HF 1002

1st Engrossment - 92nd Legislature (2021 - 2022) Posted on 03/22/2021 05:16pm

A bill for an act
relating to health insurance; codifying certain provisions of the Affordable Care
Act; requiring guaranteed issue of individual health plans offered by health plan
companies to Minnesota residents; prohibiting certain unfair discriminatory
practices; amending Minnesota Statutes 2020, sections 62A.04, subdivision 2;
62A.10, by adding a subdivision; 62A.65, subdivision 1, by adding a subdivision;
62D.095, subdivisions 2, 3, 4, 5; 62Q.01, subdivision 2a; 62Q.46; 62Q.677, by
adding a subdivision; 62Q.81; proposing coding for new law in Minnesota Statutes,
chapter 363A.

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

Section 1.

Minnesota Statutes 2020, section 62A.04, subdivision 2, is amended to read:

Subd. 2.

Required provisions.

Except as provided in subdivision 4 each such policy
delivered or issued for delivery to any person in this state shall contain the provisions
specified in this subdivision in the words in which the same appear in this section. The
insurer may, at its option, substitute for one or more of such provisions corresponding
provisions of different wording approved by the commissioner which are in each instance
not less favorable in any respect to the insured or the beneficiary. Such provisions shall be
preceded individually by the caption appearing in this subdivision or, at the option of the
insurer, by such appropriate individual or group captions or subcaptions as the commissioner
may approve.

(1) A provision as follows:

ENTIRE CONTRACT; CHANGES: This policy, including the endorsements and the
attached papers, if any, constitutes the entire contract of insurance. No change in this policy
shall be valid until approved by an executive officer of the insurer and unless such approval
be endorsed hereon or attached hereto. No agent has authority to change this policy or to
waive any of its provisions.

(2) A provision as follows:

TIME LIMIT ON CERTAIN DEFENSES: (a) After two years from the date of issue of
this policy no misstatements, except fraudulent misstatements, made by the applicant in the
application for such policy shall be used to void the policy or to deny a claim for loss incurred
or disability (as defined in the policy) commencing after the expiration of such two year
period.

The foregoing policy provision shall not be so construed as to affect any legal requirement
for avoidance of a policy or denial of a claim during such initial two year period, nor to
limit the application of clauses (1), (2), (3), (4) and (5), in the event of misstatement with
respect to age or occupation or other insurance. A policy which the insured has the right to
continue in force subject to its terms by the timely payment of premium (1) until at least
age 50 or, (2) in the case of a policy issued after age 44, for at least five years from its date
of issue, may contain in lieu of the foregoing the following provisions (from which the
clause in parentheses may be omitted at the insurer's option) under the caption
"INCONTESTABLE":

After this policy has been in force for a period of two years during the lifetime of the
insured (excluding any period during which the insured is disabled), it shall become
incontestable as to the statements contained in the application.

(b) No claim for loss incurred or disability (as defined in the policy) commencing after
two years from the date of issue of this policy shall be reduced or denied on the ground that
a disease or physical condition not excluded from coverage by name or specific description
effective on the date of loss had existed prior to the effective date of coverage of this policy.

(3)(a) Except as required for qualified health plans sold through MNsure to individuals
receiving advance payments of the premium tax credit, a provision as follows:

GRACE PERIOD: A grace period of ..... (insert a number not less than "7" for weekly
premium policies, "10" for monthly premium policies and "31" for all other policies) days
will be granted for the payment of each premium falling due after the first premium, during
which grace period the policy shall continue in force.

A policy which contains a cancellation provision may add, at the end of the above
provision,

subject to the right of the insurer to cancel in accordance with the cancellation provision
hereof.

A policy in which the insurer reserves the right to refuse any renewal shall have, at the
beginning of the above provision,

Unless not less than five days prior to the premium due date the insurer has delivered
to the insured or has mailed to the insured's last address as shown by the records of the
insurer written notice of its intention not to renew this policy beyond the period for which
the premium has been accepted.

(b) For deleted text begin qualified deleted text end new text begin individual and small group new text end health plans deleted text begin sold through MNsure to
individuals receiving advance payments of the premium tax credit deleted text end , a grace period provision
must be included that complies with deleted text begin the Affordable Care Act and is no less restrictive than
the grace period required by the Affordable Care Act deleted text end new text begin section 62A.65, subdivision 2a new text end .

