1.1 	A bill for an act
1.2 	relating to health plan regulation; regulating policy and contract coverages; 
1.3 	conforming state law to federal requirements;amending Minnesota Statutes 2012, 
1.4 	sections 13.7191, subdivision 12; 43A.23, subdivision 1; 43A.317, subdivision 
1.5 	6; 60A.08, subdivision 15; 62A.011, subdivision 3, by adding subdivisions; 
1.6 	62A.02, by adding a subdivision; 62A.03, subdivision 1; 62A.04, subdivision 2; 
1.7 	62A.047; 62A.049; 62A.136; 62A.149, subdivision 1; 62A.17, subdivisions 2, 
1.8 	6; 62A.21, subdivision 2b; 62A.28, subdivision 2; 62A.302; 62A.615; 62A.65, 
1.9 	subdivisions 3, 5, 6, 7; 62C.14, subdivision 5; 62C.142, subdivision 2; 62D.02, 
1.10 	by adding a subdivision; 62D.07, subdivision 3; 62D.095; 62D.12, by adding a 
1.11 	subdivision; 62D.181, subdivision 7; 62D.30, subdivision 8; 62E.02, by adding 
1.12 	a subdivision; 62E.04, subdivision 4; 62E.06, subdivision 1; 62E.09; 62E.10, 
1.13 	subdivision 7; 62H.04; 62L.02, subdivisions 11, 14a, 26, by adding a subdivision; 
1.14 	62L.03, subdivisions 1, 3, 4, 6; 62L.045, subdivisions 2, 4; 62L.05, subdivision 
1.15 	10; 62L.06; 62L.08; 62L.12, subdivision 2; 62M.05, subdivision 3a; 62M.06, 
1.16 	subdivision 1; 62Q.01, by adding subdivisions; 62Q.021; 62Q.17, subdivision 
1.17 	6; 62Q.18, by adding a subdivision; 62Q.19, by adding a subdivision; 62Q.23; 
1.18 	62Q.43, subdivision 2; 62Q.47; 62Q.52; 62Q.55; 62Q.68, subdivision 1; 62Q.69, 
1.19 	subdivision 3; 62Q.70, subdivisions 1, 2; 62Q.71; 62Q.73; 62Q.75, subdivision 1; 
1.20 	62Q.80, subdivision 2; 72A.20, subdivision 35; 471.61, subdivision 1a; proposing 
1.21 	coding for new law in Minnesota Statutes, chapters 62A; 62Q; 72A; repealing 
1.22 	Minnesota Statutes 2012, sections 62A.65, subdivision 6; 62E.02, subdivision 7; 
1.23 	62E.16; 62E.20; 62L.02, subdivisions 4, 18, 19, 23; 62L.05, subdivisions 1, 2, 3, 
1.24 	4, 4a, 5, 6, 7, 11, 12, 13; 62L.081; 62L.10; 62Q.37, subdivision 5.
1.25 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.26 	Section 1. Minnesota Statutes 2012, section 13.7191, subdivision 12, is amended to read:
1.27 		Subd. 12.Small employer insurance reform. (a) Health carrier data. Data 
1.28 	received by the commissioner from health carriers under chapter 62L are classified under 
1.29 	section 62L.10, subdivision 3.
1.30 	(b)Small employer reinsurance association data. Patient identifying data held by 
1.31 	the reinsurance association are classified under section 62L.16, subdivision 6.

2.1 	Sec. 2. Minnesota Statutes 2012, section 43A.23, subdivision 1, is amended to read:
2.2 		Subdivision 1.General. (a) The commissioner is authorized to request proposals 
2.3 	or to negotiate and to enter into contracts with parties which in the judgment of the 
2.4 	commissioner are best qualified to provide service to the benefit plans. Contracts entered 
2.5 	into are not subject to the requirements of sections 16C.16 to 16C.19. The commissioner 
2.6 	may negotiate premium rates and coverage. The commissioner shall consider the cost of 
2.7 	the plans, conversion options relating to the contracts, service capabilities, character, 
2.8 	financial position, and reputation of the carriers, and any other factors which the 
2.9 	commissioner deems appropriate. Each benefit contract must be for a uniform term of at 
2.10 	least one year, but may be made automatically renewable from term to term in the absence 
2.11 	of notice of termination by either party. A carrier licensed under chapter 62A is exempt 
2.12 	from the taxes imposed by chapter 297I on premiums paid to it by the state.
2.13 	(b) All self-insured hospital and medical service products must comply with coverage 
2.14 	mandates, data reporting, and consumer protection requirements applicable to the licensed 
2.15 	carrier administering the product, had the product been insured, including chapters 62J, 
2.16 	62M, and 62Q. Any self-insured products that limit coverage to a network of providers 
2.17 	or provide different levels of coverage between network and nonnetwork providers shall 
2.18 	comply with section 62D.123 and geographic access standards for health maintenance 
2.19 	organizations adopted by the commissioner of health in rule under chapter 62D.
2.20 	(c) Notwithstanding paragraph (b), a self-insured hospital and medical product 
2.21 	offered under sections 43A.22 to 43A.30 is not required to extend dependent coverage 
2.22 	to an eligible employee's unmarried child under the age of 25 to the full extent required 
2.23 	under chapters 62A and 62L. Dependent child coverage must, at a minimum, extend to an 
2.24 	eligible employee's unmarried dependent child who is under the age of 19 or an unmarried 
2.25 	child under the age of 25 who is a full-time student. A person who is at least 19 years of 
2.26 	age but who is under the age of 25 and who is not a full-time student must be permitted 
2.27 	to be enrolled as a dependent of an eligible employee until age 25 if the person: to the 
2.28 	limiting age as defined in section 62Q.01, subdivision 10, disabled children to the extent 
2.29 	required in sections 62A.14 and 62A.141, and dependent grandchildren to the extent 
2.30 	required in sections 62A.042 and 62A.302.
2.31 	(1) was a full-time student immediately prior to being ordered into active military 
2.32 	service, as defined in section 190.05, subdivision 5b or 5c;
2.33 	(2) has been separated or discharged from active military service; and
2.34 	(3) would be eligible to enroll as a dependent of an eligible employee, except that 
2.35 	the person is not a full-time student.
3.1 	The definition of "full-time student" for purposes of this paragraph includes any student 
3.2 	who by reason of illness, injury, or physical or mental disability as documented by 
3.3 	a physician is unable to carry what the educational institution considers a full-time 
3.4 	course load so long as the student's course load is at least 60 percent of what otherwise 
3.5 	is considered by the institution to be a full-time course load. Any notice regarding 
3.6 	termination of coverage due to attainment of the limiting age must include information 
3.7 	about this definition of "full-time student."
3.8 	(d) Beginning January 1, 2010, the health insurance benefit plans offered in the 
3.9 	commissioner's plan under section 43A.18, subdivision 2, and the managerial plan under 
3.10 	section 43A.18, subdivision 3, must include an option for a health plan that is compatible 
3.11 	with the definition of a high-deductible health plan in section 223 of the United States 
3.12 	Internal Revenue Code.

3.13 	EFFECTIVE DATE. This section is effective the day following final enactment.

3.14 	Sec. 3. Minnesota Statutes 2012, section 43A.317, subdivision 6, is amended to read:
3.15 		Subd. 6.Individual eligibility. (a) Procedures. The commissioner shall establish 
3.16 	procedures for eligible employees and other eligible individuals to apply for coverage 
3.17 	through the program.
3.18 	(b) Employees. An employer shall determine when it applies to the program the 
3.19 	criteria its employees must meet to be eligible for coverage under its plan. An employer 
3.20 	may subsequently change the criteria annually or at other times with approval of the 
3.21 	commissioner. The criteria must provide that new employees become eligible for coverage 
3.22 	after a probationary period of at least 30 days, but no more than 90 days.
3.23 	(c) Other individuals. An employer may elect to cover under its plan:
3.24 	(1) the spouse, dependent children to the limiting age as defined in section 62Q.01, 
3.25 	subdivision 10, disabled children to the extent required in sections 62A.14 and 62A.141, 
3.26 	and dependent grandchildren of a covered employee to the extent required in sections 
3.27 	62A.042 and 62A.302;
3.28 	(2) a retiree who is eligible to receive a pension or annuity from the employer and a 
3.29 	covered retiree's spouse, dependent children to the limiting age as defined in section 
3.30 	62Q.01, subdivision 10, disabled children to the extent required in sections 62A.14 and 
3.31 	62A.141, and dependent grandchildren to the extent required in sections 62A.042 and 
3.32 	62A.302;
3.33 	(3) the surviving spouse, dependent children to the limiting age as defined in section 
3.34 	62Q.01, subdivision 10, disabled children, and dependent grandchildren of a deceased 
4.1 	employee or retiree, if the spouse, children, or grandchildren were covered at the time of 
4.2 	the death;
4.3 	(4) a covered employee who becomes disabled, as provided in sections 62A.147
4.4 	and 62A.148; or
4.5 	(5) any other categories of individuals for whom group coverage is required by 
4.6 	state or federal law.
4.7 	An employer shall determine when it applies to the program the criteria individuals 
4.8 	in these categories must meet to be eligible for coverage. An employer may subsequently 
4.9 	change the criteria annually, or at other times with approval of the commissioner. The 
4.10 	criteria for dependent children to the limiting age as defined in section 62Q.01, subdivision 
4.11 	10, disabled children, and dependent grandchildren may be no more inclusive than the 
4.12 	criteria under section 43A.18, subdivision 2. This paragraph shall not be interpreted 
4.13 	as relieving the program from compliance with any federal and state continuation of 
4.14 	coverage requirements.
4.15 	(d) Waiver and late entrance. An eligible individual may waive coverage at the 
4.16 	time the employer joins the program or when coverage first becomes available. The 
4.17 	commissioner may establish a preexisting condition exclusion of not more than 18 months 
4.18 	for late entrants as defined in section 62L.02, subdivision 19.
4.19 	(e) Continuation coverage. The program shall provide all continuation coverage 
4.20 	required by state and federal law.

4.21 	EFFECTIVE DATE. This section is effective the day following final enactment.

4.22 	Sec. 4. Minnesota Statutes 2012, section 60A.08, subdivision 15, is amended to read:
4.23 		Subd. 15.Classification of insurance filings data. (a) All forms, rates, and related 
4.24 	information filed with the commissioner under section 61A.02 shall be nonpublic data 
4.25 	until the filing becomes effective.
4.26 	(b) All forms, rates, and related information filed with the commissioner under 
4.27 	section 62A.02 shall be nonpublic data until the filing becomes effective.
4.28 	(c) All forms, rates, and related information filed with the commissioner under 
4.29 	section 62C.14, subdivision 10, shall be nonpublic data until the filing becomes effective.
4.30 	(d) All forms, rates, and related information filed with the commissioner under 
4.31 	section 70A.06 shall be nonpublic data until the filing becomes effective.
4.32 	(e) All forms, rates, and related information filed with the commissioner under 
4.33 	section 79.56 shall be nonpublic data until the filing becomes effective.
5.1 	(f) Notwithstanding paragraphs (b) and (c), for all rate increases subject to review 
5.2 	under section 2794 of the Public Health Services Act and underlying regulations that are 
5.3 	filed with the commissioner on or after September 1, 2011, the commissioner: 
5.4 	(1) may acknowledge receipt of the information;
5.5 	(2) may acknowledge that the corresponding rate filing is pending review;
5.6 	(3) must provide public access from the Department of Commerce's Web site to parts 
5.7 	I and II of the Preliminary Justifications of the rate increases subject to review; and
5.8 	(4) must provide notice to the public on the Department of Commerce's Web site of the 
5.9 	review of the proposed rate, which must include a statement that the public has 30 calendar 
5.10 	days to submit written comments to the commissioner on the rate filing subject to review. 

5.11 	EFFECTIVE DATE. This section is effective the day following final enactment.

5.12 	Sec. 5. Minnesota Statutes 2012, section 62A.011, is amended by adding a subdivision 
5.13 	to read:
5.14 		Subd. 1a.Affordable Care Act. "Affordable Care Act" means the federal Patient 
5.15 	Protection and Affordable Care Act, Public Law 111-148, as amended, including the 
5.16 	federal Health Care and Education Reconciliation Act of 2010, Public Law 111-152, 
5.17 	and applicable regulations.

5.18 	EFFECTIVE DATE. This section is effective the day following final enactment.

5.19 	Sec. 6. Minnesota Statutes 2012, section 62A.011, is amended by adding a subdivision 
5.20 	to read:
5.21 		Subd. 1b.Covered person. "Covered person" means a policyholder, subscriber, 
5.22 	enrollee, or other individual participating in a health benefit plan.

5.23 	EFFECTIVE DATE. This section is effective the day following final enactment.

5.24 	Sec. 7. Minnesota Statutes 2012, section 62A.011, is amended by adding a subdivision 
5.25 	to read:
5.26 		Subd. 1c.Grandfathered plan coverage. "Grandfathered plan coverage" means a 
5.27 	health benefit plan in which an individual was enrolled on March 23, 2010, for as long 
5.28 	as it maintains that status in accordance with the Affordable Care Act. Unless otherwise 
5.29 	specified, grandfathered plan coverage includes both individual and group health plans.

5.30 	EFFECTIVE DATE. This section is effective the day following final enactment.

6.1 	Sec. 8. Minnesota Statutes 2012, section 62A.011, is amended by adding a subdivision 
6.2 	to read:
6.3 		Subd. 1d.Group health plan. "Group health plan" means a policy or certificate 
6.4 	issued to an employer or an employee organization that is both:
6.5 	(1) a health plan as defined in subdivision 3; and
6.6 	(2) an employee welfare benefit plan as defined in the Employee Retirement Income 
6.7 	Security Act of 1974, United States Code, title 29, section 1002, if the plan provides 
6.8 	payment for medical care to employees, including both current and former employees, or 
6.9 	their dependents, directly or through insurance, reimbursement, or otherwise. 

6.10 	EFFECTIVE DATE. This section is effective the day following final enactment.

6.11 	Sec. 9. Minnesota Statutes 2012, section 62A.011, subdivision 3, is amended to read:
6.12 		Subd. 3.Health plan. "Health plan" means a policy or certificate of accident and 
6.13 	sickness insurance as defined in section 62A.01 offered by an insurance company licensed 
6.14 	under chapter 60A; a subscriber contract or certificate offered by a nonprofit health 
6.15 	service plan corporation operating under chapter 62C; a health maintenance contract or 
6.16 	certificate offered by a health maintenance organization operating under chapter 62D; a 
6.17 	health benefit certificate offered by a fraternal benefit society operating under chapter 
6.18 	64B; or health coverage offered by a joint self-insurance employee health plan operating 
6.19 	under chapter 62H. Health plan means individual and group coverage, unless otherwise 
6.20 	specified. Health plan does not include coverage that is:
6.21 	(1) limited to disability or income protection coverage;
6.22 	(2) automobile medical payment coverage;
6.23 	(3) supplemental liability insurance, including general liability insurance and 
6.24 	automobile liability insurance, or coverage issued as a supplement to liability insurance;
6.25 	(4) designed solely to provide payments on a per diem, fixed indemnity, or 
6.26 	non-expense-incurred basis, including coverage only for a specified disease or illness or 
6.27 	hospital indemnity or other fixed indemnity insurance, if the benefits are provided under a 
6.28 	separate policy, certificate, or contract for insurance; there is no coordination between the 
6.29 	provision of benefits and any exclusion of benefits under any group health plan maintained 
6.30 	by the same plan sponsor; and the benefits are paid with respect to an event without regard 
6.31 	to whether benefits are provided with respect to such an event under any group health 
6.32 	plan maintained by the same plan sponsor;
6.33 	(5) credit accident and health insurance as defined in section 62B.02;
6.34 	(6) designed solely to provide hearing, dental, or vision care;
6.35 	(7) blanket accident and sickness insurance as defined in section 62A.11;
7.1 	(8) accident-only coverage;
7.2 	(9) a long-term care policy as defined in section 62A.46 or 62S.01;
7.3 	(10) issued as a supplement to Medicare, as defined in sections 62A.3099 to 
7.4 	62A.44, or policies, contracts, or certificates that supplement Medicare issued by health 
7.5 	maintenance organizations or those policies, contracts, or certificates governed by section 
7.6 	1833 or 1876 of the federal Social Security Act, United States Code, title 42, section 
7.7 	1395, et seq., as amended;
7.8 	(11) workers' compensation insurance; or
7.9 	(12) issued solely as a companion to a health maintenance contract as described in 
7.10 	section 62D.12, subdivision 1a, so long as the health maintenance contract meets the 
7.11 	definition of a health plan.;
7.12 	(13) coverage for on-site medical clinics; or
7.13 	(14) coverage supplemental to the coverage provided under United States Code, 
7.14 	title 10, chapter 55, Civilian Health and Medical Program of the Uniformed Services 
7.15 	(CHAMPUS).

7.16 	EFFECTIVE DATE. This section is effective the day following final enactment.

7.17 	Sec. 10. Minnesota Statutes 2012, section 62A.011, is amended by adding a 
7.18 	subdivision to read:
7.19 		Subd. 4.Individual health plan. "Individual health plan" means a health plan as 
7.20 	defined in subdivision 3 that is offered to individuals in the individual market as defined 
7.21 	in subdivision 5, but does not mean short-term coverage as defined in section 62A.65, 
7.22 	subdivision 7. For purposes of this chapter, a health carrier shall not be deemed to be 
7.23 	offering individual health plan coverage solely because the carrier offers a conversion 
7.24 	policy in connection with a group health plan.

7.25 	EFFECTIVE DATE. This section is effective the day following final enactment.

7.26 	Sec. 11. Minnesota Statutes 2012, section 62A.011, is amended by adding a 
7.27 	subdivision to read:
7.28 		Subd. 5.Individual market. "Individual market" means the market for health 
7.29 	insurance coverage offered to individuals other than in connection with a group health plan.

7.30 	EFFECTIVE DATE. This section is effective the day following final enactment.

7.31 	Sec. 12. Minnesota Statutes 2012, section 62A.02, is amended by adding a subdivision 
7.32 	to read:
8.1 		Subd. 8.Filing by insurers for purposes of complying with the certification 
8.2 	requirements of the Minnesota Insurance Marketplace. No health plan shall be 
8.3 	offered for sale through the Minnesota Insurance Marketplace until a copy of its form 
8.4 	and the premium rates pertaining to the form have been filed with the commissioner 
8.5 	and the commissioner has reviewed the health plan for compliance with the certification 
8.6 	requirements of the Minnesota Insurance Marketplace in accordance with agreement 
8.7 	between the commissioners of commerce and health and the Minnesota Insurance 
8.8 	Marketplace.

8.9 	EFFECTIVE DATE. This section is effective January 1, 2014.

8.10 	Sec. 13. Minnesota Statutes 2012, section 62A.03, subdivision 1, is amended to read:
8.11 		Subdivision 1.Conditions. No policy of individual accident and sickness insurance 
8.12 	may be delivered or issued for delivery to a person in this state unless:
8.13 	(1) Premium. The entire money and other considerations therefor are expressed 
8.14 	therein.
8.15 	(2) Time effective. The time at which the insurance takes effect and terminates is 
8.16 	expressed therein.
8.17 	(3) One person. It purports to insure only one person, except that a policy may 
8.18 	insure, originally or by subsequent amendment, upon the application of an adult member 
8.19 	of a family deemed the policyholder, any two or more eligible members of that family, 
8.20 	including:
8.21 	(a) husband,
8.22 	(b) wife,
8.23 	(c) dependent children as described in sections 62A.302 and 62A.303, or
8.24 	(d) any children under a specified age of 19 years or less, or
8.25 	(e) (d) any other person dependent upon the policyholder.
8.26 	(4) Appearance. The style, arrangement, and overall appearance of the policy give 
8.27 	no undue prominence to any portion of the text and every printed portion of the text of the 
8.28 	policy and of any endorsements or attached papers is plainly printed in light-face type 
8.29 	of a style in general use. The type size must be uniform and not less than ten point with 
8.30 	a lowercase unspaced alphabet length not less than 120 point. The "text" includes all 
8.31 	printed matter except the name and address of the insurer, name or title of the policy, the 
8.32 	brief description, if any, the reference to renewal or cancellation by a separate statement, 
8.33 	if any, and the captions and subcaptions.
8.34 	(5) Description of policy. The policy, on the first page, indicates or refers to its 
8.35 	provisions for renewal or cancellation either in the brief description, if any, or by a separate 
9.1 	statement printed in type not smaller than the type used for captions or a separate provision 
9.2 	bearing a caption which accurately describes the renewability or cancelability of the policy.
9.3 	(6) Exceptions in policy. The exceptions and reductions of indemnity are set 
9.4 	forth in the policy and, except those which are set forth in section 62A.04, printed, at 
9.5 	the insurer's option, either with the benefit provision to which they apply, or under an 
9.6 	appropriate caption such as "EXCEPTIONS" or "EXCEPTIONS AND REDUCTIONS." 
9.7 	However, if an exception or reduction specifically applies only to a particular benefit of 
9.8 	the policy, a statement of the exception or reduction must be included with the benefit 
9.9 	provision to which it applies.
9.10 	(7) Form number. Each form, including riders and endorsements, is identified by a 
9.11 	form number in the lower left hand corner of the first page thereof.
9.12 	(8) No incorporation by reference. It contains no provision purporting to make 
9.13 	any portion of the charter, rules, constitution, or bylaws of the insurer a part of the policy 
9.14 	unless the portion is set forth in full in the policy, except in the case of the incorporation 
9.15 	of, or reference to, a statement of rates, classification of risks, or short rate table filed 
9.16 	with the commissioner.
9.17 	(9) Medical benefits. If the policy contains a provision for medical expense benefits, 
9.18 	the term "medical benefits" or similar terms as used therein includes treatments by all 
9.19 	licensed practitioners of the healing arts unless, subject to the qualifications contained in 
9.20 	clause (10), the policy specifically states the practitioners whose services are covered.
9.21 	(10) Osteopath, optometrist, chiropractor, or registered nurse services. With 
9.22 	respect to any policy of individual accident and sickness insurance issued or entered 
9.23 	into subsequent to August 1, 1974, notwithstanding the provisions of the policy, if it 
9.24 	contains a provision providing for reimbursement for any service which is in the lawful 
9.25 	scope of practice of a duly licensed osteopath, optometrist, chiropractor, or registered 
9.26 	nurse meeting the requirements of section 62A.15, subdivision 3a, the person entitled to 
9.27 	benefits or person performing services under the policy is entitled to reimbursement on an 
9.28 	equal basis for the service, whether the service is performed by a physician, osteopath, 
9.29 	optometrist, chiropractor, or registered nurse meeting the requirements of section 62A.15, 
9.30 	subdivision 3a, licensed under the laws of this state.

