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Minnesota Legislature

Office of the Revisor of Statutes

HF 2639

as introduced - 91st Legislature (2019 - 2020) Posted on 03/21/2019 02:31pm

KEY: stricken = removed, old language.
underscored = added, new language.

Current Version - as introduced

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A bill for an act
relating to insurance; health; modifying requirements for health insurance
underwriting, renewability, and benefits; creating the Minnesota health risk pool
program; allowing the creation of unified personal health premium accounts;
creating the Minnesota health contribution program; eliminating certain health
plan market rules; requesting waivers;amending Minnesota Statutes 2018, sections
3.971, subdivision 6; 13.7191, by adding a subdivision; 60A.235, by adding a
subdivision; 62A.65, subdivisions 3, 5, by adding a subdivision; 62L.03, subdivision
3, by adding a subdivision; 62L.08, subdivision 7, by adding a subdivision; 62Q.18,
subdivision 10; 62V.05, subdivision 3; 290.0132, by adding a subdivision; 297I.05,
subdivisions 1, 5; proposing coding for new law in Minnesota Statutes, chapters
62A; 62K; 62Q; 256L; proposing coding for new law as Minnesota Statutes,
chapters 62W; 62X; repealing Minnesota Statutes 2018, sections 62A.303; 62A.65,
subdivision 2; 62K.01; 62K.02; 62K.03; 62K.04; 62K.05; 62K.06; 62K.07;
62K.075; 62K.08; 62K.09; 62K.10, subdivisions 1, 1a, 2, 3, 4, 5, 6, 7, 8; 62K.11;
62K.12; 62K.13; 62K.14; 62K.15; 62L.08, subdivision 4; 62L.12, subdivisions 3,
4.

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

ARTICLE 1

HEALTH INSURANCE REFORM

Section 1.

Minnesota Statutes 2018, section 60A.235, is amended by adding a subdivision
to read:


new text begin Subd. 3b. new text end

new text begin Mid-sized group coverage. new text end

new text begin Notwithstanding subdivision 3, aggregate
attachment points under that subdivision are also subject to the maximums described in this
subdivision. A group of persons between:
new text end

new text begin (1) 50 and 74 has a maximum specific attachment point of $30,000; and
new text end

new text begin (2) 75 and 100 has a maximum specific attachment point of $40,000.
new text end

Sec. 2.

new text begin [62A.101] MID-SIZED GROUP HEALTH INSURANCE RATES.
new text end

new text begin Subdivision 1. new text end

new text begin General premium variations. new text end

new text begin Every health carrier must offer premium
rates to groups with between 50 and 100 persons that are no more than 25 percent above
and no more than 25 percent below the index rate charged to similar sized groups for the
same or similar coverage, adjusted pro rata for rating periods of less than one year. The
premium variations permitted by this subdivision must be based only upon health status
and claims experience. This subdivision does not prohibit use of a constant percentage
adjustment for factors permitted under this subdivision.
new text end

new text begin Subd. 2. new text end

new text begin Limit on renewal premium increases. new text end

new text begin The percentage increase in the premium
rate charged to a group with between 50 and 100 persons for a new rating period must not
exceed 15 percent annually plus inflationary trend, adjusted pro rata for rating periods of
less than one year.
new text end

Sec. 3.

Minnesota Statutes 2018, section 62A.65, is amended by adding a subdivision to
read:


new text begin Subd. 2a. new text end

new text begin Nonrenewal of risk pools. new text end

new text begin A health carrier offering individual health plans
may not renew an individual health plan risk pool issued before January 1, 2020.
new text end

Sec. 4.

Minnesota Statutes 2018, section 62A.65, subdivision 3, is amended to read:


Subd. 3.

Premium rate restrictions.

No individual health plan may be offered, sold,
issued, or renewed to a Minnesota resident unless the premium rate charged is determined
in accordance with the following requirements:

(a) Premium rates may vary based upon the ages of covered persons in accordance with
the provisions of the Affordable Care Act.

(b) Premium rates may vary based upon geographic rating area. The commissioner shall
grant approval if the following conditions are met:

(1) the areas are established in accordance with the Affordable Care Act;

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

(3) the health carrier provides actuarial justification acceptable to the commissioner for
the proposed geographic variations in premium rates for each area, establishing that the
variations are based upon differences in the cost to the health carrier of providing coverage.

(c) Premium rates may vary based upon tobacco use, in accordance with the provisions
of the Affordable Care Act.

(d)new text begin Premium rates must be no more than 25 percent above and no more than 25 percent
below the standard rate charged to individuals for the same or similar coverage, adjusted
pro rata for rating periods of less than one year.
new text end

new text begin (e)new text end In developing its premiums for a health plan, a health carrier shall take into account
deleted text begin only the following factorsdeleted text end:

(1) actuarially valid differences in rating factors permitted under paragraphs (a) deleted text beginanddeleted text endnew text begin,new text end
(c)deleted text begin;deleted text endnew text begin,new text end andnew text begin (d); and
new text end

(2) actuarially valid geographic variations if approved by the commissioner as provided
in paragraph (b).

deleted text begin (e)deleted text endnew text begin (f)new text end The premium charged with respect to any particular individual health plan shall
not be adjusted more frequently than annually or January 1 of the year following initial
enrollment, except that the premium rates may be changed to reflect:

(1) changes to the family composition of the policyholder;

(2) changes in geographic rating area of the policyholder, as provided in paragraph (b);

(3) changes in age, as provided in paragraph (a);

(4) changes in tobacco use, as provided in paragraph (c);

(5) transfer to a new health plannew text begin, reunderwriting, or enhanced coverage asnew text end requested by
the policyholder; or

(6) other changes new text beginas provided under paragraph (d), or new text endrequired by or otherwise expressly
permitted by state or federal law or regulations.

deleted text begin (f)deleted text endnew text begin (g)new text end 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.

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

deleted text begin (h)deleted text endnew text begin (i)new text end 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 and actuarially valid changes in
risks associated with the enrollee populations.

deleted text begin (i)deleted text endnew text begin (j)new text end A health carrier 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 offered, sold, issued, and renewed only with premium rates and
premium rating practices that comply with subdivisions 2, 3, 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, 3, 4, or
5. A health carrier that complies with this paragraph in connection with a policy form is
exempt from the requirement of prior approval by the commissioner under paragraphs (b),
deleted text begin (f),deleted text endnew text begin (g),new text end and deleted text begin(h)deleted text endnew text begin (i)new text end.

deleted text begin (j)deleted text endnew text begin (k)new text end The commissioner may establish regulations to implement the provisions of this
subdivision.

Sec. 5.

Minnesota Statutes 2018, section 62A.65, subdivision 5, is amended to read:


Subd. 5.

Portability and conversion of coverage.

(a) For plan years beginning on or
after January 1, deleted text begin2014deleted text endnew text begin 2020new text end, no individual health plan may be offered, sold, issued, or
renewed, to a Minnesota resident that contains a preexisting condition limitation, preexisting
condition exclusion, or exclusionary ridernew text begin, unless the limitation or exclusion is permitted
under this subdivision or chapter 62L
new text end. An individual deleted text beginage 19 or older may be subjected to
an 18-month preexisting condition limitation during plan years beginning prior to January
1, 2014
deleted text endnew text begin who obtains coverage under this section may be subject to a preexisting condition
limitation during the first 12 months of coverage if the individual was diagnosed or treated
for that condition during the six months immediately preceding the date the application for
coverage was received
new text end, unless the individual has maintained continuous coverage as defined
in section 62L.02. The individual must not be subjected to an exclusionary rider. deleted text beginDuring
plan years beginning prior to January 1, 2014,
deleted text end An individual deleted text beginwho is age 19 or older anddeleted text end
who has maintained continuous coverage may be subjected to a onetime preexisting condition
limitation of up to 12 months, with credit for time covered under qualifying coverage as
defined in section 62L.02,new text begin without a break of 63 days or more,new text end at the time that the individual
first is covered under an individual health plan by any health carrier. Credit must be given
for all qualifying coverage with respect to all preexisting conditions, regardless of whether
the conditions were preexisting with respect to any previous qualifying coverage. The
individual must not be subjected to an exclusionary rider. Thereafter, the individual deleted text beginwho is
age 19 or older
deleted text end must not be subject to any preexisting condition limitation, preexisting
condition exclusion, or exclusionary rider under an individual health plan by any health
carrier, except an unexpired portion of a limitation under prior coverage, so long as the
individual maintains continuous coverage as defined in section 62L.02. deleted text beginThe prohibition on
preexisting condition limitations for children age 18 or under does not apply to individual
health plans that are grandfathered plans. The prohibition on preexisting condition limitations
for adults age 19 and over beginning for plan years on or after January 1, 2014, does not
apply to individual health plans that are grandfathered plans.
deleted text endnew text begin An individual who has not
maintained continuous coverage may be subject to a new 12-month preexisting condition
limitation after each break in continuous coverage.
new text end

(b) A health carrier must offer an individual health plan to any individual previously
covered under a group health plan issued by that health carrier, regardless of the size of the
group, so long as the individual maintained continuous coverage as defined in section
62L.02. deleted text beginIf the individual has available any continuation coverage provided under sections
62A.146; 62A.148; 62A.17, subdivisions 1 and 2; 62A.20; 62A.21; 62C.142; 62D.101; or
62D.105, or continuation coverage provided under federal law, the health carrier need not
offer coverage under this paragraph until the individual has exhausted the continuation
coverage.
deleted text end The offer must not be subject to underwriting, except as permitted under this
paragraph. A health plan issued under this paragraph must be a qualified plan as defined in
section 62E.02 and must not contain any preexisting condition limitation, preexisting
condition exclusion, or exclusionary rider, except for any unexpired limitation or exclusion
under the previous coverage. deleted text beginThe individual health plan must cover pregnancy on the same
basis as any other covered illness under the individual health plan. The offer of coverage
by the health carrier must inform the individual that the coverage, including what is covered
and the health care providers from whom covered care may be obtained, may not be the
same as the individual's coverage under the group health plan.
deleted text end The offer of coverage by the
health carrier must also inform the individual that the individual, if a Minnesota resident,
may be eligible to obtain coverage from (i) other private sources of health coverage, or (ii)
the Minnesota Comprehensive Health Association, without a preexisting condition limitation,
and must provide the telephone number used by that association for enrollment purposes.
The initial premium rate for the individual health plan must comply with subdivision 3. The
premium rate upon renewal must comply with subdivision 2. deleted text beginIn no event shall the premium
rate exceed 100 percent of the premium charged for comparable individual coverage by the
Minnesota Comprehensive Health Association, and the premium rate must be less than that
amount if necessary to otherwise comply with this section.
deleted text end Coverage issued under this
paragraph must provide that it cannot be canceled or nonrenewed as a result of the health
carrier's subsequent decision to leave the individual, small employer, or other group market.
Section 72A.20, subdivision 28, applies to this paragraph.

