HF 2988

2nd Engrossment - 82nd Legislature (2001 - 2002) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to insurance; regulating certain licenses, 
  1.3             fees, and coverages; providing for health care 
  1.4             administrative simplification; making certain 
  1.5             technical changes; amending Minnesota Statutes 2000, 
  1.6             sections 61A.092, subdivision 6; 62A.25, subdivision 
  1.7             2; 62A.31, subdivision 1h; 62E.11, subdivision 6; 
  1.8             62E.14, subdivisions 4, 5, 6; 62J.51, subdivision 19; 
  1.9             62J.535, subdivision 2, by adding subdivisions; 
  1.10            62J.581; 62L.03, subdivisions 1, 5; 62Q.185; 62Q.68, 
  1.11            subdivision 1; 79.251, subdivision 1; 79.252, 
  1.12            subdivision 3; 79A.04, subdivision 9; Minnesota 
  1.13            Statutes 2001 Supplement, sections 60A.14, subdivision 
  1.14            1; 60K.56, subdivisions 6, 8, 9; 62M.03, subdivision 
  1.15            2; Laws 2001, chapter 117, article 1, section 29; 
  1.16            proposing coding for new law in Minnesota Statutes, 
  1.17            chapter 62Q; repealing Minnesota Statutes 2000, 
  1.18            section 62J.535, subdivision 1. 
  1.19  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.20     Section 1.  Minnesota Statutes 2001 Supplement, section 
  1.21  60A.14, subdivision 1, is amended to read: 
  1.22     Subdivision 1.  [FEES OTHER THAN EXAMINATION FEES.] In 
  1.23  addition to the fees and charges provided for examinations, the 
  1.24  following fees must be paid to the commissioner for deposit in 
  1.25  the general fund: 
  1.26     (a) by township mutual fire insurance companies: 
  1.27     (1) for filing certificate of incorporation $25 and 
  1.28  amendments thereto, $10; 
  1.29     (2) for filing annual statements, $15; 
  1.30     (3) for each annual certificate of authority, $15; 
  1.31     (4) for filing bylaws $25 and amendments thereto, $10. 
  1.32     (b) by other domestic and foreign companies including 
  2.1   fraternals and reciprocal exchanges: 
  2.2      (1) for filing certified copy of certificate of articles of 
  2.3   incorporation, $100; 
  2.4      (2) for filing annual statement, $225; 
  2.5      (3) for filing certified copy of amendment to certificate 
  2.6   or articles of incorporation, $100; 
  2.7      (4) for filing bylaws, $75 or amendments thereto, $75; 
  2.8      (5) for each company's certificate of authority, $575, 
  2.9   annually. 
  2.10     (c) the following general fees apply: 
  2.11     (1) for each certificate, including certified copy of 
  2.12  certificate of authority, renewal, valuation of life policies, 
  2.13  corporate condition or qualification, $25; 
  2.14     (2) for each copy of paper on file in the commissioner's 
  2.15  office 50 cents per page, and $2.50 for certifying the same; 
  2.16     (3) for license to procure insurance in unadmitted foreign 
  2.17  companies, $575; 
  2.18     (4) for valuing the policies of life insurance companies, 
  2.19  one cent per $1,000 of insurance so valued, provided that the 
  2.20  fee shall not exceed $13,000 per year for any company.  The 
  2.21  commissioner may, in lieu of a valuation of the policies of any 
  2.22  foreign life insurance company admitted, or applying for 
  2.23  admission, to do business in this state, accept a certificate of 
  2.24  valuation from the company's own actuary or from the 
  2.25  commissioner of insurance of the state or territory in which the 
  2.26  company is domiciled; 
  2.27     (5) for receiving and filing certificates of policies by 
  2.28  the company's actuary, or by the commissioner of insurance of 
  2.29  any other state or territory, $50; 
  2.30     (6) for each appointment of an agent filed with the 
  2.31  commissioner, $10; 
  2.32     (7) for filing forms and rates, $75 per filing, to which 
  2.33  may be paid on a quarterly basis in response to an invoice.  
  2.34  Billing and payment may be made electronically; 
  2.35     (8) for annual renewal of surplus lines insurer license, 
  2.36  $300. 
  3.1      The commissioner shall adopt rules to define filings that 
  3.2   are subject to a fee. 
  3.3      Sec. 2.  Minnesota Statutes 2001 Supplement, section 
  3.4   60K.56, subdivision 6, is amended to read: 
  3.5      Subd. 6.  [MINIMUM EDUCATION REQUIREMENT.] Each person 
  3.6   subject to this section shall complete a minimum of 30 credit 
  3.7   hours of courses accredited by the commissioner during each 
  3.8   24-month licensing period.  Any person whose initial licensing 
  3.9   period extends more than six months shall complete 15 hours of 
  3.10  courses accredited by the commissioner during the initial 
  3.11  license period.  Any person teaching or lecturing at an 
  3.12  accredited course qualifies for 1-1/2 three times the number of 
  3.13  credit hours that would be granted to a person completing the 
  3.14  accredited course.  No more than 15 one-half of the credit hours 
  3.15  per licensing period required under this section may be credited 
  3.16  to a person for courses attending any combination of courses 
  3.17  either sponsored by, offered by, or affiliated with an insurance 
  3.18  company or its agents; or offered using new delivery technology, 
  3.19  including computer, interactive technology, and the Internet.  
  3.20  Courses sponsored by, offered by, or affiliated with an 
  3.21  insurance company or agent may restrict its students to agents 
  3.22  of the company or agency. 
  3.23     Sec. 3.  Minnesota Statutes 2001 Supplement, section 
  3.24  60K.56, subdivision 8, is amended to read: 
  3.25     Subd. 8.  [REPORTING.] (a) After completing the minimum 
  3.26  education requirement, each person subject to this section shall 
  3.27  file or cause to be filed a compliance report in accordance with 
  3.28  the procedures adopted by the commissioner.  The compliance 
  3.29  report A producer must not claim credit for continuing education 
  3.30  not actually completed at the date of filing the report. 