9.31 	EFFECTIVE DATE. This section is effective the day following final enactment.

9.32 	Sec. 14. Minnesota Statutes 2012, section 62A.04, subdivision 2, is amended to read:
9.33 		Subd. 2.Required provisions. Except as provided in subdivision 4 each such 
9.34 	policy delivered or issued for delivery to any person in this state shall contain the 
9.35 	provisions specified in this subdivision in the words in which the same appear in this 
10.1 	section. The insurer may, at its option, substitute for one or more of such provisions 
10.2 	corresponding provisions of different wording approved by the commissioner which are 
10.3 	in each instance not less favorable in any respect to the insured or the beneficiary. Such 
10.4 	provisions shall be preceded individually by the caption appearing in this subdivision or, at 
10.5 	the option of the insurer, by such appropriate individual or group captions or subcaptions 
10.6 	as the commissioner may approve.
10.7 	(1) A provision as follows:
10.8 	ENTIRE CONTRACT; CHANGES: This policy, including the endorsements and 
10.9 	the attached papers, if any, constitutes the entire contract of insurance. No change in this 
10.10 	policy shall be valid until approved by an executive officer of the insurer and unless such 
10.11 	approval be endorsed hereon or attached hereto. No agent has authority to change this 
10.12 	policy or to waive any of its provisions.
10.13 	(2) A provision as follows:
10.14 	TIME LIMIT ON CERTAIN DEFENSES: (a) After two years from the date of issue 
10.15 	of this policy no misstatements, except fraudulent misstatements, made by the applicant 
10.16 	in the application for such policy shall be used to void the policy or to deny a claim for 
10.17 	loss incurred or disability (as defined in the policy) commencing after the expiration 
10.18 	of such two year period.
10.19 	The foregoing policy provision shall not be so construed as to affect any legal 
10.20 	requirement for avoidance of a policy or denial of a claim during such initial two year 
10.21 	period, nor to limit the application of clauses (1), (2), (3), (4) and (5), in the event of 
10.22 	misstatement with respect to age or occupation or other insurance. A policy which the 
10.23 	insured has the right to continue in force subject to its terms by the timely payment of 
10.24 	premium (1) until at least age 50 or, (2) in the case of a policy issued after age 44, for at 
10.25 	least five years from its date of issue, may contain in lieu of the foregoing the following 
10.26 	provisions (from which the clause in parentheses may be omitted at the insurer's option) 
10.27 	under the caption "INCONTESTABLE":
10.28 	After this policy has been in force for a period of two years during the lifetime of 
10.29 	the insured (excluding any period during which the insured is disabled), it shall become 
10.30 	incontestable as to the statements contained in the application.
10.31 	(b) No claim for loss incurred or disability (as defined in the policy) commencing after 
10.32 	two years from the date of issue of this policy shall be reduced or denied on the ground that 
10.33 	a disease or physical condition not excluded from coverage by name or specific description 
10.34 	effective on the date of loss had existed prior to the effective date of coverage of this policy.
10.35 	(3) Except as required for health plans by the Affordable Care Act, a provision 
10.36 	as follows:
11.1 	GRACE PERIOD: A grace period of ..... (insert a number not less than "7" for 
11.2 	weekly premium policies, "10" for monthly premium policies and "31" for all other 
11.3 	policies) days will be granted for the payment of each premium falling due after the first 
11.4 	premium, during which grace period the policy shall continue in force.
11.5 	A policy which contains a cancellation provision may add, at the end of the above 
11.6 	provision,
11.7 	subject to the right of the insurer to cancel in accordance with the cancellation 
11.8 	provision hereof.
11.9 	A policy in which the insurer reserves the right to refuse any renewal shall have, 
11.10 	at the beginning of the above provision,
11.11 	Unless not less than five days prior to the premium due date the insurer has delivered 
11.12 	to the insured or has mailed to the insured's last address as shown by the records of the 
11.13 	insurer written notice of its intention not to renew this policy beyond the period for which 
11.14 	the premium has been accepted.
11.15 	All policies required to comply with the Affordable Care Act must include a grace 
11.16 	period provision no less restrictive than the grace period required by the Affordable Care 
11.17 	Act as defined under section 62A.011, subdivision 1a.
11.18 	(4) A provision as follows:
11.19 	REINSTATEMENT: If any renewal premium be not paid within the time granted the 
11.20 	insured for payment, a subsequent acceptance of premium by the insurer or by any agent 
11.21 	duly authorized by the insurer to accept such premium, without requiring in connection 
11.22 	therewith an application for reinstatement, shall reinstate the policy. If the insurer or 
11.23 	such agent requires an application for reinstatement and issues a conditional receipt for 
11.24 	the premium tendered, the policy will be reinstated upon approval of such application 
11.25 	by the insurer or, lacking such approval, upon the forty-fifth day following the date of 
11.26 	such conditional receipt unless the insurer has previously notified the insured in writing 
11.27 	of its disapproval of such application. For health plans described in section 62A.011, 
11.28 	subdivision 3, clause (10), an insurer must accept payment of a renewal premium and 
11.29 	reinstate the policy, if the insured applies for reinstatement no later than 60 days after the 
11.30 	due date for the premium payment, unless:
11.31 	(1) the insured has in the interim left the state or the insurer's service area; or
11.32 	(2) the insured has applied for reinstatement on two or more prior occasions.
11.33 	The reinstated policy shall cover only loss resulting from such accidental injury as 
11.34 	may be sustained after the date of reinstatement and loss due to such sickness as may 
11.35 	begin more than ten days after such date. In all other respects the insured and insurer shall 
11.36 	have the same rights thereunder as they had under the policy immediately before the due 
12.1 	date of the defaulted premium, subject to any provisions endorsed hereon or attached 
12.2 	hereto in connection with the reinstatement. Any premium accepted in connection with 
12.3 	a reinstatement shall be applied to a period for which premium has not been previously 
12.4 	paid, but not to any period more than 60 days prior to the date of reinstatement. The last 
12.5 	sentence of the above provision may be omitted from any policy which the insured has 
12.6 	the right to continue in force subject to its terms by the timely payment of premiums 
12.7 	(1) until at least age 50, or, (2) in the case of a policy issued after age 44, for at least 
12.8 	five years from its date of issue.
12.9 	(5) A provision as follows:
12.10 	NOTICE OF CLAIM: Written notice of claim must be given to the insurer within 
12.11 	20 days after the occurrence or commencement of any loss covered by the policy, or as 
12.12 	soon thereafter as is reasonably possible. Notice given by or on behalf of the insured or 
12.13 	the beneficiary to the insurer at ..... (insert the location of such office as the insurer may 
12.14 	designate for the purpose), or to any authorized agent of the insurer, with information 
12.15 	sufficient to identify the insured, shall be deemed notice to the insurer.
12.16 	In a policy providing a loss-of-time benefit which may be payable for at least two 
12.17 	years, an insurer may at its option insert the following between the first and second 
12.18 	sentences of the above provision:
12.19 	Subject to the qualifications set forth below, if the insured suffers loss of time on 
12.20 	account of disability for which indemnity may be payable for at least two years, the 
12.21 	insured shall, at least once in every six months after having given notice of claim, give to 
12.22 	the insurer notice of continuance of said disability, except in the event of legal incapacity. 
12.23 	The period of six months following any filing of proof by the insured or any payment by 
12.24 	the insurer on account of such claim or any denial of liability in whole or in part by the 
12.25 	insurer shall be excluded in applying this provision. Delay in the giving of such notice 
12.26 	shall not impair the insured's right to any indemnity which would otherwise have accrued 
12.27 	during the period of six months preceding the date on which such notice is actually given.
12.28 	(6) A provision as follows:
12.29 	CLAIM FORMS: The insurer, upon receipt of a notice of claim, will furnish to the 
12.30 	claimant such forms as are usually furnished by it for filing proofs of loss. If such forms 
12.31 	are not furnished within 15 days after the giving of such notice the claimant shall be 
12.32 	deemed to have complied with the requirements of this policy as to proof of loss upon 
12.33 	submitting, within the time fixed in the policy for filing proofs of loss, written proof 
12.34 	covering the occurrence, the character and the extent of the loss for which claim is made.
12.35 	(7) A provision as follows:
13.1 	PROOFS OF LOSS: Written proof of loss must be furnished to the insurer at its 
13.2 	said office in case of claim for loss for which this policy provides any periodic payment 
13.3 	contingent upon continuing loss within 90 days after the termination of the period for 
13.4 	which the insurer is liable and in case of claim for any other loss within 90 days after the 
13.5 	date of such loss. Failure to furnish such proof within the time required shall not invalidate 
13.6 	nor reduce any claim if it was not reasonably possible to give proof within such time, 
13.7 	provided such proof is furnished as soon as reasonably possible and in no event, except in 
13.8 	the absence of legal capacity, later than one year from the time proof is otherwise required.
13.9 	(8) A provision as follows:
13.10 	TIME OF PAYMENT OF CLAIMS: Indemnities payable under this policy for 
13.11 	any loss other than loss for which this policy provides periodic payment will be paid 
13.12 	immediately upon receipt of due written proof of such loss. Subject to due written proof 
13.13 	of loss, all accrued indemnities for loss for which this policy provides periodic payment 
13.14 	will be paid ..... (insert period for payment which must not be less frequently than 
13.15 	monthly) and any balance remaining unpaid upon the termination of liability will be paid 
13.16 	immediately upon receipt of due written proof.
13.17 	(9) A provision as follows:
13.18 	PAYMENT OF CLAIMS: Indemnity for loss of life will be payable in accordance 
13.19 	with the beneficiary designation and the provisions respecting such payment which may 
13.20 	be prescribed herein and effective at the time of payment. If no such designation or 
13.21 	provision is then effective, such indemnity shall be payable to the estate of the insured. 
13.22 	Any other accrued indemnities unpaid at the insured's death may, at the option of the 
13.23 	insurer, be paid either to such beneficiary or to such estate. All other indemnities will 
13.24 	be payable to the insured.
13.25 	The following provisions, or either of them, may be included with the foregoing 
13.26 	provision at the option of the insurer:
13.27 	If any indemnity of this policy shall be payable to the estate of the insured, or to an 
13.28 	insured or beneficiary who is a minor or otherwise not competent to give a valid release, 
13.29 	the insurer may pay such indemnity, up to an amount not exceeding $..... (insert an amount 
13.30 	which shall not exceed $1,000), to any relative by blood or connection by marriage of the 
13.31 	insured or beneficiary who is deemed by the insurer to be equitably entitled thereto. Any 
13.32 	payment made by the insurer in good faith pursuant to this provision shall fully discharge 
13.33 	the insurer to the extent of such payment.
13.34 	Subject to any written direction of the insured in the application or otherwise all 
13.35 	or a portion of any indemnities provided by this policy on account of hospital, nursing, 
13.36 	medical, or surgical services may, at the insurer's option and unless the insured requests 
14.1 	otherwise in writing not later than the time of filing proofs of such loss, be paid directly to 
14.2 	the hospital or person rendering such services; but it is not required that the service be 
14.3 	rendered by a particular hospital or person.
14.4 	(10) A provision as follows:
14.5 	PHYSICAL EXAMINATIONS AND AUTOPSY: The insurer at its own expense 
14.6 	shall have the right and opportunity to examine the person of the insured when and as 
14.7 	often as it may reasonably require during the pendency of a claim hereunder and to make 
14.8 	an autopsy in case of death where it is not forbidden by law.
14.9 	(11) A provision as follows:
14.10 	LEGAL ACTIONS: No action at law or in equity shall be brought to recover on this 
14.11 	policy prior to the expiration of 60 days after written proof of loss has been furnished in 
14.12 	accordance with the requirements of this policy. No such action shall be brought after the 
14.13 	expiration of three years after the time written proof of loss is required to be furnished.
14.14 	(12) A provision as follows:
14.15 	CHANGE OF BENEFICIARY: Unless the insured makes an irrevocable designation 
14.16 	of beneficiary, the right to change of beneficiary is reserved to the insured and the consent 
14.17 	of the beneficiary or beneficiaries shall not be requisite to surrender or assignment of 
14.18 	this policy or to any change of beneficiary or beneficiaries, or to any other changes in 
14.19 	this policy. The first clause of this provision, relating to the irrevocable designation of 
14.20 	beneficiary, may be omitted at the insurer's option.

14.21 	EFFECTIVE DATE. This section is effective January 1, 2014.

14.22 	Sec. 15. Minnesota Statutes 2012, section 62A.047, is amended to read:
14.23 	62A.047 CHILDREN'S HEALTH SUPERVISION SERVICES AND 
14.24 	PRENATAL CARE SERVICES.
14.25 	A policy of individual or group health and accident insurance regulated under this 
14.26 	chapter, or individual or group subscriber contract regulated under chapter 62C, health 
14.27 	maintenance contract regulated under chapter 62D, or health benefit certificate regulated 
14.28 	under chapter 64B, issued, renewed, or continued to provide coverage to a Minnesota 
14.29 	resident, must provide coverage for child health supervision services and prenatal care 
14.30 	services. The policy, contract, or certificate must specifically exempt reasonable and 
14.31 	customary charges for child health supervision services and prenatal care services from a 
14.32 	deductible, co-payment, or other coinsurance or dollar limitation requirement. Nothing 
14.33 	in this section prohibits a health carrier that has a network of providers from imposing 
14.34 	a deductible, co-payment, or other coinsurance or dollar limitation requirement for 
15.1 	child health supervision services and prenatal care services that are delivered by an 
15.2 	out-of-network provider. This section does not prohibit the use of policy waiting periods 
15.3 	or preexisting condition limitations for these services. Minimum benefits may be limited 
15.4 	to one visit payable to one provider for all of the services provided at each visit cited in 
15.5 	this section subject to the schedule set forth in this section. Nothing in this section applies 
15.6 	to a policy designed primarily to provide coverage payable on a per diem, fixed indemnity, 
15.7 	or non-expense-incurred basis, or a policy that provides only accident coverage. A policy, 
15.8 	contract, or certificate described under this section may not apply preexisting condition 
15.9 	limitations to individuals under 19 years of age. This section does not apply to individual 
15.10 	coverage that is grandfathered plan coverage, as defined in section 62A.011, subdivision 1c.
15.11 	"Child health supervision services" means pediatric preventive services, appropriate 
15.12 	immunizations, developmental assessments, and laboratory services appropriate to the age 
15.13 	of a child from birth to age six, and appropriate immunizations from ages six to 18, as 
15.14 	defined by Standards of Child Health Care issued by the American Academy of Pediatrics. 
15.15 	Reimbursement must be made for at least five child health supervision visits from birth 
15.16 	to 12 months, three child health supervision visits from 12 months to 24 months, once a 
15.17 	year from 24 months to 72 months.
15.18 	"Prenatal care services" means the comprehensive package of medical and 
15.19 	psychosocial support provided throughout the pregnancy, including risk assessment, 
15.20 	serial surveillance, prenatal education, and use of specialized skills and technology, 
15.21 	when needed, as defined by Standards for Obstetric-Gynecologic Services issued by the 
15.22 	American College of Obstetricians and Gynecologists.

15.23 	EFFECTIVE DATE. This section is effective the day following final enactment.

15.24 	Sec. 16. Minnesota Statutes 2012, section 62A.049, is amended to read:
15.25 	62A.049 LIMITATION ON PREAUTHORIZATIONS; EMERGENCIES.
15.26 	No policy of accident and sickness insurance or group subscriber contract regulated 
15.27 	under chapter 62C issued or renewed in this state may contain a provision that makes an 
15.28 	insured person ineligible to receive full benefits because of the insured's failure to obtain 
15.29 	preauthorization, if that failure occurs because of the need for emergency confinement 
15.30 	or emergency treatment. The insured or an authorized representative of the insured shall 
15.31 	notify the insurer as soon after the beginning of emergency confinement or emergency 
15.32 	treatment as reasonably possible. However, to the extent that the insurer suffers actual 
15.33 	prejudice caused by the failure to obtain preauthorization, the insured may be denied all or 
16.1 	part of the insured's benefits. This provision does not apply to admissions for treatment of 
16.2 	chemical dependency and nervous and mental disorders.

16.3 	EFFECTIVE DATE. This section is effective January 1, 2014.

16.4 	Sec. 17. Minnesota Statutes 2012, section 62A.136, is amended to read:
16.5 	62A.136 HEARING, DENTAL, AND VISION PLAN COVERAGE.
16.6 	The following provisions do not apply to health plans as defined in section 62A.011, 
16.7 	subdivision 3, clause (6), providing hearing, dental, or vision coverage only: sections 
16.8 	62A.041; 62A.0411; 62A.047; 62A.149; 62A.151; 62A.152; 62A.154; 62A.155; 62A.17, 
16.9 	subdivision 6; 62A.21, subdivision 2b; 62A.26; 62A.28; 62A.285; 62A.30; 62A.304; and
16.10 	62A.3093; and 62E.16.

16.11 	EFFECTIVE DATE. This section is effective January 1, 2014.

16.12 	Sec. 18. Minnesota Statutes 2012, section 62A.149, subdivision 1, is amended to read:
16.13 		Subdivision 1.Application. The provisions of this section apply to all group 
16.14 	policies of accident and health insurance and group subscriber contracts offered by 
16.15 	nonprofit health service plan corporations regulated under chapter 62C, and to a plan or 
16.16 	policy that is individually underwritten or provided for a specific individual and family 
16.17 	members as a nongroup policy unless the individual elects in writing to refuse benefits 
16.18 	under this subdivision in exchange for an appropriate reduction in premiums or subscriber 
16.19 	charges under the policy or plan, when the policies or subscriber contracts are issued or 
16.20 	delivered in Minnesota or provide benefits to Minnesota residents enrolled thereunder.
16.21 	This section does not apply to policies designed primarily to provide coverage 
16.22 	payable on a per diem, fixed indemnity or nonexpense incurred basis or policies that 
16.23 	provide accident only coverage.
16.24 	Every insurance policy or subscriber contract included within the provisions of this 
16.25 	subdivision, upon issuance or renewal, shall provide coverage that complies with the 
16.26 	requirements of section 62Q.47, paragraphs (b) and (c), for the treatment of alcoholism, 
16.27 	chemical dependency or drug addiction to any Minnesota resident entitled to coverage.

16.28 	EFFECTIVE DATE. This section is effective January 1, 2014.

16.29 	Sec. 19. Minnesota Statutes 2012, section 62A.17, subdivision 2, is amended to read:
16.30 		Subd. 2.Responsibility of employee. Every covered employee electing to continue 
16.31 	coverage shall pay the former employer, on a monthly basis, the cost of the continued 
17.1 	coverage. The policy, contract, or plan must require the group policyholder or contract 
17.2 	holder to, upon request, provide the employee with written verification from the insurer 
17.3 	of the cost of this coverage promptly at the time of eligibility for this coverage and at 
17.4 	any time during the continuation period. If the policy, contract, or health care plan is 
17.5 	administered by a trust, every covered employee electing to continue coverage shall pay 
17.6 	the trust the cost of continued coverage according to the eligibility rules established by the 
17.7 	trust. In no event shall the amount of premium charged exceed 102 percent of the cost 
17.8 	to the plan for such period of coverage for similarly situated employees with respect to 
17.9 	whom neither termination nor layoff has occurred, without regard to whether such cost 
17.10 	is paid by the employer or employee. The employee shall be eligible to continue the 
17.11 	coverage until the employee becomes covered under another group health plan, or for a 
17.12 	period of 18 months after the termination of or lay off from employment, whichever is 
17.13 	shorter. For an individual age 19 or older, if the employee becomes covered under another 
17.14 	group policy, contract, or health plan and the new group policy, contract, or health plan 
17.15 	contains any preexisting condition limitations, the employee may, subject to the 18-month 
17.16 	maximum continuation limit, continue coverage with the former employer until the 
17.17 	preexisting condition limitations have been satisfied. The new policy, contract, or health 
17.18 	plan is primary except as to the preexisting condition. In the case of a newborn child who 
17.19 	is a dependent of the employee, the new policy, contract, or health plan is primary upon 
17.20 	the date of birth of the child, regardless of which policy, contract, or health plan coverage 
17.21 	is deemed primary for the mother of the child.

17.22 	EFFECTIVE DATE. This section is effective the day following final enactment.

17.23 	Sec. 20. Minnesota Statutes 2012, section 62A.17, subdivision 6, is amended to read:
17.24 		Subd. 6.Conversion to individual policy. A group insurance policy that provides 
17.25 	posttermination or layoff coverage as required by this section shall also include a 
17.26 	provision allowing a covered employee, surviving spouse, or dependent at the expiration 
17.27 	of the posttermination or layoff coverage provided by subdivision 2 to obtain from the 
17.28 	insurer offering the group policy or group subscriber contract, at the employee's, spouse's, 
17.29 	or dependent's option and expense, without further evidence of insurability and without 
17.30 	interruption of coverage, an individual policy of insurance or an individual subscriber 
17.31 	contract providing at least the minimum benefits of a qualified plan as prescribed by 
17.32 	section 62E.06 and the option of a number three qualified plan, a number two qualified 
17.33 	plan, and a number one qualified plan as provided by section 62E.06, subdivisions 1 to 
17.34 	3, provided application is made to the insurer within 30 days following notice of the 
17.35 	expiration of the continued coverage and upon payment of the appropriate premium. 
18.1 	The required conversion contract must treat pregnancy the same as any other covered 
18.2 	illness under the conversion contract. A health maintenance contract issued by a health 
18.3 	maintenance organization that provides posttermination or layoff coverage as required 
18.4 	by this section shall also include a provision allowing a former employee, surviving 
18.5 	spouse, or dependent at the expiration of the posttermination or layoff coverage provided 
18.6 	in subdivision 2 to obtain from the health maintenance organization, at the former 
18.7 	employee's, spouse's, or dependent's option and expense, without further evidence of 
18.8 	insurability and without interruption of coverage, an individual health maintenance 
18.9 	contract. Effective January 1, 1985, enrollees who have become nonresidents of the health 
18.10 	maintenance organization's service area shall be given the option, to be arranged by the 
18.11 	health maintenance organization, of a number three qualified plan, a number two qualified 
18.12 	plan, or a number one qualified plan as provided by section 62E.06, subdivisions 1 to 3. 
18.13 	This option shall be made available at the enrollee's expense, without further evidence of 
18.14 	insurability and without interruption of coverage.
18.15 	A policy providing reduced benefits at a reduced premium rate may be accepted 
18.16 	by the employee, the spouse, or a dependent in lieu of the optional coverage otherwise 
18.17 	required by this subdivision.
18.18 	The An individual policy or contract issued as a conversion policy prior to January 
18.19 	1, 2014, shall be renewable at the option of the individual as long as the individual is not 
18.20 	covered under another qualified plan as defined in section 62E.02, subdivision 4. Any 
18.21 	revisions in the table of rate for the individual policy shall apply to the covered person's 
18.22 	original age at entry and shall apply equally to all similar conversion policies issued 
18.23 	by the insurer.

18.24 	EFFECTIVE DATE. This section is effective January 1, 2014.

18.25 	Sec. 21. Minnesota Statutes 2012, section 62A.21, subdivision 2b, is amended to read:
18.26 		Subd. 2b.Conversion privilege. Every policy described in subdivision 1 shall 
18.27 	contain a provision allowing a former spouse and dependent children of an insured, 
18.28 	without providing evidence of insurability, to obtain from the insurer at the expiration of 
18.29 	any continuation of coverage required under subdivision 2a or sections 62A.146 and 
18.30 	62A.20, conversion coverage providing at least the minimum benefits of a qualified 
18.31 	plan as prescribed by section 62E.06 and the option of a number three qualified plan, a 
18.32 	number two qualified plan, a number one qualified plan as provided by section 62E.06, 
18.33 	subdivisions 1 to 3, provided application is made to the insurer within 30 days following 
18.34 	notice of the expiration of the continued coverage and upon payment of the appropriate 
18.35 	premium. The An individual policy or contract issued as a conversion policy prior to 
19.1 	January 1, 2014 shall be renewable at the option of the covered person as long as the 
19.2 	covered person is not covered under another qualified plan as defined in section 62E.02, 
19.3 	subdivision 4. Any revisions in the table of rate for the individual policy shall apply to the 
19.4 	covered person's original age at entry and shall apply equally to all similar conversion
19.5 	 policies issued by the insurer.
19.6 	A policy providing reduced benefits at a reduced premium rate may be accepted by 
19.7 	the covered person in lieu of the optional coverage otherwise required by this subdivision.

19.8 	EFFECTIVE DATE. This section is effective January 1, 2014.

19.9 	Sec. 22. Minnesota Statutes 2012, section 62A.28, subdivision 2, is amended to read:
19.10 		Subd. 2.Required coverage. Every policy, plan, certificate, or contract referred to 
19.11 	in subdivision 1 issued or renewed after August 1, 1987, must provide coverage for scalp 
19.12 	hair prostheses worn for hair loss suffered as a result of alopecia areata.
19.13 	The coverage required by this section is subject to the co-payment, coinsurance, 
19.14 	deductible, and other enrollee cost-sharing requirements that apply to similar types of 
19.15 	items under the policy, plan, certificate, or contract, and is limited to a maximum of $350 
19.16 	in any benefit year and may be limited to one prostheses per benefit year.

19.17 	EFFECTIVE DATE. This section is effective January 1, 2014.

19.18 	Sec. 23. Minnesota Statutes 2012, section 62A.302, is amended to read:
19.19 	62A.302 COVERAGE OF DEPENDENTS.
19.20 		Subdivision 1.Scope of coverage. This section applies to:
19.21 	(1) a health plan as defined in section 62A.011; and
19.22 	(2) coverage described in section 62A.011, subdivision 3, clauses (4), (6), (7), (8), 
19.23 	(9), and (10); and
19.24 	(3) (2) a policy, contract, or certificate issued by a community integrated service 
19.25 	network licensed under chapter 62N.
19.26 		Subd. 2.Required coverage. Every health plan included in subdivision 1 that 
19.27 	provides dependent coverage must define "dependent" no more restrictively than the 
19.28 	definition provided in section 62L.02.
19.29 		Subd. 3.No additional restrictions permitted. Every health plan in subdivision 1 
19.30 	that makes available dependent coverage of children shall make that coverage available 
19.31 	for children until attainment of 26 years of age. Plans may not place restrictions on this 
19.32 	coverage and must comply with the following requirements:
20.1 	(1) with respect to a child who has not attained 26 years of age, a health carrier 
20.2 	shall not define dependent for purposes of eligibility for dependent coverage of children 
20.3 	other than the terms of a relationship between a child and the plan participant or spouse 
20.4 	of the plan participant, and, in the individual market, primary subscriber or spouse of 
20.5 	the primary subscriber;
20.6 	(2) a health carrier shall not deny or restrict coverage for a child who has not attained 
20.7 	26 years of age based on (i) the presence or absence of the child's financial dependency upon 
20.8 	the participant, primary subscriber, or any other person; (ii) residency with the participant 
20.9 	and in the individual market the primary subscriber, or with any other person; (iii) marital 
20.10 	status; (iv) student status; (v) employment; or (vi) any combination of those factors; and
20.11 	(3) a health carrier shall not deny or restrict coverage of a child based on eligibility 
20.12 	for other coverage, except as provided in subdivision 5.
20.13 		Subd. 4.Grandchildren. Nothing in this section requires a health carrier to make 
20.14 	coverage available for a grandchild, unless the grandparent becomes the legal guardian 
20.15 	or adoptive parent of that grandchild or unless the grandchild meets the requirements 
20.16 	of section 62A.042. For grandchildren included under a grandparent's policy pursuant 
20.17 	to section 62A.042, coverage for the grandchild may terminate if the grandchild does 
20.18 	not continue to reside with the covered grandparent continuously from birth, if the 
20.19 	grandchild does not remain financially dependent upon the covered grandparent, or when 
20.20 	the grandchild reaches age 25, except as provided in section 62A.14 or if coverage is 
20.21 	continued under section 62A.20.
20.22 		Subd. 5.Terms of coverage of dependents. The terms of coverage in a health plan 
20.23 	offered by a health carrier providing dependent coverage of children cannot vary based on 
20.24 	age except for children who are 26 years of age or older.
20.25 		Subd. 6.Opportunity to enroll. A health carrier shall comply with all provisions 
20.26 	of the Affordable Care Act in regards to providing an opportunity to enroll in coverage 
20.27 	to any child whose coverage ended, or who was denied coverage, or was not eligible for 
20.28 	coverage under a group health plan or individual health plan because, under the terms 
20.29 	of the coverage, the availability of dependent coverage of a child ended before age 26. 
20.30 	This section does not require compliance with any provision of the Affordable Care Act 
20.31 	before the effective date provided for that provision in the Affordable Care Act. The 
20.32 	commissioner shall enforce this section.
20.33 		Subd. 7.Grandfathered plan coverage. (a) For plan years beginning before 
20.34 	January 1, 2014, a group health plan that is a grandfathered plan and makes available 
20.35 	dependent coverage of children may exclude an adult child who has not attained 26 
20.36 	years of age from coverage only if the adult child is eligible to enroll in an eligible 
21.1 	employer-sponsored health benefit plan, as defined in section 5000A(f)(2) of the Internal 
21.2 	Revenue Code, other than the group health plan of a parent.
21.3 	(b) For plan years beginning on or after January 1, 2014, a group health plan that is 
21.4 	grandfathered plan coverage shall comply with all requirements of this section.

