Skip to main content Skip to office menu Skip to footer
Minnesota Legislature

Office of the Revisor of Statutes

CHAPTER 62E. COMPREHENSIVE HEALTH INSURANCE

Table of Sections
SectionHeadnote
62E.01CITATION.
62E.02DEFINITIONS.
62E.03
62E.035Repealed, 2005 c 77 s 8
62E.04DUTIES OF INSURERS.
62E.05INFORMATION ON QUALIFIED PLANS.
62E.06MINIMUM BENEFITS OF QUALIFIED PLAN.
62E.07QUALIFIED MEDICARE SUPPLEMENT PLAN.
62E.08STATE PLAN PREMIUM.
62E.081Repealed, 1987 c 384 art 3 s 34
62E.09DUTIES OF COMMISSIONER.
62E.091APPROVAL OF STATE PLAN PREMIUMS.
62E.10COMPREHENSIVE HEALTH ASSOCIATION.
62E.101MANAGED CARE DELIVERY METHOD.
62E.11OPERATION OF COMPREHENSIVE PLAN.
62E.1262E.12 MINIMUM BENEFITS OF COMPREHENSIVE HEALTH INSURANCE PLAN.
62E.13ADMINISTRATION OF PLAN.
62E.14ENROLLMENT BY AN ELIGIBLE PERSON.
62E.141INCLUSION IN EMPLOYER-SPONSORED PLAN.
62E.15SOLICITATION OF ELIGIBLE PERSONS.
62E.16POLICY CONVERSION RIGHTS.
62E.17Repealed, 1Sp1985 c 9 art 2 s 104
62E.18HEALTH INSURANCE FOR RETIRED EMPLOYEES NOT ELIGIBLE FOR MEDICARE.
62E.19PAYMENTS FOR PREEXISTING CONDITIONS.
62E.51Repealed, 1994 c 625 art 10 s 49
62E.52Repealed, 1994 c 625 art 10 s 49
62E.53Repealed, 1994 c 625 art 10 s 49
62E.531Repealed, 1994 c 625 art 10 s 49
62E.54Repealed, 1994 c 625 art 10 s 49
62E.55Repealed, 1994 c 625 art 10 s 49
62E.01 CITATION.
Sections 62E.01 to 62E.17 may be cited as the Minnesota Comprehensive Health Insurance
Act of 1976.
History: 1976 c 296 art 1 s 1
62E.02 DEFINITIONS.
    Subdivision 1. Application. For the purposes of sections 62E.01 to 62E.19, the terms and
phrases defined in this section have the meanings given them.
    Subd. 2. Employer. "Employer" means any person, partnership, association, trust, estate
or corporation, including the state of Minnesota or any agency, instrumentality or governmental
subdivision thereof, which employs ten or more individuals who are residents of this state.
    Subd. 3. Health maintenance organization. "Health maintenance organization" means a
nonprofit corporation licensed and operated as provided in chapter 62D.
    Subd. 4. Qualified plan. "Qualified plan" means those health benefit plans which have been
certified by the commissioner as providing the minimum benefits required by section 62E.06
or the actuarial equivalent of those benefits.
    Subd. 5. Qualified Medicare supplement plan. "Qualified Medicare supplement plan"
means those health benefit plans which have been certified by the commissioner as providing the
minimum benefits required by section 62E.07.
    Subd. 6. Commissioner. "Commissioner" means the commissioner of commerce.
    Subd. 7. Dependent. "Dependent" means a spouse or unmarried child under the age of 25, or
a dependent child of any age who is disabled.
    Subd. 8. Employee. "Employee" means any Minnesota resident who has entered into
the employment of or works under contract or service or apprenticeship with any employer.
"Employee" does not include a person who has been employed for less than 30 days by that
person's present employer, nor one who is employed less than 30 hours per week by that person's
present employer, nor an independent contractor.
    Subd. 9. Plan of health coverage. "Plan of health coverage" means any plan or combination
of plans of coverage, including combinations of self insurance, individual accident and health
insurance policies, group accident and health insurance policies, coverage under a nonprofit health
service plan, or coverage under a health maintenance organization subscriber contract.
    Subd. 10. Insurer. "Insurer" means those companies operating pursuant to chapter 62A
or 62C and offering, selling, issuing, or renewing policies or contracts of accident and health
insurance. "Insurer" does not include health maintenance organizations or community integrated
service networks.
    Subd. 11. Accident and health insurance policy or policy. "Accident and health insurance
policy" or "policy" means insurance or nonprofit health service plan contracts providing benefits
for hospital, surgical and medical care. "Policy" does not include coverage which is (1) limited
to disability or income protection coverage, (2) automobile medical payment coverage, (3)
supplemental to liability insurance, (4) designed solely to provide payments on a per diem, fixed
indemnity or nonexpense incurred basis, (5) credit accident and health insurance issued pursuant
to chapter 62B, (6) designed solely to provide dental or vision care, (7) blanket accident and
sickness insurance as defined in section 62A.11, or (8) accident only coverage issued by licensed
and tested insurance agents or solicitors which provides reasonable benefits in relation to the cost
of covered services. The provisions of clause (4) shall not apply to hospital indemnity coverage
which is sold by an insurer to an applicant who is not then currently covered by a qualified plan.
    Subd. 12. Health benefits. "Health benefits" means benefits offered to employees on an
indemnity or prepaid basis which pay the costs of or provide medical, surgical or hospital care.
    Subd. 13. Eligible person. (a) "Eligible person" means an individual who:
(1) is currently and has been a resident of Minnesota for the six months immediately
preceding the date of receipt by the association or its writing carrier of a completed certificate of
eligibility;
(2) meets the enrollment requirements of section 62E.14; and
(3) is not otherwise ineligible under this subdivision.
For purposes of eligibility under section 62E.14, subdivision 4c, paragraph (b), this definition is
modified as provided in that paragraph.
(b) No individual is eligible for coverage under a qualified or a Medicare supplement plan
issued by the association for whom a premium is paid or reimbursed by the medical assistance
program or general assistance medical care program as of the first day of any term for which a
premium amount is paid or reimbursed.
    Subd. 14. Minnesota Comprehensive Health Association or association. "Minnesota
Comprehensive Health Association" or "association" means the association created by section
62E.10.
    Subd. 15. Medicare. "Medicare" means part A and part B of the United States Social
Security Act, title XVIII, as amended, United States Code, title 42, sections 1394, et seq.
    Subd. 16. Medicare supplement plan. "Medicare supplement plan" means any plan of
insurance protection which provides benefits for the costs of medical, surgical or hospital care
and which is marketed as providing benefits which complement or supplement the benefits
provided by Medicare.
    Subd. 17. State plan premium. "State plan premium" means the premium determined
pursuant to section 62E.08.
    Subd. 18. Writing carrier. "Writing carrier" means the insurer or insurers, health
maintenance organization or organizations, community integrated service network or networks,
or other entity selected by the association and approved by the commissioner to administer the
comprehensive health insurance plan.
    Subd. 19. Fraternal benefit society or fraternal. "Fraternal benefit society" or "fraternal"
means a corporation, society, order, or voluntary association without capital stock which sells
health and accident insurance in accordance with chapter 64B.
    Subd. 20. Comprehensive health insurance plan or state plan. "Comprehensive health
insurance plan" or "state plan" means policies of insurance and contracts of health maintenance
organization or community integrated service network coverage offered by the association
through the writing carrier.
    Subd. 21. Self-insurer. "Self-insurer" means an employer or an employee welfare benefit
fund or plan which directly or indirectly provides a plan of health coverage to its employees
and administers the plan of health coverage itself or through an insurer, trust or agent except
to the extent of accident and health insurance premium, subscriber contract charges or health
maintenance organization contract charges. "Self-insurer" does not include an employer engaged
in the business of providing health care services to the public which provides health care services
directly to its employees at no charge to them.
    Subd. 22. Self-insurance. "Self-insurance" means a plan of health coverage offered by a
self-insurer.
    Subd. 23. Contributing member. "Contributing member" means those companies regulated
under chapter 62A and offering, selling, issuing, or renewing policies or contracts of accident
and health insurance; health maintenance organizations regulated under chapter 62D; nonprofit
health service plan corporations regulated under chapter 62C; community integrated service
networks regulated under chapter 62N; fraternal benefit societies regulated under chapter 64B;
the Minnesota employees insurance program established in section 43A.317, effective July 1,
1993; and joint self-insurance plans regulated under chapter 62H. For the purposes of determining
liability of contributing members pursuant to section 62E.11 payments received from or on
behalf of Minnesota residents for coverage by a health maintenance organization or community
integrated service network shall be considered to be accident and health insurance premiums.
