<a id="pl.1.3"></a><var>1.3</var>conforming state law to federal requirements; establishing health plan market <br/>
<a id="pl.1.4"></a><var>1.4</var>rules; modifying the designation of essential community providers;amending <br/>
<a id="pl.1.5"></a><var>1.5</var>Minnesota Statutes 2012, sections 43A.23, subdivision 1; 43A.317, subdivision <br/>
<a id="pl.1.6"></a><var>1.6</var>6; 60A.08, subdivision 15; 62A.011, subdivision 3, by adding subdivisions; <br/>
<a id="pl.1.7"></a><var>1.7</var>62A.02, by adding a subdivision; 62A.03, subdivision 1; 62A.04, subdivision <br/>
<a id="pl.1.8"></a><var>1.8</var>2; 62A.047; 62A.049; 62A.136; 62A.149, subdivision 1; 62A.17, subdivisions <br/>
<a id="pl.1.9"></a><var>1.9</var>2, 6; 62A.21, subdivision 2b; 62A.28, subdivision 2; 62A.302; 62A.615; <br/>
<a id="pl.1.10"></a><var>1.10</var>62A.65, subdivisions 3, 5, 6, 7, by adding subdivisions; 62C.14, subdivision 5; <br/>
<a id="pl.1.11"></a><var>1.11</var>62C.142, subdivision 2; 62D.07, subdivision 3; 62D.095; 62D.124, subdivision <br/>
<a id="pl.1.12"></a><var>1.12</var>4; 62D.181, subdivision 7; 62E.02, by adding a subdivision; 62E.04, subdivision <br/>
<a id="pl.1.13"></a><var>1.13</var>4, by adding a subdivision; 62E.06, subdivision 1; 62E.09; 62E.10, subdivision <br/>
<a id="pl.1.14"></a><var>1.14</var>7; 62H.04; 62L.02, subdivisions 11, 14a, 26, by adding a subdivision; 62L.03, <br/>
<a id="pl.1.15"></a><var>1.15</var>subdivisions 1, 3, 4, 6; 62L.045, subdivisions 2, 4; 62L.05, subdivision 10; <br/>
<a id="pl.1.16"></a><var>1.16</var>62L.06; 62L.08; 62L.12, subdivision 2; 62M.05, subdivision 3a; 62M.06, <br/>
<a id="pl.1.17"></a><var>1.17</var>subdivision 1; 62Q.01, by adding subdivisions; 62Q.021; 62Q.17, subdivision <br/>
<a id="pl.1.18"></a><var>1.18</var>6; 62Q.18, by adding a subdivision; 62Q.23; 62Q.43, subdivision 2; 62Q.47; <br/>
<a id="pl.1.19"></a><var>1.19</var>62Q.52; 62Q.55; 62Q.68, subdivision 1; 62Q.69, subdivision 3; 62Q.70, <br/>
<a id="pl.1.20"></a><var>1.20</var>subdivisions 1, 2; 62Q.71; 62Q.73; 62Q.75, subdivision 1; 62Q.80, subdivision <br/>
<a id="pl.1.21"></a><var>1.21</var>2; 72A.20, subdivision 35; 145.414; 471.61, subdivision 1a; proposing coding <br/>
<a id="pl.1.22"></a><var>1.22</var>for new law in Minnesota Statutes, chapters 62A; 62Q; proposing coding for new <br/>
<a id="pl.1.23"></a><var>1.23</var>law as Minnesota Statutes, chapter 62K; repealing Minnesota Statutes 2012, <br/>
<a id="pl.1.24"></a><var>1.24</var>sections 62A.615; 62A.65, subdivision 6; 62E.02, subdivision 7; 62E.16; 62E.20; <br/>
<a id="pl.1.25"></a><var>1.25</var>62L.02, subdivisions 4, 18, 19, 23, 24; 62L.05, subdivisions 1, 2, 3, 4, 4a, 5, 6, 7, <br/>
<a id="pl.1.26"></a><var>1.26</var>11, 12, 13; 62L.081; 62L.10, subdivision 5; 62Q.37, subdivision 5.<br/>
<a id="pl.1.27"></a><var>1.27</var>BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:<br/>
<br/>
<a id="bill.1.0.0"></a>

<a id="bill.1.1.0"></a><a id="pl.1.30"></a><var>1.30</var>    Section 1. Minnesota Statutes 2012, section 43A.23, subdivision 1, is amended to read:<br/>
<a id="pl.1.31"></a><var>1.31</var>    Subdivision 1. <b>General.</b> (a) The commissioner is authorized to request proposals <br/>
<a id="pl.1.32"></a><var>1.32</var>or to negotiate and to enter into contracts with parties which in the judgment of the <br/>
<a id="pl.2.1"></a><var>2.1</var>commissioner are best qualified to provide service to the benefit plans. Contracts entered <br/>
<a id="pl.2.2"></a><var>2.2</var>into are not subject to the requirements of sections 
         <statute_ref>16C.16</statute_ref> to 
         <statute_ref>16C.19</statute_ref>. The commissioner <br/>
<a id="pl.2.3"></a><var>2.3</var>may negotiate premium rates and coverage. The commissioner shall consider the cost of <br/>
<a id="pl.2.4"></a><var>2.4</var>the plans, conversion options relating to the contracts, service capabilities, character, <br/>
<a id="pl.2.5"></a><var>2.5</var>financial position, and reputation of the carriers, and any other factors which the <br/>
<a id="pl.2.6"></a><var>2.6</var>commissioner deems appropriate. Each benefit contract must be for a uniform term of at <br/>
<a id="pl.2.7"></a><var>2.7</var>least one year, but may be made automatically renewable from term to term in the absence <br/>
<a id="pl.2.8"></a><var>2.8</var>of notice of termination by either party. A carrier licensed under chapter 62A is exempt <br/>
<a id="pl.2.9"></a><var>2.9</var>from the taxes imposed by chapter 297I on premiums paid to it by the state.<br/>
<a id="pl.2.10"></a><var>2.10</var>    (b) All self-insured hospital and medical service products must comply with coverage <br/>
<a id="pl.2.11"></a><var>2.11</var>mandates, data reporting, and consumer protection requirements applicable to the licensed <br/>
<a id="pl.2.12"></a><var>2.12</var>carrier administering the product, had the product been insured, including chapters 62J, <br/>
<a id="pl.2.13"></a><var>2.13</var>62M, and 62Q. Any self-insured products that limit coverage to a network of providers <br/>
<a id="pl.2.14"></a><var>2.14</var>or provide different levels of coverage between network and nonnetwork providers shall <br/>
<a id="pl.2.15"></a><var>2.15</var>comply with section 
         <statute_ref>62D.123</statute_ref> and geographic access standards for health maintenance <br/>
<a id="pl.2.16"></a><var>2.16</var>organizations adopted by the commissioner of health in rule under chapter 62D.<br/>
<a id="pl.2.17"></a><var>2.17</var>    (c) Notwithstanding paragraph (b), a self-insured hospital and medical product <br/>
<a id="pl.2.18"></a><var>2.18</var>offered under sections 
         <statute_ref>43A.22</statute_ref> to 
         <statute_ref>43A.30</statute_ref> is not required to extend dependent coverage <br/>
<a id="pl.2.19"></a><var>2.19</var>to an eligible employee's unmarried child under the age of 25 to the full extent required <br/>
<a id="pl.2.20"></a><var>2.20</var>under chapters 62A and 62L. Dependent child coverage must, at a minimum, extend to an <br/>
<a id="pl.2.21"></a><var>2.21</var>eligible employee's unmarried dependent child who is under the age of 19 or an unmarried <br/>
<a id="pl.2.22"></a><var>2.22</var>child under the age of 25 who is a full-time student. A person who is at least 19 years of <br/>
<a id="pl.2.23"></a><var>2.23</var>age but who is under the age of 25 and who is not a full-time student must be permitted <br/>
<a id="pl.2.24"></a><var>2.24</var>to be enrolled as a dependent of an eligible employee until age 25 if the person: to the <br/>
<a id="pl.2.25"></a><var>2.25</var>limiting age as defined in section 62Q.01, subdivision 9, disabled children to the extent <br/>
<a id="pl.2.26"></a><var>2.26</var>required in sections 62A.14 and 62A.141, and dependent grandchildren to the extent <br/>
<a id="pl.2.27"></a><var>2.27</var>required in sections 62A.042 and 62A.302.<br/>
<a id="pl.2.28"></a><var>2.28</var>(1) was a full-time student immediately prior to being ordered into active military <br/>
<a id="pl.2.29"></a><var>2.29</var>service, as defined in section 
<statute_ref>190.05, subdivision 5b</statute_ref> or 5c;<br/>
<a id="pl.2.30"></a><var>2.30</var>(2) has been separated or discharged from active military service; and<br/>
<a id="pl.2.31"></a><var>2.31</var>(3) would be eligible to enroll as a dependent of an eligible employee, except that <br/>
<a id="pl.2.32"></a><var>2.32</var>the person is not a full-time student.<br/>
<a id="pl.2.33"></a><var>2.33</var>The definition of "full-time student" for purposes of this paragraph includes any student <br/>
<a id="pl.2.34"></a><var>2.34</var>who by reason of illness, injury, or physical or mental disability as documented by <br/>
<a id="pl.2.35"></a><var>2.35</var>a physician is unable to carry what the educational institution considers a full-time <br/>
<a id="pl.2.36"></a><var>2.36</var>course load so long as the student's course load is at least 60 percent of what otherwise <br/>
<a id="pl.3.1"></a><var>3.1</var>is considered by the institution to be a full-time course load. Any notice regarding <br/>
<a id="pl.3.2"></a><var>3.2</var>termination of coverage due to attainment of the limiting age must include information <br/>
<a id="pl.3.3"></a><var>3.3</var>about this definition of "full-time student."<br/>
<a id="pl.3.4"></a><var>3.4</var>    (d) Beginning January 1, 2010, the health insurance benefit plans offered in the <br/>
<a id="pl.3.5"></a><var>3.5</var>commissioner's plan under section 
         <statute_ref>43A.18, subdivision 2</statute_ref>, and the managerial plan under <br/>
<a id="pl.3.6"></a><var>3.6</var>section 
         <statute_ref>43A.18, subdivision 3</statute_ref>, must include an option for a health plan that is compatible <br/>
<a id="pl.3.7"></a><var>3.7</var>with the definition of a high-deductible health plan in section 223 of the United States <br/>
<a id="pl.3.8"></a><var>3.8</var>Internal Revenue Code.<br/>
<a id="pl.3.9"></a><var>3.9</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.2.0"></a><a id="pl.3.10"></a><var>3.10</var>    Sec. 2. Minnesota Statutes 2012, section 43A.317, subdivision 6, is amended to read:<br/>
<a id="pl.3.11"></a><var>3.11</var>    Subd. 6. <b>Individual eligibility.</b> (a) <b>Procedures.</b> The commissioner shall establish <br/>
<a id="pl.3.12"></a><var>3.12</var>procedures for eligible employees and other eligible individuals to apply for coverage <br/>
<a id="pl.3.13"></a><var>3.13</var>through the program.<br/>
<a id="pl.3.14"></a><var>3.14</var>(b) <b>Employees.</b> An employer shall determine when it applies to the program the <br/>
<a id="pl.3.15"></a><var>3.15</var>criteria its employees must meet to be eligible for coverage under its plan. An employer <br/>
<a id="pl.3.16"></a><var>3.16</var>may subsequently change the criteria annually or at other times with approval of the <br/>
<a id="pl.3.17"></a><var>3.17</var>commissioner. The criteria must provide that new employees become eligible for coverage <br/>
<a id="pl.3.18"></a><var>3.18</var>after a probationary period of at least 30 days, but no more than 90 days.<br/>
<a id="pl.3.19"></a><var>3.19</var>(c) <b>Other individuals.</b> An employer may elect to cover under its plan:<br/>
<a id="pl.3.20"></a><var>3.20</var>(1) the spouse, dependent children to the limiting age as defined in section 62Q.01, <br/>
<a id="pl.3.21"></a><var>3.21</var>subdivision 9, disabled children to the extent required in sections 62A.14 and 62A.141, <br/>
<a id="pl.3.22"></a><var>3.22</var>and dependent grandchildren of a covered employee to the extent required in sections <br/>
<a id="pl.3.23"></a><var>3.23</var>62A.042 and 62A.302;<br/>
<a id="pl.3.24"></a><var>3.24</var>(2) a retiree who is eligible to receive a pension or annuity from the employer and a <br/>
<a id="pl.3.25"></a><var>3.25</var>covered retiree's spouse, dependent children to the limiting age as defined in section <br/>
<a id="pl.3.26"></a><var>3.26</var>62Q.01, subdivision 9, disabled children to the extent required in sections 62A.14 and <br/>
<a id="pl.3.27"></a><var>3.27</var>62A.141, and dependent grandchildren to the extent required in sections 62A.042 and <br/>
<a id="pl.3.28"></a><var>3.28</var>62A.302;<br/>
<a id="pl.3.29"></a><var>3.29</var>(3) the surviving spouse, dependent children to the limiting age as defined in section <br/>
<a id="pl.3.30"></a><var>3.30</var>62Q.01, subdivision 9, disabled children, and dependent grandchildren of a deceased <br/>
<a id="pl.3.31"></a><var>3.31</var>employee or retiree, if the spouse, children, or grandchildren were covered at the time of <br/>
<a id="pl.3.32"></a><var>3.32</var>the death;<br/>
<a id="pl.3.33"></a><var>3.33</var>(4) a covered employee who becomes disabled, as provided in sections 
         <statute_ref>62A.147</statute_ref> <br/>
<a id="pl.3.34"></a><var>3.34</var>and 
         <statute_ref>62A.148</statute_ref>; or<br/>
<a id="pl.4.1"></a><var>4.1</var>(5) any other categories of individuals for whom group coverage is required by <br/>
<a id="pl.4.2"></a><var>4.2</var>state or federal law.<br/>
<a id="pl.4.3"></a><var>4.3</var>An employer shall determine when it applies to the program the criteria individuals <br/>
<a id="pl.4.4"></a><var>4.4</var>in these categories must meet to be eligible for coverage. An employer may subsequently <br/>
<a id="pl.4.5"></a><var>4.5</var>change the criteria annually, or at other times with approval of the commissioner. The <br/>
<a id="pl.4.6"></a><var>4.6</var>criteria for dependent children to the limiting age as defined in section 62Q.01, subdivision <br/>
<a id="pl.4.7"></a><var>4.7</var>9, disabled children, and dependent grandchildren may be no more inclusive than the <br/>
<a id="pl.4.8"></a><var>4.8</var>criteria under section 
         <statute_ref>43A.18, subdivision 2</statute_ref>. This paragraph shall not be interpreted <br/>
<a id="pl.4.9"></a><var>4.9</var>as relieving the program from compliance with any federal and state continuation of <br/>
<a id="pl.4.10"></a><var>4.10</var>coverage requirements.<br/>
<a id="pl.4.11"></a><var>4.11</var>(d) <b>Waiver and late entrance.</b> An eligible individual may waive coverage at the <br/>
<a id="pl.4.12"></a><var>4.12</var>time the employer joins the program or when coverage first becomes available. The <br/>
<a id="pl.4.13"></a><var>4.13</var>commissioner may establish a preexisting condition exclusion of not more than 18 months <br/>
<a id="pl.4.14"></a><var>4.14</var>for late entrants as defined in section 
         <statute_ref>62L.02, subdivision 19</statute_ref>.<br/>
<a id="pl.4.15"></a><var>4.15</var>(e) <b>Continuation coverage.</b> The program shall provide all continuation coverage <br/>
<a id="pl.4.16"></a><var>4.16</var>required by state and federal law.<br/>
<a id="pl.4.17"></a><var>4.17</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.3.0"></a><a id="pl.4.18"></a><var>4.18</var>    Sec. 3. Minnesota Statutes 2012, section 60A.08, subdivision 15, is amended to read:<br/>
<a id="pl.4.19"></a><var>4.19</var>    Subd. 15. <b>Classification of insurance filings data.</b> (a) All forms, rates, and related <br/>
<a id="pl.4.20"></a><var>4.20</var>information filed with the commissioner under section 
         <statute_ref>61A.02</statute_ref> shall be nonpublic data <br/>
<a id="pl.4.21"></a><var>4.21</var>until the filing becomes effective.<br/>
<a id="pl.4.22"></a><var>4.22</var>    (b) All forms, rates, and related information filed with the commissioner under <br/>
<a id="pl.4.23"></a><var>4.23</var>section 
         <statute_ref>62A.02</statute_ref> shall be nonpublic data until the filing becomes effective.<br/>
<a id="pl.4.24"></a><var>4.24</var>    (c) All forms, rates, and related information filed with the commissioner under <br/>
<a id="pl.4.25"></a><var>4.25</var>section 
         <statute_ref>62C.14, subdivision 10</statute_ref>, shall be nonpublic data until the filing becomes effective.<br/>
<a id="pl.4.26"></a><var>4.26</var>    (d) All forms, rates, and related information filed with the commissioner under <br/>
<a id="pl.4.27"></a><var>4.27</var>section 
         <statute_ref>70A.06</statute_ref> shall be nonpublic data until the filing becomes effective.<br/>
<a id="pl.4.28"></a><var>4.28</var>    (e) All forms, rates, and related information filed with the commissioner under <br/>
<a id="pl.4.29"></a><var>4.29</var>section 
         <statute_ref>79.56</statute_ref> shall be nonpublic data until the filing becomes effective.<br/>
<a id="pl.4.30"></a><var>4.30</var>(f) Notwithstanding paragraphs (b) and (c), for all rate increases subject to review <br/>
<a id="pl.4.31"></a><var>4.31</var>under section 2794 of the Public Health Services Act and any amendments to, or <br/>
<a id="pl.4.32"></a><var>4.32</var>regulations, or guidance issued under the act that are filed with the commissioner on or <br/>
<a id="pl.4.33"></a><var>4.33</var>after September 1, 2011, the commissioner: <br/>
<a id="pl.4.34"></a><var>4.34</var>(1) may acknowledge receipt of the information;<br/>
<a id="pl.4.35"></a><var>4.35</var>(2) may acknowledge that the corresponding rate filing is pending review;<br/>
<a id="pl.5.1"></a><var>5.1</var>(3) must provide public access from the Department of Commerce's Web site to parts <br/>
<a id="pl.5.2"></a><var>5.2</var>I and II of the Preliminary Justifications of the rate increases subject to review; and<br/>
<a id="pl.5.3"></a><var>5.3</var>(4) must provide notice to the public on the Department of Commerce's Web site of the <br/>
<a id="pl.5.4"></a><var>5.4</var>review of the proposed rate, which must include a statement that the public has 30 calendar <br/>
<a id="pl.5.5"></a><var>5.5</var>days to submit written comments to the commissioner on the rate filing subject to review. <br/>
<a id="pl.5.6"></a><var>5.6</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.4.0"></a><a id="pl.5.7"></a><var>5.7</var>    Sec. 4. Minnesota Statutes 2012, section 62A.011, is amended by adding a subdivision <br/>
<a id="pl.5.8"></a><var>5.8</var>to read:<br/>
<a id="pl.5.9"></a><var>5.9</var>    Subd. 1a. <b>Affordable Care Act.</b> "Affordable Care Act" means the federal Patient <br/>
<a id="pl.5.10"></a><var>5.10</var>Protection and Affordable Care Act, Public Law 111-148, as amended, including the <br/>
<a id="pl.5.11"></a><var>5.11</var>federal Health Care and Education Reconciliation Act of 2010, Public Law 111-152, and <br/>
<a id="pl.5.12"></a><var>5.12</var>any amendments to, and any federal guidance or regulations issued under, these acts.<br/>
<a id="pl.5.13"></a><var>5.13</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.5.0"></a><a id="pl.5.14"></a><var>5.14</var>    Sec. 5. Minnesota Statutes 2012, section 62A.011, is amended by adding a subdivision <br/>
<a id="pl.5.15"></a><var>5.15</var>to read:<br/>
<a id="pl.5.16"></a><var>5.16</var>    Subd. 1b. <b>Grandfathered plan.</b> "Grandfathered plan" means a health plan in which <br/>
<a id="pl.5.17"></a><var>5.17</var>an individual was enrolled on March 23, 2010, for as long as it maintains that status in <br/>
<a id="pl.5.18"></a><var>5.18</var>accordance with the Affordable Care Act. Unless otherwise specified, grandfathered plans <br/>
<a id="pl.5.19"></a><var>5.19</var>include both individual and group health plans.<br/>
<a id="pl.5.20"></a><var>5.20</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.6.0"></a><a id="pl.5.21"></a><var>5.21</var>    Sec. 6. Minnesota Statutes 2012, section 62A.011, is amended by adding a subdivision <br/>
<a id="pl.5.22"></a><var>5.22</var>to read:<br/>
<a id="pl.5.23"></a><var>5.23</var>    Subd. 1c. <b>Group health plan.</b> "Group health plan" means a policy or certificate <br/>
<a id="pl.5.24"></a><var>5.24</var>issued to an employer or an employee organization that is both:<br/>
<a id="pl.5.25"></a><var>5.25</var>(1) a health plan as defined in subdivision 3; and<br/>
<a id="pl.5.26"></a><var>5.26</var>(2) an employee welfare benefit plan as defined in the Employee Retirement Income <br/>
<a id="pl.5.27"></a><var>5.27</var>Security Act of 1974, United States Code, title 29, section 1002, if the plan provides <br/>
<a id="pl.5.28"></a><var>5.28</var>payment for medical care to employees, including both current and former employees, or <br/>
<a id="pl.5.29"></a><var>5.29</var>their dependents, directly or through insurance, reimbursement, or otherwise, including <br/>
<a id="pl.5.30"></a><var>5.30</var>employee welfare benefit plans specifically exempt from the provisions of the Employee <br/>
<a id="pl.5.31"></a><var>5.31</var>Retirement Income Security Act of 1974 under United States Code, title 29, section 1003.<br/>
<a id="pl.6.1"></a><var>6.1</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.7.0"></a><a id="pl.6.2"></a><var>6.2</var>    Sec. 7. Minnesota Statutes 2012, section 62A.011, subdivision 3, is amended to read:<br/>
<a id="pl.6.3"></a><var>6.3</var>    Subd. 3. <b>Health plan.</b> "Health plan" means a policy or certificate of accident and <br/>
<a id="pl.6.4"></a><var>6.4</var>sickness insurance as defined in section 
         <statute_ref>62A.01</statute_ref> offered by an insurance company licensed <br/>
<a id="pl.6.5"></a><var>6.5</var>under chapter 60A; a subscriber contract or certificate offered by a nonprofit health <br/>
<a id="pl.6.6"></a><var>6.6</var>service plan corporation operating under chapter 62C; a health maintenance contract or <br/>
<a id="pl.6.7"></a><var>6.7</var>certificate offered by a health maintenance organization operating under chapter 62D; a <br/>
<a id="pl.6.8"></a><var>6.8</var>health benefit certificate offered by a fraternal benefit society operating under chapter <br/>
<a id="pl.6.9"></a><var>6.9</var>64B; or health coverage offered by a joint self-insurance employee health plan operating <br/>
<a id="pl.6.10"></a><var>6.10</var>under chapter 62H. Health plan means individual and group coverage, unless otherwise <br/>
<a id="pl.6.11"></a><var>6.11</var>specified. Health plan does not include coverage that is:<br/>
<a id="pl.6.12"></a><var>6.12</var>(1) limited to disability or income protection coverage;<br/>
<a id="pl.6.13"></a><var>6.13</var>(2) automobile medical payment coverage;<br/>
<a id="pl.6.14"></a><var>6.14</var>(3) supplemental liability insurance, including general liability insurance and <br/>
<a id="pl.6.15"></a><var>6.15</var>automobile liability insurance, or coverage issued as a supplement to liability insurance;<br/>
<a id="pl.6.16"></a><var>6.16</var>(4) designed solely to provide payments on a per diem, fixed indemnity, or <br/>
<a id="pl.6.17"></a><var>6.17</var>non-expense-incurred basis, including coverage only for a specified disease or illness or <br/>
<a id="pl.6.18"></a><var>6.18</var>hospital indemnity or other fixed indemnity insurance, if the benefits are provided under a <br/>
<a id="pl.6.19"></a><var>6.19</var>separate policy, certificate, or contract for insurance; there is no coordination between the <br/>
<a id="pl.6.20"></a><var>6.20</var>provision of benefits and any exclusion of benefits under any group health plan maintained <br/>
<a id="pl.6.21"></a><var>6.21</var>by the same plan sponsor; and the benefits are paid with respect to an event without regard <br/>
<a id="pl.6.22"></a><var>6.22</var>to whether benefits are provided with respect to such an event under any group health <br/>
<a id="pl.6.23"></a><var>6.23</var>plan maintained by the same plan sponsor;<br/>
<a id="pl.6.24"></a><var>6.24</var>(5) credit accident and health insurance as defined in section 
         <statute_ref>62B.02</statute_ref>;<br/>
<a id="pl.6.25"></a><var>6.25</var>(6) designed solely to provide hearing, dental, or vision care;<br/>
<a id="pl.6.26"></a><var>6.26</var>(7) blanket accident and sickness insurance as defined in section 
         <statute_ref>62A.11</statute_ref>;<br/>
<a id="pl.6.27"></a><var>6.27</var>(8) accident-only coverage;<br/>
<a id="pl.6.28"></a><var>6.28</var>(9) a long-term care policy as defined in section 
         <statute_ref>62A.46</statute_ref> or 
         <statute_ref>62S.01</statute_ref>;<br/>
<a id="pl.6.29"></a><var>6.29</var>(10) issued as a supplement to Medicare, as defined in sections 
         <statute_ref>62A.3099</statute_ref> to <br/>
<statute_ref><a id="pl.6.30"></a><var>6.30</var>62A.44
         </statute_ref>, or policies, contracts, or certificates that supplement Medicare issued by health <br/>
<a id="pl.6.31"></a><var>6.31</var>maintenance organizations or those policies, contracts, or certificates governed by section <br/>
<a id="pl.6.32"></a><var>6.32</var>1833 or 1876, section 1851, et seq.; or section 1860D-1, et seq., of title XVIII of the <br/>
<a id="pl.6.33"></a><var>6.33</var>federal Social Security Act, United States Code, title 42, section 1395, et seq., as amended;<br/>
<a id="pl.6.34"></a><var>6.34</var>(11) workers' compensation insurance; or<br/>
<a id="pl.7.1"></a><var>7.1</var>(12) issued solely as a companion to a health maintenance contract as described in <br/>
<a id="pl.7.2"></a><var>7.2</var>section 
         <statute_ref>62D.12, subdivision 1a</statute_ref>, so long as the health maintenance contract meets the <br/>
<a id="pl.7.3"></a><var>7.3</var>definition of a health plan.;<br/>
<a id="pl.7.4"></a><var>7.4</var>(13) coverage for on-site medical clinics; or<br/>
<a id="pl.7.5"></a><var>7.5</var>(14) coverage supplemental to the coverage provided under United States Code, <br/>
<a id="pl.7.6"></a><var>7.6</var>title 10, chapter 55, Civilian Health and Medical Program of the Uniformed Services <br/>
<a id="pl.7.7"></a><var>7.7</var>(CHAMPUS).<br/>
<a id="pl.7.8"></a><var>7.8</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.8.0"></a><a id="pl.7.9"></a><var>7.9</var>    Sec. 8. Minnesota Statutes 2012, section 62A.011, is amended by adding a subdivision <br/>
<a id="pl.7.10"></a><var>7.10</var>to read:<br/>
<a id="pl.7.11"></a><var>7.11</var>    Subd. 4. <b>Individual health plan.</b> "Individual health plan" means a health plan as <br/>
<a id="pl.7.12"></a><var>7.12</var>defined in subdivision 3 that is offered to individuals in the individual market as defined <br/>
<a id="pl.7.13"></a><var>7.13</var>in subdivision 5, but does not mean short-term coverage as defined in section 62A.65, <br/>
<a id="pl.7.14"></a><var>7.14</var>subdivision 7. For purposes of this chapter, a health carrier shall not be deemed to be <br/>
<a id="pl.7.15"></a><var>7.15</var>offering individual health plan coverage solely because the carrier maintains a conversion <br/>
<a id="pl.7.16"></a><var>7.16</var>policy in connection with a group health plan.<br/>
<a id="pl.7.17"></a><var>7.17</var><b>EFFECTIVE DATE.</b>This section is effective for coverage effective on or after <br/>
<a id="pl.7.18"></a><var>7.18</var>January 1, 2014.<br/>
<br/>
<a id="bill.1.9.0"></a><a id="pl.7.19"></a><var>7.19</var>    Sec. 9. Minnesota Statutes 2012, section 62A.011, is amended by adding a subdivision <br/>
<a id="pl.7.20"></a><var>7.20</var>to read:<br/>
<a id="pl.7.21"></a><var>7.21</var>    Subd. 5. <b>Individual market.</b> "Individual market" means the market for health <br/>
<a id="pl.7.22"></a><var>7.22</var>insurance coverage offered to individuals other than in connection with a group health plan.<br/>
<a id="pl.7.23"></a><var>7.23</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.10.0"></a><a id="pl.7.24"></a><var>7.24</var>    Sec. 10. Minnesota Statutes 2012, section 62A.011, is amended by adding a <br/>
<a id="pl.7.25"></a><var>7.25</var>subdivision to read:<br/>
<a id="pl.7.26"></a><var>7.26</var>    Subd. 6. <b>Minnesota Insurance Marketplace.</b> "Minnesota Insurance Marketplace" <br/>
<a id="pl.7.27"></a><var>7.27</var>means the Minnesota Insurance Marketplace as defined in section 62V.02.<br/>
<br/>
<a id="bill.1.11.0"></a><a id="pl.7.28"></a><var>7.28</var>    Sec. 11. Minnesota Statutes 2012, section 62A.011, is amended by adding a <br/>
<a id="pl.7.29"></a><var>7.29</var>subdivision to read:<br/>
<a id="pl.7.30"></a><var>7.30</var>    Subd. 7. <b>Qualified health plan.</b> "Qualified health plan" means a health plan that <br/>
<a id="pl.7.31"></a><var>7.31</var>meets the definition in section 1301(a) of the Affordable Care Act and has been certified <br/>
<a id="pl.8.1"></a><var>8.1</var>by the board of the Minnesota Insurance Marketplace in accordance with chapter 62V to <br/>
<a id="pl.8.2"></a><var>8.2</var>be offered through the Minnesota Insurance Marketplace.<br/>
<br/>
<a id="bill.1.12.0"></a><a id="pl.8.3"></a><var>8.3</var>    Sec. 12. Minnesota Statutes 2012, section 62A.02, is amended by adding a subdivision <br/>
<a id="pl.8.4"></a><var>8.4</var>to read:<br/>
<a id="pl.8.5"></a><var>8.5</var>    Subd. 8. <b>Filing by health carriers for purposes of complying with the </b><br/>
<a id="pl.8.6"></a><var>8.6</var><b>certification requirements of the Minnesota Insurance Marketplace.</b> No qualified <br/>
<a id="pl.8.7"></a><var>8.7</var>health plan shall be offered through the Minnesota Insurance Marketplace until its form <br/>
<a id="pl.8.8"></a><var>8.8</var>and the premium rates pertaining to the form have been approved by the commissioner of <br/>
<a id="pl.8.9"></a><var>8.9</var>commerce or health, as appropriate, and the health plan has been determined to comply <br/>
<a id="pl.8.10"></a><var>8.10</var>with the certification requirements of the Minnesota Insurance Marketplace in accordance <br/>
<a id="pl.8.11"></a><var>8.11</var>with an agreement between the commissioners of commerce and health and the Minnesota <br/>
<a id="pl.8.12"></a><var>8.12</var>Insurance Marketplace.<br/>
<a id="pl.8.13"></a><var>8.13</var><b>EFFECTIVE DATE.</b>This section is effective for coverage effective on or after <br/>
<a id="pl.8.14"></a><var>8.14</var>January 1, 2014.<br/>
<br/>
<a id="bill.1.13.0"></a><a id="pl.8.15"></a><var>8.15</var>    Sec. 13. Minnesota Statutes 2012, section 62A.03, subdivision 1, is amended to read:<br/>
<a id="pl.8.16"></a><var>8.16</var>    Subdivision 1. <b>Conditions.</b> No policy of individual accident and sickness insurance <br/>
<a id="pl.8.17"></a><var>8.17</var>may be delivered or issued for delivery to a person in this state unless:<br/>
<a id="pl.8.18"></a><var>8.18</var>(1) <b>Premium.</b> The entire money and other considerations therefor are expressed <br/>
<a id="pl.8.19"></a><var>8.19</var>therein.<br/>
<a id="pl.8.20"></a><var>8.20</var>(2) <b>Time effective.</b> The time at which the insurance takes effect and terminates is <br/>
<a id="pl.8.21"></a><var>8.21</var>expressed therein.<br/>
<a id="pl.8.22"></a><var>8.22</var>(3) <b>One person.</b> It purports to insure only one person, except that a policy may <br/>
<a id="pl.8.23"></a><var>8.23</var>insure, originally or by subsequent amendment, upon the application of an adult member <br/>
<a id="pl.8.24"></a><var>8.24</var>of a family deemed the policyholder, any two or more eligible members of that family, <br/>
<a id="pl.8.25"></a><var>8.25</var>including:<br/>
<a id="pl.8.26"></a><var>8.26</var>(a) husband,<br/>
<a id="pl.8.27"></a><var>8.27</var>(b) wife,<br/>
<a id="pl.8.28"></a><var>8.28</var>(c) dependent children as described in sections 62A.302 and 62A.3021, or<br/>
<a id="pl.8.29"></a><var>8.29</var>(d) any children under a specified age of 19 years or less, or<br/>
<a id="pl.8.30"></a><var>8.30</var>(e) (d) any other person dependent upon the policyholder.<br/>
<a id="pl.8.31"></a><var>8.31</var>(4) <b>Appearance.</b> The style, arrangement, and overall appearance of the policy give <br/>
<a id="pl.8.32"></a><var>8.32</var>no undue prominence to any portion of the text and every printed portion of the text of the <br/>
<a id="pl.8.33"></a><var>8.33</var>policy and of any endorsements or attached papers is plainly printed in light-face type <br/>
<a id="pl.8.34"></a><var>8.34</var>of a style in general use. The type size must be uniform and not less than ten point with <br/>
<a id="pl.9.1"></a><var>9.1</var>a lowercase unspaced alphabet length not less than 120 point. The "text" includes all <br/>
<a id="pl.9.2"></a><var>9.2</var>printed matter except the name and address of the insurer, name or title of the policy, the <br/>
<a id="pl.9.3"></a><var>9.3</var>brief description, if any, the reference to renewal or cancellation by a separate statement, <br/>
<a id="pl.9.4"></a><var>9.4</var>if any, and the captions and subcaptions.<br/>
<a id="pl.9.5"></a><var>9.5</var>(5) <b>Description of policy.</b> The policy, on the first page, indicates or refers to its <br/>
<a id="pl.9.6"></a><var>9.6</var>provisions for renewal or cancellation either in the brief description, if any, or by a separate <br/>
<a id="pl.9.7"></a><var>9.7</var>statement printed in type not smaller than the type used for captions or a separate provision <br/>
<a id="pl.9.8"></a><var>9.8</var>bearing a caption which accurately describes the renewability or cancelability of the policy.<br/>
<a id="pl.9.9"></a><var>9.9</var>(6) <b>Exceptions in policy.</b> The exceptions and reductions of indemnity are set <br/>
<a id="pl.9.10"></a><var>9.10</var>forth in the policy and, except those which are set forth in section 
         <statute_ref>62A.04</statute_ref>, printed, at <br/>
<a id="pl.9.11"></a><var>9.11</var>the insurer's option, either with the benefit provision to which they apply, or under an <br/>
<a id="pl.9.12"></a><var>9.12</var>appropriate caption such as "EXCEPTIONS" or "EXCEPTIONS AND REDUCTIONS." <br/>
<a id="pl.9.13"></a><var>9.13</var>However, if an exception or reduction specifically applies only to a particular benefit of <br/>
<a id="pl.9.14"></a><var>9.14</var>the policy, a statement of the exception or reduction must be included with the benefit <br/>
<a id="pl.9.15"></a><var>9.15</var>provision to which it applies.<br/>
<a id="pl.9.16"></a><var>9.16</var>(7) <b>Form number.</b> Each form, including riders and endorsements, is identified by a <br/>
<a id="pl.9.17"></a><var>9.17</var>form number in the lower left hand corner of the first page thereof.<br/>
<a id="pl.9.18"></a><var>9.18</var>(8) <b>No incorporation by reference.</b> It contains no provision purporting to make <br/>
<a id="pl.9.19"></a><var>9.19</var>any portion of the charter, rules, constitution, or bylaws of the insurer a part of the policy <br/>
<a id="pl.9.20"></a><var>9.20</var>unless the portion is set forth in full in the policy, except in the case of the incorporation <br/>
<a id="pl.9.21"></a><var>9.21</var>of, or reference to, a statement of rates, classification of risks, or short rate table filed <br/>
<a id="pl.9.22"></a><var>9.22</var>with the commissioner.<br/>
<a id="pl.9.23"></a><var>9.23</var>(9) <b>Medical benefits.</b> If the policy contains a provision for medical expense benefits, <br/>
<a id="pl.9.24"></a><var>9.24</var>the term "medical benefits" or similar terms as used therein includes treatments by all <br/>
<a id="pl.9.25"></a><var>9.25</var>licensed practitioners of the healing arts unless, subject to the qualifications contained in <br/>
<a id="pl.9.26"></a><var>9.26</var>clause (10), the policy specifically states the practitioners whose services are covered.<br/>
<a id="pl.9.27"></a><var>9.27</var>(10) <b>Osteopath, optometrist, chiropractor, or registered nurse services.</b> With <br/>
<a id="pl.9.28"></a><var>9.28</var>respect to any policy of individual accident and sickness insurance issued or entered <br/>
<a id="pl.9.29"></a><var>9.29</var>into subsequent to August 1, 1974, notwithstanding the provisions of the policy, if it <br/>
<a id="pl.9.30"></a><var>9.30</var>contains a provision providing for reimbursement for any service which is in the lawful <br/>
<a id="pl.9.31"></a><var>9.31</var>scope of practice of a duly licensed osteopath, optometrist, chiropractor, or registered <br/>
<a id="pl.9.32"></a><var>9.32</var>nurse meeting the requirements of section 
         <statute_ref>62A.15, subdivision 3a</statute_ref>, the person entitled to <br/>
<a id="pl.9.33"></a><var>9.33</var>benefits or person performing services under the policy is entitled to reimbursement on an <br/>
<a id="pl.9.34"></a><var>9.34</var>equal basis for the service, whether the service is performed by a physician, osteopath, <br/>
<a id="pl.9.35"></a><var>9.35</var>optometrist, chiropractor, or registered nurse meeting the requirements of section 
         <statute_ref>62A.15, <br/>
<a id="pl.9.36"></a><var>9.36</var>subdivision 3a
         </statute_ref>, licensed under the laws of this state.<br/>
<a id="pl.10.1"></a><var>10.1</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.14.0"></a><a id="pl.10.2"></a><var>10.2</var>    Sec. 14. Minnesota Statutes 2012, section 62A.04, subdivision 2, is amended to read:<br/>
<a id="pl.10.3"></a><var>10.3</var>    Subd. 2. <b>Required provisions.</b> Except as provided in subdivision 4 each such <br/>
<a id="pl.10.4"></a><var>10.4</var>policy delivered or issued for delivery to any person in this state shall contain the <br/>
<a id="pl.10.5"></a><var>10.5</var>provisions specified in this subdivision in the words in which the same appear in this <br/>
<a id="pl.10.6"></a><var>10.6</var>section. The insurer may, at its option, substitute for one or more of such provisions <br/>
<a id="pl.10.7"></a><var>10.7</var>corresponding provisions of different wording approved by the commissioner which are <br/>
<a id="pl.10.8"></a><var>10.8</var>in each instance not less favorable in any respect to the insured or the beneficiary. Such <br/>
<a id="pl.10.9"></a><var>10.9</var>provisions shall be preceded individually by the caption appearing in this subdivision or, at <br/>
<a id="pl.10.10"></a><var>10.10</var>the option of the insurer, by such appropriate individual or group captions or subcaptions <br/>
<a id="pl.10.11"></a><var>10.11</var>as the commissioner may approve.<br/>
<a id="pl.10.12"></a><var>10.12</var>(1) A provision as follows:<br/>
<a id="pl.10.13"></a><var>10.13</var>ENTIRE CONTRACT; CHANGES: This policy, including the endorsements and <br/>
<a id="pl.10.14"></a><var>10.14</var>the attached papers, if any, constitutes the entire contract of insurance. No change in this <br/>
<a id="pl.10.15"></a><var>10.15</var>policy shall be valid until approved by an executive officer of the insurer and unless such <br/>
<a id="pl.10.16"></a><var>10.16</var>approval be endorsed hereon or attached hereto. No agent has authority to change this <br/>
<a id="pl.10.17"></a><var>10.17</var>policy or to waive any of its provisions.<br/>
<a id="pl.10.18"></a><var>10.18</var>(2) A provision as follows:<br/>
<a id="pl.10.19"></a><var>10.19</var>TIME LIMIT ON CERTAIN DEFENSES: (a) After two years from the date of issue <br/>
<a id="pl.10.20"></a><var>10.20</var>of this policy no misstatements, except fraudulent misstatements, made by the applicant <br/>
<a id="pl.10.21"></a><var>10.21</var>in the application for such policy shall be used to void the policy or to deny a claim for <br/>
<a id="pl.10.22"></a><var>10.22</var>loss incurred or disability (as defined in the policy) commencing after the expiration <br/>
<a id="pl.10.23"></a><var>10.23</var>of such two year period.<br/>
<a id="pl.10.24"></a><var>10.24</var>The foregoing policy provision shall not be so construed as to affect any legal <br/>
<a id="pl.10.25"></a><var>10.25</var>requirement for avoidance of a policy or denial of a claim during such initial two year <br/>
<a id="pl.10.26"></a><var>10.26</var>period, nor to limit the application of clauses (1), (2), (3), (4) and (5), in the event of <br/>
<a id="pl.10.27"></a><var>10.27</var>misstatement with respect to age or occupation or other insurance. A policy which the <br/>
<a id="pl.10.28"></a><var>10.28</var>insured has the right to continue in force subject to its terms by the timely payment of <br/>
<a id="pl.10.29"></a><var>10.29</var>premium (1) until at least age 50 or, (2) in the case of a policy issued after age 44, for at <br/>
<a id="pl.10.30"></a><var>10.30</var>least five years from its date of issue, may contain in lieu of the foregoing the following <br/>
<a id="pl.10.31"></a><var>10.31</var>provisions (from which the clause in parentheses may be omitted at the insurer's option) <br/>
<a id="pl.10.32"></a><var>10.32</var>under the caption "INCONTESTABLE":<br/>
<a id="pl.10.33"></a><var>10.33</var>After this policy has been in force for a period of two years during the lifetime of <br/>
<a id="pl.10.34"></a><var>10.34</var>the insured (excluding any period during which the insured is disabled), it shall become <br/>
<a id="pl.10.35"></a><var>10.35</var>incontestable as to the statements contained in the application.<br/>
<a id="pl.11.1"></a><var>11.1</var>(b) No claim for loss incurred or disability (as defined in the policy) commencing after <br/>
<a id="pl.11.2"></a><var>11.2</var>two years from the date of issue of this policy shall be reduced or denied on the ground that <br/>
<a id="pl.11.3"></a><var>11.3</var>a disease or physical condition not excluded from coverage by name or specific description <br/>
<a id="pl.11.4"></a><var>11.4</var>effective on the date of loss had existed prior to the effective date of coverage of this policy.<br/>
<a id="pl.11.5"></a><var>11.5</var>(3)(a) Except as required for qualified health plans sold through the Minnesota <br/>
<a id="pl.11.6"></a><var>11.6</var>Insurance Marketplace to individuals receiving advance payments of the premium tax <br/>
<a id="pl.11.7"></a><var>11.7</var>credit, a provision as follows:<br/>
<a id="pl.11.8"></a><var>11.8</var>GRACE PERIOD: A grace period of ..... (insert a number not less than "7" for <br/>
<a id="pl.11.9"></a><var>11.9</var>weekly premium policies, "10" for monthly premium policies and "31" for all other <br/>
<a id="pl.11.10"></a><var>11.10</var>policies) days will be granted for the payment of each premium falling due after the first <br/>
<a id="pl.11.11"></a><var>11.11</var>premium, during which grace period the policy shall continue in force.<br/>
<a id="pl.11.12"></a><var>11.12</var>A policy which contains a cancellation provision may add, at the end of the above <br/>
<a id="pl.11.13"></a><var>11.13</var>provision,<br/>
<a id="pl.11.14"></a><var>11.14</var>subject to the right of the insurer to cancel in accordance with the cancellation <br/>
<a id="pl.11.15"></a><var>11.15</var>provision hereof.<br/>
<a id="pl.11.16"></a><var>11.16</var>A policy in which the insurer reserves the right to refuse any renewal shall have, <br/>
<a id="pl.11.17"></a><var>11.17</var>at the beginning of the above provision,<br/>
<a id="pl.11.18"></a><var>11.18</var>Unless not less than five days prior to the premium due date the insurer has delivered <br/>
<a id="pl.11.19"></a><var>11.19</var>to the insured or has mailed to the insured's last address as shown by the records of the <br/>
<a id="pl.11.20"></a><var>11.20</var>insurer written notice of its intention not to renew this policy beyond the period for which <br/>
<a id="pl.11.21"></a><var>11.21</var>the premium has been accepted.<br/>
<a id="pl.11.22"></a><var>11.22</var>(b) For qualified health plans sold through the Minnesota Insurance Marketplace <br/>
<a id="pl.11.23"></a><var>11.23</var>to individuals receiving advance payments of the premium tax credit, a grace period <br/>
<a id="pl.11.24"></a><var>11.24</var>provision must be included that complies with the Affordable Care Act and is no less <br/>
<a id="pl.11.25"></a><var>11.25</var>restrictive than the grace period required by the Affordable Care Act.<br/>
<a id="pl.11.26"></a><var>11.26</var>(4) A provision as follows:<br/>
<a id="pl.11.27"></a><var>11.27</var>REINSTATEMENT: If any renewal premium be not paid within the time granted the <br/>
<a id="pl.11.28"></a><var>11.28</var>insured for payment, a subsequent acceptance of premium by the insurer or by any agent <br/>
<a id="pl.11.29"></a><var>11.29</var>duly authorized by the insurer to accept such premium, without requiring in connection <br/>
<a id="pl.11.30"></a><var>11.30</var>therewith an application for reinstatement, shall reinstate the policy. If the insurer or <br/>
<a id="pl.11.31"></a><var>11.31</var>such agent requires an application for reinstatement and issues a conditional receipt for <br/>
<a id="pl.11.32"></a><var>11.32</var>the premium tendered, the policy will be reinstated upon approval of such application <br/>
<a id="pl.11.33"></a><var>11.33</var>by the insurer or, lacking such approval, upon the forty-fifth day following the date of <br/>
<a id="pl.11.34"></a><var>11.34</var>such conditional receipt unless the insurer has previously notified the insured in writing <br/>
<a id="pl.11.35"></a><var>11.35</var>of its disapproval of such application. For health plans described in section 
         <statute_ref>62A.011, <br/>
<a id="pl.11.36"></a><var>11.36</var>subdivision 3
         </statute_ref>, clause (10), an insurer must accept payment of a renewal premium and <br/>
<a id="pl.12.1"></a><var>12.1</var>reinstate the policy, if the insured applies for reinstatement no later than 60 days after the <br/>
<a id="pl.12.2"></a><var>12.2</var>due date for the premium payment, unless:<br/>
<a id="pl.12.3"></a><var>12.3</var>(1) the insured has in the interim left the state or the insurer's service area; or<br/>
<a id="pl.12.4"></a><var>12.4</var>(2) the insured has applied for reinstatement on two or more prior occasions.<br/>
<a id="pl.12.5"></a><var>12.5</var>The reinstated policy shall cover only loss resulting from such accidental injury as <br/>
<a id="pl.12.6"></a><var>12.6</var>may be sustained after the date of reinstatement and loss due to such sickness as may <br/>
<a id="pl.12.7"></a><var>12.7</var>begin more than ten days after such date. In all other respects the insured and insurer shall <br/>
<a id="pl.12.8"></a><var>12.8</var>have the same rights thereunder as they had under the policy immediately before the due <br/>
<a id="pl.12.9"></a><var>12.9</var>date of the defaulted premium, subject to any provisions endorsed hereon or attached <br/>
<a id="pl.12.10"></a><var>12.10</var>hereto in connection with the reinstatement. Any premium accepted in connection with <br/>
<a id="pl.12.11"></a><var>12.11</var>a reinstatement shall be applied to a period for which premium has not been previously <br/>
<a id="pl.12.12"></a><var>12.12</var>paid, but not to any period more than 60 days prior to the date of reinstatement. The last <br/>
