Office of the Revisor of Statutes
Minnesota Session Laws - 2003, Regular Session
Key: (1) language to be deleted (2) new language
CHAPTER 109-H.F.No. 673
An act relating to insurance; changing certain loss
ratio standards; permitting the comprehensive health
association to offer policies with higher annual
deductibles; permitting extension of the writing
carrier contract; providing a new category of
individuals eligible for coverage; clarifying the
effective date of coverage and other matters; amending
Minnesota Statutes 2002, sections 62A.021, subdivision
1; 62E.08, subdivision 1; 62E.091; 62E.12; 62E.13,
subdivision 2, by adding a subdivision; 62E.14; 62E.18.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1. Minnesota Statutes 2002, section 62A.021,
subdivision 1, is amended to read:
Subdivision 1. [LOSS RATIO STANDARDS.] (a) Notwithstanding
section 62A.02, subdivision 3, relating to loss ratios, health
care policies or certificates shall not be delivered or issued
for delivery to an individual or to a small employer as defined
in section 62L.02, unless the policies or certificates can be
expected, as estimated for the entire period for which rates are
computed to provide coverage, to return to Minnesota
policyholders and certificate holders in the form of aggregate
benefits not including anticipated refunds or credits, provided
under the policies or certificates, (1) at least 75 percent of
the aggregate amount of premiums earned in the case of policies
issued in the small employer market, as defined in section
62L.02, subdivision 27, calculated on an aggregate basis; and
(2) at least 65 percent of the aggregate amount of premiums
earned in the case of each policy form or certificate form
issued in the individual market; calculated on the basis of
incurred claims experience or incurred health care expenses
where coverage is provided by a health maintenance organization
on a service rather than reimbursement basis and earned premiums
for the period and according to accepted actuarial principles
and practices. Assessments by the reinsurance association
created in chapter 62L and all types of taxes, surcharges, or
assessments created by Laws 1992, chapter 549, or created on or
after April 23, 1992, are included in the calculation of
incurred claims experience or incurred health care expenses.
The applicable percentage for policies and certificates issued
in the small employer market, as defined in section 62L.02,
increases by one percentage point on July 1 of each year,
beginning on July 1, 1994, until an 82 percent loss ratio is
reached on July 1, 2000. The applicable percentage for policy
forms and certificate forms issued in the individual market
increases by one percentage point on July 1 of each year,
beginning on July 1, 1994, until a 72 percent loss ratio is
reached on July 1, 2000. A health carrier that enters a market
after July 1, 1993, does not start at the beginning of the
phase-in schedule and must instead comply with the loss ratio
requirements applicable to other health carriers in that market
for each time period. Premiums earned and claims incurred in
markets other than the small employer and individual markets are
not relevant for purposes of this section.
(b) All filings of rates and rating schedules shall
demonstrate that actual expected claims in relation to premiums
comply with the requirements of this section when combined with
actual experience to date. Filings of rate revisions shall also
demonstrate that the anticipated loss ratio over the entire
future period for which the revised rates are computed to
provide coverage can be expected to meet the appropriate loss
ratio standards, and aggregate loss ratio from inception of the
policy form or certificate form shall equal or exceed the
appropriate loss ratio standards.
(c) A health carrier that issues health care policies and
certificates to individuals or to small employers, as defined in
section 62L.02, in this state shall file annually its rates,
rating schedule, and supporting documentation including ratios
of incurred losses to earned premiums by policy form or
certificate form duration for approval by the commissioner
according to the filing requirements and procedures prescribed
by the commissioner. The supporting documentation shall also
demonstrate in accordance with actuarial standards of practice
using reasonable assumptions that the appropriate loss ratio
standards can be expected to be met over the entire period for
which rates are computed. The demonstration shall exclude
active life reserves. If the data submitted does not confirm
that the health carrier has satisfied the loss ratio
requirements of this section, the commissioner shall notify the
health carrier in writing of the deficiency. The health carrier
shall have 30 days from the date of the commissioner's notice to
file amended rates that comply with this section. If the health
carrier fails to file amended rates within the prescribed time,
the commissioner shall order that the health carrier's filed
rates for the nonconforming policy form or certificate form be
reduced to an amount that would have resulted in a loss ratio
that complied with this section had it been in effect for the
reporting period of the supplement. The health carrier's
failure to file amended rates within the specified time or the
issuance of the commissioner's order amending the rates does not
preclude the health carrier from filing an amendment of its
rates at a later time. The commissioner shall annually make the
submitted data available to the public at a cost not to exceed
the cost of copying. The data must be compiled in a form useful
for consumers who wish to compare premium charges and loss
ratios.
