Minnesota Session Laws - 1988, Regular Session

  

                         Laws of Minnesota 1988 

                        CHAPTER 704-H.F.No. 464 
           An act relating to insurance; accident and health; 
          increasing the maximum lifetime benefit for major 
          medical coverage; amending Minnesota Statutes 1986, 
          section 62E.04, subdivision 4; and Minnesota Statutes 
          1987 Supplement, section 62E.06, subdivision 1. 
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
    Section 1.  Minnesota Statutes 1986, section 62E.04, 
subdivision 4, is amended to read: 
    Subd. 4.  [MAJOR MEDICAL COVERAGE.] Each insurer and 
fraternal shall affirmatively offer coverage of major medical 
expenses to every applicant who applies to the insurer or 
fraternal for a new unqualified policy at the time of 
application and annually to every holder of an unqualified 
policy of accident and health insurance renewed by the insurer 
or fraternal.  The coverage shall provide that when a covered 
individual incurs out-of-pocket expenses of $5,000 or more 
within a calendar year for services covered in section 62E.06, 
subdivision 1, benefits shall be payable, subject to any 
copayment authorized by the commissioner, up to a maximum 
lifetime limit of $250,000 $500,000.  The offer of coverage of 
major medical expenses may consist of the offer of a rider on an 
existing unqualified policy or a new policy which is a qualified 
plan.  
     Sec. 2.  Minnesota Statutes 1987 Supplement, section 
62E.06, subdivision 1, is amended to read:  
    Subdivision 1.  [NUMBER THREE PLAN.] A plan of health 
coverage shall be certified as a number three qualified plan if 
it otherwise meets the requirements established by chapters 62A 
and 62C, and the other laws of this state, whether or not the 
policy is issued in Minnesota, and meets or exceeds the 
following minimum standards: 
    (a) The minimum benefits for a covered individual shall, 
subject to the other provisions of this subdivision, be equal to 
at least 80 percent of the cost of covered services in excess of 
an annual deductible which does not exceed $150 per person.  The 
coverage shall include a limitation of $3,000 per person on 
total annual out-of-pocket expenses for services covered under 
this subdivision.  The coverage shall be subject to a maximum 
lifetime benefit of not less than $250,000 $500,000. 
    The $3,000 limitation on total annual out-of-pocket 
expenses and the $250,000 $500,000 maximum lifetime benefit 
shall not be subject to change or substitution by use of an 
actuarially equivalent benefit. 
    (b) Covered expenses shall be the usual and customary 
charges for the following services and articles when prescribed 
by a physician: 
    (1) hospital services; 
    (2) professional services for the diagnosis or treatment of 
injuries, illnesses, or conditions, other than dental, which are 
rendered by a physician or at the physician's direction; 
    (3) drugs requiring a physician's prescription; 
    (4) services of a nursing home for not more than 120 days 
in a year if the services would qualify as reimbursable services 
under Medicare; 
    (5) services of a home health agency if the services would 
qualify as reimbursable services under Medicare; 
    (6) use of radium or other radioactive materials; 
    (7) oxygen; 
    (8) anesthetics; 
    (9) prostheses other than dental but including scalp hair 
prostheses worn for hair loss suffered as a result of alopecia 
areata; 
    (10) rental or purchase, as appropriate, of durable medical 
equipment other than eyeglasses and hearing aids; 
    (11) diagnostic X-rays and laboratory tests; 
    (12) oral surgery for partially or completely unerupted 
impacted teeth, a tooth root without the extraction of the 
entire tooth, or the gums and tissues of the mouth when not 
performed in connection with the extraction or repair of teeth; 
    (13) services of a physical therapist; 
    (14) transportation provided by licensed ambulance service 
to the nearest facility qualified to treat the condition; or a 
reasonable mileage rate for transportation to a kidney dialysis 
center for treatment; and 
    (15) services of an occupational therapist. 
    (c) Covered expenses for the services and articles 
specified in this subdivision do not include the following: 
    (1) any charge for care for injury or disease either (i) 
arising out of an injury in the course of employment and subject 
to a workers' compensation or similar law, (ii) for which 
benefits are payable without regard to fault under coverage 
statutorily required to be contained in any motor vehicle, or 
other liability insurance policy or equivalent self-insurance, 
or (iii) for which benefits are payable under another policy of 
accident and health insurance, Medicare or any other 
governmental program except as otherwise provided by law; 
    (2) any charge for treatment for cosmetic purposes other 
than for reconstructive surgery when such service is incidental 
to or follows surgery resulting from injury, sickness or other 
diseases of the involved part or when such service is performed 
on a covered dependent child because of congenital disease or 
anomaly which has resulted in a functional defect as determined 
by the attending physician; 
    (3) care which is primarily for custodial or domiciliary 
purposes which would not qualify as eligible services under 
Medicare; 
    (4) any charge for confinement in a private room to the 
extent it is in excess of the institution's charge for its most 
common semiprivate room, unless a private room is prescribed as 
medically necessary by a physician, provided, however, that if 
the institution does not have semiprivate rooms, its most common 
semiprivate room charge shall be considered to be 90 percent of 
its lowest private room charge; 
    (5) that part of any charge for services or articles 
rendered or prescribed by a physician, dentist, or other health 
care personnel which exceeds the prevailing charge in the 
locality where the service is provided; and 
    (6) any charge for services or articles the provision of 
which is not within the scope of authorized practice of the 
institution or individual rendering the services or articles. 
    (d) The minimum benefits for a qualified plan shall 
include, in addition to those benefits specified in clauses (a) 
and (e), benefits for well baby care, effective July 1, 1980, 
subject to applicable deductibles, coinsurance provisions, and 
maximum lifetime benefit limitations. 
    (e) Effective July 1, 1979, the minimum benefits of a 
qualified plan shall include, in addition to those benefits 
specified in clause (a), a second opinion from a physician on 
all surgical procedures expected to cost a total of $500 or more 
in physician, laboratory and hospital fees, provided that the 
coverage need not include the repetition of any diagnostic tests.
    (f) Effective August 1, 1985, the minimum benefits of a 
qualified plan must include, in addition to the benefits 
specified in clauses (a), (d), and (e), coverage for special 
dietary treatment for phenylketonuria when recommended by a 
physician. 
    (g) Outpatient mental health coverage is subject to section 
62A.152, subdivision 2. 
    Approved May 4, 1988