21.5 	EFFECTIVE DATE. This section is effective the day following final enactment.

21.6 	Sec. 24. [62A.3021] COVERAGE OF DEPENDENTS BY PLANS OTHER THAN 
21.7 	HEALTH PLANS.
21.8 		Subdivision 1.Scope of coverage. This section applies to coverage described in 
21.9 	section 62A.011, subdivision 3, clauses (4), (6), (7), (8), (9), and (10).
21.10 		Subd. 2.Dependent. "Dependent" means an eligible employee's spouse, unmarried 
21.11 	child who is under the age of 25 years, dependent child of any age who is disabled and 
21.12 	who meets the eligibility criteria in section 62A.14, subdivision 2, or any other person 
21.13 	whom state or federal law requires to be treated as a dependent for purposes of health 
21.14 	plans. For the purpose of this definition, a child includes a child for whom the employee or 
21.15 	the employee's spouse has been appointed legal guardian and an adoptive child as provided 
21.16 	in section 62A.27. A child also includes grandchildren as provided in section 62A.042 
21.17 	with continued eligibility of grandchildren as provided in section 62A.302, subdivision 4.

21.18 	EFFECTIVE DATE. This section is effective the day following final enactment.

21.19 	Sec. 25. Minnesota Statutes 2012, section 62A.615, is amended to read:
21.20 	62A.615 PREEXISTING CONDITIONS DISCLOSED AT TIME OF 
21.21 	APPLICATION.
21.22 	No insurer may cancel or rescind a health insurance policy for a preexisting 
21.23 	condition of which the application or other information provided by the insured reasonably 
21.24 	gave the insurer notice. No insurer may restrict coverage for a preexisting condition 
21.25 	of which the application or other information provided by the insured reasonably gave 
21.26 	the insurer notice unless the coverage is restricted at the time the policy is issued and 
21.27 	the restriction is disclosed in writing to the insured at the time the policy is issued. In 
21.28 	addition, no health plan may restrict coverage for a preexisting condition for an individual 
21.29 	who is under 19 years of age. This section does not apply to individual coverage that is 
21.30 	grandfathered plan coverage as defined in section 62A.011, subdivision 1c.

21.31 	EFFECTIVE DATE. This section is effective the day following final enactment.

22.1 	Sec. 26. Minnesota Statutes 2012, section 62A.65, subdivision 3, is amended to read:
22.2 		Subd. 3.Premium rate restrictions. No individual health plan may be offered, 
22.3 	sold, issued, or renewed to a Minnesota resident unless the premium rate charged is 
22.4 	determined in accordance with the following requirements:
22.5 	(a) Premium rates must be no more than 25 percent above and no more than 25 
22.6 	percent below the index rate charged to individuals for the same or similar coverage, 
22.7 	adjusted pro rata for rating periods of less than one year. The premium variations 
22.8 	permitted by this paragraph must be based only upon health status, claims experience, 
22.9 	and occupation. For purposes of this paragraph, health status includes refraining from 
22.10 	tobacco use or other actuarially valid lifestyle factors associated with good health, 
22.11 	provided that the lifestyle factor and its effect upon premium rates have been determined 
22.12 	by the commissioner to be actuarially valid and have been approved by the commissioner. 
22.13 	Variations permitted under this paragraph must not be based upon age or applied 
22.14 	differently at different ages. This paragraph does not prohibit use of a constant percentage 
22.15 	adjustment for factors permitted to be used under this paragraph.
22.16 	(b) (a) Premium rates may vary based upon the ages of covered persons only as 
22.17 	provided in this paragraph. In addition to the variation permitted under paragraph (a), each 
22.18 	health carrier may use an additional premium variation based upon age of up to plus or 
22.19 	minus 50 percent of the index rate except that the rate shall not vary by more than three to 
22.20 	one for adults in accordance with the provisions of the Affordable Care Act.
22.21 	(c) A health carrier may request approval by the commissioner to establish separate 
22.22 	geographic regions determined by the health carrier and to establish separate index rates 
22.23 	for each such region. 
22.24 	(b) Premium rates may vary based upon geographic rating area. The commissioner 
22.25 	shall grant approval if the following conditions are met:
22.26 	(1) the geographic regions must be applied uniformly by the health carrier the areas 
22.27 	are established in accordance with the Affordable Care Act;
22.28 	(2) each geographic region must be composed of no fewer than seven counties that 
22.29 	create a contiguous region; and
22.30 	(3) the health carrier provides actuarial justification acceptable to the commissioner 
22.31 	for the proposed geographic variations in index rates premium rates for each area, 
22.32 	establishing that the variations are based upon differences in the cost to the health carrier 
22.33 	of providing coverage.
22.34 	(d) Health carriers may use rate cells and must file with the commissioner the rate 
22.35 	cells they use. Rate cells must be based upon the number of adults or children covered 
22.36 	under the policy and may reflect the availability of Medicare coverage. The rates for 
23.1 	different rate cells must not in any way reflect generalized differences in expected costs 
23.2 	between principal insureds and their spouses.
23.3 	(c) Premium rates may vary based upon tobacco use, except that the rate shall not 
23.4 	vary by more than 1.5 to 1.
23.5 	(e) (d) In developing its index rates and premiums for a health plan, a health carrier 
23.6 	shall take into account only the following factors:
23.7 	(1) actuarially valid differences in rating factors permitted under paragraphs (a) 
23.8 	and (b) (c); and
23.9 	(2) actuarially valid geographic variations if approved by the commissioner as 
23.10 	provided in paragraph (c) (b).
23.11 	(e) The premium charged with respect to any particular health plan or individual 
23.12 	market health insurance coverage shall not be adjusted more frequently than annually, 
23.13 	except that the premium rates may be changed to reflect:
23.14 	(1) changes to the family composition of the policyholder;
23.15 	(2) changes in geographic rating area of the policyholder, as provided in paragraph 
23.16 	(b);
23.17 	(3) changes in age, as provided in paragraph (a);
23.18 	(4) changes in tobacco use, as provided in paragraph (c);
23.19 	(5) changes to the health plan requested by the policyholder; or
23.20 	(6) other changes required by federal law or regulations or otherwise expressly 
23.21 	permitted by state law.
23.22 	(f) A health carrier shall consider all enrollees in all health plans, other than 
23.23 	grandfathered health plan coverage, offered by the carrier in the individual market, 
23.24 	including those enrollees who do not enroll in such plans through an exchange, as 
23.25 	established under section 1311 of the Affordable Care Act, to be members of a single 
23.26 	risk pool.
23.27 	(g) The commissioner may establish regulations to implement the provisions of 
23.28 	this section.
23.29 	(h) In connection with the offering for sale of individual market health insurance 
23.30 	coverage under this act, a health carrier shall make a reasonable disclosure, as part of its 
23.31 	solicitation and sales materials, of all of the following:
23.32 	(1) the provisions of the coverage concerning the carrier's right to change premium 
23.33 	rates and the factors that may affect changes in premium rates; and
23.34 	(2) a listing of and descriptive information, including benefits and premiums, about 
23.35 	all health plans offered by the carrier that provide individual market health insurance 
23.36 	coverage and the availability of the health plans for which the individual is qualified.
24.1 	(i) All premium variations must be justified in initial rate filings and upon request of 
24.2 	the commissioner in rate revision filings. All rate variations are subject to approval by 
24.3 	the commissioner.
24.4 	(g) (j) The loss ratio must comply with the section 62A.021 requirements for 
24.5 	individual health plans.
24.6 	(h) (k) The rates must not be approved, unless the commissioner has determined that 
24.7 	the rates are reasonable. In determining reasonableness, the commissioner shall consider 
24.8 	the growth rates applied under section 62J.04, subdivision 1, paragraph (b), to the calendar 
24.9 	year or years that the proposed premium rate would be in effect, and actuarially valid 
24.10 	changes in risks associated with the enrollee populations, and actuarially valid changes as 
24.11 	a result of statutory changes in Laws 1992, chapter 549.
24.12 	(i) (l) An insurer may, as part of a minimum lifetime loss ratio guarantee filing under 
24.13 	section 62A.02, subdivision 3a, include a rating practices guarantee as provided in this 
24.14 	paragraph. The rating practices guarantee must be in writing and must guarantee that 
24.15 	the policy form will be offered, sold, issued, and renewed only with premium rates and 
24.16 	premium rating practices that comply with subdivisions 2, 3, 4, and 5. The rating practices 
24.17 	guarantee must be accompanied by an actuarial memorandum that demonstrates that the 
24.18 	premium rates and premium rating system used in connection with the policy form will 
24.19 	satisfy the guarantee. The guarantee must guarantee refunds of any excess premiums to 
24.20 	policyholders charged premiums that exceed those permitted under subdivision 2, 3, 4, 
24.21 	or 5. An insurer that complies with this paragraph in connection with a policy form is 
24.22 	exempt from the requirement of prior approval by the commissioner under paragraphs 
24.23 	(c), (f), and (h).

24.24 	EFFECTIVE DATE. This section is effective January 1, 2014.

24.25 	Sec. 27. Minnesota Statutes 2012, section 62A.65, subdivision 5, is amended to read:
24.26 		Subd. 5.Portability and conversion of coverage. (a) For plan years beginning 
24.27 	on or after January 1, 2014, no individual health plan may be offered, sold, issued, or 
24.28 	with respect to children age 18 or under renewed, to a Minnesota resident that contains a 
24.29 	preexisting condition limitation, preexisting condition exclusion, or exclusionary rider, 
24.30 	unless the limitation or exclusion is permitted under this subdivision and under chapter 
24.31 	62L, provided that, except for children age 18 or under, underwriting restrictions may 
24.32 	be retained on individual contracts that are issued without evidence of insurability as 
24.33 	a replacement for prior individual coverage that was sold before May 17, 1993. The
24.34 	 An individual age 19 or older may be subjected to an 18-month preexisting condition 
24.35 	limitation during plan years beginning prior to January 1, 2014, unless the individual has 
25.1 	maintained continuous coverage as defined in section 62L.02. The individual must not be 
25.2 	subjected to an exclusionary rider. During plan years beginning prior to January 1, 2014,
25.3 	 an individual who is age 19 or older and who has maintained continuous coverage may be 
25.4 	subjected to a onetime preexisting condition limitation of up to 12 months, with credit for 
25.5 	time covered under qualifying coverage as defined in section 62L.02, at the time that the 
25.6 	individual first is covered under an individual health plan by any health carrier. Credit must 
25.7 	be given for all qualifying coverage with respect to all preexisting conditions, regardless of 
25.8 	whether the conditions were preexisting with respect to any previous qualifying coverage. 
25.9 	The individual must not be subjected to an exclusionary rider. Thereafter, the individual
25.10 	 who is age 19 or older must not be subject to any preexisting condition limitation, 
25.11 	preexisting condition exclusion, or exclusionary rider under an individual health plan by 
25.12 	any health carrier, except an unexpired portion of a limitation under prior coverage, so 
25.13 	long as the individual maintains continuous coverage as defined in section 62L.02. The 
25.14 	prohibition on preexisting condition limitations for children age 18 or under does not apply 
25.15 	to an individual health plan that is a grandfathered plan, as defined in section 62A.011, 
25.16 	subdivision 1c. The prohibition on preexisting condition limitations for adults age 19 and 
25.17 	over beginning for plan years on or after January 1, 2014 does not apply to individual 
25.18 	health plans that are grandfathered plans as defined in section 62A.011, subdivision 1c.
25.19 	(b) A health carrier must offer an individual health plan to any individual previously 
25.20 	covered under a group health plan issued by that health carrier, regardless of the size of 
25.21 	the group, so long as the individual maintained continuous coverage as defined in section 
25.22 	62L.02. If the individual has available any continuation coverage provided under sections 
25.23 	62A.146; 62A.148; 62A.17, subdivisions 1 and 2; 62A.20; 62A.21; 62C.142; 62D.101; or 
25.24 	62D.105, or continuation coverage provided under federal law, the health carrier need not 
25.25 	offer coverage under this paragraph until the individual has exhausted the continuation 
25.26 	coverage. The offer must not be subject to underwriting, except as permitted under this 
25.27 	paragraph. A health plan issued under this paragraph must be a qualified plan as defined 
25.28 	in section 62E.02 and must not contain any preexisting condition limitation, preexisting 
25.29 	condition exclusion, or exclusionary rider, except for any unexpired limitation or 
25.30 	exclusion under the previous coverage. The individual health plan must cover pregnancy 
25.31 	on the same basis as any other covered illness under the individual health plan. The offer 
25.32 	of coverage by the health carrier must inform the individual that the coverage, including 
25.33 	what is covered and the health care providers from whom covered care may be obtained, 
25.34 	may not be the same as the individual's coverage under the group health plan. The offer 
25.35 	of coverage by the health carrier must also inform the individual that the individual, if 
25.36 	a Minnesota resident, may be eligible to obtain coverage from (i) other private sources 
26.1 	of health coverage, or (ii) the Minnesota Comprehensive Health Association, without a 
26.2 	preexisting condition limitation, and must provide the telephone number used by that 
26.3 	association for enrollment purposes. The initial premium rate for the individual health 
26.4 	plan must comply with subdivision 3. The premium rate upon renewal must comply with 
26.5 	subdivision 2. In no event shall the premium rate exceed 100 percent of the premium 
26.6 	charged for comparable individual coverage by the Minnesota Comprehensive Health 
26.7 	Association, and the premium rate must be less than that amount if necessary to otherwise 
26.8 	comply with this section. An individual health plan offered under this paragraph to a 
26.9 	person satisfies the health carrier's obligation to offer conversion coverage under section 
26.10 	62E.16, with respect to that person. Coverage issued under this paragraph must provide 
26.11 	that it cannot be canceled or nonrenewed as a result of the health carrier's subsequent 
26.12 	decision to leave the individual, small employer, or other group market. Section 72A.20, 
26.13 	subdivision 28, applies to this paragraph.

26.14 	EFFECTIVE DATE. This section is effective January 1, 2014.

26.15 	Sec. 28. Minnesota Statutes 2012, section 62A.65, subdivision 6, is amended to read:
26.16 		Subd. 6.Guaranteed issue not required. (a) Nothing in this section requires a 
26.17 	health carrier to initially issue a health plan to a Minnesota resident who is age 19 or older 
26.18 	on the date the health plan becomes effective if the effective date is prior to January 1, 
26.19 	2014, except as otherwise expressly provided in subdivision 4 or 5.
26.20 	(b) Guaranteed issue is required for all health plans, except grandfathered plans, 
26.21 	beginning January 1, 2014.

26.22 	EFFECTIVE DATE. This section is effective the day following final enactment.

26.23 	Sec. 29. Minnesota Statutes 2012, section 62A.65, subdivision 7, is amended to read:
26.24 		Subd. 7.Short-term coverage. (a) For purposes of this section, "short-term 
26.25 	coverage" means an individual health plan that:
26.26 	(1) is issued to provide coverage for a period of 185 days or less, except that the 
26.27 	health plan may permit coverage to continue until the end of a period of hospitalization 
26.28 	for a condition for which the covered person was hospitalized on the day that coverage 
26.29 	would otherwise have ended;
26.30 	(2) is nonrenewable, provided that the health carrier may provide coverage for one or 
26.31 	more subsequent periods that satisfy clause (1), if the total of the periods of coverage do not 
26.32 	exceed a total of 365 days out of any 555-day period, plus any additional days covered as a 
26.33 	result of hospitalization on the day that a period of coverage would otherwise have ended;
27.1 	(3) does not cover any preexisting conditions, including ones that originated during 
27.2 	a previous identical policy or contract with the same health carrier where coverage was 
27.3 	continuous between the previous and the current policy or contract; and
27.4 	(4) is available with an immediate effective date without underwriting upon receipt 
27.5 	of a completed application indicating eligibility under the health carrier's eligibility 
27.6 	requirements, provided that coverage that includes optional benefits may be offered on a 
27.7 	basis that does not meet this requirement.
27.8 	(b) Short-term coverage is not subject to subdivisions 2 and 5. Short-term coverage 
27.9 	may exclude as a preexisting condition any injury, illness, or condition for which the 
27.10 	covered person had medical treatment, symptoms, or any manifestations before the 
27.11 	effective date of the coverage, but dependent children born or placed for adoption during 
27.12 	the policy period must not be subject to this provision.
27.13 	(c) Notwithstanding subdivision 3, and section 62A.021, a health carrier may 
27.14 	combine short-term coverage with its most commonly sold individual qualified plan, as 
27.15 	defined in section 62E.02, other than short-term coverage, for purposes of complying 
27.16 	with the loss ratio requirement.
27.17 	(d) The 365-day coverage limitation provided in paragraph (a) applies to the total 
27.18 	number of days of short-term coverage that covers a person, regardless of the number of 
27.19 	policies, contracts, or health carriers that provide the coverage. A written application for 
27.20 	short-term coverage must ask the applicant whether the applicant has been covered by 
27.21 	short-term coverage by any health carrier within the 555 days immediately preceding the 
27.22 	effective date of the coverage being applied for. Short-term coverage issued in violation 
27.23 	of the 365-day limitation is valid until the end of its term and does not lose its status as 
27.24 	short-term coverage, in spite of the violation. A health carrier that knowingly issues 
27.25 	short-term coverage in violation of the 365-day limitation is subject to the administrative 
27.26 	penalties otherwise available to the commissioner of commerce or the commissioner 
27.27 	of health, as appropriate.
27.28 	(e) Time spent under short-term coverage counts as time spent under a preexisting 
27.29 	condition limitation for purposes of group or individual health plans, other than short-term 
27.30 	coverage, subsequently issued to that person, or to cover that person, by any health carrier, 
27.31 	if the person maintains continuous coverage as defined in section 62L.02. Short-term 
27.32 	coverage is a health plan and is qualifying coverage as defined in section 62L.02. 
27.33 	Notwithstanding any other law to the contrary, a health carrier is not required under any 
27.34 	circumstances to provide a person covered by short-term coverage the right to obtain 
27.35 	coverage on a guaranteed issue basis under another health plan offered by the health 
27.36 	carrier, as a result of the person's enrollment in short-term coverage.

28.1 	EFFECTIVE DATE. This section is effective the day following final enactment.

28.2 	Sec. 30. [62A.67] COMPREHENSIVE HEALTH INSURANCE COVERAGE 
28.3 	REQUIREMENTS.
28.4 		Subdivision 1.Generally. Health carriers offering health plans providing individual 
28.5 	market health insurance coverage shall ensure that the coverage:
28.6 	(1) includes the essential health benefits package required under section 1302(a) of 
28.7 	the Affordable Care Act;
28.8 	(2) limits cost-sharing for such coverage in accordance with section 1302(c) of the 
28.9 	Federal Act, as described in subdivision 2; and
28.10 	(3) subject to subdivision 3, provides bronze, silver, gold, or platinum level of 
28.11 	coverage described in section 1302(d) of the Affordable Care Act as follows:
28.12 	(i) a health plan in the bronze level shall provide a level of coverage that is designed 
28.13 	to provide benefits that are actuarially equivalent to 60 percent of the full actuarial value 
28.14 	of the benefits provided under the plan;
28.15 	(ii) a health plan in the silver level shall provide a level of coverage that is designed 
28.16 	to provide benefits that are actuarially equivalent to 70 percent of the full actuarial value 
28.17 	of the benefits provided under the plan;
28.18 	(iii) a health plan in the gold level shall provide a level of coverage that is designed 
28.19 	to provide benefits that are actuarially equivalent to 80 percent of the full actuarial value 
28.20 	of the benefits provided under the plan; and
28.21 	(iv) a health plan in the platinum level shall provide a level of coverage that is 
28.22 	designed to provide benefits that are actuarially equivalent to 90 percent of the full 
28.23 	actuarial value of the benefits provided under the plan.
28.24 		Subd. 2.Coverage for enrollees under the age of 21. If a health carrier offers 
28.25 	health insurance coverage in any level of coverage specified under section 1302(d) of the 
28.26 	Affordable Care Act, as described in subdivision 1, clause (3), the carrier shall also offer 
28.27 	such coverage in that level as a health plan in which the only enrollees are individuals 
28.28 	who, as of the beginning of a policy year, have not attained the age of 21 years.
28.29 		Subd. 3.Alternative compliance for catastrophic plans. A health plan not 
28.30 	providing a bronze, silver, gold, or platinum level of coverage, as described in subdivision 
28.31 	1, clause (3), shall be treated as meeting the requirements of section 1302(d) of the 
28.32 	Affordable Care Act with respect to any policy year if it provides a catastrophic plan that 
28.33 	meets the requirements of section 1302(e) of the Affordable Care Act.
28.34 	This section shall not apply to a dental plan described in section 1311(d)(2)(B)(ii) of 
28.35 	the Affordable Care Act.
29.1 		Subd. 4.Essential health benefit package benefits package; definition. For 
29.2 	purposes of this section, "essential health benefits package" means coverage that:
29.3 	(1) provides for the essential health benefits. "Essential health benefits" include:
29.4 	(i) ambulatory patient services;
29.5 	(ii) emergency services;
29.6 	(iii) hospitalization;
29.7 	(iv) laboratory services;
29.8 	(v) maternity and newborn care;
29.9 	(vi) mental health and substance abuse disorder services, including behavioral health 
29.10 	treatment;
29.11 	(vii) pediatric services, including oral and vision care;
29.12 	(viii) prescription drugs;
29.13 	(ix) preventative and wellness services and chronic disease management; and
29.14 	(x) rehabilitative and habilitative services and devices.

29.15 	EFFECTIVE DATE. This section is effective January 1, 2014.

29.16 	Sec. 31. Minnesota Statutes 2012, section 62C.14, subdivision 5, is amended to read:
29.17 		Subd. 5.Disabled dependents. A subscriber's individual contract or any group 
29.18 	contract delivered or issued for delivery in this state and providing that coverage of 
29.19 	a dependent child of the subscriber or a dependent child of a covered group member 
29.20 	shall terminate upon attainment of a specified limiting age as defined in section 62Q.01, 
29.21 	subdivision 10, shall also provide in substance that attainment of that age shall not 
29.22 	terminate coverage while the child is (a) incapable of self-sustaining employment by reason 
29.23 	of developmental disability, mental illness or disorder, or physical disability, and (b) chiefly 
29.24 	dependent upon the subscriber or employee for support and maintenance, provided proof 
29.25 	of incapacity and dependency is furnished by the subscriber within 31 days of attainment 
29.26 	of the limiting age as defined in section 62Q.01, subdivision 10, and subsequently as 
29.27 	required by the corporation, but not more frequently than annually after a two-year period 
29.28 	following attainment of the age. Any notice regarding termination of coverage due to 
29.29 	attainment of the limiting age must include information about this provision.

29.30 	EFFECTIVE DATE. This section is effective the day following final enactment.

29.31 	Sec. 32. Minnesota Statutes 2012, section 62C.142, subdivision 2, is amended to read:
29.32 		Subd. 2.Conversion privilege. Every subscriber contract, other than a contract 
29.33 	whose continuance is contingent upon continued employment or membership, which 
30.1 	contains a provision for termination of coverage of the spouse upon dissolution of 
30.2 	marriage shall contain a provision allowing a former spouse and dependent children of a 
30.3 	subscriber, without providing evidence of insurability, to obtain from the corporation at 
30.4 	the expiration of any continuation of coverage required under subdivision 2a or section 
30.5 	62A.146, or upon termination of coverage by reason of an entry of a valid decree of 
30.6 	dissolution which does not require the insured to provide continued coverage for the 
30.7 	former spouse, an individual subscriber contract providing at least the minimum benefits 
30.8 	of a qualified plan as prescribed by section 62E.06 and the option of a number three 
30.9 	qualified plan, a number two qualified plan, a number one qualified plan as provided by 
30.10 	section 62E.06, subdivisions 1 to 3, provided application is made to the corporation within 
30.11 	30 days following notice of the expiration of the continued coverage and upon payment of 
30.12 	the appropriate fee. A subscriber contract providing reduced benefits at a reduced fee may 
30.13 	be accepted by the former spouse and dependent children in lieu of the optional coverage 
30.14 	otherwise required by this subdivision. The An individual subscriber contract issued as 
30.15 	conversion coverage shall be renewable at the option of the former spouse as long as the 
30.16 	former spouse is not covered under another qualified plan as defined in section 62E.02, 
30.17 	subdivision 4. Any revisions in the table of rate for the individual subscriber contract shall 
30.18 	apply to the former spouse's original age at entry and shall apply equally to all similar 
30.19 	contracts issued as conversion coverage by the corporation.

30.20 	EFFECTIVE DATE. This section is effective January 1, 2014.

30.21 	Sec. 33. Minnesota Statutes 2012, section 62D.02, is amended by adding a subdivision 
30.22 	to read:
30.23 		Subd. 17.Health care services. "Health care services" means services for the 
30.24 	diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or 
30.25 	disease.