(d) Each sale of a policy or certificate that does not
comply with the loss ratio requirements of this section is an
unfair or deceptive act or practice in the business of insurance
and is subject to the penalties in sections 72A.17 to 72A.32.
(e)(1) For purposes of this section, health care policies
issued as a result of solicitations of individuals through the
mail or mass media advertising, including both print and
broadcast advertising, shall be treated as individual policies.
(2) For purposes of this section, (i) "health care policy"
or "health care certificate" is a health plan as defined in
section 62A.011; and (ii) "health carrier" has the meaning given
in section 62A.011 and includes all health carriers delivering
or issuing for delivery health care policies or certificates in
this state or offering these policies or certificates to
residents of this state.
(f) The loss ratio phase-in as described in paragraph (a)
does not apply to individual policies and small employer
policies issued by a health plan company that is assessed less
than three percent of the total annual amount assessed by the
Minnesota comprehensive health association. These policies must
meet a 68 percent loss ratio for individual policies, a 71
percent loss ratio for small employer policies with fewer than
ten employees, and a 75 percent loss ratio for all other small
employer policies.
(g) Notwithstanding paragraphs (a) and (f), the loss ratio
shall be 60 percent for a policy or certificate of accident and
sickness insurance as defined in section 62A.01 health plan as
defined in section 62A.011, offered by an insurance company
licensed under chapter 60A that is assessed less than ten
percent of the total annual amount assessed by the Minnesota
Comprehensive Health Association. For purposes of the
percentage calculation of the association's assessments, an
insurance company's assessments include those of its affiliates.
(h) The commissioners of commerce and health shall each
annually issue a public report listing, by health plan company,
the actual loss ratios experienced in the individual and small
employer markets in this state by the health plan companies that
the commissioners respectively regulate. The commissioners
shall coordinate release of these reports so as to release them
as a joint report or as separate reports issued the same day.
The report or reports shall be released no later than June 1 for
loss ratios experienced for the preceding calendar year. Health
plan companies shall provide to the commissioners any
information requested by the commissioners for purposes of this
paragraph.
Sec. 2. Minnesota Statutes 2002, section 62E.08,
subdivision 1, is amended to read:
Subdivision 1. [ESTABLISHMENT.] The association shall
establish the following maximum premiums to be charged for
membership in the comprehensive health insurance plan:
(a) the premium for the number one qualified plan shall
range from a minimum of 101 percent to a maximum of 125 percent
of the weighted average of rates charged by those insurers and
health maintenance organizations with individuals enrolled in:
(1) $1,000 annual deductible individual plans of insurance
in force in Minnesota;
(2) individual health maintenance organization contracts of
coverage with a $1,000 annual deductible which are in force in
Minnesota; and
(3) other plans of coverage similar to plans offered by the
association based on generally accepted actuarial principles;
(b) the premium for the number two qualified plan shall
range from a minimum of 101 percent to a maximum of 125 percent
of the weighted average of rates charged by those insurers and
health maintenance organizations with individuals enrolled in:
(1) $500 annual deductible individual plans of insurance in
force in Minnesota;
(2) individual health maintenance organization contracts of
coverage with a $500 annual deductible which are in force in
Minnesota; and
(3) other plans of coverage similar to plans offered by the
association based on generally accepted actuarial principles;
(c) the premium premiums for the plan plans with a
$2,000, $5,000, or $10,000 annual deductible shall range from a
minimum of 101 percent to a maximum of 125 percent of the
weighted average of rates charged by those insurers and health
maintenance organizations with individuals enrolled in:
(1) $2,000, $5,000, or $10,000 annual deductible individual
plans, respectively, in force in Minnesota; and
(2) individual health maintenance organization contracts of
coverage with a $2,000, $5,000, or $10,000 annual deductible,
respectively, which are in force in Minnesota; or
(3) other plans of coverage similar to plans offered by the
association based on generally accepted actuarial principles;
(d) the premium for each type of Medicare supplement plan
required to be offered by the association pursuant to section
62E.12 shall range from a minimum of 101 percent to a maximum of
125 percent of the weighted average of rates charged by those
insurers and health maintenance organizations with individuals
enrolled in:
(1) Medicare supplement plans in force in Minnesota;
(2) health maintenance organization Medicare supplement
contracts of coverage which are in force in Minnesota; and
(3) other plans of coverage similar to plans offered by the
association based on generally accepted actuarial principles;
and
(e) the charge for health maintenance organization coverage
shall be based on generally accepted actuarial principles.