History: 1976 c 296 art 1 s 2; 1977 c 409 s 4-7; 1979 c 272 s 1,2; 1981 c 318 s 13; 1983 c
289 s 114 subd 1; 1984 c 655 art 1 s 92; 1985 c 49 s 41; 1986 c 444; 1987 c 268 art 2 s 17; 1987
c 384 art 2 s 1; art 3 s 47; 1988 c 612 s 27; 1992 c 549 art 3 s 13; 1992 c 564 art 1 s 34,54; 1994
c 625 art 8 s 7-10; art 10 s 50; 1995 c 258 s 40; 1997 c 175 art 1 s 1; 1997 c 225 art 2 s 62; art 6
s 1,2; 1999 c 177 s 44; 1999 c 245 art 10 s 10; 2007 c 147 art 12 s 2
62E.03    Subdivision 1.[Repealed, 2005 c 132 s 38]
    Subd. 2.[Repealed, 1Sp1985 c 14 art 1 s 59]
62E.035 [Repealed, 2005 c 77 s 8]
62E.04 DUTIES OF INSURERS.
    Subdivision 1. Individual policies. For each type of qualified plan described in section
62E.06, an insurer or fraternal issuing individual policies of accident and health insurance in this
state, other than group conversion policies, shall develop and file with the commissioner an
individual policy which meets the minimum standards of that type of qualified plan. An insurer
or fraternal issuing individual policies of accident and health insurance in this state shall offer
each type of qualified plan to each person who applies and is eligible for accident and health
insurance from that insurer or fraternal.
    Subd. 2. Medicare supplement plan. An insurer or fraternal issuing Medicare supplement
plans in this state shall develop and file with the commissioner a Medicare supplement policy
which meets the minimum standards of a qualified Medicare supplement plan. An insurer
or fraternal issuing Medicare supplement plans in this state shall offer a qualified medicare
supplement plan to each person who is eligible for coverage and who applies for a Medicare
supplement plan.
    Subd. 3. Group policies. For each type of qualified plan described in section 62E.06, an
insurer or fraternal issuing group policies of accident and health insurance in this state shall
develop and file with the commissioner a group policy which provides for each member of the
group the minimum benefits required by that type of qualified plan. An insurer or fraternal issuing
group policies of accident and health insurance in this state shall offer each type of qualified plan
to each eligible applicant for group accident and health insurance.
    Subd. 4. Major medical coverage. Each insurer and fraternal shall affirmatively offer
coverage of major medical expenses to every applicant who applies to the insurer or fraternal for
a new unqualified policy, which has a lifetime benefit limit of less than $1,000,000, at the time
of application and annually to every holder of such an unqualified policy of accident and health
insurance renewed by the insurer or fraternal. The coverage shall provide that when a covered
individual incurs out-of-pocket expenses of $5,000 or more within a calendar year for services
covered in section 62E.06, subdivision 1, benefits shall be payable, subject to any co-payment
authorized by the commissioner, up to a maximum lifetime limit of not less than $1,000,000. The
offer of coverage of major medical expenses may consist of the offer of a rider on an existing
unqualified policy or a new policy which is a qualified plan.
    Subd. 5. Effect of noncompliance. No policy of accident and health insurance may be
issued or renewed in this state 180 days after July 1, 1976 by an insurer or a fraternal which has
not complied with the requirements of this section.
    Subd. 6. Reinsurance allowed. An insurer or fraternal may fulfill its obligations under
this section by issuing the required coverages in their own name and reinsuring the risk and
administration of the coverages with the association in accordance with section 62E.10,
subdivision 7
, clauses (e) and (f).
    Subd. 7. Underwriting standards may apply. Nothing in this section shall require an
insurer or fraternal to offer or issue a policy to any person who does not meet the underwriting or
membership requirements of the insurer or fraternal.
    Subd. 8. Reduction of benefits because of other services. No policy of accident and
health insurance shall contain any provision denying or reducing benefits because services are
rendered to an insured or dependent who is eligible for or receiving benefits pursuant to chapters
256B and 256D, or sections 252.27; 260B.331, subdivision 2; 260C.331, subdivision 2; 393.07,
subdivision 1
or 2.
    Subd. 9.[Repealed, 1995 c 207 art 10 s 25]
    Subd. 10.[Repealed, 1995 c 207 art 10 s 25]
History: 1976 c 296 art 1 s 4; 1977 c 409 s 9,10; 1979 c 174 s 3; 1979 c 272 s 4; 1988 c
689 art 2 s 14,15; 1988 c 704 s 1; 1996 c 305 art 1 s 21; 1999 c 139 art 4 s 2; 2000 c 483 s
14; 2001 c 215 s 18
62E.05 INFORMATION ON QUALIFIED PLANS.
    Subdivision 1. Certification. Upon application by an insurer, fraternal, or employer for
certification of a plan of health coverage as a qualified plan or a qualified Medicare supplement
plan for the purposes of sections 62E.01 to 62E.19, the commissioner shall make a determination
within 90 days as to whether the plan is qualified. All plans of health coverage, except Medicare
supplement policies, shall be labeled as "qualified" or "nonqualified" on the front of the policy
or contract, or on the schedule page. All qualified plans shall indicate whether they are number
one, two, or three coverage plans.
    Subd. 2. Annual report. The state of Minnesota or any of its departments, agencies,
programs, instrumentalities, or political subdivisions, shall report in writing to the association and
to the commissioner of commerce no later than September 15 of each year regarding the number
of persons and the amount of premiums, deductibles, co-payments, or coinsurance that it paid
for on behalf of enrollees in the Comprehensive Health Association. This report must contain
only summary information and must not include any individually identifiable data. The report
must cover the 12-month period ending the preceding June 30.
History: 1976 c 296 art 1 s 5; 1987 c 384 art 2 s 1; 1994 c 485 s 34; 1995 c 234 art 7 s 8;
1996 c 446 art 1 s 41; 1999 c 177 s 45; 2000 c 398 s 1; 2005 c 77 s 2
62E.06 MINIMUM BENEFITS OF QUALIFIED PLAN.
    Subdivision 1. Number three plan. A plan of health coverage shall be certified as a number
three qualified plan if it otherwise meets the requirements established by chapters 62A, 62C, and
62Q, and the other laws of this state, whether or not the policy is issued in Minnesota, and meets
or exceeds the following minimum standards:
(a) The minimum benefits for a covered individual shall, subject to the other provisions
of this subdivision, be equal to at least 80 percent of the cost of covered services in excess of
an annual deductible which does not exceed $150 per person. The coverage shall include a
limitation of $3,000 per person on total annual out-of-pocket expenses for services covered
under this subdivision. The coverage shall be subject to a maximum lifetime benefit of not less
than $1,000,000.
The $3,000 limitation on total annual out-of-pocket expenses and the $1,000,000 maximum
lifetime benefit shall not be subject to change or substitution by use of an actuarially equivalent
benefit.
(b) Covered expenses shall be the usual and customary charges for the following services
and articles when prescribed by a physician:
(1) hospital services;
(2) professional services for the diagnosis or treatment of injuries, illnesses, or conditions,
other than dental, which are rendered by a physician or at the physician's direction;
(3) drugs requiring a physician's prescription;
(4) services of a nursing home for not more than 120 days in a year if the services would
qualify as reimbursable services under Medicare;
(5) services of a home health agency if the services would qualify as reimbursable services
under Medicare;
(6) use of radium or other radioactive materials;
(7) oxygen;
(8) anesthetics;
(9) prostheses other than dental but including scalp hair prostheses worn for hair loss
suffered as a result of alopecia areata;
(10) rental or purchase, as appropriate, of durable medical equipment other than eyeglasses
and hearing aids, unless coverage is required under section 62Q.675;
(11) diagnostic x-rays and laboratory tests;
(12) oral surgery for partially or completely unerupted impacted teeth, a tooth root without
the extraction of the entire tooth, or the gums and tissues of the mouth when not performed in
connection with the extraction or repair of teeth;
(13) services of a physical therapist;
(14) transportation provided by licensed ambulance service to the nearest facility qualified to
treat the condition; or a reasonable mileage rate for transportation to a kidney dialysis center for
treatment; and
(15) services of an occupational therapist.
(c) Covered expenses for the services and articles specified in this subdivision do not include
the following:
(1) any charge for care for injury or disease either (i) arising out of an injury in the course
of employment and subject to a workers' compensation or similar law, (ii) for which benefits
are payable without regard to fault under coverage statutorily required to be contained in any
motor vehicle, or other liability insurance policy or equivalent self-insurance, or (iii) for which
benefits are payable under another policy of accident and health insurance, Medicare, or any other
governmental program except as otherwise provided by section 62A.04, subdivision 3, clause (4);
(2) any charge for treatment for cosmetic purposes other than for reconstructive surgery
when such service is incidental to or follows surgery resulting from injury, sickness, or other
diseases of the involved part or when such service is performed on a covered dependent child
because of congenital disease or anomaly which has resulted in a functional defect as determined
by the attending physician;
(3) care which is primarily for custodial or domiciliary purposes which would not qualify as
eligible services under Medicare;
(4) any charge for confinement in a private room to the extent it is in excess of the
institution's charge for its most common semiprivate room, unless a private room is prescribed
as medically necessary by a physician, provided, however, that if the institution does not have
semiprivate rooms, its most common semiprivate room charge shall be considered to be 90
percent of its lowest private room charge;
(5) that part of any charge for services or articles rendered or prescribed by a physician,
dentist, or other health care personnel which exceeds the prevailing charge in the locality where
the service is provided; and
(6) any charge for services or articles the provision of which is not within the scope of
authorized practice of the institution or individual rendering the services or articles.
