SF 4096
Introduction - 94th Legislature (2025 - 2026)
Posted on 03/05/2026 09:24 a.m.
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A bill for an act
relating to health; making changes to provisions covering health maintenance
organizations; amending Minnesota Statutes 2024, sections 62D.02, subdivision
7, by adding a subdivision; 62D.08, subdivisions 5, 6; 62D.09, subdivisions 1, 5;
62D.124, subdivision 6; repealing Minnesota Statutes 2024, sections 62D.08,
subdivision 7; 62D.181.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2024, section 62D.02, subdivision 7, is amended to read:
Subd. 7.
Comprehensive health maintenance services.
"Comprehensive health
maintenance services" means a set of comprehensive health services which the enrollees
might reasonably require to be maintained in good health including as a minimum, but not
limited to, emergency care, emergency ground ambulance transportation services, inpatient
hospital and physician care, outpatient health services and preventive deleted text begin healthdeleted text end new text begin items andnew text end
services.
Sec. 2.
Minnesota Statutes 2024, section 62D.02, is amended by adding a subdivision to
read:
new text begin Subd. 18. new text end
new text begin Service area. new text end
new text begin
"Service area" means the geographic locations in which the
health maintenance organization is approved by the commissioner to sell its health
maintenance organization products. Geographic locations shall be identified according to
recognized political subdivisions such as cities, counties, and townships.
new text end
Sec. 3.
Minnesota Statutes 2024, section 62D.08, subdivision 5, is amended to read:
Subd. 5.
Changes in participating entities; penalty.
Any cancellation or discontinuance
of any contract or agreement listed in section 62D.03, subdivision 4, clause (e), or listed
subsequently in accordance with this subdivision, shall be reported to the commissioner
120 days before the effective date. When the health maintenance organization terminates a
deleted text begin providerdeleted text end new text begin participating entitynew text end for cause, death, disability, or loss of license, the health
maintenance organization must notify the commissioner within ten working days of the
date the health maintenance organization sends out or receives the notice of cancellation,
discontinuance, or termination. Any health maintenance organization which fails to notify
the commissioner within the time periods prescribed in this subdivision shall be subject to
the levy of a fine up to $200 per contract for each day the notice is past due, accruing up to
the date the organization notifies the commissioner of the cancellation or discontinuance.
Any fine levied under this subdivision is subject to the contested case and judicial review
provisions of chapter 14. The levy of a fine does not preclude the commissioner from using
other penalties described in sections 62D.15 to 62D.17.
Sec. 4.
Minnesota Statutes 2024, section 62D.08, subdivision 6, is amended to read:
Subd. 6.
new text begin Quarterly new text end financial statements.
new text begin (a) new text end A health maintenance organization shall
submit to the commissioner unaudited financial statements of the organization for the first
three quarters of the year on forms prescribed by the commissioner. The statements are due
30 days after the end of the quarter and shall be maintained as nonpublic data, as defined
by section 13.02, subdivision 9. Unaudited financial statements for the fourth quarter shall
be submitted at the request of the commissioner.
new text begin
(b) Every health maintenance organization must directly allocate administrative expenses
to specific lines of business or products when such information is available. Remaining
expenses that cannot be directly allocated must be allocated based on other methods, as
recommended by the Advisory Group on Administrative Expenses. Health maintenance
organizations must submit this information, including administrative expenses for dental
services, using the reporting template provided by the commissioner of health.
new text end
new text begin
(c) Every health maintenance organization must allocate investment income based on
cumulative net income over time by business line or product and must submit this
information, including investment income for dental services, using the reporting template
provided by the commissioner of health.
new text end
Sec. 5.
Minnesota Statutes 2024, section 62D.09, subdivision 1, is amended to read:
Subdivision 1.
Marketing requirements.
(a) Any written marketing materials which
may be directed toward potential enrollees and which include a detailed description of
benefits provided by the health maintenance organization shall include a statement of enrollee
information and rights as described in section 62D.07, subdivision 3, clauses (2) and (3).
Prior to any oral marketing presentation, the agent marketing the plan must inform the
potential enrollees that any complaints concerning the material presented should be directed
to the health maintenance organization, the commissioner of health, or, if applicable, the
employer.
(b) Detailed marketing materials must affirmatively disclose all exclusions and limitations
in the organization's services or kinds of services offered to the contracting party, including
but not limited to the following types of exclusions and limitations:
(1) health care services not provided;
(2) health care services requiring co-payments or deductibles paid by enrollees;
(3) the fact that access to health care services does not guarantee access to a particular
new text begin provider or new text end provider type; and
(4) health care services that are or may be provided only by referral of a physician,
advanced practice registered nurse, or physician assistant.
(c) No marketing materials may lead consumers to believe that all health care needs will
be covered. All marketing materials must alert consumers to possible uncovered expenses
with the following language in bold print: "THIS HEALTH CARE PLAN MAY NOT
COVER ALL YOUR HEALTH CARE EXPENSES; READ YOUR CONTRACT
CAREFULLY TO DETERMINE WHICH EXPENSES ARE COVERED." Immediately
following the disclosure required under paragraph (b), clause (3), consumers must be given
a telephone number to use to contact the health maintenance organization for specific
information about access to provider types.
(d) The disclosures required in paragraphs (b) and (c) are not required on billboards or
image, and name identification advertisement.
Sec. 6.
Minnesota Statutes 2024, section 62D.09, subdivision 5, is amended to read:
Subd. 5.
