HEALTH MAINTENANCE ORGANIZATIONS

Accessibility of services, Minn. Rules 4685.1010

Advertising

Improper practices, Minn. Rules 4685.3400

Open enrollment, Minn. Rules 4685.3100

Agents, solicitors, and brokers, licensing, examinations, Minn. Rules 2730.0300, 2730.0400

Alcoholism treatment, limitations on outpatient treatment, Minn. Rules 4685.0700

Ambulance services, transportation, limitation or exclusion of coverage, Minn. Rules 4685.0700

Annual reports

Auditing, Minn. Rules 4685.1960

Contents, Minn. Rules 4685.2100

Deadline for reports, Minn. Rules 4685.2150

Definitions, Minn. Rules 4685.1930

Enrollment and utilization table, Minn. Rules 4685.1950

Filing date, Minn. Rules 4685.1930

Filing fee, Minn. Rules 4685.2800

Financial disclosure, Minn. Rules 4685.1970

Forms, Minn. Rules 4685.1920

Instructions, Minn. Rules 4685.1930

NAIC Blank, Minn. Rules 4685.1910, 4685.1920

Participating entities, list, Minn. Rules 4685.2100

Statement of revenue and expenses, Minn. Rules 4685.1940

Supplemental benefits, Minn. Rules 4685.1955

Uniform reporting, Minn. Rules 4685.1910

Appeals, termination of coverage, Minn. Rules 4685.2200

Application, certificates of authority, Minn. Rules 4685.0300

Arbitration, enrollee complaints, Minn. Rules 4685.1900

Artificial aids, limitation on minimum services, Minn. Rules 4685.0700

Assumption of risk, insurance against, certificates of authority application, Minn. Rules 4685.0300

Audits, NAIC Blank reports, Minn. Rules 4685.1960

Authority for rules, Minn. Rules 2730.0200

Availability of services, Minn. Rules 4685.1010

Average aggregate charge, categories of similar services, Minn. Rules 4685.0801

Basic services, Minn. Rules 4685.1010

Bylaws, governing body, selection, Minn. Rules 4685.1400

Cancellation of coverage, Minn. Rules 4685.2200

Category of similar goods or services, copayment determinations, Minn. Rules 4685.0801

Certificates and certification, comprehensive health insurance qualified plans, Minn. Rules 2740.1500, 2740.9934

Certificates of authority

Amendment, filing fee, Minn. Rules 4685.2800

Application, Minn. Rules 4685.0300, 4685.2800

Renewal, fee, Minn. Rules 4685.2800

Requirements for issuance, Minn. Rules 4685.0400

Certificates of need, Minn. Rules 4685.2600

Chemical dependency, treatment coverage, Minn. Rules 4685.0700

Children, termination at limiting age, Minn. Rules 4685.2200

Claims, Minn. Rules 4685.0815

Committees, governing body, meetings, open to enrollee opinions, Minn. Rules 4685.1500

Complaints

Generally, Minn. Rules 4685.1900

Ongoing evaluation, Minn. Rules 4685.1110, 4685.1120

Opportunity to participate, Minn. Rules 4685.1600

Comprehensive health insurance plans, see under HEALTH AND ACCIDENT INSURANCE

Comprehensive services, providing, Minn. Rules 4685.0700

Conflicts of interest, disclosure, certificates of authority application, Minn. Rules 4685.0300

Consumer information, supplemental benefits, Minn. Rules 4685.1955

Consumer representatives on governing body

Election results, annual report, Minn. Rules 4685.2100

Nomination and selection by enrollees who are contractor holders, Minn. Rules 4685.1600

Selection, Minn. Rules 4685.1400

Contact lenses, limitations or exclusions of coverage, Minn. Rules 4685.0700

Continuation and conversion privileges, comprehensive health insurance qualified plans, effect, Minn. Rules 2740.1600

Contracts

Changes, time of implementation, Minn. Rules 4685.1300

Discrimination, prohibited, Minn. Rules 2735.0100 to 2735.0500

Filing requirements, Minn. Rules 4685.3300

Reinsurance pooling agreements, comprehensive health insurance, Minn. Rules 2740.5200

