1.1                          A bill for an act 
  1.2             relating to insurance; modifying basic Medicare 
  1.3             supplement plan coverage; increasing the maximum 
  1.4             lifetime benefit for policies of the comprehensive 
  1.5             health insurance plan; amending Minnesota Statutes 
  1.6             1996, section 62E.12; Minnesota Statutes 1997 
  1.7             Supplement, section 62A.316. 
  1.8   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.9      Section 1.  Minnesota Statutes 1997 Supplement, section 
  1.10  62A.316, is amended to read: 
  1.11     62A.316 [BASIC MEDICARE SUPPLEMENT PLAN; COVERAGE.] 
  1.12     (a) The basic Medicare supplement plan must have a level of 
  1.13  coverage that will provide: 
  1.14     (1) coverage for all of the Medicare part A inpatient 
  1.15  hospital coinsurance amounts, and 100 percent of all Medicare 
  1.16  part A eligible expenses for hospitalization not covered by 
  1.17  Medicare, after satisfying the Medicare part A deductible; 
  1.18     (2) coverage for the daily copayment amount of Medicare 
  1.19  part A eligible expenses for the calendar year incurred for 
  1.20  skilled nursing facility care; 
  1.21     (3) coverage for the copayment amount of Medicare eligible 
  1.22  expenses under Medicare part B regardless of hospital 
  1.23  confinement, subject to the Medicare part B deductible amount; 
  1.24     (4) 80 percent of the hospital and medical expenses and 
  1.25  supplies incurred during travel outside the United States as a 
  1.26  result of a medical emergency; 
  2.1      (5) coverage for the reasonable cost of the first three 
  2.2   pints of blood, or equivalent quantities of packed red blood 
  2.3   cells as defined under federal regulations under Medicare parts 
  2.4   A and B, unless replaced in accordance with federal regulations; 
  2.5   and 
  2.6      (6) 100 percent of the cost of immunizations and routine 
  2.7   screening procedures for cancer screening including mammograms 
  2.8   and pap smears; and 
  2.9      (7) 80 percent of coverage for all physician prescribed 
  2.10  medically appropriate and necessary equipment and supplies used 
  2.11  in the management and treatment of diabetes.  Coverage must 
  2.12  include persons with gestational, type I, or type II diabetes. 
  2.13     (b) Only the following optional benefit riders may be added 
  2.14  to this plan: 
  2.15     (1) coverage for all of the Medicare part A inpatient 
  2.16  hospital deductible amount; 
  2.17     (2) a minimum of 80 percent of eligible medical expenses 
  2.18  and supplies not covered by Medicare part B, not to exceed any 
  2.19  charge limitation established by the Medicare program or state 
  2.20  law; 
  2.21     (3) coverage for all of the Medicare part B annual 
  2.22  deductible; 
  2.23     (4) coverage for at least 50 percent, or the equivalent of 
  2.24  50 percent, of usual and customary prescription drug expenses; 
  2.25     (5) coverage for the following preventive health services: 
  2.26     (i) an annual clinical preventive medical history and 
  2.27  physical examination that may include tests and services from 
  2.28  clause (ii) and patient education to address preventive health 
  2.29  care measures; 
  2.30     (ii) any one or a combination of the following preventive 
  2.31  screening tests or preventive services, the frequency of which 
  2.32  is considered medically appropriate: 
  2.33     (A) fecal occult blood test and/or digital rectal 
  2.34  examination; 
  2.35     (B) dipstick urinalysis for hematuria, bacteriuria, and 
  2.36  proteinuria; 
  3.1      (C) pure tone (air only) hearing screening test, 
  3.2   administered or ordered by a physician; 
  3.3      (D) serum cholesterol screening every five years; 
  3.4      (E) thyroid function test; 
  3.5      (F) diabetes screening; 
  3.6      (iii) any other tests or preventive measures determined 
  3.7   appropriate by the attending physician. 