(d) The minimum benefits for a qualified plan shall include, in addition to those benefits
specified in clauses (a) and (e), benefits for well baby care, effective July 1, 1980, subject to
applicable deductibles, coinsurance provisions, and maximum lifetime benefit limitations.
(e) Effective July 1, 1979, the minimum benefits of a qualified plan shall include, in addition
to those benefits specified in clause (a), a second opinion from a physician on all surgical
procedures expected to cost a total of $500 or more in physician, laboratory, and hospital fees,
provided that the coverage need not include the repetition of any diagnostic tests.
(f) Effective August 1, 1985, the minimum benefits of a qualified plan must include, in
addition to the benefits specified in clauses (a), (d), and (e), coverage for special dietary treatment
for phenylketonuria when recommended by a physician.
(g) Outpatient mental health coverage is subject to section 62A.152, subdivision 2.
    Subd. 2. Number two plan. A plan of health coverage shall be certified as a number two
qualified plan if it meets the requirements established by subdivision 1 except that the deductible
shall not exceed $500 per person.
    Subd. 3. Number one plan. A plan of health coverage shall be certified as a number one
qualified plan if it meets the requirements established by subdivision 1 except that the deductible
shall not exceed $1,000 per person.
    Subd. 4. Health maintenance plans. A health maintenance organization which provides the
services required by chapter 62D shall be deemed to be providing a number three qualified plan.
History: 1975 c 359 s 23; 1976 c 296 art 1 s 6; 1977 c 409 s 11; 1979 c 272 s 5; 1980 c 496
s 3; 1981 c 265 s 2; 1Sp1985 c 9 art 2 s 2; 1986 c 444; 1987 c 202 s 2; 1987 c 337 s 66; 1988 c
704 s 2; 1989 c 330 s 24; 2001 c 215 s 19; 1Sp2003 c 14 art 7 s 10
62E.07 QUALIFIED MEDICARE SUPPLEMENT PLAN.
Any plan which provides benefits may be certified as a qualified Medicare supplement plan
if the plan is designed to supplement Medicare and provides coverage of 100 percent of the
deductibles required under Medicare and 80 percent of the charges for covered services described
in section 62E.06, subdivision 1, which charges are not paid by Medicare. The coverage shall
include a limitation of $1,000 per person on total annual out-of-pocket expenses for the covered
services.
History: 1976 c 296 art 1 s 7; 1989 c 258 s 12; 1992 c 554 art 1 s 14
62E.08 STATE PLAN PREMIUM.
    Subdivision 1. Establishment. The association shall establish the following maximum
premiums to be charged for membership in the comprehensive health insurance plan:
(a) the premium for the number one qualified plan shall range from a minimum of 101
percent to a maximum of 125 percent of the weighted average of rates charged by those insurers
and health maintenance organizations with individuals enrolled in:
(1) $1,000 annual deductible individual plans of insurance in force in Minnesota;
(2) individual health maintenance organization contracts of coverage with a $1,000 annual
deductible which are in force in Minnesota; and
(3) other plans of coverage similar to plans offered by the association based on generally
accepted actuarial principles;
(b) the premium for the number two qualified plan shall range from a minimum of 101
percent to a maximum of 125 percent of the weighted average of rates charged by those insurers
and health maintenance organizations with individuals enrolled in:
(1) $500 annual deductible individual plans of insurance in force in Minnesota;
(2) individual health maintenance organization contracts of coverage with a $500 annual
deductible which are in force in Minnesota; and
(3) other plans of coverage similar to plans offered by the association based on generally
accepted actuarial principles;
(c) the premiums for the plans with a $2,000, $5,000, or $10,000 annual deductible shall
range from a minimum of 101 percent to a maximum of 125 percent of the weighted average of
rates charged by those insurers and health maintenance organizations with individuals enrolled in:
(1) $2,000, $5,000, or $10,000 annual deductible individual plans, respectively, in force in
Minnesota; and
(2) individual health maintenance organization contracts of coverage with a $2,000, $5,000,
or $10,000 annual deductible, respectively, which are in force in Minnesota; or
(3) other plans of coverage similar to plans offered by the association based on generally
accepted actuarial principles;
(d) the premium for each type of Medicare supplement plan required to be offered by the
association pursuant to section 62E.12 shall range from a minimum of 101 percent to a maximum
of 125 percent of the weighted average of rates charged by those insurers and health maintenance
organizations with individuals enrolled in:
(1) Medicare supplement plans in force in Minnesota;
(2) health maintenance organization Medicare supplement contracts of coverage which are
in force in Minnesota; and
(3) other plans of coverage similar to plans offered by the association based on generally
accepted actuarial principles; and
(e) the charge for health maintenance organization coverage shall be based on generally
accepted actuarial principles.
The list of insurers and health maintenance organizations whose rates are used to establish
the premium for coverage offered by the association pursuant to paragraphs (a) to (d) shall be
established by the commissioner on the basis of information which shall be provided to the
association by all insurers and health maintenance organizations annually at the commissioner's
request. This information shall include the number of individuals covered by each type of plan or
contract specified in paragraphs (a) to (d) that is sold, issued, and renewed by the insurers and
health maintenance organizations, including those plans or contracts available only on a renewal
basis. The information shall also include the rates charged for each type of plan or contract.
In establishing premiums pursuant to this section, the association shall utilize generally
accepted actuarial principles, provided that the association shall not discriminate in charging
premiums based upon sex. In order to compute a weighted average for each type of plan or
contract specified under paragraphs (a) to (d), the association shall, using the information collected
pursuant to this subdivision, list insurers and health maintenance organizations in rank order of
the total number of individuals covered by each insurer or health maintenance organization. The
association shall then compute a weighted average of the rates charged for coverage by all the
insurers and health maintenance organizations by:
(1) multiplying the numbers of individuals covered by each insurer or health maintenance
organization by the rates charged for coverage;
(2) separately summing both the number of individuals covered by all the insurers and health
maintenance organizations and all the products computed under clause (1); and
(3) dividing the total of the products computed under clause (1) by the total number of
individuals covered.
The association may elect to use a sample of information from the insurers and health
maintenance organizations for purposes of computing a weighted average. In no case, however,
may a sample used by the association to compute a weighted average include information from
fewer than the two insurers or health maintenance organizations highest in rank order.
    Subd. 2. Self-supporting. Subject to subdivision 1, the schedule of premiums for coverage
under the comprehensive health insurance plan shall be designed to be self-supporting and based
on generally accepted actuarial principles.
    Subd. 3. Determination of rates. Premium rates under this section must be determined
annually. These rates are effective July 1 of each year and must be based on a survey of approved
rates of insurers and health maintenance organizations in effect, or to be in effect, on April 1 of
the same calendar year. These rates may be trended to July 1 in order to reflect economic and
inflationary changes.
    Subd. 4. Smoker's rates. The association may establish smoker and nonsmoker premium
rates that are based on generally accepted actuarial principles.
History: 1976 c 296 art 1 s 8; 1977 c 409 s 12; 1979 c 272 s 6; 1983 c 123 s 1; 1991 c 165 s
2; 1993 c 324 s 1; 2000 c 398 s 2; 2003 c 109 s 2
62E.081 [Repealed, 1987 c 384 art 3 s 34]
62E.09 DUTIES OF COMMISSIONER.
The commissioner may:
(a) formulate general policies to advance the purposes of sections 62E.01 to 62E.19;
(b) supervise the creation of the Minnesota Comprehensive Health Association within the
limits described in section 62E.10;
(c) approve the selection of the writing carrier by the association, approve the association's
contract with the writing carrier, and approve the state plan coverage;
(d) appoint advisory committees;
(e) conduct periodic audits to assure the general accuracy of the financial data submitted by
the writing carrier and the association;
(f) contract with the federal government or any other unit of government to ensure
coordination of the state plan with other governmental assistance programs;
(g) undertake directly or through contracts with other persons studies or demonstration
programs to develop awareness of the benefits of sections 62E.01 to 62E.16, so that the residents
of this state may best avail themselves of the health care benefits provided by these sections;
(h) contract with insurers and others for administrative services; and
(i) adopt, amend, suspend and repeal rules as reasonably necessary to carry out and make
effective the provisions and purposes of sections 62E.01 to 62E.19.
History: 1976 c 296 art 1 s 9; 1977 c 409 s 13; 1987 c 384 art 2 s 1; 1993 c 324 s 2;
1996 c 305 art 2 s 7; 1999 c 177 s 46
62E.091 APPROVAL OF STATE PLAN PREMIUMS.
