1.1 	A bill for an act
1.2 	relating to health care coverage; providing a temporary program to help pay for 
1.3 	health insurance premiums; modifying requirements for health maintenance 
1.4 	organizations; modifying provisions governing health insurance; requiring reports; 
1.5 	appropriating money;amending Minnesota Statutes 2016, sections 60A.08, 
1.6 	subdivision 15; 60A.235, subdivision 3; 60A.236; 62D.02, subdivision 4; 62D.03, 
1.7 	subdivision 1; 62D.05, subdivision 1; 62D.06, subdivision 1; 62D.19; 62E.02, 
1.8 	subdivision 3; 62K.10, by adding a subdivision; 62L.12, subdivision 2; proposing 
1.9 	coding for new law in Minnesota Statutes, chapters 62H; 62Q; repealing Minnesota 
1.10 	Statutes 2016, sections 62D.12, subdivision 9; 62K.11.
1.11 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.12 	ARTICLE 1
1.13 	PREMIUM ASSISTANCE

1.14 	Section 1. PREMIUM ASSISTANCE PROGRAM ESTABLISHED.
 1.15 	The commissioner of Minnesota Management and Budget, in consultation with the 
1.16 	commissioner of commerce and the commissioner of revenue, shall establish and administer 
1.17 	a premium assistance program to help eligible individuals pay expenses for qualified health 
1.18 	coverage in 2017.

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

1.20 	Sec. 2. DEFINITIONS.
 1.21 		Subdivision 1.Scope. For purposes of sections 1 to 5, the following terms have the 
1.22 	meanings given, unless the context clearly indicates otherwise.
1.23 		Subd. 2.Commissioner. "Commissioner" means the commissioner of Minnesota 
1.24 	Management and Budget.
2.1 		Subd. 3.Eligible individual. "Eligible individual" means an individual who:
2.2 	(1) is a resident of Minnesota;
2.3 	(2) purchased qualified health coverage for calendar year 2017;
2.4 	(3) meets the income eligibility requirements under section 3, subdivision 3;
2.5 	(4) is not receiving a premium assistance credit under section 36B of the Internal Revenue 
2.6 	Code for calendar year 2017; and
2.7 	(5) is approved by the commissioner as qualifying for premium assistance.
2.8 		Subd. 4.Health plan. "Health plan" has the meaning provided in Minnesota Statutes, 
2.9 	section 62A.011, subdivision 3.
2.10 		Subd. 5.Health plan company. "Health plan company" means a health carrier, as 
2.11 	defined in Minnesota Statutes, section 62A.011, subdivision 2, that provides qualified health 
2.12 	coverage in the individual market through MNsure or outside of MNsure to Minnesota 
2.13 	resident individuals in 2017.
2.14 		Subd. 6.Individual market. "Individual market" means the individual market as defined 
2.15 	in Minnesota Statutes, section 62A.011, subdivision 5.
2.16 		Subd. 7.Internal Revenue Code. "Internal Revenue Code" means the Internal Revenue 
2.17 	Code as amended through December 31, 2016.
2.18 		Subd. 8.Modified adjusted gross income. "Modified adjusted gross income" means 
2.19 	the modified adjusted gross income for taxable year 2016, as defined in section 36B(d)(2)(B) 
2.20 	of the Internal Revenue Code.
2.21 		Subd. 9.Premium assistance. "Premium assistance," "assistance amount," or "assistance" 
2.22 	means the amount allowed to an eligible individual as determined by the commissioner 
2.23 	under section 3 as a percentage of the qualified premium.
2.24 		Subd. 10.Program. "Program" means the premium assistance program established 
2.25 	under section 1.
2.26 		Subd. 11.Qualified health coverage. "Qualified health coverage" means an individual 
2.27 	health plan, as defined under section 62A.011, subdivision 4, that is:
2.28 	(1) not a grandfathered plan, as defined under section 62A.011, subdivision 1b; and
2.29 	(2) provided by a health plan company through MNsure or outside of MNsure.
2.30 		Subd. 12.Qualified premium. "Qualified premium" means the premium for qualified 
2.31 	health coverage purchased by an eligible individual.