Sec. 6.

new text begin [62A.652] PREEXISTING CONDITIONS DISCLOSED AT TIME OF
APPLICATION.
new text end

new text begin An insurer is prohibited from canceling or rescinding a health insurance policy for a
preexisting condition if the application or other information provided by the insured
reasonably gave the insurer notice. An insurer is prohibited from restricting coverage for a
preexisting condition if the application or other information provided by the insured
reasonably gave the insurer notice. Preexisting condition limitations are offset or reduced
by duration of time qualified if prior continuous coverage has been in place for the insured
uninterrupted by a break of coverage 63 days or more.
new text end

Sec. 7.

new text begin [62K.16] TERMINATION OF COVERAGE DUE TO NONPAYMENT.
new text end

new text begin (a) Notwithstanding section 62V.05, subdivision 5, a health carrier may terminate an
enrollee's coverage due to premium nonpayment, regardless of whether the enrollee is
receiving advance premium tax credits under the Affordable Care Act, if the enrollee has
previously paid at least one full month's premium during the benefit year. Prior to terminating
coverage, the health carrier must notify the enrollee of the premium payment delinquency,
including the amount of premium owed.
new text end

new text begin (b) Coverage termination for premium nonpayment under this section is effective 30
days after the date the premium was due.
new text end

new text begin (c) The health carrier is not responsible for claims for services rendered to the enrollee
during the grace period described in paragraph (b).
new text end

Sec. 8.

Minnesota Statutes 2018, section 62L.03, subdivision 3, is amended to read:


Subd. 3.

Minimum participation and contribution.

(a) A small employer that has at
least 75 percent of its eligible employees who have not waived coverage participating in a
health benefit plan and that contributes at least 50 percent toward the cost of coverage of
each eligible employeenew text begin or have enrolled in a qualified health plan, as defined in section
62V.02, subdivision 11,
new text end must be guaranteed coverage on a guaranteed issue basis from any
health carrier participating in the small employer market. The participation level of eligible
employees must be determined at the initial offering of coverage and at the renewal date of
coverage. A health carrier must not increase the participation requirements applicable to a
small employer at any time after the small employer has been accepted for coverage. For
the purposes of this subdivision, waiver of coverage includes only waivers due to: (1)
coverage under another group health plan; (2) coverage under Medicare Parts A and B; or
(3) coverage under medical assistance under chapter 256B.

(b) If a small employer does not satisfy the contribution or participation requirements
under this subdivision, a health carrier may voluntarily issue or renew individual health
plans, or a health benefit plan which must fully comply with this chapter. A health carrier
that provides a health benefit plan to a small employer that does not meet the contribution
or participation requirements of this subdivision must maintain this information in its files
for audit by the commissioner. A health carrier may not offer an individual health plan,
purchased through an arrangement between the employer and the health carrier, to any
employee unless the health carrier also offers the individual health plan, on a guaranteed
issue basis, to all other employees of the same employer. An arrangement permitted under
section 62L.12, subdivision 2, paragraph (l), is not an arrangement between the employer
and the health carrier for purposes of this paragraph.

(c) Nothing in this section obligates a health carrier to issue coverage to a small employer
that currently offers coverage through a health benefit plan from another health carrier,
unless the new coverage will replace the existing coverage and not serve as one of two or
more health benefit plans offered by the employer. This paragraph does not apply if the
small employer will meet the required participation level with respect to the new coverage.

(d) If a small employer cannot meet either the participation or contribution requirement,
the small employer may purchase coverage only during an open enrollment period each
year between November 15 and December 15.

Sec. 9.

Minnesota Statutes 2018, section 62L.03, is amended by adding a subdivision to
read:


new text begin Subd. 4a. new text end

new text begin Preexisting conditions. new text end

new text begin (a) Preexisting conditions may be excluded by a health
carrier for the first 12 months of coverage if the eligible employee was diagnosed or treated
for that condition during the six months immediately preceding the enrollment date, but
exclusionary riders must not be used. When calculating any length of preexisting condition
limitation, a health carrier must credit the time period an eligible employee or dependent
was previously covered by qualifying coverage, provided the individual maintains continuous
coverage without a break of 63 days or more. The credit must be given for all qualifying
coverage with respect to all preexisting conditions, regardless of whether the conditions
were preexisting with respect to any previous qualifying coverage. Section 60A.082, relating
to replacement of group coverage, and the rules adopted under that section apply to this
chapter. This chapter's requirements are in addition to the requirements of section 60A.082
and the rules adopted under it. An insurer is prohibited from canceling or rescinding a health
insurance policy for a preexisting condition if the application or other information provided
by the insured reasonably gave the insurer notice.
new text end

new text begin (b) A health carrier is prohibited from restricting coverage for a preexisting condition
if the application or other information provided by the insured reasonably gave the insurer
notice.
new text end

Sec. 10.

Minnesota Statutes 2018, section 62L.08, is amended by adding a subdivision to
read:


new text begin Subd. 1a. new text end

new text begin General premium variations. new text end

new text begin Each health carrier must offer premium rates
to small employers that are no more than 25 percent above and no more than 25 percent
below the standard rate charged to small employers for the same or similar coverage, adjusted
pro rata for rating periods of less than one year. The premium variations permitted by this
subdivision must be based only on health status, claims experience, and duration of coverage
from the date of issue. For purposes of this subdivision, health status includes refraining
from tobacco use or other actuarially valid lifestyle factors associated with good health,
provided the lifestyle factor and its effect upon premium rates have been deemed actuarially
valid and approved by the commissioner. This subdivision does not prohibit use of a constant
percentage adjustment for factors permitted under this subdivision.
new text end

Sec. 11.

Minnesota Statutes 2018, section 62L.08, subdivision 7, is amended to read:


Subd. 7.

Premium rate development.

(a) In developing its new text beginstandard rates, new text endratesnew text begin,new text end and
premiums, a health carrier may take into account only the following factors:

(1) actuarially valid differences in benefit designs of health benefit plans; and

(2) deleted text beginactuarially valid geographic variations if approved by the commissioner as provided
in subdivision 4
deleted text endnew text begin differences in the rating factors permitted in subdivisions 1a and 3new text end.

(b) All premium variations permitted under this section must be based upon actuarially
valid differences in expected cost to the health carrier of providing coverage. The variation
must be justified in initial rate filings and upon request of the commissioner in rate revision
filings. All premium variations are subject to approval by the commissioner.

Sec. 12.

Minnesota Statutes 2018, section 62Q.18, subdivision 10, is amended to read:


Subd. 10.

Guaranteed issue.

new text begin(a) new text endNo health plan company shall offer, sell, or issue any
health plan that does not make coverage available on a guaranteed issue basis deleted text beginin accordance
with the Affordable Care Act
deleted text end.

new text begin (b) Notwithstanding paragraph (a), a health plan company may offer, sell, or issue an
individual health plan that contains a preexisting condition limitation or exclusion as
permitted under section 62A.65, subdivision 5.
new text end

Sec. 13.

new text begin [62Q.678] HEALTH PLAN OPEN ENROLLMENT.
new text end

new text begin (a) All health plans must be made available in the manner required by Code of Federal
Regulations, title 45, section 147.104.
new text end

new text begin (b) In addition to the requirements under paragraph (a), any individual health plan:
new text end

new text begin (1) must be made available for purchase at any time during the calendar year; and
new text end

new text begin (2) is not retroactive from the date the application for coverage was received.
new text end

Sec. 14.

Minnesota Statutes 2018, section 62V.05, subdivision 3, is amended to read:


Subd. 3.

Insurance producers.

(a) By April 30, 2013, the board, in consultation with
the commissioner of commerce, shall establish certification requirements that must be met
by insurance producers in order to assist individuals and small employers with purchasing
coverage through MNsure. Prior to January 1, 2015, the board may amend the requirements,
only if necessary, due to a change in federal rules.

deleted text begin (b) Certification requirements shall not exceed the requirements established under Code
of Federal Regulations, title 45, part 155.220. Certification shall include training on health
plans available through MNsure, available tax credits and cost-sharing arrangements,
compliance with privacy and security standards, eligibility verification processes, online
enrollment tools, and basic information on available public health care programs. Training
required for certification under this subdivision shall qualify for continuing education
requirements for insurance producers required under chapter 60K, and must comply with
course approval requirements under chapter 45.
deleted text end

deleted text begin (c)deleted text endnew text begin (b)new text end Producer compensation shall be established by health carriersdeleted text begin that provide health
plans through MNsure. The structure of compensation to insurance producers must be
similar
deleted text endnew text begin, and must be consistent and comparablenew text end for health plans sold through MNsure and
outside MNsure.

deleted text begin (d)deleted text endnew text begin (c)new text end Any insurance producer compensation structure established by a health carrier
for the small group market must include compensation for defined contribution plans that
involve multiple health carriers. The compensation offered must be commensurate with
other small group market defined health plans.

deleted text begin (e) Any insurance producer assisting an individual or small employer with purchasing
coverage through MNsure must disclose, orally and in writing, to the individual or small
employer at the time of the first solicitation with the prospective purchaser the following:
deleted text end

deleted text begin (1) the health carriers and qualified health plans offered through MNsure that the producer
is authorized to sell, and that the producer may not be authorized to sell all the qualified
health plans offered through MNsure;
deleted text end

deleted text begin (2) that the producer may be receiving compensation from a health carrier for enrolling
the individual or small employer into a particular health plan; and
deleted text end

deleted text begin (3) that information on all qualified health plans offered through MNsure is available
through the MNsure website.
deleted text end

deleted text begin For purposes of this paragraph, "solicitation" means any contact by a producer, or any person
acting on behalf of a producer made for the purpose of selling or attempting to sell coverage
deleted text end deleted text begin through MNsure. If the first solicitation is made by telephone, the disclosures required under
this paragraph need not be made in writing, but the fact that disclosure has been made must
be acknowledged on the application.
deleted text end

deleted text begin (f)deleted text endnew text begin (d)new text end Beginning January 15, 2015, each health carrier that offers or sells qualified health
plans through MNsure shall report in writing to the board and the commissioner of commerce
the compensation and other incentives it offers or provides to insurance producers with
regard to each type of health plan the health carrier offers or sells both inside and outside
of MNsure. Each health carrier shall submit a report annually and upon any change to the
compensation or other incentives offered or provided to insurance producers.

deleted text begin (g)deleted text endnew text begin (e)new text end Nothing in this chapter shall prohibit an insurance producer from offering
professional advice and recommendations to a small group purchaser based upon information
provided to the producer.

deleted text begin (h)deleted text endnew text begin (f)new text end An insurance producer that offers health plans in the small group market shall
notify each small group purchaser of which group health plans qualify for Internal Revenue
Service approved section 125 tax benefits. The insurance producer shall also notify small
group purchasers of state law provisions that benefit small group plans when the employer
agrees to pay 50 percent or more of its employees' premiumnew text begin, or when employees enroll in
a qualified health plan
new text end. Individuals who are eligible for cost-effective medical assistance
deleted text begin willdeleted text end new text beginand individuals who enroll in qualified health plans new text endcount toward the 75 percent
participation requirement in section 62L.03, subdivision 3.

deleted text begin (i)deleted text endnew text begin (g)new text end Nothing in this subdivision shall be construed to limit the licensure requirements
or regulatory functions of the commissioner of commerce under chapter 60K.