The association shall submit to the commissioner any premiums it proposes to become
effective for coverage under the comprehensive health insurance plan, pursuant to section 62E.08,
subdivision 3
. No later than 45 days before the effective date for premiums specified in section
62E.08, subdivision 3, the commissioner shall approve, modify, or reject the proposed premiums
on the basis of the following criteria:
(a) whether the association has complied with the provisions of section 62E.11, subdivision
11
;
(b) whether the association has submitted the proposed premiums in a manner which
provides sufficient time for individuals covered under the comprehensive insurance plan to receive
notice of any premium increase no less than 30 days prior to the effective date of the increase;
(c) the degree to which the association's computations and conclusions are consistent with
section 62E.08;
(d) the degree to which any sample used to compute a weighted average by the association
pursuant to section 62E.08 reasonably reflects circumstances existing in the private marketplace
for individual coverage;
(e) the degree to which a weighted average computed pursuant to section 62E.08 that uses
information pertaining to individual coverage available only on a renewal basis reflects the
circumstances existing in the private marketplace for individual coverage;
(f) a comparison of the proposed increases with increases in the cost of medical care and
increases experienced in the private marketplace for individual coverage;
(g) the financial consequences to enrollees of the proposed increase;
(h) the actuarially projected effect of the proposed increase upon both total enrollment in,
and the nature of the risks assumed by, the comprehensive health insurance plan;
(i) the relative solvency of the contributing members; and
(j) other factors deemed relevant by the commissioner.
In no case, however, may the commissioner approve premiums for those plans of coverage
described in section 62E.08, subdivision 1, paragraphs (a) to (d), that are lower than 101 percent
or greater than 125 percent of the weighted averages computed by the association pursuant to
section 62E.08. The commissioner shall support a decision to approve, modify, or reject any
premium proposed by the association with written findings and conclusions addressing each
criterion specified in this section. If the commissioner does not approve, modify, or reject the
premiums proposed by the association sooner than 45 days before the effective date for premiums
specified in section 62E.08, subdivision 3, the premiums proposed by the association under this
section become effective.
History: 1993 c 324 s 3; 2003 c 109 s 3
62E.10 COMPREHENSIVE HEALTH ASSOCIATION.
    Subdivision 1. Creation; tax exemption. There is established a Comprehensive Health
Association to promote the public health and welfare of the state of Minnesota with membership
consisting of all insurers; self-insurers; fraternals; joint self-insurance plans regulated under
chapter 62H; the Minnesota employees insurance program established in section 43A.317,
effective July 1, 1993; health maintenance organizations; and community integrated service
networks licensed or authorized to do business in this state. The Comprehensive Health
Association is exempt from the taxes imposed under chapter 297I and any other laws of this state
and all property owned by the association is exempt from taxation.
    Subd. 2. Board of directors; organization. The board of directors of the association shall be
made up of eleven members as follows: six directors selected by contributing members, subject
to approval by the commissioner, one of which must be a health actuary; five public directors
selected by the commissioner, at least two of whom must be plan enrollees, two of whom must
be representatives of employers whose accident and health insurance premiums are part of the
association's assessment base, and one of whom must be a licensed insurance agent. At least two
of the public directors must reside outside of the seven county metropolitan area. In determining
voting rights at members' meetings, each member shall be entitled to vote in person or proxy.
The vote shall be a weighted vote based upon the member's cost of self-insurance, accident and
health insurance premium, subscriber contract charges, health maintenance contract payment, or
community integrated service network payment derived from or on behalf of Minnesota residents
in the previous calendar year, as determined by the commissioner. In approving directors of the
board, the commissioner shall consider, among other things, whether all types of members are
fairly represented. Directors selected by contributing members may be reimbursed from the
money of the association for expenses incurred by them as directors, but shall not otherwise
be compensated by the association for their services. The costs of conducting meetings of the
association and its board of directors shall be borne by members of the association.
    Subd. 2a. Appeals. A person may appeal to the commissioner within 30 days after notice
of an action, ruling, or decision by the board.
A final action or order of the commissioner under this subdivision is subject to judicial
review in the manner provided by chapter 14.
In lieu of the appeal to the commissioner, a person may seek judicial review of the board's
action.
    Subd. 3. Mandatory membership. All members shall maintain their membership in
the association as a condition of doing accident and health insurance, self-insurance, health
maintenance organization, or community integrated service network business in this state.
The association shall submit its articles, bylaws and operating rules to the commissioner for
approval; provided that the adoption and amendment of articles, bylaws and operating rules by
the association and the approval by the commissioner thereof shall be exempt from the provisions
of sections 14.001 to 14.69.
    Subd. 4. Open meetings. All meetings of the association, its board, and any committees of
the association shall comply with the provisions of chapter 13D, except that during any portion of
a meeting during which an enrollee's appeal of an action of the writing carrier is being heard, that
portion of the meeting must be closed at the enrollee's request.
    Subd. 5.[Repealed, 1979 c 272 s 11]
    Subd. 6. Antitrust exemption. In the performance of their duties as members of the
association, the members shall be exempt from the provisions of sections 325D.49 to 325D.66.
    Subd. 7. General powers. The association may:
(a) Exercise the powers granted to insurers under the laws of this state;
(b) Sue or be sued;
(c) Enter into contracts with insurers, similar associations in other states or with other
persons for the performance of administrative functions including the functions provided for
in clauses (e) and (f);
(d) Establish administrative and accounting procedures for the operation of the association;
(e) Provide for the reinsuring of risks incurred as a result of issuing the coverages required
by sections 62E.04 and 62E.16 by members of the association. Each member which elects to
reinsure its required risks shall determine the categories of coverage it elects to reinsure in the
association. The categories of coverage are:
(1) individual qualified plans, excluding group conversions;
(2) group conversions;
(3) group qualified plans with fewer than 50 employees or members; and
(4) major medical coverage.
A separate election may be made for each category of coverage. If a member elects to reinsure
the risks of a category of coverage, it must reinsure the risk of the coverage of every life covered
under every policy issued in that category. A member electing to reinsure risks of a category of
coverage shall enter into a contract with the association establishing a reinsurance plan for the
risks. This contract may include provision for the pooling of members' risks reinsured through the
association and it may provide for assessment of each member reinsuring risks for losses and
operating and administrative expenses incurred, or estimated to be incurred in the operation of
the reinsurance plan. This reinsurance plan shall be approved by the commissioner before it is
effective. Members electing to administer the risks which are reinsured in the association shall
comply with the benefit determination guidelines and accounting procedures established by the
association. The fee charged by the association for the reinsurance of risks shall not be less than
110 percent of the total anticipated expenses incurred by the association for the reinsurance; and
(f) Provide for the administration by the association of policies which are reinsured
pursuant to clause (e). Each member electing to reinsure one or more categories of coverage in
the association may elect to have the association administer the categories of coverage on the
member's behalf. If a member elects to have the association administer the categories of coverage,
it must do so for every life covered under every policy issued in that category. The fee for the
administration shall not be less than 110 percent of the total anticipated expenses incurred by the
association for the administration.
    Subd. 8. Department of state exemption. The association is exempt from the Administrative
Procedure Act but, to the extent authorized by law to adopt rules, the association may use the
provisions of section 14.386, paragraph (a), clauses (1) and (3). Section 14.386, paragraph (b),
does not apply to these rules.
    Subd. 9. Experimental delivery method. The association may petition the commissioner of
commerce for a waiver to allow the experimental use of alternative means of health care delivery.
The commissioner may approve the use of the alternative means the commissioner considers
appropriate. The commissioner may waive any of the requirements of this chapter and chapters
60A, 62A, and 62D in granting the waiver. The commissioner may also grant to the association
any additional powers as are necessary to facilitate the specific waiver, including the power
to implement a provider payment schedule.
    Subd. 10. Cost containment goals. (a) By July 1, 2001, the association shall investigate
managed care delivery systems, and if cost effective, enter into contracts with third-party entities
as provided in section 62E.101.
(b) By July 1, 2001, the association shall establish a system to annually identify individuals
insured by the Minnesota Comprehensive Health Association who may be eligible for private
health care coverage, medical assistance, state drug programs, or other state or federal programs
and notify them about their eligibility for these programs.
(c) The association shall endeavor to reduce health care costs using additional methods
consistent with effective patient care. At a minimum, by July 1, 2001, the association shall:
(1) develop a focused chronic disease management and case management program;
(2) develop a comprehensive program of preventive care; and
(3) implement a total drug formulary program.
The association may establish an enrollee incentive based on enrollee participation in the
chronic disease management and case management program developed under this section.