30.26 	EFFECTIVE DATE. This section is effective the day following final enactment.

30.27 	Sec. 34. Minnesota Statutes 2012, section 62D.07, subdivision 3, is amended to read:
30.28 		Subd. 3.Required provisions. Contracts and evidences of coverage shall contain:
30.29 	(a) no provisions or statements which are unjust, unfair, inequitable, misleading, 
30.30 	deceptive, or which are untrue, misleading, or deceptive as defined in section 62D.12, 
30.31 	subdivision 1;
30.32 	(b) a clear, concise and complete statement of:
31.1 	(1) the health care services and the insurance or other benefits, if any, to which the 
31.2 	enrollee is entitled under the health maintenance contract;
31.3 	(2) any exclusions or limitations on the services, kind of services, benefits, or kind of 
31.4 	benefits, to be provided, including any deductible or co-payment feature and requirements 
31.5 	for referrals, prior authorizations, and second opinions;
31.6 	(3) where and in what manner information is available as to how services, including 
31.7 	emergency and out of area services, may be obtained;
31.8 	(4) the total amount of payment and co-payment, if any, for health care services 
31.9 	and the indemnity or service benefits, if any, which the enrollee is obligated to pay 
31.10 	with respect to individual contracts, or an indication whether the plan is contributory or 
31.11 	noncontributory with respect to group certificates; and
31.12 	(5) a description of the health maintenance organization's method for resolving 
31.13 	enrollee complaints and a statement identifying the commissioner as an external source 
31.14 	with whom complaints may be registered; and
31.15 	(c) on the cover page of the evidence of coverage and contract, a clear and complete 
31.16 	statement of enrollees' rights. The statement must be in bold print and captioned 
31.17 	"Important Enrollee Information and Enrollee Bill of Rights" and must include but not be 
31.18 	limited to the following provisions in the following language or in substantially similar 
31.19 	language approved in advance by the commissioner, except that paragraph (8) does not 
31.20 	apply to prepaid health plans providing coverage for programs administered by the 
31.21 	commissioner of human services:
31.22 	ENROLLEE INFORMATION
31.23 	(1) COVERED SERVICES: Services provided by (name of health maintenance 
31.24 	organization) will be covered only if services are provided by participating (name of 
31.25 	health maintenance organization) providers or authorized by (name of health maintenance 
31.26 	organization). Your contract fully defines what services are covered and describes 
31.27 	procedures you must follow to obtain coverage.
31.28 	(2) PROVIDERS: Enrolling in (name of health maintenance organization) does not 
31.29 	guarantee services by a particular provider on the list of providers. When a provider is 
31.30 	no longer part of (name of health maintenance organization), you must choose among 
31.31 	remaining (name of the health maintenance organization) providers.
31.32 	(3) REFERRALS: Certain services are covered only upon referral. See section 
31.33 	(section number) of your contract for referral requirements. All referrals to non-(name of 
31.34 	health maintenance organization) providers and certain types of health care providers must 
31.35 	be authorized by (name of health maintenance organization).
32.1 	(4) EMERGENCY SERVICES: Emergency services from providers who are not 
32.2 	affiliated with (name of health maintenance organization) will be covered only if proper 
32.3 	procedures are followed. Your contract explains the procedures and benefits associated 
32.4 	with emergency care from (name of health maintenance organization) and non-(name of 
32.5 	health maintenance organization) providers.
32.6 	(5) EXCLUSIONS: Certain services or medical supplies are not covered. You 
32.7 	should read the contract for a detailed explanation of all exclusions.
32.8 	(6) CONTINUATION: You may convert to an individual health maintenance 
32.9 	organization contract or continue coverage under certain circumstances. These 
32.10 	continuation and conversion rights are explained fully in your contract.
32.11 	(7) CANCELLATION: Your coverage may be canceled by you or (name of health 
32.12 	maintenance organization) only under certain conditions. Your contract describes all 
32.13 	reasons for cancellation of coverage.
32.14 	(8) NEWBORN COVERAGE: If your health plan provides for dependent coverage, 
32.15 	a newborn infant is covered from birth, but only if services are provided by participating 
32.16 	(name of health maintenance organization) providers or authorized by (name of health 
32.17 	maintenance organization). Certain services are covered only upon referral. (Name 
32.18 	of health maintenance organization) will not automatically know of the infant's birth 
32.19 	or that you would like coverage under your plan. You should notify (name of health 
32.20 	maintenance organization) of the infant's birth and that you would like coverage. If your 
32.21 	contract requires an additional premium for each dependent, (name of health maintenance 
32.22 	organization) is entitled to all premiums due from the time of the infant's birth until the 
32.23 	time you notify (name of health maintenance organization) of the birth. (Name of health 
32.24 	maintenance organization) may withhold payment of any health benefits for the newborn 
32.25 	infant until any premiums you owe are paid.
32.26 	(9) PRESCRIPTION DRUGS AND MEDICAL EQUIPMENT: Enrolling in (name 
32.27 	of health maintenance organization) does not guarantee that any particular prescription 
32.28 	drug will be available nor that any particular piece of medical equipment will be available, 
32.29 	even if the drug or equipment is available at the start of the contract year.
32.30 	ENROLLEE BILL OF RIGHTS
32.31 	(1) Enrollees have the right to available and accessible services including emergency 
32.32 	services, as defined in your contract, 24 hours a day and seven days a week;
32.33 	(2) Enrollees have the right to be informed of health problems, and to receive 
32.34 	information regarding treatment alternatives and risks which is sufficient to assure 
32.35 	informed choice;
33.1 	(3) Enrollees have the right to refuse treatment, and the right to privacy of medical 
33.2 	and financial records maintained by the health maintenance organization and its health 
33.3 	care providers, in accordance with existing law;
33.4 	(4) Enrollees have the right to file a complaint with the health maintenance 
33.5 	organization and the commissioner of health and the right to initiate a legal proceeding 
33.6 	when experiencing a problem with the health maintenance organization or its health 
33.7 	care providers;
33.8 	(5) Enrollees have the right to a grace period of 31 days for the payment of each 
33.9 	premium for an individual health maintenance contract falling due after the first premium 
33.10 	during which period the contract shall continue in force;
33.11 	(6) Medicare enrollees have the right to voluntarily disenroll from the health 
33.12 	maintenance organization and the right not to be requested or encouraged to disenroll 
33.13 	except in circumstances specified in federal law; and
33.14 	(7) Medicare enrollees have the right to a clear description of nursing home and 
33.15 	home care benefits covered by the health maintenance organization.

33.16 	EFFECTIVE DATE. This section is effective the day following final enactment.

33.17 	Sec. 35. Minnesota Statutes 2012, section 62D.095, is amended to read:
33.18 	62D.095 ENROLLEE COST SHARING.
33.19 		Subdivision 1.General application. A health maintenance contract may contain 
33.20 	enrollee cost-sharing provisions as specified in this section. Co-payment and deductible 
33.21 	provisions in a group contract must not discriminate on the basis of age, sex, race, 
33.22 	disability, economic status, or length of enrollment in the health plan. During an 
33.23 	open enrollment period in which all offered health plans fully participate without any 
33.24 	underwriting restrictions, co-payment and deductible provisions must not discriminate 
33.25 	on the basis of preexisting health status.
33.26 		Subd. 2.Co-payments. (a) A health maintenance contract may impose a 
33.27 	co-payment as authorized under Minnesota Rules, part 4685.0801, or under this section
33.28 	 and coinsurance consistent with the provisions of the Affordable Care Act as defined 
33.29 	under section 62A.011, subdivision 1a.
33.30 	(b) A health maintenance organization may impose a flat fee co-payment on 
33.31 	outpatient office visits not to exceed 40 percent of the median provider's charges for 
33.32 	similar services or goods received by the enrollees as calculated under Minnesota Rules, 
33.33 	part 4685.0801. A health maintenance organization may impose a flat fee co-payment on 
33.34 	outpatient prescription drugs not to exceed 50 percent of the median provider's charges 
34.1 	for similar services or goods received by the enrollees as calculated under Minnesota 
34.2 	Rules, part 4685.0801.
34.3 	(c) If a health maintenance contract is permitted to impose a co-payment for 
34.4 	preexisting health status under sections 62D.01 to 62D.30, these provisions may vary with 
34.5 	respect to length of enrollment in the health plan.
34.6 		Subd. 3.Deductibles. (a) A health maintenance contract issued by a health 
34.7 	maintenance organization that is assessed less than three percent of the total annual amount 
34.8 	assessed by the Minnesota comprehensive health association may impose deductibles not 
34.9 	to exceed $3,000 per person, per year and $6,000 per family, per year. For purposes of 
34.10 	the percentage calculation, a health maintenance organization's assessments include those 
34.11 	of its affiliates may impose a deductible consistent with the provisions of the Affordable 
34.12 	Care Act as defined under section 62A.011, subdivision 1a.
34.13 	(b) All other health maintenance contracts may impose deductibles not to exceed 
34.14 	$2,250 per person, per year and $4,500 per family, per year.
34.15 		Subd. 4.Annual out-of-pocket maximums. (a) A health maintenance contract 
34.16 	issued by a health maintenance organization that is assessed less than three percent of the 
34.17 	total annual amount assessed by the Minnesota comprehensive health association must 
34.18 	include a limitation not to exceed $4,500 per person and $7,500 per family on total annual 
34.19 	out-of-pocket enrollee cost-sharing expenses. For purposes of the percentage calculation, 
34.20 	a health maintenance organization's assessments include those of its affiliates may impose 
34.21 	an annual out-of-pocket maximum consistent with the provisions of the Affordable Care 
34.22 	Act as defined under section 62A.011, subdivision 1a.
34.23 	(b) All other health maintenance contracts must include a limitation not to 
34.24 	exceed $3,000 per person and $6,000 per family on total annual out-of-pocket enrollee 
34.25 	cost-sharing expenses.
34.26 		Subd. 5.Exceptions. No co-payments or deductibles may be imposed on preventive 
34.27 	health care services as described in Minnesota Rules, part 4685.0801, subpart 8 consistent 
34.28 	with the provisions of the Affordable Care Act as defined under section 62A.011, 
34.29 	subdivision 1a.
34.30 		Subd. 6.Public programs. This section does not apply to the prepaid medical 
34.31 	assistance program, the MinnesotaCare program, the prepaid general assistance program, 
34.32 	the federal Medicare program, or the health plans provided through any of those programs.

34.33 	EFFECTIVE DATE. This section is effective January 1, 2014.

34.34 	Sec. 36. Minnesota Statutes 2012, section 62D.12, is amended by adding a subdivision 
34.35 	to read:
35.1 		Subd. 2b.Rescission of coverage. A health maintenance organization shall not 
35.2 	rescind individual or group coverage except for an act or practice that constitutes fraud or 
35.3 	intentional misrepresentation of material fact as prohibited by the plan or coverage. A 
35.4 	health maintenance organization shall provide 30 days' prior written notice to the enrollee 
35.5 	of the intended rescission.

35.6 	EFFECTIVE DATE. This section is effective January 1, 2014.

35.7 	Sec. 37. Minnesota Statutes 2012, section 62D.181, subdivision 7, is amended to read:
35.8 		Subd. 7.Replacement coverage; limitations. The association is not obligated 
35.9 	to offer replacement coverage under this chapter or conversion coverage under section 
35.10 	62E.16 at the end of the periods specified in subdivision 6. Any continuation obligation 
35.11 	arising under this chapter or chapter 62A will cease at the end of the periods specified in 
35.12 	subdivision 6.

35.13 	EFFECTIVE DATE. This section is effective January 1, 2014.

35.14 	Sec. 38. Minnesota Statutes 2012, section 62D.30, subdivision 8, is amended to read:
35.15 		Subd. 8.Rural demonstration project. (a) The commissioner may permit 
35.16 	demonstration projects to allow health maintenance organizations to extend coverage to a 
35.17 	health improvement and purchasing coalition located in rural Minnesota, comprised of 
35.18 	the health maintenance organization and members from a geographic area. For purposes 
35.19 	of this subdivision, rural is defined as greater Minnesota excluding the seven-county 
35.20 	metropolitan area of Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, and Washington. 
35.21 	The coalition must be designed in such a way that members will:
35.22 	(1) become better informed about health care trends and cost increases;
35.23 	(2) be actively engaged in the design of health benefit options that will meet the 
35.24 	needs of their community;
35.25 	(3) pool their insurance risk;
35.26 	(4) purchase these products from the health maintenance organization involved in 
35.27 	the demonstration project; and
35.28 	(5) actively participate in health improvement decisions for their community.
35.29 	(b) The commissioner must consider the following when approving applications 
35.30 	for rural demonstration projects:
35.31 	(1) the extent of consumer involvement in development of the project;
35.32 	(2) the degree to which the project is likely to reduce the number of uninsured or to 
35.33 	maintain existing coverage; and
36.1 	(3) a plan to evaluate and report to the commissioner and legislature as prescribed by 
36.2 	paragraph (e).
36.3 	(c) For purposes of this subdivision, the commissioner must waive compliance with 
36.4 	the following statutes and rules: the cost-sharing restrictions under section 62D.095, 
36.5 	subdivisions 2, 3, and 4, and Minnesota Rules, part 4685.0801, subparts 1 to 7; for a 
36.6 	period of at least two years, participation in government programs under section 62D.04, 
36.7 	subdivision 5, in the counties of the demonstration project if that compliance would have 
36.8 	been required solely due to participation in the demonstration project and shall continue 
36.9 	to waive this requirement beyond two years if the enrollment in the demonstration 
36.10 	project is less than 10,000 enrollees; small employer marketing under section 62L.05, 
36.11 	subdivisions 1 to 3; and small employer geographic premium variations under section 
36.12 	62L.08, subdivision 4. The commissioner shall approve enrollee cost-sharing features 
36.13 	desired by the coalition that appropriately share costs between employers, individuals, 
36.14 	and the health maintenance organization.
36.15 	(d) The health maintenance organization may make the starting date of the project 
36.16 	contingent upon a minimum number of enrollees as cited in the application, provide 
36.17 	for an initial term of contract with the purchasers of a minimum of three years, and 
36.18 	impose a reasonable penalty for employers who withdraw early from the project. For 
36.19 	purposes of this subdivision, loss ratios are to be determined as if the policies issued under 
36.20 	this section are considered individual or small employer policies pursuant to section 
36.21 	62A.021, subdivision 1, paragraph (f). The health maintenance organization may consider 
36.22 	businesses of one to be a small employer under section 62L.02, subdivision 26. The 
36.23 	health maintenance organization may limit enrollment and establish enrollment criteria for 
36.24 	businesses of one. Health improvement and purchasing coalitions under this subdivision 
36.25 	are not associations under section 62L.045, subdivision 1, paragraph (a).
36.26 	(e) The health improvement and purchasing coalition must report to the 
36.27 	commissioner and legislature annually on the progress of the demonstration project and, to 
36.28 	the extent possible, any significant findings in the criteria listed in clauses (1), (2), and (3) 
36.29 	for the final report. The coalition must submit a final report five years from the starting date 
36.30 	of the project. The final report must detail significant findings from the project and must 
36.31 	include, to the extent available, but should not be limited to, information on the following:
36.32 	(1) the extent to which the project had an impact on the number of uninsured 
36.33 	in the project area;
36.34 	(2) the effect on health coverage premiums for groups in the project's geographic 
36.35 	area, including those purchasing health coverage outside the health improvement and 
36.36 	purchasing coalition; and
37.1 	(3) the degree to which health care consumers were involved in the development and 
37.2 	implementation of the demonstration project.
37.3 	(f) The commissioner must limit the number of demonstration projects under this 
37.4 	subdivision to five projects.
37.5 	(g) Approval of the application for the demonstration project is deemed to be in 
37.6 	compliance with section 62E.06, subdivisions 1, paragraph (a), 2, and 3.
37.7 	(h) Subdivisions 2 to 7 apply to demonstration projects under this subdivision. 
37.8 	Waivers permitted under subdivision 1 do not apply to demonstration projects under 
37.9 	this subdivision.
37.10 	(i) If a demonstration project under this subdivision works in conjunction with a 
37.11 	purchasing alliance formed under chapter 62T, that chapter will apply to the purchasing 
37.12 	alliance except to the extent that chapter 62T is inconsistent with this subdivision.

37.13 	EFFECTIVE DATE. This section is effective January 1, 2014.

37.14 	Sec. 39. Minnesota Statutes 2012, section 62E.02, is amended by adding a subdivision 
37.15 	to read:
37.16 		Subd. 2a.Essential health benefits. "Essential health benefits" has the meaning 
37.17 	given under section 1302(b) of the Patient Protection and Affordable Care Act (PPACA) 
37.18 	and applicable regulations. Essential health benefits include:
37.19 	(1) ambulatory patient services;
37.20 	(2) emergency services;
37.21 	(3) hospitalization;
37.22 	(4) laboratory services;
37.23 	(5) maternity and newborn care;
37.24 	(6) mental health and substance abuse disorder services, including behavioral health 
37.25 	treatment;
37.26 	(7) pediatric services, including oral and vision care;
37.27 	(8) prescription drugs;
37.28 	(9) preventive and wellness services and chronic disease management;
37.29 	(10) rehabilitative and habilitative services and devices; and
37.30 	(11) other services defined as essential health benefits under the Affordable Care Act 
37.31 	as defined in section 62A.011, subdivision 1a.

37.32 	EFFECTIVE DATE. This section is effective January 1, 2014.

37.33 	Sec. 40. Minnesota Statutes 2012, section 62E.04, subdivision 4, is amended to read:
38.1 		Subd. 4.Major medical coverage. Each insurer and fraternal shall affirmatively 
38.2 	offer coverage of major medical expenses to every applicant who applies to the insurer 
38.3 	or fraternal for a new unqualified policy, which has a lifetime benefit limit of less than 
38.4 	$1,000,000, at the time of application and annually to every holder of such an unqualified 
38.5 	policy of accident and health insurance renewed by the insurer or fraternal. The coverage 
38.6 	shall provide that when a covered individual incurs out-of-pocket expenses of $5,000 
38.7 	or more within a calendar year for services covered in section 62E.06, subdivision 1, 
38.8 	benefits shall be payable, subject to any co-payment authorized by the commissioner, up 
38.9 	to a maximum lifetime limit of not less than $1,000,000 and shall not contain a lifetime 
38.10 	maximum on essential health benefits. The offer of coverage of major medical expenses 
38.11 	may consist of the offer of a rider on an existing unqualified policy or a new policy which 
38.12 	is a qualified plan.

38.13 	EFFECTIVE DATE. This section is effective the day following final enactment.

38.14 	Sec. 41. Minnesota Statutes 2012, section 62E.06, subdivision 1, is amended to read:
38.15 		Subdivision 1.Number three plan. A plan of health coverage shall be certified as a 
38.16 	number three qualified plan if it otherwise meets the requirements established by chapters 
38.17 	62A, 62C, and 62Q, and the other laws of this state, whether or not the policy is issued in 
38.18 	Minnesota, and meets or exceeds the following minimum standards:
38.19 	(a) The minimum benefits for a covered individual shall, subject to the other 
38.20 	provisions of this subdivision, be equal to at least 80 percent of the cost of covered services 
38.21 	in excess of an annual deductible which does not exceed $150 per person. The coverage 
38.22 	shall include a limitation of $3,000 per person on total annual out-of-pocket expenses for 
38.23 	services covered under this subdivision. The coverage shall  not be subject to a maximum 
38.24 	lifetime benefit of not less than $1,000,000 lifetime maximum on essential health benefits.
38.25 	The prohibition on lifetime maximums for essential health benefits and $3,000 
38.26 	limitation on total annual out-of-pocket expenses and the $1,000,000 maximum lifetime 
38.27 	benefit shall not be subject to change or substitution by use of an actuarially equivalent 
38.28 	benefit.
38.29 	(b) Covered expenses shall be the usual and customary charges for the following 
38.30 	services and articles when prescribed by a physician:
38.31 	(1) hospital services;
38.32 	(2) professional services for the diagnosis or treatment of injuries, illnesses, or 
38.33 	conditions, other than dental, which are rendered by a physician or at the physician's 
38.34 	direction;
38.35 	(3) drugs requiring a physician's prescription;
39.1 	(4) services of a nursing home for not more than 120 days in a year if the services 
39.2 	would qualify as reimbursable services under Medicare;
39.3 	(5) services of a home health agency if the services would qualify as reimbursable 
39.4 	services under Medicare;
39.5 	(6) use of radium or other radioactive materials;
39.6 	(7) oxygen;
39.7 	(8) anesthetics;
39.8 	(9) prostheses other than dental but including scalp hair prostheses worn for hair 
39.9 	loss suffered as a result of alopecia areata;
39.10 	(10) rental or purchase, as appropriate, of durable medical equipment other than 
39.11 	eyeglasses and hearing aids, unless coverage is required under section 62Q.675;
39.12 	(11) diagnostic x-rays and laboratory tests;
39.13 	(12) oral surgery for partially or completely unerupted impacted teeth, a tooth root 
39.14 	without the extraction of the entire tooth, or the gums and tissues of the mouth when not 
39.15 	performed in connection with the extraction or repair of teeth;
39.16 	(13) services of a physical therapist;
39.17 	(14) transportation provided by licensed ambulance service to the nearest facility 
39.18 	qualified to treat the condition; or a reasonable mileage rate for transportation to a kidney 
39.19 	dialysis center for treatment; and
39.20 	(15) services of an occupational therapist.
39.21 	(c) Covered expenses for the services and articles specified in this subdivision do 
39.22 	not include the following:
39.23 	(1) any charge for care for injury or disease either (i) arising out of an injury in the 
39.24 	course of employment and subject to a workers' compensation or similar law, (ii) for 
39.25 	which benefits are payable without regard to fault under coverage statutorily required 
39.26 	to be contained in any motor vehicle, or other liability insurance policy or equivalent 
39.27 	self-insurance, or (iii) for which benefits are payable under another policy of accident and 
39.28 	health insurance, Medicare, or any other governmental program except as otherwise 
39.29 	provided by section 62A.04, subdivision 3, clause (4);
39.30 	(2) any charge for treatment for cosmetic purposes other than for reconstructive 
39.31 	surgery when such service is incidental to or follows surgery resulting from injury, 
39.32 	sickness, or other diseases of the involved part or when such service is performed on a 
39.33 	covered dependent child because of congenital disease or anomaly which has resulted in a 
39.34 	functional defect as determined by the attending physician;
39.35 	(3) care which is primarily for custodial or domiciliary purposes which would not 
39.36 	qualify as eligible services under Medicare;
40.1 	(4) any charge for confinement in a private room to the extent it is in excess of 
40.2 	the institution's charge for its most common semiprivate room, unless a private room is 
40.3 	prescribed as medically necessary by a physician, provided, however, that if the institution 
40.4 	does not have semiprivate rooms, its most common semiprivate room charge shall be 
40.5 	considered to be 90 percent of its lowest private room charge;
40.6 	(5) that part of any charge for services or articles rendered or prescribed by a 
40.7 	physician, dentist, or other health care personnel which exceeds the prevailing charge in 
40.8 	the locality where the service is provided; and
40.9 	(6) any charge for services or articles the provision of which is not within the scope 
40.10 	of authorized practice of the institution or individual rendering the services or articles.
40.11 	(d) The minimum benefits for a qualified plan shall include, in addition to those 
40.12 	benefits specified in clauses (a) and (e), benefits for well baby care, effective July 1, 
40.13 	1980, subject to applicable deductibles, coinsurance provisions, and maximum lifetime 
40.14 	benefit limitations.
40.15 	(e) Effective July 1, 1979, the minimum benefits of a qualified plan shall include, in 
40.16 	addition to those benefits specified in clause (a), a second opinion from a physician on 
40.17 	all surgical procedures expected to cost a total of $500 or more in physician, laboratory, 
40.18 	and hospital fees, provided that the coverage need not include the repetition of any 
40.19 	diagnostic tests.
40.20 	(f) Effective August 1, 1985, the minimum benefits of a qualified plan must include, 
40.21 	in addition to the benefits specified in clauses (a), (d), and (e), coverage for special dietary 
40.22 	treatment for phenylketonuria when recommended by a physician.
40.23 	(g) Outpatient mental health coverage is subject to section 62A.152, subdivision 2.

40.24 	EFFECTIVE DATE. This section is effective the day following final enactment.

40.25 	Sec. 42. Minnesota Statutes 2012, section 62E.09, is amended to read:
40.26 	62E.09 DUTIES OF COMMISSIONER.
40.27 	The commissioner may:
40.28 	(a) formulate general policies to advance the purposes of sections 62E.01 to 62E.19;
40.29 	(b) supervise the creation of the Minnesota Comprehensive Health Association 
40.30 	within the limits described in section 62E.10;
40.31 	(c) approve the selection of the writing carrier by the association, approve the 
40.32 	association's contract with the writing carrier, and approve the state plan coverage;
40.33 	(d) appoint advisory committees;
41.1 	(e) conduct periodic audits to assure the general accuracy of the financial data 
41.2 	submitted by the writing carrier and the association;
41.3 	(f) contract with the federal government or any other unit of government to ensure 
41.4 	coordination of the state plan with other governmental assistance programs;
41.5 	(g) undertake directly or through contracts with other persons studies or 
41.6 	demonstration programs to develop awareness of the benefits of sections 62E.01 to 62E.16
41.7 	 62E.15, so that the residents of this state may best avail themselves of the health care 
41.8 	benefits provided by these sections;
41.9 	(h) contract with insurers and others for administrative services; and
41.10 	(i) adopt, amend, suspend and repeal rules as reasonably necessary to carry out and 
41.11 	make effective the provisions and purposes of sections 62E.01 to 62E.19.

41.12 	EFFECTIVE DATE. This section is effective January 1, 2014.

41.13 	Sec. 43. Minnesota Statutes 2012, section 62E.10, subdivision 7, is amended to read:
41.14 		Subd. 7.General powers. The association may:
41.15 	(a) Exercise the powers granted to insurers under the laws of this state;
41.16 	(b) Sue or be sued;
41.17 	(c) Enter into contracts with insurers, similar associations in other states or with 
41.18 	other persons for the performance of administrative functions including the functions 
41.19 	provided for in clauses (e) and (f);
41.20 	(d) Establish administrative and accounting procedures for the operation of the 
41.21 	association;
41.22 	(e) Provide for the reinsuring of risks incurred as a result of issuing the coverages 
41.23 	required by sections section62E.04and 62E.16 by members of the association. Each 
41.24 	member which elects to reinsure its required risks shall determine the categories of 
41.25 	coverage it elects to reinsure in the association. The categories of coverage are:
41.26 	(1) individual qualified plans, excluding group conversions;
41.27 	(2) group conversions;
41.28 	(3) group qualified plans with fewer than 50 employees or members; and
41.29 	(4) major medical coverage.
41.30 	A separate election may be made for each category of coverage. If a member elects 
41.31 	to reinsure the risks of a category of coverage, it must reinsure the risk of the coverage 
41.32 	of every life covered under every policy issued in that category. A member electing to 
41.33 	reinsure risks of a category of coverage shall enter into a contract with the association 
41.34 	establishing a reinsurance plan for the risks. This contract may include provision for 
41.35 	the pooling of members' risks reinsured through the association and it may provide for 
42.1 	assessment of each member reinsuring risks for losses and operating and administrative 
42.2 	expenses incurred, or estimated to be incurred in the operation of the reinsurance plan. This 
42.3 	reinsurance plan shall be approved by the commissioner before it is effective. Members 
42.4 	electing to administer the risks which are reinsured in the association shall comply with the 
42.5 	benefit determination guidelines and accounting procedures established by the association. 
42.6 	The fee charged by the association for the reinsurance of risks shall not be less than 110 
42.7 	percent of the total anticipated expenses incurred by the association for the reinsurance; and
42.8 	(f) Provide for the administration by the association of policies which are reinsured 
42.9 	pursuant to clause (e). Each member electing to reinsure one or more categories of 
42.10 	coverage in the association may elect to have the association administer the categories of 
42.11 	coverage on the member's behalf. If a member elects to have the association administer 
42.12 	the categories of coverage, it must do so for every life covered under every policy issued 
42.13 	in that category. The fee for the administration shall not be less than 110 percent of the 
42.14 	total anticipated expenses incurred by the association for the administration.