Sec. 15.

Minnesota Statutes 2018, section 290.0132, is amended by adding a subdivision
to read:


new text begin Subd. 27. new text end

new text begin Expenditures for medical care and health insurance. new text end

new text begin (a) The amount paid
during the taxable year for medical care, as defined in section 213(d) of the Internal Revenue
Code, but excluding any amount described in paragraph (b), is a subtraction.
new text end

new text begin (b) The subtraction under this subdivision does not include amounts:
new text end

new text begin (1) compensated by insurance or paid or reimbursed by an employer or a plan under
sections 104 (health care reimbursement accounts), 105 (accident and health plans), 125
(cafeteria and flexible spending accounts), 223 (health care savings accounts), or other
similar provisions of the Internal Revenue Code; or
new text end

new text begin (2) used to compute the credit under section 290.0672.
new text end

Sec. 16.new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2018, sections 62A.303; 62A.65, subdivision 2; 62L.08, subdivision
4; and 62L.12, subdivisions 3 and 4,
new text end new text begin are repealed.
new text end

Sec. 17. new text beginEFFECTIVE DATE.
new text end

new text begin Sections 1 to 14 and 16 are effective January 1, 2020, or upon the effective date of any
necessary federal waivers or law changes, whichever is later, and apply to health plans
offered, issued, or renewed on or after that date. Section 15 is effective for taxable years
beginning after December 31, 2019.
new text end

ARTICLE 2

HEALTH RISK POOL PROGRAM

Section 1.

Minnesota Statutes 2018, section 3.971, subdivision 6, is amended to read:


Subd. 6.

Financial audits.

The legislative auditor shall audit the financial statements
of the state of Minnesota required by section 16A.50 and, as resources permit, Minnesota
State Colleges and Universities, the University of Minnesota, state agencies, departments,
boards, commissions, offices, courts, and other organizations subject to audit by the
legislative auditor, including, but not limited to, the State Agricultural Society, Agricultural
Utilization Research Institute, Enterprise Minnesota, Inc., Minnesota Historical Society,
ClearWay Minnesota, Minnesota Sports Facilities Authority, Metropolitan Council,
Metropolitan Airports Commission, new text beginMinnesota Health Risk Pool Association, new text endand
Metropolitan Mosquito Control District. Financial audits must be conducted according to
generally accepted government auditing standards. The legislative auditor shall see that all
provisions of law respecting the appropriate and economic use of public funds and other
public resources are complied with and may, as part of a financial audit or separately,
investigate allegations of noncompliance.

Sec. 2.

Minnesota Statutes 2018, section 13.7191, is amended by adding a subdivision to
read:


new text begin Subd. 26. new text end

new text begin Minnesota Health Risk Pool Association. new text end

new text begin Certain data maintained by the
Minnesota Health Risk Pool Association is classified under section 62W.05, subdivision 6.
new text end

Sec. 3.

new text begin [62W.01] CITATION.
new text end

new text begin This chapter may be cited as the "Minnesota Health Risk Pool Association Act."
new text end

Sec. 4.

new text begin [62W.02] DEFINITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Application. new text end

new text begin For the purposes of this chapter, the terms defined in this
section have the meanings given them.
new text end

new text begin Subd. 2. new text end

new text begin Board. new text end

new text begin "Board" means the board of directors of the Minnesota Health Risk
Pool Association established under section 62W.05, subdivision 2.
new text end

new text begin Subd. 3. new text end

new text begin Commissioner. new text end

new text begin "Commissioner" means the commissioner of commerce.
new text end

new text begin Subd. 4. new text end

new text begin Eligible individual. new text end

new text begin "Eligible individual" means a natural person who has
received a diagnosis of one of the conditions in section 62W.06, subdivision 1, paragraph
(a), that qualifies claims for the person to be submitted by a member for risk pool payments
under the program.
new text end

new text begin Subd. 5. new text end

new text begin Health carrier. new text end

new text begin "Health carrier" means a health carrier as defined in section
62A.011, subdivision 2.
new text end

new text begin Subd. 6. new text end

new text begin Risk pool program or program. new text end

new text begin "Risk pool program" or "program" means
the risk pool program created by this chapter.
new text end

new text begin Subd. 7. new text end

new text begin Individual health plan. new text end

new text begin "Individual health plan" means a health plan as defined
in section 62A.011, subdivision 4.
new text end

new text begin Subd. 8. new text end

new text begin Individual market. new text end

new text begin "Individual market" means the market for individual health
plans, as defined in section 62A.011, subdivision 5.
new text end

new text begin Subd. 9. new text end

new text begin Member. new text end

new text begin "Member" means a health carrier offering, issuing, or renewing
individual health plans to a Minnesota resident.
new text end

new text begin Subd. 10. new text end

new text begin Minnesota Health Risk Pool Association or association. new text end

new text begin "Minnesota Health
Risk Pool Association" or "association" means the association created under section 62W.05,
subdivision 1.
new text end

new text begin Subd. 11. new text end

new text begin Risk pool payments. new text end

new text begin "Risk pool payments" means a payment made by the
association to a member under the requirements of the program and this chapter.
new text end

Sec. 5.

new text begin [62W.03] DUTIES OF COMMISSIONER.
new text end

new text begin The commissioner may:
new text end

new text begin (1) formulate general policies to advance the purposes of this chapter;
new text end

new text begin (2) supervise the creation of the Minnesota Health Risk Pool Association, subject to the
limits described in section 62W.05;
new text end

new text begin (3) appoint advisory committees;
new text end

new text begin (4) conduct periodic audits to ensure the accuracy of the data submitted by members
and the association, and the compliance of the association and members with requirements
of the plan of operation and this chapter;
new text end

new text begin (5) contract with the federal government or any other unit of government to ensure
program coordination with other individual health plan reinsurance or subsidy programs;
new text end

new text begin (6) contract with health carriers and others for administrative services; and
new text end

new text begin (7) adopt, amend, suspend, and repeal rules as reasonably necessary to carry out and
make effective the provisions and purposes of this chapter.
new text end

Sec. 6.

new text begin [62W.04] APPROVAL OF RISK POOL PAYMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Information submitted to commissioner. new text end

new text begin The association must submit
to the commissioner information regarding the risk pool payments the association anticipates
making for the calendar year immediately following the year the information is submitted.
The information must include historical risk pool payment data, underlying principles of
the model used to calculate anticipated risk pool payments, and any other relevant information
or data the association used to determine anticipated risk pool payments for the following
calendar year. This information must be submitted to the commissioner by August 30 of
each year for risk pool payments anticipated to be made in the calendar year immediately
following the year the information is submitted. By October 15 each year, the commissioner
must approve or modify the anticipated risk pool payment schedule.
new text end

new text begin Subd. 2. new text end

new text begin Modification by commissioner. new text end

new text begin The commissioner may modify the association's
anticipated risk pool payment schedule submitted under subdivision 1 on the basis of the
following criteria:
new text end

new text begin (1) whether the association is complying with the requirements contained in the plan of
operation and this chapter;
new text end

new text begin (2) the degree to which the computations and conclusions consider the current and future
individual market regulations;
new text end

new text begin (3) the degree to which any sample used to compute the effect on premiums reasonably
reflects projected individual market circumstances, using accepted actuarial principles;
new text end

new text begin (4) the degree to which the computations and conclusions consider the current and future
health care needs and health condition demographics of Minnesota residents purchasing
individual health plans;
new text end

new text begin (5) the actuarially projected effect of the risk pool payments upon both total enrollment
in the individual market and the nature of the risks assumed by the association;
new text end

new text begin (6) the financial cost to the individual market and the entire health insurance market in
this state;
new text end

new text begin (7) the projected cost of all risk pool payments in relation to funding available for the
program; and
new text end

new text begin (8) other relevant factors determined by the commissioner.
new text end

Sec. 7.

new text begin [62W.05] MINNESOTA HEALTH RISK POOL ASSOCIATION.
new text end

new text begin Subdivision 1. new text end

new text begin Creation; tax exemption. new text end

new text begin The Minnesota Health Risk Pool Association
is established to promote the stabilization and cost control of individual health plans in
Minnesota. Membership in the association consists of all health carriers offering, issuing,
or renewing individual health plans in Minnesota. The association is exempt from the taxes
imposed under chapter 297I and any other laws of this state. All property owned by the
association is exempt from taxation.
new text end

new text begin Subd. 2. new text end

new text begin Board of directors; organization. new text end

new text begin (a) The board of directors of the association
is made up of 11 members as follows: six directors selected by members, subject to approval
by the commissioner, one of whom must be a health actuary; five public directors selected
by the commissioner, four of whom must be individual health plan enrollees, and one of
whom must be a licensed insurance agent. At least two of the public directors must reside
outside of the seven-county metropolitan area.
new text end

new text begin (b) In determining voting rights to elect directors at the member's meeting, each member
is entitled to vote in person or proxy. The vote must be a weighted vote based upon the
member's cost of accident and health insurance premium, subscriber contract charges, or
health maintenance contract payment in the individual market, derived from or on behalf
of Minnesota residents in the previous calendar year, as determined by the commissioner.
new text end

new text begin (c) When approving directors of the board, the commissioner must consider, among
other things, whether all types of members are fairly represented. Directors selected by
members may be reimbursed from the money of the association for expenses incurred as
directors, but otherwise must not be compensated by the association for their services.
new text end

new text begin Subd. 3. new text end

new text begin Membership. new text end

new text begin All members must maintain membership in the association as a
condition of participating in the individual market in Minnesota.
new text end

new text begin Subd. 4. new text end

new text begin Operation. new text end

new text begin The association must submit its articles, bylaws, and operating
rules to the commissioner for approval. The adoption and amendment of articles, bylaws,
and operating rules by the association, and the approval of the articles, bylaws, and operating
rules by the commissioner, are exempt from sections 14.001 to 14.69.
new text end

