SF 4020

Introduction - 94th Legislature (2025 - 2026)

Posted on 03/03/2026 09:11 a.m.

A bill for an act
relating to health insurance; expanding guaranteed issuance of Medicare supplement
policies for enrollees of a Medicare supplement policy that is involuntarily
terminated or issued by an insolvent issuer; amending Minnesota Statutes 2025
Supplement, section 62A.31, subdivision 1u.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2025 Supplement, section 62A.31, subdivision 1u, is
amended to read:

Subd. 1u.

Guaranteed issue for eligible persons.

(a)(1) Eligible persons are those
individuals described in paragraph (b) who seek to enroll under the policy during the period
specified in paragraph (c) and who submit evidence of the date of termination or
disenrollment described in paragraph (b), or of the date of Medicare Part D enrollment, with
the application for a Medicare supplement policy.

(2) With respect to eligible persons, an issuer shall not: deny or condition the issuance
or effectiveness of a Medicare supplement policy described in paragraph (c) that is offered
and is available for issuance to new enrollees by the issuer; discriminate in the pricing of
such a Medicare supplement policy because of health status, claims experience, receipt of
health care, medical condition, or age; or impose an exclusion of benefits based upon a
preexisting condition under such a Medicare supplement policy.

(b) An eligible person is an individual described in any of the following:

(1) the individual is enrolled under an employee welfare benefit plan that provides health
benefits that supplement the benefits under Medicare; and the plan terminates, or the plan
ceases to provide all such supplemental health benefits to the individual;

(2) the individual is enrolled with a Medicare Advantage organization under a Medicare
Advantage plan under Medicare Part C, and any of the following circumstances apply, or
the individual is 65 years of age or older and is enrolled with a Program of All-Inclusive
Care for the Elderly (PACE) provider under section 1894 of the federal Social Security Act,
and there are circumstances similar to those described in this clause that would permit
discontinuance of the individual's enrollment with the provider if the individual were enrolled
in a Medicare Advantage plan:

(i) the organization's or plan's certification under Medicare Part C has been terminated
or the organization has terminated or otherwise discontinued providing the plan in the area
in which the individual resides;

(ii) the individual is no longer eligible to elect the plan because of a change in the
individual's place of residence or other change in circumstances specified by the secretary,
but not including termination of the individual's enrollment on the basis described in section
1851(g)(3)(B) of the federal Social Security Act, United States Code, title 42, section
1395w-21(g)(3)(b) (where the individual has not paid premiums on a timely basis or has
engaged in disruptive behavior as specified in standards under section 1856 of the federal
Social Security Act, United States Code, title 42, section 1395w-26), or the plan is terminated
for all individuals within a residence area;

(iii) the individual demonstrates, in accordance with guidelines established by the
Secretary, that:

(A) the organization offering the plan substantially violated a material provision of the
organization's contract in relation to the individual, including the failure to provide an
enrollee on a timely basis medically necessary care for which benefits are available under
the plan or the failure to provide such covered care in accordance with applicable quality
standards; or

(B) the organization, or agent or other entity acting on the organization's behalf, materially
misrepresented the plan's provisions in marketing the plan to the individual; or

(iv) the individual meets such other exceptional conditions as the secretary may provide;

(3)(i) the individual is enrolled with:

(A) an eligible organization under a contract under section 1876 of the federal Social
Security Act, United States Code, title 42, section 1395mm (Medicare cost);

(B) a similar organization operating under demonstration project authority, effective for
periods before April 1, 1999;

(C) an organization under an agreement under section 1833(a)(1)(A) of the federal Social
Security Act, United States Code, title 42, section 1395l(a)(1)(A) (health care prepayment
plan); or

(D) an organization under a Medicare Select policy under section 62A.318 or the similar
law of another state; and

(ii) the enrollment ceases under the same circumstances that would permit discontinuance
of an individual's election of coverage under clause (2);

(4) the individual is enrolled under a Medicare supplement policy, and the enrollment
ceases because:

(i)(A) of the insolvency of the issuer or bankruptcy of the nonissuer organization; or

(B) of other involuntary termination of coverage or enrollment under the policy;