  3.31     (b) An institution offering an accredited course shall 
  3.32  comply with the procedure for reporting compliance adopted by 
  3.33  the commissioner.  
  3.34     (c) If a person subject to this section completes a 
  3.35  nonaccredited course, that person may submit a written report to 
  3.36  the advisory committee an application of the commissioner for 
  4.1   approval of the course accompanied by a fee of not more than $10 
  4.2   payable to the state of Minnesota for deposit in the general 
  4.3   fund.  This report must be accompanied by proof satisfactory to 
  4.4   the commissioner that the person has completed the minimum 
  4.5   education requirement for the annual period during which the 
  4.6   nonaccredited course was completed.  Upon the recommendation of 
  4.7   the advisory committee a determination that the course satisfies 
  4.8   the criteria for course accreditation, the commissioner may 
  4.9   approve the nonaccredited course and shall so inform the 
  4.10  person.  If the nonaccredited course is approved by the 
  4.11  commissioner, it may be used to satisfy the minimum education 
  4.12  requirement for the person's next annual compliance period.  
  4.13     Sec. 4.  Minnesota Statutes 2001 Supplement, section 
  4.14  60K.56, subdivision 9, is amended to read: 
  4.15     Subd. 9.  [ENFORCEMENT.] If a person subject to this 
  4.16  section fails to complete the minimum education or reporting 
  4.17  requirement or to pay the prescribed fees for any licensing 
  4.18  period, no license may be renewed or continued in force for that 
  4.19  person for any class of insurance beginning June November 1 of 
  4.20  the year due and that person may not act as an insurance 
  4.21  producer until the person has demonstrated to the satisfaction 
  4.22  of the commissioner that all requirements of this section have 
  4.23  been complied with or that a waiver or extension has been 
  4.24  obtained.  
  4.25     Sec. 5.  Minnesota Statutes 2000, section 61A.092, 
  4.26  subdivision 6, is amended to read: 
  4.27     Subd. 6.  [APPLICATION.] This section applies to a policy, 
  4.28  certificate of insurance, or similar evidence of coverage issued 
  4.29  to a Minnesota resident or issued to provide coverage to a 
  4.30  Minnesota resident.  This section does not apply to:  (1) a 
  4.31  certificate of insurance or similar evidence of coverage that 
  4.32  meets the conditions of section 61A.093, subdivision 2; or (2) a 
  4.33  group life insurance policy that contains a provision permitting 
  4.34  the certificate holder, upon termination or layoff from 
  4.35  employment, to retain the coverage provided under the group 
  4.36  policy by paying premiums directly to the insurer, provided that 
  5.1   the employer shall give the employee notice of the employee's 
  5.2   and each related certificate holder's right to continue the 
  5.3   insurance by paying premiums directly to the insurer.  The 
  5.4   insurer may reserve the right to increase premium rates after 
  5.5   the first 18 months of continued coverage provided for under 
  5.6   clause (2).  A related certificate holder is an insured spouse 
  5.7   or dependent child of the employee.  Upon termination of this 
  5.8   group policy or at the option of the insured who has continued 
  5.9   coverage under clause (2), each covered employee, spouse, and 
  5.10  dependent child is entitled to have issued to them a life 
  5.11  conversion policy as prescribed in section 61A.09, subdivision 
  5.12  1, paragraph (h). 
  5.13     Sec. 6.  Minnesota Statutes 2000, section 62A.25, 
  5.14  subdivision 2, is amended to read: 
  5.15     Subd. 2. (a) Every policy, plan, certificate or contract to 
  5.16  which this section applies shall provide benefits for 
  5.17  reconstructive surgery when such service is incidental to or 
  5.18  follows surgery resulting from injury, sickness or other 
  5.19  diseases of the involved part or when such service is performed 
  5.20  on a covered dependent child because of congenital disease or 
  5.21  anomaly which has resulted in a functional defect as determined 
  5.22  by the attending physician.  
  5.23     (b) The coverage limitations on reconstructive surgery in 
  5.24  paragraph (a) do not apply to reconstructive breast surgery 
  5.25  following mastectomies.  In such cases, coverage for 
  5.26  reconstructive surgery must be provided if the mastectomy is 
  5.27  medically necessary as determined by the attending physician. 
  5.28     (c) Reconstructive surgery benefits include all stages of 
  5.29  reconstruction of the breast on which the mastectomy has been 
  5.30  performed, surgery and reconstruction of the other breast to 
  5.31  produce a symmetrical appearance, and prosthesis and physical 
  5.32  complications at all stages of a mastectomy, including 
  5.33  lymphedemas, in a manner determined in consultation with the 
  5.34  attending physician and patient.  Coverage may be subject to 
  5.35  annual deductible, copayment, and coinsurance provisions as may 
  5.36  be deemed appropriate and as are consistent with those 
  6.1   established for other benefits under the plan or coverage. 
  6.2   Coverage may not: 
  6.3      (1) deny to a patient eligibility, or continued 
  6.4   eligibility, to enroll or to renew coverage under the terms of 
  6.5   the plan, solely for the purpose of avoiding the requirements of 
  6.6   this section; and 
  6.7      (2) penalize or otherwise reduce or limit the reimbursement 
  6.8   of an attending provider, or provide monetary or other 
  6.9   incentives to an attending provider to induce the provider to 
  6.10  provide care to an individual participant or beneficiary in a 
  6.11  manner inconsistent with this section. 
  6.12  Written notice of the availability of the coverage must be 
  6.13  delivered to the participant upon enrollment and annually 
  6.14  thereafter. 