<a id="pl.12.13"></a><var>12.13</var>sentence of the above provision may be omitted from any policy which the insured has <br/>
<a id="pl.12.14"></a><var>12.14</var>the right to continue in force subject to its terms by the timely payment of premiums <br/>
<a id="pl.12.15"></a><var>12.15</var>(1) until at least age 50, or, (2) in the case of a policy issued after age 44, for at least <br/>
<a id="pl.12.16"></a><var>12.16</var>five years from its date of issue.<br/>
<a id="pl.12.17"></a><var>12.17</var>(5) A provision as follows:<br/>
<a id="pl.12.18"></a><var>12.18</var>NOTICE OF CLAIM: Written notice of claim must be given to the insurer within <br/>
<a id="pl.12.19"></a><var>12.19</var>20 days after the occurrence or commencement of any loss covered by the policy, or as <br/>
<a id="pl.12.20"></a><var>12.20</var>soon thereafter as is reasonably possible. Notice given by or on behalf of the insured or <br/>
<a id="pl.12.21"></a><var>12.21</var>the beneficiary to the insurer at ..... (insert the location of such office as the insurer may <br/>
<a id="pl.12.22"></a><var>12.22</var>designate for the purpose), or to any authorized agent of the insurer, with information <br/>
<a id="pl.12.23"></a><var>12.23</var>sufficient to identify the insured, shall be deemed notice to the insurer.<br/>
<a id="pl.12.24"></a><var>12.24</var>In a policy providing a loss-of-time benefit which may be payable for at least two <br/>
<a id="pl.12.25"></a><var>12.25</var>years, an insurer may at its option insert the following between the first and second <br/>
<a id="pl.12.26"></a><var>12.26</var>sentences of the above provision:<br/>
<a id="pl.12.27"></a><var>12.27</var>Subject to the qualifications set forth below, if the insured suffers loss of time on <br/>
<a id="pl.12.28"></a><var>12.28</var>account of disability for which indemnity may be payable for at least two years, the <br/>
<a id="pl.12.29"></a><var>12.29</var>insured shall, at least once in every six months after having given notice of claim, give to <br/>
<a id="pl.12.30"></a><var>12.30</var>the insurer notice of continuance of said disability, except in the event of legal incapacity. <br/>
<a id="pl.12.31"></a><var>12.31</var>The period of six months following any filing of proof by the insured or any payment by <br/>
<a id="pl.12.32"></a><var>12.32</var>the insurer on account of such claim or any denial of liability in whole or in part by the <br/>
<a id="pl.12.33"></a><var>12.33</var>insurer shall be excluded in applying this provision. Delay in the giving of such notice <br/>
<a id="pl.12.34"></a><var>12.34</var>shall not impair the insured's right to any indemnity which would otherwise have accrued <br/>
<a id="pl.12.35"></a><var>12.35</var>during the period of six months preceding the date on which such notice is actually given.<br/>
<a id="pl.12.36"></a><var>12.36</var>(6) A provision as follows:<br/>
<a id="pl.13.1"></a><var>13.1</var>CLAIM FORMS: The insurer, upon receipt of a notice of claim, will furnish to the <br/>
<a id="pl.13.2"></a><var>13.2</var>claimant such forms as are usually furnished by it for filing proofs of loss. If such forms <br/>
<a id="pl.13.3"></a><var>13.3</var>are not furnished within 15 days after the giving of such notice the claimant shall be <br/>
<a id="pl.13.4"></a><var>13.4</var>deemed to have complied with the requirements of this policy as to proof of loss upon <br/>
<a id="pl.13.5"></a><var>13.5</var>submitting, within the time fixed in the policy for filing proofs of loss, written proof <br/>
<a id="pl.13.6"></a><var>13.6</var>covering the occurrence, the character and the extent of the loss for which claim is made.<br/>
<a id="pl.13.7"></a><var>13.7</var>(7) A provision as follows:<br/>
<a id="pl.13.8"></a><var>13.8</var>PROOFS OF LOSS: Written proof of loss must be furnished to the insurer at its <br/>
<a id="pl.13.9"></a><var>13.9</var>said office in case of claim for loss for which this policy provides any periodic payment <br/>
<a id="pl.13.10"></a><var>13.10</var>contingent upon continuing loss within 90 days after the termination of the period for <br/>
<a id="pl.13.11"></a><var>13.11</var>which the insurer is liable and in case of claim for any other loss within 90 days after the <br/>
<a id="pl.13.12"></a><var>13.12</var>date of such loss. Failure to furnish such proof within the time required shall not invalidate <br/>
<a id="pl.13.13"></a><var>13.13</var>nor reduce any claim if it was not reasonably possible to give proof within such time, <br/>
<a id="pl.13.14"></a><var>13.14</var>provided such proof is furnished as soon as reasonably possible and in no event, except in <br/>
<a id="pl.13.15"></a><var>13.15</var>the absence of legal capacity, later than one year from the time proof is otherwise required.<br/>
<a id="pl.13.16"></a><var>13.16</var>(8) A provision as follows:<br/>
<a id="pl.13.17"></a><var>13.17</var>TIME OF PAYMENT OF CLAIMS: Indemnities payable under this policy for <br/>
<a id="pl.13.18"></a><var>13.18</var>any loss other than loss for which this policy provides periodic payment will be paid <br/>
<a id="pl.13.19"></a><var>13.19</var>immediately upon receipt of due written proof of such loss. Subject to due written proof <br/>
<a id="pl.13.20"></a><var>13.20</var>of loss, all accrued indemnities for loss for which this policy provides periodic payment <br/>
<a id="pl.13.21"></a><var>13.21</var>will be paid ..... (insert period for payment which must not be less frequently than <br/>
<a id="pl.13.22"></a><var>13.22</var>monthly) and any balance remaining unpaid upon the termination of liability will be paid <br/>
<a id="pl.13.23"></a><var>13.23</var>immediately upon receipt of due written proof.<br/>
<a id="pl.13.24"></a><var>13.24</var>(9) A provision as follows:<br/>
<a id="pl.13.25"></a><var>13.25</var>PAYMENT OF CLAIMS: Indemnity for loss of life will be payable in accordance <br/>
<a id="pl.13.26"></a><var>13.26</var>with the beneficiary designation and the provisions respecting such payment which may <br/>
<a id="pl.13.27"></a><var>13.27</var>be prescribed herein and effective at the time of payment. If no such designation or <br/>
<a id="pl.13.28"></a><var>13.28</var>provision is then effective, such indemnity shall be payable to the estate of the insured. <br/>
<a id="pl.13.29"></a><var>13.29</var>Any other accrued indemnities unpaid at the insured's death may, at the option of the <br/>
<a id="pl.13.30"></a><var>13.30</var>insurer, be paid either to such beneficiary or to such estate. All other indemnities will <br/>
<a id="pl.13.31"></a><var>13.31</var>be payable to the insured.<br/>
<a id="pl.13.32"></a><var>13.32</var>The following provisions, or either of them, may be included with the foregoing <br/>
<a id="pl.13.33"></a><var>13.33</var>provision at the option of the insurer:<br/>
<a id="pl.13.34"></a><var>13.34</var>If any indemnity of this policy shall be payable to the estate of the insured, or to an <br/>
<a id="pl.13.35"></a><var>13.35</var>insured or beneficiary who is a minor or otherwise not competent to give a valid release, <br/>
<a id="pl.13.36"></a><var>13.36</var>the insurer may pay such indemnity, up to an amount not exceeding $..... (insert an amount <br/>
<a id="pl.14.1"></a><var>14.1</var>which shall not exceed $1,000), to any relative by blood or connection by marriage of the <br/>
<a id="pl.14.2"></a><var>14.2</var>insured or beneficiary who is deemed by the insurer to be equitably entitled thereto. Any <br/>
<a id="pl.14.3"></a><var>14.3</var>payment made by the insurer in good faith pursuant to this provision shall fully discharge <br/>
<a id="pl.14.4"></a><var>14.4</var>the insurer to the extent of such payment.<br/>
<a id="pl.14.5"></a><var>14.5</var>Subject to any written direction of the insured in the application or otherwise all <br/>
<a id="pl.14.6"></a><var>14.6</var>or a portion of any indemnities provided by this policy on account of hospital, nursing, <br/>
<a id="pl.14.7"></a><var>14.7</var>medical, or surgical services may, at the insurer's option and unless the insured requests <br/>
<a id="pl.14.8"></a><var>14.8</var>otherwise in writing not later than the time of filing proofs of such loss, be paid directly to <br/>
<a id="pl.14.9"></a><var>14.9</var>the hospital or person rendering such services; but it is not required that the service be <br/>
<a id="pl.14.10"></a><var>14.10</var>rendered by a particular hospital or person.<br/>
<a id="pl.14.11"></a><var>14.11</var>(10) A provision as follows:<br/>
<a id="pl.14.12"></a><var>14.12</var>PHYSICAL EXAMINATIONS AND AUTOPSY: The insurer at its own expense <br/>
<a id="pl.14.13"></a><var>14.13</var>shall have the right and opportunity to examine the person of the insured when and as <br/>
<a id="pl.14.14"></a><var>14.14</var>often as it may reasonably require during the pendency of a claim hereunder and to make <br/>
<a id="pl.14.15"></a><var>14.15</var>an autopsy in case of death where it is not forbidden by law.<br/>
<a id="pl.14.16"></a><var>14.16</var>(11) A provision as follows:<br/>
<a id="pl.14.17"></a><var>14.17</var>LEGAL ACTIONS: No action at law or in equity shall be brought to recover on this <br/>
<a id="pl.14.18"></a><var>14.18</var>policy prior to the expiration of 60 days after written proof of loss has been furnished in <br/>
<a id="pl.14.19"></a><var>14.19</var>accordance with the requirements of this policy. No such action shall be brought after the <br/>
<a id="pl.14.20"></a><var>14.20</var>expiration of three years after the time written proof of loss is required to be furnished.<br/>
<a id="pl.14.21"></a><var>14.21</var>(12) A provision as follows:<br/>
<a id="pl.14.22"></a><var>14.22</var>CHANGE OF BENEFICIARY: Unless the insured makes an irrevocable designation <br/>
<a id="pl.14.23"></a><var>14.23</var>of beneficiary, the right to change of beneficiary is reserved to the insured and the consent <br/>
<a id="pl.14.24"></a><var>14.24</var>of the beneficiary or beneficiaries shall not be requisite to surrender or assignment of <br/>
<a id="pl.14.25"></a><var>14.25</var>this policy or to any change of beneficiary or beneficiaries, or to any other changes in <br/>
<a id="pl.14.26"></a><var>14.26</var>this policy. The first clause of this provision, relating to the irrevocable designation of <br/>
<a id="pl.14.27"></a><var>14.27</var>beneficiary, may be omitted at the insurer's option.<br/>
<a id="pl.14.28"></a><var>14.28</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.15.0"></a><a id="pl.14.29"></a><var>14.29</var>    Sec. 15. Minnesota Statutes 2012, section 62A.047, is amended to read:<br/>
<a id="pl.14.30"></a><var>14.30</var><b>62A.047 CHILDREN'S HEALTH SUPERVISION SERVICES AND </b><br/>
<a id="pl.14.31"></a><var>14.31</var><b>PRENATAL CARE SERVICES.</b><br/>
<a id="pl.14.32"></a><var>14.32</var>A policy of individual or group health and accident insurance regulated under this <br/>
<a id="pl.14.33"></a><var>14.33</var>chapter, or individual or group subscriber contract regulated under chapter 62C, health <br/>
<a id="pl.14.34"></a><var>14.34</var>maintenance contract regulated under chapter 62D, or health benefit certificate regulated <br/>
<a id="pl.15.1"></a><var>15.1</var>under chapter 64B, issued, renewed, or continued to provide coverage to a Minnesota <br/>
<a id="pl.15.2"></a><var>15.2</var>resident, must provide coverage for child health supervision services and prenatal care <br/>
<a id="pl.15.3"></a><var>15.3</var>services. The policy, contract, or certificate must specifically exempt reasonable and <br/>
<a id="pl.15.4"></a><var>15.4</var>customary charges for child health supervision services and prenatal care services from a <br/>
<a id="pl.15.5"></a><var>15.5</var>deductible, co-payment, or other coinsurance or dollar limitation requirement. Nothing <br/>
<a id="pl.15.6"></a><var>15.6</var>in this section prohibits a health carrier that has a network of providers from imposing <br/>
<a id="pl.15.7"></a><var>15.7</var>a deductible, co-payment, or other coinsurance or dollar limitation requirement for <br/>
<a id="pl.15.8"></a><var>15.8</var>child health supervision services and prenatal care services that are delivered by an <br/>
<a id="pl.15.9"></a><var>15.9</var>out-of-network provider. This section does not prohibit the use of policy waiting periods <br/>
<a id="pl.15.10"></a><var>15.10</var>or preexisting condition limitations for these services. Minimum benefits may be limited <br/>
<a id="pl.15.11"></a><var>15.11</var>to one visit payable to one provider for all of the services provided at each visit cited in <br/>
<a id="pl.15.12"></a><var>15.12</var>this section subject to the schedule set forth in this section. Nothing in this section applies <br/>
<a id="pl.15.13"></a><var>15.13</var>to a policy designed primarily to provide coverage payable on a per diem, fixed indemnity, <br/>
<a id="pl.15.14"></a><var>15.14</var>or non-expense-incurred basis, or a policy that provides only accident coverage. A policy, <br/>
<a id="pl.15.15"></a><var>15.15</var>contract, or certificate described under this section may not apply to preexisting condition <br/>
<a id="pl.15.16"></a><var>15.16</var>limitations to individuals under 19 years of age. This section does not apply to individual <br/>
<a id="pl.15.17"></a><var>15.17</var>coverage under a grandfathered plan.<br/>
<a id="pl.15.18"></a><var>15.18</var>"Child health supervision services" means pediatric preventive services, appropriate <br/>
<a id="pl.15.19"></a><var>15.19</var>immunizations, developmental assessments, and laboratory services appropriate to the age <br/>
<a id="pl.15.20"></a><var>15.20</var>of a child from birth to age six, and appropriate immunizations from ages six to 18, as <br/>
<a id="pl.15.21"></a><var>15.21</var>defined by Standards of Child Health Care issued by the American Academy of Pediatrics. <br/>
<a id="pl.15.22"></a><var>15.22</var>Reimbursement must be made for at least five child health supervision visits from birth <br/>
<a id="pl.15.23"></a><var>15.23</var>to 12 months, three child health supervision visits from 12 months to 24 months, once a <br/>
<a id="pl.15.24"></a><var>15.24</var>year from 24 months to 72 months.<br/>
<a id="pl.15.25"></a><var>15.25</var>"Prenatal care services" means the comprehensive package of medical and <br/>
<a id="pl.15.26"></a><var>15.26</var>psychosocial support provided throughout the pregnancy, including risk assessment, <br/>
<a id="pl.15.27"></a><var>15.27</var>serial surveillance, prenatal education, and use of specialized skills and technology, <br/>
<a id="pl.15.28"></a><var>15.28</var>when needed, as defined by Standards for Obstetric-Gynecologic Services issued by the <br/>
<a id="pl.15.29"></a><var>15.29</var>American College of Obstetricians and Gynecologists.<br/>
<a id="pl.15.30"></a><var>15.30</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.16.0"></a><a id="pl.15.31"></a><var>15.31</var>    Sec. 16. Minnesota Statutes 2012, section 62A.049, is amended to read:<br/>
<a id="pl.15.32"></a><var>15.32</var><b>62A.049 LIMITATION ON PREAUTHORIZATIONS; EMERGENCIES.</b><br/>
<a id="pl.15.33"></a><var>15.33</var>No policy of accident and sickness insurance or group subscriber contract regulated <br/>
<a id="pl.15.34"></a><var>15.34</var>under chapter 62C issued or renewed in this state may contain a provision that makes an <br/>
<a id="pl.16.1"></a><var>16.1</var>insured person ineligible to receive full benefits because of the insured's failure to obtain <br/>
<a id="pl.16.2"></a><var>16.2</var>preauthorization, if that failure occurs because of the need for emergency confinement <br/>
<a id="pl.16.3"></a><var>16.3</var>or emergency treatment. The insured or an authorized representative of the insured shall <br/>
<a id="pl.16.4"></a><var>16.4</var>notify the insurer as soon after the beginning of emergency confinement or emergency <br/>
<a id="pl.16.5"></a><var>16.5</var>treatment as reasonably possible. However, to the extent that the insurer suffers actual <br/>
<a id="pl.16.6"></a><var>16.6</var>prejudice caused by the failure to obtain preauthorization, the insured may be denied all or <br/>
<a id="pl.16.7"></a><var>16.7</var>part of the insured's benefits. This provision does not apply to admissions for treatment of <br/>
<a id="pl.16.8"></a><var>16.8</var>chemical dependency and nervous and mental disorders.<br/>
<a id="pl.16.9"></a><var>16.9</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.17.0"></a><a id="pl.16.10"></a><var>16.10</var>    Sec. 17. Minnesota Statutes 2012, section 62A.136, is amended to read:<br/>
<a id="pl.16.11"></a><var>16.11</var><b>62A.136 HEARING, DENTAL, AND VISION PLAN COVERAGE.</b><br/>
<a id="pl.16.12"></a><var>16.12</var>The following provisions do not apply to health plans as defined in section 
         <statute_ref>62A.011, <br/>
<a id="pl.16.13"></a><var>16.13</var>subdivision 3
         </statute_ref>, clause (6), providing hearing, dental, or vision coverage only: sections <br/>
<statute_ref><a id="pl.16.14"></a><var>16.14</var>62A.041
         </statute_ref>; 
         <statute_ref>62A.0411</statute_ref>; 
         <statute_ref>62A.047</statute_ref>; 
         <statute_ref>62A.149</statute_ref>; 
         <statute_ref>62A.151</statute_ref>; 
         <statute_ref>62A.152</statute_ref>; 
         <statute_ref>62A.154</statute_ref>; 
         <statute_ref>62A.155</statute_ref>; 
         <statute_ref>62A.17, <br/>
<a id="pl.16.15"></a><var>16.15</var>subdivision 6
         </statute_ref>; 
         <statute_ref>62A.21, subdivision 2b</statute_ref>; 
         <statute_ref>62A.26</statute_ref>; 
         <statute_ref>62A.28</statute_ref>; 
         <statute_ref>62A.285</statute_ref>; 
         <statute_ref>62A.30</statute_ref>; 
         <statute_ref>62A.304</statute_ref>; and<br/>
<a id="pl.16.16"></a><var>16.16</var>
<statute_ref>62A.3093</statute_ref>; and 
<statute_ref>62E.16</statute_ref>.<br/>
<a id="pl.16.17"></a><var>16.17</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.18.0"></a><a id="pl.16.18"></a><var>16.18</var>    Sec. 18. Minnesota Statutes 2012, section 62A.149, subdivision 1, is amended to read:<br/>
<a id="pl.16.19"></a><var>16.19</var>    Subdivision 1. <b>Application.</b> The provisions of this section apply to all group <br/>
<a id="pl.16.20"></a><var>16.20</var>policies of accident and health insurance and group subscriber contracts offered by <br/>
<a id="pl.16.21"></a><var>16.21</var>nonprofit health service plan corporations regulated under chapter 62C, and to a plan or <br/>
<a id="pl.16.22"></a><var>16.22</var>policy that is individually underwritten or provided for a specific individual and family <br/>
<a id="pl.16.23"></a><var>16.23</var>members as a nongroup policy unless the individual elects in writing to refuse benefits <br/>
<a id="pl.16.24"></a><var>16.24</var>under this subdivision in exchange for an appropriate reduction in premiums or subscriber <br/>
<a id="pl.16.25"></a><var>16.25</var>charges under the policy or plan, when the policies or subscriber contracts are issued or <br/>
<a id="pl.16.26"></a><var>16.26</var>delivered in Minnesota or provide benefits to Minnesota residents enrolled thereunder.<br/>
<a id="pl.16.27"></a><var>16.27</var>    This section does not apply to policies designed primarily to provide coverage <br/>
<a id="pl.16.28"></a><var>16.28</var>payable on a per diem, fixed indemnity or nonexpense incurred basis or policies that <br/>
<a id="pl.16.29"></a><var>16.29</var>provide accident only coverage.<br/>
<a id="pl.16.30"></a><var>16.30</var>    Every insurance policy or subscriber contract included within the provisions of this <br/>
<a id="pl.16.31"></a><var>16.31</var>subdivision, upon issuance or renewal, shall provide coverage that complies with the <br/>
<a id="pl.16.32"></a><var>16.32</var>requirements of section 
         <statute_ref>62Q.47</statute_ref>, paragraphs (b) and (c), for the treatment of alcoholism, <br/>
<a id="pl.16.33"></a><var>16.33</var>chemical dependency or drug addiction to any Minnesota resident entitled to coverage.<br/>
<a id="pl.17.1"></a><var>17.1</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.19.0"></a><a id="pl.17.2"></a><var>17.2</var>    Sec. 19. Minnesota Statutes 2012, section 62A.17, subdivision 2, is amended to read:<br/>
<a id="pl.17.3"></a><var>17.3</var>    Subd. 2. <b>Responsibility of employee.</b> Every covered employee electing to continue <br/>
<a id="pl.17.4"></a><var>17.4</var>coverage shall pay the former employer, on a monthly basis, the cost of the continued <br/>
<a id="pl.17.5"></a><var>17.5</var>coverage. The policy, contract, or plan must require the group policyholder or contract <br/>
<a id="pl.17.6"></a><var>17.6</var>holder to, upon request, provide the employee with written verification from the insurer <br/>
<a id="pl.17.7"></a><var>17.7</var>of the cost of this coverage promptly at the time of eligibility for this coverage and at <br/>
<a id="pl.17.8"></a><var>17.8</var>any time during the continuation period. If the policy, contract, or health care plan is <br/>
<a id="pl.17.9"></a><var>17.9</var>administered by a trust, every covered employee electing to continue coverage shall pay <br/>
<a id="pl.17.10"></a><var>17.10</var>the trust the cost of continued coverage according to the eligibility rules established by the <br/>
<a id="pl.17.11"></a><var>17.11</var>trust. In no event shall the amount of premium charged exceed 102 percent of the cost <br/>
<a id="pl.17.12"></a><var>17.12</var>to the plan for such period of coverage for similarly situated employees with respect to <br/>
<a id="pl.17.13"></a><var>17.13</var>whom neither termination nor layoff has occurred, without regard to whether such cost <br/>
<a id="pl.17.14"></a><var>17.14</var>is paid by the employer or employee. The employee shall be eligible to continue the <br/>
<a id="pl.17.15"></a><var>17.15</var>coverage until the employee becomes covered under another group health plan, or for a <br/>
<a id="pl.17.16"></a><var>17.16</var>period of 18 months after the termination of or lay off from employment, whichever is <br/>
<a id="pl.17.17"></a><var>17.17</var>shorter. For an individual age 19 or older, if the employee becomes covered under another <br/>
<a id="pl.17.18"></a><var>17.18</var>group policy, contract, or health plan and the new group policy, contract, or health plan <br/>
<a id="pl.17.19"></a><var>17.19</var>contains any preexisting condition limitations, the employee may, subject to the 18-month <br/>
<a id="pl.17.20"></a><var>17.20</var>maximum continuation limit, continue coverage with the former employer until the <br/>
<a id="pl.17.21"></a><var>17.21</var>preexisting condition limitations have been satisfied. The new policy, contract, or health <br/>
<a id="pl.17.22"></a><var>17.22</var>plan is primary except as to the preexisting condition. In the case of a newborn child who <br/>
<a id="pl.17.23"></a><var>17.23</var>is a dependent of the employee, the new policy, contract, or health plan is primary upon <br/>
<a id="pl.17.24"></a><var>17.24</var>the date of birth of the child, regardless of which policy, contract, or health plan coverage <br/>
<a id="pl.17.25"></a><var>17.25</var>is deemed primary for the mother of the child.<br/>
<a id="pl.17.26"></a><var>17.26</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.20.0"></a><a id="pl.17.27"></a><var>17.27</var>    Sec. 20. Minnesota Statutes 2012, section 62A.17, subdivision 6, is amended to read:<br/>
<a id="pl.17.28"></a><var>17.28</var>    Subd. 6. <b>Conversion to individual policy.</b> A group insurance policy that provides <br/>
<a id="pl.17.29"></a><var>17.29</var>posttermination or layoff coverage as required by this section shall also include a <br/>
<a id="pl.17.30"></a><var>17.30</var>provision allowing a covered employee, surviving spouse, or dependent at the expiration <br/>
<a id="pl.17.31"></a><var>17.31</var>of the posttermination or layoff coverage provided by subdivision 2 to obtain from the <br/>
<a id="pl.17.32"></a><var>17.32</var>insurer offering the group policy or group subscriber contract, at the employee's, spouse's, <br/>
<a id="pl.17.33"></a><var>17.33</var>or dependent's option and expense, without further evidence of insurability and without <br/>
<a id="pl.17.34"></a><var>17.34</var>interruption of coverage, an individual policy of insurance or an individual subscriber <br/>
<a id="pl.18.1"></a><var>18.1</var>contract providing at least the minimum benefits of a qualified plan as prescribed by <br/>
<a id="pl.18.2"></a><var>18.2</var>section 
<statute_ref>62E.06</statute_ref> and the option of a number three qualified plan, a number two qualified <br/>
<a id="pl.18.3"></a><var>18.3</var>plan, and a number one qualified plan as provided by section 
<statute_ref>62E.06</statute_ref>, subdivisions 1 to <br/>
<a id="pl.18.4"></a><var>18.4</var>3, provided application is made to the insurer within 30 days following notice of the <br/>
<a id="pl.18.5"></a><var>18.5</var>expiration of the continued coverage and upon payment of the appropriate premium. <br/>
<a id="pl.18.6"></a><var>18.6</var>The required conversion contract must treat pregnancy the same as any other covered <br/>
<a id="pl.18.7"></a><var>18.7</var>illness under the conversion contract. A health maintenance contract issued by a health <br/>
<a id="pl.18.8"></a><var>18.8</var>maintenance organization that provides posttermination or layoff coverage as required <br/>
<a id="pl.18.9"></a><var>18.9</var>by this section shall also include a provision allowing a former employee, surviving <br/>
<a id="pl.18.10"></a><var>18.10</var>spouse, or dependent at the expiration of the posttermination or layoff coverage provided <br/>
<a id="pl.18.11"></a><var>18.11</var>in subdivision 2 to obtain from the health maintenance organization, at the former <br/>
<a id="pl.18.12"></a><var>18.12</var>employee's, spouse's, or dependent's option and expense, without further evidence of <br/>
<a id="pl.18.13"></a><var>18.13</var>insurability and without interruption of coverage, an individual health maintenance <br/>
<a id="pl.18.14"></a><var>18.14</var>contract. Effective January 1, 1985, enrollees who have become nonresidents of the health <br/>
<a id="pl.18.15"></a><var>18.15</var>maintenance organization's service area shall be given the option, to be arranged by the <br/>
<a id="pl.18.16"></a><var>18.16</var>health maintenance organization, of a number three qualified plan, a number two qualified <br/>
<a id="pl.18.17"></a><var>18.17</var>plan, or a number one qualified plan as provided by section 
<statute_ref>62E.06</statute_ref>, subdivisions 1 to 3. <br/>
<a id="pl.18.18"></a><var>18.18</var>This option shall be made available at the enrollee's expense, without further evidence of <br/>
<a id="pl.18.19"></a><var>18.19</var>insurability and without interruption of coverage.<br/>
<a id="pl.18.20"></a><var>18.20</var>A policy providing reduced benefits at a reduced premium rate may be accepted <br/>
<a id="pl.18.21"></a><var>18.21</var>by the employee, the spouse, or a dependent in lieu of the optional coverage otherwise <br/>
<a id="pl.18.22"></a><var>18.22</var>required by this subdivision.<br/>
<a id="pl.18.23"></a><var>18.23</var>The An individual policy or contract issued as a conversion policy prior to January <br/>
<a id="pl.18.24"></a><var>18.24</var>1, 2014, shall be renewable at the option of the individual as long as the individual is not <br/>
<a id="pl.18.25"></a><var>18.25</var>covered under another qualified plan as defined in section 
         <statute_ref>62E.02, subdivision 4</statute_ref>. Any <br/>
<a id="pl.18.26"></a><var>18.26</var>revisions in the table of rate for the individual policy shall apply to the covered person's <br/>
<a id="pl.18.27"></a><var>18.27</var>original age at entry and shall apply equally to all similar conversion policies issued <br/>
<a id="pl.18.28"></a><var>18.28</var>by the insurer.<br/>
<a id="pl.18.29"></a><var>18.29</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.21.0"></a><a id="pl.18.30"></a><var>18.30</var>    Sec. 21. Minnesota Statutes 2012, section 62A.21, subdivision 2b, is amended to read:<br/>
<a id="pl.18.31"></a><var>18.31</var>    Subd. 2b. <b>Conversion privilege.</b> Every policy described in subdivision 1 shall <br/>
<a id="pl.18.32"></a><var>18.32</var>contain a provision allowing a former spouse and dependent children of an insured, <br/>
<a id="pl.18.33"></a><var>18.33</var>without providing evidence of insurability, to obtain from the insurer at the expiration of <br/>
<a id="pl.18.34"></a><var>18.34</var>any continuation of coverage required under subdivision 2a or sections 
<statute_ref>62A.146</statute_ref> and <br/>
<a id="pl.18.35"></a><var>18.35</var><statute_ref>62A.20</statute_ref>, conversion coverage providing at least the minimum benefits of a qualified <br/>
<a id="pl.19.1"></a><var>19.1</var>plan as prescribed by section 
<statute_ref>62E.06</statute_ref> and the option of a number three qualified plan, a <br/>
<a id="pl.19.2"></a><var>19.2</var>number two qualified plan, a number one qualified plan as provided by section 
<statute_ref>62E.06</statute_ref>, <br/>
<a id="pl.19.3"></a><var>19.3</var>subdivisions 1 to 3, provided application is made to the insurer within 30 days following <br/>
<a id="pl.19.4"></a><var>19.4</var>notice of the expiration of the continued coverage and upon payment of the appropriate <br/>
<a id="pl.19.5"></a><var>19.5</var>premium. The An individual policy or contract issued as a conversion policy prior to <br/>
<a id="pl.19.6"></a><var>19.6</var>January 1, 2014, shall be renewable at the option of the covered person as long as the <br/>
<a id="pl.19.7"></a><var>19.7</var>covered person is not covered under another qualified plan as defined in section 
         <statute_ref>62E.02, <br/>
<a id="pl.19.8"></a><var>19.8</var>subdivision 4
         </statute_ref>. Any revisions in the table of rate for the individual policy shall apply to the <br/>
<a id="pl.19.9"></a><var>19.9</var>covered person's original age at entry and shall apply equally to all similar conversion<br/>
<a id="pl.19.10"></a><var>19.10</var> policies issued by the insurer.<br/>
<a id="pl.19.11"></a><var>19.11</var>A policy providing reduced benefits at a reduced premium rate may be accepted by <br/>
<a id="pl.19.12"></a><var>19.12</var>the covered person in lieu of the optional coverage otherwise required by this subdivision.<br/>
<a id="pl.19.13"></a><var>19.13</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.22.0"></a><a id="pl.19.14"></a><var>19.14</var>    Sec. 22. Minnesota Statutes 2012, section 62A.28, subdivision 2, is amended to read:<br/>
<a id="pl.19.15"></a><var>19.15</var>    Subd. 2. <b>Required coverage.</b> Every policy, plan, certificate, or contract referred to <br/>
<a id="pl.19.16"></a><var>19.16</var>in subdivision 1 issued or renewed after August 1, 1987, must provide coverage for scalp <br/>
<a id="pl.19.17"></a><var>19.17</var>hair prostheses worn for hair loss suffered as a result of alopecia areata.<br/>
<a id="pl.19.18"></a><var>19.18</var>The coverage required by this section is subject to the co-payment, coinsurance, <br/>
<a id="pl.19.19"></a><var>19.19</var>deductible, and other enrollee cost-sharing requirements that apply to similar types of <br/>
<a id="pl.19.20"></a><var>19.20</var>items under the policy, plan, certificate, or contract, and is limited to a maximum of $350 <br/>
<a id="pl.19.21"></a><var>19.21</var>in any benefit year and may be limited to one prosthesis per benefit year.<br/>
<a id="pl.19.22"></a><var>19.22</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.23.0"></a><a id="pl.19.23"></a><var>19.23</var>    Sec. 23. Minnesota Statutes 2012, section 62A.302, is amended to read:<br/>
<a id="pl.19.24"></a><var>19.24</var><b>62A.302 COVERAGE OF DEPENDENTS.</b><br/>
<a id="pl.19.25"></a><var>19.25</var>    Subdivision 1. <b>Scope of coverage.</b> This section applies to:<br/>
<a id="pl.19.26"></a><var>19.26</var>(1) a health plan as defined in section 
         <statute_ref>62A.011</statute_ref>; and<br/>
<a id="pl.19.27"></a><var>19.27</var>(2) coverage described in section 
<statute_ref>62A.011, subdivision 3</statute_ref>, clauses (4), (6), (7), (8), <br/>
<a id="pl.19.28"></a><var>19.28</var>(9), and (10); and<br/>
<a id="pl.19.29"></a><var>19.29</var>(3) (2) a policy, contract, or certificate issued by a community integrated service <br/>
<a id="pl.19.30"></a><var>19.30</var>network licensed under chapter 62N.<br/>
<a id="pl.19.31"></a><var>19.31</var>    Subd. 2. <b>Required coverage.</b> Every health plan included in subdivision 1 that <br/>
<a id="pl.19.32"></a><var>19.32</var>provides dependent coverage must define "dependent" no more restrictively than the <br/>
<a id="pl.19.33"></a><var>19.33</var>definition provided in section 
         <statute_ref>62L.02, subdivision 11</statute_ref>.<br/>
<a id="pl.20.1"></a><var>20.1</var>    Subd. 3. <b>No additional restrictions permitted.</b> Any health plan included in <br/>
<a id="pl.20.2"></a><var>20.2</var>subdivision 1 that provides dependent coverage of children shall make that coverage <br/>
<a id="pl.20.3"></a><var>20.3</var>available to children until the child attains 26 years of age. A health carrier must not place <br/>
<a id="pl.20.4"></a><var>20.4</var>restrictions on this coverage and must comply with the following requirements:<br/>
<a id="pl.20.5"></a><var>20.5</var>(1) with respect to a child who has not attained 26 years of age, a health carrier shall <br/>
<a id="pl.20.6"></a><var>20.6</var>not define dependent for purposes of eligibility for dependent coverage of children other <br/>
<a id="pl.20.7"></a><var>20.7</var>than the terms of a relationship between a child and the enrollee or spouse of the enrollee;<br/>
<a id="pl.20.8"></a><var>20.8</var>(2) a health carrier must not deny or restrict coverage for a child who has not attained <br/>
<a id="pl.20.9"></a><var>20.9</var>26 years of age based on (i) the presence or absence of the child's financial dependency upon <br/>
<a id="pl.20.10"></a><var>20.10</var>the participant, primary subscriber, or any other person; (ii) residency with the participant <br/>
<a id="pl.20.11"></a><var>20.11</var>and in the individual market the primary subscriber, or with any other person; (iii) marital <br/>
<a id="pl.20.12"></a><var>20.12</var>status; (iv) student status; (v) employment; or (vi) any combination of those factors; and<br/>
<a id="pl.20.13"></a><var>20.13</var>(3) a health carrier must not deny or restrict coverage of a child based on eligibility <br/>
<a id="pl.20.14"></a><var>20.14</var>for other coverage, except as provided in subdivision 5.<br/>
<a id="pl.20.15"></a><var>20.15</var>    Subd. 4. <b>Grandchildren.</b> Nothing in this section requires a health carrier to make <br/>
<a id="pl.20.16"></a><var>20.16</var>coverage available for a grandchild, unless the grandparent becomes the legal guardian <br/>
<a id="pl.20.17"></a><var>20.17</var>or adoptive parent of that grandchild or unless the grandchild meets the requirements <br/>
<a id="pl.20.18"></a><var>20.18</var>of section 62A.042. For grandchildren included under a grandparent's policy pursuant <br/>
<a id="pl.20.19"></a><var>20.19</var>to section 62A.042, coverage for the grandchild may terminate if the grandchild does <br/>
<a id="pl.20.20"></a><var>20.20</var>not continue to reside with the covered grandparent continuously from birth, if the <br/>
<a id="pl.20.21"></a><var>20.21</var>grandchild does not remain financially dependent upon the covered grandparent, or when <br/>
<a id="pl.20.22"></a><var>20.22</var>the grandchild reaches age 25, except as provided in section 62A.14 or if coverage is <br/>
<a id="pl.20.23"></a><var>20.23</var>continued under section 62A.20.<br/>
<a id="pl.20.24"></a><var>20.24</var>    Subd. 5. <b>Terms of coverage of dependents.</b> The terms of coverage in a health plan <br/>
<a id="pl.20.25"></a><var>20.25</var>offered by a health carrier providing dependent coverage of children cannot vary based on <br/>
<a id="pl.20.26"></a><var>20.26</var>age except for children who are 26 years of age or older.<br/>
<a id="pl.20.27"></a><var>20.27</var>    Subd. 6. <b>Opportunity to enroll.</b> A health carrier must comply with all provisions <br/>
<a id="pl.20.28"></a><var>20.28</var>of the Affordable Care Act in regards to providing an opportunity to enroll in coverage to <br/>
<a id="pl.20.29"></a><var>20.29</var>any child whose coverage ended, or was not eligible for coverage under a group health <br/>
<a id="pl.20.30"></a><var>20.30</var>plan or individual health plan because, under the terms of the coverage, the availability of <br/>
<a id="pl.20.31"></a><var>20.31</var>dependent coverage of a child ended before age 26. <br/>
<a id="pl.20.32"></a><var>20.32</var>    Subd. 7. <b>Grandfathered plan coverage.</b> (a) For plan years beginning before <br/>
<a id="pl.20.33"></a><var>20.33</var>January 1, 2014, a group health plan that is a grandfathered plan and makes available <br/>
<a id="pl.20.34"></a><var>20.34</var>dependent coverage of children may exclude an adult child who has not attained 26 <br/>
<a id="pl.20.35"></a><var>20.35</var>years of age from coverage only if the adult child is eligible to enroll in an eligible <br/>
<a id="pl.21.1"></a><var>21.1</var>employer-sponsored health benefit plan, as defined in section 5000A(f)(2) of the Internal <br/>
<a id="pl.21.2"></a><var>21.2</var>Revenue Code, other than the group health plan of a parent.<br/>
<a id="pl.21.3"></a><var>21.3</var>(b) For plan years beginning on or after January 1, 2014, a group health plan that is a <br/>
<a id="pl.21.4"></a><var>21.4</var>grandfathered plan must comply with all requirements of this section.<br/>
<a id="pl.21.5"></a><var>21.5</var>    Subd. 8. <b>Compliance.</b> This section does not require compliance with any provision <br/>
<a id="pl.21.6"></a><var>21.6</var>of the Affordable Care Act before the effective date provided for that provision in the <br/>
<a id="pl.21.7"></a><var>21.7</var>Affordable Care Act.<br/>
<a id="pl.21.8"></a><var>21.8</var>    Subd. 9. <b>Enforcement.</b> The commissioner shall enforce this section.<br/>
<a id="pl.21.9"></a><var>21.9</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.24.0"></a><a id="pl.21.10"></a><var>21.10</var>    Sec. 24. <b>[62A.3021] COVERAGE OF DEPENDENTS BY PLANS OTHER THAN </b><br/>
<a id="pl.21.11"></a><var>21.11</var><b>HEALTH PLANS.</b><br/>
<a id="pl.21.12"></a><var>21.12</var>    Subdivision 1. <b>Scope of coverage.</b> This section applies to coverage described in <br/>
<a id="pl.21.13"></a><var>21.13</var>section 62A.011, subdivision 3, clauses (4), (6), (7), (8), (9), and (10).<br/>
<a id="pl.21.14"></a><var>21.14</var>    Subd. 2. <b>Dependent.</b> "Dependent" means an eligible employee's spouse, unmarried <br/>
<a id="pl.21.15"></a><var>21.15</var>child who is under the age of 25, dependent child of any age who is disabled and who <br/>
<a id="pl.21.16"></a><var>21.16</var>meets the eligibility criteria in section 62A.14, subdivision 2, or any other person whom <br/>
<a id="pl.21.17"></a><var>21.17</var>state or federal law requires to be treated as a dependent for purposes of health plans. For <br/>
<a id="pl.21.18"></a><var>21.18</var>the purpose of this definition, a child includes a child for whom the employee or the <br/>
<a id="pl.21.19"></a><var>21.19</var>employee's spouse has been appointed legal guardian and an adoptive child as provided in <br/>
<a id="pl.21.20"></a><var>21.20</var>section 62A.27. A child also includes grandchildren as provided in section 62A.042 with <br/>
<a id="pl.21.21"></a><var>21.21</var>continued eligibility of grandchildren as provided in section 62A.302, subdivision 4.<br/>
<a id="pl.21.22"></a><var>21.22</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.25.0"></a><a id="pl.21.23"></a><var>21.23</var>    Sec. 25. Minnesota Statutes 2012, section 62A.615, is amended to read:<br/>
<a id="pl.21.24"></a><var>21.24</var><b>62A.615 PREEXISTING CONDITIONS DISCLOSED AT TIME OF </b><br/>
<a id="pl.21.25"></a><var>21.25</var><b>APPLICATION.</b><br/>
<a id="pl.21.26"></a><var>21.26</var>No insurer may cancel or rescind a health insurance policy for a preexisting condition <br/>
<a id="pl.21.27"></a><var>21.27</var>of which the application or other information provided by the insured reasonably gave <br/>
<a id="pl.21.28"></a><var>21.28</var>the insurer notice. No insurer may restrict coverage for a preexisting condition of which <br/>
<a id="pl.21.29"></a><var>21.29</var>the application or other information provided by the insured reasonably gave the insurer <br/>
<a id="pl.21.30"></a><var>21.30</var>notice unless the coverage is restricted at the time the policy is issued and the restriction is <br/>
<a id="pl.21.31"></a><var>21.31</var>disclosed in writing to the insured at the time the policy is issued. In addition, no health plan <br/>
<a id="pl.21.32"></a><var>21.32</var>may restrict coverage for a preexisting condition for an individual who is under 19 years <br/>
<a id="pl.21.33"></a><var>21.33</var>of age. This section does not apply to individual health plans that are grandfathered plans.<br/>
<a id="pl.22.1"></a><var>22.1</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.26.0"></a><a id="pl.22.2"></a><var>22.2</var>    Sec. 26. Minnesota Statutes 2012, section 62A.65, subdivision 3, is amended to read:<br/>
<a id="pl.22.3"></a><var>22.3</var>    Subd. 3. <b>Premium rate restrictions.</b> No individual health plan may be offered, <br/>
<a id="pl.22.4"></a><var>22.4</var>sold, issued, or renewed to a Minnesota resident unless the premium rate charged is <br/>
<a id="pl.22.5"></a><var>22.5</var>determined in accordance with the following requirements:<br/>
<a id="pl.22.6"></a><var>22.6</var>(a) Premium rates must be no more than 25 percent above and no more than 25 <br/>
<a id="pl.22.7"></a><var>22.7</var>percent below the index rate charged to individuals for the same or similar coverage, <br/>
<a id="pl.22.8"></a><var>22.8</var>adjusted pro rata for rating periods of less than one year. The premium variations <br/>
<a id="pl.22.9"></a><var>22.9</var>permitted by this paragraph must be based only upon health status, claims experience, <br/>
<a id="pl.22.10"></a><var>22.10</var>and occupation. For purposes of this paragraph, health status includes refraining from <br/>
<a id="pl.22.11"></a><var>22.11</var>tobacco use or other actuarially valid lifestyle factors associated with good health, <br/>
<a id="pl.22.12"></a><var>22.12</var>provided that the lifestyle factor and its effect upon premium rates have been determined <br/>
<a id="pl.22.13"></a><var>22.13</var>by the commissioner to be actuarially valid and have been approved by the commissioner. <br/>
<a id="pl.22.14"></a><var>22.14</var>Variations permitted under this paragraph must not be based upon age or applied <br/>
<a id="pl.22.15"></a><var>22.15</var>differently at different ages. This paragraph does not prohibit use of a constant percentage <br/>
<a id="pl.22.16"></a><var>22.16</var>adjustment for factors permitted to be used under this paragraph.<br/>
<a id="pl.22.17"></a><var>22.17</var>(b) (a) Premium rates may vary based upon the ages of covered persons only as <br/>
<a id="pl.22.18"></a><var>22.18</var>provided in this paragraph. In addition to the variation permitted under paragraph (a), each <br/>
<a id="pl.22.19"></a><var>22.19</var>health carrier may use an additional premium variation based upon age of up to plus or <br/>
<a id="pl.22.20"></a><var>22.20</var>minus 50 percent of the index rate in accordance with the provisions of the Affordable <br/>
<a id="pl.22.21"></a><var>22.21</var>Care Act.<br/>
<a id="pl.22.22"></a><var>22.22</var>(c) A health carrier may request approval by the commissioner to establish separate <br/>
<a id="pl.22.23"></a><var>22.23</var>geographic regions determined by the health carrier and to establish separate index rates <br/>
<a id="pl.22.24"></a><var>22.24</var>for each such region. <br/>
<a id="pl.22.25"></a><var>22.25</var>(b) Premium rates may vary based upon geographic rating area. The commissioner <br/>
<a id="pl.22.26"></a><var>22.26</var>shall grant approval if the following conditions are met:<br/>
<a id="pl.22.27"></a><var>22.27</var>(1) the geographic regions must be applied uniformly by the health carrier the areas <br/>
<a id="pl.22.28"></a><var>22.28</var>are established in accordance with the Affordable Care Act;<br/>
<a id="pl.22.29"></a><var>22.29</var>(2) each geographic region must be composed of no fewer than seven counties that <br/>
<a id="pl.22.30"></a><var>22.30</var>create a contiguous region; and<br/>
<a id="pl.22.31"></a><var>22.31</var>(3) the health carrier provides actuarial justification acceptable to the commissioner <br/>
<a id="pl.22.32"></a><var>22.32</var>for the proposed geographic variations in index rates premium rates for each area, <br/>
<a id="pl.22.33"></a><var>22.33</var>establishing that the variations are based upon differences in the cost to the health carrier <br/>
<a id="pl.22.34"></a><var>22.34</var>of providing coverage.<br/>
<a id="pl.23.1"></a><var>23.1</var>(d) Health carriers may use rate cells and must file with the commissioner the rate <br/>
<a id="pl.23.2"></a><var>23.2</var>cells they use. Rate cells must be based upon the number of adults or children covered <br/>