42.15 	EFFECTIVE DATE. This section is effective January 1, 2014.

42.16 	Sec. 44. Minnesota Statutes 2012, section 62H.04, is amended to read:
42.17 	62H.04 COMPLIANCE WITH OTHER LAWS.
42.18 	(a) A joint self-insurance plan is subject to the requirements of chapters 62A, 62E, 
42.19 	62L, and 62Q, and sections 72A.17 to 72A.32 unless otherwise specifically exempt. A 
42.20 	joint self-insurance plan must pay assessments made by the Minnesota Comprehensive 
42.21 	Health Association, as required under section 62E.11.
42.22 	(b) A joint self-insurance plan is exempt from providing the mandated health 
42.23 	benefits described in chapters 62A, 62E, 62L, and 62Q if it otherwise provides the benefits 
42.24 	required under the Employee Retirement Income Security Act of 1974, United States 
42.25 	Code, title 29, sections 1001, et seq., for all employers and not just for the employers with 
42.26 	50 or more employees who are covered by that federal law.
42.27 	(c) A joint self-insurance plan is exempt from section 62L.03, subdivision 1, if the 
42.28 	plan offers an annual open enrollment period of no less than 15 days during which all 
42.29 	employers that qualify for membership may enter the plan without preexisting condition 
42.30 	limitations or exclusions except those permitted under chapter 62L.
42.31 	(d) A joint self-insurance plan is exempt from sections 62A.146, 62A.16, 62A.17, 
42.32 	62A.20, 62A.21, and 62A.65, subdivision 5, paragraph (b), and 62E.16 if the joint 
42.33 	self-insurance plan complies with the continuation requirements under the Employee 
42.34 	Retirement Income Security Act of 1974, United States Code, title 29, sections 1001, et 
43.1 	seq., for all employers and not just for the employers with 20 or more employees who 
43.2 	are covered by that federal law.
43.3 	(e) A joint self-insurance plan must provide to all employers the maternity coverage 
43.4 	required by federal law for employers with 15 or more employees.
43.5 	(f) A joint self-insurance plan must comply with all the provisions and requirements 
43.6 	of the Affordable Care Act as defined under section 62A.011, subdivision 1a, to the extent 
43.7 	that they apply to such plans.

43.8 	EFFECTIVE DATE. This section is effective the day following final enactment, 
43.9 	except that the amendment made to paragraph (d) is effective January 1, 2014.

43.10 	Sec. 45. Minnesota Statutes 2012, section 62L.02, subdivision 11, is amended to read:
43.11 		Subd. 11.Dependent. "Dependent" means an eligible employee's spouse, 
43.12 	unmarried child who is under the age of 25 years dependent child to the limiting age as 
43.13 	defined in section 62Q.01, subdivision 10, dependent child of any age who is disabled and 
43.14 	who meets the eligibility criteria in section 62A.14, subdivision 2, or any other person 
43.15 	whom state or federal law requires to be treated as a dependent for purposes of health 
43.16 	plans. For the purpose of this definition, a dependent child to the limiting age as defined in 
43.17 	section 62Q.01, subdivision 10, includes a child for whom the employee or the employee's 
43.18 	spouse has been appointed legal guardian and an adoptive child as provided in section 
43.19 	62A.27. A child also means a grandchild as provided in section 62A.042 with continued 
43.20 	eligibility of grandchildren as provided in section 62A.302, subdivision 4.

43.21 	EFFECTIVE DATE. This section is effective the day following final enactment.

43.22 	Sec. 46. Minnesota Statutes 2012, section 62L.02, subdivision 14a, is amended to read:
43.23 		Subd. 14a.Guaranteed issue. "Guaranteed issue" means that a health carrier shall 
43.24 	not decline an application by a small employer for any health benefit plan offered by 
43.25 	that health carrier and shall not decline to cover under a health benefit plan any eligible 
43.26 	employee or eligible dependent, including persons who become eligible employees or 
43.27 	eligible dependents after initial issuance of the health benefit plan, subject to the health 
43.28 	carrier's right to impose preexisting condition limitations permitted under this chapter.

43.29 	EFFECTIVE DATE. This section is effective January 1, 2014.

43.30 	Sec. 47. Minnesota Statutes 2012, section 62L.02, is amended by adding a subdivision 
43.31 	to read:
44.1 		Subd. 17a.Individual health plan. "Individual health plan" means a health plan 
44.2 	as defined under section 62A.011, subdivision 3, that is offered to individuals in the 
44.3 	individual market, other than conversion policies or short-term coverage. Small group 
44.4 	market health plans offered though the Minnesota Insurance Marketplace to employees of 
44.5 	a small employer are not considered individual health plans, regardless of whether the 
44.6 	plan is purchased using a defined contribution from the employer.

44.7 	EFFECTIVE DATE. This section is effective January 1, 2014.

44.8 	Sec. 48. Minnesota Statutes 2012, section 62L.02, subdivision 26, is amended to read:
44.9 		Subd. 26.Small employer. (a) "Small employer" means, with respect to a calendar 
44.10 	year and a plan year, a person, firm, corporation, partnership, association, or other entity 
44.11 	actively engaged in business in Minnesota, including a political subdivision of the state, that 
44.12 	employed an average of no fewer than two nor at least one, not including a sole proprietor, 
44.13 	but not more than 50 current employees on business days during the preceding calendar 
44.14 	year and that employs at least two one current employees employee, not including a sole 
44.15 	proprietor, on the first day of the plan year. If an employer has only one eligible employee 
44.16 	who has not waived coverage, the sale of a health plan to or for that eligible employee 
44.17 	is not a sale to a small employer and is not subject to this chapter and may be treated as 
44.18 	the sale of an individual health plan. A small employer plan may be offered through a 
44.19 	domiciled association to self-employed individuals and small employers who are members 
44.20 	of the association, even if the self-employed individual or small employer has fewer than 
44.21 	two current employees. Entities that are treated as a single employer under subsection (b), 
44.22 	(c), (m), or (o) of section 414 of the federal Internal Revenue Code are considered a single 
44.23 	employer for purposes of determining the number of current employees. Small employer 
44.24 	status must be determined on an annual basis as of the renewal date of the health benefit 
44.25 	plan. The provisions of this chapter continue to apply to an employer who no longer meets 
44.26 	the requirements of this definition until the annual renewal date of the employer's health 
44.27 	benefit plan. If an employer was not in existence throughout the preceding calendar year, 
44.28 	the determination of whether the employer is a small employer is based upon the average 
44.29 	number of current employees that it is reasonably expected that the employer will employ 
44.30 	on business days in the current calendar year. For purposes of this definition, the term 
44.31 	employer includes any predecessor of the employer. An employer that has more than 50 
44.32 	current employees but has 50 or fewer employees, as "employee" is defined under United 
44.33 	States Code, title 29, section 1002(6), is a small employer under this subdivision.
44.34 	(b) Where an association, as defined in section 62L.045, comprised of employers 
44.35 	contracts with a health carrier to provide coverage to its members who are small employers, 
45.1 	the association and health benefit plans it provides to small employers, are subject to 
45.2 	section 62L.045, with respect to small employers in the association, even though the 
45.3 	association also provides coverage to its members that do not qualify as small employers.
45.4 	(c) If an employer has employees covered under a trust specified in a collective 
45.5 	bargaining agreement under the federal Labor-Management Relations Act of 1947, 
45.6 	United States Code, title 29, section 141, et seq., as amended, or employees whose health 
45.7 	coverage is determined by a collective bargaining agreement and, as a result of the 
45.8 	collective bargaining agreement, is purchased separately from the health plan provided 
45.9 	to other employees, those employees are excluded in determining whether the employer 
45.10 	qualifies as a small employer. Those employees are considered to be a separate small 
45.11 	employer if they constitute a group that would qualify as a small employer in the absence 
45.12 	of the employees who are not subject to the collective bargaining agreement.

45.13 	EFFECTIVE DATE. This section is effective January 1, 2014.

45.14 	Sec. 49. Minnesota Statutes 2012, section 62L.03, subdivision 1, is amended to read:
45.15 		Subdivision 1.Guaranteed issue and reissue. (a) Every health carrier shall, as a 
45.16 	condition of authority to transact business in this state in the small employer market, 
45.17 	affirmatively market, offer, sell, issue, and renew any of its health benefit plans, on a 
45.18 	guaranteed issue basis, to any small employer, including a small employer covered by 
45.19 	paragraph (b), that meets the participation and contribution requirements of subdivision 3, 
45.20 	as provided in this chapter.
45.21 	(b) A small employer that has its no longer meets the definition of small employer 
45.22 	because of a reduction in workforce reduced to one employee may continue coverage as a 
45.23 	small employer for 12 months from the date the group is reduced to one employee.
45.24 	(c) Notwithstanding paragraph (a), a health carrier may, at the time of coverage 
45.25 	renewal, modify the health coverage for a product offered in the small employer market if 
45.26 	the modification is consistent with state law, approved by the commissioner, and effective 
45.27 	on a uniform basis for all small employers purchasing that product other than through a 
45.28 	qualified association in compliance with section 62L.045, subdivision 2.
45.29 	Paragraph (a) does not apply to a health benefit plan designed for a small employer 
45.30 	to comply with a collective bargaining agreement, provided that the health benefit plan 
45.31 	otherwise complies with this chapter and is not offered to other small employers, except 
45.32 	for other small employers that need it for the same reason. This paragraph applies only 
45.33 	with respect to collective bargaining agreements entered into prior to August 21, 1996, 
45.34 	and only with respect to plan years beginning before the later of July 1, 1997, or the date 
46.1 	upon which the last of the collective bargaining agreements relating to the plan terminates 
46.2 	determined without regard to any extension agreed to after August 21, 1996.
46.3 	(d) Every health carrier participating in the small employer market shall make 
46.4 	available both of the plans described in section 62L.05 to small employers and shall fully 
46.5 	comply with the underwriting and the rate restrictions specified in this chapter for all 
46.6 	health benefit plans issued to small employers.
46.7 	(e) (d) A health carrier may cease to transact business in the small employer market 
46.8 	as provided under section 62L.09.

46.9 	EFFECTIVE DATE. This section is effective January 1, 2014.

46.10 	Sec. 50. Minnesota Statutes 2012, section 62L.03, subdivision 3, is amended to read:
46.11 		Subd. 3.Minimum participation and contribution. (a) A small employer that has 
46.12 	at least 75 percent of its eligible employees who have not waived coverage participating in 
46.13 	a health benefit plan and that contributes at least 50 percent toward the cost of coverage of 
46.14 	each eligible employee must be guaranteed coverage on a guaranteed issue basis from 
46.15 	any health carrier participating in the small employer market. The participation level 
46.16 	of eligible employees must be determined at the initial offering of coverage and at the 
46.17 	renewal date of coverage. A health carrier must not increase the participation requirements 
46.18 	applicable to a small employer at any time after the small employer has been accepted for 
46.19 	coverage. For the purposes of this subdivision, waiver of coverage includes only waivers 
46.20 	due to: (1) coverage under another group health plan; (2) unaffordability as specified by 
46.21 	the Affordable Care Act as defined under section 62A.011, subdivision 1a; (3) coverage 
46.22 	under Medicare Parts A and B; or (3) (4) coverage under medical assistance under chapter 
46.23 	256B or general assistance medical care under chapter 256D.
46.24 	(b) If a small employer does not satisfy the contribution or participation requirements 
46.25 	under this subdivision, a health carrier may voluntarily issue or renew individual health 
46.26 	plans, or a health benefit plan which must fully comply with this chapter. A health carrier 
46.27 	that provides a health benefit plan to a small employer that does not meet the contribution 
46.28 	or participation requirements of this subdivision must maintain this information in its files 
46.29 	for audit by the commissioner. A health carrier may not offer an individual health plan, 
46.30 	purchased through an arrangement between the employer and the health carrier, to any 
46.31 	employee unless the health carrier also offers the individual health plan, on a guaranteed 
46.32 	issue basis, to all other employees of the same employer. An arrangement permitted under 
46.33 	section 62L.12, subdivision 2, paragraph (k), is not an arrangement between the employer 
46.34 	and the health carrier for purposes of this paragraph.
47.1 	(c) Nothing in this section obligates a health carrier to issue coverage to a small 
47.2 	employer that currently offers coverage through a health benefit plan from another health 
47.3 	carrier, unless the new coverage will replace the existing coverage and not serve as one 
47.4 	of two or more health benefit plans offered by the employer. This paragraph does not 
47.5 	apply if the small employer will meet the required participation level with respect to 
47.6 	the new coverage.

47.7 	EFFECTIVE DATE. This section is effective January 1, 2014.

47.8 	Sec. 51. Minnesota Statutes 2012, section 62L.03, subdivision 4, is amended to read:
47.9 		Subd. 4.Underwriting restrictions. (a) Health carriers may apply underwriting 
47.10 	restrictions to coverage for health benefit plans for small employers, including any 
47.11 	preexisting condition limitations, only as expressly permitted under this chapter. For 
47.12 	purposes of this section, "underwriting restrictions" means any refusal of the health carrier 
47.13 	to issue or renew coverage, any premium rate higher than the lowest rate charged by the 
47.14 	health carrier for the same coverage, any preexisting condition limitation, preexisting 
47.15 	condition exclusion, or any exclusionary rider.
47.16 	(b) Health carriers may collect information relating to the case characteristics and 
47.17 	demographic composition of small employers, as well as health status and health history 
47.18 	information about employees, and dependents of employees, of small employers.
47.19 	(c) Except as otherwise authorized for late entrants, preexisting conditions may be 
47.20 	excluded by a health carrier for a period not to exceed 12 months from the enrollment 
47.21 	date of an eligible employee or dependent, but exclusionary riders must not be used. Late 
47.22 	entrants may be subject to a preexisting condition limitation not to exceed 18 months from 
47.23 	the enrollment date of the late entrant, but must not be subject to any exclusionary rider or 
47.24 	preexisting condition exclusion. When calculating any length of preexisting condition 
47.25 	limitation, a health carrier shall credit the time period an eligible employee or dependent 
47.26 	was previously covered by qualifying coverage, provided that the individual maintains 
47.27 	continuous coverage. The credit must be given for all qualifying coverage with respect 
47.28 	to all preexisting conditions, regardless of whether the conditions were preexisting with 
47.29 	respect to any previous qualifying coverage. Section 60A.082, relating to replacement of 
47.30 	group coverage, and the rules adopted under that section apply to this chapter, and this 
47.31 	chapter's requirements are in addition to the requirements of that section and the rules 
47.32 	adopted under it. A health carrier shall, at the time of first issuance or renewal of a health 
47.33 	benefit plan on or after July 1, 1993, credit against any preexisting condition limitation 
47.34 	or exclusion permitted under this section, the time period prior to July 1, 1993, during 
48.1 	which an eligible employee or dependent was covered by qualifying coverage, if the 
48.2 	person has maintained continuous coverage.
48.3 	(d) Health carriers shall not use pregnancy as a preexisting condition under this 
48.4 	chapter.

48.5 	EFFECTIVE DATE. This section is effective January 1, 2014.

48.6 	Sec. 52. Minnesota Statutes 2012, section 62L.03, subdivision 6, is amended to read:
48.7 		Subd. 6.MCHA enrollees. Health carriers shall offer coverage to any eligible 
48.8 	employee or dependent enrolled in MCHA at the time of the health carrier's issuance or 
48.9 	renewal of a health benefit plan to a small employer. The health benefit plan must require 
48.10 	that the employer permit MCHA enrollees to enroll in the small employer's health benefit 
48.11 	plan as of the first date of renewal of a health benefit plan occurring on or after July 
48.12 	1, 1993, and as of each date of renewal after that, or, in the case of a new group, as of 
48.13 	the initial effective date of the health benefit plan and as of each date of renewal after 
48.14 	that. Unless otherwise permitted by this chapter, Health carriers must not impose any 
48.15 	underwriting restrictions, including any preexisting condition limitations or exclusions, on 
48.16 	any eligible employee or dependent previously enrolled in MCHA and transferred to a 
48.17 	health benefit plan so long as continuous coverage is maintained, provided that the health 
48.18 	carrier may impose any unexpired portion of a preexisting condition limitation under the 
48.19 	person's MCHA coverage. An MCHA enrollee is not a late entrant, so long as the enrollee 
48.20 	has maintained continuous coverage.

48.21 	EFFECTIVE DATE. This section is effective January 1, 2014.

48.22 	Sec. 53. Minnesota Statutes 2012, section 62L.045, subdivision 2, is amended to read:
48.23 		Subd. 2.Qualified associations. (a) A qualified association, as defined in this 
48.24 	section, and health coverage offered by it, to it, or through it, to a small employer in 
48.25 	this state must comply with the requirements of this chapter regarding guaranteed issue, 
48.26 	guaranteed renewal, preexisting condition limitations, credit against preexisting condition 
48.27 	limitations for continuous coverage, treatment of MCHA enrollees, and the definition of 
48.28 	dependent, and with section 62A.65, subdivision 5, paragraph (b). They must also comply 
48.29 	with all other requirements of this chapter not specifically exempted in paragraph (b) or (c).
48.30 	(b) A qualified association and a health carrier offering, selling, issuing, or renewing 
48.31 	health coverage to, or to cover, a small employer in this state through the qualified 
48.32 	association, may, but are not, in connection with that health coverage, required to:
48.33 	(1) offer the two small employer plans described in section 62L.05; and
49.1 	(2) offer to small employers that are not members of the association, health coverage 
49.2 	offered to, by, or through the qualified association.
49.3 	(c) A qualified association, and a health carrier offering, selling, issuing, and 
49.4 	renewing health coverage to, or to cover, a small employer in this state must comply 
49.5 	with section 62L.08, except that:
49.6 	(1) a separate index rate may be applied by a health carrier to each qualified 
49.7 	association, provided that:
49.8 	(i) the premium rate applied to participating small employer members of the 
49.9 	qualified association is no more than 25 percent above and no more than 25 percent below 
49.10 	the index rate applied to the qualified association, irrespective of when members applied 
49.11 	for health coverage; and
49.12 	(ii) the index rate applied by a health carrier to a qualified association is no more 
49.13 	than 20 percent above and no more than 20 percent below the index rate applied by the 
49.14 	health carrier to any other qualified association or to any small employer. In comparing 
49.15 	index rates for purposes of this clause, the 20 percent shall be calculated as a percent of 
49.16 	the larger index rate; and
49.17 	(2) a qualified association described in subdivision 1, paragraph (a), clauses (2) 
49.18 	to (4), providing health coverage through a health carrier, or on a self-insured basis in 
49.19 	compliance with section 471.617 and the rules adopted under that section, may cover 
49.20 	small employers and other employers within the same pool and may charge premiums 
49.21 	to small employer members on the same basis as it charges premiums to members that 
49.22 	are not small employers, if the premium rates charged to small employers do not have 
49.23 	greater variation than permitted under section 62L.08. A qualified association operating 
49.24 	under this clause shall annually prove to the commissioner of commerce that it complies 
49.25 	with this clause through a sampling procedure acceptable to the commissioner. If the 
49.26 	qualified association fails to prove compliance to the satisfaction of the commissioner, 
49.27 	the association shall agree to a written plan of correction acceptable to the commissioner. 
49.28 	The qualified association is considered to be in compliance under this clause if there is 
49.29 	a premium rate that would, if used as an index rate, result in all premium rates in the 
49.30 	sample being in compliance with section 62L.08. This clause does not exempt a qualified 
49.31 	association or a health carrier providing coverage through the qualified association from 
49.32 	the loss ratio requirement of section 62L.08, subdivision 11.

49.33 	EFFECTIVE DATE. This section is effective January 1, 2014.

49.34 	Sec. 54. Minnesota Statutes 2012, section 62L.045, subdivision 4, is amended to read:
50.1 		Subd. 4.Principles; association coverage. (a) This subdivision applies to 
50.2 	associations as defined in this section, whether qualified associations or not, and is 
50.3 	intended to clarify subdivisions 1 to 3.
50.4 	(b) This section applies only to associations that provide health coverage to small 
50.5 	employers.
50.6 	(c) A health carrier is not required under this chapter to comply with guaranteed 
50.7 	issue and guaranteed renewal with respect to its relationship with the association itself.
50.8 	 An arrangement between the health carrier and the association, once entered into, must 
50.9 	comply with guaranteed issue and guaranteed renewal with respect to members of the 
50.10 	association that are small employers and persons covered through them.
50.11 	(d) When an arrangement between a health carrier and an association has validly 
50.12 	terminated, the health carrier has no continuing obligation to small employers and persons 
50.13 	covered through them, except as otherwise provided in:
50.14 	(1) section 62A.65, subdivision 5, paragraph (b);
50.15 	(2) any other continuation or conversion rights applicable under state or federal 
50.16 	law; and
50.17 	(3) section 60A.082, relating to group replacement coverage, and rules adopted 
50.18 	under that section.
50.19 	(e) When an association's arrangement with a health carrier has terminated and the 
50.20 	association has entered into a new arrangement with that health carrier or a different 
50.21 	health carrier, the new arrangement is subject to section 60A.082 and rules adopted under 
50.22 	it, with respect to members of the association that are small employers and persons 
50.23 	covered through them.
50.24 	(f) An association that offers its members more than one plan of health coverage 
50.25 	may have uniform rules restricting movement between the plans of health coverage, if the 
50.26 	rules do not discriminate against small employers.
50.27 	(g) This chapter does not require or prohibit separation of an association's members 
50.28 	into one group consisting only of small employers and another group or other groups 
50.29 	consisting of all other members. The association must comply with this section with 
50.30 	respect to the small employer group.
50.31 	(h) For purposes of this section, "member" of an association includes an employer 
50.32 	participant in the association.
50.33 	(i) For purposes of this section, health coverage issued to, or to cover, a small 
50.34 	employer includes a certificate of coverage issued directly to the employer's employees 
50.35 	and dependents, rather than to the small employer.

50.36 	EFFECTIVE DATE. This section is effective January 1, 2014.

51.1 	Sec. 55. Minnesota Statutes 2012, section 62L.05, subdivision 10, is amended to read:
51.2 		Subd. 10.Medical expense reimbursement. Health carriers may reimburse 
51.3 	or pay for medical services, supplies, or articles provided under a small employer plan 
51.4 	in accordance with the health carrier's provider contract requirements including, but 
51.5 	not limited to, salaried arrangements, capitation, the payment of usual and customary 
51.6 	charges, fee schedules, discounts from fee-for-service, per diems, diagnosis-related 
51.7 	groups (DRGs), and other payment arrangements. Nothing in this chapter requires a 
51.8 	health carrier to develop, implement, or change its provider contract requirements for 
51.9 	a small employer plan. Coinsurance, deductibles, and out-of-pocket maximums, and 
51.10 	maximum lifetime benefits must be calculated and determined in accordance with each 
51.11 	health carrier's standard business practices.

51.12 	EFFECTIVE DATE. This section is effective the day following final enactment.

51.13 	Sec. 56. Minnesota Statutes 2012, section 62L.06, is amended to read:
51.14 	62L.06 DISCLOSURE OF UNDERWRITING RATING PRACTICES.
51.15 	When offering or renewing a health benefit plan, health carriers shall disclose in all 
51.16 	solicitation and sales materials:
51.17 	(1) the case characteristics and other rating factors used to determine initial and 
51.18 	renewal rates;
51.19 	(2) the extent to which premium rates for a small employer are established or 
51.20 	adjusted based upon actual or expected variation in claim experience;
51.21 	(3) provisions concerning the health carrier's right to change premium rates and the 
51.22 	factors other than claim experience that affect changes in premium rates;
51.23 	(4) (2) provisions relating to renewability of coverage;
51.24 	(5) the use and effect of any preexisting condition provisions, if permitted;
51.25 	(6) (3) the application of any provider network limitations and their effect on 
51.26 	eligibility for benefits; and
51.27 	(7) (4) the ability of small employers to insure eligible employees and dependents 
51.28 	currently receiving coverage from the Comprehensive Health Association through health 
51.29 	benefit plans.

