1.1                          A bill for an act 
  1.2             relating to health; health maintenance organizations; 
  1.3             authorizing various cost-sharing provisions in 
  1.4             contracts; amending Minnesota Statutes 2000, section 
  1.5             62D.02, subdivision 8. 
  1.6   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.7      Section 1.  Minnesota Statutes 2000, section 62D.02, 
  1.8   subdivision 8, is amended to read: 
  1.9      Subd. 8.  [HEALTH MAINTENANCE CONTRACT.] "Health 
  1.10  maintenance contract" means any contract whereby a health 
  1.11  maintenance organization agrees to provide comprehensive health 
  1.12  maintenance services to enrollees, provided that the contract 
  1.13  may contain reasonable enrollee copayment cost-sharing 
  1.14  provisions.  An individual or group health maintenance contract 
  1.15  may contain the copayment and deductible provisions specified in 
  1.16  this subdivision.  Copayment and deductible provisions in group 
  1.17  contracts shall not discriminate on the basis of age, sex, race, 
  1.18  length of enrollment in the plan, or economic status; and during 
  1.19  every open enrollment period in which all offered health benefit 
  1.20  plans, including those subject to the jurisdiction of the 
  1.21  commissioners of commerce or health, fully participate without 
  1.22  any underwriting restrictions, copayment and deductible 
  1.23  provisions shall not discriminate on the basis of preexisting 
  1.24  health status.  In no event shall the sum of the annual 
  1.25  copayments and deductible exceed the maximum out-of-pocket 
  2.1   expenses allowable for a number three qualified plan under 
  2.2   section 62E.06, nor shall that sum exceed $5,000 per family.  
  2.3   The annual deductible must not exceed $1,000 $5,000 per person 
  2.4   or $10,000 per family.  The annual deductible must not apply to 
  2.5   preventive health services as described in Minnesota Rules, part 
  2.6   4685.0801, subpart 8.  Where sections 62D.01 to 62D.30 permit a 
  2.7   health maintenance organization to contain reasonable copayment 
  2.8   provisions for preexisting health status, these provisions may 
  2.9   vary with respect to length of enrollment in the plan.  A health 
  2.10  maintenance organization may impose coinsurance, expressed as 
  2.11  percentages or flat fee copayments, up to a maximum of 50 
  2.12  percent of the provider amount paid at the time the claim is 
  2.13  processed.  A health maintenance organization shall provide for 
  2.14  an out-of-pocket maximum on enrollee cost-sharing up to $8,000 
  2.15  per person per year on group health plans and up to $15,000 per 
  2.16  person per year on individual health plans.  Any contract may 
  2.17  provide for health care services in addition to those set forth 
  2.18  in subdivision 7.