The list of insurers and health maintenance organizations
whose rates are used to establish the premium for coverage
offered by the association pursuant to paragraphs (a) to (d)
shall be established by the commissioner on the basis of
information which shall be provided to the association by all
insurers and health maintenance organizations annually at the
commissioner's request. This information shall include the
number of individuals covered by each type of plan or contract
specified in paragraphs (a) to (d) that is sold, issued, and
renewed by the insurers and health maintenance organizations,
including those plans or contracts available only on a renewal
basis. The information shall also include the rates charged for
each type of plan or contract.
In establishing premiums pursuant to this section, the
association shall utilize generally accepted actuarial
principles, provided that the association shall not discriminate
in charging premiums based upon sex. In order to compute a
weighted average for each type of plan or contract specified
under paragraphs (a) to (d), the association shall, using the
information collected pursuant to this subdivision, list
insurers and health maintenance organizations in rank order of
the total number of individuals covered by each insurer or
health maintenance organization. The association shall then
compute a weighted average of the rates charged for coverage by
all the insurers and health maintenance organizations by:
(1) multiplying the numbers of individuals covered by each
insurer or health maintenance organization by the rates charged
for coverage;
(2) separately summing both the number of individuals
covered by all the insurers and health maintenance organizations
and all the products computed under clause (1); and
(3) dividing the total of the products computed under
clause (1) by the total number of individuals covered.
The association may elect to use a sample of information
from the insurers and health maintenance organizations for
purposes of computing a weighted average. In no case, however,
may a sample used by the association to compute a weighted
average include information from fewer than the two insurers or
health maintenance organizations highest in rank order.
Sec. 3. Minnesota Statutes 2002, section 62E.091, is
amended to read:
62E.091 [APPROVAL OF STATE PLAN PREMIUMS.]
The association shall submit to the commissioner any
premiums it proposes to become effective for coverage under the
comprehensive health insurance plan, pursuant to section 62E.08,
subdivision 3. No later than 45 days before the effective date
for premiums specified in section 62E.08, subdivision 3, the
commissioner shall approve, modify, or reject the proposed
premiums on the basis of the following criteria:
(a) whether the association has complied with the
provisions of section 62E.11, subdivision 11;
(b) whether the association has submitted the proposed
premiums in a manner which provides sufficient time for
individuals covered under the comprehensive insurance plan to
receive notice of any premium increase no less than 30 days
prior to the effective date of the increase;
(c) the degree to which the association's computations and
conclusions are consistent with section 62E.08;
(d) the degree to which any sample used to compute a
weighted average by the association pursuant to section 62E.08
reasonably reflects circumstances existing in the private
marketplace for individual coverage;
(e) the degree to which a weighted average computed
pursuant to section 62E.08 that uses information pertaining to
individual coverage available only on a renewal basis reflects
the circumstances existing in the private marketplace for
individual coverage;
(f) a comparison of the proposed increases with increases
in the cost of medical care and increases experienced in the
private marketplace for individual coverage;
(g) the financial consequences to enrollees of the proposed
increase;
(h) the actuarially projected effect of the proposed
increase upon both total enrollment in, and the nature of the
risks assumed by, the comprehensive health insurance plan;
(i) the relative solvency of the contributing members; and
(j) other factors deemed relevant by the commissioner.
In no case, however, may the commissioner approve premiums
for those plans of coverage described in section 62E.08,
subdivision 1, paragraphs (a) to (c) (d), that are lower than
101 percent or greater than 125 percent of the weighted averages
computed by the association pursuant to section 62E.08. The
commissioner shall support a decision to approve, modify, or
reject any premium proposed by the association with written
findings and conclusions addressing each criterion specified in
this section. If the commissioner does not approve, modify, or
reject the premiums proposed by the association sooner than 45
days before the effective date for premiums specified in section
62E.08, subdivision 3, the premiums proposed by the association
under this section become effective.