51.30 	EFFECTIVE DATE. This section is effective January 1, 2014.

51.31 	Sec. 57. Minnesota Statutes 2012, section 62L.08, is amended to read:
51.32 	62L.08 RESTRICTIONS RELATING TO PREMIUM RATES.
52.1 		Subdivision 1.Rate restrictions. Premium rates for all health benefit plans sold or 
52.2 	issued to small employers are subject to the restrictions specified in this section.
52.3 		Subd. 2.General premium variations. Beginning July 1, 1993, each health carrier 
52.4 	must offer premium rates to small employers that are no more than 25 percent above 
52.5 	and no more than 25 percent below the index rate charged to small employers for the 
52.6 	same or similar coverage, adjusted pro rata for rating periods of less than one year. The 
52.7 	premium variations permitted by this subdivision must be based only on health status, 
52.8 	claims experience, industry of the employer, and duration of coverage from the date of 
52.9 	issue. For purposes of this subdivision, health status includes refraining from tobacco use 
52.10 	or other actuarially valid lifestyle factors associated with good health, provided that the 
52.11 	lifestyle factor and its effect upon premium rates have been determined to be actuarially 
52.12 	valid and approved by the commissioner. Variations permitted under this subdivision must 
52.13 	not be based upon age or applied differently at different ages. This subdivision does not 
52.14 	prohibit use of a constant percentage adjustment for factors permitted to be used under 
52.15 	this subdivision.
52.16 		Subd. 2a.Renewal premium increases limited. (a) Beginning January 1, 2003, 
52.17 	the percentage increase in the premium rate charged to a small employer for a new rating 
52.18 	period must not exceed the sum of the following:
52.19 	(1) the percentage change in the index rate measured from the first day of the prior 
52.20 	rating period to the first day of the new rating period;
52.21 	(2) an adjustment, not to exceed 15 percent annually and adjusted pro rata for rating 
52.22 	periods of less than one year, due to the claims experience, health status, or duration of 
52.23 	coverage of the employees or dependents of the employer; and
52.24 	(3) any adjustment due to change in coverage or in the case characteristics of the 
52.25 	employer.
52.26 	(b) This subdivision does not apply if the employer, employee, or any applicant 
52.27 	provides the health carrier with false, incomplete, or misleading information.
52.28 		Subd. 3.Age-based premium variations. Beginning July 1, 1993, each health 
52.29 	carrier may offer premium rates to small employers that vary based upon the ages of 
52.30 	the eligible employees and dependents of the small employer only as provided in this 
52.31 	subdivision. In addition to the variation permitted by subdivision 2, each health carrier 
52.32 	may use an additional premium variation based upon age of up to plus or minus 50 percent 
52.33 	of the index rate. Premium rates may vary based upon the ages of covered persons except 
52.34 	that the rate shall not vary by more than three to one for adults in accordance with the 
52.35 	provisions of the Affordable Care Act as defined in section 62A.011, subdivision 1a.
53.1 		Subd. 4.Geographic premium variations. A health carrier may request approval 
53.2 	by the commissioner to establish separate geographic regions determined by the health 
53.3 	carrier and to establish separate index rates for each such region Premium rates may vary 
53.4 	based on geographic rating areas set by the commissioner. The commissioner shall grant 
53.5 	approval if the following conditions are met:
53.6 	(1) the geographic regions must be applied uniformly by the health carrier;
53.7 	(2) each geographic region must be composed of no fewer than seven counties that 
53.8 	create a contiguous region; and
53.9 	(3) the health carrier provides actuarial justification acceptable to the commissioner 
53.10 	for the proposed geographic variations in index rates, establishing that the variations are 
53.11 	based upon differences in the cost to the health carrier of providing coverage.
53.12 		Subd. 5.Gender-based rates prohibited. Beginning July 1, 1993, no health carrier 
53.13 	may determine premium rates through a method that is in any way based upon the gender 
53.14 	of eligible employees or dependents. Rates must not in any way reflect marital status or 
53.15 	generalized differences in expected costs between employees and spouses.
53.16 		Subd. 6.Rate cells permitted Tobacco rating. Health carriers may use rate cells 
53.17 	and must file with the commissioner the rate cells they use. Rate cells must be based on 
53.18 	the number of adults and children covered under the policy and may reflect the availability 
53.19 	of Medicare coverage. The rates for different rate cells must not in any way reflect marital 
53.20 	status or differences in expected costs between employees and spouses Premium rates may 
53.21 	vary based upon tobacco use, except that the rate shall not vary by more that 1.5 to 1.
53.22 		Subd. 7.Index and premium rate development. (a) In developing its index rates 
53.23 	and premiums, a health carrier may take into account only the following factors:
53.24 	(1) actuarially valid differences in benefit designs of health benefit plans; and
53.25 	(2) actuarially valid differences in the rating factors permitted in subdivisions 2 and 3;
53.26 	(3) (2) actuarially valid geographic variations if approved by the commissioner as 
53.27 	provided in subdivision 4.
53.28 	(b) All premium variations permitted under this section must be based upon 
53.29 	actuarially valid differences in expected cost to the health carrier of providing coverage. 
53.30 	The variation must be justified in initial rate filings and upon request of the commissioner in 
53.31 	rate revision filings. All premium variations are subject to approval by the commissioner.
53.32 		Subd. 8.Filing requirement. A health carrier that offers, sells, issues, or renews a 
53.33 	health benefit plan for small employers shall file with the commissioner the index rates and 
53.34 	must demonstrate that all rates shall be within the rating restrictions defined in this chapter. 
53.35 	Such demonstration must include the allowable range of rates from the index rates and a 
53.36 	description of how the health carrier intends to use demographic factors including case 
54.1 	characteristics in calculating the premium rates. The rates shall not be approved, unless the 
54.2 	commissioner has determined that the rates are reasonable. In determining reasonableness, 
54.3 	the commissioner shall consider the growth rates applied under section 62J.04, subdivision 
54.4 	1, paragraph (b), to the calendar year or years that the proposed premium rate would be in 
54.5 	effect, and actuarially valid changes in risk associated with the enrollee population, and 
54.6 	actuarially valid changes as a result of statutory changes in Laws 1992, chapter 549.
54.7 		Subd. 9.Effect of assessments. Premium rates must comply with the rating 
54.8 	requirements of this section, notwithstanding the imposition of any assessments or 
54.9 	premiums paid by health carriers as provided under sections 62L.13 to 62L.22.
54.10 		Subd. 10.Rating report. Beginning January 1, 1995, and annually thereafter, the 
54.11 	commissioners of health and commerce shall provide a joint report to the legislature 
54.12 	on the effect of the rating restrictions required by this section and the appropriateness 
54.13 	of proceeding with additional rate reform. Each report must include an analysis of the 
54.14 	availability of health care coverage due to the rating reform, the equitable and appropriate 
54.15 	distribution of risk and associated costs, the effect on the self-insurance market, and any 
54.16 	resulting or anticipated change in health plan design and market share and availability of 
54.17 	health carriers.
54.18 		Subd. 11.Loss ratio standards. Notwithstanding section 62A.02, subdivision 3, 
54.19 	relating to loss ratios, each policy or contract form used with respect to a health benefit 
54.20 	plan offered, or issued in the small employer market, is subject, beginning July 1, 1993, 
54.21 	to section 62A.021. The commissioner of health has, with respect to carriers under that 
54.22 	commissioner's jurisdiction, all of the powers of the commissioner of commerce under 
54.23 	that section.

54.24 	EFFECTIVE DATE. This section is effective January 1, 2014.

54.25 	Sec. 58. Minnesota Statutes 2012, section 62L.12, subdivision 2, is amended to read:
54.26 		Subd. 2.Exceptions. (a) A health carrier may sell, issue, or renew individual 
54.27 	conversion policies to eligible employees otherwise eligible for conversion coverage under 
54.28 	section 62D.104 as a result of leaving a health maintenance organization's service area.
54.29 	(b) A health carrier may sell, issue, or renew individual conversion policies to 
54.30 	eligible employees otherwise eligible for conversion coverage as a result of the expiration 
54.31 	of any continuation of group coverage required under sections 62A.146, 62A.17, 62A.21, 
54.32 	62C.142, 62D.101, and 62D.105.
54.33 	(c) A health carrier may sell, issue, or renew conversion policies under section 
54.34 	62E.16 to eligible employees.
55.1 	(d) A health carrier may sell, issue, or renew individual continuation policies to 
55.2 	eligible employees as required.
55.3 	(e) A health carrier may sell, issue, or renew individual health plans if the coverage 
55.4 	is appropriate due to an unexpired preexisting condition limitation or exclusion applicable 
55.5 	to the person under the employer's group health plan or due to the person's need for health 
55.6 	care services not covered under the employer's group health plan.
55.7 	(f) A health carrier may sell, issue, or renew an individual health plan, if the 
55.8 	individual has elected to buy the individual health plan not as part of a general plan to 
55.9 	substitute individual health plans for a group health plan nor as a result of any violation of 
55.10 	subdivision 3 or 4.
55.11 	(g) A health carrier may sell, issue, or renew an individual health plan if coverage 
55.12 	provided by the employer is determined to be unaffordable under the provisions of the 
55.13 	Affordable Care Act as defined in section 62A.011, subdivision 1a.
55.14 	(h) Nothing in this subdivision relieves a health carrier of any obligation to provide 
55.15 	continuation or conversion coverage otherwise required under federal or state law.
55.16 	(h) (i) Nothing in this chapter restricts the offer, sale, issuance, or renewal of 
55.17 	coverage issued as a supplement to Medicare under sections 62A.3099 to 62A.44, or 
55.18 	policies or contracts that supplement Medicare issued by health maintenance organizations, 
55.19 	or those contracts governed by sections 1833, 1851 to 1859, 1860D, or 1876 of the federal 
55.20 	Social Security Act, United States Code, title 42, section 1395 et seq., as amended.
55.21 	(i) (j) Nothing in this chapter restricts the offer, sale, issuance, or renewal of 
55.22 	individual health plans necessary to comply with a court order.
55.23 	(j) (k) A health carrier may offer, issue, sell, or renew an individual health plan to 
55.24 	persons eligible for an employer group health plan, if the individual health plan is a high 
55.25 	deductible health plan for use in connection with an existing health savings account, in 
55.26 	compliance with the Internal Revenue Code, section 223. In that situation, the same or 
55.27 	a different health carrier may offer, issue, sell, or renew a group health plan to cover 
55.28 	the other eligible employees in the group.
55.29 	(k) (l) A health carrier may offer, sell, issue, or renew an individual health plan to 
55.30 	one or more employees of a small employer if the individual health plan is marketed 
55.31 	directly to all employees of the small employer and the small employer does not contribute 
55.32 	directly or indirectly to the premiums or facilitate the administration of the individual 
55.33 	health plan. The requirement to market an individual health plan to all employees does not 
55.34 	require the health carrier to offer or issue an individual health plan to any employee. For 
55.35 	purposes of this paragraph, an employer is not contributing to the premiums or facilitating 
55.36 	the administration of the individual health plan if the employer does not contribute to the 
56.1 	premium and merely collects the premiums from an employee's wages or salary through 
56.2 	payroll deductions and submits payment for the premiums of one or more employees in a 
56.3 	lump sum to the health carrier. Except for coverage under section 62A.65, subdivision 5, 
56.4 	paragraph (b), or 62E.16, at the request of an employee, the health carrier may bill the 
56.5 	employer for the premiums payable by the employee, provided that the employer is not 
56.6 	liable for payment except from payroll deductions for that purpose. If an employer is 
56.7 	submitting payments under this paragraph, the health carrier shall provide a cancellation 
56.8 	notice directly to the primary insured at least ten days prior to termination of coverage for 
56.9 	nonpayment of premium. Individual coverage under this paragraph may be offered only 
56.10 	if the small employer has not provided coverage under section 62L.03 to the employees 
56.11 	within the past 12 months.
56.12 	The employer must provide a written and signed statement to the health carrier that 
56.13 	the employer is not contributing directly or indirectly to the employee's premiums. The 
56.14 	health carrier may rely on the employer's statement and is not required to guarantee-issue 
56.15 	individual health plans to the employer's other current or future employees.

56.16 	EFFECTIVE DATE. This section is effective January 1, 2014.

56.17 	Sec. 59. Minnesota Statutes 2012, section 62M.05, subdivision 3a, is amended to read:
56.18 		Subd. 3a.Standard review determination. (a) Notwithstanding subdivision 3b, an 
56.19 	initial determination on all requests for utilization review must be communicated to the 
56.20 	provider and enrollee in accordance with this subdivision within ten business days of the 
56.21 	request, provided that all information reasonably necessary to make a determination on the 
56.22 	request has been made available to the utilization review organization.
56.23 	(b) When an initial determination is made to certify, notification must be provided 
56.24 	promptly by telephone to the provider. The utilization review organization shall send 
56.25 	written notification to the provider or shall maintain an audit trail of the determination 
56.26 	and telephone notification. For purposes of this subdivision, "audit trail" includes 
56.27 	documentation of the telephone notification, including the date; the name of the person 
56.28 	spoken to; the enrollee; the service, procedure, or admission certified; and the date of 
56.29 	the service, procedure, or admission. If the utilization review organization indicates 
56.30 	certification by use of a number, the number must be called the "certification number." 
56.31 	For purposes of this subdivision, notification may also be made by facsimile to a verified 
56.32 	number or by electronic mail to a secure electronic mailbox. These electronic forms of 
56.33 	notification satisfy the "audit trail" requirement of this paragraph.
56.34 	(c) When an initial determination is made not to certify, notification must be 
56.35 	provided by telephone, by facsimile to a verified number, or by electronic mail to a secure 
57.1 	electronic mailbox within one working day after making the determination to the attending 
57.2 	health care professional and hospital as applicable. Written notification must also be sent 
57.3 	to the hospital as applicable and attending health care professional if notification occurred 
57.4 	by telephone. For purposes of this subdivision, notification may be made by facsimile to a 
57.5 	verified number or by electronic mail to a secure electronic mailbox. Written notification 
57.6 	must be sent to the enrollee and may be sent by United States mail, facsimile to a verified 
57.7 	number, or by electronic mail to a secure mailbox. The written notification must include 
57.8 	the principal reason or reasons for the determination and the process for initiating an appeal 
57.9 	of the determination. Upon request, the utilization review organization shall provide the 
57.10 	provider or enrollee with the criteria used to determine the necessity, appropriateness, 
57.11 	and efficacy of the health care service and identify the database, professional treatment 
57.12 	parameter, or other basis for the criteria. Reasons for a determination not to certify may 
57.13 	include, among other things, the lack of adequate information to certify after a reasonable 
57.14 	attempt has been made to contact the provider or enrollee.
57.15 	(d) When an initial determination is made not to certify, the written notification must 
57.16 	inform the enrollee and the attending health care professional of the right to submit an 
57.17 	appeal to the internal appeal process described in section 62M.06 and the procedure for 
57.18 	initiating the internal appeal. The written notice shall be provided in a culturally and 
57.19 	linguistically appropriate manner consistent with the provisions of the Affordable Care 
57.20 	Act as defined under section 62A.011, subdivision 1a.

57.21 	EFFECTIVE DATE. This section is effective the day following final enactment.

57.22 	Sec. 60. Minnesota Statutes 2012, section 62M.06, subdivision 1, is amended to read:
57.23 		Subdivision 1.Procedures for appeal. A utilization review organization must have 
57.24 	written procedures for appeals of determinations not to certify. The right to appeal must be 
57.25 	available to the enrollee and to the attending health care professional. The enrollee shall be 
57.26 	allowed to review the enrollee's file, present evidence and testimony as part of the appeals 
57.27 	process, and receive continued coverage pending the outcome of the appeals process.

57.28 	EFFECTIVE DATE. This section is effective the day following final enactment.

57.29 	Sec. 61. Minnesota Statutes 2012, section 62Q.01, is amended by adding a subdivision 
57.30 	to read:
57.31 		Subd. 1a.Affordable Care Act. "Affordable Care Act" means the Affordable Care 
57.32 	Act as defined in section 62A.011, subdivision 1a.

57.33 	EFFECTIVE DATE. This section is effective the day following final enactment.

58.1 	Sec. 62. Minnesota Statutes 2012, section 62Q.01, is amended by adding a subdivision 
58.2 	to read:
58.3 		Subd. 1b.Bona fide association. "Bona fide association" means an association that 
58.4 	meets all of the following criteria:
58.5 	(1) serves a single profession that requires a significant amount of education, training 
58.6 	or experience, or a license or certificate from a state authority to practice that profession;
58.7 	(2) has been actively in existence for five years;
58.8 	(3) has a constitution and bylaws or other analogous governing documents;
58.9 	(4) has been formed and maintained in good faith for purposes other than obtaining 
58.10 	insurance;
58.11 	(5) is not owned or controlled by a health plan company or affiliated with a health 
58.12 	plan company;
58.13 	(6) does not condition membership in the association on any health status related 
58.14 	factor;
58.15 	(7) has at least 1,000 members if it is a national association, 500 members if it is a 
58.16 	state association, or 200 members if it is a local association;
58.17 	(8) all members and dependents of members are eligible for coverage regardless of 
58.18 	any health status related factor;
58.19 	(9) does not make health plans offered through the association available other than 
58.20 	in connection with a member of the association;
58.21 	(10) is governed by a board of directors and sponsors annual meeting of its 
58.22 	members; and
58.23 	(11) produces only market association memberships, accepts applications for 
58.24 	membership, or signs up members in the professional association where the subject 
58.25 	individuals are actively engaged in, or directly related to, the profession represented 
58.26 	by the association.

58.27 	EFFECTIVE DATE. This section is effective the day following final enactment.

58.28 	Sec. 63. Minnesota Statutes 2012, section 62Q.01, is amended by adding a subdivision 
58.29 	to read:
58.30 		Subd. 2b.Health care professional. "Health care professional" means a physician 
58.31 	or other health care practitioner licensed, accredited, or certified to perform specified 
58.32 	health care services consistent with state law.

58.33 	EFFECTIVE DATE. This section is effective the day following final enactment.

59.1 	Sec. 64. Minnesota Statutes 2012, section 62Q.01, is amended by adding a subdivision 
59.2 	to read:
59.3 		Subd. 2c.Health care services. "Health care services" means services for the 
59.4 	diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or 
59.5 	disease.

59.6 	EFFECTIVE DATE. This section is effective the day following final enactment.

59.7 	Sec. 65. Minnesota Statutes 2012, section 62Q.01, is amended by adding a subdivision 
59.8 	to read:
59.9 		Subd. 7.Life-threatening condition. "Life-threatening condition" means a disease 
59.10 	or condition from which the likelihood of death is probable unless the course of the 
59.11 	disease or condition is interrupted.

59.12 	EFFECTIVE DATE. This section is effective the day following final enactment.

59.13 	Sec. 66. Minnesota Statutes 2012, section 62Q.01, is amended by adding a subdivision 
59.14 	to read:
59.15 		Subd. 8.Network. "Network" means the group of participating health care 
59.16 	professionals providing services in association with a managed care organization.

59.17 	EFFECTIVE DATE. This section is effective the day following final enactment.

59.18 	Sec. 67. Minnesota Statutes 2012, section 62Q.01, is amended by adding a subdivision 
59.19 	to read:
59.20 		Subd. 9.Participating health care professional. "Participating health care 
59.21 	professional" means a health care professional who, under a contract with the health plan 
59.22 	company or with its contractor or subcontractor, has agreed to provide health care services 
59.23 	to covered persons with an expectation of receiving payment, other than coinsurance, 
59.24 	co-payments, or deductibles, directly or indirectly from the health plan company.

59.25 	EFFECTIVE DATE. This section is effective the day following final enactment.

59.26 	Sec. 68. Minnesota Statutes 2012, section 62Q.01, is amended by adding a subdivision 
59.27 	to read:
59.28 		Subd. 10.Primary care provider. "Primary care provider" means a health care 
59.29 	professional designated by a covered person to supervise, coordinate, or provide initial 
59.30 	care or continuing care to the covered person, and who may be required by the health plan 
60.1 	company to initiate a referral for specialty care and maintain supervision of health care 
60.2 	services rendered to the covered person.

60.3 	EFFECTIVE DATE. This section is effective the day following final enactment.

60.4 	Sec. 69. Minnesota Statutes 2012, section 62Q.01, is amended by adding a subdivision 
60.5 	to read:
60.6 		Subd. 11.Dependent child to the limiting age. For purposes of chapters 43A, 60A, 
60.7 	and 62A to 62U, the term "dependent child to the limiting age" or "dependent children to 
60.8 	the limiting age" means those individuals who are eligible and covered as a dependent 
60.9 	child under the terms of a health plan who have not yet attained 26 years of age. A health 
60.10 	plan must not deny or restrict eligibility for a dependent child to the limiting age based on 
60.11 	financial dependency, residency, marital status, or student status. For coverage under plans 
60.12 	offered by the Minnesota Comprehensive Health Association, dependent to the limiting 
60.13 	age means dependent as defined in section 62A.302, subdivision 3. Notwithstanding the 
60.14 	provisions in this subdivision, a health plan may include:
60.15 	(1) eligibility requirements regarding the absence of other health plan coverage as 
60.16 	permitted by the Affordable Care Act as defined in section 62A.011, subdivision 1a, for 
60.17 	grandfathered plan coverage as defined in section 62A.011, subdivision 1c; or
60.18 	(2) an age greater than 26 in its policy, contract, or certificate of coverage.

60.19 	EFFECTIVE DATE. This section is effective the day following final enactment.

60.20 	Sec. 70. Minnesota Statutes 2012, section 62Q.021, is amended to read:
60.21 	62Q.021 FEDERAL ACT; COMPLIANCE REQUIRED.
60.22 		Subdivision 1.Compliance with 1996 federal law. Each health plan company shall 
60.23 	comply with the federal Health Insurance Portability and Accountability Act of 1996, 
60.24 	including any federal regulations adopted under that act, to the extent that it imposes a 
60.25 	requirement that applies in this state and that is not also required by the laws of this state. 
60.26 	This section does not require compliance with any provision of the federal act prior to 
60.27 	the effective date provided for that provision in the federal act. The commissioner shall 
60.28 	enforce this section subdivision.
60.29 		Subd. 2.Compliance with 2010 federal law. Each health plan company shall 
60.30 	comply with the federal Affordable Care Act as defined in section 62A.011, subdivision 
60.31 	1a, to the extent that it imposes a requirement that applies in this state and that is not also 
60.32 	required by the laws of this state. This section does not require compliance with any 
61.1 	provision of the federal act before the effective date provided for that provision in the 
61.2 	federal act. The commissioner shall enforce this subdivision.

61.3 	EFFECTIVE DATE. This section is effective the day following final enactment.

61.4 	Sec. 71. [62Q.022] ELIGIBILITY FOR COVERAGE REQUIREMENTS.
61.5 	The sponsor of a group health plan shall not take into consideration total hourly or 
61.6 	annual salary of a full-time employee in determining eligibility for coverage in the health 
61.7 	plan or establish eligibility rules that discriminate in favor of higher paid employees.

61.8 	EFFECTIVE DATE. This section is effective the day following final enactment.

61.9 	Sec. 72. Minnesota Statutes 2012, section 62Q.17, subdivision 6, is amended to read:
61.10 		Subd. 6.Employer-based purchasing pools. Employer-based purchasing 
61.11 	pools must, with respect to small employers as defined in section 62L.02, meet all the 
61.12 	requirements of chapter 62L. The experience of the pool must be pooled and the rates 
61.13 	blended across all groups. Pools may decide to create tiers within the pool, based on 
61.14 	experience of group members. These tiers must be designed within the requirements 
61.15 	of section 62L.08. The governing structure may establish criteria limiting movement 
61.16 	between tiers. Tiers must be phased out within two years of the pool's creation.

61.17 	EFFECTIVE DATE. This section is effective January 1, 2014.

61.18 	Sec. 73. Minnesota Statutes 2012, section 62Q.18, is amended by adding a subdivision 
61.19 	to read:
61.20 		Subd. 8.Guaranteed issue. No health plan company shall offer, sell, or issue any 
61.21 	health plan that does not make coverage available on a guaranteed issue basis.

61.22 	EFFECTIVE DATE. This section is effective January 1, 2014.

61.23 	Sec. 74. Minnesota Statutes 2012, section 62Q.19, is amended by adding a subdivision 
61.24 	to read:
61.25 		Subd. 8.Essential community providers. Health plans offered in the individual 
61.26 	and small group market shall comply with section 62K.06 requirements to include a 
61.27 	number and geographic distribution of essential community providers.

61.28 	EFFECTIVE DATE. This section is effective January 1, 2014.

62.1 	Sec. 75. Minnesota Statutes 2012, section 62Q.23, is amended to read:
62.2 	62Q.23 GENERAL SERVICES.
62.3 	(a) Health plan companies shall comply with all continuation and conversion of 
62.4 	coverage requirements applicable to health maintenance organizations under state or 
62.5 	federal law.
62.6 	(b) Health plan companies shall comply with sections 62A.047, 62A.27, and any 
62.7 	other coverage required under chapter 62A of newborn infants, dependent children who 
62.8 	do not reside with a covered person to the limiting age as defined in section 62Q.01, 
62.9 	subdivision 10, disabled children and dependents dependent children, and adopted children. 
62.10 	A health plan company providing dependent coverage shall comply with section 62A.302.
62.11 	(c) Health plan companies shall comply with the equal access requirements of 
62.12 	section 62A.15.

62.13 	EFFECTIVE DATE. This section is effective the day following final enactment.

62.14 	Sec. 76. Minnesota Statutes 2012, section 62Q.43, subdivision 2, is amended to read:
62.15 		Subd. 2.Access requirement. Every closed-panel health plan must allow enrollees 
62.16 	who are full-time students under the age of 25 26 years to change their designated clinic or 
62.17 	physician at least once per month, as long as the clinic or physician is part of the health 
62.18 	plan company's statewide clinic or physician network. A health plan company shall not 
62.19 	charge enrollees who choose this option higher premiums or cost sharing than would 
62.20 	otherwise apply to enrollees who do not choose this option. A health plan company may 
62.21 	require enrollees to provide 15 days' written notice of intent to change their designated 
62.22 	clinic or physician.