(ii) the issuer of the policy substantially violated a material provision of the policy; or

(iii) the issuer, or an agent or other entity acting on the issuer's behalf, materially
misrepresented the policy's provisions in marketing the policy to the individual;

(5)(i) the individual was enrolled under a Medicare supplement policy and terminates
that enrollment and subsequently enrolls, for the first time, with any Medicare Advantage
organization under a Medicare Advantage plan under Medicare Part C; any eligible
organization under a contract under section 1876 of the federal Social Security Act, United
States Code, title 42, section 1395mm (Medicare cost); any similar organization operating
under demonstration project authority; any PACE provider under section 1894 of the federal
Social Security Act, or a Medicare Select policy under section 62A.318 or the similar law
of another state; and

(ii) the subsequent enrollment under item (i) is terminated by the enrollee during any
period within the first 12 months of the subsequent enrollment during which the enrollee
is permitted to terminate the subsequent enrollment under section 1851(e) of the federal
Social Security Act;

(6) the individual, upon first enrolling for benefits under Medicare Part B, enrolls in a
Medicare Advantage plan under Medicare Part C, or with a PACE provider under section
1894 of the federal Social Security Act, and disenrolls from the plan by not later than 12
months after the effective date of enrollment;

(7) the individual enrolls in a Medicare Part D plan during the initial Part D enrollment
period, as defined under United States Code, title 42, section 1395ss(v)(6)(D), and, at the
time of enrollment in Part D, was enrolled under a Medicare supplement policy that covers
outpatient prescription drugs and the individual terminates enrollment in the Medicare
supplement policy and submits evidence of enrollment in Medicare Part D along with the
application for a policy described in paragraph (e), clause (4);

(8) the individual was enrolled in a state public program and is losing coverage due to
the unwinding of the Medicaid continuous enrollment conditions, as provided by Code of
Federal Regulations, title 45, section 155.420 (d)(9) and (d)(1), and Public Law 117-328,
section 5131 (2022); or

(9) the individual meets the requirements under subdivision 1r, paragraph (c), and enrolls
during the open enrollment period.

(c)(1) In the case of an individual described in paragraph (b), clause (1), the guaranteed
issue period begins on the later of: (i) the date the individual receives a notice of termination
or cessation of all supplemental health benefits or, if a notice is not received, notice that a
claim has been denied because of a termination or cessation; or (ii) the date that the applicable
coverage terminates or ceases; and ends 63 days after the later of those two dates.

(2) In the case of an individual described in paragraph (b), clause (2), (3), (5), or (6),
whose enrollment is terminated involuntarily, the guaranteed issue period begins on the
date that the individual receives a notice of termination and ends 63 days after the date the
applicable coverage is terminated.

(3) In the case of an individual described in paragraph (b), clause (4), item (i), the
guaranteed issue period begins on the earlier of: (i) the date that the individual receives a
notice of termination, a notice of the issuer's bankruptcy or insolvency, or other such similar
notice if any; and (ii) the date that the applicable coverage is terminated, and ends on the
date that is 63 days after the date the coverage is terminated.

(4) In the case of an individual described in paragraph (b), clause (2), (4), (5), or (6),
who disenrolls voluntarily, the guaranteed issue period begins on the date that is 60 days
before the effective date of the disenrollment and ends on the date that is 63 days after the
effective date.

(5) In the case of an individual described in paragraph (b), clause (7), the guaranteed
issue period begins on the date the individual receives notice pursuant to section
1882(v)(2)(B) of the Social Security Act from the Medicare supplement issuer during the
60-day period immediately preceding the initial Part D enrollment period and ends on the
date that is 63 days after the effective date of the individual's coverage under Medicare Part
D.

(6) In the case of an individual described in paragraph (b) but not described in this
paragraph, the guaranteed issue period begins on the effective date of disenrollment and
ends on the date that is 63 days after the effective date.

(7) For an individual described in paragraph (b), clause (9), the guarantee issue period
is the open enrollment period.

(d)(1) In the case of an individual described in paragraph (b), clause (5), or deemed to
be so described, pursuant to this paragraph, whose enrollment with an organization or
provider described in paragraph (b), clause (5), item (i), is involuntarily terminated within
the first 12 months of enrollment, and who, without an intervening enrollment, enrolls with
another such organization or provider, the subsequent enrollment is deemed to be an initial
enrollment described in paragraph (b), clause (5).

