SF 2139

1st Engrossment - 87th Legislature (2011 - 2012) Posted on 04/04/2012 12:41pm

A bill for an act
relating to insurance; regulating coverage for prenatal care services and
continuation coverage upon divorce; shifting regulatory authority over health
maintenance organizations from the commissioner of health to the commissioner
of commerce; amending Minnesota Statutes 2010, sections 62A.047; 62A.21,
subdivision 2a; 62D.02, subdivision 3; 62D.05, subdivision 6; 62D.101,
subdivision 2a; 62D.12, subdivision 1.

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

Section 1.

Minnesota Statutes 2010, section 62A.047, is amended to read:

62A.047 CHILDREN'S HEALTH SUPERVISION SERVICES AND
PRENATAL CARE SERVICES.

A policy of individual or group health and accident insurance regulated under this
chapter, or individual or group subscriber contract regulated under chapter 62C, health
maintenance contract regulated under chapter 62D, or health benefit certificate regulated
under chapter 64B, issued, renewed, or continued to provide coverage to a Minnesota
resident, must provide coverage for child health supervision services and prenatal care
services. The policy, contract, or certificate must specifically exempt reasonable and
customary charges for child health supervision services and prenatal care services from a
deductible, co-payment, or other coinsurance or dollar limitation requirement. new text begin Nothing
in this section prohibits a health plan company that has a network of providers from
imposing a deductible, co-payment, or other coinsurance or dollar limitation requirement
for child health supervision services and prenatal care services that are delivered by an
out-of-network provider. new text end This section does not prohibit the use of policy waiting periods
or preexisting condition limitations for these services. Minimum benefits may be limited
to one visit payable to one provider for all of the services provided at each visit cited in
this section subject to the schedule set forth in this section. deleted text begin Nothing in this section applies
to a commercial health insurance policy issued as a companion to a health maintenance
organization contract, a policy designed primarily to provide coverage payable on a
per diem, fixed indemnity, or nonexpense incurred basis, or a policy that provides
only accident coverage deleted text end new text begin Nothing in this section prevents a health plan company from
using reasonable medical management techniques to determine the frequency, method,
treatment, or setting for child health supervision services and prenatal care services new text end .

"Child health supervision services" means pediatric preventive services, appropriate
immunizations, developmental assessments, and laboratory services appropriate to the age
of a child from birth to age six, and appropriate immunizations from ages six to 18, as
defined by Standards of Child Health Care issued by the American Academy of Pediatrics.
Reimbursement must be made for at least five child health supervision visits from birth
to 12 months, three child health supervision visits from 12 months to 24 months, once a
year from 24 months to 72 months.

"Prenatal care services" means the comprehensive package of medical and
psychosocial support provided throughout the pregnancy, including risk assessment,
serial surveillance, prenatal education, and use of specialized skills and technology,
when needed, as defined by Standards for Obstetric-Gynecologic Services issued by the
American College of Obstetricians and Gynecologists.

Sec. 2.

Minnesota Statutes 2010, section 62A.21, subdivision 2a, is amended to read:

Subd. 2a.

Continuation privilege.

Every policy described in subdivision 1 shall
contain a provision which permits continuation of coverage under the policy for the
insured's former spouse and dependent children upon entry of a valid decree of dissolution
of marriage. The coverage shall be continued until the earlier of the following dates:

(a) the date the insured's former spouse becomes covered under any other group
health plan; or

(b) the date coverage would otherwise terminate under the policy.

If the coverage is provided under a group policy, any required premium contributions
for the coverage shall be paid by the insured on a monthly basis to the group policyholder
for remittance to the insurer. The policy must require the group policyholder to, upon
request, provide the insured with written verification from the insurer of the cost of this
coverage promptly at the time of eligibility for this coverage and at any time during
the continuation period. deleted text begin In no event shall the amount of premium charged exceed 102
percent of the cost to the plan for such period of coverage for other similarly situated
spouses and dependent children with respect to whom the marital relationship has not
dissolved, without regard to whether such cost is paid by the employer or employee deleted text end new text begin The
required premium amount for continuation of the coverage shall be calculated in the same
manner as provided under section 4980B of the Internal Revenue Code, its implementing
regulations and Internal Revenue Service rulings on section 4980B new text end .

Upon request by the insured's former spouse or dependent child, a health carrier
must provide the instructions necessary to enable the child or former spouse to elect
continuation of coverage.

Sec. 3.

Minnesota Statutes 2010, section 62D.02, subdivision 3, is amended to read:

Subd. 3.

Commissioner of deleted text begin health deleted text end new text begin commerce new text end or commissioner.

"Commissioner of
deleted text begin health deleted text end new text begin commerce new text end " or "commissioner" means the state commissioner of deleted text begin health deleted text end new text begin commerce new text end
or a designee.