History: 1976 c 296 art 1 s 10; 1977 c 409 s 14-16; 1979 c 272 s 7; 1981 c 253 s 23;
1982 c 424 s 130; 1Sp1985 c 10 s 63; 1987 c 337 s 67-69; 1987 c 384 art 2 s 1; 1988 c 612 s
28; 1990 c 422 s 10; 1990 c 523 s 2; 1991 c 165 s 3,4; 1991 c 264 s 1; 1992 c 549 art 3 s 14;
1992 c 554 art 1 s 15; 1992 c 564 art 1 s 35; art 4 s 11; 1993 c 324 s 4; 1994 c 426 s 12; 1994 c
625 art 8 s 11-13; art 10 s 50; 1997 c 187 art 5 s 10; 1997 c 225 art 2 s 62; 2000 c 394 art 2 s
14; 2000 c 398 s 3; 2004 c 268 s 2,3
62E.101 MANAGED CARE DELIVERY METHOD.
The association may form a preferred provider network or contract with an existing provider
network, health maintenance organization, or nonprofit health service plan corporation to deliver
the services and benefits provided for in the plans of health coverage offered. If the association
does not contract with an existing provider network, health maintenance organization, or nonprofit
health service plan corporation, the association may adopt a provider payment schedule and
negotiate provider payment rates subject to the approval of the commissioner.
History: 1991 c 165 s 5; 2000 c 398 s 4
62E.11 OPERATION OF COMPREHENSIVE PLAN.
    Subdivision 1. Enrollment. Upon certification as an eligible person in the manner provided
by section 62E.14, an eligible person may enroll in the comprehensive health insurance plan by
payment of the state plan premium to the writing carrier.
    Subd. 2. Employer premium payment. Any employer which has in its employ one or more
eligible persons enrolled in the comprehensive health insurance plan may make all or any portion
of the state plan premium payment to the state plan directly to the writing carrier.
    Subd. 3. Claims payments. Not less than 85 percent of the state plan premium paid to the
writing carrier shall be used to pay claims, and not more than 15 percent shall be used for the
payment of agent referral fees as authorized in section 62E.15, subdivision 3 and for payment of
the writing carrier's direct and indirect expenses, as specified in section 62E.13, subdivision 7.
    Subd. 4. Net income. Any income in excess of the costs incurred by the association in
providing reinsurance or administrative services pursuant to section 62E.07, clauses (e) and (f)
shall be held at interest and used by the association to offset losses due to claims expenses of the
state plan or allocated to reduce state plan premiums.
    Subd. 5. Allocation of losses. Each contributing member of the association shall share
the losses due to claims expenses of the comprehensive health insurance plan for plans issued
or approved for issuance by the association, and shall share in the operating and administrative
expenses incurred or estimated to be incurred by the association incident to the conduct of its
affairs. Claims expenses of the state plan which exceed the premium payments allocated to the
payment of benefits shall be the liability of the contributing members. Contributing members
shall share in the claims expense of the state plan and operating and administrative expenses of
the association in an amount equal to the ratio of the contributing member's total accident and
health insurance premium, received from or on behalf of Minnesota residents as divided by the
total accident and health insurance premium, received by all contributing members from or on
behalf of Minnesota residents, as determined by the commissioner. Payments made by the state
to a contributing member for medical assistance, MinnesotaCare, or general assistance medical
care services according to chapters 256, 256B, and 256D shall be excluded when determining a
contributing member's total premium.
    Subd. 6. Member assessments. The association shall make an annual determination of
each contributing member's liability, if any, and may make an annual fiscal year end assessment
if necessary. The association may also, subject to the approval of the commissioner, provide
for interim assessments against the contributing members whose aggregate assessments
comprised a minimum of 90 percent of the most recent prior annual assessment, in the event
that the association deems that methodology to be the most administratively efficient and
cost-effective means of assessment, and as may be necessary to assure the financial capability
of the association in meeting the incurred or estimated claims expenses of the state plan and
operating and administrative expenses of the association until the association's next annual fiscal
year end assessment. Payment of an assessment shall be due within 30 days of receipt by a
contributing member of a written notice of a fiscal year end or interim assessment. Failure by a
contributing member to tender to the association the assessment within 30 days shall be grounds
for termination of the contributing member's membership. A contributing member which ceases
to do accident and health insurance business within the state shall remain liable for assessments
through the calendar year during which accident and health insurance business ceased. The
association may decline to levy an assessment against a contributing member if the assessment, as
determined herein, would not exceed ten dollars.
    Subd. 7. Net gain. Net gains, if any, from the operation of the state plan shall be held at
interest and used by the association to offset future losses due to claims expenses of the state plan
or allocated to reduce state plan premiums.
    Subd. 8.[Repealed, 1987 c 268 art 2 s 38]
    Subd. 9. Special assessment upon termination of individual health coverage. Each
contributing member that terminates individual health coverage for reasons other than (a)
nonpayment of premium; (b) failure to make co-payments; (c) enrollee moving out of the area
served; or (d) a materially false statement or misrepresentation by the enrollee in the application
for membership; and does not provide or arrange for replacement coverage that meets the
requirements of section 62D.121; shall pay a special assessment to the state plan based upon the
number of terminated individuals who join the comprehensive health insurance plan as authorized
under section 62E.14, subdivisions 1, paragraph (d), and 6. Such a contributing member shall pay
the association an amount equal to the average cost of an enrollee in the state plan in the year in
which the member terminated enrollees multiplied by the total number of terminated enrollees
who enroll in the state plan.
The average cost of an enrollee in the state comprehensive health insurance plan shall be
determined by dividing the state plan's total annual losses by the total number of enrollees from
that year. This cost will be assessed to the contributing member who has terminated health
coverage before the association makes the annual determination of each contributing member's
liability as required under this section.
In the event that the contributing member is terminating health coverage because of a loss
of health care providers, the commissioner may review whether or not the special assessment
established under this subdivision will have an adverse impact on the contributing member or its
enrollees or insureds, including but not limited to causing the contributing member to fall below
statutory net worth requirements. If the commissioner determines that the special assessment
would have an adverse impact on the contributing member or its enrollees or insureds, the
commissioner may adjust the amount of the special assessment, or establish alternative payment
arrangements to the state plan. For health maintenance organizations regulated under chapter 62D,
the commissioner of health shall make the determination regarding any adjustment in the special
assessment and shall transmit that determination to the commissioner of commerce.
    Subd. 10. Termination of individual plan without replacement coverage. Any
contributing members who have terminated individual health plans and do not provide or arrange
for replacement coverage that meets the requirements of section 62D.121, and whose former
insureds or enrollees enroll in the state comprehensive health insurance plan with a waiver of
the preexisting conditions pursuant to section 62E.14, subdivisions 1, paragraph (d), and 6, will
be liable for the costs of any preexisting conditions of their former enrollees or insureds treated
during the first six months of coverage under the state plan. The liability for preexisting conditions
will be assessed before the association makes the annual determination of each contributing
member's liability as required under this section.
    Subd. 11. Rate increase or benefit change. The association must hold a public meeting to
hear public comment at least two weeks before filing a rate increase or benefit change with the
commissioner. Notice of the public meeting to hear public comment must be mailed at least two
weeks before the meeting to all plan enrollees.
    Subd. 12.[Repealed, 1997 c 225 art 2 s 63]
    Subd. 13. State funding; effect on premium rates of members. In approving the premium
rates as required in sections 62A.65, subdivision 3; and 62L.08, subdivision 8, the commissioners
of health and commerce shall ensure that any appropriation to reduce the annual assessment
made on the contributing members to cover the costs of the Minnesota comprehensive health
insurance plan as required under this section is reflected in the premium rates charged by each
contributing member.
History: 1976 c 296 art 1 s 11; 1977 c 409 s 17; 1979 c 272 s 8; 1982 c 426 s 1; 1984 c
514 art 2 s 2; 1986 c 444; 1988 c 434 s 17,18; 1991 c 54 s 1; 1991 c 264 s 2; 1992 c 549 art
3 s 15,16; 1992 c 564 art 1 s 36; 1993 c 345 art 8 s 5; 1997 c 225 art 2 s 8; 1999 c 245 art 10
s 1; 2002 c 330 s 13
62E.12 MINIMUM BENEFITS OF COMPREHENSIVE HEALTH INSURANCE PLAN.
    (a) The association through its comprehensive health insurance plan shall offer policies
which provide the benefits of a number one qualified plan and a number two qualified plan,
except that the maximum lifetime benefit on these plans shall be $5,000,000; and an extended
basic Medicare supplement plan and a basic Medicare supplement plan as described in sections
62A.3099 to 62A.44. The association may also offer a plan that is identical to a number one
and number two qualified plan except that it has a $2,000 annual deductible and a $5,000,000
maximum lifetime benefit. The association, subject to the approval of the commissioner, may also
offer plans that are identical to the number one or number two qualified plan, except that they
have annual deductibles of $5,000 and $10,000, respectively; have limitations on total annual
out-of-pocket expenses equal to those annual deductibles and therefore cover 100 percent of the
allowable cost of covered services in excess of those annual deductibles; and have a $5,000,000
maximum lifetime benefit. The association, subject to approval of the commissioner, may also
offer plans that meet all other requirements of state law except those that are inconsistent with
high deductible health plans as defined in sections 220 and 223 of the Internal Revenue Code and
supporting regulations. As of January 1, 2006, the association shall no longer be required to offer
an extended basic Medicare supplement plan.