  6.15     Sec. 7.  Minnesota Statutes 2000, section 62A.31, 
  6.16  subdivision 1h, is amended to read: 
  6.17     Subd. 1h.  [LIMITATIONS ON DENIALS, CONDITIONS, AND PRICING 
  6.18  OF COVERAGE.] No health carrier issuing Medicare-related 
  6.19  coverage in this state may impose preexisting condition 
  6.20  limitations or otherwise deny or condition the issuance or 
  6.21  effectiveness of any such coverage available for sale in this 
  6.22  state, nor may it discriminate in the pricing of such coverage, 
  6.23  because of the health status, claims experience, receipt of 
  6.24  health care, medical condition, or age of an applicant where an 
  6.25  application for such coverage is submitted prior to or during 
  6.26  the six-month period beginning with the first day of the month 
  6.27  in which an individual first enrolled for benefits under 
  6.28  Medicare Part B.  This subdivision applies to each 
  6.29  Medicare-related coverage offered by a health carrier regardless 
  6.30  of whether the individual has attained the age of 65 years.  If 
  6.31  an individual who is enrolled in Medicare Part B due to 
  6.32  disability status is involuntarily disenrolled due to loss of 
  6.33  disability status, the individual is eligible for another 
  6.34  six-month enrollment period provided under this subdivision 
  6.35  beginning the first day of the month in which the individual 
  6.36  later becomes eligible for and enrolls again in Medicare Part 
  7.1   B.  An individual who is or was previously enrolled in Medicare 
  7.2   Part B due to disability status is eligible for another 
  7.3   six-month enrollment period under this subdivision beginning the 
  7.4   first day of the month in which the individual has attained the 
  7.5   age of 65 years and either maintains enrollment in, or enrolls 
  7.6   again in, Medicare Part B.  If an individual enrolled in 
  7.7   Medicare Part B voluntarily disenrolls from Medicare Part B 
  7.8   because the individual becomes reemployed and is enrolled under 
  7.9   an employee welfare benefit plan, the individual is eligible for 
  7.10  another six-month enrollment period, as provided in this 
  7.11  subdivision, beginning the first day of the month in which the 
  7.12  individual later becomes eligible for and enrolls again in 
  7.13  Medicare Part B. 
  7.14     Sec. 8.  Minnesota Statutes 2000, section 62E.11, 
  7.15  subdivision 6, is amended to read: 
  7.16     Subd. 6.  [MEMBER ASSESSMENTS.] The association shall make 
  7.17  an annual determination of each contributing member's liability, 
  7.18  if any, and may make an annual fiscal year end assessment if 
  7.19  necessary.  The association may also, subject to the approval of 
  7.20  the commissioner, provide for interim assessments against the 
  7.21  contributing members whose aggregate assessments comprised a 
  7.22  minimum of 90 percent of the most recent prior annual 
  7.23  assessment, in the event that the association deems that 
  7.24  methodology to be the most administratively efficient and cost 
  7.25  effective means of assessment, and as may be necessary to assure 
  7.26  the financial capability of the association in meeting the 
  7.27  incurred or estimated claims expenses of the state plan and 
  7.28  operating and administrative expenses of the association until 
  7.29  the association's next annual fiscal year end assessment.  
  7.30  Payment of an assessment shall be due within 30 days of receipt 
  7.31  by a contributing member of a written notice of a fiscal year 
  7.32  end or interim assessment.  Failure by a contributing member to 
  7.33  tender to the association the assessment within 30 days shall be 
  7.34  grounds for termination of the contributing member's 
  7.35  membership.  A contributing member which ceases to do accident 
  7.36  and health insurance business within the state shall remain 
  8.1   liable for assessments through the calendar year during which 
  8.2   accident and health insurance business ceased.  The association 
  8.3   may decline to levy an assessment against a contributing member 
  8.4   if the assessment, as determined herein, would not exceed ten 
  8.5   dollars. 
  8.6      Sec. 9.  Minnesota Statutes 2000, section 62E.14, 
  8.7   subdivision 4, is amended to read: 
  8.8      Subd. 4.  [WAIVER OF PREEXISTING CONDITIONS FOR MEDICARE 
  8.9   SUPPLEMENT PLAN ENROLLEES.] Notwithstanding the above, any 
  8.10  Minnesota resident holder of a policy or certificate of Medicare 
  8.11  supplement coverages pursuant to sections 62A.315 and 62A.316, 
  8.12  or Medicare supplement plans previously approved by the 
  8.13  commissioner, may enroll in the comprehensive health insurance 
  8.14  plan as described in section 62E.07, with a waiver of the 
  8.15  preexisting condition as described in subdivision 3, without 
  8.16  interruption in coverage, provided, the policy or certificate 
  8.17  has been terminated by the insurer for reasons other than 
  8.18  nonpayment of premium and, provided further, that the option to 
  8.19  enroll in the plan is exercised within 30 90 days of termination 
  8.20  of the existing contract. 
  8.21     Coverage in the state plan for purposes of this section 
  8.22  shall be effective on the date of termination upon completion of 
  8.23  the proper application and payment of the required premium.  The 
  8.24  application must include evidence of termination of the existing 
  8.25  policy or certificate. 
  8.26     Sec. 10.  Minnesota Statutes 2000, section 62E.14, 
  8.27  subdivision 5, is amended to read: 
  8.28     Subd. 5.  [TERMINATED EMPLOYEES.] An employee who is 
  8.29  voluntarily or involuntarily terminated or laid off from 
  8.30  employment and unable to exercise the option to continue 
  8.31  coverage under section 62A.17 may enroll, within 60 90 days of 
  8.32  termination or layoff, with a waiver of the preexisting 
  8.33  condition limitation set forth in subdivision 3 and a waiver of 
  8.34  the evidence of rejection set forth in subdivision 1, paragraph 
  8.35  (c). 