(4) A provision as follows:

REINSTATEMENT: If any renewal premium be not paid within the time granted the
insured for payment, a subsequent acceptance of premium by the insurer or by any agent
duly authorized by the insurer to accept such premium, without requiring in connection
therewith an application for reinstatement, shall reinstate the policy. If the insurer or such
agent requires an application for reinstatement and issues a conditional receipt for the
premium tendered, the policy will be reinstated upon approval of such application by the
insurer or, lacking such approval, upon the forty-fifth day following the date of such
conditional receipt unless the insurer has previously notified the insured in writing of its
disapproval of such application. For health plans described in section 62A.011, subdivision
3, clause (10), an insurer must accept payment of a renewal premium and reinstate the
policy, if the insured applies for reinstatement no later than 60 days after the due date for
the premium payment, unless:

(1) the insured has in the interim left the state or the insurer's service area; or

(2) the insured has applied for reinstatement on two or more prior occasions.

The reinstated policy shall cover only loss resulting from such accidental injury as may
be sustained after the date of reinstatement and loss due to such sickness as may begin more
than ten days after such date. In all other respects the insured and insurer shall have the
same rights thereunder as they had under the policy immediately before the due date of the
defaulted premium, subject to any provisions endorsed hereon or attached hereto in
connection with the reinstatement. Any premium accepted in connection with a reinstatement
shall be applied to a period for which premium has not been previously paid, but not to any
period more than 60 days prior to the date of reinstatement. The last sentence of the above
provision may be omitted from any policy which the insured has the right to continue in
force subject to its terms by the timely payment of premiums (1) until at least age 50, or,
(2) in the case of a policy issued after age 44, for at least five years from its date of issue.

(5) A provision as follows:

NOTICE OF CLAIM: Written notice of claim must be given to the insurer within 20
days after the occurrence or commencement of any loss covered by the policy, or as soon
thereafter as is reasonably possible. Notice given by or on behalf of the insured or the
beneficiary to the insurer at ..... (insert the location of such office as the insurer may designate
for the purpose), or to any authorized agent of the insurer, with information sufficient to
identify the insured, shall be deemed notice to the insurer.

In a policy providing a loss-of-time benefit which may be payable for at least two years,
an insurer may at its option insert the following between the first and second sentences of
the above provision:

Subject to the qualifications set forth below, if the insured suffers loss of time on account
of disability for which indemnity may be payable for at least two years, the insured shall,
at least once in every six months after having given notice of claim, give to the insurer
notice of continuance of said disability, except in the event of legal incapacity. The period
of six months following any filing of proof by the insured or any payment by the insurer
on account of such claim or any denial of liability in whole or in part by the insurer shall
be excluded in applying this provision. Delay in the giving of such notice shall not impair
the insured's right to any indemnity which would otherwise have accrued during the period
of six months preceding the date on which such notice is actually given.

(6) A provision as follows:

CLAIM FORMS: The insurer, upon receipt of a notice of claim, will furnish to the
claimant such forms as are usually furnished by it for filing proofs of loss. If such forms
are not furnished within 15 days after the giving of such notice the claimant shall be deemed
to have complied with the requirements of this policy as to proof of loss upon submitting,
within the time fixed in the policy for filing proofs of loss, written proof covering the
occurrence, the character and the extent of the loss for which claim is made.

(7) A provision as follows:

PROOFS OF LOSS: Written proof of loss must be furnished to the insurer at its said
office in case of claim for loss for which this policy provides any periodic payment contingent
upon continuing loss within 90 days after the termination of the period for which the insurer
is liable and in case of claim for any other loss within 90 days after the date of such loss.
Failure to furnish such proof within the time required shall not invalidate nor reduce any
claim if it was not reasonably possible to give proof within such time, provided such proof
is furnished as soon as reasonably possible and in no event, except in the absence of legal
capacity, later than one year from the time proof is otherwise required.

(8) A provision as follows:

TIME OF PAYMENT OF CLAIMS: Indemnities payable under this policy for any loss
other than loss for which this policy provides periodic payment will be paid immediately
upon receipt of due written proof of such loss. Subject to due written proof of loss, all
accrued indemnities for loss for which this policy provides periodic payment will be paid
..... (insert period for payment which must not be less frequently than monthly) and any
balance remaining unpaid upon the termination of liability will be paid immediately upon
receipt of due written proof.