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

3.2 	Sec. 3. PREMIUM ASSISTANCE AMOUNT.
 3.3 		Subdivision 1.Applications by individuals; notification of eligibility. (a) An eligible 
3.4 	individual may apply to the commissioner to receive premium assistance under this section 
3.5 	at any time after purchase of qualified health coverage, but no later than January 31, 2018. 
3.6 	The commissioner shall prescribe the manner and form for applications, including requiring 
3.7 	any information the commissioner considers necessary or useful in determining whether an 
3.8 	applicant is eligible and the assistance amount allowed to the individual under this section. 
3.9 	The application must include a Tennessen warning as provided in Minnesota Statutes, 
3.10 	section 13.04, subdivision 2. The commissioner shall make application forms available on 
3.11 	the agency's Web site.
3.12 	(b) The commissioner shall notify applicants of their eligibility status under the program, 
3.13 	including, for applicants determined to be eligible, their premium assistance amount.
3.14 		Subd. 2.Health plan companies. (a) Through June 30, 2018, each health plan company 
3.15 	shall provide to the commissioner, by the first of each month and any other times the 
3.16 	commissioner requires, an effectuated coverage list with the following information for each 
3.17 	individual for whom it provides qualified health coverage:
3.18 	(1) name, address, and age of each individual covered by the health plan, and any other 
3.19 	identifying information that the commissioner determines appropriate to administer the 
3.20 	program;
3.21 	(2) the qualified premium for the coverage;
3.22 	(3) whether the coverage is individual or family coverage; and
3.23 	(4) whether the individual is receiving advance payment of the credit under section 36B 
3.24 	of the Internal Revenue Code, as reported to the health plan company by MNsure.
3.25 	(b) A health plan company must notify the commissioner of coverage terminations of 
3.26 	eligible individuals within ten business days of MNsure reporting the coverage termination 
3.27 	to the health plan company for qualified health coverage purchased through MNsure and 
3.28 	within ten business days of the health plan company terminating enrollee coverage, for 
3.29 	qualified health coverage purchased outside of MNsure.
3.30 	(c) Each health plan company shall make the application forms developed by the 
3.31 	commissioner under subdivision 1 available on the company's Web site, and shall include 
3.32 	application forms with premium notices for individual health coverage.
4.1 		Subd. 3.Income eligibility rules. (a) Individuals with incomes that meet the requirements 
4.2 	of this subdivision satisfy the income eligibility requirements for the program. For purposes 
4.3 	of this subdivision, "poverty line" has the meaning used in section 36B of the Internal 
4.4 	Revenue Code, except that modified adjusted gross income, as reported on the individual's 
4.5 	federal income tax return for tax year 2016, must be used instead of household income. For 
4.6 	married separate filers claiming eligibility for family coverage, modified adjusted gross 
4.7 	income equals the sum of that income reported by both spouses on their returns.
4.8 	(b) Individuals are eligible for premium assistance if their modified adjusted gross income 
4.9 	is greater than 300 percent but does not exceed 800 percent of the poverty line.
4.10 		Subd. 4.Determination of assistance amounts. (a) For the period January 1, 2017, 
4.11 	through December 31, 2017, eligible individuals qualify for premium assistance equal to 
4.12 	25 percent of the qualified premium for effectuated coverage.
4.13 	(b) The commissioner shall determine premium assistance amounts as provided under 
4.14 	this subdivision so that the estimated sum of all premium assistance for eligible individuals 
4.15 	does not exceed the appropriation for this purpose. The commissioner may adjust premium 
4.16 	assistance amounts using a sliding scale based on income, if this is necessary to remain 
4.17 	within the limits of the appropriation.
4.18 		Subd. 5.Provision of premium assistance to eligible individuals. (a) The commissioner 
4.19 	shall provide the premium assistance amount calculated under subdivision 4 on a monthly 
4.20 	basis to each eligible individual. The commissioner shall provide each eligible individual 
4.21 	with the option of receiving premium assistance through direct deposit to a financial 
4.22 	institution.
4.23 	(b) If the commissioner, for administrative reasons, is unable to provide an eligible 
4.24 	individual with the premium assistance owed for one or more months for which the eligible 
4.25 	individual had effectuated coverage, the commissioner shall include the premium assistance 
4.26 	owed for that period with the premium assistance payment for the first month for which the 
4.27 	commissioner is able to provide premium assistance in a timely manner.
4.28 	(c) The commissioner may require an eligible individual to provide any documentation 
4.29 	and substantiation of payment of the qualified premium that the commissioner considers 
4.30 	appropriate.
4.31 		Subd. 6.Contracting. The commissioner may contract with a third-party administrator 
4.32 	to determine eligibility for and administer premium assistance under this section.
5.1 		Subd. 7.Verification. The commissioner shall verify that persons applying for premium 
5.2 	assistance are residents of Minnesota. The commissioner may access information from the 
5.3 	Department of Employment and Economic Development and the Minnesota Department 
5.4 	of Revenue when verifying residency.
5.5 		Subd. 8.Data practices. (a) Information provided to the commissioner under subdivisions 
5.6 	1 and 2 is private data on individuals as defined in Minnesota Statutes, section 13.02, 
5.7 	subdivision 12.
5.8 	(b) Notwithstanding the commissioner's retention schedule, the commissioner must 
5.9 	destroy data provided under subdivision 2 on June 30, 2018.

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

5.11 	Sec. 4. AUDIT AND PROGRAM INTEGRITY.
 5.12 		Subdivision 1.Audit. The legislative auditor shall audit implementation of the premium 
5.13 	assistance program by the commissioner to determine whether premium assistance payments 
5.14 	align with the criteria established in sections 2 and 3. The legislative auditor shall present 
5.15 	a report summarizing findings of the audit to the legislative committees with jurisdiction 
5.16 	over insurance and health by June 1, 2018.
5.17 		Subd. 2.Program integrity. The commissioner of revenue shall ensure that only eligible 
5.18 	individuals, as defined in section 2, subdivision 3, have received premium assistance. The 
5.19 	commissioner of revenue shall review information available from Minnesota Management 
5.20 	and Budget, the Department of Human Services, MNsure, and the most recent Minnesota 
5.21 	tax records to identify ineligible individuals who received premium assistance. The 
5.22 	commissioner of revenue shall recover the amount of any premium assistance paid on behalf 
5.23 	of an ineligible individual from the ineligible individual, in the manner provided by law for 
5.24 	the collection of unpaid taxes or erroneously paid refunds of taxes.

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

5.26 	Sec. 5. TRANSFER.
 5.27 	$300,157,000 in fiscal year 2017 is transferred from the budget reserve account in 
5.28 	Minnesota Statutes, section 16A.152, subdivision 1a, to the general fund.

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

6.1 	Sec. 6. APPROPRIATIONS.
 6.2 	(a) $285,000,000 in fiscal year 2017 is appropriated from the general fund to the 
6.3 	commissioner of Minnesota Management and Budget for purposes of providing premium 
6.4 	assistance under section 3. No more than three percent of this appropriation is available to 
6.5 	the commissioner for administrative costs. This is a onetime appropriation and is available 
6.6 	until June 30, 2018. Any funds remaining from this appropriation on June 30, 2018, cancel 
6.7 	to the budget reserve account in Minnesota Statutes, section 16A.152, subdivision 1a.
6.8 	(b) If the commissioner of Minnesota Management and Budget determines that the 
6.9 	amount of the appropriation available for administrative costs in paragraph (a) is inadequate, 
6.10 	the commissioner may increase the amount available for administrative costs up to 
6.11 	$20,000,000 by using any available amounts of the fiscal year 2017 appropriation for agency 
6.12 	operations for that purpose or by using amounts of the appropriations for agency operations 
6.13 	in fiscal years 2018 or 2019 for that purpose. Before increasing the amount available for 
6.14 	administrative costs above the amount provided in paragraph (a), the commissioner must 
6.15 	provide information justifying the higher expenditure to the chairs and ranking minority 
6.16 	members of the Ways and Means Committee in the house and the Finance Committee in 
6.17 	the senate.
6.18 	(c) If the commissioner of revenue determines that the Department of Revenue has 
6.19 	administrative costs that are not funded elsewhere in this act, the commissioner may use up 
6.20 	to $7,802,000 for those administrative costs by using any available amounts of the fiscal 
6.21 	year 2017 appropriation for agency operations or by using amounts of the appropriations 
6.22 	for agency operations in fiscal years 2018 or 2019. Before spending amounts for 
6.23 	administrative costs as specified in this paragraph, the commissioner must provide 
6.24 	information justifying the expenditure to the chairs and ranking minority members of the 
6.25 	Ways and Means Committee in the house and the Finance Committee in the senate.
6.26 	(d) $157,000 in fiscal year 2017 is appropriated from the general fund to the legislative 
6.27 	auditor to conduct the audit required by section 4. This is a onetime appropriation and is 
6.28 	available until June 30, 2018. Any funds remaining from this appropriation on June 30, 
6.29 	2018, cancel to the budget reserve account in Minnesota Statutes, section 16A.152, 
6.30 	subdivision 1a.

