HF 686

as introduced - 79th Legislature (1995 - 1996) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act
  1.2             relating to health; MinnesotaCare; providing 
  1.3             portability of coverage into the comprehensive health 
  1.4             association; facilitating use of the small employer 
  1.5             market by employers with two related employees; 
  1.6             regulating premium billing practices that facilitate 
  1.7             discrimination; permitting MinnesotaCare family 
  1.8             coverage for families of certain children; amending 
  1.9             Minnesota Statutes 1994, sections 62E.14, subdivision 
  1.10            3; 62L.02, subdivision 26; 62L.03, subdivision 3; 
  1.11            62L.08, by adding a subdivision; and 256.9354, 
  1.12            subdivision 4. 
  1.13  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.14     Section 1.  Minnesota Statutes 1994, section 62E.14, 
  1.15  subdivision 3, is amended to read: 
  1.16     Subd. 3.  [PREEXISTING CONDITIONS.] No person who obtains 
  1.17  coverage pursuant to this section shall be covered for any 
  1.18  preexisting condition during the first six months of coverage 
  1.19  under the state plan if the person was diagnosed or treated for 
  1.20  that condition during the 90 days immediately preceding the 
  1.21  filing of an application except as provided under subdivisions 
  1.22  4, 5, and 6.  The association shall credit, against any 
  1.23  permitted preexisting condition limitation, time spent under 
  1.24  continuous coverage as defined under section 62L.02, subdivision 
  1.25  9. 
  1.26     Sec. 2.  Minnesota Statutes 1994, section 62L.02, 
  1.27  subdivision 26, is amended to read: 
  1.28     Subd. 26.  [SMALL EMPLOYER.] (a) "Small employer" means a 
  1.29  person, firm, corporation, partnership, limited liability 
  2.1   company, association, or other entity actively engaged in 
  2.2   business, including a political subdivision of the state, that, 
  2.3   on at least 50 percent of its working days during the preceding 
  2.4   12 months, employed no fewer than two nor more than 29, or after 
  2.5   June 30, 1995, more than 49, current employees, the majority of 
  2.6   whom were employed in this state.  If an employer has only two 
  2.7   eligible employees and one is the spouse, child, sibling, 
  2.8   parent, or grandparent of the other, the employer must be a 
  2.9   Minnesota domiciled employer and either have paid social 
  2.10  security or self-employment tax on behalf of both eligible 
  2.11  employees, or have filed a tax return as a partnership or 
  2.12  limited liability company with respect to that business for the 
  2.13  most recent tax year, showing those two employees as partners or 
  2.14  members.  If an employer has only one eligible employee who has 
  2.15  not waived coverage, the sale of a health plan to or for that 
  2.16  eligible employee is not a sale to a small employer and is not 
  2.17  subject to this chapter and may be treated as the sale of an 
  2.18  individual health plan.  A small employer plan may be offered 
  2.19  through a domiciled association to self-employed individuals and 
  2.20  small employers who are members of the association, even if the 
  2.21  self-employed individual or small employer has fewer than two 
  2.22  current employees.  Entities that are eligible to file a 
  2.23  combined tax return for purposes of state tax laws are 
  2.24  considered a single employer for purposes of determining the 
  2.25  number of current employees.  Small employer status must be 
  2.26  determined on an annual basis as of the renewal date of the 
  2.27  health benefit plan.  The provisions of this chapter continue to 
  2.28  apply to an employer who no longer meets the requirements of 
  2.29  this definition until the annual renewal date of the employer's 
  2.30  health benefit plan.  
