or
26.32 issue a policy of accident and sickness insurance as defined in
26.33 section 62A.01 or a nonprofit health service plan corporation
26.34 regulated under chapter 62C that only provides dental coverage
26.35 or vision coverage. For purposes of sections 62Q.69 through
26.36 62Q.73, the term "health plan company" does not include the
27.1 comprehensive health association created under chapter 62E.
27.2 Sec. 29. [62Q.731] [EXTERNAL REVIEW OF ADVERSE
27.3 DETERMINATION FROM COMPREHENSIVE HEALTH ASSOCIATION.]
27.4 Subdivision 1. [DEFINITIONS.] (a) For purposes of this
27.5 section, the terms defined in this subdivision have the meanings
27.6 given.
27.7 (b) "Enrollee" means an eligible person as defined in
27.8 section 62E.02, subdivision 13, and who meets the eligibility
27.9 criteria established in section 62E.14.
27.10 (c) "Board" means the board of directors of the
27.11 comprehensive health association, as described in section
27.12 62E.10, subdivision 2.
27.13 Subd. 2. [APPEAL TO EXTERNAL REVIEW ENTITY.] If an
27.14 enrollee receives an adverse determination as a result of the
27.15 comprehensive health association's internal appeal process, by
27.16 which an established enrollee appeal committee renders an
27.17 adverse determination, the enrollee then has the option of:
27.18 (1) appealing the adverse determination to the external
27.19 review entity under section 62Q.73, which shall constitute a
27.20 final determination subject to the conditions specified in
27.21 section 62Q.73; or
27.22 (2) appealing to the commissioner of commerce from an
27.23 adverse determination as provided by the operating rules of the
27.24 comprehensive health association, in which case the commissioner
27.25 has the option of making a determination regarding the appeal,
27.26 or submitting the appeal to the external review entity retained
27.27 under section 62Q.73.
27.28 Sec. 30. Minnesota Statutes 2000, section 72A.08,
27.29 subdivision 1, is amended to read:
27.30 Subdivision 1. [REBATE DEFINED AND PROHIBITED.] No
27.31 insurance company or association, however constituted or
27.32 entitled, including any affiliate of the insurance company or
27.33 association, doing business in this state, nor any officer,
27.34 agent, subagent, solicitor, employee, intermediary, or
27.35 representative thereof, shall make or permit any advantage or
27.36 distinction in favor of any insured individual, firm,
28.1 corporation, or association with respect to the amount of
28.2 premium named in, or to be paid on, any policy of insurance, or
28.3 shall offer to pay or allow directly or indirectly or by means
28.4 of any device or artifice, including by means of participation
28.5 in any arrangement with an affiliate, as inducements to
28.6 insurance, any rebate or premium payable on the policy, or any
28.7 special favor or advantage in the dividends or other profit to
28.8 accrue thereon, or any valuable consideration or inducement not
28.9 specified in the policy contract of insurance, including a
28.10 reduced interest rate, reduced loan-related or financing-related
28.11 fee, or other consideration or inducement in connection with a
28.12 loan or other financing arrangement provided or to be provided
28.13 by an affiliate, or give, sell, or purchase, offer to give, sell
28.14 or purchase, as inducement to insure or in connection therewith,
28.15 any stocks, bonds, or other securities of any insurance company
28.16 or other corporation, association, partnership, or individual,
28.17 or any dividends or profits accrued or to accrue thereon, or
28.18 anything of value, not specified in the policy. For purposes of
28.19 this section, "affiliate" has the meaning given in section
28.20 60D.15, subdivision 2. No person or entity may offer, sell,
28.21 issue, or renew insurance if the person or entity knows that an
28.22 affiliate of the person or entity is violating this subdivision
28.23 in connection with the offer, sale, issuance, or renewal of the
28.24 insurance.