  8.36     Sec. 11.  Minnesota Statutes 2000, section 62E.14, 
  9.1   subdivision 6, is amended to read: 
  9.2      Subd. 6.  [TERMINATION OF INDIVIDUAL POLICY OR CONTRACT.] A 
  9.3   Minnesota resident who holds an individual health maintenance 
  9.4   contract, individual nonprofit health service corporation 
  9.5   contract, or an individual insurance policy previously approved 
  9.6   by the commissioners of health or commerce, may enroll in the 
  9.7   comprehensive health insurance plan with a waiver of the 
  9.8   preexisting condition as described in subdivision 3, without 
  9.9   interruption in coverage, provided (1) no replacement coverage 
  9.10  that meets the requirements of section 62D.121 was offered by 
  9.11  the contributing member, and (2) the policy or contract has been 
  9.12  terminated for reasons other than (a) nonpayment of premium; (b) 
  9.13  failure to make copayments required by the health care plan; (c) 
  9.14  moving out of the area served; or (d) a materially false 
  9.15  statement or misrepresentation by the enrollee in the 
  9.16  application for membership; and, provided further, that the 
  9.17  option to enroll in the plan is exercised within 30 90 days of 
  9.18  termination of the existing policy or contract. 
  9.19     Coverage allowed under this section is effective when the 
  9.20  contract or policy is terminated and the enrollee has completed 
  9.21  the proper application and paid the required premium or fee. 
  9.22     Expenses incurred from the preexisting conditions of 
  9.23  individuals enrolled in the state plan under this subdivision 
  9.24  must be paid by the contributing member canceling coverage as 
  9.25  set forth in section 62E.11, subdivision 10. 
  9.26     The application must include evidence of termination of the 
  9.27  existing policy or certificate as required in subdivision 1. 
  9.28     Sec. 12.  Minnesota Statutes 2000, section 62J.51, 
  9.29  subdivision 19, is amended to read: 
  9.30     Subd. 19.  [UNIFORM DENTAL BILLING FORM.] "Uniform dental 
  9.31  billing form" means the 1990 most current version uniform dental 
  9.32  claim form developed by the American Dental Association. 
  9.33     Sec. 13.  Minnesota Statutes 2000, section 62J.535, is 
  9.34  amended by adding a subdivision to read: 
  9.35     Subd. 1a.  [ELECTRONIC CLAIM TRANSACTIONS.] Group 
  9.36  purchasers, including government programs, not defined as 
 10.1   covered entities under United States Code, title 42, sections 
 10.2   1320d to 1320d-8, as amended from time to time, and the 
 10.3   regulations promulgated under those sections, that voluntarily 
 10.4   agree with providers to accept electronic claim transactions, 
 10.5   must accept them in the ANSI X12N 837 standard electronic format 
 10.6   as established by federal law.  Nothing in this section requires 
 10.7   acceptance of electronic claim transactions by entities not 
 10.8   covered under United States Code, title 42, sections 1320d to 
 10.9   1320d-8, as amended from time to time, and the regulations 
 10.10  promulgated under those sections.  Notwithstanding the above, 
 10.11  nothing in this section or other state law prohibits group 
 10.12  purchasers not defined as covered entities under United States 
 10.13  Code, title 42, sections 1320d to 1320d-8, as amended from time 
 10.14  to time, and the regulations promulgated under those sections, 
 10.15  from requiring, as authorized by Minnesota law or rule, 
 10.16  additional information associated with a claim submitted by a 
 10.17  provider. 
 10.18     Sec. 14.  Minnesota Statutes 2000, section 62J.535, is 
 10.19  amended by adding a subdivision to read: 
 10.20     Subd. 1b.  [PAPER CLAIM TRANSACTIONS.] All group purchasers 
 10.21  that accept paper claim transactions must accept, and health 
 10.22  care providers submitting paper claim transactions must submit, 
 10.23  such transactions with use of the applicable medical and 
 10.24  nonmedical data code sets specified in the federal electronic 
 10.25  claim transaction standards adopted under United States Code, 
 10.26  title 42, sections 1320d to 1320d-8, as amended from time to 
 10.27  time, and the regulations promulgated under those sections.  The 
 10.28  paper claim transaction must also be conducted using the uniform 
 10.29  billing forms as specified in section 62J.52 and the identifiers 
 10.30  specified in section 62J.54, on and after the compliance date 
 10.31  required by law.  Notwithstanding the above, nothing in this 
 10.32  section or other state law prohibits group purchasers not 
 10.33  defined as covered entities under United States Code, title 42, 
 10.34  sections 1320d to 1320d-8, as amended from time to time, and the 
 10.35  regulations promulgated under those sections, from requiring, as 
 10.36  authorized by Minnesota law or rule, additional information 
 11.1   associated with a claim submitted by a provider. 
 11.2      Sec. 15.  Minnesota Statutes 2000, section 62J.535, 
 11.3   subdivision 2, is amended to read: 
 11.4      Subd. 2.  [COMPLIANCE.] (a) Subdivision 1a is effective 
 11.5   concurrent with the date of required compliance for covered 
 11.6   entities established under United States Code, title 42, 
 11.7   sections 1320d to 1320d-8, as amended from time to time, for 
 11.8   uniform electronic billing standards, all health care providers 
 11.9   must conform to the uniform billing standards developed under 
 11.10  subdivision 1. 
 11.11     (b) Notwithstanding paragraph (a), the requirements for the 
 11.12  uniform remittance advice report shall be effective 12 months 
 11.13  after the date of the required compliance of the standards for 
 11.14  the electronic remittance advice transaction are effective under 
 11.15  United States Code, title 42, sections 1320d to 1320d-8, as 
 11.16  amended from time to time. 
 11.17     Sec. 16.  Minnesota Statutes 2000, section 62J.581, is 
 11.18  amended to read: 
 11.19     62J.581 [STANDARDS FOR MINNESOTA UNIFORM HEALTH CARE 
 11.20  REIMBURSEMENT DOCUMENTS.] 
 11.21     Subdivision 1.  [MINNESOTA UNIFORM REMITTANCE ADVICE 
 11.22  REPORT.] (a) All group purchasers and payers shall provide a 
 11.23  uniform remittance advice report to health care providers when a 
 11.24  claim is adjudicated.  The uniform remittance advice report 
 11.25  shall comply with the standards prescribed in this section.  
