1.1 	A bill for an act
1.2 	relating to insurance; regulating coverage for prenatal care services and 
1.3 	continuation coverage upon divorce; shifting regulatory authority over health 
1.4 	maintenance organizations from the commissioner of health to the commissioner 
1.5 	of commerce;amending Minnesota Statutes 2010, sections 62A.047; 62A.21, 
1.6 	subdivision 2a; 62D.02, subdivision 3; 62D.05, subdivision 6; 62D.101, 
1.7 	subdivision 2a; 62D.12, subdivision 1.
1.8 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.9 	Section 1. Minnesota Statutes 2010, section 62A.047, is amended to read:
1.10 	62A.047 CHILDREN'S HEALTH SUPERVISION SERVICES AND 
1.11 	PRENATAL CARE SERVICES.
1.12 	A policy of individual or group health and accident insurance regulated under this 
1.13 	chapter, or individual or group subscriber contract regulated under chapter 62C, health 
1.14 	maintenance contract regulated under chapter 62D, or health benefit certificate regulated 
1.15 	under chapter 64B, issued, renewed, or continued to provide coverage to a Minnesota 
1.16 	resident, must provide coverage for child health supervision services and prenatal care 
1.17 	services. The policy, contract, or certificate must specifically exempt reasonable and 
1.18 	customary charges for child health supervision services and prenatal care services from a 
1.19 	deductible, co-payment, or other coinsurance or dollar limitation requirement. Nothing 
1.20 	in this section prohibits a health plan company that has a network of providers from 
1.21 	imposing a deductible, co-payment, or other coinsurance or dollar limitation requirement 
1.22 	for child health supervision services and prenatal care services that are delivered by an 
1.23 	out-of-network provider. This section does not prohibit the use of policy waiting periods 
1.24 	or preexisting condition limitations for these services. Minimum benefits may be limited 
1.25 	to one visit payable to one provider for all of the services provided at each visit cited in 
2.1 	this section subject to the schedule set forth in this section. Nothing in this section applies 
2.2 	to a commercial health insurance policy issued as a companion to a health maintenance 
2.3 	organization contract, a policy designed primarily to provide coverage payable on a 
2.4 	per diem, fixed indemnity, or nonexpense incurred basis, or a policy that provides 
2.5 	only accident coverage Nothing in this section prevents a health plan company from 
2.6 	using reasonable medical management techniques to determine the frequency, method, 
2.7 	treatment, or setting for child health supervision services and prenatal care services.
2.8 	"Child health supervision services" means pediatric preventive services, appropriate 
2.9 	immunizations, developmental assessments, and laboratory services appropriate to the age 
2.10 	of a child from birth to age six, and appropriate immunizations from ages six to 18, as 
2.11 	defined by Standards of Child Health Care issued by the American Academy of Pediatrics. 
2.12 	Reimbursement must be made for at least five child health supervision visits from birth 
2.13 	to 12 months, three child health supervision visits from 12 months to 24 months, once a 
2.14 	year from 24 months to 72 months.
2.15 	"Prenatal care services" means the comprehensive package of medical and 
2.16 	psychosocial support provided throughout the pregnancy, including risk assessment, 
2.17 	serial surveillance, prenatal education, and use of specialized skills and technology, 
2.18 	when needed, as defined by Standards for Obstetric-Gynecologic Services issued by the 
2.19 	American College of Obstetricians and Gynecologists.

2.20 	Sec. 2. Minnesota Statutes 2010, section 62A.21, subdivision 2a, is amended to read:
2.21 		Subd. 2a.Continuation privilege. Every policy described in subdivision 1 shall 
2.22 	contain a provision which permits continuation of coverage under the policy for the 
2.23 	insured's former spouse and dependent children upon entry of a valid decree of dissolution 
2.24 	of marriage. The coverage shall be continued until the earlier of the following dates:
2.25 	(a) the date the insured's former spouse becomes covered under any other group 
2.26 	health plan; or
2.27 	(b) the date coverage would otherwise terminate under the policy.
2.28 	If the coverage is provided under a group policy, any required premium contributions 
2.29 	for the coverage shall be paid by the insured on a monthly basis to the group policyholder 
2.30 	for remittance to the insurer. The policy must require the group policyholder to, upon 
2.31 	request, provide the insured with written verification from the insurer of the cost of this 
2.32 	coverage promptly at the time of eligibility for this coverage and at any time during 
2.33 	the continuation period. In no event shall the amount of premium charged exceed 102 
2.34 	percent of the cost to the plan for such period of coverage for other similarly situated 
2.35 	spouses and dependent children with respect to whom the marital relationship has not 
3.1 	dissolved, without regard to whether such cost is paid by the employer or employee The 
3.2 	required premium amount for continuation of the coverage shall be calculated in the same 
3.3 	manner as provided under section 4980B of the Internal Revenue Code, its implementing 
3.4 	regulations and Internal Revenue Service rulings on section 4980B.
3.5 	Upon request by the insured's former spouse or dependent child, a health carrier 
3.6 	must provide the instructions necessary to enable the child or former spouse to elect 
3.7 	continuation of coverage.

3.8 	Sec. 3. Minnesota Statutes 2010, section 62D.02, subdivision 3, is amended to read:
3.9 		Subd. 3.Commissioner of health commerce or commissioner. "Commissioner of 
3.10 	health commerce" or "commissioner" means the state commissioner of health commerce
3.11 	or a designee.