Sec. 4. Minnesota Statutes 2002, section 62E.12, is
amended to read:
62E.12 [MINIMUM BENEFITS OF COMPREHENSIVE HEALTH INSURANCE
PLAN.]
(a) The association through its comprehensive health
insurance plan shall offer policies which provide the benefits
of a number one qualified plan and a number two qualified plan,
except that the maximum lifetime benefit on these plans shall be
$2,800,000; and an extended basic Medicare supplement plan and a
basic Medicare supplement plan as described in sections 62A.31
to 62A.44. The association may also offer a plan that is
identical to a number one and number two qualified plan except
that it has a $2,000 annual deductible and a $2,800,000 maximum
lifetime benefit. The association, subject to the approval of
the commissioner, may also offer plans that are identical to the
number one or number two qualified plan, except that they have
annual deductibles of $5,000 and $10,000, respectively; have
limitations on total annual out-of-pocket expenses equal to
those annual deductibles and therefore cover 100 percent of the
allowable cost of covered services in excess of those annual
deductibles; and have a $2,800,000 maximum lifetime benefit.
(b) The requirement that a policy issued by the association
must be a qualified plan is satisfied if the association
contracts with a preferred provider network and the level of
benefits for services provided within the network satisfies the
requirements of a qualified plan. If the association uses a
preferred provider network, payments to nonparticipating
providers must meet the minimum requirements of section 72A.20,
subdivision 15.
(c) The association shall offer health maintenance
organization contracts in those areas of the state where a
health maintenance organization has agreed to make the coverage
available and has been selected as a writing carrier.
(d) Notwithstanding the provisions of section 62E.06 and
unless those charges are billed by a provider that is part of
the association's preferred provider network, the state plan
shall exclude coverage of services of a private duty nurse other
than on an inpatient basis and any charges for treatment in a
hospital located outside of the state of Minnesota in which the
covered person is receiving treatment for a mental or nervous
disorder, unless similar treatment for the mental or nervous
disorder is medically necessary, unavailable in Minnesota and
provided upon referral by a licensed Minnesota medical
practitioner.
Sec. 5. Minnesota Statutes 2002, section 62E.13,
subdivision 2, is amended to read:
Subd. 2. [SELECTION OF WRITING CARRIER.] The association
may select policies and contracts, or parts thereof, submitted
by a member or members of the association, or by the association
or others, to develop specifications for bids from any entity
which wishes to be selected as a writing carrier to administer
the state plan. The selection of the writing carrier shall be
based upon criteria established by the board of directors of the
association and approved by the commissioner. The criteria
shall outline specific qualifications that an entity must
satisfy in order to be selected and, at a minimum, shall include
the entity's proven ability to handle large group accident and
health insurance cases, efficient claim paying capacity, and the
estimate of total charges for administering the plan. The
association may select separate writing carriers for the two
types of qualified plans and the $2,000, $5,000, and $10,000
deductible plan plans, the qualified medicare supplement plan,
and the health maintenance organization contract.
Sec. 6. Minnesota Statutes 2002, section 62E.13, is
amended by adding a subdivision to read:
Subd. 3a. [EXTENSION OF WRITING CARRIER CONTRACT.] Subject
to the approval of the commissioner, and subject to the consent
of the writing carrier, the association may extend the effective
writing carrier contract for a period not to exceed three years,
if the association and the commissioner determine that it would
be in the best interest of the association's enrollees and
contributing members. This subdivision applies notwithstanding
anything to the contrary in subdivisions 2 and 3.
Sec. 7. Minnesota Statutes 2002, section 62E.14, is
amended to read:
62E.14 [ENROLLMENT BY AN ELIGIBLE PERSON.]
Subdivision 1. [CERTIFICATE APPLICATION, CONTENTS.] The
comprehensive health insurance plan shall be open for enrollment
by eligible persons. An eligible person shall enroll by
submission of a certificate of eligibility an application to the
writing carrier. The certificate shall application must provide
the following:
(a) name, address, age, list of residences for the
immediately preceding six months and length of time at current
residence of the applicant;
(b) name, address, and age of spouse and children if any,
if they are to be insured;
(c) evidence of rejection, a requirement of restrictive
riders, a rate up, or a preexisting conditions limitation on a
qualified plan, the effect of which is to substantially reduce
coverage from that received by a person considered a standard
risk, by at least one association member within six months of
the date of the certificate application, or other eligibility
requirements adopted by rule by the commissioner which are not
inconsistent with this chapter and which evidence that a person
is unable to obtain coverage substantially similar to that which
may be obtained by a person who is considered a standard risk;
(d) if the applicant has been terminated from individual
health coverage which does not provide replacement coverage,
evidence that no replacement coverage that meets the
requirements of section 62D.121 was offered, and evidence of
termination of individual health coverage by an insurer,
nonprofit health service plan corporation, or health maintenance
organization, provided that the contract or policy has been
terminated for reasons other than (1) failure to pay the charge
for health care coverage; (2) failure to make copayments
required by the health care plan; (3) enrollee moving out of the
area served; or (4) a materially false statement or
misrepresentation by the enrollee in the application for
membership the terminated contract or policy; and
(e) a designation of the coverage desired.