(9) A provision as follows:

PAYMENT OF CLAIMS: Indemnity for loss of life will be payable in accordance with
the beneficiary designation and the provisions respecting such payment which may be
prescribed herein and effective at the time of payment. If no such designation or provision
is then effective, such indemnity shall be payable to the estate of the insured. Any other
accrued indemnities unpaid at the insured's death may, at the option of the insurer, be paid
either to such beneficiary or to such estate. All other indemnities will be payable to the
insured.

The following provisions, or either of them, may be included with the foregoing provision
at the option of the insurer:

If any indemnity of this policy shall be payable to the estate of the insured, or to an
insured or beneficiary who is a minor or otherwise not competent to give a valid release,
the insurer may pay such indemnity, up to an amount not exceeding $..... (insert an amount
which shall not exceed $1,000), to any relative by blood or connection by marriage of the
insured or beneficiary who is deemed by the insurer to be equitably entitled thereto. Any
payment made by the insurer in good faith pursuant to this provision shall fully discharge
the insurer to the extent of such payment.

Subject to any written direction of the insured in the application or otherwise all or a
portion of any indemnities provided by this policy on account of hospital, nursing, medical,
or surgical services may, at the insurer's option and unless the insured requests otherwise
in writing not later than the time of filing proofs of such loss, be paid directly to the hospital
or person rendering such services; but it is not required that the service be rendered by a
particular hospital or person.

(10) A provision as follows:

PHYSICAL EXAMINATIONS AND AUTOPSY: The insurer at its own expense shall
have the right and opportunity to examine the person of the insured when and as often as it
may reasonably require during the pendency of a claim hereunder and to make an autopsy
in case of death where it is not forbidden by law.

(11) A provision as follows:

LEGAL ACTIONS: No action at law or in equity shall be brought to recover on this
policy prior to the expiration of 60 days after written proof of loss has been furnished in
accordance with the requirements of this policy. No such action shall be brought after the
expiration of three years after the time written proof of loss is required to be furnished.

(12) A provision as follows:

CHANGE OF BENEFICIARY: Unless the insured makes an irrevocable designation
of beneficiary, the right to change of beneficiary is reserved to the insured and the consent
of the beneficiary or beneficiaries shall not be requisite to surrender or assignment of this
policy or to any change of beneficiary or beneficiaries, or to any other changes in this policy.
The first clause of this provision, relating to the irrevocable designation of beneficiary, may
be omitted at the insurer's option.

Sec. 2.

Minnesota Statutes 2020, section 62A.10, is amended by adding a subdivision to
read:

new text begin Subd. 5. new text end

new text begin Prohibition on waiting periods that exceed 90 days. new text end

new text begin (a) For purposes of this
subdivision, "waiting period" means the period that must pass before coverage becomes
effective for an individual who is otherwise eligible to enroll under the terms of a group
health plan.
new text end

new text begin (b) A health carrier offering a group health plan must not apply a waiting period that
exceeds 90 days, with exceptions for the circumstances described in paragraphs (c) to (e).
A health carrier does not violate this subdivision solely because an individual is permitted
to take additional time to elect coverage beyond the end of the 90-day waiting period.
new text end

new text begin (c) If a group health plan conditions eligibility on an employee working full time or
regularly having a specified number of service hours per period, and the plan is unable to
determine whether a newly hired employee is full time or reasonably expected to regularly
work the specific number of hours per period, the plan may take a reasonable period of
time, not to exceed 12 months beginning on any date between the employee's start date and
the first day of the first calendar month after the employee's start date, to determine whether
the employee meets the plan's eligibility condition.
new text end

new text begin (d) If a group health plan conditions eligibility on an employee having completed a
cumulative number of service hours, the cumulative hours-of-service requirement must not
exceed 1,200 hours.
new text end

new text begin (e) An orientation period may be added to the 90-day waiting period if the orientation
period is one month or less. The one-month period is determined by adding one calendar
month and subtracting one calendar day, measured from an employee's start date in a position
that is otherwise eligible for coverage.
new text end

new text begin (f) A group health plan may treat an employee whose employment has terminated and
is later rehired as newly eligible upon rehire and require the rehired employee to meet the
plan's eligibility criteria and waiting period again, if doing so is reasonable under the
circumstances. Treating an employee as rehired is reasonable if the employee has a break
in service of at least 13 weeks, or at least 26 weeks if the employer is an educational
institution.
new text end

Sec. 3.