<a id="pl.23.3"></a><var>23.3</var>under the policy and may reflect the availability of Medicare coverage. The rates for <br/>
<a id="pl.23.4"></a><var>23.4</var>different rate cells must not in any way reflect generalized differences in expected costs <br/>
<a id="pl.23.5"></a><var>23.5</var>between principal insureds and their spouses.<br/>
<a id="pl.23.6"></a><var>23.6</var>(c) Premium rates may vary based upon tobacco use, in accordance with the <br/>
<a id="pl.23.7"></a><var>23.7</var>provisions of the Affordable Care Act.<br/>
<a id="pl.23.8"></a><var>23.8</var>(e) (d) In developing its index rates and premiums for a health plan, a health carrier <br/>
<a id="pl.23.9"></a><var>23.9</var>shall take into account only the following factors:<br/>
<a id="pl.23.10"></a><var>23.10</var>(1) actuarially valid differences in rating factors permitted under paragraphs (a) <br/>
<a id="pl.23.11"></a><var>23.11</var>and (b) (c); and<br/>
<a id="pl.23.12"></a><var>23.12</var>(2) actuarially valid geographic variations if approved by the commissioner as <br/>
<a id="pl.23.13"></a><var>23.13</var>provided in paragraph (c) (b).<br/>
<a id="pl.23.14"></a><var>23.14</var>(e) The premium charged with respect to any particular individual health plan shall <br/>
<a id="pl.23.15"></a><var>23.15</var>not be adjusted more frequently than annually or January 1 of the year following initial <br/>
<a id="pl.23.16"></a><var>23.16</var>enrollment, except that the premium rates may be changed to reflect:<br/>
<a id="pl.23.17"></a><var>23.17</var>(1) changes to the family composition of the policyholder;<br/>
<a id="pl.23.18"></a><var>23.18</var>(2) changes in geographic rating area of the policyholder, as provided in paragraph <br/>
<a id="pl.23.19"></a><var>23.19</var>(b);<br/>
<a id="pl.23.20"></a><var>23.20</var>(3) changes in age, as provided in paragraph (a);<br/>
<a id="pl.23.21"></a><var>23.21</var>(4) changes in tobacco use, as provided in paragraph (c);<br/>
<a id="pl.23.22"></a><var>23.22</var>(5) transfer to a new health plan requested by the policyholder; or<br/>
<a id="pl.23.23"></a><var>23.23</var>(6) other changes required by or otherwise expressly permitted by state or federal <br/>
<a id="pl.23.24"></a><var>23.24</var>law or regulations.<br/>
<a id="pl.23.25"></a><var>23.25</var>(f) All premium variations must be justified in initial rate filings and upon request of <br/>
<a id="pl.23.26"></a><var>23.26</var>the commissioner in rate revision filings. All rate variations are subject to approval by <br/>
<a id="pl.23.27"></a><var>23.27</var>the commissioner.<br/>
<a id="pl.23.28"></a><var>23.28</var>(g) The loss ratio must comply with the section 
         <statute_ref>62A.021</statute_ref> requirements for individual <br/>
<a id="pl.23.29"></a><var>23.29</var>health plans.<br/>
<a id="pl.23.30"></a><var>23.30</var>(h) The rates must not be approved, unless the commissioner has determined that the <br/>
<a id="pl.23.31"></a><var>23.31</var>rates are reasonable. In determining reasonableness, the commissioner shall consider the <br/>
<a id="pl.23.32"></a><var>23.32</var>growth rates applied under section 
         <statute_ref>62J.04, subdivision 1</statute_ref>, paragraph (b), to the calendar <br/>
<a id="pl.23.33"></a><var>23.33</var>year or years that the proposed premium rate would be in effect, and actuarially valid <br/>
<a id="pl.23.34"></a><var>23.34</var>changes in risks associated with the enrollee populations, and actuarially valid changes as <br/>
<a id="pl.23.35"></a><var>23.35</var>a result of statutory changes in Laws 1992, chapter 549.<br/>
<a id="pl.24.1"></a><var>24.1</var>(i) An insurer A health carrier may, as part of a minimum lifetime loss ratio <br/>
<a id="pl.24.2"></a><var>24.2</var>guarantee filing under section 
         <statute_ref>62A.02</statute_ref>, subdivision 3a, include a rating practices guarantee <br/>
<a id="pl.24.3"></a><var>24.3</var>as provided in this paragraph. The rating practices guarantee must be in writing and <br/>
<a id="pl.24.4"></a><var>24.4</var>must guarantee that the policy form will be offered, sold, issued, and renewed only with <br/>
<a id="pl.24.5"></a><var>24.5</var>premium rates and premium rating practices that comply with subdivisions 2, 3, 4, and 5. <br/>
<a id="pl.24.6"></a><var>24.6</var>The rating practices guarantee must be accompanied by an actuarial memorandum that <br/>
<a id="pl.24.7"></a><var>24.7</var>demonstrates that the premium rates and premium rating system used in connection with <br/>
<a id="pl.24.8"></a><var>24.8</var>the policy form will satisfy the guarantee. The guarantee must guarantee refunds of any <br/>
<a id="pl.24.9"></a><var>24.9</var>excess premiums to policyholders charged premiums that exceed those permitted under <br/>
<a id="pl.24.10"></a><var>24.10</var>subdivision 2, 3, 4, or 5. An insurer A health carrier that complies with this paragraph in <br/>
<a id="pl.24.11"></a><var>24.11</var>connection with a policy form is exempt from the requirement of prior approval by the <br/>
<a id="pl.24.12"></a><var>24.12</var>commissioner under paragraphs (c) (b), (f), and (h).<br/>
<a id="pl.24.13"></a><var>24.13</var>(j) The commissioner may establish regulations to implement the provisions of <br/>
<a id="pl.24.14"></a><var>24.14</var>this subdivision.<br/>
<a id="pl.24.15"></a><var>24.15</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.27.0"></a><a id="pl.24.16"></a><var>24.16</var>    Sec. 27. Minnesota Statutes 2012, section 62A.65, is amended by adding a subdivision <br/>
<a id="pl.24.17"></a><var>24.17</var>to read:<br/>
<a id="pl.24.18"></a><var>24.18</var>    Subd. 3a. <b>Disclosure.</b> (a) In connection with the offering for sale of a health plan <br/>
<a id="pl.24.19"></a><var>24.19</var>in the individual market, a health carrier shall make a reasonable disclosure, as part of <br/>
<a id="pl.24.20"></a><var>24.20</var>its solicitation and sales materials, of all of the following:<br/>
<a id="pl.24.21"></a><var>24.21</var>(1) the provisions of the coverage concerning the health carrier's right to change <br/>
<a id="pl.24.22"></a><var>24.22</var>premium rates and the factors that may affect changes in premium rates; and<br/>
<a id="pl.24.23"></a><var>24.23</var>(2) a listing of and descriptive information, including benefits and premiums, about <br/>
<a id="pl.24.24"></a><var>24.24</var>all individual health plans actively marketed by the health carrier and the availability of <br/>
<a id="pl.24.25"></a><var>24.25</var>the individual health plans for which the individual is qualified.<br/>
<a id="pl.24.26"></a><var>24.26</var>(b) Paragraph (a), clause (1), may be satisfied by referring individuals to the Health <br/>
<a id="pl.24.27"></a><var>24.27</var>and Human Services Web portal, as defined under the Affordable Care Act.<br/>
<br/>
<a id="bill.1.28.0"></a><a id="pl.24.28"></a><var>24.28</var>    Sec. 28. Minnesota Statutes 2012, section 62A.65, is amended by adding a subdivision <br/>
<a id="pl.24.29"></a><var>24.29</var>to read:<br/>
<a id="pl.24.30"></a><var>24.30</var>    Subd. 3b. <b>Single risk pool.</b> A health carrier shall consider all enrollees in all health <br/>
<a id="pl.24.31"></a><var>24.31</var>plans, other than short-term and grandfathered plan coverage, offered by the health carrier <br/>
<a id="pl.24.32"></a><var>24.32</var>in the individual market, including those enrollees who enroll in qualified health plans <br/>
<a id="pl.24.33"></a><var>24.33</var>offered through the Minnesota Insurance Marketplace, to be members of a single risk pool.<br/>
<br/>
<a id="bill.1.29.0"></a><a id="pl.25.1"></a><var>25.1</var>    Sec. 29. Minnesota Statutes 2012, section 62A.65, subdivision 5, is amended to read:<br/>
<a id="pl.25.2"></a><var>25.2</var>    Subd. 5. <b>Portability and conversion of coverage.</b> (a) For plan years beginning <br/>
<a id="pl.25.3"></a><var>25.3</var>on or after January 1, 2014, no individual health plan may be offered, sold, issued, or <br/>
<a id="pl.25.4"></a><var>25.4</var>with respect to children age 18 or under renewed, to a Minnesota resident that contains a <br/>
<a id="pl.25.5"></a><var>25.5</var>preexisting condition limitation, preexisting condition exclusion, or exclusionary rider, <br/>
<a id="pl.25.6"></a><var>25.6</var>unless the limitation or exclusion is permitted under this subdivision and under chapter <br/>
<a id="pl.25.7"></a><var>25.7</var>62L, provided that, except for children age 18 or under, underwriting restrictions may <br/>
<a id="pl.25.8"></a><var>25.8</var>be retained on individual contracts that are issued without evidence of insurability as a <br/>
<a id="pl.25.9"></a><var>25.9</var>replacement for prior individual coverage that was sold before May 17, 1993. The An<br/>
<a id="pl.25.10"></a><var>25.10</var> individual age 19 or older may be subjected to an 18-month preexisting condition limitation<br/>
<a id="pl.25.11"></a><var>25.11</var> during plan years beginning prior to January 1, 2014, unless the individual has maintained <br/>
<a id="pl.25.12"></a><var>25.12</var>continuous coverage as defined in section 
         <statute_ref>62L.02</statute_ref>. The individual must not be subjected to <br/>
<a id="pl.25.13"></a><var>25.13</var>an exclusionary rider. During plan years beginning prior to January 1, 2014, an individual <br/>
<a id="pl.25.14"></a><var>25.14</var>who is age 19 or older and who has maintained continuous coverage may be subjected to a <br/>
<a id="pl.25.15"></a><var>25.15</var>onetime preexisting condition limitation of up to 12 months, with credit for time covered <br/>
<a id="pl.25.16"></a><var>25.16</var>under qualifying coverage as defined in section 
         <statute_ref>62L.02</statute_ref>, at the time that the individual first <br/>
<a id="pl.25.17"></a><var>25.17</var>is covered under an individual health plan by any health carrier. Credit must be given for <br/>
<a id="pl.25.18"></a><var>25.18</var>all qualifying coverage with respect to all preexisting conditions, regardless of whether <br/>
<a id="pl.25.19"></a><var>25.19</var>the conditions were preexisting with respect to any previous qualifying coverage. The <br/>
<a id="pl.25.20"></a><var>25.20</var>individual must not be subjected to an exclusionary rider. Thereafter, the individual who is <br/>
<a id="pl.25.21"></a><var>25.21</var>age 19 or older must not be subject to any preexisting condition limitation, preexisting <br/>
<a id="pl.25.22"></a><var>25.22</var>condition exclusion, or exclusionary rider under an individual health plan by any health <br/>
<a id="pl.25.23"></a><var>25.23</var>carrier, except an unexpired portion of a limitation under prior coverage, so long as the <br/>
<a id="pl.25.24"></a><var>25.24</var>individual maintains continuous coverage as defined in section 
         <statute_ref>62L.02</statute_ref>. The prohibition on <br/>
<a id="pl.25.25"></a><var>25.25</var>preexisting condition limitations for children age 18 or under does not apply to individual <br/>
<a id="pl.25.26"></a><var>25.26</var>health plans that are grandfathered plans. The prohibition on preexisting condition <br/>
<a id="pl.25.27"></a><var>25.27</var>limitations for adults age 19 and over beginning for plan years on or after January 1, 2014, <br/>
<a id="pl.25.28"></a><var>25.28</var>does not apply to individual health plans that are grandfathered plans.<br/>
<a id="pl.25.29"></a><var>25.29</var>(b) A health carrier must offer an individual health plan to any individual previously <br/>
<a id="pl.25.30"></a><var>25.30</var>covered under a group health plan issued by that health carrier, regardless of the size of <br/>
<a id="pl.25.31"></a><var>25.31</var>the group, so long as the individual maintained continuous coverage as defined in section <br/>
<statute_ref><a id="pl.25.32"></a><var>25.32</var>62L.02
         </statute_ref>. If the individual has available any continuation coverage provided under sections <br/>
<statute_ref><a id="pl.25.33"></a><var>25.33</var>62A.146
         </statute_ref>; 
         <statute_ref>62A.148</statute_ref>; 
         <statute_ref>62A.17</statute_ref>, subdivisions 1 and 2; 
         <statute_ref>62A.20</statute_ref>; 
         <statute_ref>62A.21</statute_ref>; 
         <statute_ref>62C.142</statute_ref>; 
         <statute_ref>62D.101</statute_ref>; or <br/>
<statute_ref><a id="pl.25.34"></a><var>25.34</var>62D.105
         </statute_ref>, or continuation coverage provided under federal law, the health carrier need not <br/>
<a id="pl.25.35"></a><var>25.35</var>offer coverage under this paragraph until the individual has exhausted the continuation <br/>
<a id="pl.25.36"></a><var>25.36</var>coverage. The offer must not be subject to underwriting, except as permitted under this <br/>
<a id="pl.26.1"></a><var>26.1</var>paragraph. A health plan issued under this paragraph must be a qualified plan as defined <br/>
<a id="pl.26.2"></a><var>26.2</var>in section 
         <statute_ref>62E.02</statute_ref> and must not contain any preexisting condition limitation, preexisting <br/>
<a id="pl.26.3"></a><var>26.3</var>condition exclusion, or exclusionary rider, except for any unexpired limitation or <br/>
<a id="pl.26.4"></a><var>26.4</var>exclusion under the previous coverage. The individual health plan must cover pregnancy <br/>
<a id="pl.26.5"></a><var>26.5</var>on the same basis as any other covered illness under the individual health plan. The offer <br/>
<a id="pl.26.6"></a><var>26.6</var>of coverage by the health carrier must inform the individual that the coverage, including <br/>
<a id="pl.26.7"></a><var>26.7</var>what is covered and the health care providers from whom covered care may be obtained, <br/>
<a id="pl.26.8"></a><var>26.8</var>may not be the same as the individual's coverage under the group health plan. The offer <br/>
<a id="pl.26.9"></a><var>26.9</var>of coverage by the health carrier must also inform the individual that the individual, if <br/>
<a id="pl.26.10"></a><var>26.10</var>a Minnesota resident, may be eligible to obtain coverage from (i) other private sources <br/>
<a id="pl.26.11"></a><var>26.11</var>of health coverage, or (ii) the Minnesota Comprehensive Health Association, without a <br/>
<a id="pl.26.12"></a><var>26.12</var>preexisting condition limitation, and must provide the telephone number used by that <br/>
<a id="pl.26.13"></a><var>26.13</var>association for enrollment purposes. The initial premium rate for the individual health <br/>
<a id="pl.26.14"></a><var>26.14</var>plan must comply with subdivision 3. The premium rate upon renewal must comply with <br/>
<a id="pl.26.15"></a><var>26.15</var>subdivision 2. In no event shall the premium rate exceed 100 percent of the premium <br/>
<a id="pl.26.16"></a><var>26.16</var>charged for comparable individual coverage by the Minnesota Comprehensive Health <br/>
<a id="pl.26.17"></a><var>26.17</var>Association, and the premium rate must be less than that amount if necessary to otherwise <br/>
<a id="pl.26.18"></a><var>26.18</var>comply with this section. An individual health plan offered under this paragraph to a <br/>
<a id="pl.26.19"></a><var>26.19</var>person satisfies the health carrier's obligation to offer conversion coverage under section <br/>
<a id="pl.26.20"></a><var>26.20</var><statute_ref>62E.16</statute_ref>, with respect to that person. Coverage issued under this paragraph must provide <br/>
<a id="pl.26.21"></a><var>26.21</var>that it cannot be canceled or nonrenewed as a result of the health carrier's subsequent <br/>
<a id="pl.26.22"></a><var>26.22</var>decision to leave the individual, small employer, or other group market. Section 
         <statute_ref>72A.20, <br/>
<a id="pl.26.23"></a><var>26.23</var>subdivision 28
         </statute_ref>, applies to this paragraph.<br/>
<a id="pl.26.24"></a><var>26.24</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment, <br/>
<a id="pl.26.25"></a><var>26.25</var>except that the amendment to paragraph (b) is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.30.0"></a><a id="pl.26.26"></a><var>26.26</var>    Sec. 30. Minnesota Statutes 2012, section 62A.65, subdivision 6, is amended to read:<br/>
<a id="pl.26.27"></a><var>26.27</var>    Subd. 6. <b>Guaranteed issue </b><b>not</b><b> required.</b> (a) Nothing in this section requires a <br/>
<a id="pl.26.28"></a><var>26.28</var>health carrier to initially issue a health plan to a Minnesota resident who is age 19 or older <br/>
<a id="pl.26.29"></a><var>26.29</var>on the date the health plan becomes effective if the effective date is prior to January 1, <br/>
<a id="pl.26.30"></a><var>26.30</var>2014, except as otherwise expressly provided in subdivision 4 or 5.<br/>
<a id="pl.26.31"></a><var>26.31</var>(b) Guaranteed issue is required for all health plans, except grandfathered plans, <br/>
<a id="pl.26.32"></a><var>26.32</var>beginning January 1, 2014.<br/>
<a id="pl.26.33"></a><var>26.33</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.31.0"></a><a id="pl.27.1"></a><var>27.1</var>    Sec. 31. Minnesota Statutes 2012, section 62A.65, subdivision 7, is amended to read:<br/>
<a id="pl.27.2"></a><var>27.2</var>    Subd. 7. <b>Short-term coverage.</b> (a) For purposes of this section, "short-term <br/>
<a id="pl.27.3"></a><var>27.3</var>coverage" means an individual health plan that:<br/>
<a id="pl.27.4"></a><var>27.4</var>(1) is issued to provide coverage for a period of 185 days or less, except that the <br/>
<a id="pl.27.5"></a><var>27.5</var>health plan may permit coverage to continue until the end of a period of hospitalization <br/>
<a id="pl.27.6"></a><var>27.6</var>for a condition for which the covered person was hospitalized on the day that coverage <br/>
<a id="pl.27.7"></a><var>27.7</var>would otherwise have ended;<br/>
<a id="pl.27.8"></a><var>27.8</var>(2) is nonrenewable, provided that the health carrier may provide coverage for one or <br/>
<a id="pl.27.9"></a><var>27.9</var>more subsequent periods that satisfy clause (1), if the total of the periods of coverage do not <br/>
<a id="pl.27.10"></a><var>27.10</var>exceed a total of 365 days out of any 555-day period, plus any additional days covered as a <br/>
<a id="pl.27.11"></a><var>27.11</var>result of hospitalization on the day that a period of coverage would otherwise have ended;<br/>
<a id="pl.27.12"></a><var>27.12</var>(3) does not cover any preexisting conditions, including ones that originated during <br/>
<a id="pl.27.13"></a><var>27.13</var>a previous identical policy or contract with the same health carrier where coverage was <br/>
<a id="pl.27.14"></a><var>27.14</var>continuous between the previous and the current policy or contract; and<br/>
<a id="pl.27.15"></a><var>27.15</var>(4) is available with an immediate effective date without underwriting upon receipt <br/>
<a id="pl.27.16"></a><var>27.16</var>of a completed application indicating eligibility under the health carrier's eligibility <br/>
<a id="pl.27.17"></a><var>27.17</var>requirements, provided that coverage that includes optional benefits may be offered on a <br/>
<a id="pl.27.18"></a><var>27.18</var>basis that does not meet this requirement.<br/>
<a id="pl.27.19"></a><var>27.19</var>(b) Short-term coverage is not subject to subdivisions 2 and 5. Short-term coverage <br/>
<a id="pl.27.20"></a><var>27.20</var>may exclude as a preexisting condition any injury, illness, or condition for which the <br/>
<a id="pl.27.21"></a><var>27.21</var>covered person had medical treatment, symptoms, or any manifestations before the <br/>
<a id="pl.27.22"></a><var>27.22</var>effective date of the coverage, but dependent children born or placed for adoption during <br/>
<a id="pl.27.23"></a><var>27.23</var>the policy period must not be subject to this provision.<br/>
<a id="pl.27.24"></a><var>27.24</var>(c) Notwithstanding subdivision 3, and section 
         <statute_ref>62A.021</statute_ref>, a health carrier may <br/>
<a id="pl.27.25"></a><var>27.25</var>combine short-term coverage with its most commonly sold individual qualified plan, as <br/>
<a id="pl.27.26"></a><var>27.26</var>defined in section 
         <statute_ref>62E.02</statute_ref>, other than short-term coverage, for purposes of complying <br/>
<a id="pl.27.27"></a><var>27.27</var>with the loss ratio requirement.<br/>
<a id="pl.27.28"></a><var>27.28</var>(d) The 365-day coverage limitation provided in paragraph (a) applies to the total <br/>
<a id="pl.27.29"></a><var>27.29</var>number of days of short-term coverage that covers a person, regardless of the number of <br/>
<a id="pl.27.30"></a><var>27.30</var>policies, contracts, or health carriers that provide the coverage. A written application for <br/>
<a id="pl.27.31"></a><var>27.31</var>short-term coverage must ask the applicant whether the applicant has been covered by <br/>
<a id="pl.27.32"></a><var>27.32</var>short-term coverage by any health carrier within the 555 days immediately preceding the <br/>
<a id="pl.27.33"></a><var>27.33</var>effective date of the coverage being applied for. Short-term coverage issued in violation <br/>
<a id="pl.27.34"></a><var>27.34</var>of the 365-day limitation is valid until the end of its term and does not lose its status as <br/>
<a id="pl.27.35"></a><var>27.35</var>short-term coverage, in spite of the violation. A health carrier that knowingly issues <br/>
<a id="pl.27.36"></a><var>27.36</var>short-term coverage in violation of the 365-day limitation is subject to the administrative <br/>
<a id="pl.28.1"></a><var>28.1</var>penalties otherwise available to the commissioner of commerce or the commissioner <br/>
<a id="pl.28.2"></a><var>28.2</var>of health, as appropriate.<br/>
<a id="pl.28.3"></a><var>28.3</var>(e) Time spent under short-term coverage counts as time spent under a preexisting <br/>
<a id="pl.28.4"></a><var>28.4</var>condition limitation for purposes of group or individual health plans, other than short-term <br/>
<a id="pl.28.5"></a><var>28.5</var>coverage, subsequently issued to that person, or to cover that person, by any health carrier, <br/>
<a id="pl.28.6"></a><var>28.6</var>if the person maintains continuous coverage as defined in section 
<statute_ref>62L.02</statute_ref>. Short-term <br/>
<a id="pl.28.7"></a><var>28.7</var>coverage is a health plan and is qualifying coverage as defined in section 
<statute_ref>62L.02</statute_ref>. <br/>
<a id="pl.28.8"></a><var>28.8</var>Notwithstanding any other law to the contrary, a health carrier is not required under any <br/>
<a id="pl.28.9"></a><var>28.9</var>circumstances to provide a person covered by short-term coverage the right to obtain <br/>
<a id="pl.28.10"></a><var>28.10</var>coverage on a guaranteed issue basis under another health plan offered by the health <br/>
<a id="pl.28.11"></a><var>28.11</var>carrier, as a result of the person's enrollment in short-term coverage.<br/>
<a id="pl.28.12"></a><var>28.12</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.32.0"></a><a id="pl.28.13"></a><var>28.13</var>    Sec. 32. Minnesota Statutes 2012, section 62C.14, subdivision 5, is amended to read:<br/>
<a id="pl.28.14"></a><var>28.14</var>    Subd. 5. <b>Disabled dependents.</b> A subscriber's individual contract or any group <br/>
<a id="pl.28.15"></a><var>28.15</var>contract delivered or issued for delivery in this state and providing that coverage of <br/>
<a id="pl.28.16"></a><var>28.16</var>a dependent child of the subscriber or a dependent child of a covered group member <br/>
<a id="pl.28.17"></a><var>28.17</var>shall terminate upon attainment of a specified limiting age as defined in section 62Q.01, <br/>
<a id="pl.28.18"></a><var>28.18</var>subdivision 9, shall also provide in substance that attainment of that age shall not terminate <br/>
<a id="pl.28.19"></a><var>28.19</var>coverage while the child is (a) incapable of self-sustaining employment by reason of <br/>
<a id="pl.28.20"></a><var>28.20</var>developmental disability, mental illness or disorder, or physical disability, and (b) chiefly <br/>
<a id="pl.28.21"></a><var>28.21</var>dependent upon the subscriber or employee for support and maintenance, provided proof <br/>
<a id="pl.28.22"></a><var>28.22</var>of incapacity and dependency is furnished by the subscriber within 31 days of attainment <br/>
<a id="pl.28.23"></a><var>28.23</var>of the limiting age as defined in section 62Q.01, subdivision 9, and subsequently as <br/>
<a id="pl.28.24"></a><var>28.24</var>required by the corporation, but not more frequently than annually after a two-year period <br/>
<a id="pl.28.25"></a><var>28.25</var>following attainment of the age. Any notice regarding termination of coverage due to <br/>
<a id="pl.28.26"></a><var>28.26</var>attainment of the limiting age must include information about this provision.<br/>
<a id="pl.28.27"></a><var>28.27</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.33.0"></a><a id="pl.28.28"></a><var>28.28</var>    Sec. 33. Minnesota Statutes 2012, section 62C.142, subdivision 2, is amended to read:<br/>
<a id="pl.28.29"></a><var>28.29</var>    Subd. 2. <b>Conversion privilege.</b> Every subscriber contract, other than a contract <br/>
<a id="pl.28.30"></a><var>28.30</var>whose continuance is contingent upon continued employment or membership, which <br/>
<a id="pl.28.31"></a><var>28.31</var>contains a provision for termination of coverage of the spouse upon dissolution of <br/>
<a id="pl.28.32"></a><var>28.32</var>marriage shall contain a provision allowing a former spouse and dependent children of a <br/>
<a id="pl.28.33"></a><var>28.33</var>subscriber, without providing evidence of insurability, to obtain from the corporation at <br/>
<a id="pl.29.1"></a><var>29.1</var>the expiration of any continuation of coverage required under subdivision 2a or section <br/>
<a id="pl.29.2"></a><var>29.2</var><statute_ref>62A.146</statute_ref>, or upon termination of coverage by reason of an entry of a valid decree of <br/>
<a id="pl.29.3"></a><var>29.3</var>dissolution which does not require the insured to provide continued coverage for the <br/>
<a id="pl.29.4"></a><var>29.4</var>former spouse, an individual subscriber contract providing at least the minimum benefits <br/>
<a id="pl.29.5"></a><var>29.5</var>of a qualified plan as prescribed by section 
<statute_ref>62E.06</statute_ref> and the option of a number three <br/>
<a id="pl.29.6"></a><var>29.6</var>qualified plan, a number two qualified plan, a number one qualified plan as provided by <br/>
<a id="pl.29.7"></a><var>29.7</var>section 
<statute_ref>62E.06</statute_ref>, subdivisions 1 to 3, provided application is made to the corporation within <br/>
<a id="pl.29.8"></a><var>29.8</var>30 days following notice of the expiration of the continued coverage and upon payment of <br/>
<a id="pl.29.9"></a><var>29.9</var>the appropriate fee. A subscriber contract providing reduced benefits at a reduced fee may <br/>
<a id="pl.29.10"></a><var>29.10</var>be accepted by the former spouse and dependent children in lieu of the optional coverage <br/>
<a id="pl.29.11"></a><var>29.11</var>otherwise required by this subdivision. The An individual subscriber contract issued as <br/>
<a id="pl.29.12"></a><var>29.12</var>conversion coverage shall be renewable at the option of the former spouse as long as the <br/>
<a id="pl.29.13"></a><var>29.13</var>former spouse is not covered under another qualified plan as defined in section 
         <statute_ref>62E.02, <br/>
<a id="pl.29.14"></a><var>29.14</var>subdivision 4
         </statute_ref>. Any revisions in the table of rate for the individual subscriber contract shall <br/>
<a id="pl.29.15"></a><var>29.15</var>apply to the former spouse's original age at entry and shall apply equally to all similar <br/>
<a id="pl.29.16"></a><var>29.16</var>contracts issued as conversion coverage by the corporation.<br/>
<a id="pl.29.17"></a><var>29.17</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.34.0"></a><a id="pl.29.18"></a><var>29.18</var>    Sec. 34. Minnesota Statutes 2012, section 62D.07, subdivision 3, is amended to read:<br/>
<a id="pl.29.19"></a><var>29.19</var>    Subd. 3. <b>Required provisions.</b> Contracts and evidences of coverage shall contain:<br/>
<a id="pl.29.20"></a><var>29.20</var>(a) no provisions or statements which are unjust, unfair, inequitable, misleading, <br/>
<a id="pl.29.21"></a><var>29.21</var>deceptive, or which are untrue, misleading, or deceptive as defined in section 
         <statute_ref>62D.12, <br/>
<a id="pl.29.22"></a><var>29.22</var>subdivision 1
         </statute_ref>;<br/>
<a id="pl.29.23"></a><var>29.23</var>(b) a clear, concise and complete statement of:<br/>
<a id="pl.29.24"></a><var>29.24</var>(1) the health care services and the insurance or other benefits, if any, to which the <br/>
<a id="pl.29.25"></a><var>29.25</var>enrollee is entitled under the health maintenance contract;<br/>
<a id="pl.29.26"></a><var>29.26</var>(2) any exclusions or limitations on the services, kind of services, benefits, or kind of <br/>
<a id="pl.29.27"></a><var>29.27</var>benefits, to be provided, including any deductible or co-payment feature and requirements <br/>
<a id="pl.29.28"></a><var>29.28</var>for referrals, prior authorizations, and second opinions;<br/>
<a id="pl.29.29"></a><var>29.29</var>(3) where and in what manner information is available as to how services, including <br/>
<a id="pl.29.30"></a><var>29.30</var>emergency and out of area services, may be obtained;<br/>
<a id="pl.29.31"></a><var>29.31</var>(4) the total amount of payment and co-payment, if any, for health care services <br/>
<a id="pl.29.32"></a><var>29.32</var>and the indemnity or service benefits, if any, which the enrollee is obligated to pay <br/>
<a id="pl.29.33"></a><var>29.33</var>with respect to individual contracts, or an indication whether the plan is contributory or <br/>
<a id="pl.29.34"></a><var>29.34</var>noncontributory with respect to group certificates; and<br/>
<a id="pl.30.1"></a><var>30.1</var>(5) a description of the health maintenance organization's method for resolving <br/>
<a id="pl.30.2"></a><var>30.2</var>enrollee complaints and a statement identifying the commissioner as an external source <br/>
<a id="pl.30.3"></a><var>30.3</var>with whom complaints may be registered; and<br/>
<a id="pl.30.4"></a><var>30.4</var>(c) on the cover page of the evidence of coverage and contract, a clear and complete <br/>
<a id="pl.30.5"></a><var>30.5</var>statement of enrollees' rights. The statement must be in bold print and captioned <br/>
<a id="pl.30.6"></a><var>30.6</var>"Important Enrollee Information and Enrollee Bill of Rights" and must include but not be <br/>
<a id="pl.30.7"></a><var>30.7</var>limited to the following provisions in the following language or in substantially similar <br/>
<a id="pl.30.8"></a><var>30.8</var>language approved in advance by the commissioner, except that paragraph (8) does not <br/>
<a id="pl.30.9"></a><var>30.9</var>apply to prepaid health plans providing coverage for programs administered by the <br/>
<a id="pl.30.10"></a><var>30.10</var>commissioner of human services:<br/>

<a id="pl.30.13"></a><var>30.13</var>organization) will be covered only if services are provided by participating (name of <br/>
<a id="pl.30.14"></a><var>30.14</var>health maintenance organization) providers or authorized by (name of health maintenance <br/>
<a id="pl.30.15"></a><var>30.15</var>organization). Your contract fully defines what services are covered and describes <br/>
<a id="pl.30.16"></a><var>30.16</var>procedures you must follow to obtain coverage.<br/>
<a id="pl.30.17"></a><var>30.17</var>(2) PROVIDERS: Enrolling in (name of health maintenance organization) does not <br/>
<a id="pl.30.18"></a><var>30.18</var>guarantee services by a particular provider on the list of providers. When a provider is <br/>
<a id="pl.30.19"></a><var>30.19</var>no longer part of (name of health maintenance organization), you must choose among <br/>
<a id="pl.30.20"></a><var>30.20</var>remaining (name of the health maintenance organization) providers.<br/>
<a id="pl.30.21"></a><var>30.21</var>(3) REFERRALS: Certain services are covered only upon referral. See section <br/>
<a id="pl.30.22"></a><var>30.22</var>(section number) of your contract for referral requirements. All referrals to non-(name of <br/>
<a id="pl.30.23"></a><var>30.23</var>health maintenance organization) providers and certain types of health care providers must <br/>
<a id="pl.30.24"></a><var>30.24</var>be authorized by (name of health maintenance organization).<br/>
<a id="pl.30.25"></a><var>30.25</var>(4) EMERGENCY SERVICES: Emergency services from providers who are not <br/>
<a id="pl.30.26"></a><var>30.26</var>affiliated with (name of health maintenance organization) will be covered only if proper <br/>
<a id="pl.30.27"></a><var>30.27</var>procedures are followed. Your contract explains the procedures and benefits associated <br/>
<a id="pl.30.28"></a><var>30.28</var>with emergency care from (name of health maintenance organization) and non-(name of <br/>
<a id="pl.30.29"></a><var>30.29</var>health maintenance organization) providers.<br/>
<a id="pl.30.30"></a><var>30.30</var>(5) EXCLUSIONS: Certain services or medical supplies are not covered. You <br/>
<a id="pl.30.31"></a><var>30.31</var>should read the contract for a detailed explanation of all exclusions.<br/>
<a id="pl.30.32"></a><var>30.32</var>(6) CONTINUATION: You may convert to an individual health maintenance <br/>
<a id="pl.30.33"></a><var>30.33</var>organization contract or continue coverage under certain circumstances. These <br/>
<a id="pl.30.34"></a><var>30.34</var>continuation and conversion rights are explained fully in your contract.<br/>
<a id="pl.31.1"></a><var>31.1</var>(7) CANCELLATION: Your coverage may be canceled by you or (name of health <br/>
<a id="pl.31.2"></a><var>31.2</var>maintenance organization) only under certain conditions. Your contract describes all <br/>
<a id="pl.31.3"></a><var>31.3</var>reasons for cancellation of coverage.<br/>
<a id="pl.31.4"></a><var>31.4</var>(8) NEWBORN COVERAGE: If your health plan provides for dependent coverage, <br/>
<a id="pl.31.5"></a><var>31.5</var>a newborn infant is covered from birth, but only if services are provided by participating <br/>
<a id="pl.31.6"></a><var>31.6</var>(name of health maintenance organization) providers or authorized by (name of health <br/>
<a id="pl.31.7"></a><var>31.7</var>maintenance organization). Certain services are covered only upon referral. (Name <br/>
<a id="pl.31.8"></a><var>31.8</var>of health maintenance organization) will not automatically know of the infant's birth <br/>
<a id="pl.31.9"></a><var>31.9</var>or that you would like coverage under your plan. You should notify (name of health <br/>
<a id="pl.31.10"></a><var>31.10</var>maintenance organization) of the infant's birth and that you would like coverage. If your <br/>
<a id="pl.31.11"></a><var>31.11</var>contract requires an additional premium for each dependent, (name of health maintenance <br/>
<a id="pl.31.12"></a><var>31.12</var>organization) is entitled to all premiums due from the time of the infant's birth until the <br/>
<a id="pl.31.13"></a><var>31.13</var>time you notify (name of health maintenance organization) of the birth. (Name of health <br/>
<a id="pl.31.14"></a><var>31.14</var>maintenance organization) may withhold payment of any health benefits for the newborn <br/>
<a id="pl.31.15"></a><var>31.15</var>infant until any premiums you owe are paid.<br/>
<a id="pl.31.16"></a><var>31.16</var>(9) PRESCRIPTION DRUGS AND MEDICAL EQUIPMENT: Enrolling in (name <br/>
<a id="pl.31.17"></a><var>31.17</var>of health maintenance organization) does not guarantee that any particular prescription <br/>
<a id="pl.31.18"></a><var>31.18</var>drug will be available nor that any particular piece of medical equipment will be available, <br/>
<a id="pl.31.19"></a><var>31.19</var>even if the drug or equipment is available at the start of the contract year.<br/>

<a id="pl.31.22"></a><var>31.22</var>services, as defined in your contract, 24 hours a day and seven days a week;<br/>
<a id="pl.31.23"></a><var>31.23</var>(2) Enrollees have the right to be informed of health problems, and to receive <br/>
<a id="pl.31.24"></a><var>31.24</var>information regarding treatment alternatives and risks which is sufficient to assure <br/>
<a id="pl.31.25"></a><var>31.25</var>informed choice;<br/>
<a id="pl.31.26"></a><var>31.26</var>(3) Enrollees have the right to refuse treatment, and the right to privacy of medical <br/>
<a id="pl.31.27"></a><var>31.27</var>and financial records maintained by the health maintenance organization and its health <br/>
<a id="pl.31.28"></a><var>31.28</var>care providers, in accordance with existing law;<br/>
<a id="pl.31.29"></a><var>31.29</var>(4) Enrollees have the right to file a complaint with the health maintenance <br/>
<a id="pl.31.30"></a><var>31.30</var>organization and the commissioner of health and the right to initiate a legal proceeding <br/>
<a id="pl.31.31"></a><var>31.31</var>when experiencing a problem with the health maintenance organization or its health <br/>
<a id="pl.31.32"></a><var>31.32</var>care providers;<br/>
<a id="pl.31.33"></a><var>31.33</var>(5) Enrollees have the right to a grace period of 31 days for the payment of each <br/>
<a id="pl.31.34"></a><var>31.34</var>premium for an individual health maintenance contract falling due after the first premium <br/>
<a id="pl.31.35"></a><var>31.35</var>during which period the contract shall continue in force;<br/>
<a id="pl.32.1"></a><var>32.1</var>(6) Medicare enrollees have the right to voluntarily disenroll from the health <br/>
<a id="pl.32.2"></a><var>32.2</var>maintenance organization and the right not to be requested or encouraged to disenroll <br/>
<a id="pl.32.3"></a><var>32.3</var>except in circumstances specified in federal law; and<br/>
<a id="pl.32.4"></a><var>32.4</var>(7) Medicare enrollees have the right to a clear description of nursing home and <br/>
<a id="pl.32.5"></a><var>32.5</var>home care benefits covered by the health maintenance organization.<br/>
<a id="pl.32.6"></a><var>32.6</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.35.0"></a><a id="pl.32.7"></a><var>32.7</var>    Sec. 35. Minnesota Statutes 2012, section 62D.095, is amended to read:<br/>
<a id="pl.32.8"></a><var>32.8</var><b>62D.095 ENROLLEE COST SHARING.</b><br/>
<a id="pl.32.9"></a><var>32.9</var>    Subdivision 1. <b>General application.</b> A health maintenance contract may contain <br/>
<a id="pl.32.10"></a><var>32.10</var>enrollee cost-sharing provisions as specified in this section. Co-payment and deductible <br/>
<a id="pl.32.11"></a><var>32.11</var>provisions in a group contract must not discriminate on the basis of age, sex, race, <br/>
<a id="pl.32.12"></a><var>32.12</var>disability, economic status, or length of enrollment in the health plan. During an <br/>
<a id="pl.32.13"></a><var>32.13</var>open enrollment period in which all offered health plans fully participate without any <br/>
<a id="pl.32.14"></a><var>32.14</var>underwriting restrictions, co-payment and deductible provisions must not discriminate <br/>
<a id="pl.32.15"></a><var>32.15</var>on the basis of preexisting health status.<br/>
<a id="pl.32.16"></a><var>32.16</var>    Subd. 2. <b>Co-payments.</b> (a) A health maintenance contract may impose a <br/>
<a id="pl.32.17"></a><var>32.17</var>co-payment as authorized under Minnesota Rules, part 4685.0801, or under this section<br/>
<a id="pl.32.18"></a><var>32.18</var> and coinsurance consistent with the provisions of the Affordable Care Act as defined <br/>
<a id="pl.32.19"></a><var>32.19</var>under section 62A.011, subdivision 1a.<br/>
<a id="pl.32.20"></a><var>32.20</var>(b) A health maintenance organization may impose a flat fee co-payment on <br/>
<a id="pl.32.21"></a><var>32.21</var>outpatient office visits not to exceed 40 percent of the median provider's charges for <br/>
<a id="pl.32.22"></a><var>32.22</var>similar services or goods received by the enrollees as calculated under Minnesota Rules, <br/>
<a id="pl.32.23"></a><var>32.23</var>part 4685.0801. A health maintenance organization may impose a flat fee co-payment on <br/>
<a id="pl.32.24"></a><var>32.24</var>outpatient prescription drugs not to exceed 50 percent of the median provider's charges <br/>
<a id="pl.32.25"></a><var>32.25</var>for similar services or goods received by the enrollees as calculated under Minnesota <br/>
<a id="pl.32.26"></a><var>32.26</var>Rules, part 4685.0801.<br/>
<a id="pl.32.27"></a><var>32.27</var>(c) If a health maintenance contract is permitted to impose a co-payment for <br/>
<a id="pl.32.28"></a><var>32.28</var>preexisting health status under sections 
<statute_ref>62D.01</statute_ref> to 
<statute_ref>62D.30</statute_ref>, these provisions may vary with <br/>
<a id="pl.32.29"></a><var>32.29</var>respect to length of enrollment in the health plan.<br/>
<a id="pl.32.30"></a><var>32.30</var>    Subd. 3. <b>Deductibles.</b> (a) A health maintenance contract issued by a health <br/>
<a id="pl.32.31"></a><var>32.31</var>maintenance organization that is assessed less than three percent of the total annual amount <br/>
<a id="pl.32.32"></a><var>32.32</var>assessed by the Minnesota comprehensive health association may impose deductibles not <br/>
<a id="pl.32.33"></a><var>32.33</var>to exceed $3,000 per person, per year and $6,000 per family, per year. For purposes of <br/>
<a id="pl.32.34"></a><var>32.34</var>the percentage calculation, a health maintenance organization's assessments include those <br/>
<a id="pl.33.1"></a><var>33.1</var>of its affiliates may impose a deductible consistent with the provisions of the Affordable <br/>
<a id="pl.33.2"></a><var>33.2</var>Care Act as defined under section 62A.011, subdivision 1a.<br/>
<a id="pl.33.3"></a><var>33.3</var>(b) All other health maintenance contracts may impose deductibles not to exceed <br/>
<a id="pl.33.4"></a><var>33.4</var>$2,250 per person, per year and $4,500 per family, per year.<br/>
<a id="pl.33.5"></a><var>33.5</var>    Subd. 4. <b>Annual out-of-pocket maximums.</b> (a) A health maintenance contract <br/>
<a id="pl.33.6"></a><var>33.6</var>issued by a health maintenance organization that is assessed less than three percent of the <br/>
<a id="pl.33.7"></a><var>33.7</var>total annual amount assessed by the Minnesota comprehensive health association must <br/>
<a id="pl.33.8"></a><var>33.8</var>include a limitation not to exceed $4,500 per person and $7,500 per family on total annual <br/>
<a id="pl.33.9"></a><var>33.9</var>out-of-pocket enrollee cost-sharing expenses. For purposes of the percentage calculation, <br/>
<a id="pl.33.10"></a><var>33.10</var>a health maintenance organization's assessments include those of its affiliates may impose <br/>
<a id="pl.33.11"></a><var>33.11</var>an annual out-of-pocket maximum consistent with the provisions of the Affordable Care <br/>
<a id="pl.33.12"></a><var>33.12</var>Act as defined under section 62A.011, subdivision 1a.<br/>
<a id="pl.33.13"></a><var>33.13</var>(b) All other health maintenance contracts must include a limitation not to <br/>
<a id="pl.33.14"></a><var>33.14</var>exceed $3,000 per person and $6,000 per family on total annual out-of-pocket enrollee <br/>
<a id="pl.33.15"></a><var>33.15</var>cost-sharing expenses.<br/>
<a id="pl.33.16"></a><var>33.16</var>    Subd. 5. <b>Exceptions.</b> No co-payments or deductibles may be imposed on preventive <br/>
<a id="pl.33.17"></a><var>33.17</var>health care services as described in Minnesota Rules, part 4685.0801, subpart 8 consistent <br/>
<a id="pl.33.18"></a><var>33.18</var>with the provisions of the Affordable Care Act as defined under section 62A.011, <br/>
<a id="pl.33.19"></a><var>33.19</var>subdivision 1a.<br/>
<a id="pl.33.20"></a><var>33.20</var>    Subd. 6. <b>Public programs.</b> This section does not apply to the prepaid medical <br/>
<a id="pl.33.21"></a><var>33.21</var>assistance program, the MinnesotaCare program, the prepaid general assistance program, <br/>
<a id="pl.33.22"></a><var>33.22</var>the federal Medicare program, or the health plans provided through any of those programs.<br/>
<a id="pl.33.23"></a><var>33.23</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.36.0"></a><a id="pl.33.24"></a><var>33.24</var>    Sec. 36. Minnesota Statutes 2012, section 62D.181, subdivision 7, is amended to read:<br/>
<a id="pl.33.25"></a><var>33.25</var>    Subd. 7. <b>Replacement coverage; limitations.</b> The association is not obligated <br/>
<a id="pl.33.26"></a><var>33.26</var>to offer replacement coverage under this chapter or conversion coverage under section <br/>
<a id="pl.33.27"></a><var>33.27</var><statute_ref>62E.16</statute_ref> at the end of the periods specified in subdivision 6. Any continuation obligation <br/>
<a id="pl.33.28"></a><var>33.28</var>arising under this chapter or chapter 62A will cease at the end of the periods specified in <br/>
<a id="pl.33.29"></a><var>33.29</var>subdivision 6.<br/>
<a id="pl.33.30"></a><var>33.30</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.37.0"></a><a id="pl.33.31"></a><var>33.31</var>    Sec. 37. Minnesota Statutes 2012, section 62E.02, is amended by adding a subdivision <br/>
<a id="pl.33.32"></a><var>33.32</var>to read:<br/>