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

7.1 	ARTICLE 2
7.2 	INSURANCE MARKET REFORMS

7.3 	Section 1. Minnesota Statutes 2016, section 60A.08, subdivision 15, is amended to read:
7.4 		Subd. 15.Classification of insurance filings data. (a) All forms, rates, and related 
7.5 	information filed with the commissioner under section 61A.02 shall be nonpublic data until 
7.6 	the filing becomes effective.
7.7 	(b) All forms, rates, and related information filed with the commissioner under section 
7.8 	62A.02 shall be nonpublic data until the filing becomes effective.
7.9 	(c) All forms, rates, and related information filed with the commissioner under section 
7.10 	62C.14, subdivision 10, shall be nonpublic data until the filing becomes effective.
7.11 	(d) All forms, rates, and related information filed with the commissioner under section 
7.12 	70A.06 shall be nonpublic data until the filing becomes effective.
7.13 	(e) All forms, rates, and related information filed with the commissioner under section 
7.14 	79.56 shall be nonpublic data until the filing becomes effective.
7.15 	(f) Notwithstanding paragraphs (b) and (c), for all rate increases subject to review under 
7.16 	section 2794 of the Public Health Services Act and any amendments to, or regulations, or 
7.17 	guidance issued under the act that are filed with the commissioner on or after September 1, 
7.18 	2011, the commissioner:
7.19 	(1) may acknowledge receipt of the information;
7.20 	(2) may acknowledge that the corresponding rate filing is pending review;
7.21 	(3) must provide public access from the Department of Commerce's Web site to parts I 
7.22 	and II of the Preliminary Justifications of the rate increases subject to review; and
7.23 	(4) must provide notice to the public on the Department of Commerce's Web site of the 
7.24 	review of the proposed rate, which must include a statement that the public has 30 calendar 
7.25 	days to submit written comments to the commissioner on the rate filing subject to review.
7.26 	(g) Notwithstanding paragraphs (b) and (c), for all proposed premium rates filed with 
7.27 	the commissioner for individual health plans, as defined in section 62A.011, subdivision 4, 
7.28 	and small group health plans, as defined in section 62K.03, subdivision 12, the commissioner 
7.29 	must provide public access on the Department of Commerce's Web site to compiled data 
7.30 	of the proposed changes to rates, separated by health plan and geographic rating area, within 
7.31 	ten business days after the deadline by which health carriers, as defined in section 62A.011, 
7.32 	subdivision 2, must submit proposed rates to the commissioner for approval.

8.1 	EFFECTIVE DATE. This section is effective 30 days following final enactment.

8.2 	Sec. 2. Minnesota Statutes 2016, section 60A.235, subdivision 3, is amended to read:
8.3 		Subd. 3.Health plan policies issued as stop loss coverage. (a) An insurance company 
8.4 	or health carrier issuing or renewing an insurance policy or other evidence of coverage, that 
8.5 	provides coverage to an employer for health care expenses incurred under an 
8.6 	employer-sponsored plan provided to the employer's employees, retired employees, or their 
8.7 	dependents, shall issue the policy or evidence of coverage as a health plan if the policy or 
8.8 	evidence of coverage:
8.9 	(1) has a specific attachment point for claims incurred per individual that is lower than 
8.10 	~~$20,000~~ $10,000; or
8.11 	~~(2) has an aggregate attachment point, for groups of 50 or fewer, that is lower than the~~ 
8.12 	~~greater of:~~
8.13 	~~(i) $4,000 times the number of group members;~~
8.14 	~~(ii) 120 percent of expected claims; or~~
8.15 	~~(iii) $20,000; or~~
8.16 	~~(3)~~ (2) has an aggregate attachment point ~~for groups of 51 or more~~ that is lower than 
8.17 	110 percent of expected claims.
8.18 	(b) An insurer shall determine the number of persons in a group, for the purposes of this 
8.19 	section, on a consistent basis, at least annually. Where the insurance policy or evidence of 
8.20 	coverage applies to a contract period of more than one year, the dollar amounts set forth in 
8.21 	paragraph (a), ~~clauses~~ clause (1) ~~and (2)~~, must be multiplied by the length of the contract 
8.22 	period expressed in years.
8.23 	~~(c) The commissioner may adjust the constant dollar amounts provided in paragraph~~ 
8.24 	~~(a), clauses (1), (2), and (3), on January 1 of any year, based upon changes in the medical~~ 
8.25 	~~component of the Consumer Price Index (CPI). Adjustments must be in increments of $100~~ 
8.26 	~~and must not be made unless at least that amount of adjustment is required. The commissioner~~ 
8.27 	~~shall publish any change in these dollar amounts at least six months before their effective~~ 
8.28 	~~date.~~
8.29 	~~(d)~~ (c) A policy or evidence of coverage issued by an insurance company or health carrier 
8.30 	that provides direct coverage of health care expenses of an individual including a policy or 
8.31 	evidence of coverage administered on a group basis is a health plan regardless of whether 
8.32 	the policy or evidence of coverage is denominated as stop loss coverage.

9.1 	EFFECTIVE DATE. This section is effective 30 days following final enactment, and 
9.2 	applies to policies or evidence of coverage offered, issued, or renewed to an employer on 
9.3 	or after that date.