    (b) The requirement that a policy issued by the association must be a qualified plan is
satisfied if the association contracts with a preferred provider network and the level of benefits
for services provided within the network satisfies the requirements of a qualified plan. If the
association uses a preferred provider network, payments to nonparticipating providers must meet
the minimum requirements of section 72A.20, subdivision 15.
    (c) The association shall offer health maintenance organization contracts in those areas of the
state where a health maintenance organization has agreed to make the coverage available and has
been selected as a writing carrier.
    (d) Notwithstanding the provisions of section 62E.06 and unless those charges are billed by a
provider that is part of the association's preferred provider network, the state plan shall exclude
coverage of services of a private duty nurse other than on an inpatient basis and any charges for
treatment in a hospital located outside of the state of Minnesota in which the covered person is
receiving treatment for a mental or nervous disorder, unless similar treatment for the mental or
nervous disorder is medically necessary, unavailable in Minnesota and provided upon referral
by a licensed Minnesota medical practitioner.
History: 1976 c 296 art 1 s 12; 1980 c 565 s 1; 1Sp1985 c 10 s 64; 1991 c 165 s 6; 1992
c 554 art 1 s 16; 1992 c 564 art 4 s 12; 1995 c 96 s 1; 1995 c 258 s 41; 1998 c 293 s 2; 1999
c 130 s 1; 2000 c 398 s 5; 2003 c 109 s 4; 2004 c 268 s 4; 2005 c 17 art 1 s 14; 2005 c 132 s
13; 2007 c 104 s 16
62E.13 ADMINISTRATION OF PLAN.
    Subdivision 1. Submission of plans of coverage. Any member of the association may submit
to the commissioner the policies of accident and health insurance or the health maintenance
organization contracts which are being proposed to serve in the comprehensive health insurance
plan. The time and manner of the submission shall be prescribed by rule of the commissioner.
    Subd. 2. Selection of writing carrier. The association may select policies and contracts,
or parts thereof, submitted by a member or members of the association, or by the association or
others, to develop specifications for bids from any entity which wishes to be selected as a writing
carrier to administer the state plan. The selection of the writing carrier shall be based upon criteria
established by the board of directors of the association and approved by the commissioner. The
criteria shall outline specific qualifications that an entity must satisfy in order to be selected
and, at a minimum, shall include the entity's proven ability to handle large group accident and
health insurance cases, efficient claim paying capacity, and the estimate of total charges for
administering the plan. The association may select separate writing carriers for the two types of
qualified plans and the $2,000, $5,000, and $10,000 deductible plans, the Medicare supplement
plans, and the health maintenance organization contract.
    Subd. 3. Duties of writing carrier. The writing carrier shall perform all administrative and
claims payment functions required by this section. The writing carrier shall provide these services
for a period of five years, unless a request to terminate is approved by the commissioner. The
commissioner shall approve or deny a request to terminate within 90 days of its receipt. A failure
to make a final decision on a request to terminate within the specified period shall be deemed
to be an approval. Six months prior to the expiration of each five-year period, the association
shall invite submissions of policy forms from members of the association, including the writing
carrier. The association shall follow the provisions of subdivision 2 in selecting a writing carrier
for the subsequent five-year period.
    Subd. 3a. Extension of writing carrier contract. Subject to the approval of the
commissioner, and subject to the consent of the writing carrier, the association may extend the
effective writing carrier contract for a period not to exceed three years, if the association and the
commissioner determine that it would be in the best interest of the association's enrollees and
contributing members. This subdivision applies notwithstanding anything to the contrary in
subdivisions 2 and 3.
    Subd. 4. Policy or certificate of coverage to enrollees. The writing carrier shall provide to
all eligible persons enrolled in the plan an individual policy or certificate, setting forth a statement
as to the insurance protection to which they are entitled, with whom claims are to be filed and to
whom benefits are payable. The policy or certificate shall indicate that coverage was obtained
through the association.
    Subd. 5. Monthly report on operation of state plan. The writing carrier shall submit to the
association and the commissioner on a monthly basis a report on the operation of the state plan.
Specific information to be contained in this report shall be determined by the association prior to
the effective date of the state plan.
    Subd. 6. Claims payments. All claims shall be paid by the writing carrier pursuant to the
provisions of sections 62E.01 to 62E.19, and shall indicate that the claim was paid by the state
plan. Each claim payment shall include information specifying the procedure to be followed in
the event of a dispute over the amount of payment.
    Subd. 7. Reimbursement of writing carriers expenses. The writing carrier shall be
reimbursed from the state plan premiums received for its direct and indirect expenses. Direct and
indirect expenses shall include, but need not be limited to, a pro rata reimbursement for that
portion of the writing carrier's administrative, printing, claims administration, management and
building overhead expenses which are assignable to the maintenance and administration of the
state plan. The association shall approve cost accounting methods to substantiate the writing
carrier's cost reports consistent with generally accepted accounting principles. Direct and indirect
expenses shall not include costs directly related to the original submission of policy forms prior
to selection as the writing carrier.
    Subd. 8. Writing carrier as agent. The writing carrier shall at all times when carrying out
its duties under sections 62E.01 to 62E.19 be considered an agent of the association and the
commissioner with civil liability subject to the provisions of section 3.751.
    Subd. 9.[Repealed, 1987 c 268 art 2 s 38]
    Subd. 10. Premiums not subject to tax. Premiums received by the writing carrier for the
comprehensive health insurance plan are exempt from the taxes imposed under chapter 297I.
    Subd. 11. Classification of PPO agreement data. If the writing carrier uses its own provider
agreements for the association's preferred provider network in lieu of agreements exclusively
between the association and the providers, then the terms and conditions of those agreements
are nonpublic data as defined in section 13.02, subdivision 9.
History: 1976 c 296 art 1 s 13; 1977 c 409 s 18,19; 1979 c 272 s 9; 1986 c 444; 1987 c 384
art 2 s 1; 1988 c 719 art 2 s 3; 1991 c 165 s 7; 1997 c 225 art 6 s 3; 1999 c 177 s 47,48; 2000 c
394 art 2 s 15; 2000 c 398 s 6; 2003 c 109 s 5,6; 2005 c 132 s 14; 2006 c 255 s 19
62E.14 ENROLLMENT BY AN ELIGIBLE PERSON.
    Subdivision 1. Application, contents. The comprehensive health insurance plan shall be
open for enrollment by eligible persons. An eligible person shall enroll by submission of an
application to the writing carrier. The application must provide the following:
(a) name, address, age, list of residences for the immediately preceding six months and
length of time at current residence of the applicant;
(b) name, address, and age of spouse and children if any, if they are to be insured;
(c) evidence of rejection, a requirement of restrictive riders, a rate up, or a preexisting
conditions limitation on a qualified plan, the effect of which is to substantially reduce coverage
from that received by a person considered a standard risk, by at least one association member
within six months of the date of the application, or other eligibility requirements adopted by
rule by the commissioner which are not inconsistent with this chapter and which evidence that
a person is unable to obtain coverage substantially similar to that which may be obtained by
a person who is considered a standard risk;
(d) if the applicant has been terminated from individual health coverage which does not
provide replacement coverage, evidence that no replacement coverage that meets the requirements
of section 62D.121 was offered, and evidence of termination of individual health coverage by an
insurer, nonprofit health service plan corporation, or health maintenance organization, provided
that the contract or policy has been terminated for reasons other than (1) failure to pay the charge
for health care coverage; (2) failure to make co-payments required by the health care plan; (3)
enrollee moving out of the area served; or (4) a materially false statement or misrepresentation by
the enrollee in the application for the terminated contract or policy; and
(e) a designation of the coverage desired.
An eligible person may not purchase more than one policy from the state plan. Upon ceasing
to be a resident of Minnesota a person is no longer eligible to purchase or renew coverage under
the state plan, except as required by state or federal law with respect to renewal of Medicare
supplement coverage.
    Subd. 2. Writing carrier's response. Within 30 days of receipt of the application described
in subdivision 1, the writing carrier shall either reject the application for failing to comply with
the requirements in subdivision 1 or forward the eligible person a notice of acceptance and billing
information. If the applicant otherwise complies with the requirements of sections 62E.01 to
62E.19, insurance shall be effective immediately upon receipt of the first month's state plan
premium, and shall be retroactive to the date the application was received by the writing carrier,
unless a different effective date is provided in this section.
    Subd. 3. Preexisting conditions. No person who obtains coverage pursuant to this section
shall be covered for any preexisting condition during the first six months of coverage under the
state plan if the person was diagnosed or treated for that condition during the 90 days immediately
preceding the date the application was received by the writing carrier, except as provided under
subdivisions 4, 4a, 4b, 4c, 4d, 5, 6, and 7 and section 62E.18.
