SF 2172

as introduced - 89th Legislature (2015 - 2016) Posted on 05/14/2015 08:32am

A bill for an act
relating to insurance; establishing requirements for merged market health plans;
making related changes; amending Minnesota Statutes 2014, sections 62K.15;
62L.02, subdivision 27; proposing coding for new law in Minnesota Statutes,
chapter 62A.

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

Section 1.

new text begin [62A.67] MERGED MARKET REGULATION.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) "Eligible employer" means an employer with 100
or fewer employees.
new text end

new text begin (b) "Employer contribution" means any amount given to an employee by an
employer as part of a plan or program for the purposes of the Internal Revenue Code,
section 105, 106, 125, or 162.
new text end

new text begin (c) "Merged market" means the market for health insurance coverage offered to
individuals and dependents who purchase a group health plan using employer contributions
made by an eligible employer, in full or in part, through the individual market or MNsure.
new text end

new text begin (d) "Merged market health plan" means a group health plan issued to employers
on behalf of individual employees and dependents in the individual market or through
MNsure, using defined contributions provided by eligible employers.
new text end

new text begin Subd. 2. new text end

new text begin Purchase of plans in the merged market. new text end

new text begin (a) An eligible employer may
offer an employer contribution to allow employees and dependents to purchase health
insurance coverage in the merged market.
new text end

new text begin (b) An employee and dependents may use the employer contribution only to
purchase a merged market health plan offered through MNsure or offered outside of
MNsure by a health carrier.
new text end

new text begin (c) An eligible employer may limit the health plans from which an employee may
choose in the merged market.
new text end

new text begin (d) An employee and dependents receiving a group health plan under a plan
purchased in the merged market are not eligible for advanced premium tax credits or
cost-sharing subsidies offered through MNsure. The commissioner, in cooperation with
the commissioner of revenue, shall monitor and enforce compliance with this requirement.
new text end

new text begin Subd. 3. new text end

new text begin Regulation. new text end

new text begin (a) Any coverage purchased in the merged market is a group
health plan as defined in section 62A.011, subdivision 1c, and shall be regulated by:
new text end

new text begin (1) individual market requirements specified in section 62A.65;
new text end

new text begin (2) federal small group requirements in United States Code, title 42, sections 300gg
and 300gg-1 to 300gg-28; and
new text end

new text begin (3) requirements in chapter 62K that apply to qualified health plans.
new text end

new text begin (b) Merged market coverage issued to an eligible employer on behalf of an individual
while employed by the employer automatically converts to individual coverage if:
new text end

new text begin (1) the employer ceases to offer an employer contribution; or
new text end

new text begin (2) the individual is no longer employed by that eligible employer.
new text end

new text begin Upon the automatic conversion, the coverage shall be regulated under section 62A.65 and
the individual and dependents, if eligible, may receive advanced premium tax credits and
cost-sharing subsidies to purchase qualified health plan coverage through MNsure.
new text end

new text begin (c) Health plan companies offering health plans in the merged market are subject to
the reinsurance assessments required under section 1341 of the Affordable Care Act.
new text end

new text begin (d) An employer offering a merged market health plan that restricts enrollment to
new employees who join the health plan within 30 days of their first day of employment or
during the annual open enrollment period must be guaranteed coverage on a guaranteed
issue basis from any health carrier participating in the merged market.
new text end

new text begin (e) The sale of a group health plan in the merged market by an agent or broker is not
a violation of section 62L.12, subdivision 3.
new text end

new text begin (f) A health plan company shall consider all enrollees in all health plans, other than
grandfathered health plans, offered by the health plan company in the individual market and
the merged market, both inside and outside of MNsure, to be members of a single risk pool.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2016, and applies to
merged market health plans offered, issued, or renewed on or after that date.
new text end

Sec. 2.

Minnesota Statutes 2014, section 62K.15, is amended to read:

62K.15 ANNUAL OPEN 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.

new text begin (c) Subject to Code of Federal Regulations, title 45, section 147.104(b)(1), a health
insurance carrier offering merged market health plans, as defined in section 62A.67,
subdivision 1, must allow an eligible employer to begin purchasing a merged market
health plan for its employees at any point during the year. New employees hired by
an employer already offering a merged market health plan are subject to employee
participation requirements in section 62A.67, subdivision 3.
new text end

deleted text begin (c) deleted text end new text begin (d) new text end The commissioner of commerce shall enforce this section.

Sec. 3.

Minnesota Statutes 2014, section 62L.02, subdivision 27, is amended to read:

Subd. 27.

Small employer market.

(a) "Small employer market" means the market
for health benefit plans for small employers.

(b) A health carrier is considered to be participating in the small employer market if
the carrier offers, sells, issues, or renews a health benefit plan to: (1) any small employer;
or (2) the eligible employees of a small employer offering a health benefit plan if, with the
knowledge of the health carrier, either of the following conditions is met:

(i) any portion of the premium or benefits is paid for or reimbursed by a small
employer; or

(ii) the health benefit plan is treated by the employer or any of the eligible employees
or dependents as part of a plan or program for the purposes of the Internal Revenue Code,
section 106, 125, or 162.

new text begin (c) The small employer market does not include the merged market under section
62A.67.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2016.
new text end