  3.8      Reimbursement shall be for the actual charges up to 100 
  3.9   percent of the Medicare-approved amount for each service, as if 
  3.10  Medicare were to cover the service as identified in American 
  3.11  Medical Association current procedural terminology (AMA CPT) 
  3.12  codes, to a maximum of $120 annually under this benefit.  This 
  3.13  benefit shall not include payment for a procedure covered by 
  3.14  Medicare; 
  3.15     (6) coverage for services to provide short-term at-home 
  3.16  assistance with activities of daily living for those recovering 
  3.17  from an illness, injury, or surgery: 
  3.18     (i) For purposes of this benefit, the following definitions 
  3.19  apply: 
  3.20     (A) "activities of daily living" include, but are not 
  3.21  limited to, bathing, dressing, personal hygiene, transferring, 
  3.22  eating, ambulating, assistance with drugs that are normally 
  3.23  self-administered, and changing bandages or other dressings; 
  3.24     (B) "care provider" means a duly qualified or licensed home 
  3.25  health aide/homemaker, personal care aid, or nurse provided 
  3.26  through a licensed home health care agency or referred by a 
  3.27  licensed referral agency or licensed nurses registry; 
  3.28     (C) "home" means a place used by the insured as a place of 
  3.29  residence, provided that the place would qualify as a residence 
  3.30  for home health care services covered by Medicare.  A hospital 
  3.31  or skilled nursing facility shall not be considered the 
  3.32  insured's place of residence; 
  3.33     (D) "at-home recovery visit" means the period of a visit 
  3.34  required to provide at-home recovery care, without limit on the 
  3.35  duration of the visit, except each consecutive four hours in a 
  3.36  24-hour period of services provided by a care provider is one 
  4.1   visit; 
  4.2      (ii) Coverage requirements and limitations: 
  4.3      (A) at-home recovery services provided must be primarily 
  4.4   services that assist in activities of daily living; 
  4.5      (B) the insured's attending physician must certify that the 
  4.6   specific type and frequency of at-home recovery services are 
  4.7   necessary because of a condition for which a home care plan of 
  4.8   treatment was approved by Medicare; 
  4.9      (C) coverage is limited to: 
  4.10     (I) no more than the number and type of at-home recovery 
  4.11  visits certified as necessary by the insured's attending 
  4.12  physician.  The total number of at-home recovery visits shall 
  4.13  not exceed the number of Medicare-approved home care visits 
  4.14  under a Medicare-approved home care plan of treatment; 
  4.15     (II) the actual charges for each visit up to a maximum 
  4.16  reimbursement of $40 per visit; 
  4.17     (III) $1,600 per calendar year; 
  4.18     (IV) seven visits in any one week; 
  4.19     (V) care furnished on a visiting basis in the insured's 
  4.20  home; 
  4.21     (VI) services provided by a care provider as defined in 
  4.22  this section; 
  4.23     (VII) at-home recovery visits while the insured is covered 
  4.24  under the policy or certificate and not otherwise excluded; 
  4.25     (VIII) at-home recovery visits received during the period 
  4.26  the insured is receiving Medicare-approved home care services or 
  4.27  no more than eight weeks after the service date of the last 
  4.28  Medicare-approved home health care visit; 
  4.29     (iii) Coverage is excluded for: 
  4.30     (A) home care visits paid for by Medicare or other 
  4.31  government programs; and 
  4.32     (B) care provided by family members, unpaid volunteers, or 
  4.33  providers who are not care providers; 
  4.34     (7) coverage for at least 50 percent, or the equivalent of 
  4.35  50 percent, of usual and customary prescription drug expenses to 
  4.36  a maximum of $1,200 paid by the issuer annually under this 
  5.1   benefit.  An issuer of Medicare supplement insurance policies 
  5.2   that elects to offer this benefit rider shall also make 
  5.3   available coverage that contains the rider specified in clause 
  5.4   (4). 
  5.5      Sec. 2.  Minnesota Statutes 1996, section 62E.12, is 
  5.6   amended to read: 
  5.7      62E.12 [MINIMUM BENEFITS OF COMPREHENSIVE HEALTH INSURANCE 
  5.8   PLAN.] 
  5.9      The association through its comprehensive health insurance 
  5.10  plan shall offer policies which provide the benefits of a number 
  5.11  one qualified plan and a number two qualified plan, except that 
  5.12  the maximum lifetime benefit on these plans shall be 
  5.13  $1,500,000 $2,000,000, and an extended basic plan and a basic 
  5.14  Medicare plan as described in sections 62A.31 to 62A.44 and 
  5.15  62E.07.  The requirement that a policy issued by the association 
  5.16  must be a qualified plan is satisfied if the association 
  5.17  contracts with a preferred provider network and the level of 
  5.18  benefits for services provided within the network satisfies the 
  5.19  requirements of a qualified plan.  If the association uses a 
  5.20  preferred provider network, payments to nonparticipating 
  5.21  providers must meet the minimum requirements of section 72A.20, 
  5.22  subdivision 15.  They shall offer health maintenance 
  5.23  organization contracts in those areas of the state where a 
  5.24  health maintenance organization has agreed to make the coverage 
  5.25  available and has been selected as a writing carrier.  
  5.26  Notwithstanding the provisions of section 62E.06 and unless 
  5.27  those charges are billed by a provider that is part of the 
  5.28  association's preferred provider network, the state plan shall 
  5.29  exclude coverage of services of a private duty nurse other than 
  5.30  on an inpatient basis and any charges for treatment in a 
  5.31  hospital located outside of the state of Minnesota in which the 
  5.32  covered person is receiving treatment for a mental or nervous 
  5.33  disorder, unless similar treatment for the mental or nervous 
  5.34  disorder is medically necessary, unavailable in Minnesota and 
  5.35  provided upon referral by a licensed Minnesota medical 
  5.36  practitioner. 
  6.1      Sec. 3.  [EFFECTIVE DATE.] 
  6.2      Section 1 is effective for policies issued or renewed after 
  6.3   January 1, 1999.  Section 2 is effective the day following final 
  6.4   enactment.