9.4 	Sec. 3. Minnesota Statutes 2016, section 60A.236, is amended to read:
9.5 	60A.236 STOP LOSS REGULATION; SMALL EMPLOYER COVERAGE.
9.6 	A contract providing stop loss coverage, issued or renewed to a small employer, as 
9.7 	defined in section 62L.02, subdivision 26, or to a plan sponsored by a small employer, must 
9.8 	include a claim settlement period no less favorable to the small employer or plan than 
9.9 	~~coverage of all~~ the following:
9.10 	(1) claims incurred during the contract period ~~regardless of when the claims are~~; and
9.11 	(2) paid by the plan during the contract period or within one month after expiration of 
9.12 	the contract period.

9.13 	EFFECTIVE DATE. This section is effective 30 days following final enactment, and 
9.14 	applies to policies or evidence of coverage offered, issued, or renewed to an employer on 
9.15 	or after that date.

9.16 	Sec. 4. Minnesota Statutes 2016, section 62D.02, subdivision 4, is amended to read:
9.17 		Subd. 4.Health maintenance organization. ~~(a)~~ "Health maintenance organization" 
9.18 	means a ~~nonprofit~~foreign or domestic corporation ~~organized under chapter 317A~~, or a local 
9.19 	governmental unit as defined in subdivision 11, controlled and operated as provided in 
9.20 	sections 62D.01 to 62D.30, which provides, either directly or through arrangements with 
9.21 	providers or other persons, comprehensive health maintenance services, or arranges for the 
9.22 	provision of these services, to enrollees on the basis of a fixed prepaid sum without regard 
9.23 	to the frequency or extent of services furnished to any particular enrollee.
9.24 	~~(b) [Expired]~~

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

9.26 	Sec. 5. Minnesota Statutes 2016, section 62D.03, subdivision 1, is amended to read:
9.27 		Subdivision 1.Certificate of authority required. Notwithstanding any law of this state 
9.28 	to the contrary, any ~~nonprofit~~ foreign or domestic corporation organized to do so or a local 
9.29 	governmental unit may apply to the commissioner of health for a certificate of authority to 
9.30 	establish and operate a health maintenance organization in compliance with sections 62D.01
9.31 	to 62D.30. No person shall establish or operate a health maintenance organization in this 
10.1 	state, nor sell or offer to sell, or solicit offers to purchase or receive advance or periodic 
10.2 	consideration in conjunction with a health maintenance organization or health maintenance 
10.3 	contract unless the organization has a certificate of authority under sections 62D.01 to 
10.4 	62D.30.

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

10.6 	Sec. 6. Minnesota Statutes 2016, section 62D.05, subdivision 1, is amended to read:
10.7 		Subdivision 1.Authority granted. Any ~~nonprofit~~ corporation or local governmental 
10.8 	unit may, upon obtaining a certificate of authority as required in sections 62D.01 to 62D.30, 
10.9 	operate as a health maintenance organization.

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

10.11 	Sec. 7. Minnesota Statutes 2016, section 62D.06, subdivision 1, is amended to read:
10.12 		Subdivision 1.Governing body composition; enrollee advisory body. The governing 
10.13 	body of any health maintenance organization which is a ~~nonprofit~~ corporation may include 
10.14 	enrollees, providers, or other individuals; provided, however, that after a health maintenance 
10.15 	organization which is a ~~nonprofit~~ corporation has been authorized under sections 62D.01
10.16 	to 62D.30 for one year, at least 40 percent of the governing body shall be composed of 
10.17 	enrollees and members elected by the enrollees and members from among the enrollees and 
10.18 	members. For purposes of this section, "member" means a consumer who receives health 
10.19 	care services through a self-insured contract that is administered by the health maintenance 
10.20 	organization or its related third-party administrator. The number of members elected to the 
10.21 	governing body shall not exceed the number of enrollees elected to the governing body. An 
10.22 	enrollee or member elected to the governing board may not be a person:
10.23 	(1) whose occupation involves, or before retirement involved, the administration of 
10.24 	health activities or the provision of health services;
10.25 	(2) who is or was employed by a health care facility as a licensed health professional; 
10.26 	or
10.27 	(3) who has or had a direct substantial financial or managerial interest in the rendering 
10.28 	of a health service, other than the payment of a reasonable expense reimbursement or 
10.29 	compensation as a member of the board of a health maintenance organization.
10.30 	After a health maintenance organization which is a local governmental unit has been 
10.31 	authorized under sections 62D.01 to 62D.30 for one year, an enrollee advisory body shall 
11.1 	be established. The enrollees who make up this advisory body shall be elected by the enrollees 
11.2 	from among the enrollees.

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

11.4 	Sec. 8. Minnesota Statutes 2016, section 62D.19, is amended to read:
11.5 	62D.19 UNREASONABLE EXPENSES.
11.6 	No health maintenance organization shall incur or pay for any expense of any nature 
11.7 	which is unreasonably high in relation to the value of the service or goods provided. The 
11.8 	commissioner of health shall implement and enforce this section by rules adopted under 
11.9 	this section.
11.10 	In an effort to achieve the stated purposes of sections 62D.01 to 62D.30~~; in order to~~ 
11.11 	~~safeguard the underlying nonprofit status of health maintenance organizations;~~ and to ensure 
11.12 	that the payment of health maintenance organization money to major participating entities 
11.13 	results in a corresponding benefit to the health maintenance organization and its enrollees, 
11.14 	when determining whether an organization has incurred an unreasonable expense in relation 
11.15 	to a major participating entity, due consideration shall be given to, in addition to any other 
11.16 	appropriate factors, whether the officers and trustees of the health maintenance organization 
11.17 	have acted with good faith and in the best interests of the health maintenance organization 
11.18 	in entering into, and performing under, a contract under which the health maintenance 
11.19 	organization has incurred an expense. The commissioner has standing to sue, on behalf of 
11.20 	a health maintenance organization, officers or trustees of the health maintenance organization 
11.21 	who have breached their fiduciary duty in entering into and performing such contracts.

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

11.23 	Sec. 9. Minnesota Statutes 2016, section 62E.02, subdivision 3, is amended to read:
11.24 		Subd. 3.Health maintenance organization. "Health maintenance organization" means 
11.25 	a ~~nonprofit~~ corporation licensed and operated as provided in chapter 62D.