An eligible person may not purchase more than one policy
from the state plan. Upon ceasing to be a resident of Minnesota
a person is no longer eligible to purchase or renew coverage
under the state plan, except as required by state or federal law
with respect to renewal of Medicare supplement coverage.
Subd. 2. [WRITING CARRIER'S RESPONSE.] Within 30 days of
receipt of the certificate application described in subdivision
1, the writing carrier shall either reject the application for
failing to comply with the requirements in subdivision 1 or
forward the eligible person a notice of acceptance and billing
information. If the applicant otherwise complies with the
requirements of sections 62E.01 to 62E.19, insurance shall be
effective immediately upon receipt of the first month's state
plan premium, and shall be retroactive to the date of the
application, if the applicant otherwise complies with the
requirements of sections 62E.01 to 62E.19 the application was
received by the writing carrier, unless a different effective
date is provided in this section.
Subd. 3. [PREEXISTING CONDITIONS.] No person who obtains
coverage pursuant to this section shall be covered for any
preexisting condition during the first six months of coverage
under the state plan if the person was diagnosed or treated for
that condition during the 90 days immediately preceding the
filing of an application date the application was received by
the writing carrier, except as provided under subdivisions 4,
4a, 4b, 4c, 4d, 5, 6, and 7 and section 62E.18.
Subd. 3a. [WAIVER OF PREEXISTING CONDITION.] A person may
enroll in the comprehensive health plan with a waiver of the
preexisting condition limitation described in section 62E.14,
subdivision 3, provided that the person meets the following
requirements:
(1) group coverage was provided through a rehabilitation
facility defined in section 268A.01, subdivision 6, and coverage
was terminated;
(2) all other eligibility requirements for enrollment in
the comprehensive health plan are met; and
(3) coverage is applied for within the person submitted an
application that was received by the writing carrier no later
than 90 days of after termination of previous coverage.
Subd. 4. [WAIVER OF PREEXISTING CONDITIONS FOR MEDICARE
SUPPLEMENT PLAN ENROLLEES.] Notwithstanding the above, any
Minnesota resident holder of a policy or certificate of Medicare
supplement coverages pursuant to sections 62A.315 and 62A.316,
or Medicare supplement plans previously approved by the
commissioner, may enroll in the comprehensive health insurance
plan as described in section 62E.07, with a waiver of the
preexisting condition as described in subdivision 3, without
interruption in coverage, provided, that the policy or
certificate has been terminated by the insurer for reasons other
than nonpayment of premium and, provided further, that the
option to enroll in the plan is exercised within through
submitting an application received by the writing carrier no
later than 90 days of after termination of the existing contract
or certificate.
Coverage in the state plan for purposes of this section
shall be effective on the date of termination upon completion
receipt of the proper application by the writing carrier and
payment of the required premium. The application must include
evidence of termination of the existing policy or certificate.
Subd. 4a. [WAIVER OF PREEXISTING CONDITIONS FOR MINNESOTA
RESIDENTS.] A person may enroll in the comprehensive health plan
with a waiver of the preexisting condition limitation described
in subdivision 3, provided that the following requirements are
met:
(1) the person is a Minnesota resident eligible to enroll
in the comprehensive health plan;
(2) the person:
(a) would be eligible for continuation under federal or
state law if continuation coverage were available or were
required to be available;
(b) would be eligible for continuation under clause (a)
except that the person was exercising continuation rights and
the continuation period required under federal or state law has
expired; or
(c) is eligible for continuation of health coverage under
federal or state law;
(3) continuation coverage is not available; and
(4) the person applies person's application for coverage
within is received by the writing carrier no later than 90 days
of after termination of prior coverage from a policy or plan.