 11.26     (b) Notwithstanding paragraph (a), this section does not 
 11.27  apply to group purchasers not included as covered entities under 
 11.28  United States Code, title 42, sections 1320d to 1320d-8, as 
 11.29  amended from time to time, and the regulations promulgated under 
 11.30  those sections. 
 11.31     Subd. 2.  [MINNESOTA UNIFORM EXPLANATION OF BENEFITS 
 11.32  DOCUMENT.] (a) All group purchasers and payers shall provide a 
 11.33  uniform explanation of benefits document to health care patients 
 11.34  when a claim is adjudicated an explanation of benefits document 
 11.35  is provided as otherwise required or permitted by law.  The 
 11.36  uniform explanation of benefits document shall comply with the 
 12.1   standards prescribed in this section.  
 12.2      (b) Notwithstanding paragraph (a), this section does not 
 12.3   apply to group purchasers not included as covered entities under 
 12.4   United States Code, title 42, sections 1320d to 1320d-8, as 
 12.5   amended from time to time, and the regulations promulgated under 
 12.6   those sections. 
 12.7      Subd. 3.  [SCOPE.] For purposes of sections 62J.50 to 
 12.8   62J.61, the uniform remittance advice report and the uniform 
 12.9   explanation of benefits document format specified in subdivision 
 12.10  4 shall apply to all health care services delivered by a health 
 12.11  care provider or health care provider organization in Minnesota, 
 12.12  regardless of the location of the payer.  Health care services 
 12.13  not paid on an individual claims basis, such as capitated 
 12.14  payments, are not included in this section.  A health plan 
 12.15  company is excluded from the requirements in subdivisions 1 and 
 12.16  2 if they comply with section 62A.01, subdivisions 2 and 3. 
 12.17     Subd. 4.  [SPECIFICATIONS.] The uniform remittance advice 
 12.18  report and the uniform explanation of benefits document shall be 
 12.19  provided by use of a paper document conforming to the 
 12.20  specifications in this section or by use of the ANSI X12N 835 
 12.21  standard electronic format as established under United States 
 12.22  Code, title 42, sections 1320d to 1320d-8, and as amended from 
 12.23  time to time for the remittance advice.  The commissioner, after 
 12.24  consulting with the administrative uniformity committee, shall 
 12.25  specify the data elements and definitions for the uniform 
 12.26  remittance advice report and the uniform explanation of benefits 
 12.27  document.  The commissioner and the administrative uniformity 
 12.28  committee must consult with the Minnesota Dental Association and 
 12.29  Delta Dental Plan of Minnesota before requiring under this 
 12.30  section the use of a paper document for the uniform explanation 
 12.31  of benefits document or the uniform remittance advice report for 
 12.32  dental care services.  
 12.33     Subd. 5.  [EFFECTIVE DATE.] The requirements in 
 12.34  subdivisions 1 and 2 are effective 12 months after the date of 
 12.35  required compliance with the standards for the electronic 
 12.36  remittance advice transaction under United States Code, title 
 13.1   42, sections 1320d to 1320d-8, and as amended from time to 
 13.2   time October 16, 2004.  The requirements in subdivisions 1 and 2 
 13.3   apply regardless of when the health care service was provided to 
 13.4   the patient. 
 13.5      Sec. 17.  Minnesota Statutes 2000, section 62L.03, 
 13.6   subdivision 1, is amended to read: 
 13.7      Subdivision 1.  [GUARANTEED ISSUE AND REISSUE.] (a) Every 
 13.8   health carrier shall, as a condition of authority to transact 
 13.9   business in this state in the small employer market, 
 13.10  affirmatively market, offer, sell, issue, and renew any of its 
 13.11  health benefit plans, on a guaranteed issue basis, to any small 
 13.12  employer, including a small employer covered by paragraph (b) or 
 13.13  (c), that meets the participation and contribution requirements 
 13.14  of subdivision 3, as provided in this chapter.  
 13.15     (b) A small employer that has its workforce exceed 50 
 13.16  employees during a plan or policy year has the option to 
 13.17  continue coverage as a small employer or be nonrenewed and seek 
 13.18  replacement coverage in the large employer market. 
 13.19     (c) A small employer that has its workforce reduced to 
 13.20  fewer than two employees may continue coverage as a small 
 13.21  employer for 12 months from the date the group changes to one.  
 13.22     (d) Notwithstanding paragraph (a), a health carrier may, at 
 13.23  the time of coverage renewal, modify the health coverage for a 
 13.24  product offered in the small employer market if the modification 
 13.25  is consistent with state law, approved by the commissioner, and 
 13.26  effective on a uniform basis for all small employers purchasing 
 13.27  that product other than through a qualified association in 
 13.28  compliance with section 62L.045, subdivision 2. 
 13.29     Paragraph (a) does not apply to a health benefit plan 
 13.30  designed for a small employer to comply with a collective 
 13.31  bargaining agreement, provided that the health benefit plan 
 13.32  otherwise complies with this chapter and is not offered to other 
 13.33  small employers, except for other small employers that need it 
 13.34  for the same reason.  This paragraph applies only with respect 
 13.35  to collective bargaining agreements entered into prior to August 
 13.36  21, 1996, and only with respect to plan years beginning before 
 14.1   the later of July 1, 1997, or the date upon which the last of 
 14.2   the collective bargaining agreements relating to the plan 
 14.3   terminates determined without regard to any extension agreed to 
 14.4   after August 21, 1996. 
 14.5      (c) (e) Every health carrier participating in the small 
 14.6   employer market shall make available both of the plans described 
 14.7   in section 62L.05 to small employers and shall fully comply with 
 14.8   the underwriting and the rate restrictions specified in this 
 14.9   chapter for all health benefit plans issued to small employers.  