(2) In the case of an individual described in paragraph (b), clause (6), or deemed to be
so described, pursuant to this paragraph, whose enrollment with a plan or in a program
described in paragraph (b), clause (6), is involuntarily terminated within the first 12 months
of enrollment, and who, without an intervening enrollment, enrolls in another such plan or
program, the subsequent enrollment is deemed to be an initial enrollment described in
paragraph (b), clause (6).

(3) For purposes of paragraph (b), clauses (5) and (6), no enrollment of an individual
with an organization or provider described in paragraph (b), clause (5), item (i), or with a
plan or in a program described in paragraph (b), clause (6), may be deemed to be an initial
enrollment under this paragraph after the two-year period beginning on the date on which
the individual first enrolled with the organization, provider, plan, or program.

(e) The Medicare supplement policy to which eligible persons are entitled under:

(1) paragraph (b), clauses (1) to deleted text begin (4) deleted text end new text begin (3) new text end , is any Medicare supplement policy that has a
benefit package consisting of the basic Medicare supplement plan described in section
62A.316, paragraph (a), plus any combination of the three optional riders described in
section 62A.316, paragraph (b), clauses (1) to (3), offered by any issuer;

(2) paragraph (b), clause (5), is the same Medicare supplement policy in which the
individual was most recently previously enrolled, if available from the same issuer, or, if
not so available, any policy described in clause (1) offered by any issuer, except that after
December 31, 2005, if the individual was most recently enrolled in a Medicare supplement
policy with an outpatient prescription drug benefit, a Medicare supplement policy to which
the individual is entitled under paragraph (b), clause (5), is:

(i) the policy available from the same issuer but modified to remove outpatient
prescription drug coverage; or

(ii) at the election of the policyholder, a policy described in clause (4), except that the
policy may be one that is offered and available for issuance to new enrollees that is offered
by any issuer;

(3) paragraph (b), deleted text begin clause deleted text end new text begin clauses (4) and new text end (6), is any Medicare supplement policy offered
by any issuer;

(4) paragraph (b), clause (7), is a Medicare supplement policy that has a benefit package
classified as a basic plan under section 62A.316 if the enrollee's existing Medicare
supplement policy is a basic plan or, if the enrollee's existing Medicare supplement policy
is an extended basic plan under section 62A.315, a basic or extended basic plan at the option
of the enrollee, provided that the policy is offered and is available for issuance to new
enrollees by the same issuer that issued the individual's Medicare supplement policy with
outpatient prescription drug coverage. The issuer must permit the enrollee to retain all
optional benefits contained in the enrollee's existing coverage, other than outpatient
prescription drugs, subject to the provision that the coverage be offered and available for
issuance to new enrollees by the same issuer.

(f)(1) At the time of an event described in paragraph (b), because of which an individual
loses coverage or benefits due to the termination of a contract or agreement, policy, or plan,
the organization that terminates the contract or agreement, the issuer terminating the policy,
or the administrator of the plan being terminated, respectively, shall notify the individual
of the individual's rights under this subdivision, and of the obligations of issuers of Medicare
supplement policies under paragraph (a). The notice must be communicated
contemporaneously with the notification of termination.

(2) At the time of an event described in paragraph (b), because of which an individual
ceases enrollment under a contract or agreement, policy, or plan, the organization that offers
the contract or agreement, regardless of the basis for the cessation of enrollment, the issuer
offering the policy, or the administrator of the plan, respectively, shall notify the individual
of the individual's rights under this subdivision, and of the obligations of issuers of Medicare
supplement policies under paragraph (a). The notice must be communicated within ten
working days of the issuer receiving notification of disenrollment.

(g) Reference in this subdivision to a situation in which, or to a basis upon which, an
individual's coverage has been terminated does not provide authority under the laws of this
state for the termination in that situation or upon that basis.

(h) An individual's rights under this subdivision are in addition to, and do not modify
or limit, the individual's rights under subdivision 1h.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2027.
new text end