Supplemental benefits, Minn. Rules 4685.1955

Coordination of benefits

Application of rules, Minn. Rules 4685.0905

Definitions, Minn. Rules 4685.0910

Dependent children, Minn. Rules 4685.0915

Effective date, Minn. Rules 4685.0935

Generally, Minn. Rules 4685.0900

Model coordination of benefits provisions, Minn. Rules 4685.0940, 4685.0950

Noncomplying plans, coordinating with, Minn. Rules 4685.0930

Order of benefits, generally, Minn. Rules 4685.0915

Procedures, Minn. Rules 4685.0915

Purpose of rules, Minn. Rules 4685.0905

Secondary plan, procedures, Minn. Rules 4685.0925

Services, reasonable cash value, Minn. Rules 4685.0930

Coordination of care, Minn. Rules 4685.1010

Copayments, Minn. Rules 4685.0801

Corrective appliances, limitation or exclusion of coverage, Minn. Rules 4685.0700

Cosmetic services, Minn. Rules 4685.0700

Coverage, see Comprehensive health insurance plans under HEALTH AND ACCIDENT INSURANCE

Custodial care, limitation, Minn. Rules 4685.0700

Definitions

Annual reports, Minn. Rules 4685.1955, 4685.2800

Comprehensive health insurance, Minn. Rules 2740.2100

Coordination of benefits, Minn. Rules 4685.0910

Filing fees, Minn. Rules 4685.2800

Generally, Minn. Rules 4685.0100, 4685.0910, 4685.1105

Hospital and surgical center reporting, Minn. Rules 4650.0102

Medical assistance, Minn. Rules 9505.0015

State health care program participation, Minn. Rules 9505.5210

Supplemental benefits, Minn. Rules 4685.1955

Demographic characteristics

Enrollees, certificates of authority, application, Minn. Rules 4685.0300

Statistics, Minn. Rules 4685.1200

Denial of coverage, supplemental benefits, Minn. Rules 4685.1955

Dental services, limitation or exclusion of minimum services, Minn. Rules 4685.0700

Dependent children, termination at limiting age, Minn. Rules 4685.2200

Directors, governing body, selection, Minn. Rules 4685.1400

Disabled children, termination at limiting age, Minn. Rules 4685.2200

Disclosure

Certificates of authority, application, Minn. Rules 4685.0300

Copayment charges, Minn. Rules 4685.0801

Supplemental benefits, Minn. Rules 4685.1955

Discrimination

Contracts, prohibited practices, Minn. Rules 2735.0100 to 2735.0500

Recipients of medical assistance or Medicare, Minn. Rules 4685.2500

Domiciliary care, limitation on minimum services, Minn. Rules 4685.0700

Drugs, prescriptions, limitations, Minn. Rules 4685.0700

Effective date of operating requirements, Minn. Rules 4685.1300

Emergencies, minimum services, Minn. Rules 4685.0700

Emergency services

Out of plan, copayments, Minn. Rules 4685.0801

Payment for cost, insurance policy, Minn. Rules 4685.0500

Requirements, Minn. Rules 4685.1010

Endorsements, filing, Minn. Rules 4685.3300

Enrollee directors, governing body, selection, Minn. Rules 4685.1400

Enrollee surveys

Opinions, Minn. Rules 4685.1500

Opportunity to participate, Minn. Rules 4685.1600

Enrollment, see Open enrollment under this topic

Enrollment statistics, Minn. Rules 4685.0300, 4685.1200

Equipment and supplies, limitations of coverage, Minn. Rules 4685.0700

Essential community providers, Minn. Rules 4688.0001 to 4688.0160

Evidence of coverage

Referral procedures, Minn. Rules 4685.1010

Required changes, time of implementation, Minn. Rules 4685.1300

Exclusions

Comprehensive services, Minn. Rules 4685.0700

Copayments, Minn. Rules 4685.0801

Minimum services, Minn. Rules 4685.0700

Supplemental benefits, Minn. Rules 4685.1955

Expenses, unreasonable expenses

Determination, Minn. Rules 2730.0500

Enforcement authority, Minn. Rules 2730.0600, 2730.0700

Experimental, investigative, or unproven procedures, limitation or exclusion, Minn. Rules 4685.0700

Eye care, minimum services, Minn. Rules 4685.0700

False information, enrollment, termination of coverage, Minn. Rules 4685.2200

Family members, dependence, termination at limiting age, Minn. Rules 4685.2200

Fees, Minn. Rules 4685.2800

Filing

Date, annual report, Minn. Rules 4685.1930

Fees, Minn. Rules 4685.2800

Generally, Minn. Rules 4685.3300

Modified documents, Minn. Rules 4685.2250

Financial disclosure, principal officers, Minn. Rules 4685.1970

Financial responsibility, certificates of authority, application, Minn. Rules 4685.0300