62.23 	EFFECTIVE DATE. This section is effective the day following final enactment.

62.24 	Sec. 77. [62Q.46] PREVENTIVE ITEMS AND SERVICES.
62.25 		Subdivision 1.Coverage for preventive items and services. (a) "Preventive items 
62.26 	and services" means:
62.27 	(1) evidence-based items or services that have in effect a rating of A or B in the 
62.28 	recommendations of the United States Preventive Services Task Force as of September 
62.29 	23, 2010, with respect to the individual involved. For purposes of this paragraph, the 
62.30 	United States Preventive Services Task Force recommendations regarding breast cancer 
62.31 	screening, mammography, and prevention issued in or around November 2009 are not 
62.32 	considered to be current;
63.1 	(2) immunizations for routine use in children, adolescents, and adults that have in 
63.2 	effect a recommendation from the Advisory Committee on Immunization Practices of 
63.3 	the Centers for Disease Control and Prevention with respect to the individual involved. 
63.4 	For purposes of this paragraph, a recommendation from the Advisory Committee on 
63.5 	Immunization Practices of the Centers for Disease Control and Prevention is considered in 
63.6 	effect after is has been adopted by the Director of the Centers for Disease Control and 
63.7 	Prevention, and a recommendation is considered to be routine use if it is listed on the 
63.8 	Immunization Schedules of the Centers for Disease Control and Prevention;
63.9 	(3) evidence-informed preventive care and screenings provided for in comprehensive 
63.10 	guidelines supported by the Health Resources and Services Administration for infants, 
63.11 	children, and adolescents; and
63.12 	(4) evidence-informed preventive care and screenings provided for in comprehensive 
63.13 	guidelines supported by the Health Resources and Services Administration for women.
63.14 	(b) A health plan must provide coverage for preventive items and services at a 
63.15 	participating provider without imposing cost-sharing requirements, including a deductible, 
63.16 	coinsurance, or co-payment. Nothing in this section prohibits a health plan company that 
63.17 	has a network of providers from excluding coverage or imposing cost-sharing requirements 
63.18 	for preventive items or services that are delivered by an out-of-network provider.
63.19 	(c) A health plan is not required to provide coverage for any items or services 
63.20 	specified in any recommendation or guideline described in paragraph (a) after the 
63.21 	recommendation or guideline is no longer included as a preventive item or service as 
63.22 	defined in paragraph (a). Annually, a health plan company must determine whether any 
63.23 	additional items or services must be covered without cost-sharing requirements or whether 
63.24 	any items or services are no longer required to be covered.
63.25 	(d) Nothing prevents a health plan company from using reasonable medical 
63.26 	management techniques to determine the frequency, method, treatment, or setting for a 
63.27 	preventive item or service to the extent not specified in the recommendation or guideline.
63.28 	(e) This section does not apply to grandfathered plan coverage, as defined in section 
63.29 	62A.011, subdivision 1c. This section does not apply to plans offered by the Minnesota 
63.30 	Comprehensive Health Association.
63.31 		Subd. 2.Coverage for office visits in conjunction with preventive items and 
63.32 	services. (a) A health plan may impose cost-sharing requirements with respect to an 
63.33 	office visit if a preventive item or service is billed separately or is tracked as individual 
63.34 	encounter data separately from the office visit.
63.35 	(b) A health plan must not impose cost-sharing requirements with respect to an 
63.36 	office visit if a preventive item or service is not billed separately or is not tracked as 
64.1 	individual encounter data separately from the office visit and the primary purpose of the 
64.2 	office visit is the delivery of the preventive item or service.
64.3 	(c) A health plan may impose cost-sharing requirements with respect to an office 
64.4 	visit if a preventive item or service is not billed separately or is not tracked as individual 
64.5 	encounter data separately from the office visit and the primary purpose of the office visit is 
64.6 	not the delivery of the preventive item or service.
64.7 		Subd. 3.Additional services not prohibited. Nothing in these sections prohibits 
64.8 	a health plan company from providing coverage for items and services in addition to 
64.9 	those recommended by the United States Preventive Services Task Force or the Advisory 
64.10 	Committee on Immunization Practices of the Centers for Disease Control and Prevention, 
64.11 	or provided by guidelines supported by the Health Resources and Services Administration, 
64.12 	or from denying coverage for items and services that are not recommended by that task 
64.13 	force or that advisory committee, or under those guidelines. A health plan company may 
64.14 	impose cost-sharing requirements for a treatment not described in subdivision 1 even if 
64.15 	the treatment results from an item or service described in subdivision 1.

64.16 	EFFECTIVE DATE. This section is effective the day following final enactment.

64.17 	Sec. 78. Minnesota Statutes 2012, section 62Q.47, is amended to read:
64.18 	62Q.47 ALCOHOLISM, MENTAL HEALTH, AND CHEMICAL 
64.19 	DEPENDENCY SERVICES.
64.20 	(a) All health plans, as defined in section 62Q.01, that provide coverage for 
64.21 	alcoholism, mental health, or chemical dependency services, must comply with the 
64.22 	requirements of this section.
64.23 	(b) Cost-sharing requirements and benefit or service limitations for outpatient 
64.24 	mental health and outpatient chemical dependency and alcoholism services, except for 
64.25 	persons placed in chemical dependency services under Minnesota Rules, parts 9530.6600 
64.26 	to 9530.6660, must not place a greater financial burden on the insured or enrollee, or be 
64.27 	more restrictive than those requirements and limitations for outpatient medical services.
64.28 	(c) Cost-sharing requirements and benefit or service limitations for inpatient hospital 
64.29 	mental health and inpatient hospital and residential chemical dependency and alcoholism 
64.30 	services, except for persons placed in chemical dependency services under Minnesota 
64.31 	Rules, parts 9530.6600 to 9530.6660, must not place a greater financial burden on the 
64.32 	insured or enrollee, or be more restrictive than those requirements and limitations for 
64.33 	inpatient hospital medical services.
65.1 	(d) All health plans must meet the requirements of the federal Mental Health Parity 
65.2 	Act of 1996, Public Law 104-204, Paul Wellstone and Pete Domenici Mental Health 
65.3 	Parity and Addiction Equity Act of 2008, the Affordable Care Act, and any amendments 
65.4 	thereto, or guidance and regulations issued under those acts.

65.5 	EFFECTIVE DATE. This section is effective the day following final enactment.

65.6 	Sec. 79. Minnesota Statutes 2012, section 62Q.52, is amended to read:
65.7 	62Q.52 DIRECT ACCESS TO OBSTETRIC AND GYNECOLOGIC 
65.8 	SERVICES.
65.9 		Subdivision 1.Direct access. (a) Health plan companies shall allow female 
65.10 	enrollees direct access to obstetricians and gynecologists providers who specialize in 
65.11 	obstetrics and gynecology for the following services:
65.12 	(1) annual preventive health examinations, which shall include a gynecologic 
65.13 	examination, and any subsequent obstetric or gynecologic visits determined to be medically 
65.14 	necessary by the examining obstetrician or gynecologist, based upon the findings of the 
65.15 	examination evaluation and necessary treatment for obstetric conditions or emergencies;
65.16 	(2) maternity care; and
65.17 	(3) evaluation and necessary treatment for acute gynecologic conditions or 
65.18 	emergencies, including annual preventive health examinations.
65.19 	(b) For purposes of this section, "direct access" means that a female enrollee may 
65.20 	obtain the obstetric and gynecologic services specified in paragraph (a) from obstetricians 
65.21 	and gynecologists providers who specialize in obstetrics and gynecology in the enrollee's 
65.22 	network without a referral from, or prior approval through a primary care provider, 
65.23 	another physician, the health plan company, or its representatives.
65.24 	The health plan company shall treat the provision of obstetrical and gynecological 
65.25 	care and the ordering of related obstetrical and gynecological items and services, pursuant 
65.26 	to paragraph (a), by a participating health care professional who specializes in obstetrics 
65.27 	or gynecology as the authorization of a primary care health-care professional.
65.28 	For purposes of this section, a health-care professional who specializes in obstetrics 
65.29 	or gynecology means any individual, including an individual other than a physician, who 
65.30 	is authorized under state law to provide obstetrical or gynecological care.
65.31 	The health plan company may require the health-care professional to agree to 
65.32 	otherwise adhere to the health plan company's policies and procedures, including 
65.33 	procedures for obtaining prior authorization and provide services in accordance with a 
65.34 	treatment plan, if any, approved by the health plan company.
66.1 	(c) Health plan companies shall not require higher co-payments, coinsurance, 
66.2 	deductibles, or other enrollee cost-sharing for direct access.
66.3 	(d) This section applies only to services described in paragraph (a) that are covered 
66.4 	by the enrollee's coverage, but coverage of a preventive health examination for female 
66.5 	enrollees must not exclude coverage of a gynecologic examination.
66.6 	(e) This section does not:
66.7 	(1) waive any exclusions of coverage under the terms and conditions of the health 
66.8 	plan with respect to coverage of obstetrical or gynecological care; or 
66.9 	(2) preclude the health plan company involved from requiring that the participating 
66.10 	health care professional providing obstetrical or gynecological care notify the primary 
66.11 	care health care professional or the health plan company of treatment decisions.
66.12 		Subd. 2.Notice. A health plan company shall provide notice to covered persons 
66.13 	of the provisions of subdivision 1 in accordance with the requirements of the Affordable 
66.14 	Care Act. This commissioner shall enforce this section.

66.15 	EFFECTIVE DATE. This section is effective the day following final enactment.

66.16 	Sec. 80. [62Q.526] COVERAGE FOR PARTICIPATION IN APPROVED 
66.17 	CLINICAL TRIALS.
66.18 		Subdivision 1.Definitions. As used in this section, the following definitions apply:
66.19 	(a) "Approved clinical trial" means phase I, phase II, phase III, or phase IV clinical 
66.20 	trial that is conducted in relation to the prevention, detection, or treatment of cancer or 
66.21 	a life-threatening condition and is not designed exclusively to test toxicity or disease 
66.22 	pathophysiology and must be:
66.23 	(1) conducted under an investigational new drug application reviewed by the United 
66.24 	States Food and Drug Administration (FDA);
66.25 	(2) exempt from obtaining an investigational new drug application; or
66.26 	(3) approved or funded by:
66.27 	(i) the National Institutes of Health (NIH), the Centers for Disease Control and 
66.28 	Prevention; the Agency for Health Care Research and Quality, the Centers for Medicare 
66.29 	and Medicaid Services, or a cooperating group or center of any of the entities described in 
66.30 	this item;
66.31 	(ii) a cooperative group or center of the United States Department of Defense or the 
66.32 	United States Department of Veterans Affairs;
66.33 	(iii) a qualified nongovernmental research entity identified in the guidelines issued 
66.34 	by the NIH for center support grants; or
67.1 	(iv) the United States Departments of Veterans Affairs, Defense, or Energy if the 
67.2 	trial has been reviewed or approved through a system of peer review determined by the 
67.3 	secretary to:
67.4 	(A) be comparable to the system of peer review of studies and investigations used by 
67.5 	the NIH; and
67.6 	(B) provide an unbiased scientific review by qualified individuals who have no 
67.7 	interest in the outcome of the review.
67.8 	(b) "Qualified individual" means an individual with health plan coverage who is 
67.9 	eligible to participate in an approved clinical trial according to the trial protocol for the 
67.10 	treatment of cancer or a life-threatening condition because:
67.11 	(1) the referring health care professional is participating in the trial and has 
67.12 	concluded that the individual's participation in the trial would be appropriate; or
67.13 	(2) the individual provides medical and scientific information establishing that 
67.14 	the individual's participation in the trial is appropriate because the individual meets the 
67.15 	conditions described in the trial protocol.
67.16 	(c)(1) "Routine patient costs" includes all items and services covered by the health 
67.17 	benefit plan of individual market health insurance coverage when the items or services 
67.18 	are typically covered for an enrollee who is not a qualified individual enrolled in an 
67.19 	approved clinical trial.
67.20 	(2) Routine patient costs does not include:
67.21 	(i) an investigational item, device, or service that is part of the trial;
67.22 	(ii) an item or service provided solely to satisfy data collection and analysis needs for 
67.23 	the trial if the item or service is not used in the direct clinical management of the patient;
67.24 	(iii) a service that is clearly inconsistent with widely accepted and established 
67.25 	standards of care for the individual's diagnosis; or
67.26 	(iv) an item or service customarily provided and paid for by the sponsor of a trial.
67.27 		Subd. 2.Prohibited acts. A health plan company that offers a health plan to a 
67.28 	Minnesota resident may not:
67.29 	(1) deny participation by a qualified individual in an approved clinical trial;
67.30 	(2) deny, limit, or impose additional conditions on the coverage of routine patient 
67.31 	costs for items or services furnished in connection with participation in the trial; or
67.32 	(3) discriminate against an individual on the basis of an individual's participation in 
67.33 	an approved clinical trial.
67.34 		Subd. 3.Network plan conditions. A network plan may require a qualified 
67.35 	individual who wishes to participate in an approved clinical trial to participate in a trial that 
68.1 	is offered through a health care provider who is part of the network plan if the provider is 
68.2 	participating in the trial and the provider accepts the individual as a participant in the trial.
68.3 		Subd. 4.Application to clinical trials outside of the state. This section applies 
68.4 	to a qualified individual residing in this state who participates in an approved clinical 
68.5 	trial that is conducted outside of this state.
68.6 		Subd. 5.Construed. (a) This section shall not be construed to require a health plan 
68.7 	company offering health plan coverage through a network plan to provide benefits for 
68.8 	route patient costs if the services are provided outside of the plan's network unless the 
68.9 	out-of-network benefits are otherwise provided under the coverage.
68.10 	(b) This section shall be construed to limit a health plan company's coverage with 
68.11 	respect to clinical trials.

68.12 	EFFECTIVE DATE. This section is effective January 1, 2014.

68.13 	Sec. 81. Minnesota Statutes 2012, section 62Q.55, is amended to read:
68.14 	62Q.55 EMERGENCY SERVICES.
68.15 		Subdivision 1.Access to emergency services. (a) Enrollees have the right to 
68.16 	available and accessible emergency services, 24 hours a day and seven days a week. 
68.17 	The health plan company shall inform its enrollees how to obtain emergency care and, 
68.18 	if prior authorization for emergency services is required, shall make available a toll-free 
68.19 	number, which is answered 24 hours a day, to answer questions about emergency services 
68.20 	and to receive reports and provide authorizations, where appropriate, for treatment of 
68.21 	emergency medical conditions. Emergency services shall be covered whether provided by 
68.22 	participating or nonparticipating providers and whether provided within or outside the 
68.23 	health plan company's service area. In reviewing a denial for coverage of emergency 
68.24 	services, the health plan company shall take the following factors into consideration:
68.25 	(1) a reasonable layperson's belief that the circumstances required immediate medical 
68.26 	care that could not wait until the next working day or next available clinic appointment;
68.27 	(2) the time of day and day of the week the care was provided;
68.28 	(3) the presenting symptoms, including, but not limited to, severe pain, to ensure 
68.29 	that the decision to reimburse the emergency care is not made solely on the basis of the 
68.30 	actual diagnosis;
68.31 	(4) the enrollee's efforts to follow the health plan company's established procedures 
68.32 	for obtaining emergency care; and
68.33 	(5) any circumstances that precluded use of the health plan company's established 
68.34 	procedures for obtaining emergency care.
69.1 	(b) The health plan company may require enrollees to notify the health plan 
69.2 	company of nonreferred emergency care as soon as possible, but not later than 48 hours, 
69.3 	after the emergency care is initially provided. However, emergency care which would 
69.4 	have been covered under the contract had notice been provided within the set time frame 
69.5 	must be covered.
69.6 	(c) Notwithstanding paragraphs (a) and (b), a health plan company, health insurer, or 
69.7 	health coverage plan that is in compliance with the rules regarding accessibility of services 
69.8 	adopted under section 62D.20 is in compliance with this section.
69.9 		Subd. 2.Emergency medical condition. As used in this section, "emergency 
69.10 	medical condition" means a medical condition manifesting itself by acute symptoms of 
69.11 	sufficient severity, including severe pain, such that a prudent layperson, who possesses 
69.12 	an average knowledge of health and medicine, could reasonably expect the absence of 
69.13 	immediate medical attention to result in a condition described in clause (i), (ii), or (iii), of 
69.14 	section 1867(e)(1)(A) of the Social Security Act.
69.15 		Subd. 3.Emergency services. As used in this section, "emergency services" means, 
69.16 	with respect to an emergency medical condition:
69.17 	(1) a medical screening examination, as required under section 1867 of the Social 
69.18 	Security Act, that is within the capability of the emergency department of a hospital, 
69.19 	including ancillary services routinely available to the emergency department to evaluate 
69.20 	such emergency medical condition; and
69.21 	(2) within the capabilities of the staff and facilities available at the hospital, such 
69.22 	further medical examination and treatment as are required under section 1867 of the 
69.23 	act to stabilize the patient.
69.24 		Subd. 4.Stabilize. As used in this section, "stabilize" means, with respect to 
69.25 	an emergency medical condition in subdivision 3, has the meaning given in section 
69.26 	1867(e)(3) of the Social Security Act, United States Code, title 42, section 1395dd(e)(3). 
69.27 		Subd. 5.Coverage restrictions or limitations. If emergency services are provided 
69.28 	by a nonparticipating provider, with or without prior authorization, the health plan 
69.29 	company shall not impose coverage restrictions or limitations that are more restrictive 
69.30 	than apply to emergency services received from a participating provider. Cost-sharing 
69.31 	requirements that apply to emergency services received out-of-network must be the same 
69.32 	as the cost-sharing requirements that apply to services received in-network.

69.33 	EFFECTIVE DATE. This section is effective the day following final enactment.

69.34 	Sec. 82. [62Q.57] DESIGNATION OF PRIMARY CARE PROVIDER.
70.1 		Subdivision 1.Choice of primary care provider. If a health plan company offering 
70.2 	a group health plan as defined in section 62A.011, subdivision 1d, or an individual health 
70.3 	plan as defined in section 62A.011, subdivision 4, that is not a grandfathered plan coverage 
70.4 	as defined in section 62A.011, subdivision 1c, requires or provides for the designation 
70.5 	by a covered person of a participating primary health care professional, the health plan 
70.6 	company shall permit each covered person to:
70.7 	(i) designate any participating primary care health-care professional who is available 
70.8 	to accept the covered person; and
70.9 	(ii) for a child, designate any participating physician who specializes in pediatrics as 
70.10 	the child's primary care health-care professional and is available to accept the child.
70.11 	This section does not waive any exclusions of coverage under the terms and 
70.12 	conditions of the health plan with respect to coverage of pediatric care.
70.13 		Subd. 2.Notice. A health plan company shall provide notice to covered persons 
70.14 	of the provisions of subdivision 1 in accordance with the requirements of the Affordable 
70.15 	Care Act. The commissioner shall enforce this section.

70.16 	EFFECTIVE DATE. This section is effective the day following final enactment.

70.17 	Sec. 83. [62Q.646] REQUIRED ADDITIONAL INFORMATION.
70.18 	All individual and group health plans must submit the following information to 
70.19 	the commissioner of commerce:
70.20 	(1) claims payment policies and practices;
70.21 	(2) periodic financial disclosures;
70.22 	(3) data on enrollment;
70.23 	(4) data on disenrollment;
70.24 	(5) data on the number of claims that are denied;
70.25 	(6) data on rating practices;
70.26 	(7) information on cost sharing and payments with respect to out-of-network 
70.27 	coverage; and
70.28 	(8) other information required by the secretary of the Department of Health and 
70.29 	Human Services under the Affordable Care Act.

70.30 	EFFECTIVE DATE. This section is effective January 1, 2014.

70.31 	Sec. 84. [62Q.677] LIFETIME AND ANNUAL LIMITS.
71.1 		Subdivision 1.Applicability and scope. Except as provided in subdivision 2, 
71.2 	these sections apply to a health plan company providing coverage under an individual or 
71.3 	group health plan.
71.4 		Subd. 2.Grandfathered plan coverage limits. (a) The prohibition on lifetime 
71.5 	limits applies to grandfathered plan coverage providing individual health insurance 
71.6 	coverage or group health insurance coverage as defined in section 62A.011, subdivision 1c.
71.7 	(b) The prohibition and limits on annual limits applies to grandfathered plan 
71.8 	coverage providing group health insurance coverage, but it does not apply to grandfathered 
71.9 	plan coverage providing individual health insurance coverage.
71.10 		Subd. 3.Prohibition on lifetime and annual limits. Except as provided in 
71.11 	subdivisions 4 and 5, a health plan company offering group or individual health insurance 
71.12 	coverage shall not establish a lifetime limit on the dollar amount of essential health 
71.13 	benefits for any individual.
71.14 	Except as provided in subdivisions 4, 5, and 6, a health plan company shall not 
71.15 	establish any annual limit on the dollar amount of essential health benefits for any 
71.16 	individual.
71.17 		Subd. 4.Nonessential benefits. Subdivision 3 does not prevent a health plan 
71.18 	company from placing annual or lifetime dollar limits for any individual on specific 
71.19 	covered benefits that are not essential health benefits as defined in section 62E.02 to the 
71.20 	extent that the limits are otherwise permitted under applicable federal or state law.
71.21 		Subd. 5.Excluded benefits. This section does not prohibit a health plan company 
71.22 	from excluding all benefits for a given condition.
71.23 		Subd. 6.Annual limits prior to January 1, 2014. For plan or policy years 
71.24 	beginning before January 1, 2014, for any individual, a health plan may establish an 
71.25 	annual limit on the dollar amount of benefits that are essential health benefits provided the 
71.26 	limit is no less than the following:
71.27 	(1) for a plan or policy year beginning after September 22, 2010, but before 
71.28 	September 23, 2011, $750,000;
71.29 	(2) for a plan or policy year beginning after September 22, 2011, but before 
71.30 	September 23, 2012, $1,250,000; and
71.31 	(3) for a plan or policy year beginning after September 22, 2012, but before January 
71.32 	1, 2014, $2,000,000.
71.33 	In determining whether an individual has received benefits that meet or exceed the 
71.34 	allowable limits, a health carrier shall take into account only essential health benefits.
71.35 		Subd. 7.Waivers. For plan or policy years beginning before January 1, 2014, a 
71.36 	health plan is exempt from the annual limit requirements if the plan is approved for a 
72.1 	waiver from the requirements by the United States Department of Health and Human 
72.2 	Services, but the exemption only applies for the specified period of time that the waiver 
72.3 	from the United States Department of Health and Human Services is applicable.
72.4 		Subd. 8.Notices. (a) At the time a health plan receives a waiver from the 
72.5 	United States Department of Health and Human Services, the health plan shall notify 
72.6 	prospective applicants and affected policyholders and the commissioner in each state 
72.7 	where prospective applicants and any affected insured are known to reside.
72.8 	(b) At the time the waiver expires or is otherwise no longer in effect, the health plan 
72.9 	shall notify affected policyholders and the commissioner in each state where any affected 
72.10 	insured is known to reside.
72.11 		Subd. 9.Reinstatement. A health plan company shall comply with all provisions of 
72.12 	the Affordable Care Act in regards to reinstatement of coverage for individuals whose 
72.13 	coverage or benefits under a health plan ended by reason of reaching a lifetime dollar 
72.14 	limit on the dollar value of all benefits for the individual. This section does not require 
72.15 	compliance with any provision of the federal act before the effective date provided for that 
72.16 	provision in the Affordable Care Act. The commissioner shall enforce this section.

72.17 	EFFECTIVE DATE. This section is effective the day following final enactment.

72.18 	Sec. 85. Minnesota Statutes 2012, section 62Q.68, subdivision 1, is amended to read:
72.19 		Subdivision 1.Application. For purposes of sections 62Q.68 to 62Q.72, the terms 
72.20 	defined in this section have the meanings given them. For purposes of sections 62Q.69
72.21 	and 62Q.70, the term "health plan company" does not include an insurance company 
72.22 	licensed under chapter 60A to offer, sell, or issue a policy of accident and sickness 
72.23 	insurance as defined in section 62A.01 or a nonprofit health service plan corporation 
72.24 	regulated under chapter 62C that only provides dental coverage or vision coverage. For 
72.25 	purposes of sections 62Q.69 through 62Q.73, the term "health plan company" does 
72.26 	not include the Comprehensive Health Association created under chapter 62E. Section 
72.27 	62Q.70 does not apply to individual coverage. However, a health plan company offering 
72.28 	individual coverage that is grandfathered plan coverage as defined in section 62A.011, 
72.29 	subdivision 1c, may, pursuant to section 62Q.69, subdivision 3, paragraph (c), follow the 
72.30 	process outlined in section 62Q.70.

72.31 	EFFECTIVE DATE. This section is effective the day following final enactment.

72.32 	Sec. 86. Minnesota Statutes 2012, section 62Q.69, subdivision 3, is amended to read:
73.1 		Subd. 3.Notification of complaint decisions. (a) The health plan company must 
73.2 	notify the complainant in writing of its decision and the reasons for it as soon as practical 
73.3 	but in no case later than 30 days after receipt of a written complaint. If the health plan 
73.4 	company cannot make a decision within 30 days due to circumstances outside the control 
73.5 	of the health plan company, the health plan company may take up to 14 additional days to 
73.6 	notify the complainant of its decision. If the health plan company takes any additional 
73.7 	days beyond the initial 30-day period to make its decision, it must inform the complainant, 
73.8 	in advance, of the extension and the reasons for the extension.
73.9 	(b) For group coverage, if the decision is partially or wholly adverse to the 
73.10 	complainant, the notification must inform the complainant of the right to appeal the 
73.11 	decision to the health plan company's internal appeal process described in section 62Q.70
73.12 	and the procedure for initiating an appeal.
73.13 	(c) For individual coverage, if the decision is partially or wholly adverse to the 
73.14 	complainant, the notification must inform the complainant of the right to submit the 
73.15 	complaint decision to the external review process described in section 62Q.73 and the 
73.16 	procedure for initiating the external process. Notwithstanding the provisions in this 
73.17 	subdivision, a health plan company offering individual coverage that is grandfathered plan 
73.18 	coverage as defined in section 62A.011, subdivision 1c, may instead follow the process for 
73.19 	group coverage outlined in paragraph (b).
73.20 	(c) (d) The notification must also inform the complainant of the right to submit the 
73.21 	complaint at any time to either the commissioner of health or commerce for investigation 
73.22 	and the toll-free telephone number of the appropriate commissioner.