 14.10     (d) (f) A health carrier may cease to transact business in 
 14.11  the small employer market as provided under section 62L.09. 
 14.12     Sec. 18.  Minnesota Statutes 2000, section 62L.03, 
 14.13  subdivision 5, is amended to read: 
 14.14     Subd. 5.  [CANCELLATIONS AND FAILURES TO RENEW.] (a) No 
 14.15  health carrier shall cancel, decline to issue, or fail to renew 
 14.16  a health benefit plan as a result of the claim experience or 
 14.17  health status of the persons covered or to be covered by the 
 14.18  health benefit plan.  For purposes of this subdivision, a 
 14.19  failure to renew does not include a uniform modification of 
 14.20  coverage at time of renewal, as described in subdivision 1. 
 14.21     (b) A health carrier may cancel or fail to renew a health 
 14.22  benefit plan: 
 14.23     (1) for nonpayment of the required premium; 
 14.24     (2) for fraud or misrepresentation by the small employer 
 14.25  with respect to eligibility for coverage or any other material 
 14.26  fact; 
 14.27     (3) if the employer fails to comply with the minimum 
 14.28  contribution percentage required under subdivision 3; or 
 14.29     (4) for any other reasons or grounds expressly permitted by 
 14.30  the respective licensing laws and regulations governing a health 
 14.31  carrier, including, but not limited to, service area 
 14.32  restrictions imposed on health maintenance organizations under 
 14.33  section 62D.03, subdivision 4, paragraph (m), to the extent that 
 14.34  these grounds are not expressly inconsistent with this chapter. 
 14.35     (c) A health carrier may fail to renew a health benefit 
 14.36  plan: 
 15.1      (1) if eligible employee participation during the preceding 
 15.2   calendar year declines to less than 75 percent, subject to the 
 15.3   waiver of coverage provision in subdivision 3; 
 15.4      (2) if the health carrier ceases to do business in the 
 15.5   small employer market under section 62L.09; or 
 15.6      (3) if a failure to renew is based upon the health 
 15.7   carrier's decision to discontinue the health benefit plan form 
 15.8   previously issued to the small employer, but only if the health 
 15.9   carrier permits each small employer covered under the prior form 
 15.10  to switch to its choice of any other health benefit plan offered 
 15.11  by the health carrier, without any underwriting restrictions 
 15.12  that would not have been permitted for renewal purposes. 
 15.13     (d) A health carrier need not renew a health benefit plan, 
 15.14  and shall not renew a small employer plan, if an employer ceases 
 15.15  to qualify as a small employer as defined in section 62L.02, 
 15.16  except as provided in subdivision 1, paragraphs (b) and (c).  If 
 15.17  a health benefit plan, other than a small employer plan, 
 15.18  provides terms of renewal that do not exclude an employer that 
 15.19  is no longer a small employer, the health benefit plan may be 
 15.20  renewed according to its own terms.  If a health carrier issues 
 15.21  or renews a health plan to an employer that is no longer a small 
 15.22  employer, without interruption of coverage, the health plan is 
 15.23  subject to section 60A.082.  
 15.24     (e) A health carrier may cancel or fail to renew the 
 15.25  coverage of an individual employee or dependent under a health 
 15.26  benefit plan for fraud or misrepresentation by the eligible 
 15.27  employee or dependent with respect to eligibility for coverage 
 15.28  or any other material fact. 
 15.29     Sec. 19.  Minnesota Statutes 2001 Supplement, section 
 15.30  62M.03, subdivision 2, is amended to read: 
 15.31     Subd. 2.  [NONLICENSED UTILIZATION REVIEW ORGANIZATION.] An 
 15.32  organization that meets the definition of a utilization review 
 15.33  organization under section 62M.02, subdivision 21, that is not 
 15.34  licensed in this state that performs utilization review services 
 15.35  for Minnesota residents must register with the commissioner of 
 15.36  commerce and must certify compliance with sections 62M.01 to 
 16.1   62M.16. 
 16.2      Initial registration must occur no later than January 1, 
 16.3   1993.  The registration is effective for two years and may be 
 16.4   renewed for another two years by written request.  Applications 
 16.5   for initial and renewal registrations must be made on forms 
 16.6   prescribed by the commissioner.  Each utilization review 
 16.7   organization registered under this chapter shall notify the 
 16.8   commissioner of commerce within 30 days of any change in the 
 16.9   name, address, or ownership of the organization.  The 
 16.10  organization shall pay to the commissioner of commerce a fee of 
 16.11  $1,000 for the initial registration application and $1,000 for 
 16.12  each two-year renewal. 
 16.13     Sec. 20.  Minnesota Statutes 2000, section 62Q.185, is 
 16.14  amended to read: 
 16.15     62Q.185 [GUARANTEED RENEWABILITY; LARGE EMPLOYER GROUP 
 16.16  HEALTH COVERAGE.] 
 16.17     (a) No health plan company, as defined in section 62Q.01, 
 16.18  subdivision 4, shall refuse to renew a health benefit plan, as 
 16.19  defined in section 62L.02, subdivision 15, but issued to a large 
 16.20  employer, as defined in section 62Q.18, subdivision 1. 