Forms

Annual reports, 1985 NAIC Blank, Minn. Rules 4685.1910, 4685.1920

Certificates of authority, application, Minn. Rules 4685.0300

Supplemental benefits claims, NAIC blank, Minn. Rules 4685.1955

Governing body

Consumer representatives, Minn. Rules 4685.1400, 4685.1600, 4685.2100

Enrollee opinion surveys, Minn. Rules 4685.1500

Selection, Minn. Rules 4685.1400

Gross utilization aggregates

Certificates of authority, application, Minn. Rules 4685.0300

Statistics, Minn. Rules 4685.1200

Group contracts, replacement coverage, Minn. Rules 2755.0100 to 2755.0500

Group coverage

Cancellation of coverage, notice, Minn. Rules 4685.2200

Inpatient hospital care, limitations on number of days covered, Minn. Rules 4685.0700

Group purchasers

Data, aggregate group purchaser data, reports

Amending, Minn. Rules 4652.0130

Contents, Minn. Rules 4652.0120

Definitions, Minn. Rules 4652.0100

Errors, Minn. Rules 4652.0130

Generally, Minn. Rules 4652.0110

Incomplete, Minn. Rules 4652.0130

Incorporation by reference, Minn. Rules 4652.0010

Review, Minn. Rules 4652.0130

Variances, Minn. Rules 4652.0140

Definitions, hospital and surgical center reporting, Minn. Rules 4650.0102

Hearing aids, fitting, limitation or exclusion of coverage, Minn. Rules 4685.0700

Hearings, complaints, records, Minn. Rules 4685.1900

Home health care, limitations, Minn. Rules 4685.0700

Hospital services, Minn. Rules 4685.1010

Improper practices, Minn. Rules 4685.3400

Income, use of funds, Minn. Rules 4685.2700

Information summaries, annual report, Minn. Rules 4685.2100

Inpatient hospital care, minimum services, Minn. Rules 4685.0700

Inpatient physician care, minimum services, Minn. Rules 4685.0700

Insurance policies

Certificates of authority, application, Minn. Rules 4685.0300

Cost of services beyond minimum services, Minn. Rules 4685.0500

Joint self-insurance plans, Minn. Rules 2765.0100 to 2765.1500

Limitations on minimum services, Minn. Rules 4685.0700

Marketing, improper practices, Minn. Rules 4685.3400

Medical assistance, recipients, refusal to enroll, Minn. Rules 4685.2500

Medical care surcharge

Amount, Minn. Rules 9510.2020

Appeals, Minn. Rules 9510.2040

Civil penalties for nonpayment, Minn. Rules 9510.2050

Definitions, Minn. Rules 9510.2010

Effective date, Minn. Rules 9510.2020

Enforcement, Minn. Rules 9510.2050

Merger or cessation of operation, Minn. Rules 9510.2020

Notice of amount owed, Minn. Rules 9510.2030

Purpose of rules, Minn. Rules 9510.2000

Scope of rules, Minn. Rules 9510.2000

Medicare, refusal to enroll, Minn. Rules 4685.2500

Meetings, governing body, enrollee opinions, Minn. Rules 4685.1500

Mental illness, coverage, Minn. Rules 4685.0700

Mentally ill children, termination at limiting age, Minn. Rules 4685.2200

Minimum services, Minn. Rules 4685.0700

Minnesota Comprehensive Health Association, Minn. Rules 2740.2200 to 2740.2600, 2740.5400

Modification of documents, notice, filing, Minn. Rules 4685.2250

Mortality rates

Certificates of application, Minn. Rules 4685.0300

Statistics, Minn. Rules 4685.1200

Net earnings, Minn. Rules 4685.2700

Notice

Comprehensive health insurance qualified plans, cancellation or termination, Minn. Rules 2740.1600

Group enrollees, cancellation of coverage, Minn. Rules 4685.2200

Modification of documents, Minn. Rules 4685.2250

Open enrollment, Minn. Rules 4685.3100

Supplemental benefits, Minn. Rules 4685.1955

Termination of coverage, Minn. Rules 4685.2200

Open enrollment

Effective date, Minn. Rules 4685.2900

Improper practices, Minn. Rules 4685.3400

Notice, Minn. Rules 4685.3100

Periodic filings, Minn. Rules 4685.3300

Scope of rules, Minn. Rules 4685.3000

Underwriting restrictions, Minn. Rules 4685.3200

Waiver, Minn. Rules 4685.3200

Operating requirements, Minn. Rules 4685.0400

Operational statistics

Certificates of authority, application, Minn. Rules 4685.0300

Maintenance procedures, Minn. Rules 4685.1200

Organ transplants, limitation on minimum services, Minn. Rules 4685.0700

Out-of-area services

Minimum services, Minn. Rules 4685.0700

Payment of costs, insurance policy, Minn. Rules 4685.0500

Out-of-pocket expenses, supplemental benefits, Minn. Rules 4685.1955

Outpatient health services, minimum services, Minn. Rules 4685.0700

Payments by, reinsurance pooling payments, comprehensive health insurance, Minn. Rules 2740.5300