<a id="pl.34.1"></a><var>34.1</var>    Subd. 2a. <b>Essential health benefits.</b> "Essential health benefits" has the meaning <br/>
<a id="pl.34.2"></a><var>34.2</var>given under section 62Q.81, subdivision 4.<br/>
<a id="pl.34.3"></a><var>34.3</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.38.0"></a><a id="pl.34.4"></a><var>34.4</var>    Sec. 38. Minnesota Statutes 2012, section 62E.04, subdivision 4, is amended to read:<br/>
<a id="pl.34.5"></a><var>34.5</var>    Subd. 4. <b>Major medical coverage.</b> Each insurer and fraternal shall affirmatively <br/>
<a id="pl.34.6"></a><var>34.6</var>offer coverage of major medical expenses to every applicant who applies to the insurer <br/>
<a id="pl.34.7"></a><var>34.7</var>or fraternal for a new unqualified policy, which has a lifetime benefit limit of less than <br/>
<a id="pl.34.8"></a><var>34.8</var>$1,000,000, at the time of application and annually to every holder of such an unqualified <br/>
<a id="pl.34.9"></a><var>34.9</var>policy of accident and health insurance renewed by the insurer or fraternal. The coverage <br/>
<a id="pl.34.10"></a><var>34.10</var>shall provide that when a covered individual incurs out-of-pocket expenses of $5,000 <br/>
<a id="pl.34.11"></a><var>34.11</var>or more within a calendar year for services covered in section 
         <statute_ref>62E.06, subdivision 1</statute_ref>, <br/>
<a id="pl.34.12"></a><var>34.12</var>benefits shall be payable, subject to any co-payment authorized by the commissioner, up <br/>
<a id="pl.34.13"></a><var>34.13</var>to a maximum lifetime limit of not less than $1,000,000 and shall not contain a lifetime <br/>
<a id="pl.34.14"></a><var>34.14</var>maximum on essential health benefits. The offer of coverage of major medical expenses <br/>
<a id="pl.34.15"></a><var>34.15</var>may consist of the offer of a rider on an existing unqualified policy or a new policy which <br/>
<a id="pl.34.16"></a><var>34.16</var>is a qualified plan.<br/>
<a id="pl.34.17"></a><var>34.17</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.39.0"></a><a id="pl.34.18"></a><var>34.18</var>    Sec. 39. Minnesota Statutes 2012, section 62E.04, is amended by adding a subdivision <br/>
<a id="pl.34.19"></a><var>34.19</var>to read:<br/>
<a id="pl.34.20"></a><var>34.20</var>    Subd. 11. <b>Essential health benefits package.</b> For individual or small group health <br/>
<a id="pl.34.21"></a><var>34.21</var>plans that include the essential health benefits package and are offered, sold, issued, or <br/>
<a id="pl.34.22"></a><var>34.22</var>renewed on or after January 1, 2014, the requirements of this section do not apply.<br/>
<br/>
<a id="bill.1.40.0"></a><a id="pl.34.23"></a><var>34.23</var>    Sec. 40. Minnesota Statutes 2012, section 62E.06, subdivision 1, is amended to read:<br/>
<a id="pl.34.24"></a><var>34.24</var>    Subdivision 1. <b>Number three plan.</b> A plan of health coverage shall be certified as a <br/>
<a id="pl.34.25"></a><var>34.25</var>number three qualified plan if it otherwise meets the requirements established by chapters <br/>
<a id="pl.34.26"></a><var>34.26</var>62A, 62C, and 62Q, and the other laws of this state, whether or not the policy is issued in <br/>
<a id="pl.34.27"></a><var>34.27</var>Minnesota, and meets or exceeds the following minimum standards:<br/>
<a id="pl.34.28"></a><var>34.28</var>(a) The minimum benefits for a covered individual shall, subject to the other <br/>
<a id="pl.34.29"></a><var>34.29</var>provisions of this subdivision, be equal to at least 80 percent of the cost of covered services <br/>
<a id="pl.34.30"></a><var>34.30</var>in excess of an annual deductible which does not exceed $150 per person. The coverage <br/>
<a id="pl.34.31"></a><var>34.31</var>shall include a limitation of $3,000 per person on total annual out-of-pocket expenses for <br/>
<a id="pl.35.1"></a><var>35.1</var>services covered under this subdivision. The coverage shall  not be subject to a maximum <br/>
<a id="pl.35.2"></a><var>35.2</var>lifetime benefit of not less than $1,000,000 lifetime maximum on essential health benefits.<br/>
<a id="pl.35.3"></a><var>35.3</var>The prohibition on lifetime maximums for essential health benefits and $3,000 <br/>
<a id="pl.35.4"></a><var>35.4</var>limitation on total annual out-of-pocket expenses and the $1,000,000 maximum lifetime <br/>
<a id="pl.35.5"></a><var>35.5</var>benefit shall not be subject to change or substitution by use of an actuarially equivalent <br/>
<a id="pl.35.6"></a><var>35.6</var>benefit.<br/>
<a id="pl.35.7"></a><var>35.7</var>(b) Covered expenses shall be the usual and customary charges for the following <br/>
<a id="pl.35.8"></a><var>35.8</var>services and articles when prescribed by a physician:<br/>
<a id="pl.35.9"></a><var>35.9</var>(1) hospital services;<br/>
<a id="pl.35.10"></a><var>35.10</var>(2) professional services for the diagnosis or treatment of injuries, illnesses, or <br/>
<a id="pl.35.11"></a><var>35.11</var>conditions, other than dental, which are rendered by a physician or at the physician's <br/>
<a id="pl.35.12"></a><var>35.12</var>direction;<br/>
<a id="pl.35.13"></a><var>35.13</var>(3) drugs requiring a physician's prescription;<br/>
<a id="pl.35.14"></a><var>35.14</var>(4) services of a nursing home for not more than 120 days in a year if the services <br/>
<a id="pl.35.15"></a><var>35.15</var>would qualify as reimbursable services under Medicare;<br/>
<a id="pl.35.16"></a><var>35.16</var>(5) services of a home health agency if the services would qualify as reimbursable <br/>
<a id="pl.35.17"></a><var>35.17</var>services under Medicare;<br/>
<a id="pl.35.18"></a><var>35.18</var>(6) use of radium or other radioactive materials;<br/>
<a id="pl.35.19"></a><var>35.19</var>(7) oxygen;<br/>
<a id="pl.35.20"></a><var>35.20</var>(8) anesthetics;<br/>
<a id="pl.35.21"></a><var>35.21</var>(9) prostheses other than dental but including scalp hair prostheses worn for hair <br/>
<a id="pl.35.22"></a><var>35.22</var>loss suffered as a result of alopecia areata;<br/>
<a id="pl.35.23"></a><var>35.23</var>(10) rental or purchase, as appropriate, of durable medical equipment other than <br/>
<a id="pl.35.24"></a><var>35.24</var>eyeglasses and hearing aids, unless coverage is required under section 
         <statute_ref>62Q.675</statute_ref>;<br/>
<a id="pl.35.25"></a><var>35.25</var>(11) diagnostic x-rays and laboratory tests;<br/>
<a id="pl.35.26"></a><var>35.26</var>(12) oral surgery for partially or completely unerupted impacted teeth, a tooth root <br/>
<a id="pl.35.27"></a><var>35.27</var>without the extraction of the entire tooth, or the gums and tissues of the mouth when not <br/>
<a id="pl.35.28"></a><var>35.28</var>performed in connection with the extraction or repair of teeth;<br/>
<a id="pl.35.29"></a><var>35.29</var>(13) services of a physical therapist;<br/>
<a id="pl.35.30"></a><var>35.30</var>(14) transportation provided by licensed ambulance service to the nearest facility <br/>
<a id="pl.35.31"></a><var>35.31</var>qualified to treat the condition; or a reasonable mileage rate for transportation to a kidney <br/>
<a id="pl.35.32"></a><var>35.32</var>dialysis center for treatment; and<br/>
<a id="pl.35.33"></a><var>35.33</var>(15) services of an occupational therapist.<br/>
<a id="pl.35.34"></a><var>35.34</var>(c) Covered expenses for the services and articles specified in this subdivision do <br/>
<a id="pl.35.35"></a><var>35.35</var>not include the following:<br/>
<a id="pl.36.1"></a><var>36.1</var>(1) any charge for care for injury or disease either (i) arising out of an injury in the <br/>
<a id="pl.36.2"></a><var>36.2</var>course of employment and subject to a workers' compensation or similar law, (ii) for <br/>
<a id="pl.36.3"></a><var>36.3</var>which benefits are payable without regard to fault under coverage statutorily required <br/>
<a id="pl.36.4"></a><var>36.4</var>to be contained in any motor vehicle, or other liability insurance policy or equivalent <br/>
<a id="pl.36.5"></a><var>36.5</var>self-insurance, or (iii) for which benefits are payable under another policy of accident and <br/>
<a id="pl.36.6"></a><var>36.6</var>health insurance, Medicare, or any other governmental program except as otherwise <br/>
<a id="pl.36.7"></a><var>36.7</var>provided by section 
         <statute_ref>62A.04, subdivision 3</statute_ref>, clause (4);<br/>
<a id="pl.36.8"></a><var>36.8</var>(2) any charge for treatment for cosmetic purposes other than for reconstructive <br/>
<a id="pl.36.9"></a><var>36.9</var>surgery when such service is incidental to or follows surgery resulting from injury, <br/>
<a id="pl.36.10"></a><var>36.10</var>sickness, or other diseases of the involved part or when such service is performed on a <br/>
<a id="pl.36.11"></a><var>36.11</var>covered dependent child because of congenital disease or anomaly which has resulted in a <br/>
<a id="pl.36.12"></a><var>36.12</var>functional defect as determined by the attending physician;<br/>
<a id="pl.36.13"></a><var>36.13</var>(3) care which is primarily for custodial or domiciliary purposes which would not <br/>
<a id="pl.36.14"></a><var>36.14</var>qualify as eligible services under Medicare;<br/>
<a id="pl.36.15"></a><var>36.15</var>(4) any charge for confinement in a private room to the extent it is in excess of <br/>
<a id="pl.36.16"></a><var>36.16</var>the institution's charge for its most common semiprivate room, unless a private room is <br/>
<a id="pl.36.17"></a><var>36.17</var>prescribed as medically necessary by a physician, provided, however, that if the institution <br/>
<a id="pl.36.18"></a><var>36.18</var>does not have semiprivate rooms, its most common semiprivate room charge shall be <br/>
<a id="pl.36.19"></a><var>36.19</var>considered to be 90 percent of its lowest private room charge;<br/>
<a id="pl.36.20"></a><var>36.20</var>(5) that part of any charge for services or articles rendered or prescribed by a <br/>
<a id="pl.36.21"></a><var>36.21</var>physician, dentist, or other health care personnel which exceeds the prevailing charge in <br/>
<a id="pl.36.22"></a><var>36.22</var>the locality where the service is provided; and<br/>
<a id="pl.36.23"></a><var>36.23</var>(6) any charge for services or articles the provision of which is not within the scope <br/>
<a id="pl.36.24"></a><var>36.24</var>of authorized practice of the institution or individual rendering the services or articles.<br/>
<a id="pl.36.25"></a><var>36.25</var>(d) The minimum benefits for a qualified plan shall include, in addition to those <br/>
<a id="pl.36.26"></a><var>36.26</var>benefits specified in clauses (a) and (e), benefits for well baby care, effective July 1, <br/>
<a id="pl.36.27"></a><var>36.27</var>1980, subject to applicable deductibles, coinsurance provisions, and maximum lifetime <br/>
<a id="pl.36.28"></a><var>36.28</var>benefit limitations.<br/>
<a id="pl.36.29"></a><var>36.29</var>(e) Effective July 1, 1979, the minimum benefits of a qualified plan shall include, in <br/>
<a id="pl.36.30"></a><var>36.30</var>addition to those benefits specified in clause (a), a second opinion from a physician on <br/>
<a id="pl.36.31"></a><var>36.31</var>all surgical procedures expected to cost a total of $500 or more in physician, laboratory, <br/>
<a id="pl.36.32"></a><var>36.32</var>and hospital fees, provided that the coverage need not include the repetition of any <br/>
<a id="pl.36.33"></a><var>36.33</var>diagnostic tests.<br/>
<a id="pl.36.34"></a><var>36.34</var>(f) Effective August 1, 1985, the minimum benefits of a qualified plan must include, <br/>
<a id="pl.36.35"></a><var>36.35</var>in addition to the benefits specified in clauses (a), (d), and (e), coverage for special dietary <br/>
<a id="pl.36.36"></a><var>36.36</var>treatment for phenylketonuria when recommended by a physician.<br/>
<a id="pl.37.1"></a><var>37.1</var>(g) Outpatient mental health coverage is subject to section 
         <statute_ref>62A.152, subdivision 2</statute_ref>.<br/>
<a id="pl.37.2"></a><var>37.2</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.41.0"></a><a id="pl.37.3"></a><var>37.3</var>    Sec. 41. Minnesota Statutes 2012, section 62E.09, is amended to read:<br/>
<a id="pl.37.4"></a><var>37.4</var><b>62E.09 DUTIES OF COMMISSIONER.</b><br/>
<a id="pl.37.5"></a><var>37.5</var>The commissioner may:<br/>
<a id="pl.37.6"></a><var>37.6</var>(a) formulate general policies to advance the purposes of sections 
         <statute_ref>62E.01</statute_ref> to 
         <statute_ref>62E.19</statute_ref>;<br/>
<a id="pl.37.7"></a><var>37.7</var>(b) supervise the creation of the Minnesota Comprehensive Health Association <br/>
<a id="pl.37.8"></a><var>37.8</var>within the limits described in section 
         <statute_ref>62E.10</statute_ref>;<br/>
<a id="pl.37.9"></a><var>37.9</var>(c) approve the selection of the writing carrier by the association, approve the <br/>
<a id="pl.37.10"></a><var>37.10</var>association's contract with the writing carrier, and approve the state plan coverage;<br/>
<a id="pl.37.11"></a><var>37.11</var>(d) appoint advisory committees;<br/>
<a id="pl.37.12"></a><var>37.12</var>(e) conduct periodic audits to assure the general accuracy of the financial data <br/>
<a id="pl.37.13"></a><var>37.13</var>submitted by the writing carrier and the association;<br/>
<a id="pl.37.14"></a><var>37.14</var>(f) contract with the federal government or any other unit of government to ensure <br/>
<a id="pl.37.15"></a><var>37.15</var>coordination of the state plan with other governmental assistance programs;<br/>
<a id="pl.37.16"></a><var>37.16</var>(g) undertake directly or through contracts with other persons studies or <br/>
<a id="pl.37.17"></a><var>37.17</var>demonstration programs to develop awareness of the benefits of sections 
         <statute_ref>62E.01</statute_ref> to 
         <statute_ref>62E.16<br/>
<a id="pl.37.18"></a><var>37.18</var></statute_ref> 62E.15, so that the residents of this state may best avail themselves of the health care <br/>
<a id="pl.37.19"></a><var>37.19</var>benefits provided by these sections;<br/>
<a id="pl.37.20"></a><var>37.20</var>(h) contract with insurers and others for administrative services; and<br/>
<a id="pl.37.21"></a><var>37.21</var>(i) adopt, amend, suspend and repeal rules as reasonably necessary to carry out and <br/>
<a id="pl.37.22"></a><var>37.22</var>make effective the provisions and purposes of sections 
         <statute_ref>62E.01</statute_ref> to 
         <statute_ref>62E.19</statute_ref>.<br/>
<a id="pl.37.23"></a><var>37.23</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.42.0"></a><a id="pl.37.24"></a><var>37.24</var>    Sec. 42. Minnesota Statutes 2012, section 62E.10, subdivision 7, is amended to read:<br/>
<a id="pl.37.25"></a><var>37.25</var>    Subd. 7. <b>General powers.</b> The association may:<br/>
<a id="pl.37.26"></a><var>37.26</var>(a) Exercise the powers granted to insurers under the laws of this state;<br/>
<a id="pl.37.27"></a><var>37.27</var>(b) Sue or be sued;<br/>
<a id="pl.37.28"></a><var>37.28</var>(c) Enter into contracts with insurers, similar associations in other states or with <br/>
<a id="pl.37.29"></a><var>37.29</var>other persons for the performance of administrative functions including the functions <br/>
<a id="pl.37.30"></a><var>37.30</var>provided for in clauses (e) and (f);<br/>
<a id="pl.37.31"></a><var>37.31</var>(d) Establish administrative and accounting procedures for the operation of the <br/>
<a id="pl.37.32"></a><var>37.32</var>association;<br/>
<a id="pl.38.1"></a><var>38.1</var>(e) Provide for the reinsuring of risks incurred as a result of issuing the coverages <br/>
<a id="pl.38.2"></a><var>38.2</var>required by sections section
<statute_ref>62E.04</statute_ref> and 
<statute_ref>62E.16</statute_ref> by members of the association. Each <br/>
<a id="pl.38.3"></a><var>38.3</var>member which elects to reinsure its required risks shall determine the categories of <br/>
<a id="pl.38.4"></a><var>38.4</var>coverage it elects to reinsure in the association. The categories of coverage are:<br/>
<a id="pl.38.5"></a><var>38.5</var>(1) individual qualified plans, excluding group conversions;<br/>
<a id="pl.38.6"></a><var>38.6</var>(2) group conversions;<br/>
<a id="pl.38.7"></a><var>38.7</var>(3) group qualified plans with fewer than 50 employees or members; and<br/>
<a id="pl.38.8"></a><var>38.8</var>(4) major medical coverage.<br/>
<a id="pl.38.9"></a><var>38.9</var>A separate election may be made for each category of coverage. If a member elects <br/>
<a id="pl.38.10"></a><var>38.10</var>to reinsure the risks of a category of coverage, it must reinsure the risk of the coverage <br/>
<a id="pl.38.11"></a><var>38.11</var>of every life covered under every policy issued in that category. A member electing to <br/>
<a id="pl.38.12"></a><var>38.12</var>reinsure risks of a category of coverage shall enter into a contract with the association <br/>
<a id="pl.38.13"></a><var>38.13</var>establishing a reinsurance plan for the risks. This contract may include provision for <br/>
<a id="pl.38.14"></a><var>38.14</var>the pooling of members' risks reinsured through the association and it may provide for <br/>
<a id="pl.38.15"></a><var>38.15</var>assessment of each member reinsuring risks for losses and operating and administrative <br/>
<a id="pl.38.16"></a><var>38.16</var>expenses incurred, or estimated to be incurred in the operation of the reinsurance plan. This <br/>
<a id="pl.38.17"></a><var>38.17</var>reinsurance plan shall be approved by the commissioner before it is effective. Members <br/>
<a id="pl.38.18"></a><var>38.18</var>electing to administer the risks which are reinsured in the association shall comply with the <br/>
<a id="pl.38.19"></a><var>38.19</var>benefit determination guidelines and accounting procedures established by the association. <br/>
<a id="pl.38.20"></a><var>38.20</var>The fee charged by the association for the reinsurance of risks shall not be less than 110 <br/>
<a id="pl.38.21"></a><var>38.21</var>percent of the total anticipated expenses incurred by the association for the reinsurance; and<br/>
<a id="pl.38.22"></a><var>38.22</var>(f) Provide for the administration by the association of policies which are reinsured <br/>
<a id="pl.38.23"></a><var>38.23</var>pursuant to clause (e). Each member electing to reinsure one or more categories of <br/>
<a id="pl.38.24"></a><var>38.24</var>coverage in the association may elect to have the association administer the categories of <br/>
<a id="pl.38.25"></a><var>38.25</var>coverage on the member's behalf. If a member elects to have the association administer <br/>
<a id="pl.38.26"></a><var>38.26</var>the categories of coverage, it must do so for every life covered under every policy issued <br/>
<a id="pl.38.27"></a><var>38.27</var>in that category. The fee for the administration shall not be less than 110 percent of the <br/>
<a id="pl.38.28"></a><var>38.28</var>total anticipated expenses incurred by the association for the administration.<br/>
<a id="pl.38.29"></a><var>38.29</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.43.0"></a><a id="pl.38.30"></a><var>38.30</var>    Sec. 43. Minnesota Statutes 2012, section 62H.04, is amended to read:<br/>
<a id="pl.38.31"></a><var>38.31</var><b>62H.04 COMPLIANCE WITH OTHER LAWS.</b><br/>
<a id="pl.38.32"></a><var>38.32</var>(a) A joint self-insurance plan is subject to the requirements of chapters 62A, 62E, <br/>
<a id="pl.38.33"></a><var>38.33</var>62L, and 62Q, and sections 
         <statute_ref>72A.17</statute_ref> to 
         <statute_ref>72A.32</statute_ref> unless otherwise specifically exempt. A <br/>
<a id="pl.39.1"></a><var>39.1</var>joint self-insurance plan must pay assessments made by the Minnesota Comprehensive <br/>
<a id="pl.39.2"></a><var>39.2</var>Health Association, as required under section 
         <statute_ref>62E.11</statute_ref>.<br/>
<a id="pl.39.3"></a><var>39.3</var>(b) A joint self-insurance plan is exempt from providing the mandated health <br/>
<a id="pl.39.4"></a><var>39.4</var>benefits described in chapters 62A, 62E, 62L, and 62Q if it otherwise provides the benefits <br/>
<a id="pl.39.5"></a><var>39.5</var>required under the Employee Retirement Income Security Act of 1974, United States <br/>
<a id="pl.39.6"></a><var>39.6</var>Code, title 29, sections 1001, et seq., for all employers and not just for the employers with <br/>
<a id="pl.39.7"></a><var>39.7</var>50 or more employees who are covered by that federal law.<br/>
<a id="pl.39.8"></a><var>39.8</var>(c) A joint self-insurance plan is exempt from section 
         <statute_ref>62L.03, subdivision 1</statute_ref>, if the <br/>
<a id="pl.39.9"></a><var>39.9</var>plan offers an annual open enrollment period of no less than 15 days during which all <br/>
<a id="pl.39.10"></a><var>39.10</var>employers that qualify for membership may enter the plan without preexisting condition <br/>
<a id="pl.39.11"></a><var>39.11</var>limitations or exclusions except those permitted under chapter 62L.<br/>
<a id="pl.39.12"></a><var>39.12</var>(d) A joint self-insurance plan is exempt from sections 
         <statute_ref>62A.146</statute_ref>, 
         <statute_ref>62A.16</statute_ref>, 
         <statute_ref>62A.17</statute_ref>, <br/>
<statute_ref><a id="pl.39.13"></a><var>39.13</var>62A.20
         </statute_ref>, 
         <statute_ref>62A.21</statute_ref>, and 
<statute_ref>62A.65, subdivision 5</statute_ref>, paragraph (b), and 
<statute_ref>62E.16</statute_ref> if the joint <br/>
<a id="pl.39.14"></a><var>39.14</var>self-insurance plan complies with the continuation requirements under the Employee <br/>
<a id="pl.39.15"></a><var>39.15</var>Retirement Income Security Act of 1974, United States Code, title 29, sections 1001, et <br/>
<a id="pl.39.16"></a><var>39.16</var>seq., for all employers and not just for the employers with 20 or more employees who <br/>
<a id="pl.39.17"></a><var>39.17</var>are covered by that federal law.<br/>
<a id="pl.39.18"></a><var>39.18</var>(e) A joint self-insurance plan must provide to all employers the maternity coverage <br/>
<a id="pl.39.19"></a><var>39.19</var>required by federal law for employers with 15 or more employees.<br/>
<a id="pl.39.20"></a><var>39.20</var>(f) A joint self-insurance plan must comply with all the provisions and requirements <br/>
<a id="pl.39.21"></a><var>39.21</var>of the Affordable Care Act as defined under section 62A.011, subdivision 1a, to the extent <br/>
<a id="pl.39.22"></a><var>39.22</var>that they apply to such plans.<br/>
<a id="pl.39.23"></a><var>39.23</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment, <br/>
<a id="pl.39.24"></a><var>39.24</var>except that the amendment to paragraph (d) is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.44.0"></a><a id="pl.39.25"></a><var>39.25</var>    Sec. 44. Minnesota Statutes 2012, section 62L.02, subdivision 11, is amended to read:<br/>
<a id="pl.39.26"></a><var>39.26</var>    Subd. 11. <b>Dependent.</b> "Dependent" means an eligible employee's spouse, <br/>
<a id="pl.39.27"></a><var>39.27</var>unmarried child who is under the age of 25 years dependent child to the limiting age as <br/>
<a id="pl.39.28"></a><var>39.28</var>defined in section 62Q.01, subdivision 9, dependent child of any age who is disabled and <br/>
<a id="pl.39.29"></a><var>39.29</var>who meets the eligibility criteria in section 
         <statute_ref>62A.14, subdivision 2</statute_ref>, or any other person <br/>
<a id="pl.39.30"></a><var>39.30</var>whom state or federal law requires to be treated as a dependent for purposes of health <br/>
<a id="pl.39.31"></a><var>39.31</var>plans. For the purpose of this definition, a dependent child to the limiting age as defined in <br/>
<a id="pl.39.32"></a><var>39.32</var>section 62Q.01, subdivision 9, includes a child for whom the employee or the employee's <br/>
<a id="pl.39.33"></a><var>39.33</var>spouse has been appointed legal guardian and an adoptive child as provided in section <br/>
<statute_ref><a id="pl.39.34"></a><var>39.34</var>62A.27
         </statute_ref>. A child also means a grandchild as provided in section 62A.042 with continued <br/>
<a id="pl.39.35"></a><var>39.35</var>eligibility of grandchildren as provided in section 62A.302, subdivision 4.<br/>
<a id="pl.40.1"></a><var>40.1</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.45.0"></a><a id="pl.40.2"></a><var>40.2</var>    Sec. 45. Minnesota Statutes 2012, section 62L.02, subdivision 14a, is amended to read:<br/>
<a id="pl.40.3"></a><var>40.3</var>    Subd. 14a. <b>Guaranteed issue.</b> "Guaranteed issue" means that a health carrier shall <br/>
<a id="pl.40.4"></a><var>40.4</var>not decline an application by a small employer for any health benefit plan offered by <br/>
<a id="pl.40.5"></a><var>40.5</var>that health carrier and shall not decline to cover under a health benefit plan any eligible <br/>
<a id="pl.40.6"></a><var>40.6</var>employee or eligible dependent, including persons who become eligible employees or <br/>
<a id="pl.40.7"></a><var>40.7</var>eligible dependents after initial issuance of the health benefit plan, subject to the health <br/>
<a id="pl.40.8"></a><var>40.8</var>carrier's right to impose preexisting condition limitations permitted under this chapter.<br/>
<a id="pl.40.9"></a><var>40.9</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.46.0"></a><a id="pl.40.10"></a><var>40.10</var>    Sec. 46. Minnesota Statutes 2012, section 62L.02, is amended by adding a subdivision <br/>
<a id="pl.40.11"></a><var>40.11</var>to read:<br/>
<a id="pl.40.12"></a><var>40.12</var>    Subd. 17a. <b>Individual health plan.</b> "Individual health plan" has the meaning <br/>
<a id="pl.40.13"></a><var>40.13</var>given in section 62A.011, subdivision 4.<br/>
<a id="pl.40.14"></a><var>40.14</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.47.0"></a><a id="pl.40.15"></a><var>40.15</var>    Sec. 47. Minnesota Statutes 2012, section 62L.02, subdivision 26, is amended to read:<br/>
<a id="pl.40.16"></a><var>40.16</var>    Subd. 26. <b>Small employer.</b> (a) "Small employer" means, with respect to a calendar <br/>
<a id="pl.40.17"></a><var>40.17</var>year and a plan year, a person, firm, corporation, partnership, association, or other entity <br/>
<a id="pl.40.18"></a><var>40.18</var>actively engaged in business in Minnesota, including a political subdivision of the state, that <br/>
<a id="pl.40.19"></a><var>40.19</var>employed an average of no fewer than two nor at least one, not including a sole proprietor, <br/>
<a id="pl.40.20"></a><var>40.20</var>but not more than 50 current employees on business days during the preceding calendar <br/>
<a id="pl.40.21"></a><var>40.21</var>year and that employs at least two one current employees employee, not including a sole <br/>
<a id="pl.40.22"></a><var>40.22</var>proprietor, on the first day of the plan year. If an employer has only one eligible employee <br/>
<a id="pl.40.23"></a><var>40.23</var>who has not waived coverage, the sale of a health plan to or for that eligible employee <br/>
<a id="pl.40.24"></a><var>40.24</var>is not a sale to a small employer and is not subject to this chapter and may be treated as <br/>
<a id="pl.40.25"></a><var>40.25</var>the sale of an individual health plan. A small employer plan may be offered through a <br/>
<a id="pl.40.26"></a><var>40.26</var>domiciled association to self-employed individuals and small employers who are members <br/>
<a id="pl.40.27"></a><var>40.27</var>of the association, even if the self-employed individual or small employer has fewer than <br/>
<a id="pl.40.28"></a><var>40.28</var>two current employees. Entities that are treated as a single employer under subsection (b), <br/>
<a id="pl.40.29"></a><var>40.29</var>(c), (m), or (o) of section 414 of the federal Internal Revenue Code are considered a single <br/>
<a id="pl.40.30"></a><var>40.30</var>employer for purposes of determining the number of current employees. Small employer <br/>
<a id="pl.40.31"></a><var>40.31</var>status must be determined on an annual basis as of the renewal date of the health benefit <br/>
<a id="pl.40.32"></a><var>40.32</var>plan. The provisions of this chapter continue to apply to an employer who no longer meets <br/>
<a id="pl.41.1"></a><var>41.1</var>the requirements of this definition until the annual renewal date of the employer's health <br/>
<a id="pl.41.2"></a><var>41.2</var>benefit plan. If an employer was not in existence throughout the preceding calendar year, <br/>
<a id="pl.41.3"></a><var>41.3</var>the determination of whether the employer is a small employer is based upon the average <br/>
<a id="pl.41.4"></a><var>41.4</var>number of current employees that it is reasonably expected that the employer will employ <br/>
<a id="pl.41.5"></a><var>41.5</var>on business days in the current calendar year. For purposes of this definition, the term <br/>
<a id="pl.41.6"></a><var>41.6</var>employer includes any predecessor of the employer. An employer that has more than 50 <br/>
<a id="pl.41.7"></a><var>41.7</var>current employees but has 50 or fewer employees, as "employee" is defined under United <br/>
<a id="pl.41.8"></a><var>41.8</var>States Code, title 29, section 1002(6), is a small employer under this subdivision.<br/>
<a id="pl.41.9"></a><var>41.9</var>(b) Where an association, as defined in section 
         <statute_ref>62L.045</statute_ref>, comprised of employers <br/>
<a id="pl.41.10"></a><var>41.10</var>contracts with a health carrier to provide coverage to its members who are small employers, <br/>
<a id="pl.41.11"></a><var>41.11</var>the association and health benefit plans it provides to small employers, are subject to <br/>
<a id="pl.41.12"></a><var>41.12</var>section 
         <statute_ref>62L.045</statute_ref>, with respect to small employers in the association, even though the <br/>
<a id="pl.41.13"></a><var>41.13</var>association also provides coverage to its members that do not qualify as small employers.<br/>
<a id="pl.41.14"></a><var>41.14</var>(c) If an employer has employees covered under a trust specified in a collective <br/>
<a id="pl.41.15"></a><var>41.15</var>bargaining agreement under the federal Labor-Management Relations Act of 1947, <br/>
<a id="pl.41.16"></a><var>41.16</var>United States Code, title 29, section 141, et seq., as amended, or employees whose health <br/>
<a id="pl.41.17"></a><var>41.17</var>coverage is determined by a collective bargaining agreement and, as a result of the <br/>
<a id="pl.41.18"></a><var>41.18</var>collective bargaining agreement, is purchased separately from the health plan provided <br/>
<a id="pl.41.19"></a><var>41.19</var>to other employees, those employees are excluded in determining whether the employer <br/>
<a id="pl.41.20"></a><var>41.20</var>qualifies as a small employer. Those employees are considered to be a separate small <br/>
<a id="pl.41.21"></a><var>41.21</var>employer if they constitute a group that would qualify as a small employer in the absence <br/>
<a id="pl.41.22"></a><var>41.22</var>of the employees who are not subject to the collective bargaining agreement.<br/>
<a id="pl.41.23"></a><var>41.23</var>(d) Small group health plans offered through the Minnesota Insurance Marketplace <br/>
<a id="pl.41.24"></a><var>41.24</var>under chapter 62V to employees of a small employer are not considered individual health <br/>
<a id="pl.41.25"></a><var>41.25</var>plans, regardless of whether the health plan is purchased using a defined contribution <br/>
<a id="pl.41.26"></a><var>41.26</var>from the small employer.<br/>
<a id="pl.41.27"></a><var>41.27</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.48.0"></a><a id="pl.41.28"></a><var>41.28</var>    Sec. 48. Minnesota Statutes 2012, section 62L.03, subdivision 1, is amended to read:<br/>
<a id="pl.41.29"></a><var>41.29</var>    Subdivision 1. <b>Guaranteed issue and reissue.</b> (a) Every health carrier shall, as a <br/>
<a id="pl.41.30"></a><var>41.30</var>condition of authority to transact business in this state in the small employer market, <br/>
<a id="pl.41.31"></a><var>41.31</var>affirmatively market, offer, sell, issue, and renew any of its health benefit plans, on a <br/>
<a id="pl.41.32"></a><var>41.32</var>guaranteed issue basis, to any small employer, including a small employer covered by <br/>
<a id="pl.41.33"></a><var>41.33</var>paragraph (b), that meets the participation and contribution requirements of subdivision 3, <br/>
<a id="pl.41.34"></a><var>41.34</var>as provided in this chapter.<br/>
<a id="pl.42.1"></a><var>42.1</var>(b) A small employer that has its no longer meets the definition of small employer <br/>
<a id="pl.42.2"></a><var>42.2</var>because of a reduction in workforce reduced to one employee may continue coverage as a <br/>
<a id="pl.42.3"></a><var>42.3</var>small employer for 12 months from the date the group is reduced to one employee.<br/>
<a id="pl.42.4"></a><var>42.4</var>(c) Notwithstanding paragraph (a), a health carrier may, at the time of coverage <br/>
<a id="pl.42.5"></a><var>42.5</var>renewal, modify the health coverage for a product offered in the small employer market if <br/>
<a id="pl.42.6"></a><var>42.6</var>the modification is consistent with state law, approved by the commissioner, and effective <br/>
<a id="pl.42.7"></a><var>42.7</var>on a uniform basis for all small employers purchasing that product other than through a <br/>
<a id="pl.42.8"></a><var>42.8</var>qualified association in compliance with section 
         <statute_ref>62L.045, subdivision 2</statute_ref>.<br/>
<a id="pl.42.9"></a><var>42.9</var>Paragraph (a) does not apply to a health benefit plan designed for a small employer <br/>
<a id="pl.42.10"></a><var>42.10</var>to comply with a collective bargaining agreement, provided that the health benefit plan <br/>
<a id="pl.42.11"></a><var>42.11</var>otherwise complies with this chapter and is not offered to other small employers, except <br/>
<a id="pl.42.12"></a><var>42.12</var>for other small employers that need it for the same reason. This paragraph applies only <br/>
<a id="pl.42.13"></a><var>42.13</var>with respect to collective bargaining agreements entered into prior to August 21, 1996, <br/>
<a id="pl.42.14"></a><var>42.14</var>and only with respect to plan years beginning before the later of July 1, 1997, or the date <br/>
<a id="pl.42.15"></a><var>42.15</var>upon which the last of the collective bargaining agreements relating to the plan terminates <br/>
<a id="pl.42.16"></a><var>42.16</var>determined without regard to any extension agreed to after August 21, 1996.<br/>
<a id="pl.42.17"></a><var>42.17</var>(d) Every health carrier participating in the small employer market shall make <br/>
<a id="pl.42.18"></a><var>42.18</var>available both of the plans described in section 
<statute_ref>62L.05</statute_ref> to small employers and shall fully <br/>
<a id="pl.42.19"></a><var>42.19</var>comply with the underwriting and the rate restrictions specified in this chapter for all <br/>
<a id="pl.42.20"></a><var>42.20</var>health benefit plans issued to small employers.<br/>
<a id="pl.42.21"></a><var>42.21</var>(e) (d) A health carrier may cease to transact business in the small employer market <br/>
<a id="pl.42.22"></a><var>42.22</var>as provided under section 
         <statute_ref>62L.09</statute_ref>.<br/>
<a id="pl.42.23"></a><var>42.23</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.49.0"></a><a id="pl.42.24"></a><var>42.24</var>    Sec. 49. Minnesota Statutes 2012, section 62L.03, subdivision 3, is amended to read:<br/>
<a id="pl.42.25"></a><var>42.25</var>    Subd. 3. <b>Minimum participation and contribution.</b> (a) A small employer that has <br/>
<a id="pl.42.26"></a><var>42.26</var>at least 75 percent of its eligible employees who have not waived coverage participating in <br/>
<a id="pl.42.27"></a><var>42.27</var>a health benefit plan and that contributes at least 50 percent toward the cost of coverage of <br/>
<a id="pl.42.28"></a><var>42.28</var>each eligible employee must be guaranteed coverage on a guaranteed issue basis from <br/>
<a id="pl.42.29"></a><var>42.29</var>any health carrier participating in the small employer market. The participation level <br/>
<a id="pl.42.30"></a><var>42.30</var>of eligible employees must be determined at the initial offering of coverage and at the <br/>
<a id="pl.42.31"></a><var>42.31</var>renewal date of coverage. A health carrier must not increase the participation requirements <br/>
<a id="pl.42.32"></a><var>42.32</var>applicable to a small employer at any time after the small employer has been accepted for <br/>
<a id="pl.42.33"></a><var>42.33</var>coverage. For the purposes of this subdivision, waiver of coverage includes only waivers <br/>
<a id="pl.42.34"></a><var>42.34</var>due to: (1) coverage under another group health plan; (2) coverage under Medicare <br/>
<a id="pl.43.1"></a><var>43.1</var>Parts A and B; or (3) coverage under medical assistance under chapter 256B or general <br/>
<a id="pl.43.2"></a><var>43.2</var>assistance medical care under chapter 256D.<br/>
<a id="pl.43.3"></a><var>43.3</var>    (b) If a small employer does not satisfy the contribution or participation requirements <br/>
<a id="pl.43.4"></a><var>43.4</var>under this subdivision, a health carrier may voluntarily issue or renew individual health <br/>
<a id="pl.43.5"></a><var>43.5</var>plans, or a health benefit plan which must fully comply with this chapter. A health carrier <br/>
<a id="pl.43.6"></a><var>43.6</var>that provides a health benefit plan to a small employer that does not meet the contribution <br/>
<a id="pl.43.7"></a><var>43.7</var>or participation requirements of this subdivision must maintain this information in its files <br/>
<a id="pl.43.8"></a><var>43.8</var>for audit by the commissioner. A health carrier may not offer an individual health plan, <br/>
<a id="pl.43.9"></a><var>43.9</var>purchased through an arrangement between the employer and the health carrier, to any <br/>
<a id="pl.43.10"></a><var>43.10</var>employee unless the health carrier also offers the individual health plan, on a guaranteed <br/>
<a id="pl.43.11"></a><var>43.11</var>issue basis, to all other employees of the same employer. An arrangement permitted <br/>
<a id="pl.43.12"></a><var>43.12</var>under section 
         <statute_ref>62L.12</statute_ref>, subdivision 2, paragraph (k) (l), is not an arrangement between the <br/>
<a id="pl.43.13"></a><var>43.13</var>employer and the health carrier for purposes of this paragraph.<br/>
<a id="pl.43.14"></a><var>43.14</var>    (c) Nothing in this section obligates a health carrier to issue coverage to a small <br/>
<a id="pl.43.15"></a><var>43.15</var>employer that currently offers coverage through a health benefit plan from another health <br/>
<a id="pl.43.16"></a><var>43.16</var>carrier, unless the new coverage will replace the existing coverage and not serve as one <br/>
<a id="pl.43.17"></a><var>43.17</var>of two or more health benefit plans offered by the employer. This paragraph does not <br/>
<a id="pl.43.18"></a><var>43.18</var>apply if the small employer will meet the required participation level with respect to <br/>
<a id="pl.43.19"></a><var>43.19</var>the new coverage.<br/>
<a id="pl.43.20"></a><var>43.20</var>(d) If a small employer cannot meet either the participation or contribution <br/>
<a id="pl.43.21"></a><var>43.21</var>requirement, the small employer may purchase coverage only during an open enrollment <br/>
<a id="pl.43.22"></a><var>43.22</var>period each year between November 15 and December 15.<br/>
<a id="pl.43.23"></a><var>43.23</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.50.0"></a><a id="pl.43.24"></a><var>43.24</var>    Sec. 50. Minnesota Statutes 2012, section 62L.03, subdivision 4, is amended to read:<br/>
<a id="pl.43.25"></a><var>43.25</var>    Subd. 4. <b>Underwriting restrictions.</b> (a) Health carriers may apply underwriting <br/>
<a id="pl.43.26"></a><var>43.26</var>restrictions to coverage for health benefit plans for small employers, including any <br/>
<a id="pl.43.27"></a><var>43.27</var>preexisting condition limitations, only as expressly permitted under this chapter. For <br/>
<a id="pl.43.28"></a><var>43.28</var>purposes of this section, "underwriting restrictions" means any refusal of the health carrier <br/>
<a id="pl.43.29"></a><var>43.29</var>to issue or renew coverage, any premium rate higher than the lowest rate charged by the <br/>
<a id="pl.43.30"></a><var>43.30</var>health carrier for the same coverage, any preexisting condition limitation, preexisting <br/>
<a id="pl.43.31"></a><var>43.31</var>condition exclusion, or any exclusionary rider.<br/>
<a id="pl.43.32"></a><var>43.32</var>(b) Health carriers may collect information relating to the case characteristics and <br/>
<a id="pl.43.33"></a><var>43.33</var>demographic composition of small employers, as well as health status and health history <br/>
<a id="pl.43.34"></a><var>43.34</var>information about employees, and dependents of employees, of small employers.<br/>
<a id="pl.44.1"></a><var>44.1</var>(c) Except as otherwise authorized for late entrants, preexisting conditions may be <br/>
<a id="pl.44.2"></a><var>44.2</var>excluded by a health carrier for a period not to exceed 12 months from the enrollment <br/>
<a id="pl.44.3"></a><var>44.3</var>date of an eligible employee or dependent, but exclusionary riders must not be used. Late <br/>
<a id="pl.44.4"></a><var>44.4</var>entrants may be subject to a preexisting condition limitation not to exceed 18 months from <br/>
<a id="pl.44.5"></a><var>44.5</var>the enrollment date of the late entrant, but must not be subject to any exclusionary rider or <br/>
<a id="pl.44.6"></a><var>44.6</var>preexisting condition exclusion. When calculating any length of preexisting condition <br/>
<a id="pl.44.7"></a><var>44.7</var>limitation, a health carrier shall credit the time period an eligible employee or dependent <br/>
<a id="pl.44.8"></a><var>44.8</var>was previously covered by qualifying coverage, provided that the individual maintains <br/>
<a id="pl.44.9"></a><var>44.9</var>continuous coverage. The credit must be given for all qualifying coverage with respect <br/>
<a id="pl.44.10"></a><var>44.10</var>to all preexisting conditions, regardless of whether the conditions were preexisting with <br/>
<a id="pl.44.11"></a><var>44.11</var>respect to any previous qualifying coverage. Section 
<statute_ref>60A.082</statute_ref>, relating to replacement of <br/>
<a id="pl.44.12"></a><var>44.12</var>group coverage, and the rules adopted under that section apply to this chapter, and this <br/>
<a id="pl.44.13"></a><var>44.13</var>chapter's requirements are in addition to the requirements of that section and the rules <br/>
<a id="pl.44.14"></a><var>44.14</var>adopted under it. A health carrier shall, at the time of first issuance or renewal of a health <br/>
<a id="pl.44.15"></a><var>44.15</var>benefit plan on or after July 1, 1993, credit against any preexisting condition limitation <br/>
<a id="pl.44.16"></a><var>44.16</var>or exclusion permitted under this section, the time period prior to July 1, 1993, during <br/>
<a id="pl.44.17"></a><var>44.17</var>which an eligible employee or dependent was covered by qualifying coverage, if the <br/>
<a id="pl.44.18"></a><var>44.18</var>person has maintained continuous coverage.<br/>
<a id="pl.44.19"></a><var>44.19</var>(d) Health carriers shall not use pregnancy as a preexisting condition under this <br/>
<a id="pl.44.20"></a><var>44.20</var>chapter.<br/>
<a id="pl.44.21"></a><var>44.21</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.51.0"></a><a id="pl.44.22"></a><var>44.22</var>    Sec. 51. Minnesota Statutes 2012, section 62L.03, subdivision 6, is amended to read:<br/>
<a id="pl.44.23"></a><var>44.23</var>    Subd. 6. <b>MCHA enrollees.</b> Health carriers shall offer coverage to any eligible <br/>
<a id="pl.44.24"></a><var>44.24</var>employee or dependent enrolled in MCHA at the time of the health carrier's issuance or <br/>
<a id="pl.44.25"></a><var>44.25</var>renewal of a health benefit plan to a small employer. The health benefit plan must require <br/>
<a id="pl.44.26"></a><var>44.26</var>that the employer permit MCHA enrollees to enroll in the small employer's health benefit <br/>
<a id="pl.44.27"></a><var>44.27</var>plan as of the first date of renewal of a health benefit plan occurring on or after July <br/>
<a id="pl.44.28"></a><var>44.28</var>1, 1993, and as of each date of renewal after that, or, in the case of a new group, as of <br/>
<a id="pl.44.29"></a><var>44.29</var>the initial effective date of the health benefit plan and as of each date of renewal after <br/>
<a id="pl.44.30"></a><var>44.30</var>that. Unless otherwise permitted by this chapter, Health carriers must not impose any <br/>
<a id="pl.44.31"></a><var>44.31</var>underwriting restrictions, including any preexisting condition limitations or exclusions, on <br/>
<a id="pl.44.32"></a><var>44.32</var>any eligible employee or dependent previously enrolled in MCHA and transferred to a <br/>
<a id="pl.44.33"></a><var>44.33</var>health benefit plan so long as continuous coverage is maintained, provided that the health <br/>
<a id="pl.44.34"></a><var>44.34</var>carrier may impose any unexpired portion of a preexisting condition limitation under the <br/>