Minnesota Statutes 2020, section 62A.65, subdivision 1, is amended to read:

Subdivision 1.

Applicability.

No health carrier, as defined in section 62A.011, shall
offer, sell, issue, or renew any individual health plan, as defined in section 62A.011, to a
Minnesota resident except in compliance with this section. deleted text begin This section does not apply to
the Comprehensive Health Association established in section 62E.10. deleted text end new text begin A health carrier must
only offer, sell, issue, or renew individual health plans on a guaranteed issue basis and at a
premium rate that does not vary based on the health status of the individual.
new text end

Sec. 4.

Minnesota Statutes 2020, section 62A.65, is amended by adding a subdivision to
read:

new text begin Subd. 2a. new text end

new text begin Grace period for nonpayment of premium. new text end

new text begin (a) Notwithstanding any other
law to the contrary, an individual health plan may be canceled for nonpayment of premiums,
but must include a grace period as described in this subdivision.
new text end

new text begin (b) The grace period must be three consecutive months. During the grace period, the
health carrier must:
new text end

new text begin (1) pay all claims for services that would have been covered if the premium had been
paid, which are provided to the enrollee during the first month of the grace period, and may
pend claims for services provided to an enrollee in the second and third months of the grace
period; and
new text end

new text begin (2) notify health care providers of the possibility of denied claims when an enrollee is
in the second and third month of the grace period.
new text end

new text begin (c) In order to stop a cancellation, an enrollee must pay all outstanding premiums before
the end of the grace period.
new text end

new text begin (d) If a health plan is canceled under this subdivision, the final day of the enrollment is
the last day of the first month of the three-month grace period.
new text end

Sec. 5.

Minnesota Statutes 2020, section 62D.095, subdivision 2, is amended to read:

Subd. 2.

Co-payments.

A health maintenance contract may impose a co-payment and
coinsurance consistent with deleted text begin the provisions of the Affordable Care Act as defined under
section 62A.011, subdivision 1a deleted text end new text begin state and federal law new text end .

Sec. 6.

Minnesota Statutes 2020, section 62D.095, subdivision 3, is amended to read:

Subd. 3.

Deductibles.

A health maintenance contract may impose a deductible consistent
with deleted text begin the provisions of the Affordable Care Act as defined under section 62A.011, subdivision
1a deleted text end new text begin state and federal law new text end .

Sec. 7.

Minnesota Statutes 2020, section 62D.095, subdivision 4, is amended to read:

Subd. 4.

Annual out-of-pocket maximums.

A health maintenance contract may impose
an annual out-of-pocket maximum consistent with the provisions of deleted text begin the Affordable Care
Act as defined under section 62A.011, subdivision 1a deleted text end new text begin section 62Q.677, subdivision 6a new text end .

Sec. 8.

Minnesota Statutes 2020, section 62D.095, subdivision 5, is amended to read:

Subd. 5.

Exceptions.

No co-payments or deductibles may be imposed on preventive
deleted text begin health care deleted text end new text begin items and new text end services deleted text begin consistent with the provisions of the Affordable Care Act as
defined under section 62A.011, subdivision 1a deleted text end new text begin , as defined in section 62Q.46, subdivision
1 new text end .

Sec. 9.

Minnesota Statutes 2020, section 62Q.01, subdivision 2a, is amended to read:

Subd. 2a.

Dependent child to the limiting age.

"Dependent child to the limiting age"
or "dependent children to the limiting age" means those individuals who are eligible and
covered as a dependent child under the terms of a health plan who have not yet attained 26
years of age. A health plan company must not deny or restrict eligibility for a dependent
child to the limiting age based on financial dependency, residency, marital status, or student
status. For coverage under plans offered by the Minnesota Comprehensive Health
Association, dependent to the limiting age means dependent as defined in section 62A.302,
subdivision 3. Notwithstanding the provisions in this subdivision, a health plan may include:

(1) eligibility requirements regarding the absence of other health plan coverage deleted text begin as
permitted by the Affordable Care Act deleted text end for grandfathered plan coverage; or

(2) an age greater than 26 in its policy, contract, or certificate of coverage.

