Minnesota Legislature
HF 2997
as introduced - 89th Legislature (2015 - 2016) Posted on 03/14/2016 03:21pm
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A bill for an act
relating to commerce; regulating certain health reports and review rights;
amending Minnesota Statutes 2014, sections 62L.10, subdivision 1; 62Q.73,
subdivision 3.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2014, section 62L.10, subdivision 1, is amended to read:
Subdivision 1.
Reports.
A health carrier doing business in the small employer
market shall file by deleted text begin Aprildeleted text end new text begin Julynew text end 1 of each year an annual actuarial opinion with the
commissioner certifying that the health carrier complied with the underwriting and rating
requirements of this chapter during the preceding year and that the rating methods used
by the health carrier were actuarially sound. A health carrier shall retain a copy of the
opinion at its principal place of business.
Sec. 2.
Minnesota Statutes 2014, section 62Q.73, subdivision 3, is amended to read:
Subd. 3.
Right to external review.
(a) Any enrollee or anyone acting on behalf
of an enrollee who has received an adverse determination may submit a written request
for an external review of the adverse determination, if applicable under section 62Q.68,
subdivision 1, or 62M.06, to the commissioner of health if the request involves a health
plan company regulated by that commissioner or to the commissioner of commerce if the
request involves a health plan company regulated by that commissioner. Notification of
the enrollee's right to external reviewnew text begin , and notification of the time limit in paragraph
(d) applicable to the request,new text end must accompany the denial issued by the insurer. The
written request must be accompanied by a filing fee of $25. The fee may be waived
by the commissioner of health or commerce in cases of financial hardship and must be
refunded if the adverse determination is completely reversed. No enrollee may be subject
to filing fees totaling more than $75 during a plan year for group coverage or policy year
for individual coverage.
(b) Nothing in this section requires the commissioner of health or commerce to
independently investigate an adverse determination referred for independent external
review.
(c) If an enrollee requests an external review, the health plan company must
participate in the external review. The cost of the external review in excess of the filing
fee described in paragraph (a) shall be borne by the health plan company.
(d) The enrollee must request external review within six months from the date of
the adverse determination.