HF 2160

as introduced - 89th Legislature (2015 - 2016) Posted on 04/07/2015 11:12am

A bill for an act
relating to insurance; regulating health plans; amending Minnesota Statutes
2014, sections 62A.04, subdivision 1; 62A.047; 62A.06, by adding a subdivision;
62A.21, subdivision 2a; 62A.65, by adding a subdivision; 62D.105, subdivision
1; 62Q.18, subdivision 7; 62Q.188, subdivision 2.

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

Section 1.

Minnesota Statutes 2014, section 62A.04, subdivision 1, is amended to read:

Subdivision 1.

Reference.

Any reference to "standard provisions" which may
appear in other sections and which refer to accident and sickness or accident and health
insurance shall hereinafter be construed as referring to accident and sickness policy
provisions. new text begin Subdivision 2, clauses (4), (5), (6), (7), (8), (9), (10), and (12); subdivision 3,
clauses (1), (3), (4), (5), (6), and (7); subdivision 6; and subdivision 10 do not apply to
accident and sickness or accident and health insurance that are health plans as defined in
section 62A.011, subdivision 3.
new text end

Sec. 2.

Minnesota Statutes 2014, section 62A.047, is amended to read:

62A.047 CHILDREN'S HEALTH SUPERVISION SERVICES AND
PRENATAL CARE SERVICES.

A policy of individual or group health and accident insurance regulated under this
chapter, or individual or group subscriber contract regulated under chapter 62C, health
maintenance contract regulated under chapter 62D, or health benefit certificate regulated
under chapter 64B, issued, renewed, or continued to provide coverage to a Minnesota
resident, must provide coverage for child health supervision services and prenatal care
services. The policy, contract, or certificate must specifically exempt reasonable and
customary charges for child health supervision services and prenatal care services from a
deductible, co-payment, or other coinsurance or dollar limitation requirement. new text begin Nothing
in this section prohibits a health carrier that has a network of providers from imposing
a deductible, co-payment, or other coinsurance or dollar limitation requirement for
child health supervision services and prenatal care services that are delivered by an
out-of-network provider. new text end This section does not prohibit the use of policy waiting periods
for these services. Minimum benefits may be limited to one visit payable to one provider
for all of the services provided at each visit cited in this section subject to the schedule
set forth in this section. Nothing in this section applies to deleted text begin a commercial health insurance
policy issued as a companion to a health maintenance organization contract, deleted text end a policy
designed primarily to provide coverage payable on a per diem, fixed indemnity, or
nonexpense incurred basis, or a policy that provides only accident coverage. A policy,
contract, or certificate described under this section may not apply to preexisting condition
limitations to individuals under 19 years of age. This section does not apply to individual
coverage under a grandfathered plan.

"Child health supervision services" means pediatric preventive services, appropriate
immunizations, developmental assessments, and laboratory services appropriate to the age
of a child from birth to age six, and appropriate immunizations from ages six to 18, as
defined by Standards of Child Health Care issued by the American Academy of Pediatrics.
Reimbursement must be made for at least five child health supervision visits from birth
to 12 months, three child health supervision visits from 12 months to 24 months, once a
year from 24 months to 72 months.

"Prenatal care services" means the comprehensive package of medical and
psychosocial support provided throughout the pregnancy, including risk assessment,
serial surveillance, prenatal education, and use of specialized skills and technology,
when needed, as defined by Standards for Obstetric-Gynecologic Services issued by the
American College of Obstetricians and Gynecologists.

Sec. 3.

Minnesota Statutes 2014, section 62A.06, is amended by adding a subdivision
to read:

new text begin Subd. 4. new text end

new text begin Electronic applications. new text end

new text begin Notwithstanding subdivision 1, an issuer may
rely on statements provided by the insured in completing an electronic enrollment and
may introduce the electronic record as evidence in any action or proceeding based upon
the policy without delivering or attaching a copy of the insured's application to the policy.
The falsity of any statement made in the electronic enrollment may not bar the right to
recovery unless the false statement materially affected either the acceptance of the risk or
the hazard assumed by the insurer.
new text end

Sec. 4.

Minnesota Statutes 2014, section 62A.21, subdivision 2a, is amended to read:

Subd. 2a.

Continuation privilege.