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

11.27 	Sec. 10. [62H.18] AGRICULTURAL COOPERATIVE HEALTH PLAN.
11.28 		Subdivision 1.Definitions. (a) The definitions in this subdivision apply to this section.
11.29 	(b) "Agricultural cooperative" means a cooperative organized under chapters 308A or 
11.30 	308B that meets the requirements of subdivision 2.
12.1 	(c) "Broker" means an insurance agent engaged in brokerage business according to 
12.2 	section 60K.49.
12.3 	(d) "Employee Retirement Income Security Act" means the Employee Retirement Income 
12.4 	Security Act of 1974, United States Code, title 29, sections 1001, et seq.
12.5 	(e) "Enrollee" means a natural person covered by a joint self-insurance plan operating 
12.6 	under this section.
12.7 	(f) "Insurance agent" has the meaning given to insurance agent in section 60A.02, 
12.8 	subdivision 7.
12.9 	(g) "Joint self-insurance plan" or "plan" means a plan or any other arrangement established 
12.10 	for the benefit of two or more entities authorized to transact business in the state, in order 
12.11 	to jointly self-insure through a single employee welfare benefit plan funded through a trust, 
12.12 	to provide health, dental, or other benefits as permitted under the Employee Retirement 
12.13 	Income Security Act.
12.14 	(h) "Service plan administrator" means a vendor of risk management services licensed 
12.15 	under section 60A.23.
12.16 	(i) "Trust" means a trust established to accept and hold assets of the joint self-insurance 
12.17 	plan in trust and use and disperse funds in accordance with the terms of the written trust 
12.18 	document and joint self-insurance plan for the sole purposes of providing benefits and 
12.19 	defraying reasonable administrative costs of providing the benefits.
12.20 		Subd. 2.Exemption. A joint self-insurance plan is exempt from sections 62H.01 to 
12.21 	62H.17 and is instead governed by this section, if it is administered through a trust established 
12.22 	by an agricultural cooperative that:
12.23 	(1) has members who (i) actively work in production agriculture in Minnesota and file 
12.24 	either Form 1065 or Schedule F with the member's income tax return; or (ii) provide direct 
12.25 	services to production agriculture in Minnesota;
12.26 	(2) specifies criteria for membership in the agricultural cooperative in their articles of 
12.27 	organization or bylaws; and
12.28 	(3) grants at least 51 percent of the aggregate voting power on matters for which all 
12.29 	members may vote to members who satisfy clause (1) and any additional criteria in the 
12.30 	agricultural cooperative's articles of organization and bylaws.
12.31 		Subd. 3.Plan requirements. A joint self-insurance plan operating under this section 
12.32 	must:
13.1 	(1) offer health coverage to members of the agricultural cooperative that establishes the 
13.2 	plan and their dependents, to employees of members of the agricultural cooperative that 
13.3 	establishes the plan and their dependents, or to employees of the agricultural cooperative 
13.4 	that establishes the plan and their dependents;
13.5 	(2) include aggregate stop-loss coverage and individual stop-loss coverage provided by 
13.6 	an insurance company licensed in Minnesota;
13.7 	(3) establish a reserve fund, certified by an actuary to be sufficient to cover unpaid claim 
13.8 	liability for incurred but not reported liabilities in the event of plan termination. Certification 
13.9 	from the actuary must include all maximum funding requirements for plan fixed cost 
13.10 	requirements and current claims liability requirements, and must include a calculation of 
13.11 	the reserve levels needed to fund all incurred but not reported liabilities in the event of 
13.12 	member or plan termination. These reserve funds must be held in a trust;
13.13 	(4) be governed by a board elected by agricultural cooperative members that participate 
13.14 	in the plan;
13.15 	(5) contract for services with a service plan administrator; and
13.16 	(6) satisfy the requirements of the Employee Retirement Income Security Act that apply 
13.17 	to employee welfare benefit plans.
13.18 		Subd. 4.Submission of documents to commissioner of commerce. A joint 
13.19 	self-insurance plan operating under this section must submit to the commissioner of 
13.20 	commerce copies of all filings and reports that are submitted to the United States Department 
13.21 	of Labor according to the Employee Retirement Income Security Act. Members participating 
13.22 	in the joint self-insurance plan may designate an agricultural cooperative that establishes 
13.23 	the plan as the entity responsible for satisfying the reporting requirements of the Employee 
13.24 	Retirement Income Security Act and for providing copies of these filings and reports to the 
13.25 	commissioner of commerce.
13.26 		Subd. 5.Participation; termination of participation. If a member chooses to participate 
13.27 	in a joint self-insurance plan under this section, the member must participate in the plan for 
13.28 	at least three consecutive years. If a member terminates participation in the plan before the 
13.29 	end of the three-year period, a financial penalty may be assessed under the plan, not to 
13.30 	exceed the amount contributed by the member to the plan reserves.
13.31 		Subd. 6.Single risk pool. The enrollees of a joint self-insurance plan operating under 
13.32 	this section shall be members of a single risk pool. The plan shall provide benefits as a 
14.1 	single, self-insured plan with the size of the plan based on the total enrollees in the risk 
14.2 	pool.
14.3 		Subd. 7.Promotion, marketing, sale of coverage. (a) Coverage in a joint self-insurance 
14.4 	plan operating under this section may be promoted, marketed, and sold by insurance agents 
14.5 	and brokers to members of the agricultural cooperative sponsoring the plan and their 
14.6 	dependents, employees of members of the agricultural cooperative sponsoring the plan and 
14.7 	their dependents, and employees of the agricultural cooperative sponsoring the plan and 
14.8 	their dependents.
14.9 	(b) Coverage in a joint self-insurance plan operating under this section may be promoted 
14.10 	and marketed by a cooperative organized under chapters 308A or 308B to persons who may 
14.11 	be eligible to participate in the joint self-insurance plan.
14.12 		Subd. 8.Taxation. Joint self-insurance plans are exempt from the taxation imposed 
14.13 	under section 297I.05, subdivision 12.
14.14 		Subd. 9.Compliance with other laws. A joint self-insurance plan operating under this 
14.15 	section:
14.16 	(1) is exempt from providing the mandated health benefits in chapters 62A and 62Q, if 
14.17 	the plan otherwise provides the benefits required under the Employee Retirement Income 
14.18 	Security Act;
14.19 	(2) is exempt from the continuation requirements in sections 62A.146, 62A.16, 62A.17, 
14.20 	62A.20, and 62A.21, if the plan complies with the continuation requirements under the 
14.21 	Employee Retirement Income Security Act; and
14.22 	(3) must comply with all requirements of the Affordable Care Act, as defined in section 
14.23 	62A.011, subdivision 1a, to the extent that they apply to such plans.

