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Minnesota Legislature

Office of the Revisor of Statutes

62D.095 ENROLLEE COST SHARING.
    Subdivision 1. General application. A health maintenance contract may contain enrollee
cost-sharing provisions as specified in this section. Co-payment and deductible provisions in a
group contract must not discriminate on the basis of age, sex, race, disability, economic status, or
length of enrollment in the health plan. During an open enrollment period in which all offered
health plans fully participate without any underwriting restrictions, co-payment and deductible
provisions must not discriminate on the basis of preexisting health status.
    Subd. 2. Co-payments. (a) A health maintenance contract may impose a co-payment as
authorized under Minnesota Rules, part 4685.0801, or under this section.
(b) A health maintenance organization may impose a flat fee co-payment on outpatient
office visits not to exceed 40 percent of the median provider's charges for similar services or
goods received by the enrollees as calculated under Minnesota Rules, part 4685.0801. A health
maintenance organization may impose a flat fee co-payment on outpatient prescription drugs not
to exceed 50 percent of the median provider's charges for similar services or goods received by
the enrollees as calculated under Minnesota Rules, part 4685.0801.
(c) If a health maintenance contract is permitted to impose a co-payment for preexisting
health status under sections 62D.01 to 62D.30, these provisions may vary with respect to length
of enrollment in the health plan.
    Subd. 3. Deductibles. (a) A health maintenance contract issued by a health maintenance
organization that is assessed less than three percent of the total annual amount assessed by the
Minnesota comprehensive health association may impose deductibles not to exceed $3,000 per
person, per year and $6,000 per family, per year. For purposes of the percentage calculation, a
health maintenance organization's assessments include those of its affiliates.
(b) All other health maintenance contracts may impose deductibles not to exceed $2,250 per
person, per year and $4,500 per family, per year.
    Subd. 4. Annual out-of-pocket maximums. (a) A health maintenance contract issued by
a health maintenance organization that is assessed less than three percent of the total annual
amount assessed by the Minnesota comprehensive health association must include a limitation
not to exceed $4,500 per person and $7,500 per family on total annual out-of-pocket enrollee
cost-sharing expenses. For purposes of the percentage calculation, a health maintenance
organization's assessments include those of its affiliates.
(b) All other health maintenance contracts must include a limitation not to exceed $3,000 per
person and $6,000 per family on total annual out-of-pocket enrollee cost-sharing expenses.
    Subd. 5. Exceptions. No co-payments or deductibles may be imposed on preventive health
care services as described in Minnesota Rules, part 4685.0801, subpart 8.
    Subd. 6. Public programs. This section does not apply to the prepaid medical assistance
program, the MinnesotaCare program, the prepaid general assistance program, the federal
Medicare program, or the health plans provided through any of those programs.
History: 2002 c 387 s 3; 1Sp2003 c 14 art 7 s 8,9