new text begin Subd. 5. new text end

new text begin Open meetings. new text end

new text begin All meetings of the board and any committees must comply
with the provisions of chapter 13D.
new text end

new text begin Subd. 6. new text end

new text begin Data. new text end

new text begin The association and board are subject to chapter 13. Data received by
the association and board from a member that is data on individuals is private data on
individuals, as defined in section 13.02, subdivision 12.
new text end

new text begin Subd. 7. new text end

new text begin Appeals. new text end

new text begin An appeal may be filed with the commissioner within 30 days after
notice of an action, ruling, or decision by the board. A final action or order of the
commissioner under this subdivision is subject to judicial review under chapter 14. In lieu
of the appeal to the commissioner, a person may seek judicial review of the board's action.
new text end

new text begin Subd. 8. new text end

new text begin Antitrust exemption. new text end

new text begin In the performance of duties as members of the
association, the members are exempt from sections 325D.49 to 325D.66.
new text end

new text begin Subd. 9. new text end

new text begin General powers. new text end

new text begin The association may:
new text end

new text begin (1) exercise the powers granted to insurers under the laws of Minnesota;
new text end

new text begin (2) sue or be sued;
new text end

new text begin (3) establish administrative and accounting procedures to operate the association; and
new text end

new text begin (4) enter into contracts with insurers, similar associations in other states, or with other
persons to perform administrative functions, including the functions provided in section
62W.06.
new text end

new text begin Subd. 10. new text end

new text begin Rulemaking. new text end

new text begin The association is exempt from the Administrative Procedure
Act. However, to the extent the association wishes to adopt rules, it may use section 14.386,
paragraph (a), clauses (1) and (3). Section 14.386, paragraph (b), does not apply to rules
adopted under this subdivision.
new text end

Sec. 8.

new text begin [62W.06] ASSOCIATION; ADMINISTRATION OF PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Acceptance of risk. new text end

new text begin (a) The association must accept a transfer to the
program from a member of the risk and cost associated with providing health coverage to
an eligible individual when the eligible individual discloses to the member in the application
for an individual health plan that the eligible individual has received a diagnosis of at least
one of the conditions in paragraph (b).
new text end

new text begin (b) The diagnosis necessary to qualify as an eligible individual are:
new text end

new text begin (1) AIDS/HIV;
new text end

new text begin (2) Alzheimer's disease;
new text end

new text begin (3) amyotrophic lateral sclerosis (ALS);
new text end

new text begin (4) angina pectoris;
new text end

new text begin (5) anorexia nervosa or bulimia;
new text end

new text begin (6) aortic aneurysm;
new text end

new text begin (7) ascites;
new text end

new text begin (8) chemical dependency;
new text end

new text begin (9) chronic pancreatitis;
new text end

new text begin (10) chronic renal failure;
new text end

new text begin (11) cirrhosis of the liver;
new text end

new text begin (12) coronary insufficiency;
new text end

new text begin (13) coronary occlusion;
new text end

new text begin (14) Crohn's Disease (regional enteritis);
new text end

new text begin (15) cystic fibrosis;
new text end

new text begin (16) dermatomyositis;
new text end

new text begin (17) Friedreich's ataxia;
new text end

new text begin (18) hemophilia;
new text end

new text begin (19) hepatitis C;
new text end

new text begin (20) history of major organ transplant;
new text end

new text begin (21) Huntington Chorea;
new text end

new text begin (22) hydrocephalus;
new text end

new text begin (23) insulin dependent diabetes;
new text end

new text begin (24) leukemia;
new text end

new text begin (25) malignant lymphoma;
new text end

new text begin (26) malignant tumors;
new text end

new text begin (27) metastatic cancer;
new text end

new text begin (28) motor/sensory aphasia:
new text end

new text begin (29) multiple sclerosis;
new text end

new text begin (30) muscular dystrophy;
new text end

new text begin (31) myasthenia gravis;
new text end

new text begin (32) myocardial infarction;
new text end

new text begin (33) myotonia;
new text end

new text begin (34) open heart surgery;
new text end

new text begin (35) paraplegia;
new text end

new text begin (36) Parkinson's Disease;
new text end

new text begin (37) polyarteritis nodosa;
new text end

new text begin (38) polycystic kidney;
new text end

new text begin (39) primary cardiomyopathy;
new text end

new text begin (40) progressive systemic sclerosis (Scleroderma);
new text end

new text begin (41) quadriplegia;
new text end

new text begin (42) stroke;
new text end

new text begin (43) syringomylia;
new text end

new text begin (44) systemic lupus erythematosis (SLE);
new text end

new text begin (45) Wilson's disease; and
new text end

new text begin (46) any other injury or illness at the member's discretion.
new text end

new text begin Subd. 2. new text end

new text begin Payment to members. new text end

new text begin (a) The association must reimburse members on a
quarterly basis for claims paid on behalf of an eligible individual whose risk and cost has
been transferred to the program.
new text end

new text begin (b) Risk pool payments related to any one eligible individual is limited to $5,000,000
over the lifetime of the individual, without consideration of whether the risk pool payments
are made to one or more members.
new text end

new text begin Subd. 3. new text end

new text begin Plan of operation. new text end

new text begin (a) The association, in consultation with the commissioners
of health and commerce, must create a plan of operation to administer the program. The
plan of operation must be updated as necessary by the board, in consultation with the
commissioners.
new text end

new text begin (b) The plan of operation must include:
new text end

new text begin (1) guidance to members regarding the use of diagnosis codes to identify eligible
individuals;
new text end

new text begin (2) a description of the data a member submitting a risk pool payment request must
provide to the association for the association to implement and administer the program,
including data necessary for the association to determine a member's eligibility for risk pool
payments;
new text end

new text begin (3) the manner and time period in which a member must provide the data described in
clause (2);
new text end

new text begin (4) requirements for report submissions by an association member;
new text end

new text begin (5) requirements for processing reports received by the association under section 62W.07,
subdivision 2, clause (5);
new text end

new text begin (6) requirements for conducting audits under section 62W.08; and
new text end

new text begin (7) requirements for an annual actuarial study of Minnesota's individual market the
association must order, that:
new text end

new text begin (i) measures the program's impact;
new text end

new text begin (ii) recommends program funding levels; and
new text end

new text begin (iii) analyzes possible changes in the individual market, including the impact of the
possible changes.
new text end

new text begin Subd. 4. new text end

new text begin Use of premium payments. new text end

new text begin The association must apply all premiums received
from members to pay for transferred risks. The association may pay normal administrative
and operational expenses.
new text end

new text begin Subd. 5. new text end

new text begin Prior notification of potential enrollees. new text end

new text begin (a) A member market must notify
all applicants prior to enrollment of the potential for data transfer to the association.
Notification must include:
new text end

new text begin (1) a description of the potential transfer of cost and risk of the enrollee, transfer of
premium payments, and transfer of medical claims to the association;
new text end

new text begin (2) the address and telephone number of the association; and
new text end

new text begin (3) the Tennessen warning required under section 13.04, subdivision 2.
new text end

new text begin (b) Before a member accepts an application the member must obtain on a separate
document the potential enrollee's signature acknowledging receipt of the notification, and
a separate signature providing the individual's consent to data sharing if the member transfers
the risk and cost of the individual to the association.
new text end

Sec. 9.

new text begin [62W.07] MEMBERS; COMPLIANCE WITH PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Transfer of risk. new text end

new text begin A member transferring the risk and cost associated
with providing health coverage to an eligible individual to the program must comply with
this section. A member must transfer the risk and cost of the eligible individual after receiving
a completed application for an individual health plan from the individual. The application
must disclose that the individual, or a member of the individual's family if a family policy
is being requested, has been diagnosed with one of the conditions listed in section 62W.06,
subdivision 1, paragraph (b). The program is effective on the effective date of the individual
health plan and continues until the eligible individual ceases coverage with the member.
new text end

new text begin Subd. 2. new text end

new text begin Risk pool payments. new text end

new text begin (a) A member is eligible for risk pool payments to
reimburse the member for the claims of an eligible individual if the member:
new text end

new text begin (1) provides evidence to the association that the individual is an eligible individual;
new text end

new text begin (2) is currently paying the eligible individual's claims;
new text end

new text begin (3) pays to the association under paragraph (c) the premium the member receives under
an individual health plan for the eligible individual;
new text end

new text begin (4) pays to the association under paragraph (d) any pharmacy rebates the member receives
for health care services provided to the eligible individual; and
new text end

new text begin (5) reports and pays to the association any payments applicable to the eligible individual
that the member collects relating to:
new text end

new text begin (i) third-party liabilities;
new text end

new text begin (ii) payments the member recovers for overpayment;
new text end

new text begin (iii) payments for commercial reinsurance recoveries;
new text end

new text begin (iv) estimated federal cost-sharing reduction payments made under United States Code,
title 42, section 18071; and
new text end

new text begin (v) estimated advanced premium tax credits paid to the member on behalf of an eligible
individual made under United States Code, title 26, section 36B.
new text end

new text begin (b) A member that has transferred the associated risk and cost of an eligible individual
to the program must submit to the program all data and information required by the
association, in a manner determined by the association.
new text end

new text begin (c) A member must provide the program all premiums received for coverage under an
individual health plan from an eligible individual whose risk and associated cost has been
transferred to the program. A member must transfer all premiums, less all normal issuance
administrative and maintenance costs, to the program immediately after receipt. For each
additional eligible individual covered under a family policy who has a separately identifiable
premium equal to $0, the member must pay the association the next highest separately
identifiable premium under the family policy.
new text end

new text begin (d) A member must pay the association a pharmacy rebate required to be paid under
paragraph (a), clause (4), within 30 days of the date the pharmacy rebate was received.
new text end

new text begin Subd. 3. new text end

new text begin Duties; members. new text end

new text begin (a) A member must comply with the plan of operation created
under section 62W.06, subdivision 3, in order to receive risk pool payments under the
program.
new text end

new text begin (b) A member must continue to administer and manage an eligible individual's individual
health plan under the terms of the individual health plan after the risk and cost associated
with the eligible individual has been transferred to the program.
new text end

new text begin (c) A member may not vary premium rates based on whether the risk and cost associated
with an eligible individual has been transferred to the program.
new text end

new text begin (d) After the risk and cost of an eligible individual has been transferred to the program,
the risk and cost remain with the program for the benefit plan year.
new text end

new text begin (e) For a claim to qualify for risk pool payments from the program, a member must
submit claims incurred by an eligible individual whose risk and associated cost has been
transferred to the program within 12 months of the claim being incurred.
new text end