3.12 	Sec. 4. Minnesota Statutes 2010, section 62D.05, subdivision 6, is amended to read:
3.13 		Subd. 6.Supplemental benefits. (a) A health maintenance organization may, as 
3.14 	a supplemental benefit, provide coverage to its enrollees for health care services and 
3.15 	supplies received from providers who are not employed by, under contract with, or 
3.16 	otherwise affiliated with the health maintenance organization. Supplemental benefits may 
3.17 	be provided if the following conditions are met:
3.18 	(1) a health maintenance organization desiring to offer supplemental benefits must at 
3.19 	all times comply with the requirements of sections 62D.041 and 62D.042;
3.20 	(2) a health maintenance organization offering supplemental benefits must maintain 
3.21 	an additional surplus in the first year supplemental benefits are offered equal to the 
3.22 	lesser of $500,000 or 33 percent of the supplemental benefit expenses. At the end of 
3.23 	the second year supplemental benefits are offered, the health maintenance organization 
3.24 	must maintain an additional surplus equal to the lesser of $1,000,000 or 33 percent of the 
3.25 	supplemental benefit expenses. At the end of the third year benefits are offered and every 
3.26 	year after that, the health maintenance organization must maintain an additional surplus 
3.27 	equal to the greater of $1,000,000 or 33 percent of the supplemental benefit expenses. 
3.28 	When in the judgment of the commissioner the health maintenance organization's surplus 
3.29 	is inadequate, the commissioner may require the health maintenance organization to 
3.30 	maintain additional surplus;
3.31 	(3) claims relating to supplemental benefits must be processed in accordance with 
3.32 	the requirements of section 72A.201; and
3.33 	(4) in marketing supplemental benefits, the health maintenance organization shall 
3.34 	fully disclose and describe to enrollees and potential enrollees the nature and extent of the 
4.1 	supplemental coverage, and any claims filing and other administrative responsibilities in 
4.2 	regard to supplemental benefits.
4.3 	(b) The commissioner may, pursuant to chapter 14, adopt, enforce, and administer 
4.4 	rules relating to this subdivision, including: rules insuring that these benefits are 
4.5 	supplementary and not substitutes for comprehensive health maintenance services by 
4.6 	addressing percentage of out-of-plan coverage; rules relating to the establishment of 
4.7 	necessary financial reserves; rules relating to marketing practices; and other rules necessary 
4.8 	for the effective and efficient administration of this subdivision. The commissioner, in 
4.9 	adopting rules, shall give consideration to existing laws and rules administered and 
4.10 	enforced by the Department of Commerce relating to health insurance plans.

4.11 	Sec. 5. Minnesota Statutes 2010, section 62D.101, subdivision 2a, is amended to read:
4.12 		Subd. 2a.Continuation privilege. Every health maintenance contract as described 
4.13 	in subdivision 1 shall contain a provision which permits continuation of coverage under 
4.14 	the contract for the enrollee's former spouse and children upon entry of a valid decree of 
4.15 	dissolution of marriage. The coverage shall be continued until the earlier of the following 
4.16 	dates:
4.17 	(a) the date the enrollee's former spouse becomes covered under another group 
4.18 	plan or Medicare; or
4.19 	(b) the date coverage would otherwise terminate under the health maintenance 
4.20 	contract.
4.21 	If coverage is provided under a group policy, any required premium contributions 
4.22 	for the coverage shall be paid by the enrollee on a monthly basis to the group contract 
4.23 	holder to be paid to the health maintenance organization. The contract must require the 
4.24 	group contract holder to, upon request, provide the enrollee with written verification from 
4.25 	the insurer of the cost of this coverage promptly at the time of eligibility for this coverage 
4.26 	and at any time during the continuation period. In no event shall the fee charged exceed 
4.27 	102 percent of the cost to the plan for the period of coverage for other similarly situated 
4.28 	spouses and dependent children when the marital relationship has not dissolved, regardless 
4.29 	of whether the cost is paid by the employer or employee The required premium amount 
4.30 	for continuation of the coverage shall be calculated in the same manner as provided under 
4.31 	section 4980B in the Internal Revenue Code, its implementing regulations and Internal 
4.32 	Revenue Service rulings on section 4980B.

4.33 	Sec. 6. Minnesota Statutes 2010, section 62D.12, subdivision 1, is amended to read:
5.1 		Subdivision 1.False representations. No health maintenance organization or 
5.2 	representative thereof may cause or knowingly permit the use of advertising or solicitation 
5.3 	which is untrue or misleading, or any form of evidence of coverage which is deceptive. 
5.4 	Each health maintenance organization shall be subject to sections 72A.17 to 72A.32, 
5.5 	relating to the regulation of trade practices, except (a) to the extent that the nature of a 
5.6 	health maintenance organization renders such sections clearly inappropriate and (b) that 
5.7 	enforcement shall be by the commissioner of health and not by the commissioner of 
5.8 	commerce. Every health maintenance organization shall be subject to sections 8.31 and 
5.9 	325F.69.

5.10 	Sec. 7. REVISOR'S INSTRUCTION.
 5.11 	The revisor of statutes shall, in conforming with section 3, change the terms 
5.12 	"commissioner of health" or similar term to "commissioner of commerce" or similar term 
5.13 	and "department of health" or similar term to "department of commerce" or similar term in 
5.14 	each place it occurs in Minnesota Statutes, chapter 62D.

5.15 	Sec. 8. EFFECTIVE DATE.
 5.16 	Sections 1 to 7 are effective August 1, 2012.