28.25 Sec. 31. Minnesota Statutes 2000, section 79A.04,
28.26 subdivision 9, is amended to read:
28.27 Subd. 9. [INSOLVENCY, BANKRUPTCY, OR DEFAULT; UTILIZATION
28.28 OF SECURITY DEPOSIT.] The commissioner of labor and industry
28.29 shall notify the commissioner and the security fund if the
28.30 commissioner of labor and industry has knowledge that any
28.31 private self-insurer has failed to pay workers' compensation
28.32 benefits as required by chapter 176. If the commissioner
28.33 determines that a private self-insurer is the subject of a
28.34 voluntary or involuntary petition under the United States
28.35 Bankruptcy Code, title 11, or the commissioner determines that a
28.36 court of competent jurisdiction has declared the private
29.1 self-insurer to be bankrupt or insolvent, and the private
29.2 self-insurer has failed to pay workers' compensation as required
29.3 by chapter 176 or, if the commissioner issues a certificate of
29.4 default against a private self-insurer for failure to pay
29.5 workers' compensation as required by chapter 176, or failure to
29.6 pay an assessment to the self-insurers' security fund when due,
29.7 then the security deposit shall be utilized to administer and
29.8 pay the private self-insurers' workers' compensation or
29.9 assessment obligations or any other current or future
29.10 obligations of the self-insurers' security fund. The security
29.11 deposit shall be used to administer and pay the private
29.12 self-insurers' workers' compensation or assessment obligations
29.13 or any other current or future obligations of the self-insurers'
29.14 security fund if any of the following occurs:
29.15 (1) the private self-insurer has failed to pay workers'
29.16 compensation as required by chapter 176 and either:
29.17 (a) the commissioner determines that a private self-insurer
29.18 is the subject of a voluntary or involuntary petition under the
29.19 United States Bankruptcy Code, title 11; or
29.20 (b) the commissioner determines that a court of competent
29.21 jurisdiction has declared the private self-insurer to be
29.22 bankrupt or insolvent; or
29.23 (2) the commissioner issues a certificate of default
29.24 against a private self-insurer for failure to pay workers'
29.25 compensation as required by chapter 176; or
29.26 (3) the commissioner issues a certificate of default
29.27 against a private self-insurer for failure to pay an assessment
29.28 to the self-insurer's security fund when due.
29.29 Sec. 32. Laws 2001, chapter 117, article 1, section 29, is
29.30 amended to read:
29.31 Sec. 29. [EFFECTIVE DATE; APPLICATION.]
29.32 Sections 1 to 28 are effective July 1, 2002, and apply to
29.33 persons who sell, solicit, or negotiate insurance in this state
29.34 for any class or classes of insurance on or after that date.
29.35 However, a person required to be licensed under Minnesota
29.36 Statutes, chapter 60K, who holds a valid license under Minnesota
30.1 Statutes 2000, sections 60K.01 to 60K.20, on July 1, 2002, may
30.2 continue to sell, solicit, or negotiate insurance in this state
30.3 under the authority of that license. Upon the expiration of
30.4 that license, the person shall not sell, solicit, or negotiate
30.5 insurance in this state for any class or classes of insurance
30.6 unless the person is licensed in that line of authority under
30.7 Minnesota Statutes, chapter 60K.
30.8 Sec. 33. [REVISOR INSTRUCTION.]
30.9 The revisor of statutes is instructed to amend the headnote
30.10 of Minnesota Statutes, section 62J.535, to read "Uniform Billing
30.11 Requirements for Claim Transactions."
30.12 Sec. 34. [EXPIRATION.]
30.13 Section 30 expires June 1, 2003.
30.14 Sec. 35. [REPEALER.]
30.15 Minnesota Statutes 2000, section 62J.535, subdivision 1, is
30.16 repealed.
30.17 Sec. 36. [EFFECTIVE DATE.]
30.18 Sections 7 and 30 are effective the day following final
30.19 enactment. Section 3 is effective for dividends paid after
30.20 December 31, 2000.