Every policy described in subdivision 1 shall
contain a provision which permits continuation of coverage under the policy for the
insured's deleted text begin former spouse and deleted text end dependent children deleted text begin upon deleted text end new text begin as defined in section 62Q.01,
subdivision 2a, and former spouse, who were covered on the day before new text end entry of a valid
decree of dissolution of marriage. The coverage shall be continued until the earlier of
the following dates:

(a) the date the insured's former spouse becomes covered under any other group
health plan; or

(b) the date coverage would otherwise terminate under the policy.

If the coverage is provided under a group policy, any required premium contributions
for the coverage shall be paid by the insured on a monthly basis to the group policyholder
for remittance to the insurer. The policy must require the group policyholder to, upon
request, provide the insured with written verification from the insurer of the cost of this
coverage promptly at the time of eligibility for this coverage and at any time during the
continuation period. In no event shall the amount of premium charged exceed 102 percent
of the cost to the plan for such period of coverage for other similarly situated spouses
and dependent children with respect to whom the marital relationship has not dissolved,
without regard to whether such cost is paid by the employer or employee.

Upon request by the insured's deleted text begin former spouse or deleted text end dependent deleted text begin child deleted text end new text begin children and former
spouse, who were covered on the day before entry of a valid decree of dissolution new text end , a health
carrier must provide the instructions necessary to enable the child or former spouse to
elect continuation of coverage.

Sec. 5.

Minnesota Statutes 2014, section 62A.65, is amended by adding a subdivision
to read:

new text begin Subd. 3c. new text end

new text begin Premium rate restrictions. new text end

new text begin (a) No grandfathered plan, as defined under
section 62A.011, subdivision 1b, offered in the individual market to a Minnesota resident
may be renewed unless the premium rate charged is determined in accordance with the
requirements in paragraphs (b) to (j).
new text end

new text begin (b) Premium rates must be no more than 25 percent above and no more than 25
percent below the index rate charged to individuals for the same or similar coverage,
adjusted pro rata for rating periods of less than one year. The premium variations
permitted by this paragraph must be based only upon health status, claims experience,
and occupation. For purposes of this paragraph, health status includes refraining from
tobacco use or other actuarially valid lifestyle factors associated with good health,
provided that the lifestyle factor and its effect upon premium rates have been determined
by the commissioner to be actuarially valid and have been approved by the commissioner.
Variations permitted under this paragraph must not be based upon age or applied
differently at different ages. This paragraph does not prohibit use of a constant percentage
adjustment for factors permitted to be used under this paragraph.
new text end

new text begin (c) Premium rates may vary based upon the ages of covered persons only as
provided in this paragraph. In addition to the variations permitted under paragraph (b),
each health carrier may use an additional premium variation based upon age of up to
plus or minus 50 percent of the index rate.
new text end

new text begin (d) A health carrier may request approval by the commissioner to establish separate
geographic regions determined by the health carrier and to establish separate index rates
for each such region. The commissioner shall grant approval if the following conditions
are met:
new text end

new text begin (1) the geographic regions must be applied uniformly by the health carrier;
new text end

new text begin (2) each geographic region must be composed of no fewer than seven counties that
create a contiguous region; and
new text end

new text begin (3) the health carrier provides actuarial justification acceptable to the commissioner
for the proposed geographic variations in index rates, establishing that the variations are
based upon differences in the cost to the health carrier of providing coverage.
new text end

new text begin (e) Health carriers may use rate cells and must file with the commissioner the rate
cells they use. Rate cells must be based upon the number of adults or children covered
under the policy and may reflect the availability of Medicare coverage. The rates for
different rate cells must not in any way reflect generalized differences in expected costs
between principal insureds and their spouses.
new text end

new text begin (f) In developing its index rates and premiums for a health plan, a health carrier shall
take into account only the following factors:
new text end

new text begin (1) actuarially valid differences in rating factors permitted under paragraphs (b)
and (c); and
new text end

new text begin (2) actuarially valid geographic variations if approved by the commissioner as
provided in paragraph (d).
new text end

new text begin (g) All premium variations must be justified in initial rate filings and upon request of
the commissioner in rate revision filings. All rate variations are subject to approval by
the commissioner.
new text end

new text begin (h) The loss ratio must comply with the requirements for individual health plans
in section 62A.021.
new text end

new text begin (i) The rates must not be approved unless the commissioner has determined that the
rates are reasonable. In determining reasonableness, the commissioner shall consider the
growth rates applied under section 62J.04, subdivision 1, paragraph (b), to the calendar
year or years that the proposed premium rate would be in effect, actuarially valid changes
in risks associated with the enrollee populations, and actuarially valid changes as a result
of statutory changes in Laws 1992, chapter 549.
new text end

