SF 933

as introduced - 81st Legislature (1999 - 2000) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to health; establishing an 
  1.3             employer-subsidized health coverage program; amending 
  1.4             Minnesota Statutes 1998, section 256L.07, subdivision 
  1.5             3; proposing coding for new law as Minnesota Statutes, 
  1.6             chapter 256M. 
  1.7   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.8      Section 1.  Minnesota Statutes 1998, section 256L.07, 
  1.9   subdivision 3, is amended to read: 
  1.10     Subd. 3.  [OTHER HEALTH COVERAGE.] (a) Families and 
  1.11  individuals enrolled in the MinnesotaCare program must have no 
  1.12  health coverage while enrolled or for at least four months prior 
  1.13  to application and renewal.  Children enrolled in the original 
  1.14  children's health plan and children in families with income 
  1.15  equal to or less than 150 percent of the federal poverty 
  1.16  guidelines, who have other health insurance, are eligible if the 
  1.17  other health coverage meets the requirements of Minnesota Rules, 
  1.18  part 9506.0020, subpart 3, item B.  The commissioner may change 
  1.19  this eligibility criterion for sliding scale premiums in order 
  1.20  to remain within the limits of available appropriations.  The 
  1.21  requirement of no health coverage does not apply to newborns. 
  1.22     (b) For purposes of this section, medical assistance, 
  1.23  general assistance medical care, and civilian health and medical 
  1.24  program of the uniformed service, CHAMPUS, are not considered 
  1.25  insurance or health coverage. 
  1.26     (c) For purposes of this section, the requirement of no 
  2.1   health coverage does not apply to children who are no longer 
  2.2   eligible for the subsidized employer health coverage program 
  2.3   described in chapter 256M due to employment termination. 
  2.4      (d) For purposes of this section, Medicare Part A or B 
  2.5   coverage under title XVIII of the Social Security Act, United 
  2.6   States Code, title 42, sections 1395c to 1395w-4, is considered 
  2.7   health coverage.  An applicant or enrollee may not refuse 
  2.8   Medicare coverage to establish eligibility for MinnesotaCare. 
  2.9             SUBSIDIZED EMPLOYER HEALTH COVERAGE PROGRAM 
  2.10     Sec. 2.  [256M.01] [DEFINITIONS.] 
  2.11     Subdivision 1.  [APPLICABILITY.] For purposes of this 
  2.12  chapter, the terms defined in this section have the meanings 
  2.13  given them. 
  2.14     Subd. 2.  [COMMISSIONER.] "Commissioner" means the 
  2.15  commissioner of human services. 
  2.16     Subd. 3.  [EMPLOYER-SUBSIDIZED HEALTH 
  2.17  COVERAGE.] "Employer-subsidized health coverage" has the meaning 
  2.18  provided in section 256L.07, subdivision 2, paragraph (b). 
  2.19     Sec. 3.  [256M.03] [ELIGIBILITY FOR EMPLOYER-SUBSIDIZED 
  2.20  COVERAGE.] 
  2.21     Subdivision 1.  [GENERAL REQUIREMENTS.] (a) A child who is 
  2.22  under the age of 19 and whose family gross income is equal to or 
  2.23  less than 200 percent of the federal poverty guidelines for the 
  2.24  applicable family size and who would otherwise be eligible for 
  2.25  coverage under the MinnesotaCare program, except for the 
  2.26  availability of employer-subsidized dependent health coverage, 
  2.27  is eligible for subsidized payment of the employee share of the 
  2.28  employer-subsidized dependent health coverage available to the 
  2.29  child's family in accordance with section 256M.05.  
  2.30     (b) To be eligible under this section, a child must not be 
  2.31  covered under employer-subsidized dependent health coverage at 
  2.32  the time of application.  
  2.33     Subd. 2.  [EMPLOYER-SUBSIDIZED HEALTH COVERAGE.] To be 
  2.34  eligible for the premium payment under this chapter, the 
  2.35  employer-subsidized coverage offered to employees must be at 
  2.36  least equivalent to the coverage available under the federal 
  3.1   employee health plan.  The commissioner may request federal 
  3.2   approval to use the number 2 qualified plan described in section 
  3.3   62E.06 as the benchmark equivalent coverage. 
  3.4      Subd. 3.  [LOW-COST HEALTH PLAN OPTION.] If an employer 
  3.5   offers more than one health plan option to employees, 
  3.6   eligibility for subsidized premium payments shall be limited to 
  3.7   the lowest cost health plan option offered that serves the 
  3.8   geographic area in which the eligible child resides. 