Sec. 10.

new text begin [62W.08] ACCOUNTS AND AUDITS.
new text end

new text begin Subdivision 1. new text end

new text begin Reports and audits. new text end

new text begin (a) The association must maintain its books, records,
accounts, and operations on a calendar-year basis.
new text end

new text begin (b) The association must conduct a final accounting with respect to each calendar year
after April 15 the next calendar year.
new text end

new text begin (c) Claims for eligible individuals whose associated risk and cost have been transferred
to the program that are incurred during a calendar year and are submitted for reimbursement
before April 15 the next calendar year must be allocated to the calendar year in which the
claims were incurred. Claims for eligible individuals whose associated risk and cost have
been transferred to the program that are incurred during a calendar year and are submitted
for reimbursement after April 15 the next calendar year must be allocated to a later calendar
year, as provided by the plan of operation.
new text end

new text begin (d) If the association fund's total receipts with respect to a calendar year are expected to
be insufficient to pay all program expenses, claims for reimbursement, and other
disbursements allocable to that calendar year, all claims for reimbursement allocable to that
calendar year must be proportionately reduced to the extent necessary to prevent a deficit
in the fund for that calendar year. Any reduction in claims for reimbursement with respect
to a calendar year must apply to all claims allocable to that calendar year without regard to
when those claims are submitted for reimbursement. Any reduction must be applied to each
claim in the same proportion.
new text end

new text begin (e) The association must establish a process to audit every member that transfers the
cost and associated risk of an eligible individual to the program. Audits may include both
an audit conducted in connection with commencement of a member's first transfer to the
program and up to four periodic audits each year throughout a member's participation in
the program.
new text end

new text begin (f) Each calendar year, the association must engage an independent third-party auditor
to perform a financial and programmatic audit in accordance with generally accepted auditing
standards. The association must provide a copy of the audit to the commissioner when the
association receives the audit and must publish a copy of the audit on the association's
website within 14 days of the date the audit was received.
new text end

new text begin Subd. 2. new text end

new text begin Annual settle-up. new text end

new text begin (a) The association must establish a settle-up process with
respect to a calendar year to reflect adjustments made in establishing the final accounting
for that calendar year. The adjustments include, but are not limited to:
new text end

new text begin (1) the crediting of premiums received with respect to the cost and associated risks of
an eligible person being transferred after the end of the calendar year;
new text end

new text begin (2) retroactive reductions or other adjustments in reimbursements necessary to prevent
a deficit in the association fund for that calendar year; and
new text end

new text begin (3) retroactive reductions to prevent a windfall to a member as a result of third party
recoveries, recovery of overpayments, commercial reinsurance recoveries, federal
cost-sharing reductions made under United States Code, title 42, section 18071, advanced
premium tax credits paid under United States Code, title 26, section 36B, or risk adjustments
made under United States Code, title 42, section 18063, for that calendar year.
new text end

new text begin The settle-up must occur after April 15 of the calendar year immediately after the year the
settle-up applies to.
new text end

new text begin (b) With respect to the risk adjustment transfers as determined by the United States
Department of Health and Human Services, Centers for Medicare and Medicaid Services,
and Center for Consumer Information and Insurance Oversight:
new text end

new text begin (1) the commissioner must review the risk adjustment transfers to determine the impact
the transfer of risk and associated cost of an eligible individual to the program has had, if
any;
new text end

new text begin (2) the review must occur no later than 60 days after the notice of final risk adjustment
transfers by the Center for Consumer Information and Insurance Oversight is published;
new text end

new text begin (3) if the commissioner notifies a member of the amount of any risk adjustment transfer
it received that does not accurately reflect benefits provided under the program:
new text end

new text begin (i) the member must pay that amount to the association within 30 days of the date the
member received notice from the commissioner; and
new text end

new text begin (ii) as appropriate, the commissioner must refund to the member the amount that made
the federal risk adjustment payment; and
new text end

new text begin (4) a member must submit to the commissioner, in a form acceptable to the commissioner,
all data requested by the commissioner by March of the year immediately following the
year the risk adjustment applies to.
new text end

Sec. 11.

new text begin [62W.09] ASSESSMENT ON ISSUERS OF ACCIDENT AND HEALTH
INSURANCE POLICIES.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For the purposes of this section, the following terms have
the meanings given them.
new text end

new text begin (b) "Accident and health insurance policy" or "policy" means insurance or nonprofit
health service plan contracts providing benefits for hospital, surgical, and medical care.
Policy does not include coverage that is:
new text end

new text begin (1) limited to disability or income protection coverage;
new text end

new text begin (2) automobile medical payment coverage;
new text end

new text begin (3) supplemental to liability insurance;
new text end

new text begin (4) designed solely to provide payments on a per diem, fixed indemnity, or nonexpense
incurred basis;
new text end

new text begin (5) credit accident and health insurance issued under chapter 62B;
new text end

new text begin (6) designed solely to provide dental or vision care;
new text end

new text begin (7) blanket accident and sickness insurance as defined in section 62A.11; or
new text end

new text begin (8) accident only coverage, issued by licensed and tested insurance agents or solicitors,
that provides reasonable benefits in relation to the cost of covered services.
new text end

new text begin Clause (4) does not apply to hospital indemnity coverage sold by an insurer to an applicant
who is not currently covered by a qualified plan at the time the coverage is sold.
new text end

new text begin (c) "Market member" means companies regulated under chapter 62A that offer, sell,
issue, or renew policies or contracts of accident and health insurance; health maintenance
organizations regulated under chapter 62D; nonprofit health service plan corporations
regulated under chapter 62C; community integrated service networks regulated under chapter
62N; fraternal benefit societies regulated under chapter 64B; the Minnesota employees
insurance program established in section 43A.317; and joint self-insurance plans regulated
under chapter 62H. For the purposes of determining a market member's liability under
subdivision 2, payments received from or on behalf of Minnesota residents for coverage by
a health maintenance organization or community integrated service network are considered
accident and health insurance premiums.
new text end

new text begin Subd. 2. new text end

new text begin Assessment. new text end

new text begin The association must make an annual determination of each market
member's financial liability, if any, to support the program, as provided under section
62W.10. The association may make an annual fiscal year-end assessment if necessary. The
association may also, subject to the approval of the commissioner, provide for interim
assessments against the market members whose aggregate assessments comprised a minimum
of 90 percent of the most recent prior annual assessment if the association deems that
methodology to be the most administratively efficient and cost-effective means of assessment,
and as may be necessary to ensure the association's financial capability to meet the incurred
or estimated claims expenses, program administrative costs, and program operational costs
until the association's next annual fiscal year-end assessment. An assessment payment is
due within 30 days of the date a market member receives a written notice of a fiscal year-end
or interim assessment. Failure by a market member to pay the assessment to the association
within 30 days is grounds for termination of the market member's ability to issue accident
and health insurance policies in Minnesota. A market member that ceases to do accident
and health insurance business in Minnesota remains liable for assessments through the
calendar year the market member's accident and health insurance business ceased. The
association may decline to levy an assessment against a market member if the assessment
determined under this subdivision does not exceed $10.
new text end

Sec. 12.

new text begin [62W.10] FUNDING OF PROGRAM.
new text end

new text begin (a) The association account is created in the special revenue fund of the state treasury.
Funds in the account are appropriated to the association to operate the program.
Notwithstanding section 11A.20, all investment income and all investment losses attributable
to the investment of the association account must be credited to the association account.
new text end

new text begin (b) The association must fund the program using the following sources, in the following
priority order:
new text end

new text begin (1) any federal funds available, whether through grants or otherwise;
new text end

new text begin (2) the funds in section 15;
new text end

new text begin (3) the tax imposed on health maintenance organizations, community integrated service
networks, and nonprofit health care service plan corporations under section 297I.05,
subdivision 5; and
new text end

new text begin (4) the assessment, if any, under section 62W.09.
new text end

new text begin (c) The program must not exceed $....... in claims, administrative, and operational costs
per calendar year.
new text end

Sec. 13.

Minnesota Statutes 2018, section 297I.05, subdivision 1, is amended to read:


Subdivision 1.

Domestic and foreign companies.

Except as otherwise provided in this
section, a tax is imposed on every domestic and foreign insurance company. The rate of tax
is equal to two percent of all gross premiums less return premiums on all direct business
received by the insurer or agents of the insurer in Minnesota, in cash or otherwise, during
the year.new text begin This tax must be paid into the association account.
new text end

Sec. 14.

Minnesota Statutes 2018, section 297I.05, subdivision 5, is amended to read:


Subd. 5.

Health maintenance organizations, nonprofit health service plan
corporations, and community integrated service networks.

(a) A tax is imposed on health
maintenance organizations, community integrated service networks, and nonprofit health
care service plan corporations. The rate of tax is equal to one percent of gross premiums
less return premiums on all direct business received by the organization, network, or
corporation or its agents in Minnesota, in cash or otherwise, in the calendar year.

(b) The commissioner shall deposit all revenues, including penalties and interest, collected
under this chapter from health maintenance organizations, community integrated service
networks, and nonprofit health service plan corporations in the deleted text beginhealth care access funddeleted text endnew text begin
association account
new text end. Refunds of overpayments of tax imposed by this subdivision must be
paid from the deleted text beginhealth care access funddeleted text endnew text begin association accountnew text end. There is annually appropriated
from the deleted text beginhealth care access funddeleted text endnew text begin association accountnew text end to the commissioner the amount
necessary to make any refunds of the tax imposed under this subdivision.