<a id="pl.45.1"></a><var>45.1</var>person's MCHA coverage. An MCHA enrollee is not a late entrant, so long as the enrollee <br/>
<a id="pl.45.2"></a><var>45.2</var>has maintained continuous coverage.<br/>
<a id="pl.45.3"></a><var>45.3</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.52.0"></a><a id="pl.45.4"></a><var>45.4</var>    Sec. 52. Minnesota Statutes 2012, section 62L.045, subdivision 2, is amended to read:<br/>
<a id="pl.45.5"></a><var>45.5</var>    Subd. 2. <b>Qualified associations.</b> (a) A qualified association, as defined in this <br/>
<a id="pl.45.6"></a><var>45.6</var>section, and health coverage offered by it, to it, or through it, to a small employer in <br/>
<a id="pl.45.7"></a><var>45.7</var>this state must comply with the requirements of this chapter regarding guaranteed issue, <br/>
<a id="pl.45.8"></a><var>45.8</var>guaranteed renewal, preexisting condition limitations, credit against preexisting condition <br/>
<a id="pl.45.9"></a><var>45.9</var>limitations for continuous coverage, treatment of MCHA enrollees, and the definition of <br/>
<a id="pl.45.10"></a><var>45.10</var>dependent, and with section 
         <statute_ref>62A.65, subdivision 5</statute_ref>, paragraph (b). They must also comply <br/>
<a id="pl.45.11"></a><var>45.11</var>with all other requirements of this chapter not specifically exempted in paragraph (b) or (c).<br/>
<a id="pl.45.12"></a><var>45.12</var>(b) A qualified association and a health carrier offering, selling, issuing, or renewing <br/>
<a id="pl.45.13"></a><var>45.13</var>health coverage to, or to cover, a small employer in this state through the qualified <br/>
<a id="pl.45.14"></a><var>45.14</var>association, may, but are not, in connection with that health coverage, required to:<br/>
<a id="pl.45.15"></a><var>45.15</var>(1) offer the two small employer plans described in section 
         <statute_ref>62L.05</statute_ref>; and<br/>
<a id="pl.45.16"></a><var>45.16</var>(2) offer to small employers that are not members of the association, health coverage <br/>
<a id="pl.45.17"></a><var>45.17</var>offered to, by, or through the qualified association.<br/>
<a id="pl.45.18"></a><var>45.18</var>(c) A qualified association, and a health carrier offering, selling, issuing, and <br/>
<a id="pl.45.19"></a><var>45.19</var>renewing health coverage to, or to cover, a small employer in this state must comply <br/>
<a id="pl.45.20"></a><var>45.20</var>with section 
<statute_ref>62L.08</statute_ref>, except that:<br/>
<a id="pl.45.21"></a><var>45.21</var>(1) a separate index rate may be applied by a health carrier to each qualified <br/>
<a id="pl.45.22"></a><var>45.22</var>association, provided that:<br/>
<a id="pl.45.23"></a><var>45.23</var>(i) the premium rate applied to participating small employer members of the <br/>
<a id="pl.45.24"></a><var>45.24</var>qualified association is no more than 25 percent above and no more than 25 percent below <br/>
<a id="pl.45.25"></a><var>45.25</var>the index rate applied to the qualified association, irrespective of when members applied <br/>
<a id="pl.45.26"></a><var>45.26</var>for health coverage; and<br/>
<a id="pl.45.27"></a><var>45.27</var>(ii) the index rate applied by a health carrier to a qualified association is no more <br/>
<a id="pl.45.28"></a><var>45.28</var>than 20 percent above and no more than 20 percent below the index rate applied by the <br/>
<a id="pl.45.29"></a><var>45.29</var>health carrier to any other qualified association or to any small employer. In comparing <br/>
<a id="pl.45.30"></a><var>45.30</var>index rates for purposes of this clause, the 20 percent shall be calculated as a percent of <br/>
<a id="pl.45.31"></a><var>45.31</var>the larger index rate; and<br/>
<a id="pl.45.32"></a><var>45.32</var>(2) a qualified association described in subdivision 1, paragraph (a), clauses (2) <br/>
<a id="pl.45.33"></a><var>45.33</var>to (4), providing health coverage through a health carrier, or on a self-insured basis in <br/>
<a id="pl.45.34"></a><var>45.34</var>compliance with section 
<statute_ref>471.617</statute_ref> and the rules adopted under that section, may cover <br/>
<a id="pl.45.35"></a><var>45.35</var>small employers and other employers within the same pool and may charge premiums <br/>
<a id="pl.46.1"></a><var>46.1</var>to small employer members on the same basis as it charges premiums to members that <br/>
<a id="pl.46.2"></a><var>46.2</var>are not small employers, if the premium rates charged to small employers do not have <br/>
<a id="pl.46.3"></a><var>46.3</var>greater variation than permitted under section 
<statute_ref>62L.08</statute_ref>. A qualified association operating <br/>
<a id="pl.46.4"></a><var>46.4</var>under this clause shall annually prove to the commissioner of commerce that it complies <br/>
<a id="pl.46.5"></a><var>46.5</var>with this clause through a sampling procedure acceptable to the commissioner. If the <br/>
<a id="pl.46.6"></a><var>46.6</var>qualified association fails to prove compliance to the satisfaction of the commissioner, <br/>
<a id="pl.46.7"></a><var>46.7</var>the association shall agree to a written plan of correction acceptable to the commissioner. <br/>
<a id="pl.46.8"></a><var>46.8</var>The qualified association is considered to be in compliance under this clause if there is <br/>
<a id="pl.46.9"></a><var>46.9</var>a premium rate that would, if used as an index rate, result in all premium rates in the <br/>
<a id="pl.46.10"></a><var>46.10</var>sample being in compliance with section 
<statute_ref>62L.08</statute_ref>. This clause does not exempt a qualified <br/>
<a id="pl.46.11"></a><var>46.11</var>association or a health carrier providing coverage through the qualified association from <br/>
<a id="pl.46.12"></a><var>46.12</var>the loss ratio requirement of section 
<statute_ref>62L.08, subdivision 11</statute_ref>.<br/>
<a id="pl.46.13"></a><var>46.13</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.53.0"></a><a id="pl.46.14"></a><var>46.14</var>    Sec. 53. Minnesota Statutes 2012, section 62L.045, subdivision 4, is amended to read:<br/>
<a id="pl.46.15"></a><var>46.15</var>    Subd. 4. <b>Principles; association coverage.</b> (a) This subdivision applies to <br/>
<a id="pl.46.16"></a><var>46.16</var>associations as defined in this section, whether qualified associations or not, and is <br/>
<a id="pl.46.17"></a><var>46.17</var>intended to clarify subdivisions 1 to 3.<br/>
<a id="pl.46.18"></a><var>46.18</var>(b) This section applies only to associations that provide health coverage to small <br/>
<a id="pl.46.19"></a><var>46.19</var>employers.<br/>
<a id="pl.46.20"></a><var>46.20</var>(c) A health carrier is not required under this chapter to comply with guaranteed <br/>
<a id="pl.46.21"></a><var>46.21</var>issue and guaranteed renewal with respect to its relationship with the association itself.<br/>
<a id="pl.46.22"></a><var>46.22</var> An arrangement between the health carrier and the association, once entered into, must <br/>
<a id="pl.46.23"></a><var>46.23</var>comply with guaranteed issue and guaranteed renewal with respect to members of the <br/>
<a id="pl.46.24"></a><var>46.24</var>association that are small employers and persons covered through them.<br/>
<a id="pl.46.25"></a><var>46.25</var>(d) When an arrangement between a health carrier and an association has validly <br/>
<a id="pl.46.26"></a><var>46.26</var>terminated, the health carrier has no continuing obligation to small employers and persons <br/>
<a id="pl.46.27"></a><var>46.27</var>covered through them, except as otherwise provided in:<br/>
<a id="pl.46.28"></a><var>46.28</var>(1) section 
         <statute_ref>62A.65, subdivision 5</statute_ref>, paragraph (b);<br/>
<a id="pl.46.29"></a><var>46.29</var>(2) any other continuation or conversion rights applicable under state or federal <br/>
<a id="pl.46.30"></a><var>46.30</var>law; and<br/>
<a id="pl.46.31"></a><var>46.31</var>(3) section 
         <statute_ref>60A.082</statute_ref>, relating to group replacement coverage, and rules adopted <br/>
<a id="pl.46.32"></a><var>46.32</var>under that section.<br/>
<a id="pl.46.33"></a><var>46.33</var>(e) When an association's arrangement with a health carrier has terminated and the <br/>
<a id="pl.46.34"></a><var>46.34</var>association has entered into a new arrangement with that health carrier or a different <br/>
<a id="pl.46.35"></a><var>46.35</var>health carrier, the new arrangement is subject to section 
         <statute_ref>60A.082</statute_ref> and rules adopted under <br/>
<a id="pl.47.1"></a><var>47.1</var>it, with respect to members of the association that are small employers and persons <br/>
<a id="pl.47.2"></a><var>47.2</var>covered through them.<br/>
<a id="pl.47.3"></a><var>47.3</var>(f) An association that offers its members more than one plan of health coverage <br/>
<a id="pl.47.4"></a><var>47.4</var>may have uniform rules restricting movement between the plans of health coverage, if the <br/>
<a id="pl.47.5"></a><var>47.5</var>rules do not discriminate against small employers.<br/>
<a id="pl.47.6"></a><var>47.6</var>(g) This chapter does not require or prohibit separation of an association's members <br/>
<a id="pl.47.7"></a><var>47.7</var>into one group consisting only of small employers and another group or other groups <br/>
<a id="pl.47.8"></a><var>47.8</var>consisting of all other members. The association must comply with this section with <br/>
<a id="pl.47.9"></a><var>47.9</var>respect to the small employer group.<br/>
<a id="pl.47.10"></a><var>47.10</var>(h) For purposes of this section, "member" of an association includes an employer <br/>
<a id="pl.47.11"></a><var>47.11</var>participant in the association.<br/>
<a id="pl.47.12"></a><var>47.12</var>(i) For purposes of this section, health coverage issued to, or to cover, a small <br/>
<a id="pl.47.13"></a><var>47.13</var>employer includes a certificate of coverage issued directly to the employer's employees <br/>
<a id="pl.47.14"></a><var>47.14</var>and dependents, rather than to the small employer.<br/>
<a id="pl.47.15"></a><var>47.15</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.54.0"></a><a id="pl.47.16"></a><var>47.16</var>    Sec. 54. Minnesota Statutes 2012, section 62L.05, subdivision 10, is amended to read:<br/>
<a id="pl.47.17"></a><var>47.17</var>    Subd. 10. <b>Medical expense reimbursement.</b> Health carriers may reimburse <br/>
<a id="pl.47.18"></a><var>47.18</var>or pay for medical services, supplies, or articles provided under a small employer plan <br/>
<a id="pl.47.19"></a><var>47.19</var>in accordance with the health carrier's provider contract requirements including, but <br/>
<a id="pl.47.20"></a><var>47.20</var>not limited to, salaried arrangements, capitation, the payment of usual and customary <br/>
<a id="pl.47.21"></a><var>47.21</var>charges, fee schedules, discounts from fee-for-service, per diems, diagnosis-related <br/>
<a id="pl.47.22"></a><var>47.22</var>groups (DRGs), and other payment arrangements. Nothing in this chapter requires a <br/>
<a id="pl.47.23"></a><var>47.23</var>health carrier to develop, implement, or change its provider contract requirements for <br/>
<a id="pl.47.24"></a><var>47.24</var>a small employer plan. Coinsurance, deductibles, and out-of-pocket maximums, and <br/>
<a id="pl.47.25"></a><var>47.25</var>maximum lifetime benefits must be calculated and determined in accordance with each <br/>
<a id="pl.47.26"></a><var>47.26</var>health carrier's standard business practices.<br/>
<a id="pl.47.27"></a><var>47.27</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.55.0"></a><a id="pl.47.28"></a><var>47.28</var>    Sec. 55. Minnesota Statutes 2012, section 62L.06, is amended to read:<br/>
<a id="pl.47.29"></a><var>47.29</var><b>62L.06 DISCLOSURE OF UNDERWRITING RATING PRACTICES.</b><br/>
<a id="pl.47.30"></a><var>47.30</var>When offering or renewing a health benefit plan, health carriers shall disclose in all <br/>
<a id="pl.47.31"></a><var>47.31</var>solicitation and sales materials:<br/>
<a id="pl.47.32"></a><var>47.32</var>(1) the case characteristics and other rating factors used to determine initial and <br/>
<a id="pl.47.33"></a><var>47.33</var>renewal rates;<br/>
<a id="pl.48.1"></a><var>48.1</var>(2) the extent to which premium rates for a small employer are established or <br/>
<a id="pl.48.2"></a><var>48.2</var>adjusted based upon actual or expected variation in claim experience;<br/>
<a id="pl.48.3"></a><var>48.3</var>(3) provisions concerning the health carrier's right to change premium rates and the <br/>
<a id="pl.48.4"></a><var>48.4</var>factors other than claim experience that affect changes in premium rates;<br/>
<a id="pl.48.5"></a><var>48.5</var>(4) (2) provisions relating to renewability of coverage;<br/>
<a id="pl.48.6"></a><var>48.6</var>(5) the use and effect of any preexisting condition provisions, if permitted;<br/>
<a id="pl.48.7"></a><var>48.7</var>(6) (3) the application of any provider network limitations and their effect on <br/>
<a id="pl.48.8"></a><var>48.8</var>eligibility for benefits; and<br/>
<a id="pl.48.9"></a><var>48.9</var>(7) (4) the ability of small employers to insure eligible employees and dependents <br/>
<a id="pl.48.10"></a><var>48.10</var>currently receiving coverage from the Comprehensive Health Association through health <br/>
<a id="pl.48.11"></a><var>48.11</var>benefit plans.<br/>
<a id="pl.48.12"></a><var>48.12</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.56.0"></a><a id="pl.48.13"></a><var>48.13</var>    Sec. 56. Minnesota Statutes 2012, section 62L.08, is amended to read:<br/>
<a id="pl.48.14"></a><var>48.14</var><b>62L.08 RESTRICTIONS RELATING TO PREMIUM RATES.</b><br/>
<a id="pl.48.15"></a><var>48.15</var>    Subdivision 1. <b>Rate restrictions.</b> Premium rates for all health benefit plans sold or <br/>
<a id="pl.48.16"></a><var>48.16</var>issued to small employers are subject to the restrictions specified in this section.<br/>
<a id="pl.48.17"></a><var>48.17</var>    Subd. 2. <b>General premium variations.</b> Beginning July 1, 1993, each health carrier <br/>
<a id="pl.48.18"></a><var>48.18</var>must offer premium rates to small employers that are no more than 25 percent above <br/>
<a id="pl.48.19"></a><var>48.19</var>and no more than 25 percent below the index rate charged to small employers for the <br/>
<a id="pl.48.20"></a><var>48.20</var>same or similar coverage, adjusted pro rata for rating periods of less than one year. The <br/>
<a id="pl.48.21"></a><var>48.21</var>premium variations permitted by this subdivision must be based only on health status, <br/>
<a id="pl.48.22"></a><var>48.22</var>claims experience, industry of the employer, and duration of coverage from the date of <br/>
<a id="pl.48.23"></a><var>48.23</var>issue. For purposes of this subdivision, health status includes refraining from tobacco use <br/>
<a id="pl.48.24"></a><var>48.24</var>or other actuarially valid lifestyle factors associated with good health, provided that the <br/>
<a id="pl.48.25"></a><var>48.25</var>lifestyle factor and its effect upon premium rates have been determined to be actuarially <br/>
<a id="pl.48.26"></a><var>48.26</var>valid and approved by the commissioner. Variations permitted under this subdivision must <br/>
<a id="pl.48.27"></a><var>48.27</var>not be based upon age or applied differently at different ages. This subdivision does not <br/>
<a id="pl.48.28"></a><var>48.28</var>prohibit use of a constant percentage adjustment for factors permitted to be used under <br/>
<a id="pl.48.29"></a><var>48.29</var>this subdivision.<br/>
<a id="pl.48.30"></a><var>48.30</var>    Subd. 2a. <b>Renewal premium increases limited.</b> (a) Beginning January 1, 2003, <br/>
<a id="pl.48.31"></a><var>48.31</var>the percentage increase in the premium rate charged to a small employer for a new rating <br/>
<a id="pl.48.32"></a><var>48.32</var>period must not exceed the sum of the following:<br/>
<a id="pl.48.33"></a><var>48.33</var>(1) the percentage change in the index rate measured from the first day of the prior <br/>
<a id="pl.48.34"></a><var>48.34</var>rating period to the first day of the new rating period;<br/>
<a id="pl.49.1"></a><var>49.1</var>(2) an adjustment, not to exceed 15 percent annually and adjusted pro rata for rating <br/>
<a id="pl.49.2"></a><var>49.2</var>periods of less than one year, due to the claims experience, health status, or duration of <br/>
<a id="pl.49.3"></a><var>49.3</var>coverage of the employees or dependents of the employer; and<br/>
<a id="pl.49.4"></a><var>49.4</var>(3) any adjustment due to change in coverage or in the case characteristics of the <br/>
<a id="pl.49.5"></a><var>49.5</var>employer.<br/>
<a id="pl.49.6"></a><var>49.6</var>(b) This subdivision does not apply if the employer, employee, or any applicant <br/>
<a id="pl.49.7"></a><var>49.7</var>provides the health carrier with false, incomplete, or misleading information.<br/>
<a id="pl.49.8"></a><var>49.8</var>    Subd. 3. <b>Age-based premium variations.</b> Beginning July 1, 1993, Each health <br/>
<a id="pl.49.9"></a><var>49.9</var>carrier may offer premium rates to small employers that vary based upon the ages of <br/>
<a id="pl.49.10"></a><var>49.10</var>the eligible employees and dependents of the small employer only as provided in this <br/>
<a id="pl.49.11"></a><var>49.11</var>subdivision. In addition to the variation permitted by subdivision 2, each health carrier <br/>
<a id="pl.49.12"></a><var>49.12</var>may use an additional premium variation based upon age of up to plus or minus 50 percent <br/>
<a id="pl.49.13"></a><var>49.13</var>of the index rate. Premium rates may vary based upon the ages of the eligible employees <br/>
<a id="pl.49.14"></a><var>49.14</var>and dependents of the small employer in accordance with the provisions of the Affordable <br/>
<a id="pl.49.15"></a><var>49.15</var>Care Act as defined in section 62A.011, subdivision 1a.<br/>
<a id="pl.49.16"></a><var>49.16</var>    Subd. 4. <b>Geographic premium variations.</b> A health carrier may request approval <br/>
<a id="pl.49.17"></a><var>49.17</var>by the commissioner to establish separate geographic regions determined by the health <br/>
<a id="pl.49.18"></a><var>49.18</var>carrier and to establish separate index rates for each such region Premium rates may vary <br/>
<a id="pl.49.19"></a><var>49.19</var>based on geographic rating areas set by the commissioner. The commissioner shall grant <br/>
<a id="pl.49.20"></a><var>49.20</var>approval if the following conditions are met:<br/>
<a id="pl.49.21"></a><var>49.21</var>(1) the geographic regions must be applied uniformly by the health carrier;<br/>
<a id="pl.49.22"></a><var>49.22</var>(2) each geographic region must be composed of no fewer than seven counties that <br/>
<a id="pl.49.23"></a><var>49.23</var>create a contiguous region; and<br/>
<a id="pl.49.24"></a><var>49.24</var>(3) the health carrier provides actuarial justification acceptable to the commissioner <br/>
<a id="pl.49.25"></a><var>49.25</var>for the proposed geographic variations in index rates, establishing that the variations are <br/>
<a id="pl.49.26"></a><var>49.26</var>based upon differences in the cost to the health carrier of providing coverage.<br/>
<a id="pl.49.27"></a><var>49.27</var>    Subd. 5. <b>Gender-based rates prohibited.</b> Beginning July 1, 1993, No health carrier <br/>
<a id="pl.49.28"></a><var>49.28</var>may determine premium rates through a method that is in any way based upon the gender <br/>
<a id="pl.49.29"></a><var>49.29</var>of eligible employees or dependents. Rates must not in any way reflect marital status or <br/>
<a id="pl.49.30"></a><var>49.30</var>generalized differences in expected costs between employees and spouses.<br/>
<a id="pl.49.31"></a><var>49.31</var>    Subd. 6. <b>Rate cells permitted</b><b> Tobacco rating</b><b>.</b> Health carriers may use rate cells <br/>
<a id="pl.49.32"></a><var>49.32</var>and must file with the commissioner the rate cells they use. Rate cells must be based on <br/>
<a id="pl.49.33"></a><var>49.33</var>the number of adults and children covered under the policy and may reflect the availability <br/>
<a id="pl.49.34"></a><var>49.34</var>of Medicare coverage. The rates for different rate cells must not in any way reflect marital <br/>
<a id="pl.49.35"></a><var>49.35</var>status or differences in expected costs between employees and spouses Premium rates <br/>
<a id="pl.50.1"></a><var>50.1</var>may vary based upon tobacco use in accordance with the provisions of the Affordable <br/>
<a id="pl.50.2"></a><var>50.2</var>Care Act as defined in section 62A.011, subdivision 1a.<br/>
<a id="pl.50.3"></a><var>50.3</var>    Subd. 7. <b>Index and</b><b> Premium rate development.</b> (a) In developing its index rates <br/>
<a id="pl.50.4"></a><var>50.4</var>and premiums, a health carrier may take into account only the following factors:<br/>
<a id="pl.50.5"></a><var>50.5</var>(1) actuarially valid differences in benefit designs of health benefit plans; and<br/>
<a id="pl.50.6"></a><var>50.6</var>(2) actuarially valid differences in the rating factors permitted in subdivisions 2 and 3;<br/>
<a id="pl.50.7"></a><var>50.7</var>(3) (2) actuarially valid geographic variations if approved by the commissioner as <br/>
<a id="pl.50.8"></a><var>50.8</var>provided in subdivision 4.<br/>
<a id="pl.50.9"></a><var>50.9</var>(b) All premium variations permitted under this section must be based upon <br/>
<a id="pl.50.10"></a><var>50.10</var>actuarially valid differences in expected cost to the health carrier of providing coverage. <br/>
<a id="pl.50.11"></a><var>50.11</var>The variation must be justified in initial rate filings and upon request of the commissioner in <br/>
<a id="pl.50.12"></a><var>50.12</var>rate revision filings. All premium variations are subject to approval by the commissioner.<br/>
<a id="pl.50.13"></a><var>50.13</var>    Subd. 8. <b>Filing requirement.</b> A health carrier that offers, sells, issues, or renews a <br/>
<a id="pl.50.14"></a><var>50.14</var>health benefit plan for small employers shall file with the commissioner the index rates and <br/>
<a id="pl.50.15"></a><var>50.15</var>must demonstrate that all rates shall be within the rating restrictions defined in this chapter. <br/>
<a id="pl.50.16"></a><var>50.16</var>Such demonstration must include the allowable range of rates from the index rates and a <br/>
<a id="pl.50.17"></a><var>50.17</var>description of how the health carrier intends to use demographic factors including case <br/>
<a id="pl.50.18"></a><var>50.18</var>characteristics in calculating the premium rates. The rates shall not be approved, unless the <br/>
<a id="pl.50.19"></a><var>50.19</var>commissioner has determined that the rates are reasonable. In determining reasonableness, <br/>
<a id="pl.50.20"></a><var>50.20</var>the commissioner shall consider the growth rates applied under section 
         <statute_ref>62J.04, subdivision <br/>
<a id="pl.50.21"></a><var>50.21</var>1
         </statute_ref>, paragraph (b), to the calendar year or years that the proposed premium rate would be in <br/>
<a id="pl.50.22"></a><var>50.22</var>effect, and actuarially valid changes in risk associated with the enrollee population, and <br/>
<a id="pl.50.23"></a><var>50.23</var>actuarially valid changes as a result of statutory changes in Laws 1992, chapter 549.<br/>
<a id="pl.50.24"></a><var>50.24</var>    Subd. 9. <b>Effect of assessments.</b> Premium rates must comply with the rating <br/>
<a id="pl.50.25"></a><var>50.25</var>requirements of this section, notwithstanding the imposition of any assessments or <br/>
<a id="pl.50.26"></a><var>50.26</var>premiums paid by health carriers as provided under sections 
         <statute_ref>62L.13</statute_ref> to 
         <statute_ref>62L.22</statute_ref>.<br/>
<a id="pl.50.27"></a><var>50.27</var>    Subd. 10. <b>Rating report.</b> Beginning January 1, 1995, and annually thereafter, the <br/>
<a id="pl.50.28"></a><var>50.28</var>commissioners of health and commerce shall provide a joint report to the legislature <br/>
<a id="pl.50.29"></a><var>50.29</var>on the effect of the rating restrictions required by this section and the appropriateness <br/>
<a id="pl.50.30"></a><var>50.30</var>of proceeding with additional rate reform. Each report must include an analysis of the <br/>
<a id="pl.50.31"></a><var>50.31</var>availability of health care coverage due to the rating reform, the equitable and appropriate <br/>
<a id="pl.50.32"></a><var>50.32</var>distribution of risk and associated costs, the effect on the self-insurance market, and any <br/>
<a id="pl.50.33"></a><var>50.33</var>resulting or anticipated change in health plan design and market share and availability of <br/>
<a id="pl.50.34"></a><var>50.34</var>health carriers.<br/>
<a id="pl.50.35"></a><var>50.35</var>    Subd. 11. <b>Loss ratio standards.</b> Notwithstanding section 
         <statute_ref>62A.02, subdivision 3</statute_ref>, <br/>
<a id="pl.50.36"></a><var>50.36</var>relating to loss ratios, each policy or contract form used with respect to a health benefit <br/>
<a id="pl.51.1"></a><var>51.1</var>plan offered, or issued in the small employer market, is subject, beginning July 1, 1993, <br/>
<a id="pl.51.2"></a><var>51.2</var>to section 
         <statute_ref>62A.021</statute_ref>. The commissioner of health has, with respect to carriers under that <br/>
<a id="pl.51.3"></a><var>51.3</var>commissioner's jurisdiction, all of the powers of the commissioner of commerce under <br/>
<a id="pl.51.4"></a><var>51.4</var>that section.<br/>
<a id="pl.51.5"></a><var>51.5</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.57.0"></a><a id="pl.51.6"></a><var>51.6</var>    Sec. 57. Minnesota Statutes 2012, section 62L.12, subdivision 2, is amended to read:<br/>
<a id="pl.51.7"></a><var>51.7</var>    Subd. 2. <b>Exceptions.</b> (a) A health carrier may sell, issue, or renew individual <br/>
<a id="pl.51.8"></a><var>51.8</var>conversion policies to eligible employees otherwise eligible for conversion coverage under <br/>
<a id="pl.51.9"></a><var>51.9</var>section 
         <statute_ref>62D.104</statute_ref> as a result of leaving a health maintenance organization's service area.<br/>
<a id="pl.51.10"></a><var>51.10</var>(b) A health carrier may sell, issue, or renew individual conversion policies to <br/>
<a id="pl.51.11"></a><var>51.11</var>eligible employees otherwise eligible for conversion coverage as a result of the expiration <br/>
<a id="pl.51.12"></a><var>51.12</var>of any continuation of group coverage required under sections 
         <statute_ref>62A.146</statute_ref>, 
         <statute_ref>62A.17</statute_ref>, 
         <statute_ref>62A.21</statute_ref>, <br/>
<statute_ref><a id="pl.51.13"></a><var>51.13</var>62C.142
         </statute_ref>, 
         <statute_ref>62D.101</statute_ref>, and 
         <statute_ref>62D.105</statute_ref>.<br/>
<a id="pl.51.14"></a><var>51.14</var>(c) A health carrier may sell, issue, or renew conversion policies under section <br/>
<a id="pl.51.15"></a><var>51.15</var><statute_ref>62E.16</statute_ref> to eligible employees.<br/>
<a id="pl.51.16"></a><var>51.16</var>(d) A health carrier may sell, issue, or renew individual continuation policies to <br/>
<a id="pl.51.17"></a><var>51.17</var>eligible employees as required.<br/>
<a id="pl.51.18"></a><var>51.18</var>(e) A health carrier may sell, issue, or renew individual health plans if the coverage <br/>
<a id="pl.51.19"></a><var>51.19</var>is appropriate due to an unexpired preexisting condition limitation or exclusion applicable <br/>
<a id="pl.51.20"></a><var>51.20</var>to the person under the employer's group health plan or due to the person's need for health <br/>
<a id="pl.51.21"></a><var>51.21</var>care services not covered under the employer's group health plan.<br/>
<a id="pl.51.22"></a><var>51.22</var>(f) A health carrier may sell, issue, or renew an individual health plan, if the <br/>
<a id="pl.51.23"></a><var>51.23</var>individual has elected to buy the individual health plan not as part of a general plan to <br/>
<a id="pl.51.24"></a><var>51.24</var>substitute individual health plans for a group health plan nor as a result of any violation of <br/>
<a id="pl.51.25"></a><var>51.25</var>subdivision 3 or 4.<br/>
<a id="pl.51.26"></a><var>51.26</var>(g) A health carrier may sell, issue, or renew an individual health plan if coverage <br/>
<a id="pl.51.27"></a><var>51.27</var>provided by the employer is determined to be unaffordable under the provisions of the <br/>
<a id="pl.51.28"></a><var>51.28</var>Affordable Care Act as defined in section 62A.011, subdivision 1a.<br/>
<a id="pl.51.29"></a><var>51.29</var>(h) Nothing in this subdivision relieves a health carrier of any obligation to provide <br/>
<a id="pl.51.30"></a><var>51.30</var>continuation or conversion coverage otherwise required under federal or state law.<br/>
<a id="pl.51.31"></a><var>51.31</var>(h) (i) Nothing in this chapter restricts the offer, sale, issuance, or renewal of <br/>
<a id="pl.51.32"></a><var>51.32</var>coverage issued as a supplement to Medicare under sections 
         <statute_ref>62A.3099</statute_ref> to 
         <statute_ref>62A.44</statute_ref>, or <br/>
<a id="pl.51.33"></a><var>51.33</var>policies or contracts that supplement Medicare issued by health maintenance organizations, <br/>
<a id="pl.51.34"></a><var>51.34</var>or those contracts governed by sections 1833, 1851 to 1859, 1860D, or 1876 of the federal <br/>
<a id="pl.51.35"></a><var>51.35</var>Social Security Act, United States Code, title 42, section 1395 et seq., as amended.<br/>
<a id="pl.52.1"></a><var>52.1</var>(i) (j) Nothing in this chapter restricts the offer, sale, issuance, or renewal of <br/>
<a id="pl.52.2"></a><var>52.2</var>individual health plans necessary to comply with a court order.<br/>
<a id="pl.52.3"></a><var>52.3</var>(j) (k) A health carrier may offer, issue, sell, or renew an individual health plan to <br/>
<a id="pl.52.4"></a><var>52.4</var>persons eligible for an employer group health plan, if the individual health plan is a high <br/>
<a id="pl.52.5"></a><var>52.5</var>deductible health plan for use in connection with an existing health savings account, in <br/>
<a id="pl.52.6"></a><var>52.6</var>compliance with the Internal Revenue Code, section 223. In that situation, the same or <br/>
<a id="pl.52.7"></a><var>52.7</var>a different health carrier may offer, issue, sell, or renew a group health plan to cover <br/>
<a id="pl.52.8"></a><var>52.8</var>the other eligible employees in the group.<br/>
<a id="pl.52.9"></a><var>52.9</var>(k) (l) A health carrier may offer, sell, issue, or renew an individual health plan to <br/>
<a id="pl.52.10"></a><var>52.10</var>one or more employees of a small employer if the individual health plan is marketed <br/>
<a id="pl.52.11"></a><var>52.11</var>directly to all employees of the small employer and the small employer does not contribute <br/>
<a id="pl.52.12"></a><var>52.12</var>directly or indirectly to the premiums or facilitate the administration of the individual <br/>
<a id="pl.52.13"></a><var>52.13</var>health plan. The requirement to market an individual health plan to all employees does not <br/>
<a id="pl.52.14"></a><var>52.14</var>require the health carrier to offer or issue an individual health plan to any employee. For <br/>
<a id="pl.52.15"></a><var>52.15</var>purposes of this paragraph, an employer is not contributing to the premiums or facilitating <br/>
<a id="pl.52.16"></a><var>52.16</var>the administration of the individual health plan if the employer does not contribute to the <br/>
<a id="pl.52.17"></a><var>52.17</var>premium and merely collects the premiums from an employee's wages or salary through <br/>
<a id="pl.52.18"></a><var>52.18</var>payroll deductions and submits payment for the premiums of one or more employees in a <br/>
<a id="pl.52.19"></a><var>52.19</var>lump sum to the health carrier. Except for coverage under section 
         <statute_ref>62A.65</statute_ref>, subdivision 5, <br/>
<a id="pl.52.20"></a><var>52.20</var>paragraph (b), or 
<statute_ref>62E.16</statute_ref>, at the request of an employee, the health carrier may bill the <br/>
<a id="pl.52.21"></a><var>52.21</var>employer for the premiums payable by the employee, provided that the employer is not <br/>
<a id="pl.52.22"></a><var>52.22</var>liable for payment except from payroll deductions for that purpose. If an employer is <br/>
<a id="pl.52.23"></a><var>52.23</var>submitting payments under this paragraph, the health carrier shall provide a cancellation <br/>
<a id="pl.52.24"></a><var>52.24</var>notice directly to the primary insured at least ten days prior to termination of coverage for <br/>
<a id="pl.52.25"></a><var>52.25</var>nonpayment of premium. Individual coverage under this paragraph may be offered only <br/>
<a id="pl.52.26"></a><var>52.26</var>if the small employer has not provided coverage under section 
         <statute_ref>62L.03</statute_ref> to the employees <br/>
<a id="pl.52.27"></a><var>52.27</var>within the past 12 months.<br/>
<a id="pl.52.28"></a><var>52.28</var>The employer must provide a written and signed statement to the health carrier that <br/>
<a id="pl.52.29"></a><var>52.29</var>the employer is not contributing directly or indirectly to the employee's premiums. The <br/>
<a id="pl.52.30"></a><var>52.30</var>health carrier may rely on the employer's statement and is not required to guarantee-issue <br/>
<a id="pl.52.31"></a><var>52.31</var>individual health plans to the employer's other current or future employees.<br/>
<a id="pl.52.32"></a><var>52.32</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.58.0"></a><a id="pl.52.33"></a><var>52.33</var>    Sec. 58. Minnesota Statutes 2012, section 62M.05, subdivision 3a, is amended to read:<br/>
<a id="pl.52.34"></a><var>52.34</var>    Subd. 3a. <b>Standard review determination.</b> (a) Notwithstanding subdivision 3b, an <br/>
<a id="pl.52.35"></a><var>52.35</var>initial determination on all requests for utilization review must be communicated to the <br/>
<a id="pl.53.1"></a><var>53.1</var>provider and enrollee in accordance with this subdivision within ten business days of the <br/>
<a id="pl.53.2"></a><var>53.2</var>request, provided that all information reasonably necessary to make a determination on the <br/>
<a id="pl.53.3"></a><var>53.3</var>request has been made available to the utilization review organization.<br/>
<a id="pl.53.4"></a><var>53.4</var>(b) When an initial determination is made to certify, notification must be provided <br/>
<a id="pl.53.5"></a><var>53.5</var>promptly by telephone to the provider. The utilization review organization shall send <br/>
<a id="pl.53.6"></a><var>53.6</var>written notification to the provider or shall maintain an audit trail of the determination <br/>
<a id="pl.53.7"></a><var>53.7</var>and telephone notification. For purposes of this subdivision, "audit trail" includes <br/>
<a id="pl.53.8"></a><var>53.8</var>documentation of the telephone notification, including the date; the name of the person <br/>
<a id="pl.53.9"></a><var>53.9</var>spoken to; the enrollee; the service, procedure, or admission certified; and the date of <br/>
<a id="pl.53.10"></a><var>53.10</var>the service, procedure, or admission. If the utilization review organization indicates <br/>
<a id="pl.53.11"></a><var>53.11</var>certification by use of a number, the number must be called the "certification number." <br/>
<a id="pl.53.12"></a><var>53.12</var>For purposes of this subdivision, notification may also be made by facsimile to a verified <br/>
<a id="pl.53.13"></a><var>53.13</var>number or by electronic mail to a secure electronic mailbox. These electronic forms of <br/>
<a id="pl.53.14"></a><var>53.14</var>notification satisfy the "audit trail" requirement of this paragraph.<br/>
<a id="pl.53.15"></a><var>53.15</var>(c) When an initial determination is made not to certify, notification must be <br/>
<a id="pl.53.16"></a><var>53.16</var>provided by telephone, by facsimile to a verified number, or by electronic mail to a secure <br/>
<a id="pl.53.17"></a><var>53.17</var>electronic mailbox within one working day after making the determination to the attending <br/>
<a id="pl.53.18"></a><var>53.18</var>health care professional and hospital as applicable. Written notification must also be sent <br/>
<a id="pl.53.19"></a><var>53.19</var>to the hospital as applicable and attending health care professional if notification occurred <br/>
<a id="pl.53.20"></a><var>53.20</var>by telephone. For purposes of this subdivision, notification may be made by facsimile to a <br/>
<a id="pl.53.21"></a><var>53.21</var>verified number or by electronic mail to a secure electronic mailbox. Written notification <br/>
<a id="pl.53.22"></a><var>53.22</var>must be sent to the enrollee and may be sent by United States mail, facsimile to a verified <br/>
<a id="pl.53.23"></a><var>53.23</var>number, or by electronic mail to a secure mailbox. The written notification must include <br/>
<a id="pl.53.24"></a><var>53.24</var>the principal reason or reasons for the determination and the process for initiating an appeal <br/>
<a id="pl.53.25"></a><var>53.25</var>of the determination. Upon request, the utilization review organization shall provide the <br/>
<a id="pl.53.26"></a><var>53.26</var>provider or enrollee with the criteria used to determine the necessity, appropriateness, <br/>
<a id="pl.53.27"></a><var>53.27</var>and efficacy of the health care service and identify the database, professional treatment <br/>
<a id="pl.53.28"></a><var>53.28</var>parameter, or other basis for the criteria. Reasons for a determination not to certify may <br/>
<a id="pl.53.29"></a><var>53.29</var>include, among other things, the lack of adequate information to certify after a reasonable <br/>
<a id="pl.53.30"></a><var>53.30</var>attempt has been made to contact the provider or enrollee.<br/>
<a id="pl.53.31"></a><var>53.31</var>(d) When an initial determination is made not to certify, the written notification must <br/>
<a id="pl.53.32"></a><var>53.32</var>inform the enrollee and the attending health care professional of the right to submit an <br/>
<a id="pl.53.33"></a><var>53.33</var>appeal to the internal appeal process described in section 
         <statute_ref>62M.06</statute_ref> and the procedure for <br/>
<a id="pl.53.34"></a><var>53.34</var>initiating the internal appeal. The written notice shall be provided in a culturally and <br/>
<a id="pl.53.35"></a><var>53.35</var>linguistically appropriate manner consistent with the provisions of the Affordable Care <br/>
<a id="pl.53.36"></a><var>53.36</var>Act as defined under section 62A.011, subdivision 1a.<br/>
<a id="pl.54.1"></a><var>54.1</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.59.0"></a><a id="pl.54.2"></a><var>54.2</var>    Sec. 59. Minnesota Statutes 2012, section 62M.06, subdivision 1, is amended to read:<br/>
<a id="pl.54.3"></a><var>54.3</var>    Subdivision 1. <b>Procedures for appeal.</b> (a) A utilization review organization must <br/>
<a id="pl.54.4"></a><var>54.4</var>have written procedures for appeals of determinations not to certify. The right to appeal <br/>
<a id="pl.54.5"></a><var>54.5</var>must be available to the enrollee and to the attending health care professional.<br/>
<a id="pl.54.6"></a><var>54.6</var>(b) The enrollee shall be allowed to review the information relied upon in the course <br/>
<a id="pl.54.7"></a><var>54.7</var>of the appeal, present evidence and testimony as part of the appeals process, and receive <br/>
<a id="pl.54.8"></a><var>54.8</var>continued coverage pending the outcome of the appeals process. This paragraph does <br/>
<a id="pl.54.9"></a><var>54.9</var>not apply to managed care plans or county-based purchasing plans serving state public <br/>
<a id="pl.54.10"></a><var>54.10</var>health care program enrollees  under section 256B.69, 256B.692, or chapter 256L, or to <br/>
<a id="pl.54.11"></a><var>54.11</var>grandfathered plans as defined under section 62A.011, subdivision 1c. Nothing in this <br/>
<a id="pl.54.12"></a><var>54.12</var>paragraph shall be construed to limit or restrict the appeal rights of state public health care <br/>
<a id="pl.54.13"></a><var>54.13</var>program enrollees provided under section 256.045 and Code of Federal Regulations, title <br/>
<a id="pl.54.14"></a><var>54.14</var>42, section 438.420(d).<br/>
<a id="pl.54.15"></a><var>54.15</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.60.0"></a><a id="pl.54.16"></a><var>54.16</var>    Sec. 60. Minnesota Statutes 2012, section 62Q.01, is amended by adding a subdivision <br/>
<a id="pl.54.17"></a><var>54.17</var>to read:<br/>
<a id="pl.54.18"></a><var>54.18</var>    Subd. 1a. <b>Affordable Care Act.</b> "Affordable Care Act" means the Affordable Care <br/>
<a id="pl.54.19"></a><var>54.19</var>Act as defined in section 62A.011, subdivision 1a.<br/>
<a id="pl.54.20"></a><var>54.20</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.61.0"></a><a id="pl.54.21"></a><var>54.21</var>    Sec. 61. Minnesota Statutes 2012, section 62Q.01, is amended by adding a subdivision <br/>
<a id="pl.54.22"></a><var>54.22</var>to read:<br/>
<a id="pl.54.23"></a><var>54.23</var>    Subd. 1b. <b>Bona fide association.</b> "Bona fide association" means an association that <br/>
<a id="pl.54.24"></a><var>54.24</var>meets all of the following criteria:<br/>
<a id="pl.54.25"></a><var>54.25</var>(1) serves a single profession that requires a significant amount of education, training, <br/>
<a id="pl.54.26"></a><var>54.26</var>or experience, or a license or certificate from a state authority to practice that profession;<br/>
<a id="pl.54.27"></a><var>54.27</var>(2) has been actively in existence for five years;<br/>
<a id="pl.54.28"></a><var>54.28</var>(3) has a constitution and bylaws or other analogous governing documents;<br/>
<a id="pl.54.29"></a><var>54.29</var>(4) has been formed and maintained in good faith for purposes other than obtaining <br/>
<a id="pl.54.30"></a><var>54.30</var>insurance;<br/>
<a id="pl.54.31"></a><var>54.31</var>(5) is not owned or controlled by a health plan company or affiliated with a health <br/>
<a id="pl.54.32"></a><var>54.32</var>plan company;<br/>
<a id="pl.55.1"></a><var>55.1</var>(6) does not condition membership in the association on any health status-related <br/>
<a id="pl.55.2"></a><var>55.2</var>factor;<br/>
<a id="pl.55.3"></a><var>55.3</var>(7) has at least 1,000 members if it is a national association, 500 members if it is a <br/>
<a id="pl.55.4"></a><var>55.4</var>state association, or 200 members if it is a local association;<br/>
<a id="pl.55.5"></a><var>55.5</var>(8) all members and dependents of members are eligible for coverage regardless of <br/>
<a id="pl.55.6"></a><var>55.6</var>any health status-related factor;<br/>
<a id="pl.55.7"></a><var>55.7</var>(9) does not make health plans offered through the association available other than <br/>
<a id="pl.55.8"></a><var>55.8</var>in connection with a member of the association;<br/>
<a id="pl.55.9"></a><var>55.9</var>(10) is governed by a board of directors and sponsors an annual meeting of its <br/>
<a id="pl.55.10"></a><var>55.10</var>members; and<br/>
<a id="pl.55.11"></a><var>55.11</var>(11) produces only market association memberships, accepts applications for <br/>
<a id="pl.55.12"></a><var>55.12</var>membership, or signs up members in the professional association where the subject <br/>
<a id="pl.55.13"></a><var>55.13</var>individuals are actively engaged in, or directly related to, the profession represented <br/>
<a id="pl.55.14"></a><var>55.14</var>by the association.<br/>
<a id="pl.55.15"></a><var>55.15</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.62.0"></a><a id="pl.55.16"></a><var>55.16</var>    Sec. 62. Minnesota Statutes 2012, section 62Q.01, is amended by adding a subdivision <br/>
<a id="pl.55.17"></a><var>55.17</var>to read:<br/>
<a id="pl.55.18"></a><var>55.18</var>    Subd. 2b. <b>Grandfathered plan.</b> "Grandfathered plan" means a health plan as <br/>
<a id="pl.55.19"></a><var>55.19</var>defined in section 62A.011, subdivision 1b.<br/>
<br/>
<a id="bill.1.63.0"></a><a id="pl.55.20"></a><var>55.20</var>    Sec. 63. Minnesota Statutes 2012, section 62Q.01, is amended by adding a subdivision <br/>
<a id="pl.55.21"></a><var>55.21</var>to read:<br/>
<a id="pl.55.22"></a><var>55.22</var>    Subd. 2c. <b>Group health plan.</b> "Group health plan" means a group health plan as <br/>
<a id="pl.55.23"></a><var>55.23</var>defined in section 62A.011, subdivision 1c.<br/>
<br/>
<a id="bill.1.64.0"></a><a id="pl.55.24"></a><var>55.24</var>    Sec. 64. Minnesota Statutes 2012, section 62Q.01, is amended by adding a subdivision <br/>
<a id="pl.55.25"></a><var>55.25</var>to read:<br/>
<a id="pl.55.26"></a><var>55.26</var>    Subd. 4b. <b>Individual health plan.</b> "Individual health plan" means an individual <br/>
<a id="pl.55.27"></a><var>55.27</var>health plan as defined in section 62A.011, subdivision 4.<br/>
<br/>
<a id="bill.1.65.0"></a><a id="pl.55.28"></a><var>55.28</var>    Sec. 65. Minnesota Statutes 2012, section 62Q.01, is amended by adding a subdivision <br/>
<a id="pl.55.29"></a><var>55.29</var>to read:<br/>
<a id="pl.55.30"></a><var>55.30</var>    Subd. 7. <b>Life-threatening condition.</b> "Life-threatening condition" means a disease <br/>