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

14.25 	Sec. 11. Minnesota Statutes 2016, section 62K.10, is amended by adding a subdivision to 
14.26 	read:
14.27 		Subd. 5a.Appeal of waiver of network adequacy requirements. If a health carrier 
14.28 	receives a waiver under subdivision 5 applicable to a health plan's provider network, a 
14.29 	provider who is in the geographic area served by the health plan and who is aggrieved by 
14.30 	the issuance of the waiver, may appeal the commissioner's decision using the contested case 
14.31 	procedures in chapter 14. A contested case proceeding must be initiated within 60 days after 
14.32 	the date on which the commissioner grants a waiver, except that a proceeding regarding a 
15.1 	waiver in effect as of January 1, 2017, must be initiated within 60 days after the effective 
15.2 	date of this section. Notwithstanding any law to the contrary, each party to the proceeding 
15.3 	must pay an equal amount of the costs for the proceeding. After considering the appeal, the 
15.4 	administrative law judge must either uphold or nullify a waiver of network adequacy 
15.5 	requirements. The decision of the administrative law judge constitutes the final decision 
15.6 	regarding the waiver. A party aggrieved by the administrative law judge's decision may 
15.7 	seek judicial review of the decision as provided in chapter 14. If the waiver is nullified and 
15.8 	no judicial review is sought, the health carrier must comply with the network adequacy 
15.9 	requirements in section 62K.10, subdivisions 2, 3, and 4, within 30 days after the deadline 
15.10 	for seeking judicial review in section 14.63.

15.11 	EFFECTIVE DATE. This section is effective the day following final enactment, and 
15.12 	applies to network adequacy waivers in effect on or after January 1, 2017.

15.13 	Sec. 12. Minnesota Statutes 2016, section 62L.12, subdivision 2, is amended to read:
15.14 		Subd. 2.Exceptions. (a) A health carrier may renew individual conversion policies to 
15.15 	eligible employees otherwise eligible for conversion coverage under section 62D.104 as a 
15.16 	result of leaving a health maintenance organization's service area.
15.17 	(b) A health carrier may renew individual conversion policies to eligible employees 
15.18 	otherwise eligible for conversion coverage as a result of the expiration of any continuation 
15.19 	of group coverage required under sections 62A.146, 62A.17, 62A.21, 62C.142, 62D.101, 
15.20 	and 62D.105.
15.21 	(c) A health carrier may renew conversion policies to eligible employees.
15.22 	(d) A health carrier may sell, issue, or renew individual continuation policies to eligible 
15.23 	employees as required.
15.24 	(e) A health carrier may sell, issue, or renew individual health plans if the coverage is 
15.25 	appropriate due to an unexpired preexisting condition limitation or exclusion applicable to 
15.26 	the person under the employer's group health plan or due to the person's need for health 
15.27 	care services not covered under the employer's group health plan.
15.28 	(f) A health carrier may sell, issue, or renew an individual health plan, if the individual 
15.29 	has elected to buy the individual health plan not as part of a general plan to substitute 
15.30 	individual health plans for a group health plan nor as a result of any violation of subdivision 
15.31 	3 or 4.
16.1 	(g) A health carrier may sell, issue, or renew an individual health plan if coverage 
16.2 	provided by the employer is determined to be unaffordable under the provisions of the 
16.3 	Affordable Care Act as defined in section 62A.011, subdivision 1a.
16.4 	(h) Nothing in this subdivision relieves a health carrier of any obligation to provide 
16.5 	continuation or conversion coverage otherwise required under federal or state law.
16.6 	(i) Nothing in this chapter restricts the offer, sale, issuance, or renewal of coverage issued 
16.7 	as a supplement to Medicare under sections 62A.3099 to 62A.44, or policies or contracts 
16.8 	that supplement Medicare issued by health maintenance organizations, or those contracts 
16.9 	governed by sections 1833, 1851 to 1859, 1860D, or 1876 of the federal Social Security 
16.10 	Act, United States Code, title 42, section 1395 et seq., as amended.
16.11 	(j) Nothing in this chapter restricts the offer, sale, issuance, or renewal of individual 
16.12 	health plans necessary to comply with a court order.
16.13 	(k) A health carrier may offer, issue, sell, or renew an individual health plan to persons 
16.14 	eligible for an employer group health plan, if the individual health plan is a high deductible 
16.15 	health plan for use in connection with an existing health savings account, in compliance 
16.16 	with the Internal Revenue Code, section 223. In that situation, the same or a different health 
16.17 	carrier may offer, issue, sell, or renew a group health plan to cover the other eligible 
16.18 	employees in the group.
16.19 	(l) A health carrier may offer, sell, issue, or renew an individual health plan to one or 
16.20 	more employees of a small employer if the individual health plan is marketed directly to 
16.21 	all employees of the small employer and the small employer does not contribute directly or 
16.22 	indirectly to the premiums or facilitate the administration of the individual health plan. The 
16.23 	requirement to market an individual health plan to all employees does not require the health 
16.24 	carrier to offer or issue an individual health plan to any employee. For purposes of this 
16.25 	paragraph, an employer is not contributing to the premiums or facilitating the administration 
16.26 	of the individual health plan if the employer does not contribute to the premium and merely 
16.27 	collects the premiums from an employee's wages or salary through payroll deductions and 
16.28 	submits payment for the premiums of one or more employees in a lump sum to the health 
16.29 	carrier. Except for coverage under section 62A.65, subdivision 5, paragraph (b), at the 
16.30 	request of an employee, the health carrier may bill the employer for the premiums payable 
16.31 	by the employee, provided that the employer is not liable for payment except from payroll 
16.32 	deductions for that purpose. If an employer is submitting payments under this paragraph, 
16.33 	the health carrier shall provide a cancellation notice directly to the primary insured at least 
16.34 	ten days prior to termination of coverage for nonpayment of premium. Individual coverage 
17.1 	under this paragraph may be offered only if the small employer has not provided coverage 
17.2 	under section 62L.03 to the employees within the past 12 months.
17.3 	(m) A health carrier may offer, sell, issue, or renew an individual health plan to one or 
17.4 	more employees of a small employer if the small employer, eligible employee, and individual 
17.5 	health plan are in compliance with the 21st Century Cures Act, Public Law 114-255.

