HF 1963

as introduced - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to insurance; regulating the minimum benefits
of the comprehensive health insurance plan; amending
Minnesota Statutes 2004, section 62E.12.

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

Section 1.

Minnesota Statutes 2004, section 62E.12, is
amended to read:

62E.12 MINIMUM BENEFITS OF COMPREHENSIVE HEALTH INSURANCE
PLAN.

(a) The association through its comprehensive health
insurance plan shall offer policies which provide the benefits
of a number one qualified plan and a number two qualified plan,
except that the maximum lifetime benefit on these plans shall be
$2,800,000; and an extended basic Medicare supplement plan and a
basic Medicare supplement plan as described in sections 62A.31
to 62A.44. The association may also offer a plan that is
identical to a number one and number two qualified plan except
that it has a $2,000 annual deductible and a $2,800,000 maximum
lifetime benefit. The association, subject to the approval of
the commissioner, may also offer plans that are identical to the
number one or number two qualified plan, except that they have
annual deductibles of $5,000 and $10,000, respectively; have
limitations on total annual out-of-pocket expenses equal to
those annual deductibles and therefore cover 100 percent of the
allowable cost of covered services in excess of those annual
deductibles; and have a $2,800,000 maximum lifetime benefit. deleted text begin As
of January 1, 2006, the association shall no longer be required
to offer an extended basic Medicare supplement plan.
deleted text end

(b) The requirement that a policy issued by the association
must be a qualified plan is satisfied if the association
contracts with a preferred provider network and the level of
benefits for services provided within the network satisfies the
requirements of a qualified plan. If the association uses a
preferred provider network, payments to nonparticipating
providers must meet the minimum requirements of section 72A.20,
subdivision 15.

(c) The association shall offer health maintenance
organization contracts in those areas of the state where a
health maintenance organization has agreed to make the coverage
available and has been selected as a writing carrier.

(d) Notwithstanding the provisions of section 62E.06 and
unless those charges are billed by a provider that is part of
the association's preferred provider network, the state plan
shall exclude coverage of services of a private duty nurse other
than on an inpatient basis and any charges for treatment in a
hospital located outside of the state of Minnesota in which the
covered person is receiving treatment for a mental or nervous
disorder, unless similar treatment for the mental or nervous
disorder is medically necessary, unavailable in Minnesota and
provided upon referral by a licensed Minnesota medical
practitioner.