new text begin (j) An insurer may, as part of a minimum lifetime loss ratio guarantee filing under
section 62A.02, subdivision 3a, include a rating practices guarantee as provided in this
paragraph. The rating practices guarantee must be in writing and must guarantee that
the policy form will be renewed only with premium rates and premium rating practices
that comply with subdivisions 2, 3a, 4, and 5. The rating practices guarantee must be
accompanied by an actuarial memorandum that demonstrates that the premium rates and
premium rating system used in connection with the policy form will satisfy the guarantee.
The guarantee must guarantee refunds of any excess premiums to policyholders charged
premiums that exceed those permitted under subdivision 2, 3a, 4, or 5. An insurer that
complies with this paragraph in connection with a policy form is exempt from the
requirement of prior approval by the commissioner under paragraphs (d), (g), and (i).
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for all grandfathered plans offered in
the individual market renewed on or after January 1, 2014.
new text end

Sec. 6.

Minnesota Statutes 2014, section 62D.105, subdivision 1, is amended to read:

Subdivision 1.

Requirement.

Every health maintenance contract, which in addition
to covering the enrollee also provides coverage to the deleted text begin spouse and deleted text end dependent children
of the enrollee new text begin and spouse who were covered on the day before entry of a valid decree
of dissolution new text end shall: (1) permit the spouse and dependent children to elect to continue
coverage when the enrollee becomes enrolled for benefits under title XVIII of the Social
Security Act (Medicare); and (2) permit the dependent children to continue coverage when
they cease to be dependent children under the generally applicable requirement of the plan.

Sec. 7.

Minnesota Statutes 2014, section 62Q.18, subdivision 7, is amended to read:

Subd. 7.

Portability of coverage.

Effective July 1, 1994, no health plan company
shall offer, sell, issue, or renew any group health plan that does not, with respect to
individuals who maintain continuous coverage and who qualify under the group's
eligibility requirements:

(1) make coverage available on a guaranteed issue basis;

(2) give full credit for previous continuous coverage against any applicable
preexisting condition limitation or preexisting condition exclusion; and

(3) with respect to a group health plan offered, sold, issued, or renewed to a large
employer, impose preexisting condition limitations or preexisting condition exclusions
except to the extent that would be permitted under chapter 62L if the group sponsor were a
small employer as defined in section 62L.02, subdivision 26.

To the extent that this subdivision conflicts with chapter 62L, chapter 62L governs,
regardless of whether the group sponsor is a small employer as defined in section 62L.02,
except that for group health plans issued to groups that are not small employers, this
subdivision's requirement that the individual have maintained continuous coverage
applies. deleted text begin An individual who has maintained continuous coverage, but would be considered
a late entrant under chapter 62L, may be treated as a late entrant in the same manner under
this subdivision as permitted under chapter 62L.
deleted text end

Sec. 8.

Minnesota Statutes 2014, section 62Q.188, subdivision 2, is amended to read:

Subd. 2.

Flexible benefits plan.

new text begin Except for individual and small groups,
new text end notwithstanding any provision of this chapter, chapter 363A, or any other law to the
contrary, a health plan company may offer, sell, issue, and renew a health plan that is a
flexible benefits plan under this section if the following requirements are satisfied:

(1) the health plan must be offered in compliance with the laws of this state, except
as otherwise permitted in this section;

(2) the health plan must be designed to enable covered persons to better manage
costs and coverage options through the use of co-pays, deductibles, and other cost-sharing
arrangements;

(3) the health plan may modify or exclude any or all coverages of benefits that
would otherwise be required by law, except for maternity benefits and other benefits
required under federal law new text begin and may modify co-pays, deductibles, out-of-pocket maximum
limits, and other cost-sharing arrangements new text end ;

(4) each health plan and plan's premiums must be approved by the commissioner
of health or commerce, whichever is appropriate under section 62Q.01, subdivision 2,
but neither commissioner may disapprove a plan on the grounds of a modification or
exclusion permitted under clause (3); and

(5) prior to the sale of the health plan, the purchaser must be given a written list of
the coverages otherwise required by law that are modified or excluded in the health plan.
The list must include a description of each coverage in the list and indicate whether the
coverage is modified or excluded. If coverage is modified, the list must describe the
modification. The list may, but is not required to, also list any or all coverages otherwise
required by law that are included in the health plan and indicate that they are included.
The health plan company must require that a copy of this written list be provided, prior
to the effective date of the health plan, to each enrollee or employee who is eligible for
health coverage under the plan.