 16.21     (b) This section does not require renewal if: 
 16.22     (1) the large employer has failed to pay premiums or 
 16.23  contributions as required under the terms of the health benefit 
 16.24  plan, or the health plan company has not received timely premium 
 16.25  payments unless the late payments were received within a grace 
 16.26  period provided under state law; 
 16.27     (2) the large employer has performed an act or practice 
 16.28  that constitutes fraud or misrepresentation of material fact 
 16.29  under the terms of the health benefit plan; 
 16.30     (3) the large employer has failed to comply with a material 
 16.31  plan provision relating to employer contribution or group 
 16.32  participation rules not prohibited by state law; 
 16.33     (4) the health plan company is ceasing to offer coverage in 
 16.34  the large employer market in this state in compliance with 
 16.35  United States Code, title 42, section 300gg-12(c), and 
 16.36  applicable state law; 
 17.1      (5) in the case of a health maintenance organization, there 
 17.2   is no longer any enrollee in the large employer's health benefit 
 17.3   plan who lives, resides, or works in the approved service area; 
 17.4   or 
 17.5      (6) in the case of a health benefit plan made available to 
 17.6   large employers only through one or more bona fide associations, 
 17.7   the membership of the large employer in the association ceases, 
 17.8   but only if such coverage is terminated uniformly without regard 
 17.9   to any health-related factor relating to any covered individual. 
 17.10     (c) This section does not prohibit a health plan company 
 17.11  from modifying the premium rate or from modifying the coverage 
 17.12  for purposes of renewal. 
 17.13     (d) This section does not require renewal of the coverage 
 17.14  of individual enrollees under the health benefit plan if the 
 17.15  individual enrollee has performed an act or practice that 
 17.16  constitutes fraud or misrepresentation of material fact under 
 17.17  the terms of the health benefit plan. 
 17.18     (e) If a large employer's number of employees decreases 
 17.19  below 51 employees, coverage may be renewed by the employer in 
 17.20  the large employer group health coverage market. 
 17.21     Sec. 21.  Minnesota Statutes 2000, section 62Q.68, 
 17.22  subdivision 1, is amended to read: 
 17.23     Subdivision 1.  [APPLICATION.] For purposes of sections 
 17.24  62Q.68 to 62Q.72, the terms defined in this section have the 
 17.25  meanings given them.  For purposes of sections 62Q.69 and 
 17.26  62Q.70, the term "health plan company" does not include an 
 17.27  insurance company licensed under chapter 60A to offer, sell, or 
 17.28  issue a policy of accident and sickness insurance as defined in 
 17.29  section 62A.01 or a nonprofit health service plan corporation 
 17.30  regulated under chapter 62C that only provides dental coverage 
 17.31  or vision coverage.  For purposes of sections 62Q.69 through 
 17.32  62Q.73, the term "health plan company" does not include the 
 17.33  comprehensive health association created under chapter 62E. 
 17.34     Sec. 22.  [62Q.731] [EXTERNAL REVIEW OF ADVERSE 
 17.35  DETERMINATION FROM COMPREHENSIVE HEALTH ASSOCIATION.] 
 17.36     Subdivision 1.  [DEFINITIONS.] (a) For purposes of this 
 18.1   section, the terms defined in this subdivision have the meanings 
 18.2   given. 
 18.3      (b) "Enrollee" means an eligible person as defined in 
 18.4   section 62E.02, subdivision 13, and who meets the eligibility 
 18.5   criteria established in section 62E.14. 
 18.6      (c) "Board" means the board of directors of the 
 18.7   comprehensive health association, as described in section 
 18.8   62E.10, subdivision 2. 
 18.9      Subd. 2.  [APPEAL TO EXTERNAL REVIEW ENTITY.] If an 
 18.10  enrollee receives an adverse determination as a result of the 
 18.11  comprehensive health association's internal appeal process, by 
 18.12  which an established enrollee appeal committee renders an 
 18.13  adverse determination, the enrollee then has the option of: 
 18.14     (1) appealing the adverse determination to the external 
 18.15  review entity under section 62Q.73, which shall constitute a 
 18.16  final determination subject to the conditions specified in 
 18.17  section 62Q.73; or 
 18.18     (2) appealing to the commissioner of commerce from an 
 18.19  adverse determination as provided by the operating rules of the 
 18.20  comprehensive health association, in which case the commissioner 
 18.21  has the option of making a determination regarding the appeal, 
 18.22  or submitting the appeal to the external review entity retained 
 18.23  under section 62Q.73. 
 18.24     Sec. 23.  Minnesota Statutes 2000, section 79.251, 
 18.25  subdivision 1, is amended to read: 
 18.26     Subdivision 1.  [ASSIGNED RISK PLAN REVIEW BOARD GENERAL 
 18.27  DUTIES OF COMMISSIONER.] (1) An assigned risk plan review board 
 18.28  is created for the purposes of review of the operation of 
 18.29  section 79.252 and this section.  The board commissioner shall 
 18.30  have all the usual powers and authorities necessary for the 
 18.31  discharge of its duties under this section and may contract with 
 18.32  individuals in discharge of those duties.  
 18.33     (2) The board shall consist of six members to be appointed 
 18.34  by the commissioner of commerce.  Three members shall be 
 18.35  insureds holding policies or contracts of coverage issued 
 18.36  pursuant to subdivision 4.  Two members shall be insurers 
 19.1   licensed pursuant to section 60A.06, subdivision 1, clause (5), 
 19.2   paragraph (b).  The commissioner shall be the sixth member and 
 19.3   shall vote. 
 19.4      Initial appointments shall be made by September 1, 1981, 
 19.5   and terms shall be for three years duration.  Removal, the 
 19.6   filling of vacancies and compensation of the members other than 
 19.7   the commissioner shall be as provided in section 15.059.  
 19.8      (3) The assigned risk plan review board commissioner shall 
 19.9   audit the reserves established (a) for individual cases arising 
 19.10  under policies and contracts of coverage issued under 
 19.11  subdivision 4 and (b) for the total book of business issued 
 19.12  under subdivision 4.  
 19.13     (4) (2) The assigned risk plan review board commissioner 
 19.14  shall monitor the operations of section 79.252 and this section 
 19.15  and shall periodically make recommendations to the commissioner, 
 19.16  and to the governor and legislature when appropriate, for 
 19.17  improvement in the operation of those sections.  