  3.9      Subd. 4.  [PROBATIONARY PERIOD.] If an employer has a 
  3.10  probationary period during which an employee or an employee's 
  3.11  dependent is not eligible for employer-subsidized health 
  3.12  coverage, the employee's dependent shall not be considered 
  3.13  eligible under this section until the employer's probationary 
  3.14  period is over. 
  3.15     Sec. 4.  [256M.05] [PAYMENTS.] 
  3.16     Subdivision 1.  [PREMIUMS.] Children who are eligible under 
  3.17  section 256M.03 shall pay a premium in accordance with the 
  3.18  MinnesotaCare sliding premium scale as specified in section 
  3.19  256L.15.  For children whose family income is equal to or less 
  3.20  than 150 percent of the federal poverty guidelines for the 
  3.21  applicable family size, the premium charged must not exceed the 
  3.22  maximum monthly charge allowable under title XXI of the Social 
  3.23  Security Act, section 2103(e)(3)(A).  The commissioner shall 
  3.24  inform the employer of the premium owed by each eligible 
  3.25  family.  The employee shall pay the employer the premium owed.  
  3.26  The employer may deduct the premium from the employee's paycheck.
  3.27     Subd. 2.  [PAYMENT TO EMPLOYER.] The commissioner shall pay 
  3.28  the employer the difference between the premiums paid by the 
  3.29  employee as specified under subdivision 1 and the cost of the 
  3.30  employee share of the employer-subsidized health coverage.  
  3.31  Payment of the employee share is limited to the amount of the 
  3.32  premium attributable to the cost of dependent coverage for the 
  3.33  eligible child, unless the amount of the premium for dependent 
  3.34  coverage does not differentiate between dependents.  
  3.35     Subd. 3.  [PAYMENTS TO HEALTH CARE PROVIDERS.] Any 
  3.36  copayments, deductibles, or coinsurance required to be paid by a 
  4.1   family for an eligible child under the employer's health plan 
  4.2   shall be paid by the commissioner to the health care provider.  
  4.3   The family is responsible for notifying the health care provider 
  4.4   that they are covered under the subsidized employer health 
  4.5   coverage program.  The provider must bill the commissioner for 
  4.6   any copayment, deductible, or coinsurance owed by the family for 
  4.7   covered services provided to the eligible child by the health 
  4.8   care provider.  Upon the submission of a bill, the commissioner 
  4.9   must promptly pay the provider the amount of any copay, 
  4.10  deductible, or coinsurance owed plus an administrative fee equal 
  4.11  to one percent of the total bill.  
  4.12     Sec. 5.  [256M.07] [APPLICATIONS.] 
  4.13     Subdivision 1.  [AVAILABILITY.] Applicants may apply to the 
  4.14  commissioner or to a local insurance agent.  A local insurance 
  4.15  agent shall accept applications and forward them to the 
  4.16  commissioner for processing.  
  4.17     Subd. 2.  [PROCESSING.] The commissioner shall determine an 
  4.18  applicant's initial eligibility.  Applicants who from the 
  4.19  information provided on the application appear to meet the 
  4.20  eligibility requirements shall be enrolled without income 
  4.21  verification.  
  4.22     Subd. 3.  [RENEWAL OF ELIGIBILITY.] An enrollee's 
  4.23  eligibility must be renewed every 12 months.  Renewal of 
  4.24  eligibility may be completed by the local insurance agent.  
  4.25  Renewal applications must include income verification 
  4.26  information.  If an applicant's family income is equal to or 
  4.27  less than 100 percent of the federal poverty guidelines for the 
  4.28  applicable family size, further processing must be completed to 
  4.29  ensure ineligibility for medical assistance before eligibility 
  4.30  to this program can be determined.  
  4.31     Subd. 4.  [OUTREACH.] Any local insurance agent who refers 
  4.32  a family to the MinnesotaCare program in the process of 
  4.33  determining eligibility under this section shall be paid a 
  4.34  one-time application fee of $25 per referral if any member of 
  4.35  the family is determined to be eligible for the MinnesotaCare 
  4.36  program. 
  5.1      Sec. 6.  [WAIVER REQUESTS.] 
  5.2      (a) The commissioner of human services shall seek federal 
  5.3   approval to permit a premium structure under the subsidized 
  5.4   employer health coverage program that would exceed the five 
  5.5   percent cap for families with family gross incomes greater than 
  5.6   200 percent and equal to or less than 275 percent of the federal 
  5.7   poverty guidelines. 
  5.8      (b) The commissioner shall also seek federal approval to 
  5.9   allow a child who is eligible for medical assistance to be 
  5.10  covered under the subsidized employer health coverage program 
  5.11  upon the request of the child's family.