<a id="pl.55.31"></a><var>55.31</var>or condition from which the likelihood of death is probable unless the course of the <br/>
<a id="pl.55.32"></a><var>55.32</var>disease or condition is interrupted.<br/>
<a id="pl.56.1"></a><var>56.1</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.66.0"></a><a id="pl.56.2"></a><var>56.2</var>    Sec. 66. Minnesota Statutes 2012, section 62Q.01, is amended by adding a subdivision <br/>
<a id="pl.56.3"></a><var>56.3</var>to read:<br/>
<a id="pl.56.4"></a><var>56.4</var>    Subd. 8. <b>Primary care provider.</b> "Primary care provider" means a health care <br/>
<a id="pl.56.5"></a><var>56.5</var>professional who specializes in the practice of family medicine, general internal medicine, <br/>
<a id="pl.56.6"></a><var>56.6</var>obstetrics and gynecology, or general pediatrics and is a licensed physician, a licensed and <br/>
<a id="pl.56.7"></a><var>56.7</var>certified advanced practice registered nurse, or a licensed physician assistant.<br/>
<a id="pl.56.8"></a><var>56.8</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.67.0"></a><a id="pl.56.9"></a><var>56.9</var>    Sec. 67. Minnesota Statutes 2012, section 62Q.01, is amended by adding a subdivision <br/>
<a id="pl.56.10"></a><var>56.10</var>to read:<br/>
<a id="pl.56.11"></a><var>56.11</var>    Subd. 9. <b>Dependent child to the limiting age.</b> "Dependent child to the limiting <br/>
<a id="pl.56.12"></a><var>56.12</var>age" or "dependent children to the limiting age" means those individuals who are eligible <br/>
<a id="pl.56.13"></a><var>56.13</var>and covered as a dependent child under the terms of a health plan who have not yet <br/>
<a id="pl.56.14"></a><var>56.14</var>attained 26 years of age. A health plan company must not deny or restrict eligibility <br/>
<a id="pl.56.15"></a><var>56.15</var>for a dependent child to the limiting age based on financial dependency, residency, <br/>
<a id="pl.56.16"></a><var>56.16</var>marital status, or student status. For coverage under plans offered by the Minnesota <br/>
<a id="pl.56.17"></a><var>56.17</var>Comprehensive Health Association, dependent to the limiting age means dependent <br/>
<a id="pl.56.18"></a><var>56.18</var>as defined in section 62A.302, subdivision 3. Notwithstanding the provisions in this <br/>
<a id="pl.56.19"></a><var>56.19</var>subdivision, a health plan may include:<br/>
<a id="pl.56.20"></a><var>56.20</var>(1) eligibility requirements regarding the absence of other health plan coverage as <br/>
<a id="pl.56.21"></a><var>56.21</var>permitted by the Affordable Care Act for grandfathered plan coverage; or<br/>
<a id="pl.56.22"></a><var>56.22</var>(2) an age greater than 26 in its policy, contract, or certificate of coverage.<br/>
<a id="pl.56.23"></a><var>56.23</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.68.0"></a><a id="pl.56.24"></a><var>56.24</var>    Sec. 68. Minnesota Statutes 2012, section 62Q.021, is amended to read:<br/>
<a id="pl.56.25"></a><var>56.25</var><b>62Q.021 FEDERAL ACT; COMPLIANCE REQUIRED.</b><br/>
<a id="pl.56.26"></a><var>56.26</var>    Subdivision 1. <b>Compliance with 1996 federal law.</b> Each health plan company shall <br/>
<a id="pl.56.27"></a><var>56.27</var>comply with the federal Health Insurance Portability and Accountability Act of 1996, <br/>
<a id="pl.56.28"></a><var>56.28</var>including any federal regulations adopted under that act, to the extent that it imposes a <br/>
<a id="pl.56.29"></a><var>56.29</var>requirement that applies in this state and that is not also required by the laws of this state. <br/>
<a id="pl.56.30"></a><var>56.30</var>This section does not require compliance with any provision of the federal act prior to <br/>
<a id="pl.56.31"></a><var>56.31</var>the effective date provided for that provision in the federal act. The commissioner shall <br/>
<a id="pl.56.32"></a><var>56.32</var>enforce this section subdivision.<br/>
<a id="pl.57.1"></a><var>57.1</var>    Subd. 2. <b>Compliance with 2010 federal law.</b> Each health plan company shall <br/>
<a id="pl.57.2"></a><var>57.2</var>comply with the Affordable Care Act to the extent that it imposes a requirement that <br/>
<a id="pl.57.3"></a><var>57.3</var>applies in this state but is not required under the laws of this state. This section does not <br/>
<a id="pl.57.4"></a><var>57.4</var>require compliance with any provision of the Affordable Care Act before the effective <br/>
<a id="pl.57.5"></a><var>57.5</var>date provided for that provision in the Affordable Care Act. The commissioner shall <br/>
<a id="pl.57.6"></a><var>57.6</var>enforce this subdivision.<br/>
<a id="pl.57.7"></a><var>57.7</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.69.0"></a><a id="pl.57.8"></a><var>57.8</var>    Sec. 69. Minnesota Statutes 2012, section 62Q.17, subdivision 6, is amended to read:<br/>
<a id="pl.57.9"></a><var>57.9</var>    Subd. 6. <b>Employer-based purchasing pools.</b> Employer-based purchasing <br/>
<a id="pl.57.10"></a><var>57.10</var>pools must, with respect to small employers as defined in section 
         <statute_ref>62L.02</statute_ref>, meet all the <br/>
<a id="pl.57.11"></a><var>57.11</var>requirements of chapter 62L. The experience of the pool must be pooled and the rates <br/>
<a id="pl.57.12"></a><var>57.12</var>blended across all groups. Pools may decide to create tiers within the pool, based on <br/>
<a id="pl.57.13"></a><var>57.13</var>experience of group members. These tiers must be designed within the requirements <br/>
<a id="pl.57.14"></a><var>57.14</var>of section 
<statute_ref>62L.08</statute_ref>. The governing structure may establish criteria limiting movement <br/>
<a id="pl.57.15"></a><var>57.15</var>between tiers. Tiers must be phased out within two years of the pool's creation.<br/>
<a id="pl.57.16"></a><var>57.16</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.70.0"></a><a id="pl.57.17"></a><var>57.17</var>    Sec. 70. Minnesota Statutes 2012, section 62Q.18, is amended by adding a subdivision <br/>
<a id="pl.57.18"></a><var>57.18</var>to read:<br/>
<a id="pl.57.19"></a><var>57.19</var>    Subd. 8. <b>Guaranteed issue.</b> No health plan company shall offer, sell, or issue <br/>
<a id="pl.57.20"></a><var>57.20</var>any health plan that does not make coverage available on a guaranteed issue basis in <br/>
<a id="pl.57.21"></a><var>57.21</var>accordance with the Affordable Care Act.<br/>
<a id="pl.57.22"></a><var>57.22</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.71.0"></a><a id="pl.57.23"></a><var>57.23</var>    Sec. 71. <b>[62Q.186] PROHIBITION ON RESCISSIONS OF HEALTH PLANS.</b><br/>
<a id="pl.57.24"></a><var>57.24</var>    Subdivision 1. <b>Definitions.</b> (a) "Rescission" means a cancellation or discontinuance <br/>
<a id="pl.57.25"></a><var>57.25</var>of coverage under a health plan that has a retroactive effect.<br/>
<a id="pl.57.26"></a><var>57.26</var>(b) "Rescission" does not include:<br/>
<a id="pl.57.27"></a><var>57.27</var>(1) a cancellation or discontinuance of coverage under a health plan if:<br/>
<a id="pl.57.28"></a><var>57.28</var>(i) the cancellation or discontinuance of coverage has only a prospective effect; or<br/>
<a id="pl.57.29"></a><var>57.29</var>(ii) the cancellation or discontinuance of coverage is effective retroactively to the <br/>
<a id="pl.57.30"></a><var>57.30</var>extent it is attributable to a failure to timely pay required premiums or contributions <br/>
<a id="pl.57.31"></a><var>57.31</var>toward the cost of coverage; or<br/>
<a id="pl.58.1"></a><var>58.1</var>(2) when the health plan covers only active employees and, if applicable, <br/>
<a id="pl.58.2"></a><var>58.2</var>dependents and those covered under continuation coverage provisions, the employee <br/>
<a id="pl.58.3"></a><var>58.3</var>pays no premiums for coverage after termination of employment and the cancellation or <br/>
<a id="pl.58.4"></a><var>58.4</var>discontinuance of coverage is effective retroactively back to the date of termination of <br/>
<a id="pl.58.5"></a><var>58.5</var>employment due to a delay in administrative record keeping.<br/>
<a id="pl.58.6"></a><var>58.6</var>    Subd. 2. <b>Prohibition on rescissions.</b> (a) A health plan company shall not rescind <br/>
<a id="pl.58.7"></a><var>58.7</var>coverage under a health plan with respect to an individual, including a group to which <br/>
<a id="pl.58.8"></a><var>58.8</var>the individual belongs or family coverage in which the individual is included, after the <br/>
<a id="pl.58.9"></a><var>58.9</var>individual is covered under the health plan, unless:<br/>
<a id="pl.58.10"></a><var>58.10</var>(1) the individual, or a person seeking coverage on behalf of the individual, performs <br/>
<a id="pl.58.11"></a><var>58.11</var>an act, practice, or omission that constitutes fraud; or<br/>
<a id="pl.58.12"></a><var>58.12</var>(2) the individual makes an intentional misrepresentation or omission of material <br/>
<a id="pl.58.13"></a><var>58.13</var>fact, as prohibited by the terms of the health plan.<br/>
<a id="pl.58.14"></a><var>58.14</var>For purposes of this section, a person seeking coverage on behalf of an individual <br/>
<a id="pl.58.15"></a><var>58.15</var>does not include an insurance producer or employee or authorized representative of the <br/>
<a id="pl.58.16"></a><var>58.16</var>health carrier.<br/>
<a id="pl.58.17"></a><var>58.17</var>(b) This section does not apply to any benefits classified as excepted benefits under <br/>
<a id="pl.58.18"></a><var>58.18</var>United States Code, title 42, section 300gg-91(c), or regulations enacted thereunder <br/>
<a id="pl.58.19"></a><var>58.19</var>from time to time.<br/>
<a id="pl.58.20"></a><var>58.20</var>    Subd. 3. <b>Notice required.</b> A health plan company shall provide at least 30 days' <br/>
<a id="pl.58.21"></a><var>58.21</var>advance written notice to each individual who would be affected by the proposed rescission <br/>
<a id="pl.58.22"></a><var>58.22</var>of coverage before coverage under the health plan may be terminated retroactively.<br/>
<a id="pl.58.23"></a><var>58.23</var>    Subd. 4. <b>Compliance with other restrictions on rescissions.</b> Nothing in this <br/>
<a id="pl.58.24"></a><var>58.24</var>section allows rescission if rescission would otherwise be prohibited under section <br/>
<a id="pl.58.25"></a><var>58.25</var>62A.04, subdivision 2, clause (2), or 62A.615.<br/>
<a id="pl.58.26"></a><var>58.26</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.72.0"></a><a id="pl.58.27"></a><var>58.27</var>    Sec. 72. Minnesota Statutes 2012, section 62Q.23, is amended to read:<br/>
<a id="pl.58.28"></a><var>58.28</var><b>62Q.23 GENERAL SERVICES.</b><br/>
<a id="pl.58.29"></a><var>58.29</var>(a) Health plan companies shall comply with all continuation and conversion of <br/>
<a id="pl.58.30"></a><var>58.30</var>coverage requirements applicable to health maintenance organizations under state or <br/>
<a id="pl.58.31"></a><var>58.31</var>federal law.<br/>
<a id="pl.58.32"></a><var>58.32</var>(b) Health plan companies shall comply with sections 
         <statute_ref>62A.047</statute_ref>, 
         <statute_ref>62A.27</statute_ref>, and any <br/>
<a id="pl.58.33"></a><var>58.33</var>other coverage required under chapter 62A of newborn infants, dependent children who <br/>
<a id="pl.58.34"></a><var>58.34</var>do not reside with a covered person to the limiting age as defined in section 62Q.01, <br/>
<a id="pl.59.1"></a><var>59.1</var>subdivision 9, disabled children and dependents dependent children, and adopted children. <br/>
<a id="pl.59.2"></a><var>59.2</var>A health plan company providing dependent coverage shall comply with section 
         <statute_ref>62A.302</statute_ref>.<br/>
<a id="pl.59.3"></a><var>59.3</var>(c) Health plan companies shall comply with the equal access requirements of <br/>
<a id="pl.59.4"></a><var>59.4</var>section 
         <statute_ref>62A.15</statute_ref>.<br/>
<a id="pl.59.5"></a><var>59.5</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.73.0"></a><a id="pl.59.6"></a><var>59.6</var>    Sec. 73. Minnesota Statutes 2012, section 62Q.43, subdivision 2, is amended to read:<br/>
<a id="pl.59.7"></a><var>59.7</var>    Subd. 2. <b>Access requirement.</b> Every closed-panel health plan must allow enrollees <br/>
<a id="pl.59.8"></a><var>59.8</var>who are full-time students under the age of 25 26 years to change their designated clinic or <br/>
<a id="pl.59.9"></a><var>59.9</var>physician at least once per month, as long as the clinic or physician is part of the health <br/>
<a id="pl.59.10"></a><var>59.10</var>plan company's statewide clinic or physician network. A health plan company shall not <br/>
<a id="pl.59.11"></a><var>59.11</var>charge enrollees who choose this option higher premiums or cost sharing than would <br/>
<a id="pl.59.12"></a><var>59.12</var>otherwise apply to enrollees who do not choose this option. A health plan company may <br/>
<a id="pl.59.13"></a><var>59.13</var>require enrollees to provide 15 days' written notice of intent to change their designated <br/>
<a id="pl.59.14"></a><var>59.14</var>clinic or physician.<br/>
<a id="pl.59.15"></a><var>59.15</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.74.0"></a><a id="pl.59.16"></a><var>59.16</var>    Sec. 74. <b>[62Q.46] PREVENTIVE ITEMS AND SERVICES.</b><br/>
<a id="pl.59.17"></a><var>59.17</var>    Subdivision 1. <b>Coverage for preventive items and services.</b> (a) "Preventive items <br/>
<a id="pl.59.18"></a><var>59.18</var>and services" has the meaning specified in the Affordable Care Act.<br/>
<a id="pl.59.19"></a><var>59.19</var>(b) A health plan company must provide coverage for preventive items and services <br/>
<a id="pl.59.20"></a><var>59.20</var>at a participating provider without imposing cost-sharing requirements, including a <br/>
<a id="pl.59.21"></a><var>59.21</var>deductible, coinsurance, or co-payment. Nothing in this section prohibits a health <br/>
<a id="pl.59.22"></a><var>59.22</var>plan company that has a network of providers from excluding coverage or imposing <br/>
<a id="pl.59.23"></a><var>59.23</var>cost-sharing requirements for preventive items or services that are delivered by an <br/>
<a id="pl.59.24"></a><var>59.24</var>out-of-network provider.<br/>
<a id="pl.59.25"></a><var>59.25</var>(c) A health plan company is not required to provide coverage for any items or <br/>
<a id="pl.59.26"></a><var>59.26</var>services specified in any recommendation or guideline described in paragraph (a) if the <br/>
<a id="pl.59.27"></a><var>59.27</var>recommendation or guideline is no longer included as a preventive item or service as <br/>
<a id="pl.59.28"></a><var>59.28</var>defined in paragraph (a). Annually, a health plan company must determine whether any <br/>
<a id="pl.59.29"></a><var>59.29</var>additional items or services must be covered without cost-sharing requirements or whether <br/>
<a id="pl.59.30"></a><var>59.30</var>any items or services are no longer required to be covered.<br/>
<a id="pl.59.31"></a><var>59.31</var>(d) Nothing in this section prevents a health plan company from using reasonable <br/>
<a id="pl.59.32"></a><var>59.32</var>medical management techniques to determine the frequency, method, treatment, or setting <br/>
<a id="pl.60.1"></a><var>60.1</var>for a preventive item or service to the extent not specified in the recommendation or <br/>
<a id="pl.60.2"></a><var>60.2</var>guideline.<br/>
<a id="pl.60.3"></a><var>60.3</var>(e) This section does not apply to grandfathered plans.<br/>
<a id="pl.60.4"></a><var>60.4</var>(f) This section does not apply to plans offered by the Minnesota Comprehensive <br/>
<a id="pl.60.5"></a><var>60.5</var>Health Association.<br/>
<a id="pl.60.6"></a><var>60.6</var>    Subd. 2. <b>Coverage for office visits in conjunction with preventive items and </b><br/>
<a id="pl.60.7"></a><var>60.7</var><b>services.</b> (a) A health plan company may impose cost-sharing requirements with respect <br/>
<a id="pl.60.8"></a><var>60.8</var>to an office visit if a preventive item or service is billed separately or is tracked separately <br/>
<a id="pl.60.9"></a><var>60.9</var>as individual encounter data from the office visit.<br/>
<a id="pl.60.10"></a><var>60.10</var>(b) A health plan company must not impose cost-sharing requirements with respect <br/>
<a id="pl.60.11"></a><var>60.11</var>to an office visit if a preventive item or service is not billed separately or is not tracked <br/>
<a id="pl.60.12"></a><var>60.12</var>separately as individual encounter data from the office visit and the primary purpose of the <br/>
<a id="pl.60.13"></a><var>60.13</var>office visit is the delivery of the preventive item or service.<br/>
<a id="pl.60.14"></a><var>60.14</var>(c) A health plan company may impose cost-sharing requirements with respect to <br/>
<a id="pl.60.15"></a><var>60.15</var>an office visit if a preventive item or service is not billed separately or is not tracked <br/>
<a id="pl.60.16"></a><var>60.16</var>separately as individual encounter data from the office visit and the primary purpose of the <br/>
<a id="pl.60.17"></a><var>60.17</var>office visit is not the delivery of the preventive item or service.<br/>
<a id="pl.60.18"></a><var>60.18</var>    Subd. 3. <b>Additional services not prohibited.</b> Nothing in this section prohibits a <br/>
<a id="pl.60.19"></a><var>60.19</var>health plan company from providing coverage for preventive items and services in addition <br/>
<a id="pl.60.20"></a><var>60.20</var>to those specified in the Affordable Care Act, or from denying coverage for preventive <br/>
<a id="pl.60.21"></a><var>60.21</var>items and services that are not recommended as preventive items and services under the <br/>
<a id="pl.60.22"></a><var>60.22</var>Affordable Care Act. A health plan company may impose cost-sharing requirements for a <br/>
<a id="pl.60.23"></a><var>60.23</var>treatment not described in the Affordable Care Act even if the treatment results from a <br/>
<a id="pl.60.24"></a><var>60.24</var>preventive item or service described in the Affordable Care Act.<br/>
<a id="pl.60.25"></a><var>60.25</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.75.0"></a><a id="pl.60.26"></a><var>60.26</var>    Sec. 75. Minnesota Statutes 2012, section 62Q.47, is amended to read:<br/>
<a id="pl.60.27"></a><var>60.27</var><b>62Q.47 ALCOHOLISM, MENTAL HEALTH, AND CHEMICAL </b><br/>
<a id="pl.60.28"></a><var>60.28</var><b>DEPENDENCY SERVICES.</b><br/>
<a id="pl.60.29"></a><var>60.29</var>    (a) All health plans, as defined in section 
         <statute_ref>62Q.01</statute_ref>, that provide coverage for <br/>
<a id="pl.60.30"></a><var>60.30</var>alcoholism, mental health, or chemical dependency services, must comply with the <br/>
<a id="pl.60.31"></a><var>60.31</var>requirements of this section.<br/>
<a id="pl.60.32"></a><var>60.32</var>    (b) Cost-sharing requirements and benefit or service limitations for outpatient <br/>
<a id="pl.60.33"></a><var>60.33</var>mental health and outpatient chemical dependency and alcoholism services, except for <br/>
<a id="pl.60.34"></a><var>60.34</var>persons placed in chemical dependency services under Minnesota Rules, parts 9530.6600 <br/>
<a id="pl.61.1"></a><var>61.1</var>to 9530.6660, must not place a greater financial burden on the insured or enrollee, or be <br/>
<a id="pl.61.2"></a><var>61.2</var>more restrictive than those requirements and limitations for outpatient medical services.<br/>
<a id="pl.61.3"></a><var>61.3</var>    (c) Cost-sharing requirements and benefit or service limitations for inpatient hospital <br/>
<a id="pl.61.4"></a><var>61.4</var>mental health and inpatient hospital and residential chemical dependency and alcoholism <br/>
<a id="pl.61.5"></a><var>61.5</var>services, except for persons placed in chemical dependency services under Minnesota <br/>
<a id="pl.61.6"></a><var>61.6</var>Rules, parts 9530.6600 to 9530.6660, must not place a greater financial burden on the <br/>
<a id="pl.61.7"></a><var>61.7</var>insured or enrollee, or be more restrictive than those requirements and limitations for <br/>
<a id="pl.61.8"></a><var>61.8</var>inpatient hospital medical services.<br/>
<a id="pl.61.9"></a><var>61.9</var>    (d) All health plans must meet the requirements of the federal Mental Health Parity <br/>
<a id="pl.61.10"></a><var>61.10</var>Act of 1996, Public Law 104-204; Paul Wellstone and Pete Domenici Mental Health <br/>
<a id="pl.61.11"></a><var>61.11</var>Parity and Addiction Equity Act of 2008; the Affordable Care Act; and any amendments <br/>
<a id="pl.61.12"></a><var>61.12</var>to, and federal guidance or regulations issued under, those acts.<br/>
<a id="pl.61.13"></a><var>61.13</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.76.0"></a><a id="pl.61.14"></a><var>61.14</var>    Sec. 76. Minnesota Statutes 2012, section 62Q.52, is amended to read:<br/>
<a id="pl.61.15"></a><var>61.15</var><b>62Q.52 DIRECT ACCESS TO OBSTETRIC AND GYNECOLOGIC </b><br/>
<a id="pl.61.16"></a><var>61.16</var><b>SERVICES.</b><br/>
<a id="pl.61.17"></a><var>61.17</var>    Subdivision 1. <b>Direct access.</b> (a) Health plan companies shall allow female <br/>
<a id="pl.61.18"></a><var>61.18</var>enrollees direct access to obstetricians and gynecologists providers who specialize in <br/>
<a id="pl.61.19"></a><var>61.19</var>obstetrics and gynecology for the following services:<br/>
<a id="pl.61.20"></a><var>61.20</var>(1) annual preventive health examinations, which shall include a gynecologic <br/>
<a id="pl.61.21"></a><var>61.21</var>examination, and any subsequent obstetric or gynecologic visits determined to be medically <br/>
<a id="pl.61.22"></a><var>61.22</var>necessary by the examining obstetrician or gynecologist, based upon the findings of the <br/>
<a id="pl.61.23"></a><var>61.23</var>examination evaluation and necessary treatment for obstetric conditions or emergencies;<br/>
<a id="pl.61.24"></a><var>61.24</var>(2) maternity care; and<br/>
<a id="pl.61.25"></a><var>61.25</var>(3) evaluation and necessary treatment for acute gynecologic conditions or <br/>
<a id="pl.61.26"></a><var>61.26</var>emergencies, including annual preventive health examinations.<br/>
<a id="pl.61.27"></a><var>61.27</var>(b) For purposes of this section, "direct access" means that a female enrollee may <br/>
<a id="pl.61.28"></a><var>61.28</var>obtain the obstetric and gynecologic services specified in paragraph (a) from obstetricians <br/>
<a id="pl.61.29"></a><var>61.29</var>and gynecologists providers who specialize in obstetrics and gynecology in the enrollee's <br/>
<a id="pl.61.30"></a><var>61.30</var>network without a referral from, or prior approval through a primary care provider, <br/>
<a id="pl.61.31"></a><var>61.31</var>another physician, the health plan company, or its representatives.<br/>
<a id="pl.61.32"></a><var>61.32</var>(c) The health plan company shall treat the provision of obstetrical and gynecological <br/>
<a id="pl.61.33"></a><var>61.33</var>care and the ordering of related obstetrical and gynecological items and services, pursuant <br/>
<a id="pl.62.1"></a><var>62.1</var>to paragraph (a), by a participating health care provider who specializes in obstetrics or <br/>
<a id="pl.62.2"></a><var>62.2</var>gynecology as the authorization of a primary care provider.<br/>
<a id="pl.62.3"></a><var>62.3</var>(d) The health plan company may require the health care provider to agree to <br/>
<a id="pl.62.4"></a><var>62.4</var>otherwise adhere to the health plan company's policies and procedures, including <br/>
<a id="pl.62.5"></a><var>62.5</var>procedures for obtaining prior authorization and for providing services in accordance with <br/>
<a id="pl.62.6"></a><var>62.6</var>a treatment plan, if any, approved by the health plan company.<br/>
<a id="pl.62.7"></a><var>62.7</var>(c) (e) Health plan companies shall not require higher co-payments, coinsurance, <br/>
<a id="pl.62.8"></a><var>62.8</var>deductibles, or other enrollee cost-sharing for direct access.<br/>
<a id="pl.62.9"></a><var>62.9</var>(d) (f) This section applies only to services described in paragraph (a) that are <br/>
<a id="pl.62.10"></a><var>62.10</var>covered by the enrollee's coverage, but coverage of a preventive health examination for <br/>
<a id="pl.62.11"></a><var>62.11</var>female enrollees must not exclude coverage of a gynecologic examination.<br/>
<a id="pl.62.12"></a><var>62.12</var>(g) For purposes of this section, a health care provider who specializes in obstetrics <br/>
<a id="pl.62.13"></a><var>62.13</var>or gynecology means any individual, including an individual other than a physician, who <br/>
<a id="pl.62.14"></a><var>62.14</var>is authorized under state law to provide obstetrical or gynecological care.<br/>
<a id="pl.62.15"></a><var>62.15</var>(h) This section does not:<br/>
<a id="pl.62.16"></a><var>62.16</var>(1) waive any exclusions of coverage under the terms and conditions of the health <br/>
<a id="pl.62.17"></a><var>62.17</var>plan with respect to coverage of obstetrical or gynecological care; or <br/>
<a id="pl.62.18"></a><var>62.18</var>(2) preclude the health plan company from requiring that the participating health <br/>
<a id="pl.62.19"></a><var>62.19</var>care provider providing obstetrical or gynecological care notify the primary care provider <br/>
<a id="pl.62.20"></a><var>62.20</var>or the health plan company of treatment decisions.<br/>
<a id="pl.62.21"></a><var>62.21</var>    Subd. 2. <b>Notice.</b> A health plan company shall provide notice to enrollees of the <br/>
<a id="pl.62.22"></a><var>62.22</var>provisions of subdivision 1 in accordance with the requirements of the Affordable Care Act.<br/>
<a id="pl.62.23"></a><var>62.23</var>    Subd. 3. <b>Enforcement.</b> The commissioner of health shall enforce this section.<br/>
<a id="pl.62.24"></a><var>62.24</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.77.0"></a><a id="pl.62.25"></a><var>62.25</var>    Sec. 77. <b>[62Q.526] COVERAGE FOR PARTICIPATION IN APPROVED </b><br/>
<a id="pl.62.26"></a><var>62.26</var><b>CLINICAL TRIALS.</b><br/>
<a id="pl.62.27"></a><var>62.27</var>    Subdivision 1. <b>Definitions.</b> As used in this section, the following definitions apply:<br/>
<a id="pl.62.28"></a><var>62.28</var>(a) "Approved clinical trial" means a phase I, phase II, phase III, or phase IV clinical <br/>
<a id="pl.62.29"></a><var>62.29</var>trial that is conducted in relation to the prevention, detection, or treatment of cancer or <br/>
<a id="pl.62.30"></a><var>62.30</var>a life-threatening condition and is not designed exclusively to test toxicity or disease <br/>
<a id="pl.62.31"></a><var>62.31</var>pathophysiology and must be:<br/>
<a id="pl.62.32"></a><var>62.32</var>(1) conducted under an investigational new drug application reviewed by the United <br/>
<a id="pl.62.33"></a><var>62.33</var>States Food and Drug Administration (FDA);<br/>
<a id="pl.62.34"></a><var>62.34</var>(2) exempt from obtaining an investigational new drug application; or<br/>
<a id="pl.62.35"></a><var>62.35</var>(3) approved or funded by:<br/>
<a id="pl.63.1"></a><var>63.1</var>(i) the National Institutes of Health (NIH), the Centers for Disease Control and <br/>
<a id="pl.63.2"></a><var>63.2</var>Prevention, the Agency for Health Care Research and Quality, the Centers for Medicare <br/>
<a id="pl.63.3"></a><var>63.3</var>and Medicaid Services, or a cooperating group or center of any of the entities described in <br/>
<a id="pl.63.4"></a><var>63.4</var>this item;<br/>
<a id="pl.63.5"></a><var>63.5</var>(ii) a cooperative group or center of the United States Department of Defense or the <br/>
<a id="pl.63.6"></a><var>63.6</var>United States Department of Veterans Affairs;<br/>
<a id="pl.63.7"></a><var>63.7</var>(iii) a qualified nongovernmental research entity identified in the guidelines issued <br/>
<a id="pl.63.8"></a><var>63.8</var>by the NIH for center support grants; or<br/>
<a id="pl.63.9"></a><var>63.9</var>(iv) the United States Departments of Veterans Affairs, Defense, or Energy if the <br/>
<a id="pl.63.10"></a><var>63.10</var>trial has been reviewed or approved through a system of peer review determined by the <br/>
<a id="pl.63.11"></a><var>63.11</var>secretary to:<br/>
<a id="pl.63.12"></a><var>63.12</var>(A) be comparable to the system of peer review of studies and investigations used by <br/>
<a id="pl.63.13"></a><var>63.13</var>the NIH; and<br/>
<a id="pl.63.14"></a><var>63.14</var>(B) provide an unbiased scientific review by qualified individuals who have no <br/>
<a id="pl.63.15"></a><var>63.15</var>interest in the outcome of the review.<br/>
<a id="pl.63.16"></a><var>63.16</var>(b) "Qualified individual" means an individual with health plan coverage who is <br/>
<a id="pl.63.17"></a><var>63.17</var>eligible to participate in an approved clinical trial according to the trial protocol for the <br/>
<a id="pl.63.18"></a><var>63.18</var>treatment of cancer or a life-threatening condition because:<br/>
<a id="pl.63.19"></a><var>63.19</var>(1) the referring health care professional is participating in the trial and has <br/>
<a id="pl.63.20"></a><var>63.20</var>concluded that the individual's participation in the trial would be appropriate; or<br/>
<a id="pl.63.21"></a><var>63.21</var>(2) the individual provides medical and scientific information establishing that <br/>
<a id="pl.63.22"></a><var>63.22</var>the individual's participation in the trial is appropriate because the individual meets the <br/>
<a id="pl.63.23"></a><var>63.23</var>conditions described in the trial protocol.<br/>
<a id="pl.63.24"></a><var>63.24</var>(c)(1) "Routine patient costs" includes all items and services covered by the health <br/>
<a id="pl.63.25"></a><var>63.25</var>benefit plan of individual market health insurance coverage when the items or services <br/>
<a id="pl.63.26"></a><var>63.26</var>are typically covered for an enrollee who is not a qualified individual enrolled in an <br/>
<a id="pl.63.27"></a><var>63.27</var>approved clinical trial.<br/>
<a id="pl.63.28"></a><var>63.28</var>(2) Routine patient costs does not include:<br/>
<a id="pl.63.29"></a><var>63.29</var>(i) an investigational item, device, or service that is part of the trial;<br/>
<a id="pl.63.30"></a><var>63.30</var>(ii) an item or service provided solely to satisfy data collection and analysis needs for <br/>
<a id="pl.63.31"></a><var>63.31</var>the trial if the item or service is not used in the direct clinical management of the patient;<br/>
<a id="pl.63.32"></a><var>63.32</var>(iii) a service that is clearly inconsistent with widely accepted and established <br/>
<a id="pl.63.33"></a><var>63.33</var>standards of care for the individual's diagnosis; or<br/>
<a id="pl.63.34"></a><var>63.34</var>(iv) an item or service customarily provided and paid for by the sponsor of a trial.<br/>
<a id="pl.63.35"></a><var>63.35</var>    Subd. 2. <b>Prohibited acts.</b> A health plan company that offers a health plan to a <br/>
<a id="pl.63.36"></a><var>63.36</var>Minnesota resident may not:<br/>
<a id="pl.64.1"></a><var>64.1</var>(1) deny participation by a qualified individual in an approved clinical trial;<br/>
<a id="pl.64.2"></a><var>64.2</var>(2) deny, limit, or impose additional conditions on the coverage of routine patient <br/>
<a id="pl.64.3"></a><var>64.3</var>costs for items or services furnished in connection with participation in the trial; or<br/>
<a id="pl.64.4"></a><var>64.4</var>(3) discriminate against an individual on the basis of an individual's participation in <br/>
<a id="pl.64.5"></a><var>64.5</var>an approved clinical trial.<br/>
<a id="pl.64.6"></a><var>64.6</var>    Subd. 3. <b>Network plan conditions.</b> A health plan company that designates a <br/>
<a id="pl.64.7"></a><var>64.7</var>network or networks of contracted providers may require a qualified individual who <br/>
<a id="pl.64.8"></a><var>64.8</var>wishes to participate in an approved clinical trial to participate in a trial that is offered <br/>
<a id="pl.64.9"></a><var>64.9</var>through a health care provider who is part of the plan's network if the provider is <br/>
<a id="pl.64.10"></a><var>64.10</var>participating in the trial and the provider accepts the individual as a participant in the trial.<br/>
<a id="pl.64.11"></a><var>64.11</var>    Subd. 4. <b>Application to clinical trials outside of the state.</b> This section applies <br/>
<a id="pl.64.12"></a><var>64.12</var>to a qualified individual residing in this state who participates in an approved clinical <br/>
<a id="pl.64.13"></a><var>64.13</var>trial that is conducted outside of this state.<br/>
<a id="pl.64.14"></a><var>64.14</var>    Subd. 5. <b>Construction.</b> (a) This section shall not be construed to require a health <br/>
<a id="pl.64.15"></a><var>64.15</var>plan company offering health plan coverage through a network or networks of contracted <br/>
<a id="pl.64.16"></a><var>64.16</var>providers to provide benefits for routine patient costs if the services are provided outside <br/>
<a id="pl.64.17"></a><var>64.17</var>of the plan's network unless the out-of-network benefits are otherwise provided under <br/>
<a id="pl.64.18"></a><var>64.18</var>the coverage.<br/>
<a id="pl.64.19"></a><var>64.19</var>(b) This section shall not be construed to limit a health plan company's coverage <br/>
<a id="pl.64.20"></a><var>64.20</var>with respect to clinical trials.<br/>
<a id="pl.64.21"></a><var>64.21</var>(c) This section shall apply to all health plan companies offering a health plan to a <br/>
<a id="pl.64.22"></a><var>64.22</var>Minnesota resident, unless otherwise amended by federal regulations under the Affordable <br/>
<a id="pl.64.23"></a><var>64.23</var>Care Act.<br/>
<a id="pl.64.24"></a><var>64.24</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.78.0"></a><a id="pl.64.25"></a><var>64.25</var>    Sec. 78. Minnesota Statutes 2012, section 62Q.55, is amended to read:<br/>
<a id="pl.64.26"></a><var>64.26</var><b>62Q.55 EMERGENCY SERVICES.</b><br/>
<a id="pl.64.27"></a><var>64.27</var>    Subdivision 1. <b>Access to emergency services.</b> (a) Enrollees have the right to <br/>
<a id="pl.64.28"></a><var>64.28</var>available and accessible emergency services, 24 hours a day and seven days a week. <br/>
<a id="pl.64.29"></a><var>64.29</var>The health plan company shall inform its enrollees how to obtain emergency care and, <br/>
<a id="pl.64.30"></a><var>64.30</var>if prior authorization for emergency services is required, shall make available a toll-free <br/>
<a id="pl.64.31"></a><var>64.31</var>number, which is answered 24 hours a day, to answer questions about emergency services <br/>
<a id="pl.64.32"></a><var>64.32</var>and to receive reports and provide authorizations, where appropriate, for treatment of <br/>
<a id="pl.64.33"></a><var>64.33</var>emergency medical conditions. Emergency services shall be covered whether provided by <br/>
<a id="pl.64.34"></a><var>64.34</var>participating or nonparticipating providers and whether provided within or outside the <br/>
<a id="pl.65.1"></a><var>65.1</var>health plan company's service area. In reviewing a denial for coverage of emergency <br/>
<a id="pl.65.2"></a><var>65.2</var>services, the health plan company shall take the following factors into consideration:<br/>
<a id="pl.65.3"></a><var>65.3</var>(1) a reasonable layperson's belief that the circumstances required immediate medical <br/>
<a id="pl.65.4"></a><var>65.4</var>care that could not wait until the next working day or next available clinic appointment;<br/>
<a id="pl.65.5"></a><var>65.5</var>(2) the time of day and day of the week the care was provided;<br/>
<a id="pl.65.6"></a><var>65.6</var>(3) the presenting symptoms, including, but not limited to, severe pain, to ensure <br/>
<a id="pl.65.7"></a><var>65.7</var>that the decision to reimburse the emergency care is not made solely on the basis of the <br/>
<a id="pl.65.8"></a><var>65.8</var>actual diagnosis;<br/>
<a id="pl.65.9"></a><var>65.9</var>(4) the enrollee's efforts to follow the health plan company's established procedures <br/>
<a id="pl.65.10"></a><var>65.10</var>for obtaining emergency care; and<br/>
<a id="pl.65.11"></a><var>65.11</var>(5) any circumstances that precluded use of the health plan company's established <br/>
<a id="pl.65.12"></a><var>65.12</var>procedures for obtaining emergency care.<br/>
<a id="pl.65.13"></a><var>65.13</var>(b) The health plan company may require enrollees to notify the health plan <br/>
<a id="pl.65.14"></a><var>65.14</var>company of nonreferred emergency care as soon as possible, but not later than 48 hours, <br/>
<a id="pl.65.15"></a><var>65.15</var>after the emergency care is initially provided. However, emergency care which would <br/>
<a id="pl.65.16"></a><var>65.16</var>have been covered under the contract had notice been provided within the set time frame <br/>
<a id="pl.65.17"></a><var>65.17</var>must be covered.<br/>
<a id="pl.65.18"></a><var>65.18</var>(c) Notwithstanding paragraphs (a) and (b), a health plan company, health insurer, or <br/>
<a id="pl.65.19"></a><var>65.19</var>health coverage plan that is in compliance with the rules regarding accessibility of services <br/>
<a id="pl.65.20"></a><var>65.20</var>adopted under section 
         <statute_ref>62D.20</statute_ref> is in compliance with this section.<br/>
<a id="pl.65.21"></a><var>65.21</var>    Subd. 2. <b>Emergency medical condition.</b> For purposes of this section, "emergency <br/>
<a id="pl.65.22"></a><var>65.22</var>medical condition" means a medical condition manifesting itself by acute symptoms of <br/>
<a id="pl.65.23"></a><var>65.23</var>sufficient severity, including severe pain, such that a prudent layperson, who possesses <br/>
<a id="pl.65.24"></a><var>65.24</var>an average knowledge of health and medicine, could reasonably expect the absence of <br/>
<a id="pl.65.25"></a><var>65.25</var>immediate medical attention to result in a condition described in clause (i), (ii), or (iii), of <br/>
<a id="pl.65.26"></a><var>65.26</var>section 1867(e)(1)(A) of the Social Security Act.<br/>
<a id="pl.65.27"></a><var>65.27</var>    Subd. 3. <b>Emergency services.</b> As used in this section, "emergency services" means, <br/>
<a id="pl.65.28"></a><var>65.28</var>with respect to an emergency medical condition:<br/>
<a id="pl.65.29"></a><var>65.29</var>(1) a medical screening examination, as required under section 1867 of the Social <br/>
<a id="pl.65.30"></a><var>65.30</var>Security Act, that is within the capability of the emergency department of a hospital, <br/>
<a id="pl.65.31"></a><var>65.31</var>including ancillary services routinely available to the emergency department to evaluate <br/>
<a id="pl.65.32"></a><var>65.32</var>such emergency medical condition; and<br/>
<a id="pl.65.33"></a><var>65.33</var>(2) within the capabilities of the staff and facilities available at the hospital, such <br/>
<a id="pl.65.34"></a><var>65.34</var>further medical examination and treatment as are required under section 1867 of the <br/>
<a id="pl.65.35"></a><var>65.35</var>Social Security Act to stabilize the patient.<br/>
<a id="pl.66.1"></a><var>66.1</var>    Subd. 4. <b>Stabilize.</b> For purposes of this section, "stabilize," with respect to an <br/>
<a id="pl.66.2"></a><var>66.2</var>emergency medical condition, has the meaning given in section 1867(e)(3) of the Social <br/>
<a id="pl.66.3"></a><var>66.3</var>Security Act, United States Code, title 42, section 1395dd(e)(3). <br/>
<a id="pl.66.4"></a><var>66.4</var>    Subd. 5. <b>Coverage restrictions or limitations.</b> If emergency services are provided <br/>
<a id="pl.66.5"></a><var>66.5</var>by a nonparticipating provider, with or without prior authorization, the health plan <br/>
<a id="pl.66.6"></a><var>66.6</var>company shall not impose coverage restrictions or limitations that are more restrictive <br/>
<a id="pl.66.7"></a><var>66.7</var>than apply to emergency services received from a participating provider. Cost-sharing <br/>
<a id="pl.66.8"></a><var>66.8</var>requirements that apply to emergency services received out-of-network must be the same <br/>
<a id="pl.66.9"></a><var>66.9</var>as the cost-sharing requirements that apply to services received in-network.<br/>
<a id="pl.66.10"></a><var>66.10</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.79.0"></a><a id="pl.66.11"></a><var>66.11</var>    Sec. 79. <b>[62Q.57] DESIGNATION OF PRIMARY CARE PROVIDER.</b><br/>
<a id="pl.66.12"></a><var>66.12</var>    Subdivision 1. <b>Choice of primary care provider.</b> (a) If a health plan company <br/>
<a id="pl.66.13"></a><var>66.13</var>offering a group health plan, or an individual health plan that is not a grandfathered plan, <br/>
<a id="pl.66.14"></a><var>66.14</var>requires or provides for the designation by an enrollee of a participating primary care <br/>
<a id="pl.66.15"></a><var>66.15</var>provider, the health plan company shall permit each enrollee to:<br/>
<a id="pl.66.16"></a><var>66.16</var>(1) designate any participating primary care provider available to accept the <br/>
<a id="pl.66.17"></a><var>66.17</var>enrollee; and<br/>
<a id="pl.66.18"></a><var>66.18</var>(2) for a child, designate any participating physician who specializes in pediatrics as <br/>
<a id="pl.66.19"></a><var>66.19</var>the child's primary care provider and is available to accept the child.<br/>
<a id="pl.66.20"></a><var>66.20</var>(b) This section does not waive any exclusions of coverage under the terms and <br/>
<a id="pl.66.21"></a><var>66.21</var>conditions of the health plan with respect to coverage of pediatric care.<br/>
<a id="pl.66.22"></a><var>66.22</var>    Subd. 2. <b>Notice.</b> A health plan company shall provide notice to enrollees of the <br/>
<a id="pl.66.23"></a><var>66.23</var>provisions of subdivision 1 in accordance with the requirements of the Affordable Care Act. <br/>
<a id="pl.66.24"></a><var>66.24</var>    Subd. 3. <b>Enforcement.</b> The commissioner shall enforce this section.<br/>
<a id="pl.66.25"></a><var>66.25</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.80.0"></a><a id="pl.66.26"></a><var>66.26</var>    Sec. 80. <b>[62Q.677] LIFETIME AND ANNUAL LIMITS.</b><br/>
<a id="pl.66.27"></a><var>66.27</var>    Subdivision 1. <b>Applicability and scope.</b> Except as provided in subdivision 2, <br/>
<a id="pl.66.28"></a><var>66.28</var>this section applies to a health plan company providing coverage under an individual or <br/>
<a id="pl.66.29"></a><var>66.29</var>group health plan. For purposes of this section, essential health benefits is defined under <br/>
<a id="pl.66.30"></a><var>66.30</var>section 62Q.81.<br/>
<a id="pl.66.31"></a><var>66.31</var>    Subd. 2. <b>Grandfathered plan limits.</b> (a) The prohibition on lifetime limits applies <br/>
<a id="pl.66.32"></a><var>66.32</var>to grandfathered plans providing individual health plan coverage or group health plan <br/>
<a id="pl.66.33"></a><var>66.33</var>coverage.<br/>
<a id="pl.67.1"></a><var>67.1</var>(b) The prohibition and limits on annual limits apply to grandfathered plans <br/>
<a id="pl.67.2"></a><var>67.2</var>providing group health plan coverage, but do not apply to grandfathered plans providing <br/>
<a id="pl.67.3"></a><var>67.3</var>individual health plan coverage.<br/>
<a id="pl.67.4"></a><var>67.4</var>    Subd. 3. <b>Prohibition on lifetime and annual limits.</b> (a) Except as provided in <br/>
<a id="pl.67.5"></a><var>67.5</var>subdivisions 4 and 5, a health plan company offering coverage under an individual or <br/>
<a id="pl.67.6"></a><var>67.6</var>group health plan shall not establish a lifetime limit on the dollar amount of essential <br/>
<a id="pl.67.7"></a><var>67.7</var>health benefits for any individual.<br/>
<a id="pl.67.8"></a><var>67.8</var>(b) Except as provided in subdivisions 4, 5, and 6, a health plan company shall <br/>
<a id="pl.67.9"></a><var>67.9</var>not establish any annual limit on the dollar amount of essential health benefits for any <br/>
<a id="pl.67.10"></a><var>67.10</var>individual.<br/>
<a id="pl.67.11"></a><var>67.11</var>    Subd. 4. <b>Nonessential benefits; out-of-network providers.</b> (a) Subdivision 3 does <br/>
<a id="pl.67.12"></a><var>67.12</var>not prevent a health plan company from placing annual or lifetime dollar limits for any <br/>
<a id="pl.67.13"></a><var>67.13</var>individual on specific covered benefits that are not essential health benefits as defined in <br/>
<a id="pl.67.14"></a><var>67.14</var>section 62Q.81, subdivision 4, to the extent that the limits are otherwise permitted under <br/>
<a id="pl.67.15"></a><var>67.15</var>applicable federal or state law.<br/>
<a id="pl.67.16"></a><var>67.16</var>(b) Subdivision 3 does not prevent a health plan company from placing an annual or <br/>
<a id="pl.67.17"></a><var>67.17</var>lifetime limit for services provided by out-of-network providers.<br/>
<a id="pl.67.18"></a><var>67.18</var>    Subd. 5. <b>Excluded benefits.</b> This section does not prohibit a health plan company <br/>
<a id="pl.67.19"></a><var>67.19</var>from excluding all benefits for a given condition.<br/>
<a id="pl.67.20"></a><var>67.20</var>    Subd. 6. <b>Annual limits prior to January 1, 2014.</b> For plan or policy years <br/>
<a id="pl.67.21"></a><var>67.21</var>beginning before January 1, 2014, for any individual, a health plan company may establish <br/>