Sec. 15. new text beginTRANSFER.
new text end

new text begin $....... in fiscal year 2020 is transferred from the health care access fund to the
commissioner of commerce for transfer to the association account in the special revenue
fund for the purposes described in Minnesota Statutes, section 62W.10.
new text end

Sec. 16. new text beginEFFECTIVE DATE.
new text end

new text begin Sections 1 to 11 are effective January 1, 2021, and apply to individual health plans
providing coverage on or after that date. Sections 12 to 15 are effective the day following
final enactment and apply to individual health plans providing coverage on or after January
1, 2020, until December 31, 2020.
new text end

ARTICLE 3

UNIFIED PERSONAL HEALTH PREMIUM ACCOUNT

Section 1.

new text begin [62X.01] DEFINITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Scope of definitions. new text end

new text begin For purposes of this chapter, the terms defined in
this section have the meanings given.
new text end

new text begin Subd. 2. new text end

new text begin Commissioner. new text end

new text begin "Commissioner" means the commissioner of commerce.
new text end

new text begin Subd. 3. new text end

new text begin Dependent. new text end

new text begin "Dependent" means an individual's spouse or tax dependent.
new text end

new text begin Subd. 4. new text end

new text begin Health insurance. new text end

new text begin "Health insurance" means:
new text end

new text begin (1) individual health insurance and individual policies that cover cancer, accidents,
critical illness, hospital confinement/medical bridge, short-term disability, long-term care,
and high deductible health plans including those that are compatible with health savings
accounts; and
new text end

new text begin (2) any other coverages identified under sections 60A.06, subdivision 1, clause (5),
paragraph (a); 62Q.01, subdivisions 4a and 6; and 62Q.188.
new text end

new text begin Subd. 5. new text end

new text begin Trustee. new text end

new text begin "Trustee" means an entity that has trust powers under state or federal
law.
new text end

new text begin Subd. 6. new text end

new text begin Unified personal health premium account or account. new text end

new text begin "Unified personal
health premium account" or "account" means a trust account created to receive funds from
multiple sources to pay or reimburse for health insurance premiums.
new text end

new text begin Subd. 7. new text end

new text begin Unified personal health premium account administrator or
administrator.
new text end

new text begin "Unified personal health premium account administrator" or "administrator"
means an entity that has the authority to administer a unified personal health premium
account.
new text end

Sec. 2.

new text begin [62X.02] REGISTRATION REQUIRED.
new text end

new text begin (a) Only a private-sector entity or individual registered with the commissioner as a
unified personal health premium account administrator may administer an account on behalf
of a Minnesota resident.
new text end

new text begin (b) To register under this section, a private sector entity or individual must be:
new text end

new text begin (1) a licensed insurance producer, as defined in section 60K.31, subdivision 6, under
the insurance authority described in section 60K.38, subdivision 1, paragraph (b), clause
(1), (2), or (5);
new text end

new text begin (2) a licensed vendor of risk management services or entity administering a self-insurance
or insurance plan under section 60A.23, subdivision 8; or
new text end

new text begin (3) a federally or state-chartered bank or credit union.
new text end

new text begin (c) An applicant for registration under this section must pay a $250 fee for initial
registration and a $50 fee for each three-year renewal.
new text end

Sec. 3.

new text begin [62X.03] UNIFIED PERSONAL HEALTH PREMIUM ACCOUNT
ADMINISTRATION; REQUIREMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Nature of arrangements. new text end

new text begin (a) A unified personal health premium account
administrator under contract with an employer must conduct business in accordance with
a written contract.
new text end

new text begin (b) Administrators may conduct business directly with individuals in accordance with
a written agreement.
new text end

new text begin (c) The written agreement between a unified personal health premium account
administrator and its customer must specify (i) the services to be provided to the customer,
(ii) the payment for each service, including administrative costs, and (iii) the timing and
method of each payment or type of payment.
new text end

new text begin (d) An administrator may administer unified personal health premium accounts separately
or in conjunction with other employee benefit services, including services that facilitate and
coordinate tax-preferred payments for health care and coverage under Internal Revenue
Code, sections 105, 106, and 9831(d).
new text end

new text begin (e) An administrator must create and maintain records of receipts, payments, and other
transactions, sufficient to enable the individual to benefit from tax advantages available to
the individual for health insurance paid by or on behalf of the individual under Internal
Revenue Code, sections 105, 106, 125, and other relevant sections, and under Minnesota
income tax law. The records and procedures must be capable of segregating funds to maintain
restrictions on the funds received from contributors.
new text end

new text begin (f) Individual insurance market products paid for through the account under this section
are not an employer-sponsored plan subject to state or federal group insurance market
requirements.
new text end

new text begin Subd. 2. new text end

new text begin Trust account requirements. new text end

new text begin (a) Contributions to an individual's account may
be made by the individual, the individual's employer or former employer, the individual's
family members or dependents, charitable organizations, a government entity, or any other
source.
new text end

new text begin (b) A contributor to the account may restrict the use of funds the contributor contributes
to the payment of premiums for one or more of the types of health insurance included in
section 62X.01, subdivision 4.
new text end

new text begin (c) A trust created and trustees appointed under this chapter must:
new text end

new text begin (1) have the powers granted under, and must comply with, the provisions under chapter
501B that are relevant to a trust created for purposes of this chapter;
new text end

new text begin (2) permit financial contributions from multiple sources, including tax-preferred
contributions from individuals and employers and nontax-preferred contributions from
individuals and other sources;
new text end

new text begin (3) use funds exclusively for the benefit of the individual account holder or the
individual's tax dependents;
new text end

new text begin (4) make funds available for the payment of premiums on any type of health insurance
included in section 62X.01, subdivision 4, from any insurance company, subject to any
restriction under paragraph (b);
new text end

new text begin (5) grant the unified personal health premium account administrator authority to direct
payments to insurance companies or to reimburse account owners for qualified health
insurance premium expenses;
new text end

new text begin (6) segregate funds to maintain restrictions on the funds received from contributors; and
new text end

new text begin (7) guarantee that funds contributed by an employer will remain available to the account
holder after the account holder's term of employment with the employer ends.
new text end

Sec. 4.

new text begin [62X.04] COORDINATION WITH HEALTHY MINNESOTA PROGRAM.
new text end

new text begin The commissioner of human services must enter into agreements under which unified
personal health premium account administrators may receive public funds to subsidize
payment of premiums for health coverage provided to eligible individuals who have a trust
account for that purpose.
new text end

Sec. 5.

new text begin [256L.032] HEALTHY MINNESOTA CONTRIBUTION PROGRAM.
new text end

new text begin Subdivision 1. new text end

new text begin Defined contributions to enrollees. new text end

new text begin (a) The commissioner must provide
a monthly defined contribution to purchase health coverage under a health plan as defined
in section 62A.011, subdivision 3, to each MinnesotaCare enrollee who (1) does not reside
in a county that offers county-based purchasing, (2) is eligible under section 256L.04,
subdivision 7, and (3) has a family income equal to or greater than 200 percent of the federal
poverty guidelines.
new text end

new text begin (b) Enrollees eligible under this section must not be charged premiums under section
256L.15 and are exempt from the managed care enrollment requirement of section 256L.12.
new text end

new text begin (c) Sections 256L.03; 256L.05, subdivision 3; and 256L.11 do not apply to enrollees
eligible under this section unless otherwise provided in this section. Covered services, cost
sharing, disenrollment for nonpayment of premium, enrollee appeal rights and complaint
procedures, and the effective date of coverage for enrollees eligible under this section are
governed by the terms of the health plan purchased by the enrollee.
new text end

new text begin (d) Unless otherwise provided in this section, all MinnesotaCare requirements related
to eligibility, income and asset methodology, income reporting, and program administration
continue to apply to enrollees obtaining coverage under this section.
new text end

new text begin Subd. 2. new text end

new text begin Use of defined contribution; health plan requirements. new text end

new text begin (a) An enrollee may
use up to the monthly defined contribution to pay premiums for coverage under a health
plan as defined in section 62A.011, subdivision 3.
new text end

new text begin (b) An enrollee must select a health plan within four calendar months of the date the
enrollee is approved for MinnesotaCare eligibility. If a health plan is not selected and
purchased within this time period, the enrollee must reapply and must meet all eligibility
criteria. The commissioner may determine criteria under which an enrollee has more than
four calendar months to select a health plan.
new text end

new text begin (c) Coverage purchased under this section may be in the form of a flexible benefits plan
under section 62Q.188.
new text end

new text begin (d) Coverage purchased under this section must comply with the coverage limitations
specified under section 256L.03, subdivision 1, paragraph (b).
new text end

new text begin Subd. 3. new text end

new text begin Determination of defined contribution amount. new text end

new text begin The commissioner must
determine the defined contribution sliding scale using the base contribution for specific age
ranges. The commissioner must use a sliding scale for defined contributions based on the
federal poverty guidelines for household income.
new text end

new text begin Subd. 4. new text end

new text begin Administration by commissioner. new text end

new text begin (a) The commissioner must administer the
defined contributions. The commissioner must:
new text end

new text begin (1) calculate and process defined contributions for enrollees; and
new text end

new text begin (2) pay the defined contribution amount to health plan companies for enrollee health
plan coverage.
new text end

new text begin (b) Health plan premium nonpayment results in disenrollment from MinnesotaCare,
effective the first day of the calendar month immediately following the calendar month
when the premium was due. Persons disenrolled for nonpayment or who voluntarily terminate
coverage are prohibited from reenrolling until four calendar months have elapsed.
new text end

new text begin Subd. 5. new text end

new text begin Assistance to enrollees. new text end

new text begin The commissioner of human services, in consultation
with the commissioner of commerce, must develop an efficient and cost-effective method
to refer eligible applicants to professional insurance agent associations.
new text end

Sec. 6. new text beginEFFECTIVE DATE.
new text end

new text begin Sections 1 to 5 are effective the day following final enactment.
new text end

ARTICLE 4

FEDERAL WAIVER

Section 1. new text beginSTATE INNOVATION WAIVER.
new text end

new text begin Subdivision 1. new text end

new text begin Submission of waiver application. new text end

new text begin The commissioner of commerce
must apply to the secretary of the Department of Health and Human Services under United
States Code, title 42, sections 18051 and 18052, and for a state innovation waiver to
implement any sections of this act that necessitate a waiver for plan years beginning on or
after January 1, 2020.
new text end

new text begin Subd. 2. new text end

new text begin Consultation. new text end

new text begin When developing the waiver application, the commissioner must
consult with the commissioner of human services and the commissioner of health.
new text end

new text begin Subd. 3. new text end

new text begin Application timelines; notification. new text end

new text begin The commissioner must submit the waiver
application to the Secretary of Health and Human Services on or before July 5, 2019. The
commissioner must make a draft application available for public review and comment on
or before June 1, 2019. The commissioner must notify the chairs and ranking minority
members of the legislative committees with jurisdiction over health insurance and health
care of any federal actions regarding the waiver request.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

ARTICLE 5

REPEALER

Section 1. new text beginREPEALER.
new text end

new text begin Minnesota Statutes 2018, sections 62K.01; 62K.02; 62K.03; 62K.04; 62K.05; 62K.06;
62K.07; 62K.075; 62K.08; 62K.09; 62K.10, subdivisions 1, 1a, 2, 3, 4, 5, 6, 7, and 8;
62K.11; 62K.12; 62K.13; 62K.14; and 62K.15,
new text end new text begin are repealed.
new text end

APPENDIX

Repealed Minnesota Statutes: 19-4519

62A.303 PROHIBITION; SEVERING OF GROUPS.

Section 62L.12, subdivisions 3 and 4, apply to all employer group health plans, as defined in section 62A.011, regardless of the size of the group.

62A.65 INDIVIDUAL MARKET REGULATION.