Coverage in the comprehensive health plan is effective on
the date of termination of prior coverage. The availability of
conversion rights does not affect a person's rights under this
subdivision.
Subd. 4b. [WAIVER OF PREEXISTING CONDITIONS FOR PERSONS
COVERED BY RETIREE PLANS.] A person who was covered by a retiree
health care plan may enroll in the comprehensive health plan
with a waiver of the preexisting condition limitation described
in subdivision 3, provided that the following requirements are
met:
(1) the person is a Minnesota resident eligible to enroll
in the comprehensive health plan;
(2) the person was covered by a retiree health care plan
from an employer and the coverage is no longer available to the
person; and
(3) the person applies person's application for coverage
within is received by the writing carrier no later than 90 days
of after termination of prior coverage.
Coverage in the comprehensive health plan is effective on
the date of termination of prior coverage. The availability of
conversion rights does not affect a person's rights under this
section.
Subd. 4c. [WAIVER OF PREEXISTING CONDITIONS FOR PERSONS
WHOSE COVERAGE IS TERMINATED OR WHO EXCEED THE MAXIMUM LIFETIME
BENEFIT.] (a) A Minnesota resident may enroll in the
comprehensive health plan with a waiver of the preexisting
condition limitation described in subdivision 3 if that person
applies persons's application for coverage within is received by
the writing carrier no later than 90 days of after termination
of prior coverage and if the termination is for reasons other
than fraud or nonpayment of premiums.
For purposes of this paragraph, termination of prior
coverage includes exceeding the maximum lifetime benefit of
existing coverage.
Coverage in the comprehensive health plan is effective on
the date of termination of prior coverage. The availability of
conversion rights does not affect a person's rights under this
paragraph.
This section does not apply to prior coverage provided
under policies designed primarily to provide coverage payable on
a per diem, fixed indemnity, or nonexpense incurred basis, or
policies providing only accident coverage.
(b) An eligible individual, as defined under United States
Code, chapter 42, section 300gg-41(b) may enroll in the
comprehensive health insurance plan with a waiver of the
preexisting condition limitation described in subdivision 3 and
a waiver of the evidence of rejection or similar events
described in subdivision 1, clause (c). The eligible individual
must apply for enrollment under this paragraph within by
submitting a substantially complete application that is received
by the writing carrier no later than 63 days of after
termination of prior coverage, and coverage under the
comprehensive health insurance plan is effective as of the date
of receipt of the complete application. The six month
durational residency requirement provided in section 62E.02,
subdivision 13, does not apply with respect to eligibility for
enrollment under this paragraph, but the applicant must be a
Minnesota resident as of the date of that the application was
received by the writing carrier. A person's eligibility to
enroll under this paragraph does not affect the person's
eligibility to enroll under any other provision.
(c) A qualifying individual, as defined in the Internal
Revenue Code of 1986, section 35(e)(2)(B), who is eligible under
the Federal Trade Act of 2002 for the credit for health
insurance costs under the Internal Revenue Code of 1986, section
35, may enroll in the comprehensive health insurance plan with a
waiver of the preexisting condition limitation described in
subdivision 3, and without presenting evidence of rejection or
similar requirements described in subdivision 1, paragraph (c).
The six-month durational residency requirement provided in
section 62E.02, subdivision 13, does not apply with respect to
eligibility for enrollment under this paragraph, but the
applicant must be a Minnesota resident as of the date of
application. A person's eligibility to enroll under this
paragraph does not affect the person's eligibility to enroll
under any other provision. This paragraph is intended solely to
meet the minimum requirements necessary to qualify the
comprehensive health insurance plan as qualified health coverage
under the Internal Revenue Code of 1986, section 35(e)(2).
Subd. 4d. [INSURER INSOLVENCY; WAIVER OF PREEXISTING
CONDITIONS.] A Minnesota resident who is otherwise eligible may
enroll in the comprehensive health insurance plan with a waiver
of the preexisting condition limitation described in subdivision
3, if that person applies submits an application for coverage
within that is received by the writing carrier no later than 90
days of after termination of prior coverage due to the
insolvency of the insurer.
Coverage in the comprehensive insurance plan is effective
on the date of termination of prior coverage. The availability
of conversion rights does not affect a person's rights under
this subdivision.