<a id="pl.67.22"></a><var>67.22</var>an annual limit on the dollar amount of benefits that are essential health benefits provided <br/>
<a id="pl.67.23"></a><var>67.23</var>the limit is no less than the following:<br/>
<a id="pl.67.24"></a><var>67.24</var>(1) for a plan or policy year beginning after September 22, 2010, but before <br/>
<a id="pl.67.25"></a><var>67.25</var>September 23, 2011, $750,000;<br/>
<a id="pl.67.26"></a><var>67.26</var>(2) for a plan or policy year beginning after September 22, 2011, but before <br/>
<a id="pl.67.27"></a><var>67.27</var>September 23, 2012, $1,250,000; and<br/>
<a id="pl.67.28"></a><var>67.28</var>(3) for a plan or policy year beginning after September 22, 2012, but before January <br/>
<a id="pl.67.29"></a><var>67.29</var>1, 2014, $2,000,000.<br/>
<a id="pl.67.30"></a><var>67.30</var>In determining whether an individual has received benefits that meet or exceed the <br/>
<a id="pl.67.31"></a><var>67.31</var>allowable limits, a health plan company shall take into account only essential health <br/>
<a id="pl.67.32"></a><var>67.32</var>benefits.<br/>
<a id="pl.67.33"></a><var>67.33</var>    Subd. 7. <b>Waivers.</b> For plan or policy years beginning before January 1, 2014, a <br/>
<a id="pl.67.34"></a><var>67.34</var>health plan is exempt from the annual limit requirements if the health plan is approved for <br/>
<a id="pl.67.35"></a><var>67.35</var>a waiver from the requirements by the United States Department of Health and Human <br/>
<a id="pl.68.1"></a><var>68.1</var>Services, but the exemption only applies for the specified period of time that the waiver <br/>
<a id="pl.68.2"></a><var>68.2</var>from the United States Department of Health and Human Services is applicable.<br/>
<a id="pl.68.3"></a><var>68.3</var>    Subd. 8. <b>Notices.</b> (a) At the time a health plan company receives a waiver from the <br/>
<a id="pl.68.4"></a><var>68.4</var>United States Department of Health and Human Services, the health plan company shall <br/>
<a id="pl.68.5"></a><var>68.5</var>notify prospective applicants and affected policyholders and the commissioner in each <br/>
<a id="pl.68.6"></a><var>68.6</var>state where prospective applicants and any affected insured are known to reside.<br/>
<a id="pl.68.7"></a><var>68.7</var>(b) At the time the waiver expires or is otherwise no longer in effect, the health plan <br/>
<a id="pl.68.8"></a><var>68.8</var>company shall notify affected policyholders and the commissioner in each state where <br/>
<a id="pl.68.9"></a><var>68.9</var>any affected insured is known to reside.<br/>
<a id="pl.68.10"></a><var>68.10</var>    Subd. 9. <b>Reinstatement.</b> A health plan company shall comply with all provisions of <br/>
<a id="pl.68.11"></a><var>68.11</var>the Affordable Care Act with regard to reinstatement of coverage for individuals whose <br/>
<a id="pl.68.12"></a><var>68.12</var>coverage or benefits under a health plan ended by reason of reaching a lifetime dollar limit <br/>
<a id="pl.68.13"></a><var>68.13</var>on the dollar value of all benefits for the individual.<br/>
<a id="pl.68.14"></a><var>68.14</var>    Subd. 10. <b>Compliance.</b> This section does not require compliance with any <br/>
<a id="pl.68.15"></a><var>68.15</var>provision of the Affordable Care Act before the effective date provided for that provision <br/>
<a id="pl.68.16"></a><var>68.16</var>in the Affordable Care Act. The commissioner shall enforce this section.<br/>
<a id="pl.68.17"></a><var>68.17</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.81.0"></a><a id="pl.68.18"></a><var>68.18</var>    Sec. 81. Minnesota Statutes 2012, section 62Q.68, subdivision 1, is amended to read:<br/>
<a id="pl.68.19"></a><var>68.19</var>    Subdivision 1. <b>Application.</b> For purposes of sections 
         <statute_ref>62Q.68</statute_ref> to 
         <statute_ref>62Q.72</statute_ref>, the terms <br/>
<a id="pl.68.20"></a><var>68.20</var>defined in this section have the meanings given them. For purposes of sections 
         <statute_ref>62Q.69</statute_ref> <br/>
<a id="pl.68.21"></a><var>68.21</var>and 
         <statute_ref>62Q.70</statute_ref>, the term "health plan company" does not include an insurance company <br/>
<a id="pl.68.22"></a><var>68.22</var>licensed under chapter 60A to offer, sell, or issue a policy of accident and sickness <br/>
<a id="pl.68.23"></a><var>68.23</var>insurance as defined in section 
         <statute_ref>62A.01</statute_ref> or a nonprofit health service plan corporation <br/>
<a id="pl.68.24"></a><var>68.24</var>regulated under chapter 62C that only provides dental coverage or vision coverage. For <br/>
<a id="pl.68.25"></a><var>68.25</var>purposes of sections 
         <statute_ref>62Q.69</statute_ref> through 
         <statute_ref>62Q.73</statute_ref>, the term "health plan company" does <br/>
<a id="pl.68.26"></a><var>68.26</var>not include the Comprehensive Health Association created under chapter 62E. Section <br/>
<a id="pl.68.27"></a><var>68.27</var>62Q.70 does not apply to individual coverage. However, a health plan company offering <br/>
<a id="pl.68.28"></a><var>68.28</var>individual coverage may, pursuant to section 62Q.69, subdivision 3, paragraph (c), follow <br/>
<a id="pl.68.29"></a><var>68.29</var>the process outlined in section 62Q.70.<br/>
<a id="pl.68.30"></a><var>68.30</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.82.0"></a><a id="pl.68.31"></a><var>68.31</var>    Sec. 82. Minnesota Statutes 2012, section 62Q.69, subdivision 3, is amended to read:<br/>
<a id="pl.68.32"></a><var>68.32</var>    Subd. 3. <b>Notification of complaint decisions.</b> (a) The health plan company must <br/>
<a id="pl.68.33"></a><var>68.33</var>notify the complainant in writing of its decision and the reasons for it as soon as practical <br/>
<a id="pl.69.1"></a><var>69.1</var>but in no case later than 30 days after receipt of a written complaint. If the health plan <br/>
<a id="pl.69.2"></a><var>69.2</var>company cannot make a decision within 30 days due to circumstances outside the control <br/>
<a id="pl.69.3"></a><var>69.3</var>of the health plan company, the health plan company may take up to 14 additional days to <br/>
<a id="pl.69.4"></a><var>69.4</var>notify the complainant of its decision. If the health plan company takes any additional <br/>
<a id="pl.69.5"></a><var>69.5</var>days beyond the initial 30-day period to make its decision, it must inform the complainant, <br/>
<a id="pl.69.6"></a><var>69.6</var>in advance, of the extension and the reasons for the extension.<br/>
<a id="pl.69.7"></a><var>69.7</var>(b) For group health plans, if the decision is partially or wholly adverse to the <br/>
<a id="pl.69.8"></a><var>69.8</var>complainant, the notification must inform the complainant of the right to appeal the <br/>
<a id="pl.69.9"></a><var>69.9</var>decision to the health plan company's internal appeal process described in section 
         <statute_ref>62Q.70</statute_ref> <br/>
<a id="pl.69.10"></a><var>69.10</var>and the procedure for initiating an appeal.<br/>
<a id="pl.69.11"></a><var>69.11</var>(c) For individual health plans, if the decision is partially or wholly adverse to <br/>
<a id="pl.69.12"></a><var>69.12</var>the complainant, the notification must inform the complainant of the right to submit the <br/>
<a id="pl.69.13"></a><var>69.13</var>complaint decision to the external review process described in section 62Q.73 and the <br/>
<a id="pl.69.14"></a><var>69.14</var>procedure for initiating the external review process. Notwithstanding the provisions in <br/>
<a id="pl.69.15"></a><var>69.15</var>this subdivision, a health plan company offering individual coverage may instead follow <br/>
<a id="pl.69.16"></a><var>69.16</var>the process for group health plans outlined in paragraph (b).<br/>
<a id="pl.69.17"></a><var>69.17</var>(c) (d) The notification must also inform the complainant of the right to submit the <br/>
<a id="pl.69.18"></a><var>69.18</var>complaint at any time to either the commissioner of health or commerce for investigation <br/>
<a id="pl.69.19"></a><var>69.19</var>and the toll-free telephone number of the appropriate commissioner.<br/>
<a id="pl.69.20"></a><var>69.20</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.83.0"></a><a id="pl.69.21"></a><var>69.21</var>    Sec. 83. Minnesota Statutes 2012, section 62Q.70, subdivision 1, is amended to read:<br/>
<a id="pl.69.22"></a><var>69.22</var>    Subdivision 1. <b>Establishment.</b> (a) Each health plan company shall establish an <br/>
<a id="pl.69.23"></a><var>69.23</var>internal appeal process for reviewing a health plan company's decision regarding a <br/>
<a id="pl.69.24"></a><var>69.24</var>complaint filed in accordance with section 
         <statute_ref>62Q.69</statute_ref>. The appeal process must meet the <br/>
<a id="pl.69.25"></a><var>69.25</var>requirements of this section. This section applies only to group health plans. However, <br/>
<a id="pl.69.26"></a><var>69.26</var>a health plan company offering individual coverage may, pursuant to section 62Q.69, <br/>
<a id="pl.69.27"></a><var>69.27</var>subdivision 3, paragraph (c), follow the process outlined in this section.<br/>
<a id="pl.69.28"></a><var>69.28</var>(b) The person or persons with authority to resolve or recommend the resolution of <br/>
<a id="pl.69.29"></a><var>69.29</var>the internal appeal must not be solely the same person or persons who made the complaint <br/>
<a id="pl.69.30"></a><var>69.30</var>decision under section 
         <statute_ref>62Q.69</statute_ref>.<br/>
<a id="pl.69.31"></a><var>69.31</var>(c) The internal appeal process must permit the enrollee to review the information <br/>
<a id="pl.69.32"></a><var>69.32</var>relied upon in the course of the appeal and the receipt of testimony, correspondence, <br/>
<a id="pl.69.33"></a><var>69.33</var>explanations, or other information from the complainant, staff persons, administrators, <br/>
<a id="pl.69.34"></a><var>69.34</var>providers, or other persons as deemed necessary by the person or persons investigating or <br/>
<a id="pl.69.35"></a><var>69.35</var>presiding over the appeal.<br/>
<a id="pl.70.1"></a><var>70.1</var>(d) The enrollee must be allowed to receive continued coverage pending the <br/>
<a id="pl.70.2"></a><var>70.2</var>outcome of the appeals process.<br/>
<a id="pl.70.3"></a><var>70.3</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.84.0"></a><a id="pl.70.4"></a><var>70.4</var>    Sec. 84. Minnesota Statutes 2012, section 62Q.70, subdivision 2, is amended to read:<br/>
<a id="pl.70.5"></a><var>70.5</var>    Subd. 2. <b>Procedures for filing an appeal.</b> The health plan company must provide <br/>
<a id="pl.70.6"></a><var>70.6</var>notice to enrollees of its internal appeals process in a culturally and linguistically <br/>
<a id="pl.70.7"></a><var>70.7</var>appropriate manner consistent with the provisions of the Affordable Care Act. If a <br/>
<a id="pl.70.8"></a><var>70.8</var>complainant notifies the health plan company of the complainant's desire to appeal the <br/>
<a id="pl.70.9"></a><var>70.9</var>health plan company's decision regarding the complaint through the internal appeal <br/>
<a id="pl.70.10"></a><var>70.10</var>process, the health plan company must provide the complainant the option for the appeal <br/>
<a id="pl.70.11"></a><var>70.11</var>to occur either in writing or by hearing.<br/>
<a id="pl.70.12"></a><var>70.12</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.85.0"></a><a id="pl.70.13"></a><var>70.13</var>    Sec. 85. Minnesota Statutes 2012, section 62Q.71, is amended to read:<br/>
<a id="pl.70.14"></a><var>70.14</var><b>62Q.71 NOTICE TO ENROLLEES.</b><br/>
<a id="pl.70.15"></a><var>70.15</var>Each health plan company shall provide to enrollees a clear and concise description <br/>
<a id="pl.70.16"></a><var>70.16</var>of its complaint resolution procedure, if applicable under section 
         <statute_ref>62Q.68, subdivision 1</statute_ref>, <br/>
<a id="pl.70.17"></a><var>70.17</var>and the procedure used for utilization review as defined under chapter 62M as part of <br/>
<a id="pl.70.18"></a><var>70.18</var>the member handbook, subscriber contract, or certificate of coverage. If the health plan <br/>
<a id="pl.70.19"></a><var>70.19</var>company does not issue a member handbook, the health plan company may provide <br/>
<a id="pl.70.20"></a><var>70.20</var>the description in another written document. The description must specifically inform <br/>
<a id="pl.70.21"></a><var>70.21</var>enrollees:<br/>
<a id="pl.70.22"></a><var>70.22</var>(1) how to submit a complaint to the health plan company;<br/>
<a id="pl.70.23"></a><var>70.23</var>(2) if the health plan includes utilization review requirements, how to notify the <br/>
<a id="pl.70.24"></a><var>70.24</var>utilization review organization in a timely manner and how to obtain certification for <br/>
<a id="pl.70.25"></a><var>70.25</var>health care services;<br/>
<a id="pl.70.26"></a><var>70.26</var>(3) how to request an appeal either through the procedures described in sections <br/>
<a id="pl.70.27"></a><var>70.27</var><statute_ref>62Q.69</statute_ref> and section
<statute_ref>62Q.70</statute_ref>, if applicable, or through the procedures described in chapter <br/>
<a id="pl.70.28"></a><var>70.28</var>62M;<br/>
<a id="pl.70.29"></a><var>70.29</var>(4) of the right to file a complaint with either the commissioner of health or <br/>
<a id="pl.70.30"></a><var>70.30</var>commerce at any time during the complaint and appeal process;<br/>
<a id="pl.70.31"></a><var>70.31</var>(5) of the toll-free telephone number of the appropriate commissioner; and<br/>
<a id="pl.70.32"></a><var>70.32</var>(6) of the right, for individual and group coverage, to obtain an external review <br/>
<a id="pl.70.33"></a><var>70.33</var>under section 
         <statute_ref>62Q.73</statute_ref> and a description of when and how that right may be exercised., <br/>
<a id="pl.71.1"></a><var>71.1</var>including that under most circumstances an enrollee must exhaust the internal complaint <br/>
<a id="pl.71.2"></a><var>71.2</var>or appeal process prior to external review. However, an enrollee may proceed to external <br/>
<a id="pl.71.3"></a><var>71.3</var>review without exhausting the internal complaint or appeal process under the following <br/>
<a id="pl.71.4"></a><var>71.4</var>circumstances:<br/>
<a id="pl.71.5"></a><var>71.5</var>(i) the health plan company waives the exhaustion requirement;<br/>
<a id="pl.71.6"></a><var>71.6</var>(ii) the health plan company is considered to have waived the exhaustion requirement <br/>
<a id="pl.71.7"></a><var>71.7</var>by failing to substantially comply with any requirements including, but not limited to, <br/>
<a id="pl.71.8"></a><var>71.8</var>time limits for internal complaints or appeals; or<br/>
<a id="pl.71.9"></a><var>71.9</var>(iii) the enrollee has applied for an expedited external review at the same time the <br/>
<a id="pl.71.10"></a><var>71.10</var>enrollee qualifies for and has applied for an expedited internal review under chapter 62M.<br/>
<a id="pl.71.11"></a><var>71.11</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.86.0"></a><a id="pl.71.12"></a><var>71.12</var>    Sec. 86. Minnesota Statutes 2012, section 62Q.73, is amended to read:<br/>
<a id="pl.71.13"></a><var>71.13</var><b>62Q.73 EXTERNAL REVIEW OF ADVERSE DETERMINATIONS.</b><br/>
<a id="pl.71.14"></a><var>71.14</var>    Subdivision 1. <b>Definition.</b> For purposes of this section, "adverse determination" <br/>
<a id="pl.71.15"></a><var>71.15</var>means:<br/>
<a id="pl.71.16"></a><var>71.16</var>(1) for individual health plans, a complaint decision relating to a health care service <br/>
<a id="pl.71.17"></a><var>71.17</var>or claim that is partially or wholly adverse to the complainant;<br/>
<a id="pl.71.18"></a><var>71.18</var>(2) an individual health plan that is grandfathered plan coverage may instead apply <br/>
<a id="pl.71.19"></a><var>71.19</var>the definition of adverse determination for group coverage in clause (3);<br/>
<a id="pl.71.20"></a><var>71.20</var>(3) for group health plans, a complaint decision relating to a health care service or <br/>
<a id="pl.71.21"></a><var>71.21</var>claim that has been appealed in accordance with section 
         <statute_ref>62Q.70</statute_ref> and the appeal decision is <br/>
<a id="pl.71.22"></a><var>71.22</var>partially or wholly adverse to the complainant;<br/>
<a id="pl.71.23"></a><var>71.23</var>(2) (4) any initial determination not to certify that has been appealed in accordance <br/>
<a id="pl.71.24"></a><var>71.24</var>with section 
         <statute_ref>62M.06</statute_ref> and the appeal did not reverse the initial determination not to certify; or<br/>
<a id="pl.71.25"></a><var>71.25</var>(3) (5) a decision relating to a health care service made by a health plan company <br/>
<a id="pl.71.26"></a><var>71.26</var>licensed under chapter 60A that denies the service on the basis that the service was not <br/>
<a id="pl.71.27"></a><var>71.27</var>medically necessary.; or<br/>
<a id="pl.71.28"></a><var>71.28</var>(6) the enrollee has met the requirements of subdivision 6, paragraph (e).<br/>
<a id="pl.71.29"></a><var>71.29</var>An adverse determination does not include complaints relating to fraudulent marketing <br/>
<a id="pl.71.30"></a><var>71.30</var>practices or agent misrepresentation.<br/>
<a id="pl.71.31"></a><var>71.31</var>    Subd. 2. <b>Exception.</b> (a) This section does not apply to governmental programs <br/>
<a id="pl.71.32"></a><var>71.32</var>except as permitted under paragraph (b). For purposes of this subdivision, "governmental <br/>
<a id="pl.71.33"></a><var>71.33</var>programs" means the prepaid medical assistance program, the MinnesotaCare program, <br/>
<a id="pl.72.1"></a><var>72.1</var>the prepaid general assistance medical care program, the demonstration project for people <br/>
<a id="pl.72.2"></a><var>72.2</var>with disabilities, and the federal Medicare program.<br/>
<a id="pl.72.3"></a><var>72.3</var>(b) In the course of a recipient's appeal of a medical determination to the <br/>
<a id="pl.72.4"></a><var>72.4</var>commissioner of human services under section 
         <statute_ref>256.045</statute_ref>, the recipient may request an <br/>
<a id="pl.72.5"></a><var>72.5</var>expert medical opinion be arranged by the external review entity under contract to provide <br/>
<a id="pl.72.6"></a><var>72.6</var>independent external reviews under this section. If such a request is made, the cost of the <br/>
<a id="pl.72.7"></a><var>72.7</var>review shall be paid by the commissioner of human services. Any medical opinion obtained <br/>
<a id="pl.72.8"></a><var>72.8</var>under this paragraph shall only be used by a state human services referee as evidence in <br/>
<a id="pl.72.9"></a><var>72.9</var>the recipient's appeal to the commissioner of human services under section 
         <statute_ref>256.045</statute_ref>.<br/>
<a id="pl.72.10"></a><var>72.10</var>(c) Nothing in this subdivision shall be construed to limit or restrict the appeal rights <br/>
<a id="pl.72.11"></a><var>72.11</var>provided in section 
         <statute_ref>256.045</statute_ref> for governmental program recipients.<br/>
<a id="pl.72.12"></a><var>72.12</var>    Subd. 3. <b>Right to external review.</b> (a) Any enrollee or anyone acting on behalf <br/>
<a id="pl.72.13"></a><var>72.13</var>of an enrollee who has received an adverse determination may submit a written request <br/>
<a id="pl.72.14"></a><var>72.14</var>for an external review of the adverse determination, if applicable under section 
         <statute_ref>62Q.68, <br/>
<a id="pl.72.15"></a><var>72.15</var>subdivision 1
         </statute_ref>, or 
         <statute_ref>62M.06</statute_ref>, to the commissioner of health if the request involves a health <br/>
<a id="pl.72.16"></a><var>72.16</var>plan company regulated by that commissioner or to the commissioner of commerce if the <br/>
<a id="pl.72.17"></a><var>72.17</var>request involves a health plan company regulated by that commissioner. Notification of <br/>
<a id="pl.72.18"></a><var>72.18</var>the enrollee's right to external review must accompany the denial issued by the insurer. <br/>
<a id="pl.72.19"></a><var>72.19</var>The written request must be accompanied by a filing fee of $25. The fee may be waived <br/>
<a id="pl.72.20"></a><var>72.20</var>by the commissioner of health or commerce in cases of financial hardship and must be <br/>
<a id="pl.72.21"></a><var>72.21</var>refunded if the adverse determination is completely reversed. No enrollee may be subject <br/>
<a id="pl.72.22"></a><var>72.22</var>to filing fees totaling more than $75 during a plan year for group coverage or policy year <br/>
<a id="pl.72.23"></a><var>72.23</var>for individual coverage.<br/>
<a id="pl.72.24"></a><var>72.24</var>(b) Nothing in this section requires the commissioner of health or commerce to <br/>
<a id="pl.72.25"></a><var>72.25</var>independently investigate an adverse determination referred for independent external <br/>
<a id="pl.72.26"></a><var>72.26</var>review.<br/>
<a id="pl.72.27"></a><var>72.27</var>(c) If an enrollee requests an external review, the health plan company must <br/>
<a id="pl.72.28"></a><var>72.28</var>participate in the external review. The cost of the external review in excess of the filing <br/>
<a id="pl.72.29"></a><var>72.29</var>fee described in paragraph (a) shall be borne by the health plan company.<br/>
<a id="pl.72.30"></a><var>72.30</var>(d) The enrollee must request external review within six months from the date of <br/>
<a id="pl.72.31"></a><var>72.31</var>the adverse determination.<br/>
<a id="pl.72.32"></a><var>72.32</var>    Subd. 4. <b>Contract.</b> Pursuant to a request for proposal, the commissioner of <br/>
<a id="pl.72.33"></a><var>72.33</var>administration, in consultation with the commissioners of health and commerce, shall <br/>
<a id="pl.72.34"></a><var>72.34</var>contract with an organization at least three organizations or business entity entities to <br/>
<a id="pl.72.35"></a><var>72.35</var>provide independent external reviews of all adverse determinations submitted for external <br/>
<a id="pl.73.1"></a><var>73.1</var>review. The contract shall ensure that the fees for services rendered in connection with the <br/>
<a id="pl.73.2"></a><var>73.2</var>reviews be are reasonable.<br/>
<a id="pl.73.3"></a><var>73.3</var>    Subd. 5. <b>Criteria.</b> (a) The request for proposal must require that the entity <br/>
<a id="pl.73.4"></a><var>73.4</var>demonstrate:<br/>
<a id="pl.73.5"></a><var>73.5</var>(1) no conflicts of interest in that it is not owned, a subsidiary of, or affiliated <br/>
<a id="pl.73.6"></a><var>73.6</var>with a health plan company or, utilization review organization, or a trade organization <br/>
<a id="pl.73.7"></a><var>73.7</var>of health care providers;<br/>
<a id="pl.73.8"></a><var>73.8</var>(2) an expertise in dispute resolution;<br/>
<a id="pl.73.9"></a><var>73.9</var>(3) an expertise in health-related law;<br/>
<a id="pl.73.10"></a><var>73.10</var>(4) an ability to conduct reviews using a variety of alternative dispute resolution <br/>
<a id="pl.73.11"></a><var>73.11</var>procedures depending upon the nature of the dispute;<br/>
<a id="pl.73.12"></a><var>73.12</var>(5) an ability to maintain written records, for at least three years, regarding reviews <br/>
<a id="pl.73.13"></a><var>73.13</var>conducted and provide data to the commissioners of health and commerce upon request on <br/>
<a id="pl.73.14"></a><var>73.14</var>reviews conducted; and<br/>
<a id="pl.73.15"></a><var>73.15</var>(6) an ability to ensure confidentiality of medical records and other enrollee <br/>
<a id="pl.73.16"></a><var>73.16</var>information.;<br/>
<a id="pl.73.17"></a><var>73.17</var>(7) accreditation by nationally recognized private accrediting organization; and<br/>
<a id="pl.73.18"></a><var>73.18</var>(8) the ability to provide an expedited external review process.<br/>
<a id="pl.73.19"></a><var>73.19</var>(b) The commissioner of administration shall take into consideration, in awarding <br/>
<a id="pl.73.20"></a><var>73.20</var>the contract according to subdivision 4, any national accreditation standards that pertain to <br/>
<a id="pl.73.21"></a><var>73.21</var>an external review entity.<br/>
<a id="pl.73.22"></a><var>73.22</var>    Subd. 6. <b>Process.</b> (a) Upon receiving a request for an external review, the<br/>
<a id="pl.73.23"></a><var>73.23</var> commissioner shall assign an external review entity on a random basis. The assigned<br/>
<a id="pl.73.24"></a><var>73.24</var> external review entity must provide immediate notice of the review to the enrollee and to <br/>
<a id="pl.73.25"></a><var>73.25</var>the health plan company. Within ten business days of receiving notice of the review, the <br/>
<a id="pl.73.26"></a><var>73.26</var>health plan company and the enrollee must provide the assigned external review entity <br/>
<a id="pl.73.27"></a><var>73.27</var>with any information that they wish to be considered. Each party shall be provided an <br/>
<a id="pl.73.28"></a><var>73.28</var>opportunity to present its version of the facts and arguments. The assigned external review <br/>
<a id="pl.73.29"></a><var>73.29</var>entity must furnish to the health plan company any additional information submitted by <br/>
<a id="pl.73.30"></a><var>73.30</var>the enrollee within one business day of receipt. An enrollee may be assisted or represented <br/>
<a id="pl.73.31"></a><var>73.31</var>by a person of the enrollee's choice.<br/>
<a id="pl.73.32"></a><var>73.32</var>(b) As part of the external review process, any aspect of an external review involving <br/>
<a id="pl.73.33"></a><var>73.33</var>a medical determination must be performed by a health care professional with expertise in <br/>
<a id="pl.73.34"></a><var>73.34</var>the medical issue being reviewed.<br/>
<a id="pl.73.35"></a><var>73.35</var>(c) An external review shall be made as soon as practical but in no case later than 40<br/>
<a id="pl.73.36"></a><var>73.36</var> 45 days after receiving the request for an external review and must promptly send written <br/>
<a id="pl.74.1"></a><var>74.1</var>notice of the decision and the reasons for it to the enrollee, the health plan company, and <br/>
<a id="pl.74.2"></a><var>74.2</var>the commissioner who is responsible for regulating the health plan company.<br/>
<a id="pl.74.3"></a><var>74.3</var>(d) The external review entity and the clinical reviewer assigned must not have a <br/>
<a id="pl.74.4"></a><var>74.4</var>material professional, familial, or financial conflict of interest with:<br/>
<a id="pl.74.5"></a><var>74.5</var>(1) the health plan company that is the subject of the external review;<br/>
<a id="pl.74.6"></a><var>74.6</var>(2) the enrollee, or any parties related to the enrollee, whose treatment is the subject <br/>
<a id="pl.74.7"></a><var>74.7</var>of the external review;<br/>
<a id="pl.74.8"></a><var>74.8</var>(3) any officer, director, or management employee of the health plan company;<br/>
<a id="pl.74.9"></a><var>74.9</var>(4) a plan administrator, plan fiduciaries, or plan employees;<br/>
<a id="pl.74.10"></a><var>74.10</var>(5) the health care provider, the health care provider's group, or practice association <br/>
<a id="pl.74.11"></a><var>74.11</var>recommending treatment that is the subject of the external review;<br/>
<a id="pl.74.12"></a><var>74.12</var>(6) the facility at which the recommended treatment would be provided; or<br/>
<a id="pl.74.13"></a><var>74.13</var>(7) the developer or manufacturer of the principal drug, device, procedure, or other <br/>
<a id="pl.74.14"></a><var>74.14</var>therapy being recommended.<br/>
<a id="pl.74.15"></a><var>74.15</var>(e)(1) An expedited external review must be provided if the enrollee requests it <br/>
<a id="pl.74.16"></a><var>74.16</var>after receiving:<br/>
<a id="pl.74.17"></a><var>74.17</var>(i) an adverse determination that involves a medical condition for which the time <br/>
<a id="pl.74.18"></a><var>74.18</var>frame for completion of an expedited internal appeal would seriously jeopardize the life <br/>
<a id="pl.74.19"></a><var>74.19</var>or health of the enrollee or would jeopardize the enrollee's ability to regain maximum <br/>
<a id="pl.74.20"></a><var>74.20</var>function and the enrollee has simultaneously requested an expedited internal appeal;<br/>
<a id="pl.74.21"></a><var>74.21</var>(ii) an adverse determination that concerns an admission, availability of care, <br/>
<a id="pl.74.22"></a><var>74.22</var>continued stay, or health care service for which the enrollee received emergency services <br/>
<a id="pl.74.23"></a><var>74.23</var>but has not been discharged from a facility; or<br/>
<a id="pl.74.24"></a><var>74.24</var>(iii) an adverse determination that involves a medical condition for which the <br/>
<a id="pl.74.25"></a><var>74.25</var>standard external review time would seriously jeopardize the life or health of the enrollee <br/>
<a id="pl.74.26"></a><var>74.26</var>or jeopardize the enrollee's ability to regain maximum function.<br/>
<a id="pl.74.27"></a><var>74.27</var>(2) The external review entity must make its expedited determination to uphold or <br/>
<a id="pl.74.28"></a><var>74.28</var>reverse the adverse determination as expeditiously as possible but within no more than 72 <br/>
<a id="pl.74.29"></a><var>74.29</var>hours after the receipt of the request for expedited review and notify the enrollee and the <br/>
<a id="pl.74.30"></a><var>74.30</var>health plan company of the determination.<br/>
<a id="pl.74.31"></a><var>74.31</var>(3) If the external review entity's notification is not in writing, the external review <br/>
<a id="pl.74.32"></a><var>74.32</var>entity must provide written confirmation of the determination within 48 hours of the <br/>
<a id="pl.74.33"></a><var>74.33</var>notification.<br/>
<a id="pl.74.34"></a><var>74.34</var>    Subd. 7. <b>Standards of review.</b> (a) For an external review of any issue in an adverse <br/>
<a id="pl.74.35"></a><var>74.35</var>determination that does not require a medical necessity determination, the external review <br/>
<a id="pl.75.1"></a><var>75.1</var>must be based on whether the adverse determination was in compliance with the enrollee's <br/>
<a id="pl.75.2"></a><var>75.2</var>health benefit plan.<br/>
<a id="pl.75.3"></a><var>75.3</var>(b) For an external review of any issue in an adverse determination by a health plan <br/>
<a id="pl.75.4"></a><var>75.4</var>company licensed under chapter 62D that requires a medical necessity determination, the <br/>
<a id="pl.75.5"></a><var>75.5</var>external review must determine whether the adverse determination was consistent with the <br/>
<a id="pl.75.6"></a><var>75.6</var>definition of medically necessary care in Minnesota Rules, part 4685.0100, subpart 9b.<br/>
<a id="pl.75.7"></a><var>75.7</var>(c) For an external review of any issue in an adverse determination by a health plan <br/>
<a id="pl.75.8"></a><var>75.8</var>company, other than a health plan company licensed under chapter 62D, that requires a <br/>
<a id="pl.75.9"></a><var>75.9</var>medical necessity determination, the external review must determine whether the adverse <br/>
<a id="pl.75.10"></a><var>75.10</var>determination was consistent with the definition of medically necessary care in section <br/>
<statute_ref><a id="pl.75.11"></a><var>75.11</var>62Q.53, subdivision 2
         </statute_ref>.<br/>
<a id="pl.75.12"></a><var>75.12</var>(d) For an external review of an adverse determination involving experimental <br/>
<a id="pl.75.13"></a><var>75.13</var>or investigational treatment, the external review entity must base its decision on all <br/>
<a id="pl.75.14"></a><var>75.14</var>documents submitted by the health plan company and enrollee, including medical <br/>
<a id="pl.75.15"></a><var>75.15</var>records, the attending physician or health care professional's recommendation, consulting <br/>
<a id="pl.75.16"></a><var>75.16</var>reports from health care professionals, the terms of coverage, federal Food and Drug <br/>
<a id="pl.75.17"></a><var>75.17</var>Administration approval, and medical or scientific evidence or evidence-based standards.<br/>
<a id="pl.75.18"></a><var>75.18</var>    Subd. 8. <b>Effects of external review.</b> A decision rendered under this section shall <br/>
<a id="pl.75.19"></a><var>75.19</var>be nonbinding on the enrollee and binding on the health plan company. The health plan <br/>
<a id="pl.75.20"></a><var>75.20</var>company may seek judicial review of the decision on the grounds that the decision was <br/>
<a id="pl.75.21"></a><var>75.21</var>arbitrary and capricious or involved an abuse of discretion.<br/>
<a id="pl.75.22"></a><var>75.22</var>    Subd. 9. <b>Immunity from civil liability.</b> A person who participates in an external <br/>
<a id="pl.75.23"></a><var>75.23</var>review by investigating, reviewing materials, providing technical expertise, or rendering a <br/>
<a id="pl.75.24"></a><var>75.24</var>decision shall not be civilly liable for any action that is taken in good faith, that is within <br/>
<a id="pl.75.25"></a><var>75.25</var>the scope of the person's duties, and that does not constitute willful or reckless misconduct.<br/>
<a id="pl.75.26"></a><var>75.26</var>    Subd. 10. <b>Data reporting.</b> The commissioners shall make available to the public, <br/>
<a id="pl.75.27"></a><var>75.27</var>upon request, summary data on the decisions rendered under this section, including the <br/>
<a id="pl.75.28"></a><var>75.28</var>number of reviews heard and decided and the final outcomes. Any data released to the <br/>
<a id="pl.75.29"></a><var>75.29</var>public must not individually identify the enrollee initiating the request for external review.<br/>
<a id="pl.75.30"></a><var>75.30</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.87.0"></a><a id="pl.75.31"></a><var>75.31</var>    Sec. 87. Minnesota Statutes 2012, section 62Q.75, subdivision 1, is amended to read:<br/>
<a id="pl.75.32"></a><var>75.32</var>    Subdivision 1. <b>Definitions.</b> (a) For purposes of this section, the following terms <br/>
<a id="pl.75.33"></a><var>75.33</var>have the meanings given to them.<br/>
<a id="pl.75.34"></a><var>75.34</var>(b) "Clean claim" means a claim that has no defect or impropriety, including any lack <br/>
<a id="pl.75.35"></a><var>75.35</var>of any required substantiating documentation, including, but not limited to, coordination <br/>
<a id="pl.76.1"></a><var>76.1</var>of benefits information, or particular circumstance requiring special treatment that <br/>
<a id="pl.76.2"></a><var>76.2</var>prevents timely payment from being made on a claim under this section. A special <br/>
<a id="pl.76.3"></a><var>76.3</var>circumstance includes, but is not limited to, a claim held pending payment of an overdue <br/>
<a id="pl.76.4"></a><var>76.4</var>premium for the time period during which the expense was incurred as allowed by the <br/>
<a id="pl.76.5"></a><var>76.5</var>Affordable Care Act. Nothing in this section alters an enrollee's obligation to disclose <br/>
<a id="pl.76.6"></a><var>76.6</var>information as required by law.<br/>
<a id="pl.76.7"></a><var>76.7</var>(c) "Third-party administrator" means a third-party administrator or other entity <br/>
<a id="pl.76.8"></a><var>76.8</var>subject to section 
         <statute_ref>60A.23, subdivision 8</statute_ref>, and Minnesota Rules, chapter 2767.<br/>
<a id="pl.76.9"></a><var>76.9</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.88.0"></a><a id="pl.76.10"></a><var>76.10</var>    Sec. 88. Minnesota Statutes 2012, section 62Q.80, subdivision 2, is amended to read:<br/>
<a id="pl.76.11"></a><var>76.11</var>    Subd. 2. <b>Definitions. </b> For purposes of this section, the following definitions apply:<br/>
<a id="pl.76.12"></a><var>76.12</var>(a) "Community-based" means located in or primarily relating to the community, <br/>
<a id="pl.76.13"></a><var>76.13</var>as determined by the board of a community-based health initiative that is served by the <br/>
<a id="pl.76.14"></a><var>76.14</var>community-based health care coverage program.<br/>
<a id="pl.76.15"></a><var>76.15</var>(b) "Community-based health care coverage program" or "program" means a <br/>
<a id="pl.76.16"></a><var>76.16</var>program administered by a community-based health initiative that provides health care <br/>
<a id="pl.76.17"></a><var>76.17</var>services through provider members of a community-based health network or combination <br/>
<a id="pl.76.18"></a><var>76.18</var>of networks to eligible individuals and their dependents who are enrolled in the program.<br/>
<a id="pl.76.19"></a><var>76.19</var>(c) "Community-based health initiative" or "initiative" means a nonprofit corporation <br/>
<a id="pl.76.20"></a><var>76.20</var>that is governed by a board that has at least 80 percent of its members residing in the <br/>
<a id="pl.76.21"></a><var>76.21</var>community and includes representatives of the participating network providers and <br/>
<a id="pl.76.22"></a><var>76.22</var>employers, or a county-based purchasing organization as defined in section 
         <statute_ref>256B.692</statute_ref>.<br/>
<a id="pl.76.23"></a><var>76.23</var>(d) "Community-based health network" means a contract-based network of health <br/>
<a id="pl.76.24"></a><var>76.24</var>care providers organized by the community-based health initiative to provide or support <br/>
<a id="pl.76.25"></a><var>76.25</var>the delivery of health care services to enrollees of the community-based health care <br/>
<a id="pl.76.26"></a><var>76.26</var>coverage program on a risk-sharing or nonrisk-sharing basis.<br/>
<a id="pl.76.27"></a><var>76.27</var>(e) "Dependent" means an eligible employee's spouse or unmarried child who <br/>
<a id="pl.76.28"></a><var>76.28</var>is under the age of 19 26 years.<br/>
<a id="pl.76.29"></a><var>76.29</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.89.0"></a><a id="pl.76.30"></a><var>76.30</var>    Sec. 89. <b>[62Q.81] ESSENTIAL HEALTH BENEFIT PACKAGE </b><br/>
<a id="pl.76.31"></a><var>76.31</var><b>REQUIREMENTS.</b><br/>
<a id="pl.76.32"></a><var>76.32</var>    Subdivision 1. <b>Essential health benefits package.</b> (a) Health plan companies <br/>
<a id="pl.76.33"></a><var>76.33</var>offering individual and small group health plans must include the essential health benefits <br/>
<a id="pl.77.1"></a><var>77.1</var>package required under section 1302(a) of the Affordable Care Act and as described <br/>
<a id="pl.77.2"></a><var>77.2</var>in this subdivision.<br/>
<a id="pl.77.3"></a><var>77.3</var>    (b) The essential health benefits package means coverage that:<br/>
<a id="pl.77.4"></a><var>77.4</var>    (1) provides essential health benefits as outlined in the Affordable Care Act;<br/>
<a id="pl.77.5"></a><var>77.5</var>    (2) limits cost-sharing for such coverage in accordance with the Affordable Care <br/>
<a id="pl.77.6"></a><var>77.6</var>Act, as described in subdivision 2; and<br/>
<a id="pl.77.7"></a><var>77.7</var>    (3) subject to subdivision 3, provides bronze, silver, gold, or platinum level of <br/>
<a id="pl.77.8"></a><var>77.8</var>coverage in accordance with the Affordable Care Act.<br/>
<a id="pl.77.9"></a><var>77.9</var>    Subd. 2. <b>Coverage for enrollees under the age of 21.</b> If a health plan company <br/>
<a id="pl.77.10"></a><var>77.10</var>offers health plans in any level of coverage specified under section 1302(d) of the <br/>
<a id="pl.77.11"></a><var>77.11</var>Affordable Care Act, as described in subdivision 1, paragraph (b), clause (3), the health <br/>
<a id="pl.77.12"></a><var>77.12</var>plan company shall also offer coverage in that level to individuals who have not attained <br/>
<a id="pl.77.13"></a><var>77.13</var>21 years of age as of the beginning of a policy year.<br/>
<a id="pl.77.14"></a><var>77.14</var>    Subd. 3. <b>Alternative compliance for catastrophic plans.</b> A health plan company <br/>
<a id="pl.77.15"></a><var>77.15</var>that does not provide an individual or small group health plan in the bronze, silver, gold, <br/>
<a id="pl.77.16"></a><var>77.16</var>or platinum level of coverage, as described in subdivision 1, paragraph (b), clause (3), <br/>
<a id="pl.77.17"></a><var>77.17</var>shall be treated as meeting the requirements of section 1302(d) of the Affordable Care Act <br/>
<a id="pl.77.18"></a><var>77.18</var>with respect to any policy year if the health plan company provides a catastrophic plan <br/>
<a id="pl.77.19"></a><var>77.19</var>that meets the requirements of section 1302(e) of the Affordable Care Act.<br/>
<a id="pl.77.20"></a><var>77.20</var>    Subd. 4. <b>Essential health benefits; definition.</b> For purposes of this section, <br/>
<a id="pl.77.21"></a><var>77.21</var>"essential health benefits" has the meaning given under section 1302(b) of the Affordable <br/>
<a id="pl.77.22"></a><var>77.22</var>Care Act and includes:<br/>
<a id="pl.77.23"></a><var>77.23</var>    (1) ambulatory patient services;<br/>
<a id="pl.77.24"></a><var>77.24</var>    (2) emergency services;<br/>
<a id="pl.77.25"></a><var>77.25</var>    (3) hospitalization;<br/>
<a id="pl.77.26"></a><var>77.26</var>    (4) laboratory services;<br/>
<a id="pl.77.27"></a><var>77.27</var>    (5) maternity and newborn care;<br/>
<a id="pl.77.28"></a><var>77.28</var>    (6) mental health and substance use disorder services, including behavioral health <br/>
<a id="pl.77.29"></a><var>77.29</var>treatment;<br/>
<a id="pl.77.30"></a><var>77.30</var>    (7) pediatric services, including oral and vision care;<br/>
<a id="pl.77.31"></a><var>77.31</var>    (8) prescription drugs;<br/>
<a id="pl.77.32"></a><var>77.32</var>    (9) preventive and wellness services and chronic disease management;<br/>
<a id="pl.77.33"></a><var>77.33</var>    (10) rehabilitative and habilitative services and devices; and<br/>
<a id="pl.77.34"></a><var>77.34</var>    (11) additional essential health benefits included in the EHB-benchmark plan, as <br/>
<a id="pl.77.35"></a><var>77.35</var>defined under the Affordable Care Act.<br/>
<a id="pl.78.1"></a><var>78.1</var>    Subd. 5. <b>Exception.</b> This section does not apply to a dental plan described in <br/>
<a id="pl.78.2"></a><var>78.2</var>section 1311(d)(2)(B)(ii) of the Affordable Care Act.<br/>
<a id="pl.78.3"></a><var>78.3</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.1.90.0"></a><a id="pl.78.4"></a><var>78.4</var>    Sec. 90. <b>[62Q.82] BENEFITS AND COVERAGE EXPLANATION.</b><br/>
<a id="pl.78.5"></a><var>78.5</var>    Subdivision 1. <b>Summary.</b> Health plan companies offering health plans shall provide <br/>
<a id="pl.78.6"></a><var>78.6</var>a summary of benefits and coverage explanation as required by the Affordable Care Act to:<br/>
<a id="pl.78.7"></a><var>78.7</var>(1) an applicant at the time of application;<br/>
<a id="pl.78.8"></a><var>78.8</var>(2) an enrollee prior to the time of enrollment or reenrollment, as applicable; and<br/>
<a id="pl.78.9"></a><var>78.9</var>(3) a policyholder at the time of issuance of the policy.<br/>
<a id="pl.78.10"></a><var>78.10</var>    Subd. 2. <b>Compliance.</b> A health plan company described in subdivision 1 shall be <br/>
<a id="pl.78.11"></a><var>78.11</var>deemed to have complied with subdivision 1 if the summary of benefits and coverage <br/>
<a id="pl.78.12"></a><var>78.12</var>explanation is provided in paper or electronic form as required under the Affordable <br/>
<a id="pl.78.13"></a><var>78.13</var>Care Act.<br/>
<a id="pl.78.14"></a><var>78.14</var>    Subd. 3. <b>Notice of modification.</b> Except in connection with a policy renewal or <br/>
<a id="pl.78.15"></a><var>78.15</var>reissuance, if a health plan company makes any material modifications in any of the <br/>
<a id="pl.78.16"></a><var>78.16</var>terms of the coverage, as defined for purposes of section 102 of the federal Employee <br/>
<a id="pl.78.17"></a><var>78.17</var>Retirement Income Security Act of 1974, as amended, that is not reflected in the most <br/>
<a id="pl.78.18"></a><var>78.18</var>recently provided summary of benefits and coverage explanation, the health plan company <br/>
<a id="pl.78.19"></a><var>78.19</var>shall provide notice of the modification to enrollees not later than 60 days prior to the date <br/>
<a id="pl.78.20"></a><var>78.20</var>on which the modification will become effective.<br/>
<a id="pl.78.21"></a><var>78.21</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.91.0"></a><a id="pl.78.22"></a><var>78.22</var>    Sec. 91. Minnesota Statutes 2012, section 72A.20, subdivision 35, is amended to read:<br/>
<a id="pl.78.23"></a><var>78.23</var>    Subd. 35. <b>Determination of health plan policy limits.</b> Any health plan under <br/>
<a id="pl.78.24"></a><var>78.24</var>section 62A.011, subdivision 3, that includes a specific policy limit within its insurance <br/>
<a id="pl.78.25"></a><var>78.25</var>policy, certificate, or subscriber agreement shall calculate the policy limit by using the <br/>
<a id="pl.78.26"></a><var>78.26</var>amount actually paid on behalf of the insured, subscriber, or dependents for services <br/>
<a id="pl.78.27"></a><var>78.27</var>covered under the policy, subscriber agreement, or certificate unless the amount paid is <br/>