Subd. 2.

Guaranteed renewal.

No individual health plan may be offered, sold, issued, or renewed to a Minnesota resident unless the health plan provides that the plan is guaranteed renewable at a premium rate that does not take into account the claims experience or any change in the health status of any covered person that occurred after the initial issuance of the health plan to the person. The premium rate upon renewal must also otherwise comply with this section. A health carrier must not refuse to renew an individual health plan, except for nonpayment of premiums, fraud, or misrepresentation.

62K.01 TITLE.

This chapter may be cited as the "Minnesota Health Plan Market Rules."

62K.02 PURPOSE AND SCOPE.

Subdivision 1.

Purpose.

The market rules set forth in this chapter serve to clarify and provide guidance on the application of state law and certain requirements of the Affordable Care Act on all health carriers offering health plans in Minnesota, whether or not through MNsure, to ensure fair competition for all health carriers in Minnesota, to minimize adverse selection, and to ensure that health plans are offered in a manner that protects consumers and promotes the provision of high-quality affordable health care, and improved health outcomes. This chapter contains the regulatory requirements as specified in section 62V.05, subdivision 5, paragraph (b), and shall fully satisfy the requirements of section 62V.05, subdivision 5, paragraph (b).

Subd. 2.

Scope.

(a) This chapter applies only to health plans offered in the individual market or the small group market.

(b) This chapter applies to health carriers with respect to individual health plans and small group health plans, unless otherwise specified.

(c) If a health carrier issues or renews individual or small group health plans in other states, this chapter applies only to health plans issued or renewed in this state to a Minnesota resident, or to cover a resident of the state, or issued or renewed to a small employer that is actively engaged in business in this state, unless otherwise specified.

(d) This chapter does not apply to short-term coverage as defined in section 62A.65, subdivision 7, or grandfathered plan coverage as defined in section 62A.011, subdivision 1b.

62K.03 DEFINITIONS.

Subdivision 1.

Applicability.

For purposes of this chapter, the terms defined in this section have the meanings given.

Subd. 2.

Affordable Care Act.

"Affordable Care Act" means the federal Patient Protection and Affordable Care Act, Public Law 111-148, as amended, including the federal Health Care and Education Reconciliation Act of 2010, Public Law 111-152, and any amendments, and any federal guidance or regulations issued under these acts.

Subd. 3.

Dental plan.

"Dental plan" means a dental plan as defined in section 62Q.76, subdivision 3.

Subd. 4.

Enrollee.

"Enrollee" means a natural person covered by a health plan and includes an insured policyholder, subscriber, contract holder, member, covered person, or certificate holder.

Subd. 5.

Health carrier.

"Health carrier" means a health carrier as defined in section 62A.011, subdivision 2.

Subd. 6.

Health plan.

"Health plan" means a health plan as defined in section 62A.011, subdivision 3.

Subd. 7.

Individual health plan.

"Individual health plan" means an individual health plan as defined in section 62A.011, subdivision 4.

Subd. 8.

Limited-scope pediatric dental plan.

"Limited-scope pediatric dental plan" means a dental plan meeting the requirements of section 9832(c)(2)(A) of the Internal Revenue Code of 1986, as amended, that provides only pediatric dental benefits meeting the requirements of the Affordable Care Act and is offered by a health carrier. A limited-scope pediatric dental plan includes a dental plan that is offered separately or in conjunction with an individual or small group health plan to individuals who have not attained the age of 19 years as of the beginning of the policy year or to a family.

Subd. 9.

MNsure.

"MNsure" means MNsure as defined in section 62V.02.

Subd. 10.

Preferred provider organization.

"Preferred provider organization" means a health plan that provides discounts to enrollees or subscribers for services they receive from certain health care providers.

Subd. 11.

Qualified health plan.

"Qualified health plan" means a health plan that meets the definition in the Affordable Care Act and has been certified by the board of MNsure in accordance with chapter 62V to be offered through MNsure.

Subd. 12.

Small group health plan.

"Small group health plan" means a health plan issued by a health carrier to a small employer as defined in section 62L.02, subdivision 26.

62K.04 MARKET RULES; VIOLATION.

Subdivision 1.

Compliance.

(a) A health carrier issuing an individual health plan to a Minnesota resident or a small group health plan to provide coverage to a small employer that is actively engaged in business in Minnesota shall meet all of the requirements set forth in this chapter. The failure to meet any of the requirements under this chapter constitutes a violation of section 72A.20.

(b) The requirements of this chapter do not apply to short-term coverage as defined in section 62A.65, subdivision 7, or grandfathered plan coverage as defined in section 62A.011, subdivision 1c.

Subd. 2.

Penalties.

In addition to any other penalties provided by the laws of this state or by federal law, a health carrier or any other person found to have violated any requirement of this chapter may be subject to the administrative procedures, enforcement actions, and penalties provided under section 45.027 and chapters 62D and 72A.

62K.05 FEDERAL ACT; COMPLIANCE REQUIRED.

A health carrier shall comply with all provisions of the Affordable Care Act to the extent that it imposes a requirement that applies in this state. Compliance with any provision of the Affordable Care Act is required as of the effective date established for that provision in the federal act, except as otherwise specifically stated earlier in state law.

62K.06 METAL LEVEL MANDATORY OFFERINGS.

Subdivision 1.

Identification.

A health carrier that offers individual or small group health plans in Minnesota must provide documentation to the commissioner of commerce to justify actuarial value levels as specified in section 1302(d) of the Affordable Care Act for all individual and small group health plans offered inside and outside of MNsure.

Subd. 2.

Minimum levels.

(a) A health carrier that offers a catastrophic plan or a bronze level health plan within a service area in either the individual or small group market must also offer a silver level and a gold level health plan in that market and within that service area.

(b) A health carrier with less than five percent market share in the respective individual or small group market in Minnesota is exempt from paragraph (a), until January 1, 2017, unless the health carrier offers a qualified health plan through MNsure. If the health carrier offers a qualified health plan through MNsure, the health carrier must comply with paragraph (a).

Subd. 3.

MNsure restriction.

MNsure may not, by contract or otherwise, mandate the types of health plans to be offered by a health carrier to individuals or small employers purchasing health plans outside of MNsure. Solely for purposes of this subdivision, "health plan" includes coverage that is excluded under section 62A.011, subdivision 3, clause (6).

Subd. 4.

Metal level defined.

For purposes of this section, the metal levels and catastrophic plans are defined in section 1302(d) and (e) of the Affordable Care Act.

Subd. 5.

Enforcement.

The commissioner of commerce shall enforce this section.

62K.07 INFORMATION DISCLOSURES.

(a) A health carrier offering individual or small group health plans must submit the following information in a format determined by the commissioner of commerce:

(1) claims payment policies and practices;

(2) periodic financial disclosures;

(3) data on enrollment;

(4) data on disenrollment;

(5) data on the number of claims that are denied;

(6) data on rating practices;

(7) information on cost-sharing and payments with respect to out-of-network coverage; and

(8) other information required by the secretary of the United States Department of Health and Human Services under the Affordable Care Act.

(b) A health carrier offering an individual or small group health plan must comply with all information disclosure requirements of all applicable state and federal law, including the Affordable Care Act.

(c) Except for qualified health plans sold on MNsure, information reported under paragraph (a), clauses (3) and (4), is nonpublic data as defined under section 13.02, subdivision 9. Information reported under paragraph (a), clauses (1) through (8), must be reported by MNsure for qualified health plans sold through MNsure.

(d) The commissioner of commerce shall enforce this section.

62K.075 PROVIDER NETWORK NOTIFICATIONS.

(a) A health carrier must update the carrier's website at least once a month with any changes to the carrier's provider network, including provider changes from in-network status to out-of-network status.

(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.

(c) The limitations of section 62Q.56, subdivision 2a, shall apply to payments required by paragraph (b).

62K.08 MARKETING STANDARDS.

Subdivision 1.

Marketing.

(a) A health carrier offering individual or small group health plans must comply with all applicable provisions of the Affordable Care Act, including, but not limited to, the following:

(1) compliance with all state laws pertaining to the marketing of individual or small group health plans; and

(2) establishing marketing practices and benefit designs that will not have the effect of discouraging the enrollment of individuals with significant health needs in the health plan.

(b) No marketing materials may lead consumers to believe that all health care needs will be covered.

Subd. 2.

Enforcement.

The commissioner of commerce shall enforce this section.

62K.09 ACCREDITATION STANDARDS.

Subdivision 1.

Accreditation; general.

(a) A health carrier that offers any individual or small group health plans in Minnesota outside of MNsure must be accredited in accordance with this subdivision. A health carrier must obtain accreditation through URAC, the National Committee for Quality Assurance (NCQA), or any entity recognized by the United States Department of Health and Human Services for accreditation of health insurance issuers or health plans by January 1, 2018. Proof of accreditation must be submitted to the commissioner of health in a form prescribed by the commissioner of health.

(b) A health carrier that rents a provider network is exempt from this subdivision, unless it is part of a holding company as defined in section 60D.15 that in aggregate exceeds ten percent market share in either the individual or small group market in Minnesota.

Subd. 2.

Accreditation; MNsure.

(a) MNsure shall require all health carriers offering a qualified health plan through MNsure to obtain the appropriate level of accreditation no later than the third year after the first year the health carrier offers a qualified health plan through MNsure. A health carrier must take the first step of the accreditation process during the first year in which it offers a qualified health plan. A health carrier that offers a qualified health plan on January 1, 2014, must obtain accreditation by the end of the 2016 plan year.

(b) To the extent a health carrier cannot obtain accreditation due to low volume of enrollees, an exception to this accreditation criterion may be granted by MNsure until such time as the health carrier has a sufficient volume of enrollees.

Subd. 3.

Oversight.

A health carrier shall comply with a request from the commissioner of health to confirm accreditation or progress toward accreditation.

Subd. 4.

Enforcement.

The commissioner of health shall enforce this section.

62K.10 GEOGRAPHIC ACCESSIBILITY; PROVIDER NETWORK ADEQUACY.

Subdivision 1.

Applicability.

(a) This section applies to all health carriers that either require an enrollee to use or that create incentives, including financial incentives, for an enrollee to use, health care providers that are managed, owned, under contract with, or employed by the health carrier. A health carrier that does not manage, own, or contract directly with providers in Minnesota is exempt from this section, unless it is part of a holding company as defined in section 60D.15 that in aggregate exceeds ten percent in either the individual or small group market in Minnesota.

(b) Health carriers renting provider networks from other entities must submit the rental agreement or contract to the commissioner of health for approval. In reviewing the agreements or contracts, the commissioner shall review the agreement or contract to ensure that the entity contracting with health care providers accepts responsibility to meet the requirements in this section.