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

17.7 	Sec. 13. [62Q.022] FEDERAL ACT AND STATE MANDATES; COMPLIANCE 
17.8 	NOT REQUIRED.
17.9 	(a) Notwithstanding any state or federal law to the contrary, a health plan company may 
17.10 	offer health plans that do not include federally required health benefit mandates.
17.11 	(b) Notwithstanding any state or federal law to the contrary, a health plan company may 
17.12 	offer health plans that do not include all or some of the health benefit mandates in chapters 
17.13 	62A and 62Q, if the health plan company also offers a health plan that includes all of the 
17.14 	health benefit mandates in chapters 62A and 62Q in the same service area.

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

17.16 	Sec. 14. [62Q.556] UNAUTHORIZED PROVIDER SERVICES.
17.17 		Subdivision 1.Unauthorized provider services. (a) Except as provided in paragraph 
17.18 	(c), unauthorized provider services occur when an enrollee receives services:
17.19 	(1) from a nonparticipating provider at a participating hospital or ambulatory surgical 
17.20 	center, when the services are rendered:
17.21 	(i) due to the unavailability of a participating provider;
17.22 	(ii) by a nonparticipating provider without the enrollee's knowledge; or
17.23 	(iii) due to the need for unforeseen services arising at the time the services are being 
17.24 	rendered;
17.25 	(2) from a nonparticipating provider in a participating provider's practice setting under 
17.26 	circumstances not described in clause (1);
17.27 	(3) from a participating provider that sends a specimen taken from the enrollee in the 
17.28 	participating provider's practice setting to a nonparticipating laboratory, pathologist, or other 
17.29 	medical testing facility; or
18.1 	(4) not described in clause (3) that are performed by a nonparticipating provider, if a 
18.2 	referral for the services is required by the health plan.
18.3 	(b) Unauthorized provider services do not include emergency services as defined in 
18.4 	section 62Q.55, subdivision 3.
18.5 	(c) The services described in paragraph (a), clauses (2) to (4), are not unauthorized 
18.6 	provider services if the enrollee gives advance written consent to the provider acknowledging 
18.7 	that the use of a provider, or the services to be rendered, may result in costs not covered by 
18.8 	the health plan.
18.9 		Subd. 2.Prohibition. An enrollee must have the same cost-sharing requirements for 
18.10 	unauthorized provider services, including co-payments, deductibles, coinsurance, coverage 
18.11 	restrictions, and coverage limitations as those applicable to services received by the enrollee 
18.12 	from a participating provider.

18.13 	EFFECTIVE DATE. This section is effective 30 days following final enactment and 
18.14 	applies to provider services provided on or after that date.

18.15 	Sec. 15. [62Q.557] BALANCE BILLING PROHIBITED.
18.16 	(a) A participating provider is prohibited from billing an enrollee for any amount in 
18.17 	excess of the allowable amount the health plan company has contracted for with the provider 
18.18 	as total payment for the health care services. A participating provider is permitted to bill an 
18.19 	enrollee the approved co-payment, deductible, or coinsurance.
18.20 	(b) A participating provider is permitted to bill an enrollee for services not covered by 
18.21 	the enrollee's health plan as long as the enrollee agrees in writing in advance before the 
18.22 	service is performed to pay for the noncovered service.

18.23 	EFFECTIVE DATE. This section is effective July 1, 2017, and applies to health plans 
18.24 	offered, issued, or renewed to a Minnesota resident on or after that date.