Participating providers.
new text begin (a) new text end Health maintenance organizations shall deleted text begin provide
enrollees with a list of the names and locations of participating providers to whom enrollees
have direct access without referral no later than the effective date of enrollment or date the
evidence of coverage is issued and upon requestdeleted text end new text begin publish an up-to-date, accurate, and complete
provider directory, including information on which providers are accepting new patients,
the provider's location, contact information, specialty, medical group, and any institutional
affiliations, in a manner that is easily accessible to enrollees and potential enrolleesnew text end . Health
maintenance organizations need not provide the names of their employed providers.
new text begin
(b) Upon request, a health maintenance organization shall provide a hard copy of the
provider directory to enrollees or potential enrollees.
new text end
Sec. 7.
Minnesota Statutes 2024, section 62D.124, subdivision 6, is amended to read:
Subd. 6.
Provider network notifications.
new text begin (a) new text end A health maintenance organization must
provide on the organization's website the provider network for each product offered by the
organization, and must update the organization's website at least once a month with any
changes to the organization's provider network, including provider changes from in-network
status to out-of-network status. A health maintenance organization must also provide on
the organization's website, for each product offered by the organization, a list of the current
waivers of the requirements in subdivision 1 or 2, in a format that is easily accessed and
searchable by enrollees and prospective enrollees.
new text begin
(b) Upon notification from an enrollee, a health carrier must reprocess any claim for
services provided by a provider whose status has changed from in-network to out-of-network
as an in-network claim if the service was provided after the network change went into effect
but before the change was posted as required under paragraph (a), unless the health carrier
notified the enrollee of the network change prior to the service being provided. This paragraph
does not apply if the health carrier is able to verify that the health carrier's website displayed
the correct provider network status on the health carrier's website at the time the service
was provided.
new text end
Sec. 8. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes shall renumber the section of Minnesota Statutes listed in column
A with the number listed in column B. The revisor shall also make necessary cross reference
changes consistent with the renumbering.
new text end
|
new text begin
Column A new text end |
new text begin
Column B new text end |
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|
new text begin
62Q.075 new text end |
new text begin
62D.081 new text end |
Sec. 9. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2024, sections 62D.08, subdivision 7; and 62D.181,
new text end
new text begin
are repealed.
new text end
APPENDIX
Repealed Minnesota Statutes: 26-06196
62D.08 ANNUAL REPORT.
Subd. 7.
Consistent administrative expenses and investment income reporting.
(a) Every health maintenance organization must directly allocate administrative expenses to specific lines of business or products when such information is available. Remaining expenses that cannot be directly allocated must be allocated based on other methods, as recommended by the Advisory Group on Administrative Expenses. Health maintenance organizations must submit this information, including administrative expenses for dental services, using the reporting template provided by the commissioner of health.
(b) Every health maintenance organization must allocate investment income based on cumulative net income over time by business line or product and must submit this information, including investment income for dental services, using the reporting template provided by the commissioner of health.
62D.181 INSOLVENCY; MCHA ALTERNATIVE COVERAGE.
Subdivision 1.
Definition.
"Association" means the Minnesota Comprehensive Health Association created in section 62E.10.
Subd. 2.
Eligible individuals.
An individual is eligible for alternative coverage under this section if:
(1) the individual had individual health coverage through a health maintenance organization or community integrated service network, the coverage is no longer available due to the insolvency of the health maintenance organization or community integrated service network, and the individual has not obtained alternative coverage; or
(2) the individual had group health coverage through a health maintenance organization or community integrated service network, the coverage is no longer available due to the insolvency of the health maintenance organization or community integrated service network, and the individual has not obtained alternative coverage.
Subd. 3.
Application and issuance.
If a health maintenance organization or community integrated service network will be liquidated, individuals eligible for alternative coverage under subdivision 2 may apply to the association to obtain alternative coverage. Upon receiving an application and evidence that the applicant was enrolled in the health maintenance organization or community integrated service network at the time of an order for liquidation, the association shall issue policies to eligible individuals, without the limitation on preexisting conditions described in section 62E.14, subdivision 3.
Subd. 4.
Coverage.
Alternative coverage issued under this section must be at least a number two qualified plan, as described in section 62E.06, subdivision 2, or for individuals over age 65, a basic Medicare supplement plan, as described in section 62A.316.
Subd. 5.
Premium.
The premium for alternative coverage issued under this section must not exceed 80 percent of the premium for the comparable coverage offered by the association.
Subd. 6.
Duration.
The duration of alternative coverage issued under this section is:
(1) for individuals eligible under subdivision 2, clause (1), 90 days; and
(2) for individuals eligible under subdivision 2, clause (2), 90 days or the length of time remaining in the group contract with the insolvent health maintenance organization or community integrated service network, whichever is greater.
Subd. 7.
Replacement coverage; limitations.
The association is not obligated to offer replacement coverage under this chapter at the end of the periods specified in subdivision 6. Any continuation obligation arising under this chapter or chapter 62A will cease at the end of the periods specified in subdivision 6.
Subd. 8.
Claims expenses exceeding premiums.
Claims expenses resulting from the operation of this section which exceed premiums received shall be borne by contributing members of the association in accordance with section 62E.11, subdivision 5.
Subd. 9.
Coordination of policies.
If an insolvent health maintenance organization or community integrated service network has insolvency insurance coverage at the time of an order for liquidation, the association may coordinate the benefits of the policy issued under this section with those of the insolvency insurance policy available to the enrollees. The premium level for the combined association policy and the insolvency insurance policy may not exceed those described in subdivision 5.