  2.31     (b) Where an association, described in section 62A.10, 
  2.32  subdivision 1, comprised of employers contracts with a health 
  2.33  carrier to provide coverage to its members who are small 
  2.34  employers, the association shall be considered to be a small 
  2.35  employer, with respect to those employers in the association 
  2.36  that employ no fewer than two nor more than 29, or after June 
  3.1   30, 1995, more than 49, current employees, even though the 
  3.2   association provides coverage to its members that do not qualify 
  3.3   as small employers.  An association in existence prior to July 
  3.4   1, 1993, is exempt from this chapter with respect to small 
  3.5   employers that are members as of that date.  However, in 
  3.6   providing coverage to new employers after July 1, 1993, the 
  3.7   existing association must comply with all requirements of this 
  3.8   chapter.  Existing associations must register with the 
  3.9   commissioner of commerce prior to July 1, 1993.  With respect to 
  3.10  small employers having not fewer than 30 nor more than 49 
  3.11  current employees, the July 1, 1993, date in this paragraph 
  3.12  becomes July 1, 1995, and the reference to "after" that date 
  3.13  becomes "on or after." 
  3.14     (c) If an employer has employees covered under a trust 
  3.15  specified in a collective bargaining agreement under the federal 
  3.16  Labor-Management Relations Act of 1947, United States Code, 
  3.17  title 29, section 141, et seq., as amended, or employees whose 
  3.18  health coverage is determined by a collective bargaining 
  3.19  agreement and, as a result of the collective bargaining 
  3.20  agreement, is purchased separately from the health plan provided 
  3.21  to other employees, those employees are excluded in determining 
  3.22  whether the employer qualifies as a small employer.  Those 
  3.23  employees are considered to be a separate small employer if they 
  3.24  constitute a group that would qualify as a small employer in the 
  3.25  absence of the employees who are not subject to the collective 
  3.26  bargaining agreement. 
  3.27     Sec. 3.  Minnesota Statutes 1994, section 62L.03, 
  3.28  subdivision 3, is amended to read: 
  3.29     Subd. 3.  [MINIMUM PARTICIPATION AND CONTRIBUTION.] (a) A 
  3.30  small employer that has at least 75 percent of its eligible 
  3.31  employees who have not waived coverage participating in a health 
  3.32  benefit plan and that contributes at least 50 percent toward the 
  3.33  cost of coverage of each eligible employees employee must be 
  3.34  guaranteed coverage on a guaranteed issue basis from any health 
  3.35  carrier participating in the small employer market.  The 
  3.36  participation level of eligible employees must be determined at 
  4.1   the initial offering of coverage and at the renewal date of 
  4.2   coverage.  A health carrier must not increase the participation 
  4.3   requirements applicable to a small employer at any time after 
  4.4   the small employer has been accepted for coverage.  For the 
  4.5   purposes of this subdivision, waiver of coverage includes only 
  4.6   waivers due to:  (1) coverage under another group health plan; 
  4.7   (2) coverage under Medicare Parts A and B; or (3) coverage under 
  4.8   MCHA permitted under section 62E.141.  For purposes of this 
  4.9   subdivision, "the cost of coverage" means the cost of coverage 
  4.10  for the employee-only rate cell permitted under section 62L.08, 
  4.11  subdivision 6, and must not vary based upon other rating 
  4.12  factors, whether permitted under section 62L.08 with respect to 
  4.13  the entire group or not. 
  4.14     (b) If a small employer does not satisfy the contribution 
  4.15  or participation requirements under this subdivision, a health 
  4.16  carrier may voluntarily issue or renew individual health plans, 
  4.17  or a health benefit plan which must fully comply with this 
  4.18  chapter.  A health carrier that provides a health benefit plan 
  4.19  to a small employer that does not meet the contribution or 
  4.20  participation requirements of this subdivision must maintain 
  4.21  this information in its files for audit by the commissioner.  A 
  4.22  health carrier may not offer an individual health plan, 
  4.23  purchased through an arrangement between the employer and the 
  4.24  health carrier, to any employee unless the health carrier also 
  4.25  offers the individual health plan, on a guaranteed issue basis, 
  4.26  to all other employees of the same employer. 