Subd. 4e. [WAIVER OF PREEXISTING CONDITIONS; PERSONS
COVERED BY PUBLICLY FUNDED HEALTH PROGRAMS.] A person may enroll
in the comprehensive plan with a waiver of the preexisting
condition limitation in subdivision 3, provided that:
(1) the person was formerly enrolled in the medical
assistance, general assistance medical care, or MinnesotaCare
program;
(2) the person is a Minnesota resident; and
(3) the person applies within submits an application for
coverage that is received by the writing carrier no later than
90 days of after termination from medical assistance, general
assistance medical care, or MinnesotaCare program.
Subd. 5. [TERMINATED EMPLOYEES.] An employee who is
voluntarily or involuntarily terminated or laid off from
employment and unable to exercise the option to continue
coverage under section 62A.17 may enroll, within by submitting
an application that is received by the writing carrier no later
than 90 days of after termination or layoff, with a waiver of
the preexisting condition limitation set forth in subdivision 3
and a waiver of the evidence of rejection set forth in
subdivision 1, paragraph (c).
Subd. 6. [TERMINATION OF INDIVIDUAL POLICY OR CONTRACT.] A
Minnesota resident who holds an individual health maintenance
contract, individual nonprofit health service corporation
contract, or an individual insurance policy previously approved
by the commissioners of health or commerce, may enroll in the
comprehensive health insurance plan with a waiver of the
preexisting condition as described in subdivision 3, without
interruption in coverage, provided (1) no replacement coverage
that meets the requirements of section 62D.121 was offered by
the contributing member, and (2) the policy or contract has been
terminated for reasons other than (a) nonpayment of premium; (b)
failure to make copayments required by the health care plan; (c)
moving out of the area served; or (d) a materially false
statement or misrepresentation by the enrollee in the
application for membership the terminated policy or contract;
and, provided further, that the option to enroll in the plan is
exercised within by submitting an application that is received
by the writing carrier no later than 90 days of after
termination of the existing policy or contract.
Coverage allowed under this section is effective when the
contract or policy is terminated and the enrollee has completed
submitted the proper application that is received within the
time period stated in this subdivision and paid the required
premium or fee.
Expenses incurred from the preexisting conditions of
individuals enrolled in the state plan under this subdivision
must be paid by the contributing member canceling coverage as
set forth in section 62E.11, subdivision 10.
The application must include evidence of termination of the
existing policy or certificate as required in subdivision 1.
Subd. 7. [TERMINATIONS OF CONVERSION POLICIES.] (a) A
Minnesota resident who is covered by a conversion policy or
contract of health coverage may enroll in the comprehensive
health plan with a waiver of the preexisting condition
limitation in subdivision 3 and a waiver of the evidence of
rejection in subdivision 1, paragraph (c), at any time for any
reason by submitting an application that is received by the
writing carrier during the term of coverage.
(b) A Minnesota resident who was covered by a conversion
policy or contract of health coverage may enroll in the
comprehensive health plan with a waiver of the preexisting
condition limitation in subdivision 3 and a waiver of the
evidence of rejection in subdivision 1, paragraph (c), if that
person applies for coverage within by submitting an application
that is received by the writing carrier no later than 90 days
after termination of the conversion policy or contract coverage
regardless of: (1) the reasons for the termination; or (2) the
party terminating coverage.
(c) Coverage under this subdivision is effective upon
termination of prior coverage if the enrollee has submitted a
completed application that is received within the time period
stated in paragraph (a) or (b), whichever applies, and paid the
required premium or fee.
Sec. 8. Minnesota Statutes 2002, section 62E.18, is
amended to read:
62E.18 [HEALTH INSURANCE FOR RETIRED EMPLOYEES NOT ELIGIBLE
FOR MEDICARE.]
A Minnesota resident who is age 65 or over and is not
eligible for the health insurance benefits of the federal
Medicare program is entitled to purchase the benefits of a
qualified plan, one or two, or the $2,000, $5,000, or $10,000
annual deductible plan if available, offered by the Minnesota
comprehensive health association without any of the limitations
set forth in section 62E.14, subdivision 1, paragraph (c), and
subdivision 3.
Sec. 9. [EFFECTIVE DATE.]
Sections 1 to 8 are effective the day following final
enactment and apply to applications received on or after that
date.
Presented to the governor May 23, 2003
Signed by the governor May 27, 2003, 2:09 p.m.
Official Publication of the State of Minnesota
Revisor of Statutes