<a id="pl.78.28"></a><var>78.28</var>greater than the billed charge. This provision does not permit the application of a specific <br/>
<a id="pl.78.29"></a><var>78.29</var>policy limit within a health plan where the limit is prohibited under the Affordable Care <br/>
<a id="pl.78.30"></a><var>78.30</var>Act as defined in section 62A.011, subdivision 1a.<br/>
<a id="pl.78.31"></a><var>78.31</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.92.0"></a><a id="pl.79.1"></a><var>79.1</var>    Sec. 92. Minnesota Statutes 2012, section 145.414, is amended to read:<br/>
<a id="pl.79.2"></a><var>79.2</var><b>145.414 ABORTION NOT MANDATORY.</b><br/>
<a id="pl.79.3"></a><var>79.3</var>(a) No person and no hospital or institution shall be coerced, held liable or <br/>
<a id="pl.79.4"></a><var>79.4</var>discriminated against in any manner because of a refusal to perform, accommodate, assist <br/>
<a id="pl.79.5"></a><var>79.5</var>or submit to an abortion for any reason.<br/>
<a id="pl.79.6"></a><var>79.6</var>(b) It is the policy of the state of Minnesota that no health plan company as defined <br/>
<a id="pl.79.7"></a><var>79.7</var>under section 
         <statute_ref>62Q.01, subdivision 4</statute_ref>, or health care cooperative as defined under section <br/>
<statute_ref><a id="pl.79.8"></a><var>79.8</var>62R.04, subdivision 2
         </statute_ref>, shall be required to provide or provide coverage for an abortion. <br/>
<a id="pl.79.9"></a><var>79.9</var>No provision of this chapter; of chapter 62A, 62C, 62D, 62H, 62L, 62M, 62N, 62R, <br/>
<a id="pl.79.10"></a><var>79.10</var>62V, 64B, or of any other chapter; of Minnesota Rules; or of Laws 1995, chapter 234, <br/>
<a id="pl.79.11"></a><var>79.11</var>shall be construed as requiring a health plan company as defined under section 
         <statute_ref>62Q.01, <br/>
<a id="pl.79.12"></a><var>79.12</var>subdivision 4
         </statute_ref>, or a health care cooperative as defined under section 
         <statute_ref>62R.04, subdivision 2</statute_ref>, <br/>
<a id="pl.79.13"></a><var>79.13</var>to provide or provide coverage for an abortion.<br/>
<a id="pl.79.14"></a><var>79.14</var>(c) This section supersedes any provision of Laws 1995, chapter 234, or any act <br/>
<a id="pl.79.15"></a><var>79.15</var>enacted prior to enactment of Laws 1995, chapter 234, that in any way limits or is <br/>
<a id="pl.79.16"></a><var>79.16</var>inconsistent with this section. No provision of any act enacted subsequent to Laws 1995, <br/>
<a id="pl.79.17"></a><var>79.17</var>chapter 234 shall be construed as in any way limiting or being inconsistent with this <br/>
<a id="pl.79.18"></a><var>79.18</var>section, unless the act amends this section or expressly provides that it is intended to <br/>
<a id="pl.79.19"></a><var>79.19</var>limit or be inconsistent with this section.<br/>
<br/>
<a id="bill.1.93.0"></a><a id="pl.79.20"></a><var>79.20</var>    Sec. 93. Minnesota Statutes 2012, section 471.61, subdivision 1a, is amended to read:<br/>
<a id="pl.79.21"></a><var>79.21</var>    Subd. 1a. <b>Dependents.</b> Notwithstanding the provisions of Minnesota Statutes 1969, <br/>
<a id="pl.79.22"></a><var>79.22</var>section 
         <statute_ref>471.61</statute_ref>, as amended by Laws 1971, chapter 451, section 1, the word "dependents" as <br/>
<a id="pl.79.23"></a><var>79.23</var>used therein shall mean spouse and minor unmarried children under the age of 18 26 years <br/>
<a id="pl.79.24"></a><var>79.24</var>and dependent students under the age of 25 years actually dependent upon the employee.<br/>
<a id="pl.79.25"></a><var>79.25</var><b>EFFECTIVE DATE.</b>This section is effective the day following final enactment.<br/>
<br/>
<a id="bill.1.94.0"></a><a id="pl.79.26"></a><var>79.26</var>    Sec. 94. <b> REPEALER.</b><br/>
<a id="pl.79.27"></a><var>79.27</var>(a) Minnesota Statutes 2012, section 62E.02, subdivision 7, is repealed effective the <br/>
<a id="pl.79.28"></a><var>79.28</var>day following final enactment.<br/>
<a id="pl.79.29"></a><var>79.29</var>(b) Minnesota Statutes 2012, sections 62A.615; 62A.65, subdivision 6; 62E.16; <br/>
<a id="pl.79.30"></a><var>79.30</var>62E.20; 62L.02, subdivisions 4, 18, 19, 23, and 24; 62L.05, subdivisions 1, 2, 3, 4, 4a, <br/>
<a id="pl.79.31"></a><var>79.31</var>5, 6, 7, 11, 12, and 13; 62L.081; 62L.10, subdivision 5; and 62Q.37, subdivision 5, are <br/>
<a id="pl.79.32"></a><var>79.32</var>repealed effective January 1, 2014.<br/>
<br/>
<a id="bill.2.0.0"></a>

<a id="bill.2.1.0"></a><a id="pl.80.3"></a><var>80.3</var>    Section 1. Minnesota Statutes 2012, section 62D.124, subdivision 4, is amended to read:<br/>
<a id="pl.80.4"></a><var>80.4</var>    Subd. 4. <b>Application.</b> (a) Subdivisions 1 and 2 do not apply if an enrollee is referred <br/>
<a id="pl.80.5"></a><var>80.5</var>to a referral center for health care services.<br/>
<a id="pl.80.6"></a><var>80.6</var>(b) Subdivision 1 does not apply:<br/>
<a id="pl.80.7"></a><var>80.7</var>(1) if an enrollee has chosen a health plan with full knowledge that the health plan <br/>
<a id="pl.80.8"></a><var>80.8</var>has no participating providers within 30 miles or 30 minutes of the enrollee's place of <br/>
<a id="pl.80.9"></a><var>80.9</var>residence; or<br/>
<a id="pl.80.10"></a><var>80.10</var>(2) to service areas approved before May 24, 1993.<br/>
<a id="pl.80.11"></a><var>80.11</var>(c) Beginning for coverage effective on or after January 1, 2015, subdivisions 1 to 4 <br/>
<a id="pl.80.12"></a><var>80.12</var>shall only apply to individual or small group health plans that are grandfathered plans, as <br/>
<a id="pl.80.13"></a><var>80.13</var>defined under section 62A.011, subdivision 1c.<br/>
<br/>
<a id="bill.2.2.0"></a><a id="pl.80.14"></a><var>80.14</var>    Sec. 2. <b>[62K.01] TITLE.</b><br/>
<a id="pl.80.15"></a><var>80.15</var>This chapter may be cited as the "Minnesota Health Plan Market Rules."<br/>
<br/>
<a id="bill.2.3.0"></a><a id="pl.80.16"></a><var>80.16</var>    Sec. 3. <b>[62K.02] PURPOSE AND SCOPE.</b><br/>
<a id="pl.80.17"></a><var>80.17</var>    Subdivision 1. <b>Purpose.</b> The market rules set forth in this chapter serve to clarify <br/>
<a id="pl.80.18"></a><var>80.18</var>and provide guidance on the application of state law and certain requirements of the <br/>
<a id="pl.80.19"></a><var>80.19</var>Affordable Care Act on all health carriers offering health plans in Minnesota, whether <br/>
<a id="pl.80.20"></a><var>80.20</var>or not through the Minnesota Insurance Marketplace, to ensure fair competition for all <br/>
<a id="pl.80.21"></a><var>80.21</var>health carriers in Minnesota, to minimize adverse selection, and to ensure that health <br/>
<a id="pl.80.22"></a><var>80.22</var>plans are offered in a manner that protects consumers and promotes the provision of <br/>
<a id="pl.80.23"></a><var>80.23</var>high-quality affordable health care, and improved health outcomes. This chapter contains <br/>
<a id="pl.80.24"></a><var>80.24</var>the regulatory requirements as specified in section 62V.05, subdivision 5, paragraph (b), <br/>
<a id="pl.80.25"></a><var>80.25</var>and shall fully satisfy the requirements of section 62V.05, subdivision 5, paragraph (b).<br/>
<a id="pl.80.26"></a><var>80.26</var>    Subd. 2. <b>Scope.</b> (a) This chapter applies only to health plans offered in the <br/>
<a id="pl.80.27"></a><var>80.27</var>individual market or the small group market.<br/>
<a id="pl.80.28"></a><var>80.28</var>(b) This chapter applies to health carriers with respect to individual health plans and <br/>
<a id="pl.80.29"></a><var>80.29</var>small group health plans, unless otherwise specified.<br/>
<a id="pl.80.30"></a><var>80.30</var>(c) If a health carrier issues or renews individual or small group health plans in <br/>
<a id="pl.80.31"></a><var>80.31</var>other states, this chapter applies only to health plans issued or renewed in this state to a <br/>
<a id="pl.80.32"></a><var>80.32</var>Minnesota resident, or to cover a resident of the state, or issued or renewed to a small <br/>
<a id="pl.80.33"></a><var>80.33</var>employer that is actively engaged in business in this state, unless otherwise specified.<br/>
<a id="pl.81.1"></a><var>81.1</var>(d) This chapter does not apply to short-term coverage as defined in section 62A.65, <br/>
<a id="pl.81.2"></a><var>81.2</var>subdivision 7, or grandfathered plan coverage as defined in section 62A.011, subdivision <br/>
<a id="pl.81.3"></a><var>81.3</var>1b.<br/>
<a id="pl.81.4"></a><var>81.4</var><b>EFFECTIVE DATE.</b>This section is effective for health plans that are offered, sold, <br/>
<a id="pl.81.5"></a><var>81.5</var>issued or renewed on or after January 1, 2014.<br/>
<br/>
<a id="bill.2.4.0"></a><a id="pl.81.6"></a><var>81.6</var>    Sec. 4. <b>[62K.03] DEFINITIONS.</b><br/>
<a id="pl.81.7"></a><var>81.7</var>    Subdivision 1. <b>Applicability.</b> For purposes of this chapter, the terms defined in this <br/>
<a id="pl.81.8"></a><var>81.8</var>section have the meanings given.<br/>
<a id="pl.81.9"></a><var>81.9</var>    Subd. 2. <b>Affordable Care Act.</b> "Affordable Care Act" means the federal Patient <br/>
<a id="pl.81.10"></a><var>81.10</var>Protection and Affordable Care Act, Public Law 111-148, as amended, including the <br/>
<a id="pl.81.11"></a><var>81.11</var>federal Health Care and Education Reconciliation Act of 2010, Public Law 111-152, and <br/>
<a id="pl.81.12"></a><var>81.12</var>any amendments, and any federal guidance or regulations issued under these acts. <br/>
<a id="pl.81.13"></a><var>81.13</var>    Subd. 3. <b>Dental plan.</b> "Dental plan" means a dental plan as defined in section <br/>
<a id="pl.81.14"></a><var>81.14</var>62Q.76, subdivision 3.<br/>
<a id="pl.81.15"></a><var>81.15</var>    Subd. 4. <b>Enrollee.</b> "Enrollee" means a natural person covered by a health plan and <br/>
<a id="pl.81.16"></a><var>81.16</var>includes an insured policyholder, subscriber, contract holder, member, covered person, <br/>
<a id="pl.81.17"></a><var>81.17</var>or certificate holder.<br/>
<a id="pl.81.18"></a><var>81.18</var>    Subd. 5. <b>Health carrier.</b> "Health carrier" means a health carrier as defined in <br/>
<a id="pl.81.19"></a><var>81.19</var>section 62A.011, subdivision 2.<br/>
<a id="pl.81.20"></a><var>81.20</var>    Subd. 6. <b>Health plan.</b> "Health plan" means a health plan as defined in section <br/>
<a id="pl.81.21"></a><var>81.21</var>62A.011, subdivision 3.<br/>
<a id="pl.81.22"></a><var>81.22</var>    Subd. 7. <b>Individual health plan.</b> "Individual health plan" means an individual <br/>
<a id="pl.81.23"></a><var>81.23</var>health plan as defined in Minnesota Statutes, section 62A.011, subdivision 4.<br/>
<a id="pl.81.24"></a><var>81.24</var>    Subd. 8. <b>Limited-scope pediatric dental plan.</b> "Limited-scope pediatric dental <br/>
<a id="pl.81.25"></a><var>81.25</var>plan" means a dental plan meeting the requirements of section 9832(c)(2)(A) of the <br/>
<a id="pl.81.26"></a><var>81.26</var>Internal Revenue Code of 1986, as amended, that provides only pediatric dental benefits <br/>
<a id="pl.81.27"></a><var>81.27</var>meeting the requirements of the Affordable Care Act and is offered by a health carrier. A <br/>
<a id="pl.81.28"></a><var>81.28</var>limited-scope pediatric dental plan includes a dental plan that is offered separately or in <br/>
<a id="pl.81.29"></a><var>81.29</var>conjunction with an individual or small group health plan to individuals who have not <br/>
<a id="pl.81.30"></a><var>81.30</var>attained the age of 19 years as of the beginning of the policy year or to a family.<br/>
<a id="pl.81.31"></a><var>81.31</var>    Subd. 9. <b>Minnesota Insurance Marketplace.</b> "Minnesota Insurance Marketplace" <br/>
<a id="pl.81.32"></a><var>81.32</var>means the Minnesota Insurance Marketplace as defined in section 62V.02.<br/>
<a id="pl.81.33"></a><var>81.33</var>    Subd. 10. <b>Preferred provider organization.</b> "Preferred provider organization" <br/>
<a id="pl.81.34"></a><var>81.34</var>means a health plan that provides discounts to enrollees or subscribers for services they <br/>
<a id="pl.81.35"></a><var>81.35</var>receive from certain health care providers.<br/>
<a id="pl.82.1"></a><var>82.1</var>    Subd. 11. <b>Qualified health plan.</b> "Qualified health plan" means a health plan <br/>
<a id="pl.82.2"></a><var>82.2</var>that meets the definition in the Affordable Care Act and has been certified by the board <br/>
<a id="pl.82.3"></a><var>82.3</var>of the Minnesota Insurance Marketplace in accordance with chapter 62V to be offered <br/>
<a id="pl.82.4"></a><var>82.4</var>through the Minnesota Insurance Marketplace.<br/>
<a id="pl.82.5"></a><var>82.5</var>    Subd. 12. <b>Small group health plan.</b> "Small group health plan" means a health plan <br/>
<a id="pl.82.6"></a><var>82.6</var>issued by a health carrier to a small employer as defined in section 62L.02, subdivision 26.<br/>
<a id="pl.82.7"></a><var>82.7</var><b>EFFECTIVE DATE.</b>This section is effective for health plans that are offered, sold, <br/>
<a id="pl.82.8"></a><var>82.8</var>issued, or renewed on or after January 1, 2014.<br/>
<br/>
<a id="bill.2.5.0"></a><a id="pl.82.9"></a><var>82.9</var>    Sec. 5. <b>[62K.04] MARKET RULES; VIOLATION.</b><br/>
<a id="pl.82.10"></a><var>82.10</var>    Subdivision 1. <b>Compliance.</b> (a) A health carrier issuing an individual health plan to <br/>
<a id="pl.82.11"></a><var>82.11</var>a Minnesota resident or a small group health plan to provide coverage to a small employer <br/>
<a id="pl.82.12"></a><var>82.12</var>that is actively engaged in business in Minnesota shall meet all of the requirements set <br/>
<a id="pl.82.13"></a><var>82.13</var>forth in this chapter. The failure to meet any of the requirements under this chapter <br/>
<a id="pl.82.14"></a><var>82.14</var>constitutes a violation of section 72A.20.<br/>
<a id="pl.82.15"></a><var>82.15</var>(b) The requirements of this chapter do not apply to short-term coverage as defined <br/>
<a id="pl.82.16"></a><var>82.16</var>in section 62A.65, subdivision 7, or grandfathered plan coverage as defined in section <br/>
<a id="pl.82.17"></a><var>82.17</var>62A.011, subdivision 1c.<br/>
<a id="pl.82.18"></a><var>82.18</var>    Subd. 2. <b>Penalties.</b> In addition to any other penalties provided by the laws of this <br/>
<a id="pl.82.19"></a><var>82.19</var>state or by federal law, a health carrier or any other person found to have violated any <br/>
<a id="pl.82.20"></a><var>82.20</var>requirement of this chapter may be subject to the administrative procedures, enforcement <br/>
<a id="pl.82.21"></a><var>82.21</var>actions, and penalties provided under section 45.027 and chapters 62D and 72A.<br/>
<a id="pl.82.22"></a><var>82.22</var><b>EFFECTIVE DATE.</b>This section is effective for health plans that are offered, sold, <br/>
<a id="pl.82.23"></a><var>82.23</var>issued, or renewed on or after January 1, 2014.<br/>
<br/>
<a id="bill.2.6.0"></a><a id="pl.82.24"></a><var>82.24</var>    Sec. 6. <b>[62K.05] FEDERAL ACT; COMPLIANCE REQUIRED.</b><br/>
<a id="pl.82.25"></a><var>82.25</var>A health carrier shall comply with all provisions of the Affordable Care Act to <br/>
<a id="pl.82.26"></a><var>82.26</var>the extent that it imposes a requirement that applies in this state. Compliance with any <br/>
<a id="pl.82.27"></a><var>82.27</var>provision of the Affordable Care Act is required as of the effective date established for <br/>
<a id="pl.82.28"></a><var>82.28</var>that provision in the federal act, except as otherwise specifically stated earlier in state law.<br/>
<a id="pl.82.29"></a><var>82.29</var><b>EFFECTIVE DATE.</b>This section is effective for health plans that are offered, sold, <br/>
<a id="pl.82.30"></a><var>82.30</var>issued, or renewed on or after January 1, 2014.<br/>
<br/>
<a id="bill.2.7.0"></a><a id="pl.82.31"></a><var>82.31</var>    Sec. 7. <b>[62K.06] METAL LEVEL MANDATORY OFFERINGS.</b><br/>
<a id="pl.83.1"></a><var>83.1</var>    Subdivision 1. <b>Identification.</b> A health carrier that offers individual or small group <br/>
<a id="pl.83.2"></a><var>83.2</var>health plans in Minnesota must provide documentation to the commissioner of commerce <br/>
<a id="pl.83.3"></a><var>83.3</var>to justify actuarial value levels as specified in section 1302(d) of the Affordable Care Act <br/>
<a id="pl.83.4"></a><var>83.4</var>for all individual and small group health plans offered inside and outside of the Minnesota <br/>
<a id="pl.83.5"></a><var>83.5</var>Insurance Marketplace.<br/>
<a id="pl.83.6"></a><var>83.6</var>    Subd. 2. <b>Minimum levels.</b> (a) A health carrier that offers a catastrophic plan or a <br/>
<a id="pl.83.7"></a><var>83.7</var>bronze level health plan within a service area in either the individual or small group <br/>
<a id="pl.83.8"></a><var>83.8</var>market must also offer a silver level and a gold level health plan in that market and <br/>
<a id="pl.83.9"></a><var>83.9</var>within that service area.<br/>
<a id="pl.83.10"></a><var>83.10</var>(b) A health carrier with less than five percent market share in the respective <br/>
<a id="pl.83.11"></a><var>83.11</var>individual or small group market in Minnesota is exempt from paragraph (a), until January <br/>
<a id="pl.83.12"></a><var>83.12</var>1, 2017, unless the health carrier offers a qualified health plan through the Minnesota <br/>
<a id="pl.83.13"></a><var>83.13</var>Insurance Marketplace. If the health carrier offers a qualified health plan through the <br/>
<a id="pl.83.14"></a><var>83.14</var>Minnesota Insurance Marketplace, the health carrier must comply with paragraph (a).<br/>
<a id="pl.83.15"></a><var>83.15</var>    Subd. 3. <b>Minnesota Insurance Marketplace restriction.</b> The Minnesota Insurance <br/>
<a id="pl.83.16"></a><var>83.16</var>Marketplace may not, by contract or otherwise, mandate the types of health plans to be <br/>
<a id="pl.83.17"></a><var>83.17</var>offered by a health carrier to individuals or small employers purchasing health plans outside <br/>
<a id="pl.83.18"></a><var>83.18</var>of the Minnesota Insurance Marketplace. Solely for purposes of this subdivision, "health <br/>
<a id="pl.83.19"></a><var>83.19</var>plan" includes coverage that is excluded under section 62A.011, subdivision 3, clause (6).<br/>
<a id="pl.83.20"></a><var>83.20</var>    Subd. 4. <b>Metal level defined.</b> For purposes of this section, the metal levels and <br/>
<a id="pl.83.21"></a><var>83.21</var>catastrophic plans are defined in section 1302(d) and (e) of the Affordable Care Act.<br/>
<a id="pl.83.22"></a><var>83.22</var>    Subd. 5. <b>Enforcement.</b> The commissioner of commerce shall enforce this section.<br/>
<br/>
<a id="bill.2.8.0"></a><a id="pl.83.23"></a><var>83.23</var>    Sec. 8. <b>[62K.07] INFORMATION DISCLOSURES.</b><br/>
<a id="pl.83.24"></a><var>83.24</var>(a) A health carrier offering individual or small group health plans must submit the <br/>
<a id="pl.83.25"></a><var>83.25</var>following information in a format determined by the commissioner of commerce:<br/>
<a id="pl.83.26"></a><var>83.26</var>(1) claims payment policies and practices;<br/>
<a id="pl.83.27"></a><var>83.27</var>(2) periodic financial disclosures;<br/>
<a id="pl.83.28"></a><var>83.28</var>(3) data on enrollment;<br/>
<a id="pl.83.29"></a><var>83.29</var>(4) data on disenrollment;<br/>
<a id="pl.83.30"></a><var>83.30</var>(5) data on the number of claims that are denied;<br/>
<a id="pl.83.31"></a><var>83.31</var>(6) data on rating practices;<br/>
<a id="pl.83.32"></a><var>83.32</var>(7) information on cost-sharing and payments with respect to out-of-network <br/>
<a id="pl.83.33"></a><var>83.33</var>coverage; and<br/>
<a id="pl.83.34"></a><var>83.34</var>(8) other information required by the secretary of the United States Department of <br/>
<a id="pl.83.35"></a><var>83.35</var>Health and Human Services under the Affordable Care Act.<br/>
<a id="pl.84.1"></a><var>84.1</var>(b) A health carrier offering an individual or small group health plan must comply <br/>
<a id="pl.84.2"></a><var>84.2</var>with all information disclosure requirements of all applicable state and federal law, <br/>
<a id="pl.84.3"></a><var>84.3</var>including the Affordable Care Act.<br/>
<a id="pl.84.4"></a><var>84.4</var>(c) Except for qualified health plans sold on the Minnesota Insurance Marketplace, <br/>
<a id="pl.84.5"></a><var>84.5</var>information reported under paragraph (a), clauses (3) and (4), is nonpublic data as defined <br/>
<a id="pl.84.6"></a><var>84.6</var>under section 13.02, subdivision 9. Information reported under paragraph (a), clauses (1) <br/>
<a id="pl.84.7"></a><var>84.7</var>through (8), must be reported by the Minnesota Insurance Marketplace for qualified health <br/>
<a id="pl.84.8"></a><var>84.8</var>plans sold through the Minnesota Insurance Marketplace.<br/>
<a id="pl.84.9"></a><var>84.9</var>(d) The commissioner of commerce shall enforce this section.<br/>
<br/>
<a id="bill.2.9.0"></a><a id="pl.84.10"></a><var>84.10</var>    Sec. 9. <b>[62K.08] MARKETING STANDARDS.</b><br/>
<a id="pl.84.11"></a><var>84.11</var>    Subdivision 1. <b>Marketing.</b> (a) A health carrier offering individual or small group <br/>
<a id="pl.84.12"></a><var>84.12</var>health plans must comply with all applicable provisions of the Affordable Care Act, <br/>
<a id="pl.84.13"></a><var>84.13</var>including, but not limited to, the following:<br/>
<a id="pl.84.14"></a><var>84.14</var>(1) compliance with all state laws pertaining to the marketing of individual or small <br/>
<a id="pl.84.15"></a><var>84.15</var>group health plans; and<br/>
<a id="pl.84.16"></a><var>84.16</var>(2) establishing marketing practices and benefit designs that will not have the effect of <br/>
<a id="pl.84.17"></a><var>84.17</var>discouraging the enrollment of individuals with significant health needs in the health plan.<br/>
<a id="pl.84.18"></a><var>84.18</var>(b) No marketing materials may lead consumers to believe that all health care needs <br/>
<a id="pl.84.19"></a><var>84.19</var>will be covered.<br/>
<a id="pl.84.20"></a><var>84.20</var>    Subd. 2. <b>Enforcement.</b> The commissioner of commerce shall enforce this section.<br/>
<a id="pl.84.21"></a><var>84.21</var><b>EFFECTIVE DATE.</b>This section is effective for health plans offered, sold, issued, <br/>
<a id="pl.84.22"></a><var>84.22</var>or renewed on or after January 1, 2014.<br/>
<br/>
<a id="bill.2.10.0"></a><a id="pl.84.23"></a><var>84.23</var>    Sec. 10. <b>[62K.09] ACCREDITATION STANDARDS.</b><br/>
<a id="pl.84.24"></a><var>84.24</var>    Subdivision 1. <b>Accreditation; general.</b> (a) A health carrier that offers any <br/>
<a id="pl.84.25"></a><var>84.25</var>individual or small group health plans in Minnesota outside of the Minnesota Insurance <br/>
<a id="pl.84.26"></a><var>84.26</var>Marketplace must be accredited in accordance with this subdivision. A health carrier <br/>
<a id="pl.84.27"></a><var>84.27</var>must obtain accreditation through URAC, the National Committee for Quality Assurance <br/>
<a id="pl.84.28"></a><var>84.28</var>(NCQA), or any entity recognized by the United States Department of Health and Human <br/>
<a id="pl.84.29"></a><var>84.29</var>Services for accreditation of health insurance issuers or health plans by January 1, <br/>
<a id="pl.84.30"></a><var>84.30</var>2018. Proof of accreditation must be submitted to the commissioner of health in a form <br/>
<a id="pl.84.31"></a><var>84.31</var>prescribed by the commissioner of health.<br/>
<a id="pl.84.32"></a><var>84.32</var>(b) A health carrier that rents a provider network is exempt from this subdivision, <br/>
<a id="pl.84.33"></a><var>84.33</var>unless it is part of a holding company as defined in section 60D.15 that in aggregate exceeds <br/>
<a id="pl.84.34"></a><var>84.34</var>ten percent market share in either the individual or small group market in Minnesota.<br/>
<a id="pl.85.1"></a><var>85.1</var>    Subd. 2. <b>Accreditation; Minnesota Insurance Marketplace.</b> (a) The Minnesota <br/>
<a id="pl.85.2"></a><var>85.2</var>Insurance Marketplace shall require all health carriers offering a qualified health <br/>
<a id="pl.85.3"></a><var>85.3</var>plan through the Minnesota Insurance Marketplace to obtain the appropriate level of <br/>
<a id="pl.85.4"></a><var>85.4</var>accreditation no later than the third year after the first year the health carrier offers a <br/>
<a id="pl.85.5"></a><var>85.5</var>qualified health plan through the Minnesota Insurance Marketplace. A health carrier <br/>
<a id="pl.85.6"></a><var>85.6</var>must take the first step of the accreditation process during the first year in which it offers <br/>
<a id="pl.85.7"></a><var>85.7</var>a qualified health plan. A health carrier that offers a qualified health plan on January 1, <br/>
<a id="pl.85.8"></a><var>85.8</var>2014, must obtain accreditation by the end of the 2016 plan year.<br/>
<a id="pl.85.9"></a><var>85.9</var>(b) To the extent a health carrier cannot obtain accreditation due to low volume of <br/>
<a id="pl.85.10"></a><var>85.10</var>enrollees, an exception to this accreditation criterion may be granted by the Minnesota <br/>
<a id="pl.85.11"></a><var>85.11</var>Insurance Marketplace until such time as the health carrier has a sufficient volume of <br/>
<a id="pl.85.12"></a><var>85.12</var>enrollees.<br/>
<a id="pl.85.13"></a><var>85.13</var>    Subd. 3. <b>Oversight.</b> A health carrier shall comply with a request from the <br/>
<a id="pl.85.14"></a><var>85.14</var>commissioner of health to confirm accreditation or progress toward accreditation.<br/>
<a id="pl.85.15"></a><var>85.15</var>    Subd. 4. <b>Enforcement.</b> The commissioner of health shall enforce this section.<br/>
<br/>
<a id="bill.2.11.0"></a><a id="pl.85.16"></a><var>85.16</var>    Sec. 11. <b>[62K.10] GEOGRAPHIC ACCESSIBILITY; PROVIDER NETWORK </b><br/>
<a id="pl.85.17"></a><var>85.17</var><b>ADEQUACY.</b><br/>
<a id="pl.85.18"></a><var>85.18</var>    Subdivision 1. <b>Applicability.</b> (a) This section applies to all health carriers that either <br/>
<a id="pl.85.19"></a><var>85.19</var>require an enrollee to use or that create incentives, including financial incentives, for an <br/>
<a id="pl.85.20"></a><var>85.20</var>enrollee to use, health care providers that are managed, owned, under contract with, or <br/>
<a id="pl.85.21"></a><var>85.21</var>employed by the health carrier. A health carrier that does not manage, own, or contract <br/>
<a id="pl.85.22"></a><var>85.22</var>directly with providers in Minnesota is exempt from this section, unless it is part of a <br/>
<a id="pl.85.23"></a><var>85.23</var>holding company as defined in section 60D.15 that in aggregate exceeds ten percent in <br/>
<a id="pl.85.24"></a><var>85.24</var>either the individual or small group market in Minnesota.<br/>
<a id="pl.85.25"></a><var>85.25</var>(b) Health carriers renting provider networks from other entities must submit the <br/>
<a id="pl.85.26"></a><var>85.26</var>rental agreement or contract to the commissioner of health for approval. In reviewing the <br/>
<a id="pl.85.27"></a><var>85.27</var>agreements or contracts, the commissioner shall review the agreement or contract to <br/>
<a id="pl.85.28"></a><var>85.28</var>ensure that the entity contracting with health care providers accepts responsibility to meet <br/>
<a id="pl.85.29"></a><var>85.29</var>the requirements in this section.<br/>
<a id="pl.85.30"></a><var>85.30</var>    Subd. 2. <b>Primary care; mental health services; general hospital services.</b> The <br/>
<a id="pl.85.31"></a><var>85.31</var>maximum travel distance or time shall be the lesser of 30 miles or 30 minutes to the <br/>
<a id="pl.85.32"></a><var>85.32</var>nearest provider of each of the following services: primary care services, mental health <br/>
<a id="pl.85.33"></a><var>85.33</var>services, and general hospital services.<br/>
<a id="pl.85.34"></a><var>85.34</var>    Subd. 3. <b>Other health services.</b> The maximum travel distance or time shall be the <br/>
<a id="pl.85.35"></a><var>85.35</var>lesser of 60 miles or 60 minutes to the nearest provider of specialty physician services, <br/>
<a id="pl.86.1"></a><var>86.1</var>ancillary services, specialized hospital services, and all other health services not listed in <br/>
<a id="pl.86.2"></a><var>86.2</var>subdivision 2.<br/>
<a id="pl.86.3"></a><var>86.3</var>    Subd. 4. <b>Network adequacy.</b> Each designated provider network must include a <br/>
<a id="pl.86.4"></a><var>86.4</var>sufficient number and type of providers, including providers that specialize in mental <br/>
<a id="pl.86.5"></a><var>86.5</var>health and substance use disorder services, to ensure that covered services are available <br/>
<a id="pl.86.6"></a><var>86.6</var>to all enrollees without unreasonable delay. In determining network adequacy, the <br/>
<a id="pl.86.7"></a><var>86.7</var>commissioner of health shall consider availability of services, including the following:<br/>
<a id="pl.86.8"></a><var>86.8</var>(1) primary care physician services are available and accessible 24 hours per day, <br/>
<a id="pl.86.9"></a><var>86.9</var>seven days per week, within the network area;<br/>
<a id="pl.86.10"></a><var>86.10</var>(2) a sufficient number of primary care physicians have hospital admitting privileges <br/>
<a id="pl.86.11"></a><var>86.11</var>at one or more participating hospitals within the network area so that necessary admissions <br/>
<a id="pl.86.12"></a><var>86.12</var>are made on a timely basis consistent with generally accepted practice parameters;<br/>
<a id="pl.86.13"></a><var>86.13</var>(3) specialty physician service is available through the network or contract <br/>
<a id="pl.86.14"></a><var>86.14</var>arrangement;<br/>
<a id="pl.86.15"></a><var>86.15</var>(4) mental health and substance use disorder treatment providers are available and <br/>
<a id="pl.86.16"></a><var>86.16</var>accessible through the network or contract arrangement;<br/>
<a id="pl.86.17"></a><var>86.17</var>(5) to the extent that primary care services are provided through primary care <br/>
<a id="pl.86.18"></a><var>86.18</var>providers other than physicians, and to the extent permitted under applicable scope of <br/>
<a id="pl.86.19"></a><var>86.19</var>practice in state law for a given provider, these services shall be available and accessible; <br/>
<a id="pl.86.20"></a><var>86.20</var>and<br/>
<a id="pl.86.21"></a><var>86.21</var>(6) the network has available, either directly or through arrangements, appropriate <br/>
<a id="pl.86.22"></a><var>86.22</var>and sufficient personnel, physical resources, and equipment to meet the projected needs of <br/>
<a id="pl.86.23"></a><var>86.23</var>enrollees for covered health care services.<br/>
<a id="pl.86.24"></a><var>86.24</var>    Subd. 5. <b>Waiver.</b> A health carrier or preferred provider organization may apply to <br/>
<a id="pl.86.25"></a><var>86.25</var>the commissioner of health for a waiver of the requirements in subdivision 2 or 3 if it is <br/>
<a id="pl.86.26"></a><var>86.26</var>unable to meet the statutory requirements. A waiver application must be submitted on a <br/>
<a id="pl.86.27"></a><var>86.27</var>form provided by the commissioner and must:<br/>
<a id="pl.86.28"></a><var>86.28</var>(1) demonstrate with specific data that the requirement of subdivision 2 or 3 is not <br/>
<a id="pl.86.29"></a><var>86.29</var>feasible in a particular service area or part of a service area; and<br/>
<a id="pl.86.30"></a><var>86.30</var>(2) include information as to the steps that were and will be taken to address the <br/>
<a id="pl.86.31"></a><var>86.31</var>network inadequacy.<br/>
<a id="pl.86.32"></a><var>86.32</var>The waiver shall automatically expire after four years. If a renewal of the waiver <br/>
<a id="pl.86.33"></a><var>86.33</var>is sought, the commissioner of health shall take into consideration steps that have been <br/>
<a id="pl.86.34"></a><var>86.34</var>taken to address network adequacy.<br/>
<a id="pl.86.35"></a><var>86.35</var>    Subd. 6. <b>Referral centers.</b> Subdivisions 2 and 3 shall not apply if an enrollee <br/>
<a id="pl.86.36"></a><var>86.36</var>is referred to a referral center for health care services. A referral center is a medical <br/>
<a id="pl.87.1"></a><var>87.1</var>facility that provides highly specialized medical care, including but not limited to organ <br/>
<a id="pl.87.2"></a><var>87.2</var>transplants. A health carrier or preferred provider organization may consider the volume <br/>
<a id="pl.87.3"></a><var>87.3</var>of services provided annually, case mix, and severity adjusted mortality and morbidity <br/>
<a id="pl.87.4"></a><var>87.4</var>rates in designating a referral center.<br/>
<a id="pl.87.5"></a><var>87.5</var>    Subd. 7. <b>Essential community providers.</b> Each health carrier must comply with <br/>
<a id="pl.87.6"></a><var>87.6</var>section 62Q.19.<br/>
<a id="pl.87.7"></a><var>87.7</var>    Subd. 8. <b>Enforcement.</b> The commissioner of health shall enforce this section.<br/>
<br/>
<a id="bill.2.12.0"></a><a id="pl.87.8"></a><var>87.8</var>    Sec. 12. <b>[62K.11] BALANCE BILLING PROHIBITED.</b><br/>
<a id="pl.87.9"></a><var>87.9</var>(a) A network provider is prohibited from billing an enrollee for any amount in <br/>
<a id="pl.87.10"></a><var>87.10</var>excess of the allowable amount the health carrier has contracted for with the provider <br/>
<a id="pl.87.11"></a><var>87.11</var>as total payment for the health care service. A network provider is permitted to bill an <br/>
<a id="pl.87.12"></a><var>87.12</var>enrollee the approved co-payment, deductible, or coinsurance.<br/>
<a id="pl.87.13"></a><var>87.13</var>(b) A network provider is permitted to bill an enrollee for services not covered by <br/>
<a id="pl.87.14"></a><var>87.14</var>the enrollee's health plan as long as the enrollee agrees in writing in advance before the <br/>
<a id="pl.87.15"></a><var>87.15</var>service is performed to pay for the noncovered service.<br/>
<a id="pl.87.16"></a><var>87.16</var><b>EFFECTIVE DATE.</b>This section is effective January 1, 2014.<br/>
<br/>
<a id="bill.2.13.0"></a><a id="pl.87.17"></a><var>87.17</var>    Sec. 13. <b>[62K.12] QUALITY ASSURANCE AND IMPROVEMENT.</b><br/>
<a id="pl.87.18"></a><var>87.18</var>    Subdivision 1. <b>General.</b> (a) All health carriers offering an individual health plan or <br/>
<a id="pl.87.19"></a><var>87.19</var>small group health plan must have a written internal quality assurance and improvement <br/>
<a id="pl.87.20"></a><var>87.20</var>program that, at a minimum:<br/>
<a id="pl.87.21"></a><var>87.21</var>(1) provides for ongoing evaluation of the quality of health care provided to its <br/>
<a id="pl.87.22"></a><var>87.22</var>enrollees;<br/>
<a id="pl.87.23"></a><var>87.23</var>(2) periodically reports the evaluation of the quality of health care to the health <br/>
<a id="pl.87.24"></a><var>87.24</var>carrier's governing body;<br/>
<a id="pl.87.25"></a><var>87.25</var>(3) follows policies and procedures for the selection and credentialing of network <br/>
<a id="pl.87.26"></a><var>87.26</var>providers that is consistent with community standards;<br/>
<a id="pl.87.27"></a><var>87.27</var>(4) conducts focused studies directed at problems, potential problems, or areas <br/>
<a id="pl.87.28"></a><var>87.28</var>with potential for improvements in care;<br/>
<a id="pl.87.29"></a><var>87.29</var>(5) conducts enrollee satisfaction surveys and monitors oral and written complaints <br/>
<a id="pl.87.30"></a><var>87.30</var>submitted by enrollees or members; and<br/>
<a id="pl.87.31"></a><var>87.31</var>(6) collects and reports Health Effectiveness Data and Information Set (HEDIS) <br/>
<a id="pl.87.32"></a><var>87.32</var>measures and conducts other quality assessment and improvement activities as directed <br/>
<a id="pl.87.33"></a><var>87.33</var>by the commissioner of health.<br/>
<a id="pl.88.1"></a><var>88.1</var>    (b) The commissioner of health shall submit a report to the chairs and ranking <br/>
<a id="pl.88.2"></a><var>88.2</var>minority members of senate and house of representatives committees with primary <br/>
<a id="pl.88.3"></a><var>88.3</var>jurisdiction over commerce and health policy by February 15, 2015, with recommendations <br/>
<a id="pl.88.4"></a><var>88.4</var>for specific quality assurance and improvement standards for all Minnesota health carriers. <br/>
<a id="pl.88.5"></a><var>88.5</var>The recommended standards must not require duplicative data gathering, analysis, or <br/>
<a id="pl.88.6"></a><var>88.6</var>reporting by health carriers.<br/>
<a id="pl.88.7"></a><var>88.7</var>    Subd. 2. <b>Exemption.</b> A health carrier that rents a provider network is exempt from <br/>
<a id="pl.88.8"></a><var>88.8</var>this section, unless it is part of a holding company as defined in section 60D.15 that in <br/>
<a id="pl.88.9"></a><var>88.9</var>aggregate exceeds ten percent market share in either the individual or small group market <br/>
<a id="pl.88.10"></a><var>88.10</var>in Minnesota.<br/>
<a id="pl.88.11"></a><var>88.11</var>    Subd. 3. <b>Waiver.</b> A health carrier that has obtained accreditation through the URAC <br/>
<a id="pl.88.12"></a><var>88.12</var>for network management; quality improvement; credentialing; member protection; and <br/>
<a id="pl.88.13"></a><var>88.13</var>utilization management, or has achieved an excellent or commendable level ranking <br/>
<a id="pl.88.14"></a><var>88.14</var>from the National Committee for Quality Assurance (NCQA), shall be deemed to meet <br/>
<a id="pl.88.15"></a><var>88.15</var>the requirements of subdivision 1. Proof of accreditation must be submitted to the <br/>
<a id="pl.88.16"></a><var>88.16</var>commissioner of health in a form prescribed by the commissioner. The commissioner may <br/>
<a id="pl.88.17"></a><var>88.17</var>adopt rules to recognize similar accreditation standards from any entity recognized by <br/>
<a id="pl.88.18"></a><var>88.18</var>the United States Department of Health and Human Services for accreditation of health <br/>
<a id="pl.88.19"></a><var>88.19</var>insurance issuers or health plans.<br/>
<a id="pl.88.20"></a><var>88.20</var>    Subd. 4. <b>Enforcement.</b> The commissioner of health shall enforce this section.<br/>
<br/>
<a id="bill.2.14.0"></a><a id="pl.88.21"></a><var>88.21</var>    Sec. 14. <b>[62K.13] SERVICE AREA REQUIREMENTS.</b><br/>
<a id="pl.88.22"></a><var>88.22</var>(a) Any health carrier that offers an individual or small group health plan, must offer <br/>
<a id="pl.88.23"></a><var>88.23</var>the health plan in a service area that is at least the entire geographic area of a county <br/>
<a id="pl.88.24"></a><var>88.24</var>unless serving a smaller geographic area is necessary, nondiscriminatory, and in the best <br/>
<a id="pl.88.25"></a><var>88.25</var>interest of enrollees. The service area for any individual or small group health plan must <br/>
<a id="pl.88.26"></a><var>88.26</var>be established without regard to racial, ethnic, language, concentrated poverty, or health <br/>
<a id="pl.88.27"></a><var>88.27</var>status-related factors, or other factors that exclude specific high-utilizing, high-cost, or <br/>
<a id="pl.88.28"></a><var>88.28</var>medically underserved populations.<br/>
<a id="pl.88.29"></a><var>88.29</var>(b) If a health carrier that offers an individual or small group health plan requests <br/>
<a id="pl.88.30"></a><var>88.30</var>to serve less than the entire county, the request must be made to the commissioner of <br/>
<a id="pl.88.31"></a><var>88.31</var>health on a form and manner determined by the commissioner and must provide specific <br/>
<a id="pl.88.32"></a><var>88.32</var>data demonstrating that the service area is not discriminatory, is necessary, and is in the <br/>
<a id="pl.88.33"></a><var>88.33</var>best interest of enrollees.<br/>
<a id="pl.88.34"></a><var>88.34</var>(c) The commissioner of health shall enforce this section.<br/>
<br/>
<a id="bill.2.15.0"></a><a id="pl.89.1"></a><var>89.1</var>    Sec. 15. <b>[62K.14] LIMITED-SCOPE PEDIATRIC DENTAL PLANS.</b><br/>
<a id="pl.89.2"></a><var>89.2</var>    (a) Limited-scope pediatric dental plans must be offered to the extent permitted <br/>
<a id="pl.89.3"></a><var>89.3</var>under the Affordable Care Act: (1) on a guaranteed issue and guaranteed renewable basis; <br/>
<a id="pl.89.4"></a><var>89.4</var>(2) with premiums rated on allowable rating factors used for health plans; and (3) without <br/>
<a id="pl.89.5"></a><var>89.5</var>any exclusions or limitations based on preexisting conditions.<br/>
<a id="pl.89.6"></a><var>89.6</var>    (b) Notwithstanding paragraph (a), a health carrier may discontinue a limited scope <br/>
<a id="pl.89.7"></a><var>89.7</var>pediatric dental plan at the end of a plan year if the health carrier provides written <br/>
<a id="pl.89.8"></a><var>89.8</var>notice to enrollees before coverage is to be discontinued that the particular plan is being <br/>
<a id="pl.89.9"></a><var>89.9</var>discontinued and the health carrier offers enrollees other dental plan options that are the <br/>
<a id="pl.89.10"></a><var>89.10</var>same or substantially similar to the dental plan being discontinued in terms of premiums, <br/>
<a id="pl.89.11"></a><var>89.11</var>benefits, cost-sharing requirements, and network adequacy. The written notice to enrollees <br/>
<a id="pl.89.12"></a><var>89.12</var>must be provided at least 105 days before the end of the plan year.<br/>
<a id="pl.89.13"></a><var>89.13</var>(c) Limited-scope pediatric dental plans must ensure primary care dental services <br/>
<a id="pl.89.14"></a><var>89.14</var>are available within 60 miles or 60 minutes' travel time.<br/>
<a id="pl.89.15"></a><var>89.15</var>(d) If a stand-alone dental plan as defined under the Affordable Care Act or a <br/>
<a id="pl.89.16"></a><var>89.16</var>limited-scope pediatric dental plan is offered, either separately or in conjunction with <br/>
<a id="pl.89.17"></a><var>89.17</var>a health plan offered to individuals or small employers, the health plan shall not be <br/>
<a id="pl.89.18"></a><var>89.18</var>considered in noncompliance with the requirements of the essential benefit package in the <br/>
<a id="pl.89.19"></a><var>89.19</var>Affordable Care Act because the health plan does not offer coverage of pediatric dental <br/>
<a id="pl.89.20"></a><var>89.20</var>benefits if these benefits are covered through the stand-alone or limited-scope pediatric <br/>
<a id="pl.89.21"></a><var>89.21</var>dental plan, to the extent permitted under the Affordable Care Act.<br/>
<a id="pl.89.22"></a><var>89.22</var>(e) Health carriers offering limited-scope pediatric dental plans must comply with <br/>
<a id="pl.89.23"></a><var>89.23</var>this section and sections 62K.07, 62K.08, 62K.13, and 62K.15.<br/>
<a id="pl.89.24"></a><var>89.24</var>    (f) The commissioner of commerce shall enforce paragraphs (a) and (b). Any limited <br/>
<a id="pl.89.25"></a><var>89.25</var>scope pediatric dental plan that is to be offered to replace a discontinued dental plan under <br/>
<a id="pl.89.26"></a><var>89.26</var>paragraph (b) must be approved by the commissioner of commerce in terms of cost and <br/>
<a id="pl.89.27"></a><var>89.27</var>benefit similarity, and the commissioner of health in terms of network adequacy similarity. <br/>
<a id="pl.89.28"></a><var>89.28</var>The commissioner of health shall enforce paragraph (c).<br/>
<a id="pl.89.29"></a><var>89.29</var><b>EFFECTIVE DATE.</b>This section is effective for health plans and dental plans that <br/>
<a id="pl.89.30"></a><var>89.30</var>are offered, sold, issued, or renewed on or after January 1, 2014, with the exception of <br/>
<a id="pl.89.31"></a><var>89.31</var>paragraphs (a) and (b), which are effective for health plans and dental plans that are <br/>
<a id="pl.89.32"></a><var>89.32</var>offered, sold, issued, or renewed on or after January 1, 2015.<br/>
<br/>
<a id="bill.2.16.0"></a><a id="pl.89.33"></a><var>89.33</var>    Sec. 16. <b>[62K.15] ANNUAL OPEN ENROLLMENT PERIODS.</b><br/>
<a id="pl.89.34"></a><var>89.34</var>(a) Health carriers offering individual health plans must limit annual enrollment in <br/>
<a id="pl.89.35"></a><var>89.35</var>the individual market to the annual open enrollment periods for the Minnesota Insurance <br/>
<a id="pl.90.1"></a><var>90.1</var>Marketplace. Nothing in this section limits the application of special or limited open <br/>
<a id="pl.90.2"></a><var>90.2</var>enrollment periods as defined under the Affordable Care Act.<br/>
<a id="pl.90.3"></a><var>90.3</var>(b) Health carriers offering individual health plans must inform all applicants at the <br/>
<a id="pl.90.4"></a><var>90.4</var>time of application and enrollees at least annually of the open and special enrollment <br/>
<a id="pl.90.5"></a><var>90.5</var>periods as defined under the Affordable Care Act.<br/>
<a id="pl.90.6"></a><var>90.6</var>(c) The commissioner of commerce shall enforce this section.<br/>
<br/>
<a id="bill.2.17.0"></a><a id="pl.90.7"></a><var>90.7</var>    Sec. 17. <b>EFFECTIVE DATE.</b><br/>
<a id="pl.90.8"></a><var>90.8</var>Sections 1 to 16 are effective for health plans offered, sold, issued, or renewed on or <br/>
<a id="pl.90.9"></a><var>90.9</var>after January 1, 2015, unless otherwise specified.<br/>