    Subd. 3a. Waiver of preexisting condition. A person may enroll in the comprehensive
health plan with a waiver of the preexisting condition limitation described in section 62E.14,
subdivision 3
, provided that the person meets the following requirements:
(1) group coverage was provided through a rehabilitation facility defined in section 268A.01,
subdivision 6
, and coverage was terminated;
(2) all other eligibility requirements for enrollment in the comprehensive health plan are
met; and
(3) the person submitted an application that was received by the writing carrier no later than
90 days after termination of previous coverage.
    Subd. 4. Waiver of preexisting conditions for Medicare supplement plan enrollees.
Notwithstanding the above, any Minnesota resident holder of a policy or certificate of Medicare
supplement coverages pursuant to sections 62A.315 and 62A.316, or Medicare supplement plans
previously approved by the commissioner, may enroll in the comprehensive health insurance
plan as described in section 62E.07, with a waiver of the preexisting condition as described in
subdivision 3, without interruption in coverage, provided that the policy or certificate has been
terminated by the insurer for reasons other than nonpayment of premium and, provided further
that the option to enroll in the plan is exercised through submitting an application received by the
writing carrier no later than 90 days after termination of the existing contract or certificate.
Coverage in the state plan for purposes of this section shall be effective on the date of
termination upon receipt of the proper application by the writing carrier and payment of the
required premium. The application must include evidence of termination of the existing policy or
certificate.
    Subd. 4a. Waiver of preexisting conditions for Minnesota residents. A person may enroll
in the comprehensive health plan with a waiver of the preexisting condition limitation described
in subdivision 3, provided that the following requirements are met:
(1) the person is a Minnesota resident eligible to enroll in the comprehensive health plan;
(2) the person:
(a) would be eligible for continuation under federal or state law if continuation coverage
were available or were required to be available;
(b) would be eligible for continuation under clause (a) except that the person was exercising
continuation rights and the continuation period required under federal or state law has expired; or
(c) is eligible for continuation of health coverage under federal or state law;
(3) continuation coverage is not available; and
(4) the person's application for coverage is received by the writing carrier no later than 90
days after termination of prior coverage from a policy or plan.
Coverage in the comprehensive health plan is effective on the date of termination of prior
coverage. The availability of conversion rights does not affect a person's rights under this
subdivision.
    Subd. 4b. Waiver of preexisting conditions for persons covered by retiree plans. A
person who was covered by a retiree health care plan may enroll in the comprehensive health plan
with a waiver of the preexisting condition limitation described in subdivision 3, provided that
the following requirements are met:
(1) the person is a Minnesota resident eligible to enroll in the comprehensive health plan;
(2) the person was covered by a retiree health care plan from an employer and the coverage
is no longer available to the person; and
(3) the person's application for coverage is received by the writing carrier no later than
90 days after termination of prior coverage.
Coverage in the comprehensive health plan is effective on the date of termination of prior
coverage. The availability of conversion rights does not affect a person's rights under this section.
    Subd. 4c. Waiver of preexisting conditions for persons whose coverage is terminated
or who exceed the maximum lifetime benefit. (a) A Minnesota resident may enroll in the
comprehensive health plan with a waiver of the preexisting condition limitation described in
subdivision 3 if that persons's application for coverage is received by the writing carrier no later
than 90 days after termination of prior coverage and if the termination is for reasons other than
fraud or nonpayment of premiums.
For purposes of this paragraph, termination of prior coverage includes exceeding the
maximum lifetime benefit of existing coverage.
Coverage in the comprehensive health plan is effective on the date of termination of prior
coverage. The availability of conversion rights does not affect a person's rights under this
paragraph.
This section does not apply to prior coverage provided under policies designed primarily
to provide coverage payable on a per diem, fixed indemnity, or nonexpense incurred basis, or
policies providing only accident coverage.
(b) An eligible individual, as defined under United States Code, chapter 42, section
300gg-41(b) may enroll in the comprehensive health insurance plan with a waiver of the
preexisting condition limitation described in subdivision 3 and a waiver of the evidence of
rejection or similar events described in subdivision 1, clause (c). The eligible individual must
apply for enrollment under this paragraph by submitting a substantially complete application that
is received by the writing carrier no later than 63 days after termination of prior coverage, and
coverage under the comprehensive health insurance plan is effective as of the date of receipt of
the complete application. The six-month durational residency requirement provided in section
62E.02, subdivision 13, does not apply with respect to eligibility for enrollment under this
paragraph, but the applicant must be a Minnesota resident as of the date that the application was
received by the writing carrier. A person's eligibility to enroll under this paragraph does not affect
the person's eligibility to enroll under any other provision.
(c) A qualifying individual, as defined in the Internal Revenue Code of 1986, section
35(e)(2)(B), who is eligible under the Federal Trade Act of 2002 for the credit for health insurance
costs under the Internal Revenue Code of 1986, section 35, may enroll in the comprehensive
health insurance plan with a waiver of the preexisting condition limitation described in
subdivision 3, and without presenting evidence of rejection or similar requirements described
in subdivision 1, paragraph (c). The six-month durational residency requirement provided in
section 62E.02, subdivision 13, does not apply with respect to eligibility for enrollment under
this paragraph, but the applicant must be a Minnesota resident as of the date of application. A
person's eligibility to enroll under this paragraph does not affect the person's eligibility to enroll
under any other provision. This paragraph is intended solely to meet the minimum requirements
necessary to qualify the comprehensive health insurance plan as qualified health coverage under
the Internal Revenue Code of 1986, section 35(e)(2).
    Subd. 4d. Insurer insolvency; waiver of preexisting conditions. A Minnesota resident who
is otherwise eligible may enroll in the comprehensive health insurance plan with a waiver of the
preexisting condition limitation described in subdivision 3, if that person submits an application
for coverage that is received by the writing carrier no later than 90 days after termination of prior
coverage due to the insolvency of the insurer.
Coverage in the comprehensive insurance plan is effective on the date of termination
of prior coverage. The availability of conversion rights does not affect a person's rights under
this subdivision.
    Subd. 4e. Waiver of preexisting conditions; persons covered by publicly funded health
programs. A person may enroll in the comprehensive plan with a waiver of the preexisting
condition limitation in subdivision 3, provided that:
(1) the person was formerly enrolled in the medical assistance, general assistance medical
care, or MinnesotaCare program;
(2) the person is a Minnesota resident; and
(3) the person submits an application for coverage that is received by the writing carrier no
later than 90 days after termination from medical assistance, general assistance medical care,
or MinnesotaCare program.
    Subd. 5. Terminated employees. An employee who is voluntarily or involuntarily
terminated or laid off from employment and unable to exercise the option to continue coverage
under section 62A.17, and who is a Minnesota resident and who is otherwise eligible, may enroll
in the comprehensive health insurance plan, by submitting an application that is received by the
writing carrier no later than 90 days after termination or layoff, with a waiver of the preexisting
condition limitation set forth in subdivision 3.
    Subd. 6. Termination of individual policy or contract. A Minnesota resident who holds
an individual health maintenance contract, individual nonprofit health service corporation
contract, or an individual insurance policy previously approved by the commissioners of health
or commerce, may enroll in the comprehensive health insurance plan with a waiver of the
preexisting condition as described in subdivision 3, without interruption in coverage, provided
(1) no replacement coverage that meets the requirements of section 62D.121 was offered by the
contributing member, and (2) the policy or contract has been terminated for reasons other than
(a) nonpayment of premium; (b) failure to make co-payments required by the health care plan;
(c) moving out of the area served; or (d) a materially false statement or misrepresentation by the
enrollee in the application for the terminated policy or contract; and, provided further, that the
option to enroll in the plan is exercised by submitting an application that is received by the writing
carrier no later than 90 days after termination of the existing policy or contract.
Coverage allowed under this section is effective when the contract or policy is terminated
and the enrollee has submitted the proper application that is received within the time period stated
in this subdivision and paid the required premium or fee.
Expenses incurred from the preexisting conditions of individuals enrolled in the state plan
under this subdivision must be paid by the contributing member canceling coverage as set forth
in section 62E.11, subdivision 10.
The application must include evidence of termination of the existing policy or certificate as
required in subdivision 1.
    Subd. 7. Terminations of conversion policies. (a) A Minnesota resident who is covered
by a conversion policy or contract of health coverage may enroll in the comprehensive health
plan with a waiver of the preexisting condition limitation in subdivision 3 and a waiver of the
evidence of rejection in subdivision 1, paragraph (c), at any time for any reason by submitting an
application that is received by the writing carrier during the term of coverage.
(b) A Minnesota resident who was covered by a conversion policy or contract of health
coverage may enroll in the comprehensive health plan with a waiver of the preexisting condition
limitation in subdivision 3 and a waiver of the evidence of rejection in subdivision 1, paragraph
(c), if that person applies for coverage by submitting an application that is received by the writing
carrier no later than 90 days after termination of the conversion policy or contract coverage
regardless of: (1) the reasons for the termination; or (2) the party terminating coverage.