Sec. 10.

Minnesota Statutes 2020, section 62Q.46, is amended to read:

62Q.46 PREVENTIVE ITEMS AND SERVICES.

Subdivision 1.

Coverage for preventive items and services.

(a) "Preventive items and
services" deleted text begin has the meaning specified in the Affordable Care Act deleted text end new text begin means the items and services
categorized as preventive under subdivision 1a new text end .

(b) A health plan company must provide coverage for preventive items and services at
a participating provider without imposing cost-sharing requirements, including a deductible,
coinsurance, or co-payment. Nothing in this section prohibits a health plan company that
has a network of providers from excluding coverage or imposing cost-sharing requirements
for preventive items or services that are delivered by an out-of-network provider.

(c) A health plan company is not required to provide coverage for any items or services
specified in any recommendation or guideline described in paragraph (a) if the
recommendation or guideline is no longer included as a preventive item or service as defined
in paragraph (a). Annually, a health plan company must determine whether any additional
items or services must be covered without cost-sharing requirements or whether any items
or services are no longer required to be covered.

(d) Nothing in this section prevents a health plan company from using reasonable medical
management techniques to determine the frequency, method, treatment, or setting for a
preventive item or service to the extent not specified in the recommendation or guideline.

(e) This section does not apply to grandfathered plans.

(f) This section does not apply to plans offered by the Minnesota Comprehensive Health
Association.

new text begin Subd. 1a. new text end

new text begin Preventive items and services. new text end

new text begin The commissioner of commerce must provide
health plan companies with information regarding which items and services must be
categorized as preventive.
new text end

Subd. 2.

Coverage for office visits in conjunction with preventive items and
services.

(a) A health plan company may impose cost-sharing requirements with respect to
an office visit if a preventive item or service is billed separately or is tracked separately as
individual encounter data from the office visit.

(b) A health plan company must not impose cost-sharing requirements with respect to
an office visit if a preventive item or service is not billed separately or is not tracked
separately as individual encounter data from the office visit and the primary purpose of the
office visit is the delivery of the preventive item or service.

(c) A health plan company may impose cost-sharing requirements with respect to an
office visit if a preventive item or service is not billed separately or is not tracked separately
as individual encounter data from the office visit and the primary purpose of the office visit
is not the delivery of the preventive item or service.

Subd. 3.

Additional services not prohibited.

Nothing in this section prohibits a health
plan company from providing coverage for preventive items and services in addition to
those specified in deleted text begin the Affordable Care Act deleted text end new text begin subdivision 1a new text end , or from denying coverage for
preventive items and services that are not recommended as preventive items and services
under deleted text begin the Affordable Care Act deleted text end new text begin subdivision 1a new text end . A health plan company may impose
cost-sharing requirements for a treatment not described in deleted text begin the Affordable Care Act deleted text end new text begin
subdivision 1a new text end even if the treatment results from a preventive item or service described in
deleted text begin the Affordable Care Act deleted text end new text begin subdivision 1a new text end .

Sec. 11.

Minnesota Statutes 2020, section 62Q.677, is amended by adding a subdivision
to read:

new text begin Subd. 6a. new text end

new text begin Out-of-pocket annual maximum. new text end

new text begin By October of each year, the commissioner
of commerce must determine the maximum annual out-of-pocket limits applicable to
individual health plans and small group health plans.
new text end

Sec. 12.

Minnesota Statutes 2020, section 62Q.81, is amended to read:

62Q.81 ESSENTIAL HEALTH BENEFIT PACKAGE REQUIREMENTS.

Subdivision 1.

Essential health benefits package.

(a) Health plan companies offering
individual and small group health plans must include the essential health benefits package
deleted text begin required under section 1302(a) of the Affordable Care Act and as deleted text end described in this
subdivision.

(b) The essential health benefits package means new text begin insurance new text end coverage that:

(1) provides new text begin the new text end essential health benefits deleted text begin as outlined in the Affordable Care Act deleted text end new text begin described
in subdivision 4 new text end ;

(2) limits cost-sharing for deleted text begin such deleted text end new text begin the new text end coverage deleted text begin in accordance with the Affordable Care
Act deleted text end , as described in subdivision 2; and

(3) deleted text begin subject to subdivision 3, deleted text end provides bronze, silver, gold, or platinum level of coverage
deleted text begin in accordance with the Affordable Care Act deleted text end new text begin , as described in subdivision 3 new text end .

