2006 Minnesota Statutes

62Q.51 POINT-OF-SERVICE OPTION.
    Subdivision 1. Definition. For purposes for this section, "point-of-service option" means
a health plan under which the health plan company will reimburse an appropriately licensed or
registered provider for providing covered services to an enrollee, without regard to whether the
provider belongs to a particular network and without regard to whether the enrollee was referred
to the provider by another provider.
    Subd. 2. Required point-of-service option. Each health plan company operating in the
small group or large group market shall offer at least one point-of-service option in each such
market in which it operates.
    Subd. 3. Rate approval. The premium rates and cost sharing requirements for each option
must be submitted to the commissioner of health or the commissioner of commerce as required
by law. A health plan that includes lower enrollee cost sharing for services provided by network
providers than for services provided by out-of-network providers, or lower enrollee cost sharing
for services provided with prior authorization or second opinion than for services provided
without prior authorization or second opinion, qualifies as a point-of-service option.
    Subd. 4. Exemption. This section does not apply to a health plan company with fewer than
50,000 enrollees in its commercial health plan products.
History: 1996 c 446 art 1 s 52; 1999 c 181 s 6