  4.27     (c) Nothing in this section obligates a health carrier to 
  4.28  issue coverage to a small employer that currently offers 
  4.29  coverage through a health benefit plan from another health 
  4.30  carrier, unless the new coverage will replace the existing 
  4.31  coverage and not serve as one of two or more health benefit 
  4.32  plans offered by the employer. 
  4.33     Sec. 4.  Minnesota Statutes 1994, section 62L.08, is 
  4.34  amended by adding a subdivision to read: 
  4.35     Subd. 12.  [LIST BILLING PROHIBITED.] No health carrier 
  4.36  shall provide to a small employer a bill for, or itemization of, 
  5.1   the premium that lists the portion of the premium attributable 
  5.2   to particular employees, dependents, or families.  This 
  5.3   subdivision does not prohibit providing a bill or itemization 
  5.4   that shows the premium rate that applies to each covered 
  5.5   employee, based solely upon the rate cells permitted under 
  5.6   subdivision 6. 
  5.7      Sec. 5.  Minnesota Statutes 1994, section 256.9354, 
  5.8   subdivision 4, is amended to read: 
  5.9      Subd. 4.  [FAMILIES WITH CHILDREN; ELIGIBILITY BASED ON 
  5.10  PERCENTAGE OF INCOME PAID FOR HEALTH COVERAGE.] Beginning 
  5.11  January 1, 1993, "eligible persons" means children, parents, and 
  5.12  dependent siblings residing in the same household who are not 
  5.13  eligible for medical assistance without a spenddown under 
  5.14  chapter 256B.  Children who meet the criteria in subdivision 1 
  5.15  shall continue to be enrolled pursuant to subdivision 1.  
  5.16  Persons who are eligible under this subdivision or subdivision 
  5.17  2, 3, or 5 must pay a premium as determined under sections 
  5.18  256.9357 and 256.9358, and children eligible under subdivision 1 
  5.19  must pay the premium required under section 256.9356, 
  5.20  subdivision 1.  Individuals and families whose income is greater 
  5.21  than the limits established under section 256.9358 may not 
  5.22  enroll in MinnesotaCare.  For purposes of this section, members 
  5.23  of a household are eligible as a family if the only reason for 
  5.24  ineligibility is that an otherwise eligible child is enrolled in 
  5.25  the Minnesota comprehensive health association and will not be 
  5.26  enrolled in the MinnesotaCare program; "child" for this purpose 
  5.27  includes a child of any age who is handicapped and meets the 
  5.28  eligibility criteria provided in section 62A.14, subdivision 2. 
  5.29     Sec. 6.  [STUDY; GUARANTEED ISSUE AND PORTABILITY.] 
  5.30     (a) The Minnesota health care commission shall study: 
  5.31     (1) whether integrated service networks should be required 
  5.32  to provide guaranteed issue coverage in the individual market, 
  5.33  with appropriate risk adjustment, prior to the time that 
  5.34  requirement applies to other health plan companies; and 
  5.35     (2) whether portability in the individual market should be 
  5.36  extended to require guaranteed issue to persons who have had 
  6.1   continuous coverage for at least one year, with appropriate 
  6.2   safeguards to protect against abuse of the privilege.  The 
  6.3   commission shall identify categories of persons who might have a 
  6.4   particular need for this privilege, such as persons who no 
  6.5   longer live or work in their previous health plan service area. 
  6.6      (b) The Minnesota health care commission shall report its 
  6.7   conclusions and recommendations to the legislature, in 
  6.8   compliance with Minnesota Statutes, section 3.195, no later than 
  6.9   January 15, 1996. 
  6.10     Sec. 7.  [EFFECTIVE DATE.] 
  6.11     Section 1 is effective July 1, 1996, and applies to 
  6.12  coverage issued or renewed on or after that date.  Sections 2 to 
  6.13  4 are effective January 1, 1996, and apply to coverage issued or 
  6.14  renewed on or after that date.  Section 5 is effective July 1, 
  6.15  1995.  Section 6 is effective the day following final enactment.