Subd. 2.

new text begin Cost-sharing; new text end coverage for enrollees under the age of 21.

new text begin (a) Cost-sharing
includes (1) deductibles, coinsurance, co-payments, or similar charges, and (2) qualified
medical expenses, as defined in section 223(d)(2) of the Internal Revenue Code of 1986,
as amended. Cost-sharing does not include premiums, balance billing from non-network
providers, or spending for noncovered services.
new text end

new text begin (b) Cost-sharing per year for individual health plans is limited to the amount allowed
under section 223(c)(2)(A)(ii) of the Internal Revenue Code of 1986, as amended, increased
by an amount equal to the product of that amount and the premium adjustment percentage.
The premium adjustment percentage is the percentage that the average per capita premium
for health insurance coverage in the United States for the preceding calendar year exceeds
the average per capita premium for 2017. If the amount of the increase is not a multiple of
$50, the increases must be rounded to the next lowest multiple of $50.
new text end

new text begin (c) Cost-sharing per year for small group health plans is limited to twice the amount
allowed under paragraph (b).
new text end

new text begin (d) new text end If a health plan company offers health plans in any level of coverage deleted text begin specified under
section 1302(d) of the Affordable Care Act, as deleted text end described in subdivision deleted text begin 1, paragraph (b),
clause (3) deleted text end new text begin 3 new text end , the health plan company shall also offer coverage in that level to individuals
who have not attained 21 years of age as of the beginning of a policy year.

Subd. 3.

new text begin Levels of coverage; new text end alternative compliance for catastrophic plans.

new text begin (a) A
health plan in the bronze level must provide a level of coverage designed to provide benefits
that are actuarially equivalent to 60 percent of the full actuarial value of the benefits provided
under the plan.
new text end

new text begin (b) A health plan in the silver level must provide a level of coverage designed to provide
benefits that are actuarially equivalent to 70 percent of the full actuarial value of the benefits
provided under the plan.
new text end

new text begin (c) A health plan in the gold level must provide a level of coverage designed to provide
benefits that are actuarially equivalent to 80 percent of the full actuarial value of the benefits
provided under the plan.
new text end

new text begin (d) A health plan in the platinum level must provide a level of coverage designed to
provide benefits that are actuarially equivalent to 90 percent of the full actuarial value of
the benefits provided under the plan.
new text end

new text begin (e) new text end A health plan company that does not provide an individual or small group health
plan in the bronze, silver, gold, or platinum level of coverage deleted text begin , as described in subdivision
1, paragraph (b), clause (3), shall be treated as meeting deleted text end new text begin meets new text end the requirements of new text begin this new text end section
deleted text begin 1302(d) of the Affordable Care Act deleted text end with respect to any deleted text begin policy deleted text end new text begin plan new text end year if the health plan
company provides a catastrophic plan that meets the new text begin following new text end requirements deleted text begin of section
1302(e) of the Affordable Care Act. deleted text end new text begin :
new text end

new text begin (1) enrollment in the health plan is limited only to individuals that:
new text end

new text begin (i) have not attained age 30 before the beginning of the plan year;
new text end

new text begin (ii) are unable to access affordable coverage; or
new text end

new text begin (iii) are experiencing a hardship in reference to the individual's capability to access
coverage; and
new text end

new text begin (2) the health plan provides:
new text end

new text begin (i) essential health benefits, except that the plan does not provide benefits for any plan
year until the individual has incurred cost-sharing expenses in an amount equal to the
limitation in effect under subdivision 2; and
new text end

new text begin (ii) coverage for at least three primary care visits.
new text end

Subd. 4.