18.25 	Sec. 16. TRANSITION OF CARE COVERAGE FOR CALENDAR YEAR 2017; 
18.26 	INVOLUNTARY TERMINATION OF COVERAGE.
 18.27 		Subdivision 1.Definitions. (a) For purposes of this section, the following terms have 
18.28 	the meanings given.
18.29 	(b) "Enrollee" has the meaning given in Minnesota Statutes, section 62Q.01, subdivision 
18.30 	2b.
19.1 	(c) "Health plan" has the meaning given in Minnesota Statutes, section 62Q.01, 
19.2 	subdivision 3.
19.3 	(d) "Health plan company" has the meaning given in Minnesota Statutes, section 62Q.01, 
19.4 	subdivision 4.
19.5 	(e) "Individual market" has the meaning given in Minnesota Statutes, section 62A.011, 
19.6 	subdivision 5.
19.7 	(f) "Involuntary termination of coverage" means the termination of a health plan due to 
19.8 	a health plan company's refusal to renew the health plan in the individual market because 
19.9 	the health plan company elects to cease offering individual market health plans in all or 
19.10 	some geographic rating areas of the state.
19.11 		Subd. 2.Application. This section applies to an enrollee who is subject to a change in 
19.12 	health plans in the individual market due to an involuntary termination of coverage from a 
19.13 	health plan in the individual market after October 31, 2016, and before January 1, 2017, 
19.14 	and who enrolls in a new health plan in the individual market for all or a portion of calendar 
19.15 	year 2017 that goes into effect after December 31, 2016, and before March 2, 2017.
19.16 		Subd. 3.Change in health plans; transition of care coverage. (a) If an enrollee satisfies 
19.17 	the criteria in subdivision 2, the enrollee's new health plan company must provide, upon 
19.18 	request of the enrollee or the enrollee's health care provider, authorization to receive services 
19.19 	that are otherwise covered under the terms of the enrollee's calendar year 2017 health plan 
19.20 	from a provider who provided care on an in-network basis to the enrollee during calendar 
19.21 	year 2016 but who is out of network in the enrollee's calendar year 2017 health plan:
19.22 	(1) for up to 120 days if the enrollee has received a diagnosis of, or is engaged in a 
19.23 	current course of treatment for, one or more of the following conditions:
19.24 	(i) an acute condition;
19.25 	(ii) a life-threatening mental or physical illness;
19.26 	(iii) pregnancy beyond the first trimester of pregnancy;
19.27 	(iv) a physical or mental disability defined as an inability to engage in one or more major 
19.28 	life activities, provided the disability has lasted or can be expected to last for at least one 
19.29 	year or can be expected to result in death; or
19.30 	(v) a disabling or chronic condition that is in an acute phase; or
19.31 	(2) for the rest of the enrollee's life if a physician certifies that the enrollee has an expected 
19.32 	lifetime of 180 days or less.
20.1 	(b) For all requests for authorization under this subdivision, the health plan company 
20.2 	must grant the request for authorization unless the enrollee does not meet the criteria in 
20.3 	paragraph (a) or subdivision 2.
20.4 	(c) The commissioner of Minnesota Management and Budget must reimburse the 
20.5 	enrollee's new health plan company for costs attributed to services authorized under this 
20.6 	subdivision. Costs eligible for reimbursement under this paragraph are the difference between 
20.7 	the health plan company's reimbursement rate for in-network providers for a service 
20.8 	authorized under this subdivision and its rate for out-of-network providers for the service. 
20.9 	The health plan company must seek reimbursement from the commissioner for costs 
20.10 	attributed to services authorized under this subdivision, in a form and manner mutually 
20.11 	agreed upon by the commissioner and the affected health plan companies. Total state 
20.12 	reimbursements to health plan companies under this paragraph are subject to the limits of 
20.13 	the available appropriation. In the event that funding for reimbursements to health plan 
20.14 	companies is not sufficient to fully reimburse health plan companies for the costs attributed 
20.15 	to services authorized under this subdivision, health plan companies must continue to cover 
20.16 	services authorized under this subdivision.
20.17 		Subd. 4.Limitations. (a) Subdivision 3 applies only if the enrollee's health care provider 
20.18 	agrees to:
20.19 	(1) accept as payment in full the lesser of:
20.20 	(i) the health plan company's reimbursement rate for in-network providers for the same 
20.21 	or similar service; or
20.22 	(ii) the provider's regular fee for that service;
20.23 	(2) request authorization for services in the form and manner specified by the enrollee's 
20.24 	new health plan company; and
20.25 	(3) provide the enrollee's new health plan company with all necessary medical information 
20.26 	related to the care provided to the enrollee.
20.27 	(b) Nothing in this section requires a health plan company to provide coverage for a 
20.28 	health care service or treatment that is not covered under the enrollee's health plan.
20.29 		Subd. 5.Request for authorization. The enrollee's health plan company may require 
20.30 	medical records and other supporting documentation to be submitted with a request for 
20.31 	authorization under subdivision 3. If authorization is denied, the health plan company must 
20.32 	explain the criteria used to make its decision on the request for authorization and must 
20.33 	explain the enrollee's right to appeal the decision. If an enrollee chooses to appeal a denial, 
21.1 	the enrollee must appeal the denial within five business days of the date on which the enrollee 
21.2 	receives the denial. If authorization is granted, the health plan company must provide the 
21.3 	enrollee, within five business days of granting the authorization, with an explanation of 
21.4 	how transition of care will be provided.

21.5 	EFFECTIVE DATE. This section is effective for health plans issued after December 
21.6 	31, 2016, and before March 2, 2017, and that are in effect for all or a portion of calendar 
21.7 	year 2017. This section expires June 30, 2018.

21.8 	Sec. 17. COSTS RELATED TO IMPLEMENTATION OF THIS ACT.
 21.9 	A state agency that incurs administrative costs to implement one or more provisions in 
21.10 	this act and does not receive an appropriation for administrative costs in section 16 or article 
21.11 	1, section 6, must implement the act within the limits of existing appropriations.

21.12 	Sec. 18. INSURANCE MARKET OPTIONS.
 21.13 	The commissioner of commerce shall report by February 15, 2017, to the standing 
21.14 	committees of the legislature having jurisdiction over insurance and health on:
21.15 	(1) a plan to implement and operate a residency verification process for individual health 
21.16 	insurance market participants; and
21.17 	(2) the past and future use of Minnesota Statutes 2005, section 62L.056, and Minnesota 
21.18 	Statutes, section 62Q.188, including:
21.19 	(i) rate and form filings received, approved, or withdrawn;
21.20 	(ii) barriers to current utilization, including federal and state laws; and
21.21 	(iii) recommendations for allowing or increasing the offering of health plans compliant 
21.22 	with Minnesota Statutes, section 62Q.188.

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

21.24 	Sec. 19. APPROPRIATION; COVERAGE FOR TRANSITION OF CARE.
 21.25 	$15,000,000 in fiscal year 2017 is appropriated from the general fund to the commissioner 
21.26 	of Minnesota Management and Budget to reimburse health plan companies for costs attributed 
21.27 	to coverage of transition of care services under section 13. No more than three percent of 
21.28 	this appropriation is available to the commissioner for administrative costs. This is a onetime 
21.29 	appropriation and is available until June 30, 2018. Any funds remaining from this 
22.1 	appropriation on June 30, 2018, cancel to the budget reserve account in Minnesota Statutes, 
22.2 	section 16A.152, subdivision 1a.

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

22.4 	Sec. 20.  REPEALER.
 22.5 	(a) Minnesota Statutes 2016, section 62D.12, subdivision 9, is repealed effective the 
22.6 	day following final enactment.
22.7 	(b) Minnesota Statutes 2016, section 62K.11, is repealed effective July 1, 2017.

APPENDIX 

Repealed Minnesota Statutes: UES0001-1 

62D.12 PROHIBITED PRACTICES.Subd. 9.Net earnings. 
All net earnings of the health maintenance organization shall be devoted to the nonprofit purposes of the health maintenance organization in providing comprehensive health care. No health maintenance organization shall provide for the payment, whether directly or indirectly, of any part of its net earnings, to any person as a dividend or rebate; provided, however, that health maintenance organizations may make payments to providers or other persons based upon the efficient provision of services or as incentives to provide quality care. The commissioner of health shall, pursuant to sections 62D.01 to 62D.30, revoke the certificate of authority of any health maintenance organization in violation of this subdivision. 

62K.11 BALANCE BILLING PROHIBITED.
(a) A network provider is prohibited from billing an enrollee for any amount in excess of the allowable amount the health carrier has contracted for with the provider as total payment for the health care service. A network provider is permitted to bill an enrollee the approved co-payment, deductible, or coinsurance. 

(b) A network provider is permitted to bill an enrollee for services not covered by the enrollee's health plan as long as the enrollee agrees in writing in advance before the service is performed to pay for the noncovered service.