HF 3379

as introduced - 80th Legislature (1997 - 1998) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to insurance; regulating trade practices; 
  1.3             providing for reimbursement for licensed ambulance 
  1.4             services; amending Minnesota Statutes 1996, section 
  1.5             72A.201, subdivision 5; Minnesota Statutes 1997 
  1.6             Supplement, section 62J.48. 
  1.7   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.8      Section 1.  Minnesota Statutes 1997 Supplement, section 
  1.9   62J.48, is amended to read: 
  1.10     62J.48 [CRITERIA FOR REIMBURSEMENT.] 
  1.11     All ambulance services licensed under section 144E.10 are 
  1.12  eligible for reimbursement under health plan companies. The 
  1.13  commissioner shall require health plan companies to adopt the 
  1.14  following reimbursement policies. 
  1.15     (1) All scheduled or prearranged air and ground ambulance 
  1.16  transports must be reimbursed if requested by an attending 
  1.17  physician or nurse, and, if the person is an enrollee in a 
  1.18  health plan company, if approved by a designated representative 
  1.19  of a health plan company who is immediately available on a 
  1.20  24-hour basis.  The designated representative must be a 
  1.21  registered nurse or a physician assistant with at least three 
  1.22  years of critical care or trauma experience, or a licensed 
  1.23  physician. 
  1.24     (2) Reimbursement must be provided for all emergency 
  1.25  ambulance calls in which a patient is transported or medical 
  1.26  treatment rendered. 
  2.1      (3) Special transportation services must not be billed or 
  2.2   reimbursed if the patient needs medical attention immediately 
  2.3   before transportation. 
  2.4      (4) The check or draft issued by the health plan company as 
  2.5   reimbursement for ambulance services must be payable to the 
  2.6   licensee and the insured, enrollee, or covered person and may be 
  2.7   negotiated, discharged, or enforced only by both of them. 
  2.8      Sec. 2.  Minnesota Statutes 1996, section 72A.201, 
  2.9   subdivision 5, is amended to read: 
  2.10     Subd. 5.  [STANDARDS FOR FAIR SETTLEMENT OFFERS AND 
  2.11  AGREEMENTS.] The following acts by an insurer, an adjuster, a 
  2.12  self-insured, or a self-insurance administrator constitute 
  2.13  unfair settlement practices:  
  2.14     (1) making any partial or final payment, settlement, or 
  2.15  offer of settlement, which does not include an explanation of 
  2.16  what the payment, settlement, or offer of settlement is for; 
  2.17     (2) making an offer to an insured of partial or total 
  2.18  settlement of one part of a claim contingent upon agreement to 
  2.19  settle another part of the claim; 
  2.20     (3) refusing to pay one or more elements of a claim by an 
  2.21  insured for which there is no good faith dispute; 
  2.22     (4) threatening cancellation, rescission, or nonrenewal of 
  2.23  a policy as an inducement to settlement of a claim; 
  2.24     (5) notwithstanding any inconsistent provision of section 
  2.25  65A.01, subdivision 3, failing to issue payment for any amount 
  2.26  finally agreed upon in settlement of all or part of any claim 
  2.27  within five business days from the receipt of the agreement by 
  2.28  the insurer or from the date of the performance by the claimant 
  2.29  of any conditions set by such agreement, whichever is later; 
  2.30     (6) failing to inform the insured of the policy provision 
  2.31  or provisions under which payment is made; 
  2.32     (7) settling or attempting to settle a claim or part of a 
  2.33  claim with an insured under actual cash value provisions for 
  2.34  less than the value of the property immediately preceding the 
  2.35  loss, including all applicable taxes and license fees.  In no 
  2.36  case may an insurer be required to pay an amount greater than 
  3.1   the amount of insurance; 
  3.2      (8) except where limited by policy provisions, settling or 
  3.3   offering to settle a claim or part of a claim with an insured 
  3.4   under replacement value provisions for less than the sum 
  3.5   necessary to replace the damaged item with one of like kind and 
  3.6   quality, including all applicable taxes, license, and transfer 
  3.7   fees; 
  3.8      (9) reducing or attempting to reduce for depreciation any 
  3.9   settlement or any offer of settlement for items not adversely 
  3.10  affected by age, use, or obsolescence; 
  3.11     (10) reducing or attempting to reduce for betterment any 
  3.12  settlement or any offer of settlement unless the resale value of 
  3.13  the item has increased over the preloss value by the repair of 
  3.14  the damage.; 
  3.15     (11) failing to satisfy the reimbursement policy in section 
  3.16  62J.48, clause (4).