Essential health benefits; definition.

new text begin (a) new text end For purposes of this section, "essential
health benefits" deleted text begin has the meaning given under section 1302(b) of the Affordable Care Act
and includes deleted text end new text begin means new text end :

(1) ambulatory patient services;

(2) emergency services;

(3) hospitalization;

(4) laboratory services;

(5) maternity and newborn care;

(6) mental health and substance use disorder services, including behavioral health
treatment;

(7) pediatric services, including oral and vision care;

(8) prescription drugs;

(9) preventive and wellness services and chronic disease management;

(10) rehabilitative and habilitative services and devices; and

(11) additional essential health benefits included in the deleted text begin EHB-benchmark plan, as defined
under the Affordable Care Act deleted text end new text begin health plan described in paragraph (c) new text end .

new text begin (b) If a service provider does not have a contractual relationship with the health plan to
provide services, emergency services must be provided without imposing any prior
authorization requirement or limitation on coverage that is more restrictive than the
requirements or limitations that apply to emergency services received from providers who
have a contractual relationship with the health plan. If services are provided out-of-network,
the cost-sharing must be equivalent to services provided in-network.
new text end

new text begin (c) The scope of essential health benefits under paragraph (a) must be equal to the scope
of benefits provided under a typical employer plan.
new text end

new text begin (d) Essential health benefits must:
new text end

new text begin (1) reflect an appropriate balance among the categories to ensure benefits are not unduly
weighted toward any category;
new text end

new text begin (2) not make coverage decisions, determine reimbursement rates, establish incentive
programs, or design benefits in a manner that discriminates against individuals on the basis
of age, disability, or expected length of life;
new text end

new text begin (3) account for the health care needs of diverse segments of the population, including
women, children, persons with disabilities, and other groups; and
new text end

new text begin (4) ensure that health benefits established as essential are not subject to denial against
the individual's wishes on the basis of the individual's age or expected length of life or of
the individual's present or predicted disability, degree of medical dependency, or quality of
life.
new text end

Subd. 5.

Exception.

This section does not apply to a dental plan deleted text begin described in section
1311(d)(2)(B)(ii) of the Affordable Care Act deleted text end new text begin that is limited in scope and provides pediatric
dental benefits new text end .

Sec. 13.

new text begin [363A.115] UNFAIR DISCRIMINATORY PRACTICES RELATED TO
HEALTH CARE.
new text end

new text begin (a) It is an unfair discriminatory practice for an individual to be excluded from
participation in, be denied the benefits of, or be subjected to discrimination on the basis of
race, color, creed, religion, disability, national origin, marital status, sexual orientation, or
sex by any health program or health insurance provider if any part of the health care program
receives federal financial assistance or is administered by a state or federal agency, or by
any health insurance provider that provides insurance through a state or federal marketplace.
new text end

new text begin (b) An entity covered under this section is required to: (1) make all programs and activities
provided through electronic and information technology accessible; (2) ensure the physical
accessibility of newly constructed or altered facilities; and (3) provide appropriate auxiliary
aids and services to individuals with disabilities. Entities covered under this section must
take reasonable steps to provide meaningful access to each individual with limited English
proficiency and provide information about language assistance services.
new text end

Sec. 14. new text begin COMMISSIONER OF COMMERCE; DETERMINATION OF
PREVENTIVE ITEMS AND SERVICES.
new text end

new text begin (a) The commissioner of commerce must determine the items and services that are
preventive under Minnesota Statutes, section 62Q.46, subdivision 1a. Items and services
that are preventive must include:
new text end

new text begin (1) evidence-based items or services that have in effect a rating of A or B pursuant to
the recommendations of the United States Preventive Services Task Force in effect January
1, 2021, and with respect to the individual involved;
new text end

new text begin (2) immunizations for routine use in children, adolescents, and adults that have in effect
a recommendation from the Advisory Committee on Immunization Practices of the Centers
for Disease Control and Prevention with respect to the individual involved. For the purposes
of this clause, a recommendation from the Advisory Committee on Immunization Practices
of the Centers for Disease Control and Prevention is considered in effect after it has been
adopted by the Director of the Centers for Disease Control and Prevention and a
recommendation is considered to be for routine use if it is listed on the Immunization
Schedules of the Centers for Disease Control and Prevention;
new text end

new text begin (3) with respect to infants, children, and adolescents, evidence-informed preventive care
and screenings provided for in comprehensive guidelines supported by the Health Resources
and Services Administration; and
new text end

new text begin (4) with respect to women, additional preventive care and screenings not described in
clause (1), as provided for in comprehensive guidelines supported by the Health Resources
and Services Administration.
new text end

Sec. 15. new text begin EFFECTIVE DATE.
new text end

new text begin Sections 1 to 13 are effective January 1, 2022, for health plans offered, issued, or renewed
on or after that date.
new text end