73.23 	EFFECTIVE DATE. This section is effective the day following final enactment.

73.24 	Sec. 87. Minnesota Statutes 2012, section 62Q.70, subdivision 1, is amended to read:
73.25 		Subdivision 1.Establishment. (a) Each health plan company shall establish an 
73.26 	internal appeal process for reviewing a health plan company's decision regarding a 
73.27 	complaint filed in accordance with section 62Q.69. The appeal process must meet the 
73.28 	requirements of this section. This section applies only to group coverage. However, a 
73.29 	health plan company offering individual coverage that is grandfathered plan coverage as 
73.30 	defined in section 62A.011, subdivision 1c, may, pursuant to section 62Q.69, subdivision 
73.31 	3, paragraph (c), follow the process outlined in this section.
73.32 	(b) The person or persons with authority to resolve or recommend the resolution of 
73.33 	the internal appeal must not be solely the same person or persons who made the complaint 
73.34 	decision under section 62Q.69.
74.1 	(c) The internal appeal process must permit the enrollee to review the enrollee's file 
74.2 	and the receipt of testimony, correspondence, explanations, or other information from 
74.3 	the complainant, staff persons, administrators, providers, or other persons as deemed 
74.4 	necessary by the person or persons investigating or presiding over the appeal.
74.5 	(d) The enrollee must be allowed to receive continued coverage pending the 
74.6 	outcome of the appeals process.

74.7 	EFFECTIVE DATE. This section is effective the day following final enactment.

74.8 	Sec. 88. Minnesota Statutes 2012, section 62Q.70, subdivision 2, is amended to read:
74.9 		Subd. 2.Procedures for filing an appeal. The health plan company must provide 
74.10 	notice to enrollees of its internal appeals process, in a culturally and linguistically 
74.11 	appropriate manner consistent with the provisions of the Affordable Care Act. If a 
74.12 	complainant notifies the health plan company of the complainant's desire to appeal the 
74.13 	health plan company's decision regarding the complaint through the internal appeal 
74.14 	process, the health plan company must provide the complainant the option for the appeal 
74.15 	to occur either in writing or by hearing.

74.16 	EFFECTIVE DATE. This section is effective the day following final enactment.

74.17 	Sec. 89. Minnesota Statutes 2012, section 62Q.71, is amended to read:
74.18 	62Q.71 NOTICE TO ENROLLEES.
74.19 	Each health plan company shall provide to enrollees a clear and concise description 
74.20 	of its complaint resolution procedure, if applicable under section 62Q.68, subdivision 1, 
74.21 	and the procedure used for utilization review as defined under chapter 62M as part of 
74.22 	the member handbook, subscriber contract, or certificate of coverage. If the health plan 
74.23 	company does not issue a member handbook, the health plan company may provide 
74.24 	the description in another written document. The description must specifically inform 
74.25 	enrollees:
74.26 	(1) how to submit a complaint to the health plan company;
74.27 	(2) if the health plan includes utilization review requirements, how to notify the 
74.28 	utilization review organization in a timely manner and how to obtain certification for 
74.29 	health care services;
74.30 	(3) how to request an appeal either through the procedures described in sections 
74.31 	62Q.69 and section62Q.70if applicable, or through the procedures described in chapter 
74.32 	62M;
75.1 	(4) of the right to file a complaint with either the commissioner of health or 
75.2 	commerce at any time during the complaint and appeal process;
75.3 	(5) of the toll-free telephone number of the appropriate commissioner; and
75.4 	(6) of the right, for individual and group coverage, to obtain an external review 
75.5 	under section 62Q.73 and a description of when and how that right may be exercised., 
75.6 	including that under most circumstances an enrollee must exhaust the internal complaint 
75.7 	or appeal process prior to external review. However, an enrollee may proceed to external 
75.8 	review without exhausting the internal complaint or appeal process under the following 
75.9 	circumstances:
75.10 	(i) the health plan company waives the exhaustion requirement;
75.11 	(ii) the health plan company is considered to have waived the exhaustion requirement 
75.12 	by failing to substantially comply with any requirements including, but not limited to, 
75.13 	time limits for internal complaints or appeals; or
75.14 	(iii) the enrollee has applied for an expedited external review at the same time the 
75.15 	enrollee qualifies for and has applied for an expedited internal review under chapter 62M.

75.16 	EFFECTIVE DATE. This section is effective the day following final enactment.

75.17 	Sec. 90. Minnesota Statutes 2012, section 62Q.73, is amended to read:
75.18 	62Q.73 EXTERNAL REVIEW OF ADVERSE DETERMINATIONS.
75.19 		Subdivision 1.Definition. For purposes of this section, "adverse determination" 
75.20 	means:
75.21 	(1) for individual coverage, a complaint decision relating to a health care service or 
75.22 	claim that is partially or wholly adverse to the complainant;
75.23 	(2) individual coverage offered by a health plan that is grandfathered plan coverage 
75.24 	as defined in section 62A.011, subdivision 1c, may instead apply the definition of adverse 
75.25 	determination for group coverage in clause (3);
75.26 	(3) for group coverage, a complaint decision relating to a health care service or 
75.27 	claim that has been appealed in accordance with section 62Q.70 and the appeal decision is 
75.28 	partially or wholly adverse to the complainant;
75.29 	(2) (4) any initial determination not to certify that has been appealed in accordance 
75.30 	with section 62M.06 and the appeal did not reverse the initial determination not to certify; or
75.31 	(3) (5) a decision relating to a health care service made by a health plan company 
75.32 	licensed under chapter 60A that denies the service on the basis that the service was not 
75.33 	medically necessary.; or
75.34 	(6) the enrollee has met the requirements of subdivision 6, paragraph (e).
76.1 	An adverse determination does not include complaints relating to fraudulent marketing 
76.2 	practices or agent misrepresentation.
76.3 		Subd. 2.Exception. (a) This section does not apply to governmental programs 
76.4 	except as permitted under paragraph (b). For purposes of this subdivision, "governmental 
76.5 	programs" means the prepaid medical assistance program, the MinnesotaCare program, 
76.6 	the prepaid general assistance medical care program, the demonstration project for people 
76.7 	with disabilities, and the federal Medicare program.
76.8 	(b) In the course of a recipient's appeal of a medical determination to the 
76.9 	commissioner of human services under section 256.045, the recipient may request an 
76.10 	expert medical opinion be arranged by the external review entity under contract to provide 
76.11 	independent external reviews under this section. If such a request is made, the cost of the 
76.12 	review shall be paid by the commissioner of human services. Any medical opinion obtained 
76.13 	under this paragraph shall only be used by a state human services referee as evidence in 
76.14 	the recipient's appeal to the commissioner of human services under section 256.045.
76.15 	(c) Nothing in this subdivision shall be construed to limit or restrict the appeal rights 
76.16 	provided in section 256.045 for governmental program recipients.
76.17 		Subd. 3.Right to external review. (a) Any enrollee or anyone acting on behalf 
76.18 	of an enrollee who has received an adverse determination may submit a written request 
76.19 	for an external review of the adverse determination, if applicable under section 62Q.68, 
76.20 	subdivision 1, or 62M.06, to the commissioner of health if the request involves a health 
76.21 	plan company regulated by that commissioner or to the commissioner of commerce if the 
76.22 	request involves a health plan company regulated by that commissioner. Notification of 
76.23 	the enrollee's right to external review must accompany the denial issued by the insurer. 
76.24 	The written request must be accompanied by a filing fee of $25. The fee may be waived 
76.25 	by the commissioner of health or commerce in cases of financial hardship and must be 
76.26 	refunded if the adverse determination is completely reversed. No enrollee may be subject 
76.27 	to filing fees totaling more than $75 during a plan year for group coverage or policy year 
76.28 	for individual coverage.
76.29 	(b) Nothing in this section requires the commissioner of health or commerce to 
76.30 	independently investigate an adverse determination referred for independent external 
76.31 	review.
76.32 	(c) If an enrollee requests an external review, the health plan company must 
76.33 	participate in the external review. The cost of the external review in excess of the filing 
76.34 	fee described in paragraph (a) shall be borne by the health plan company.
76.35 	(d) The enrollee must request external review within six months from the date of 
76.36 	the adverse determination.
77.1 		Subd. 4.Contract. Pursuant to a request for proposal, the commissioner of 
77.2 	administration, in consultation with the commissioners of health and commerce, shall 
77.3 	contract with an organization at least three organizations or business entity entities to 
77.4 	provide independent external reviews of all adverse determinations submitted for external 
77.5 	review. The contract shall ensure that the fees for services rendered in connection with the 
77.6 	reviews be are reasonable.
77.7 		Subd. 5.Criteria. (a) The request for proposal must require that the entity 
77.8 	demonstrate:
77.9 	(1) no conflicts of interest in that it is not owned, a subsidiary of, or affiliated 
77.10 	with a health plan company or, utilization review organization, or a trade organization 
77.11 	of health care providers;
77.12 	(2) an expertise in dispute resolution;
77.13 	(3) an expertise in health-related law;
77.14 	(4) an ability to conduct reviews using a variety of alternative dispute resolution 
77.15 	procedures depending upon the nature of the dispute;
77.16 	(5) an ability to maintain written records, for at least three years, regarding reviews 
77.17 	conducted and provide data to the commissioners of health and commerce upon request on 
77.18 	reviews conducted; and
77.19 	(6) an ability to ensure confidentiality of medical records and other enrollee 
77.20 	information.;
77.21 	(7) accreditation by nationally recognized private accrediting organization; and
77.22 	(8) the ability to provide an expedited external review process.
77.23 	(b) The commissioner of administration shall take into consideration, in awarding 
77.24 	the contract according to subdivision 4, any national accreditation standards that pertain to 
77.25 	an external review entity.
77.26 		Subd. 6.Process. (a) Upon receiving a request for an external review, the
77.27 	 commissioner shall assign an external review entity on a random basis. The assigned
77.28 	 external review entity must provide immediate notice of the review to the enrollee and to 
77.29 	the health plan company. Within ten business days of receiving notice of the review, the 
77.30 	health plan company and the enrollee must provide the assigned external review entity 
77.31 	with any information that they wish to be considered. Each party shall be provided an 
77.32 	opportunity to present its version of the facts and arguments. The assigned external review 
77.33 	entity must furnish to the health plan company any additional information submitted by 
77.34 	the enrollee within one business day of receipt. An enrollee may be assisted or represented 
77.35 	by a person of the enrollee's choice.
78.1 	(b) As part of the external review process, any aspect of an external review involving 
78.2 	a medical determination must be performed by a health care professional with expertise in 
78.3 	the medical issue being reviewed.
78.4 	(c) An external review shall be made as soon as practical but in no case later than 40
78.5 	 45 days after receiving the request for an external review and must promptly send written 
78.6 	notice of the decision and the reasons for it to the enrollee, the health plan company, and 
78.7 	the commissioner who is responsible for regulating the health plan company.
78.8 	(d) The external review entity and the clinical reviewer assigned must not have a 
78.9 	material professional, familial, or financial conflict of interest with:
78.10 	(1) the health plan company that is the subject of the external review;
78.11 	(2) the enrollee, or any parties related to the enrollee, whose treatment is the subject 
78.12 	of the external review;
78.13 	(3) any officer, director, or management employee of the health plan company;
78.14 	(4) a plan administrator, plan fiduciaries, or plan employees;
78.15 	(5) the health care provider, the health care provider's group, or practice association 
78.16 	recommending treatment that is the subject of the external review;
78.17 	(6) the facility at which the recommended treatment would be provided; or
78.18 	(7) the developer or manufacturer of the principle drug, device, procedure, or other 
78.19 	therapy being recommended.
78.20 	(e)(1) An expedited external review must be provided if the enrollee requests it 
78.21 	after receiving:
78.22 	(i) an adverse determination that involves a medical condition for which the time 
78.23 	frame for completion of an expedited internal appeal would seriously jeopardize the life 
78.24 	or health of the enrollee or would jeopardize the enrollee's ability to regain maximum 
78.25 	function and the enrollee has simultaneously requested an expedited internal appeal;
78.26 	(ii) an adverse determination that concerns an admission, availability of care, 
78.27 	continued stay, or health care service for which the enrollee received emergency services 
78.28 	but has not been discharged from a facility; or
78.29 	(iii) an adverse determination that involves a medical condition for which the 
78.30 	standard external review time would seriously jeopardize the life or health of the enrollee 
78.31 	or jeopardize the enrollee's ability to regain maximum function.
78.32 	(2) The external review entity must make its expedited determination to uphold or 
78.33 	reverse the adverse determination as expeditiously as possible but within no more than 72 
78.34 	hours after the receipt of the request for expedited review and notify the enrollee and the 
78.35 	health plan company of the determination.
79.1 	(3) If the external review entity's notification is not in writing, the external review 
79.2 	entity must provide written confirmation of the determination within 48 hours of the 
79.3 	notification.
79.4 		Subd. 7.Standards of review. (a) For an external review of any issue in an adverse 
79.5 	determination that does not require a medical necessity determination, the external review 
79.6 	must be based on whether the adverse determination was in compliance with the enrollee's 
79.7 	health benefit plan.
79.8 	(b) For an external review of any issue in an adverse determination by a health plan 
79.9 	company licensed under chapter 62D that requires a medical necessity determination, the 
79.10 	external review must determine whether the adverse determination was consistent with the 
79.11 	definition of medically necessary care in Minnesota Rules, part 4685.0100, subpart 9b.
79.12 	(c) For an external review of any issue in an adverse determination by a health plan 
79.13 	company, other than a health plan company licensed under chapter 62D, that requires a 
79.14 	medical necessity determination, the external review must determine whether the adverse 
79.15 	determination was consistent with the definition of medically necessary care in section 
79.16 	62Q.53, subdivision 2.
79.17 	(d) For an external review of an adverse determination involving experimental 
79.18 	or investigational treatment, the external review entity must base its decision on all 
79.19 	documents submitted by the health plan company and enrollee, including medical 
79.20 	records the attending physician or health care professional's recommendation, consulting 
79.21 	reports from health care professionals, the terms of coverage, federal Food and Drug 
79.22 	Administration approval, and medical or scientific evidence or evidence-based standards.
79.23 		Subd. 8.Effects of external review. A decision rendered under this section shall 
79.24 	be nonbinding on the enrollee and binding on the health plan company. The health plan 
79.25 	company may seek judicial review of the decision on the grounds that the decision was 
79.26 	arbitrary and capricious or involved an abuse of discretion.
79.27 		Subd. 9.Immunity from civil liability. A person who participates in an external 
79.28 	review by investigating, reviewing materials, providing technical expertise, or rendering a 
79.29 	decision shall not be civilly liable for any action that is taken in good faith, that is within 
79.30 	the scope of the person's duties, and that does not constitute willful or reckless misconduct.
79.31 		Subd. 10.Data reporting. The commissioners shall make available to the public, 
79.32 	upon request, summary data on the decisions rendered under this section, including the 
79.33 	number of reviews heard and decided and the final outcomes. Any data released to the 
79.34 	public must not individually identify the enrollee initiating the request for external review.

79.35 	EFFECTIVE DATE. This section is effective the day following final enactment.

80.1 	Sec. 91. Minnesota Statutes 2012, section 62Q.75, subdivision 1, is amended to read:
80.2 		Subdivision 1.Definitions. (a) For purposes of this section, the following terms 
80.3 	have the meanings given to them.
80.4 	(b) "Clean claim" means a claim that has no defect or impropriety, including any lack 
80.5 	of any required substantiating documentation, including, but not limited to, coordination 
80.6 	of benefits information, or particular circumstance requiring special treatment that 
80.7 	prevents timely payment from being made on a claim under this section. A special 
80.8 	circumstance may include, but is not limited to, a claim held pending payment of an 
80.9 	overdue premium for the time period during which the expense was incurred as allowed 
80.10 	by the Affordable Care Act. Nothing in this section alters an enrollee's obligation to 
80.11 	disclose information as required by law.
80.12 	(c) "Third-party administrator" means a third-party administrator or other entity 
80.13 	subject to section 60A.23, subdivision 8, and Minnesota Rules, chapter 2767.

80.14 	EFFECTIVE DATE. This section is effective January 1, 2014.

80.15 	Sec. 92. Minnesota Statutes 2012, section 62Q.80, subdivision 2, is amended to read:
80.16 		Subd. 2.Definitions.  For purposes of this section, the following definitions apply:
80.17 	(a) "Community-based" means located in or primarily relating to the community, 
80.18 	as determined by the board of a community-based health initiative that is served by the 
80.19 	community-based health care coverage program.
80.20 	(b) "Community-based health care coverage program" or "program" means a 
80.21 	program administered by a community-based health initiative that provides health care 
80.22 	services through provider members of a community-based health network or combination 
80.23 	of networks to eligible individuals and their dependents who are enrolled in the program.
80.24 	(c) "Community-based health initiative" or "initiative" means a nonprofit corporation 
80.25 	that is governed by a board that has at least 80 percent of its members residing in the 
80.26 	community and includes representatives of the participating network providers and 
80.27 	employers, or a county-based purchasing organization as defined in section 256B.692.
80.28 	(d) "Community-based health network" means a contract-based network of health 
80.29 	care providers organized by the community-based health initiative to provide or support 
80.30 	the delivery of health care services to enrollees of the community-based health care 
80.31 	coverage program on a risk-sharing or nonrisk-sharing basis.
80.32 	(e) "Dependent" means an eligible employee's spouse or unmarried child who 
80.33 	is under the age of 19 26 years.

80.34 	EFFECTIVE DATE. This section is effective the day following final enactment.

81.1 	Sec. 93. [62Q.81] COMPREHENSIVE HEALTH INSURANCE COVERAGE 
81.2 	REQUIREMENTS.
81.3 		Subdivision 1.Essential health benefits. All health plans shall include the essential 
81.4 	health benefits package required under section 1302(a) of the Affordable Care Act and 
81.5 	as described in this subdivision.
81.6 	The essential health benefits package means coverage that:
81.7 	(a) provides essential health benefits as outlined in the Affordable Care Act. 
81.8 	Essential health benefits include:
81.9 	(1) ambulatory patient services;
81.10 	(2) emergency services;
81.11 	(3) hospitalization;
81.12 	(4) laboratory services;
81.13 	(5) maternity and newborn care;
81.14 	(6) mental health and substance abuse disorder services, including behavioral health 
81.15 	treatment;
81.16 	(7) pediatric services, including oral and vision care;
81.17 	(8) prescription drugs;
81.18 	(9) preventive and wellness services and chronic disease management;
81.19 	(10) rehabilitative and habilitative services and devices; and
81.20 	(11) other services defined as essential health benefits under the Affordable Care Act 
81.21 	as defined in section 62A.011, subdivision 1a;
81.22 	(b) limits cost-sharing for such coverage in accordance with section 1302(c) of the 
81.23 	Affordable Care Act, as described in subdivision 2; and
81.24 	(c) subject to subdivision 3, provides bronze, silver, gold, or platinum level of 
81.25 	coverage described in section 1302(d) of the Affordable Care Act as follows:
81.26 	(1) a health plan in the bronze level shall provide a level of coverage that is designed 
81.27 	to provide benefits that are actuarially equivalent to 60 percent of the full actuarial value 
81.28 	of the benefits provided under the plan;
81.29 	(2) a health plan in the silver level shall provide a level of coverage that is designed 
81.30 	to provide benefits that are actuarially equivalent to 70 percent of the full actuarial value 
81.31 	of the benefits provided under the plan;
81.32 	(3) a health plan in the gold level shall provide a level of coverage that is designed to 
81.33 	provide benefits that are actuarially equivalent to 80 percent of the full actuarial value of 
81.34 	the benefits provided under the plan; and
82.1 	(4) a health plan in the platinum level shall provide a level of coverage that is 
82.2 	designed to provide benefits that are actuarially equivalent to 90 percent of the full 
82.3 	actuarial value of the benefits provided under the plan.
82.4 		Subd. 2.Young adults. If a health carrier offers health insurance coverage in any 
82.5 	level of coverage specified under section 1302(d) of the Affordable Care Act, as described 
82.6 	in subdivision 1, paragraph (c), above, the carrier shall also offer such coverage in that 
82.7 	level as a health benefit plan in which the only enrollees are individuals who, as of the 
82.8 	beginning of a policy year, have not attained the age of 21 years.
82.9 		Subd. 3.Catastrophic plan coverage. A health plan not providing a bronze, 
82.10 	silver, gold, or platinum level of coverage, as described in subdivision 1, paragraph (c), 
82.11 	above, shall be treated as meeting the requirements of section 1302(d) of the Affordable 
82.12 	Care Act with respect to any policy year if it provides a catastrophic plan that meets the 
82.13 	requirements of section 1302(e) of the Affordable Care Act.
82.14 		Subd. 4.Nonapplication to dental plans. This section does not apply to a dental 
82.15 	plan described in section 1311(d)(2)(B)(ii) of the Affordable Care Act.

82.16 	EFFECTIVE DATE. This section is effective January 1, 2014.

82.17 	Sec. 94. [62Q.82] BENEFITS AND COVERAGE EXPLANATION.
82.18 		Subdivision 1.Summary. Health plan companies offering health plans shall provide 
82.19 	a summary of benefits and coverage explanation as required by the Affordable Care Act to:
82.20 	(1) an applicant at the time of application;
82.21 	(2) an enrollee prior to the time of enrollment or reenrollment, as applicable; and
82.22 	(3) a policyholder at the time of issuance of the policy.
82.23 		Subd. 2.Compliance. A health plan company described in subdivision 1 shall be 
82.24 	deemed to have complied with subdivision 1 if the summary of benefits and coverage is 
82.25 	provided in paper or electronic form.
82.26 		Subd. 3.Notice of modification. Except in connection with a policy renewal or 
82.27 	reissuance, if a health plan company makes any material modifications in any of the 
82.28 	terms of the coverage, as defined for purposes of section 102 of the federal Employee 
82.29 	Retirement Income Security Act of 1974, as amended, that is not reflected in the most 
82.30 	recently provided summary of benefits and coverage, the health plan company shall 
82.31 	provide notice of the modification to covered persons not later than 60 days prior to the 
82.32 	date on which the modification will become effective.

82.33 	EFFECTIVE DATE. This section is effective the day following final enactment.

83.1 	Sec. 95. Minnesota Statutes 2012, section 72A.20, subdivision 35, is amended to read:
83.2 		Subd. 35.Determination of health plan policy limits. Any health plan under 
83.3 	section 62A.011, subdivision 3, that includes a specific policy limit within its insurance 
83.4 	policy, certificate, or subscriber agreement shall calculate the policy limit by using the 
83.5 	amount actually paid on behalf of the insured, subscriber, or dependents for services 
83.6 	covered under the policy, subscriber agreement, or certificate unless the amount paid is 
83.7 	greater than the billed charge. This provision does not permit the application of a specific 
83.8 	policy limit within a plan where such a limit is prohibited under the Affordable Care Act 
83.9 	as defined in section 62A.011, subdivision 1a.

83.10 	EFFECTIVE DATE. This section is effective the day following final enactment.

83.11 	Sec. 96. [72A.328] PROHIBITION ON RESCISSIONS OF HEALTH PLAN.
83.12 		Subdivision 1.Definitions. (a) "Rescission" means a cancellation or discontinuance 
83.13 	of coverage under a health plan that has a retroactive effect.
83.14 	(b) "Rescission" does not include:
83.15 	(1) a cancellation or discontinuance of coverage under a health benefit plan if:
83.16 	(i) the cancellation or discontinuance of coverage has only a prospective effect; or
83.17 	(ii) the cancellation or discontinuance of coverage is effective retroactively to the 
83.18 	extent it is attributable to a failure to timely pay required premiums or contributions 
83.19 	toward the cost of coverage; or
83.20 	(2) when the health plan covers only active employees and, if applicable, 
83.21 	dependents and those covered under continuation coverage provisions, the employee 
83.22 	pays no premiums for coverage after termination of employment and the cancellation or 
83.23 	discontinuance of coverage is effective retroactively back to the date of termination of 
83.24 	employment due to a delay in administrative record-keeping.
83.25 		Subd. 2.Prohibition on rescissions. (a) A health carrier, as defined in section 
83.26 	62A.011, shall not rescind coverage under a health plan with respect to an individual, 
83.27 	including a group to which the individual belongs or family coverage in which the 
83.28 	individual is included, after the individual is covered under the health plan, unless:
83.29 	(1) the individual or a person seeking coverage on behalf of the individual, performs 
83.30 	an act, practice, or omission that constitutes fraud; and
83.31 	(2) the individual makes an intentional misrepresentation or omission of material 
83.32 	fact, as prohibited by the terms of the health plan.
83.33 	For purposes of this section, a person seeking coverage on behalf of an individual 
83.34 	does not include an insurance producer or employee or authorized representative of the 
83.35 	health carrier.
84.1 	(b) This section does not apply to any benefits classified as excepted benefits under 
84.2 	United States Code, title 42, section 300gg-91(c), or regulations enacted thereunder 
84.3 	from time to time.
84.4 		Subd. 3.Notice required. A health carrier shall provide at least 30 days advance 
84.5 	written notice to each individual who would be affected by the proposed rescission of 
84.6 	coverage before coverage under the plan may be terminated retroactively.
84.7 		Subd. 4.Compliance with other restrictions on rescissions. Nothing in this 
84.8 	section allows rescission if rescission would otherwise be prohibited under section 
84.9 	62A.04, subdivision 2, clause (2), or 62A.615.

84.10 	EFFECTIVE DATE. This section is effective the day following final enactment.

84.11 	Sec. 97. Minnesota Statutes 2012, section 471.61, subdivision 1a, is amended to read:
84.12 		Subd. 1a.Dependents. Notwithstanding the provisions of Minnesota Statutes 1969, 
84.13 	section 471.61, as amended by Laws 1971, chapter 451, section 1, the word "dependents" as 
84.14 	used therein shall mean spouse and minor unmarried children under the age of 18 26 years 
84.15 	and dependent students under the age of 25 years actually dependent upon the employee.

84.16 	EFFECTIVE DATE. This section is effective the day following final enactment.

84.17 	Sec. 98.  REPEALER.
 84.18 	(a) Minnesota Statutes 2012, sections 62E.02, subdivision 7; 62L.081; and 62L.10,
84.19 	 are repealed effective the day following final enactment.
84.20 	(b) Minnesota Statutes 2012, sections 62A.65, subdivision 6; 62E.16; 62E.20; 
84.21 	62L.02, subdivisions 4, 18, 19, and 23; 62L.05, subdivisions 1, 2, 3, 4, 4a, 5, 6, 7, 11, 12, 
84.22 	and 13; and 62Q.37, subdivision 5, are repealed.