Sec. 4.

Minnesota Statutes 2010, section 62D.05, subdivision 6, is amended to read:

Subd. 6.

Supplemental benefits.

(a) A health maintenance organization may, as
a supplemental benefit, provide coverage to its enrollees for health care services and
supplies received from providers who are not employed by, under contract with, or
otherwise affiliated with the health maintenance organization. Supplemental benefits may
be provided if the following conditions are met:

(1) a health maintenance organization desiring to offer supplemental benefits must at
all times comply with the requirements of sections 62D.041 and 62D.042;

(2) a health maintenance organization offering supplemental benefits must maintain
an additional surplus in the first year supplemental benefits are offered equal to the
lesser of $500,000 or 33 percent of the supplemental benefit expenses. At the end of
the second year supplemental benefits are offered, the health maintenance organization
must maintain an additional surplus equal to the lesser of $1,000,000 or 33 percent of the
supplemental benefit expenses. At the end of the third year benefits are offered and every
year after that, the health maintenance organization must maintain an additional surplus
equal to the greater of $1,000,000 or 33 percent of the supplemental benefit expenses.
When in the judgment of the commissioner the health maintenance organization's surplus
is inadequate, the commissioner may require the health maintenance organization to
maintain additional surplus;

(3) claims relating to supplemental benefits must be processed in accordance with
the requirements of section 72A.201; and

(4) in marketing supplemental benefits, the health maintenance organization shall
fully disclose and describe to enrollees and potential enrollees the nature and extent of the
supplemental coverage, and any claims filing and other administrative responsibilities in
regard to supplemental benefits.

(b) The commissioner may, pursuant to chapter 14, adopt, enforce, and administer
rules relating to this subdivision, including: rules insuring that these benefits are
supplementary and not substitutes for comprehensive health maintenance services by
addressing percentage of out-of-plan coverage; rules relating to the establishment of
necessary financial reserves; rules relating to marketing practices; and other rules necessary
for the effective and efficient administration of this subdivision. deleted text begin The commissioner, in
adopting rules, shall give consideration to existing laws and rules administered and
enforced by the Department of Commerce relating to health insurance plans.
deleted text end

Sec. 5.

Minnesota Statutes 2010, section 62D.101, subdivision 2a, is amended to read:

Subd. 2a.

Continuation privilege.

Every health maintenance contract as described
in subdivision 1 shall contain a provision which permits continuation of coverage under
the contract for the enrollee's former spouse and children upon entry of a valid decree of
dissolution of marriage. The coverage shall be continued until the earlier of the following
dates:

(a) the date the enrollee's former spouse becomes covered under another group
plan or Medicare; or

(b) the date coverage would otherwise terminate under the health maintenance
contract.

If coverage is provided under a group policy, any required premium contributions
for the coverage shall be paid by the enrollee on a monthly basis to the group contract
holder to be paid to the health maintenance organization. The contract must require the
group contract holder to, upon request, provide the enrollee with written verification from
the insurer of the cost of this coverage promptly at the time of eligibility for this coverage
and at any time during the continuation period. deleted text begin In no event shall the fee charged exceed
102 percent of the cost to the plan for the period of coverage for other similarly situated
spouses and dependent children when the marital relationship has not dissolved, regardless
of whether the cost is paid by the employer or employee deleted text end new text begin The required premium amount
for continuation of the coverage shall be calculated in the same manner as provided under
section 4980B in the Internal Revenue Code, its implementing regulations and Internal
Revenue Service rulings on section 4980B new text end .

Sec. 6.

Minnesota Statutes 2010, section 62D.12, subdivision 1, is amended to read:

Subdivision 1.

False representations.

No health maintenance organization or
representative thereof may cause or knowingly permit the use of advertising or solicitation
which is untrue or misleading, or any form of evidence of coverage which is deceptive.
Each health maintenance organization shall be subject to sections 72A.17 to 72A.32,
relating to the regulation of trade practices, except deleted text begin (a) deleted text end to the extent that the nature of a
health maintenance organization renders such sections clearly inappropriate deleted text begin and (b) that
enforcement shall be by the commissioner of health and not by the commissioner of
commerce deleted text end . Every health maintenance organization shall be subject to sections 8.31 and
325F.69.

Sec. 7. new text begin REVISOR'S INSTRUCTION.
new text end

new text begin The revisor of statutes shall, in conforming with section 3, change the terms
"commissioner of health" or similar term to "commissioner of commerce" or similar term
and "department of health" or similar term to "department of commerce" or similar term in
each place it occurs in Minnesota Statutes, chapter 62D.
new text end

Sec. 8. new text begin EFFECTIVE DATE.
new text end

new text begin Sections 1 to 7 are effective August 1, 2012.
new text end