Prepayment charges, schedule, annual report, Minn. Rules 4685.2100

Prescription drugs, limitations, Minn. Rules 4685.0700

Preventive health care services

Copayments, prohibited, Minn. Rules 4685.0801

Minimum services, Minn. Rules 4685.0700

Primary care physician services, Minn. Rules 4685.1010

Prior authorization, supplemental benefits, Minn. Rules 4685.1955

Private room accommodations, inpatient hospital care, limitations or exclusions, Minn. Rules 4685.0700

Provider agreements, certificates of authority, application, Minn. Rules 4685.0300

Purpose for rules, Minn. Rules 2730.0200

Purpose of rules, Minn. Rules 4685.0200

Quality assurance

Annual work plan, Minn. Rules 4685.1130

Correcting problems, Minn. Rules 4685.1120

Definitions, Minn. Rules 4685.1105

Evaluations, Minn. Rules 4685.1110, 4685.1115

Focused studies, Minn. Rules 4685.1125

Generally, Minn. Rules 4685.1110

Identifying problems, Minn. Rules 4685.1120

Written plan, Minn. Rules 4685.1110, 4685.1130

Quarterly reports, Minn. Rules 4685.1980

Records and record keeping

Claims, Minn. Rules 4685.0815

Complaints, Minn. Rules 4685.1900

Coverage, uncovered expenditures, Minn. Rules 4685.0805

Referral centers, Minn. Rules 4685.1010

Referral procedures, Minn. Rules 4685.0100, 4685.1010

Refractions, eyes, limitations or exclusions, Minn. Rules 4685.0700

Reinsurance, comprehensive health insurance, Minn. Rules 2740.5100 to 2740.5500

Renewal of coverage, termination, Minn. Rules 4685.2200

Replacement insurance, group contracts, Minn. Rules 2755.0100 to 2755.0500

Reports

Annual report, Minn. Rules 4685.2100

Filing fees, Minn. Rules 4685.2800

Quarterly reports, Minn. Rules 4685.1980

Statistics, Minn. Rules 4685.1200

Riders, filing, Minn. Rules 4685.3300

Scope of rules, Minn. Rules 4685.0200

Second opinions, supplemental benefits, Minn. Rules 4685.1955

Self-insurance, joint plans, Minn. Rules 2765.0100 to 2765.1500

Service area

Defined, Minn. Rules 4685.1010

Enrollment of persons outside of service area, improper practices, Minn. Rules 4685.3400

Expansion, filing request, Minn. Rules 4685.3300

Specialty physician services, Minn. Rules 4685.1010

State health care programs

Definitions, Minn. Rules 9505.5210

Participation requirements, Minn. Rules 9505.5200, 9505.5220, 9505.5240

Statistics

Certificates of authority, application, Minn. Rules 4685.0300

Maintenance procedures, Minn. Rules 4685.1200

Subrogation, Minn. Rules 4685.0900

Supplemental benefits, Minn. Rules 4685.1955

Telephone service, inpatient care, limitations or exclusions of coverage, Minn. Rules 4685.0700

Televisions, inpatient hospital care, limitations or exclusions, Minn. Rules 4685.0700

Termination of coverage, Minn. Rules 4685.2200

Terminology, insurance terminology, Minn. Rules 4685.2300

Time

Open enrollment notice, Minn. Rules 4685.3100

Termination of coverage, notice, Minn. Rules 4685.2200

Timely access to health care services, Minn. Rules 4685.1010

Uncovered expenditures, Minn. Rules 4685.0805

Underwriting restrictions, open enrollment, Minn. Rules 4685.3200

Violations and penalties, comprehensive health insurance qualified plans, noncompliance, cease and desist orders, Minn. Rules 2740.1200

Waiver, open enrollment, Minn. Rules 4685.3200

Workers' compensation, subrogation and coordination of benefits, Minn. Rules 4685.0900