 19.18     (5) (3) All insurers and self-insurance administrators 
 19.19  issuing policies or contracts under subdivision 4 shall pay to 
 19.20  the commissioner a .25 percent assessment on premiums for 
 19.21  policies and contracts of coverage issued under subdivision 4 
 19.22  for the purpose of defraying the costs of the assigned risk plan 
 19.23  review board performing the duties under clauses (1) and (2).  
 19.24  Proceeds of the assessment shall be deposited in the state 
 19.25  treasury and credited to the general fund. 
 19.26     (6) (4) The assigned risk plan and the assigned risk plan 
 19.27  review board shall not be deemed a state agency.  
 19.28     Sec. 24.  Minnesota Statutes 2000, section 79.252, 
 19.29  subdivision 3, is amended to read: 
 19.30     Subd. 3.  [COVERAGE.] (a) Policies and contracts of 
 19.31  coverage issued pursuant to section 79.251, subdivision 4, shall 
 19.32  contain the usual and customary provisions of workers' 
 19.33  compensation insurance policies, and shall be deemed to meet the 
 19.34  mandatory workers' compensation insurance requirements of 
 19.35  section 176.181, subdivision 2.  
 19.36     (b) Policies issued by the assigned risk plan pursuant to 
 20.1   this chapter may also provide workers' compensation coverage 
 20.2   required under the laws of states other than Minnesota, 
 20.3   including coverages commonly known as "all states coverage."  
 20.4   The assigned risk plan review board commissioner may apply for 
 20.5   and obtain any licensure required in any other state to issue 
 20.6   that coverage. 
 20.7      Sec. 25.  Minnesota Statutes 2000, section 79A.04, 
 20.8   subdivision 9, is amended to read: 
 20.9      Subd. 9.  [INSOLVENCY, BANKRUPTCY, OR DEFAULT; UTILIZATION 
 20.10  OF SECURITY DEPOSIT.] The commissioner of labor and industry 
 20.11  shall notify the commissioner and the security fund if the 
 20.12  commissioner of labor and industry has knowledge that any 
 20.13  private self-insurer has failed to pay workers' compensation 
 20.14  benefits as required by chapter 176.  If the commissioner 
 20.15  determines that a private self-insurer is the subject of a 
 20.16  voluntary or involuntary petition under the United States 
 20.17  Bankruptcy Code, title 11, or the commissioner determines that a 
 20.18  court of competent jurisdiction has declared the private 
 20.19  self-insurer to be bankrupt or insolvent, and the private 
 20.20  self-insurer has failed to pay workers' compensation as required 
 20.21  by chapter 176 or, if the commissioner issues a certificate of 
 20.22  default against a private self-insurer for failure to pay 
 20.23  workers' compensation as required by chapter 176, or failure to 
 20.24  pay an assessment to the self-insurers' security fund when due, 
 20.25  then the security deposit shall be utilized to administer and 
 20.26  pay the private self-insurers' workers' compensation or 
 20.27  assessment obligations or any other current or future 
 20.28  obligations of the self-insurers' security fund.  The security 
 20.29  deposit shall be used to administer and pay the private 
 20.30  self-insurers' workers' compensation or assessment obligations 
 20.31  or any other current or future obligations of the self-insurers' 
 20.32  security fund if any of the following occurs: 
 20.33     (1) the private self-insurer has failed to pay workers' 
 20.34  compensation as required by chapter 176 and either: 
 20.35     (a) the commissioner determines that a private self-insurer 
 20.36  is the subject of a voluntary or involuntary petition under the 
 21.1   United States Bankruptcy Code, title 11; or 
 21.2      (b) the commissioner determines that a court of competent 
 21.3   jurisdiction has declared the private self-insurer to be 
 21.4   bankrupt or insolvent; or 
 21.5      (2) the commissioner issues a certificate of default 
 21.6   against a private self-insurer for failure to pay workers' 
 21.7   compensation as required by chapter 176; or 
 21.8      (3) the commissioner issues a certificate of default 
 21.9   against a private self-insurer for failure to pay an assessment 
 21.10  to the self-insurer's security fund when due. 
 21.11     Sec. 26.  Laws 2001, chapter 117, article 1, section 29, is 
 21.12  amended to read: 
 21.13     Sec. 29.  [EFFECTIVE DATE; APPLICATION.] 
 21.14     Sections 1 to 28 are effective July 1, 2002, and apply to 
 21.15  persons who sell, solicit, or negotiate insurance in this state 
 21.16  for any class or classes of insurance on or after that date.  
 21.17  However, a person required to be licensed under Minnesota 
 21.18  Statutes, chapter 60K, who holds a valid license under Minnesota 
 21.19  Statutes 2000, sections 60K.01 to 60K.20, on July 1, 2002, may 
 21.20  continue to sell, solicit, or negotiate insurance in this state 
 21.21  under the authority of that license.  Upon the expiration of 
 21.22  that license, the person shall not sell, solicit, or negotiate 
 21.23  insurance in this state for any class or classes of insurance 
 21.24  unless the person is licensed in that line of authority under 
 21.25  Minnesota Statutes, chapter 60K. 
 21.26     Sec. 27.  [INTENT OF AMENDMENTS.] 
 21.27     The legislature intends the amendments in sections 23 and 
 21.28  24 to be technical clarifications necessitated by the expiration 
 21.29  of the assigned risk plan review board on June 30, 1997, 
 21.30  according to the terms of Minnesota Statutes, section 15.059. 
 21.31     Sec. 28.  [REVISOR INSTRUCTION.] 
 21.32     The revisor of statutes is instructed to amend the headnote 
 21.33  of Minnesota Statutes, section 62J.535, to read "Uniform Billing 
 21.34  Requirements for Claim Transactions." 
 21.35     Sec. 29.  [REPEALER.] 
 21.36     Minnesota Statutes 2000, section 62J.535, subdivision 1, is 
 22.1   repealed. 
 22.2      Sec. 30.  [EFFECTIVE DATE.] 
 22.3      Section 5 is effective the day following final enactment.