Subd. 1a.

Health care provider system access.

For those counties in which a health carrier actively markets an individual health plan, the health carrier must offer, in those same counties, at least one individual health plan with a provider network that includes in-network access to more than a single health care provider system. This subdivision is applicable only for the year in which the health carrier actively markets an individual health plan.

Subd. 2.

Primary care; mental health services; general hospital services.

The maximum travel distance or time shall be the lesser of 30 miles or 30 minutes to the nearest provider of each of the following services: primary care services, mental health services, and general hospital services.

Subd. 3.

Other health services.

The maximum travel distance or time shall be the lesser of 60 miles or 60 minutes to the nearest provider of specialty physician services, ancillary services, specialized hospital services, and all other health services not listed in subdivision 2.

Subd. 4.

Network adequacy.

Each designated provider network must include a sufficient number and type of providers, including providers that specialize in mental health and substance use disorder services, to ensure that covered services are available to all enrollees without unreasonable delay. In determining network adequacy, the commissioner of health shall consider availability of services, including the following:

(1) primary care physician services are available and accessible 24 hours per day, seven days per week, within the network area;

(2) a sufficient number of primary care physicians have hospital admitting privileges at one or more participating hospitals within the network area so that necessary admissions are made on a timely basis consistent with generally accepted practice parameters;

(3) specialty physician service is available through the network or contract arrangement;

(4) mental health and substance use disorder treatment providers are available and accessible through the network or contract arrangement;

(5) to the extent that primary care services are provided through primary care providers other than physicians, and to the extent permitted under applicable scope of practice in state law for a given provider, these services shall be available and accessible; and

(6) the network has available, either directly or through arrangements, appropriate and sufficient personnel, physical resources, and equipment to meet the projected needs of enrollees for covered health care services.

Subd. 5.

Waiver.

A health carrier or preferred provider organization may apply to the commissioner of health for a waiver of the requirements in subdivision 2 or 3 if it is unable to meet the statutory requirements. A waiver application must be submitted on a form provided by the commissioner and must:

(1) demonstrate with specific data that the requirement of subdivision 2 or 3 is not feasible in a particular service area or part of a service area; and

(2) include information as to the steps that were and will be taken to address the network inadequacy.

The waiver shall automatically expire after four years. If a renewal of the waiver is sought, the commissioner of health shall take into consideration steps that have been taken to address network adequacy.

Subd. 6.

Referral centers.

Subdivisions 2 and 3 shall not apply if an enrollee is referred to a referral center for health care services. A referral center is a medical facility that provides highly specialized medical care, including but not limited to organ transplants. A health carrier or preferred provider organization may consider the volume of services provided annually, case mix, and severity adjusted mortality and morbidity rates in designating a referral center.

Subd. 7.

Essential community providers.

Each health carrier must comply with section 62Q.19.

Subd. 8.

Enforcement.

The commissioner of health shall enforce this section.

62K.11 BALANCE BILLING PROHIBITED.

(a) A network provider is prohibited from billing an enrollee for any amount in excess of the allowable amount the health carrier has contracted for with the provider as total payment for the health care service. A network provider is permitted to bill an enrollee the approved co-payment, deductible, or coinsurance.

(b) A network provider is permitted to bill an enrollee for services not covered by the enrollee's health plan as long as the enrollee agrees in writing in advance before the service is performed to pay for the noncovered service.

62K.12 QUALITY ASSURANCE AND IMPROVEMENT.

Subdivision 1.

General.

(a) All health carriers offering an individual health plan or small group health plan must have a written internal quality assurance and improvement program that, at a minimum:

(1) provides for ongoing evaluation of the quality of health care provided to its enrollees;

(2) periodically reports the evaluation of the quality of health care to the health carrier's governing body;

(3) follows policies and procedures for the selection and credentialing of network providers that is consistent with community standards;

(4) conducts focused studies directed at problems, potential problems, or areas with potential for improvements in care;

(5) conducts enrollee satisfaction surveys and monitors oral and written complaints submitted by enrollees or members; and

(6) collects and reports Health Effectiveness Data and Information Set (HEDIS) measures and conducts other quality assessment and improvement activities as directed by the commissioner of health.

(b) The commissioner of health shall submit a report to the chairs and ranking minority members of senate and house of representatives committees with primary jurisdiction over commerce and health policy by February 15, 2015, with recommendations for specific quality assurance and improvement standards for all Minnesota health carriers. The recommended standards must not require duplicative data gathering, analysis, or reporting by health carriers.

Subd. 2.

Exemption.

A health carrier that rents a provider network is exempt from this section, unless it is part of a holding company as defined in section 60D.15 that in aggregate exceeds ten percent market share in either the individual or small group market in Minnesota.

Subd. 3.

Waiver.

A health carrier that has obtained accreditation through the URAC for network management; quality improvement; credentialing; member protection; and utilization management, or has achieved an excellent or commendable level ranking from the National Committee for Quality Assurance (NCQA), shall be deemed to meet the requirements of subdivision 1. Proof of accreditation must be submitted to the commissioner of health in a form prescribed by the commissioner. The commissioner may adopt rules to recognize similar accreditation standards from any entity recognized by the United States Department of Health and Human Services for accreditation of health insurance issuers or health plans.

Subd. 4.

Enforcement.

The commissioner of health shall enforce this section.

62K.13 SERVICE AREA REQUIREMENTS.

(a) Any health carrier that offers an individual or small group health plan, must offer the health plan in a service area that is at least the entire geographic area of a county unless serving a smaller geographic area is necessary, nondiscriminatory, and in the best interest of enrollees. The service area for any individual or small group health plan must be established without regard to racial, ethnic, language, concentrated poverty, or health status-related factors, or other factors that exclude specific high-utilizing, high-cost, or medically underserved populations.

(b) If a health carrier that offers an individual or small group health plan requests to serve less than the entire county, the request must be made to the commissioner of health on a form and manner determined by the commissioner and must provide specific data demonstrating that the service area is not discriminatory, is necessary, and is in the best interest of enrollees.

(c) The commissioner of health shall enforce this section.

62K.14 LIMITED-SCOPE PEDIATRIC DENTAL PLANS.

(a) Limited-scope pediatric dental plans must be offered to the extent permitted under the Affordable Care Act: (1) on a guaranteed issue and guaranteed renewable basis; (2) with premiums rated on allowable rating factors used for health plans; and (3) without any exclusions or limitations based on preexisting conditions.

(b) Notwithstanding paragraph (a), a health carrier may discontinue a limited scope pediatric dental plan at the end of a plan year if the health carrier provides written notice to enrollees before coverage is to be discontinued that the particular plan is being discontinued and the health carrier offers enrollees other dental plan options that are the same or substantially similar to the dental plan being discontinued in terms of premiums, benefits, cost-sharing requirements, and network adequacy. The written notice to enrollees must be provided at least 105 days before the end of the plan year.

(c) Limited-scope pediatric dental plans must ensure primary care dental services are available within 60 miles or 60 minutes' travel time.

(d) If a stand-alone dental plan as defined under the Affordable Care Act or a limited-scope pediatric dental plan is offered, either separately or in conjunction with a health plan offered to individuals or small employers, the health plan shall not be considered in noncompliance with the requirements of the essential benefit package in the Affordable Care Act because the health plan does not offer coverage of pediatric dental benefits if these benefits are covered through the stand-alone or limited-scope pediatric dental plan, to the extent permitted under the Affordable Care Act.

(e) Health carriers offering limited-scope pediatric dental plans must comply with this section and sections 62K.07, 62K.08, 62K.13, and 62K.15.

(f) The commissioner of commerce shall enforce paragraphs (a) and (b). Any limited-scope pediatric dental plan that is to be offered to replace a discontinued dental plan under paragraph (b) must be approved by the commissioner of commerce in terms of cost and benefit similarity, and the commissioner of health in terms of network adequacy similarity. The commissioner of health shall enforce paragraph (c).

62K.15 ANNUAL OPEN ENROLLMENT PERIODS; SPECIAL ENROLLMENT PERIODS.

(a) Health carriers offering individual health plans must limit annual enrollment in the individual market to the annual open enrollment periods for MNsure. Nothing in this section limits the application of special or limited open enrollment periods as defined under the Affordable Care Act.

(b) Health carriers offering individual health plans must inform all applicants at the time of application and enrollees at least annually of the open and special enrollment periods as defined under the Affordable Care Act.

(c) Health carriers offering individual health plans must provide a special enrollment period for enrollment in the individual market by employees of a small employer that offers a qualified small employer health reimbursement arrangement in accordance with United States Code, title 26, section 9831(d). The special enrollment period shall be available only to employees newly hired by a small employer offering a qualified small employer health reimbursement arrangement, and to employees employed by the small employer at the time the small employer initially offers a qualified small employer health reimbursement arrangement. For employees newly hired by the small employer, the special enrollment period shall last for 30 days after the employee's first day of employment. For employees employed by the small employer at the time the small employer initially offers a qualified small employer health reimbursement arrangement, the special enrollment period shall last for 30 days after the date the arrangement is initially offered to employees.

(d) The commissioner of commerce shall enforce this section.

62L.08 RESTRICTIONS RELATING TO PREMIUM RATES.

Subd. 4.

Geographic premium variations.

Premium rates may vary based on geographic rating areas set by the commissioner. The commissioner shall grant approval if the health carrier provides actuarial justification acceptable to the commissioner for the proposed geographic variations in rates.

62L.12 PROHIBITED PRACTICES.

Subd. 3.

Agent's licensure.

An agent licensed under chapter 60K or section 62C.17 who knowingly and willfully breaks apart a small group for the purpose of selling individual health plans to eligible employees and dependents of a small employer that meets the participation and contribution requirements of section 62L.03, subdivision 3, is guilty of an unfair trade practice and subject to disciplinary action, including the revocation or suspension of license, under section 60K.43 or 62C.17. The action must be by order and subject to the notice, hearing, and appeal procedures specified in section 60K.43. The action of the commissioner is subject to judicial review as provided under chapter 14. This section does not apply to any action performed by an agent that would be permitted for a health carrier under subdivision 2.

Subd. 4.

Employer prohibition.

A small employer shall not encourage or direct an employee or applicant to:

(1) refrain from filing an application for health coverage when other similarly situated employees may file an application for health coverage;

(2) file an application for health coverage during initial eligibility for coverage, the acceptance of which is contingent on health status, when other similarly situated employees may apply for health coverage, the acceptance of which is not contingent on health status;

(3) seek coverage from another health carrier, including, but not limited to, MCHA; or

(4) cause coverage to be issued on different terms because of the health status or claims experience of that person or the person's dependents.