(c) Coverage under this subdivision is effective upon termination of prior coverage if the
enrollee has submitted a completed application that is received within the time period stated in
paragraph (a) or (b), whichever applies, and paid the required premium or fee.
History: 1976 c 296 art 1 s 14; 1977 c 409 s 20; 1979 c 272 s 10; 1984 c 592 s 48; 1986
c 455 s 14; 1986 c 458 s 2; 1987 c 337 s 70; 1987 c 384 art 2 s 1; 1988 c 434 s 19-21; 1988 c
612 s 29,31; 1989 c 258 s 13; 1990 c 523 s 3-5; 1991 c 165 s 8; 1991 c 325 art 21 s 6; 1992 c
564 art 1 s 37; 1997 c 175 art 1 s 2,3; 1997 c 203 art 7 s 1; 1999 c 177 s 49; 2002 c 330 s
14-16; 2003 c 109 s 7; 2006 c 255 s 20
62E.141 INCLUSION IN EMPLOYER-SPONSORED PLAN.
No employee of an employer that offers a health plan, under which the employee is eligible
for coverage, is eligible to enroll, or continue to be enrolled, in the comprehensive health
association, except for enrollment or continued enrollment necessary to cover conditions that
are subject to an unexpired preexisting condition limitation, preexisting condition exclusion,
or exclusionary rider under the employer's health plan. This section does not apply to persons
enrolled in the Comprehensive Health Association as of June 30, 1993. With respect to persons
eligible to enroll in the health plan of an employer that has more than 29 current employees, as
defined in section 62L.02, this section does not apply to persons enrolled in the Comprehensive
Health Association as of December 31, 1994.
History: 1992 c 549 art 3 s 17; 1994 c 625 art 10 s 14; 1995 c 234 art 7 s 9
62E.15 SOLICITATION OF ELIGIBLE PERSONS.
    Subdivision 1. Commissioner's duty. The association pursuant to a plan approved by the
commissioner shall disseminate appropriate information to the residents of this state regarding
the existence of the comprehensive health insurance plan and the means of enrollment. Means
of communication may include use of the press, radio and television, as well as publication
in appropriate state offices and publications.
    Subd. 2. Association's duty. The association shall devise and implement means of
maintaining public awareness of the provisions of sections 62E.01 to 62E.19 and shall administer
these sections in a manner which facilitates public participation in the state plan.
    Subd. 2a. Annual verification. The association may annually verify the uninsurability of
each policyholder to insure that only eligible persons are enrolled in the plan.
    Subd. 3. Agent's referral fee. The writing carrier shall pay an agent's referral fee of $50
to each insurance agent who refers an applicant to the state plan, if the application is accepted.
Selling or marketing of qualified state plans shall not be limited to the writing carrier or its
agents. The referral fees shall be paid by the writing carrier from money received as premiums
for the state plan.
    Subd. 4. Rejection or underwriting restrictions. Every insurer and health maintenance
organization which rejects or applies underwriting restrictions to an applicant for a plan of health
coverage shall: (1) provide the applicant with a written notice of rejection or the underwriting
restrictions applied to the applicant in a manner consistent with the requirements in section
72A.499; (2) notify the applicant of the existence of the state plan, the requirements for being
accepted in it, and the procedure for applying to it; and (3) provide the applicant with written
materials explaining the state plan in greater detail. This written material shall be provided by
the association to every insurer at no charge.
    Subd. 5. Initial notification. Every insurer and health maintenance organization before
issuing a conversion policy or contract of health insurance shall:
(1) notify the applicant of the existence of the state plan, the requirements for being accepted
in it, the procedure for applying to it, and the plan rates; and
(2) provide the applicant with written materials explaining the state plan in greater detail.
This written material shall be provided by the association to every insurer and health maintenance
organization at no charge.
    Subd. 6. Annual notification. Every insurer and health maintenance organization which
provides health coverage to an insured through a conversion plan shall annually:
(1) notify the insured of the existence of the state plan, the requirements for being accepted
in it, the procedure for applying to it, and the plan rates; and
(2) provide the applicant with written materials explaining the state plan in greater detail.
This written material shall be provided by the association to every insurer and health maintenance
organization at no charge.
    Subd. 7. Conversion rates. For Medicare supplement conversion policies issued prior to
August 1, 1992, the requirements of subdivisions 5 and 6 apply only when the conversion rates
offered to the applicant by the insurer or health maintenance organization exceed the association
rates.
History: 1976 c 296 art 1 s 15; 1984 c 592 s 49; 1990 c 523 s 6; 1992 c 564 art 1 s 38-41;
1999 c 177 s 50; 2000 c 398 s 7
62E.16 POLICY CONVERSION RIGHTS.
Every program of self-insurance, policy of group accident and health insurance or contract of
coverage by a health maintenance organization written or renewed in this state, shall include,
in addition to the provisions required by section 62A.17, the right to convert to an individual
coverage qualified plan without the addition of underwriting restrictions after the individual
insured has exhausted any continuation coverage provided under section 62A.146; 62A.148;
62A.17, subdivisions 1 and 2; 62A.20; 62A.21; 62C.142; 62D.101; or 62D.105, or continuation
coverage provided under federal law, if any continuation coverage is available to the individual,
and then leaves the group regardless of the reason for leaving the group or if an employer
member of a group ceases to remit payment so as to terminate coverage for its employees, or
upon cancellation or termination of the coverage for the group except where uninterrupted
and continuous group coverage is otherwise provided to the group. If the health maintenance
organization has canceled coverage for the group because of a loss of providers in a service area,
the health maintenance organization shall arrange for other health maintenance or indemnity
conversion options that shall be offered to enrollees without the addition of underwriting
restrictions. The required conversion contract must treat pregnancy the same as any other covered
illness under the conversion contract. The person may exercise this right to conversion within 30
days of exhausting any continuation coverage provided under section 62A.146; 62A.148; 62A.17,
subdivisions 1 and 2
; 62A.20; or 62A.21, or continuation coverage provided under federal law,
and then leaving the group or within 30 days following receipt of due notice of cancellation
or termination of coverage of the group or of the employer member of the group and upon
payment of premiums from the date of termination or cancellation. Due notice of cancellation or
termination of coverage for a group or of the employer member of the group shall be provided to
each employee having coverage in the group by the insurer, self-insurer or health maintenance
organization canceling or terminating the coverage except where reasonable evidence indicates
that uninterrupted and continuous group coverage is otherwise provided to the group. Every
employer having a policy of group accident and health insurance, group subscriber or contract of
coverage by a health maintenance organization shall, upon request, provide the insurer or health
maintenance organization a list of the names and addresses of covered employees. Plans of health
coverage shall also include a provision which, upon the death of the individual in whose name the
contract was issued, permits every other individual then covered under the contract to elect, within
the period specified in the contract, to continue coverage under the same or a different contract
without the addition of underwriting restrictions until the individual would have ceased to have
been entitled to coverage had the individual in whose name the contract was issued lived. An
individual conversion contract issued by a health maintenance organization shall not be deemed
to be an individual enrollment contract for the purposes of section 62D.10. An individual health
plan offered under section 62A.65, subdivision 5, paragraph (b), to a person satisfies the health
carrier's obligation to offer conversion coverage under this section with respect to that person.
History: 1976 c 296 art 1 s 16; 1977 c 335 s 1; 1Sp1985 c 10 s 65; 1986 c 444; 1988 c 434 s
22; 1992 c 564 art 1 s 42; 1994 c 625 art 10 s 15; 1998 c 407 art 8 s 3
62E.17 [Repealed, 1Sp1985 c 9 art 2 s 104]
62E.18 HEALTH INSURANCE FOR RETIRED EMPLOYEES NOT ELIGIBLE FOR
MEDICARE.
A Minnesota resident who is age 65 or over and is not eligible for the health insurance
benefits of the federal Medicare program is entitled to purchase the benefits of a qualified plan,
one or two, or the $2,000, $5,000, or $10,000 annual deductible plan if available, offered by the
Minnesota Comprehensive Health Association without any of the limitations set forth in section
62E.14, subdivision 1, paragraph (c), and subdivision 3.
History: 1987 c 337 s 71; 2000 c 398 s 8; 2003 c 109 s 8
62E.19 PAYMENTS FOR PREEXISTING CONDITIONS.
    Subdivision 1. Employer liability. An employer is liable to the association for the costs
of any preexisting conditions of the employer's former employees or their dependents during
the first six months of coverage under the state comprehensive health insurance plan under the
following conditions:
(1)(i) the employer has terminated or laid off employees and is required to meet the notice
requirements under section 116L.976, subdivision 2;
(ii) the employer has failed to provide, arrange for, or make available continuation health
insurance coverage required to be provided under federal or state law to employees or their
dependents; and
(iii) the employer's former employees or their dependents enroll in the state comprehensive
health insurance plan with a waiver of the preexisting condition limitation under section 62E.14,
subdivision 4a
or 5; or
(2)(i) the employer has terminated or allowed the employer's plan of health insurance
coverage to lapse within 90 days prior to the date of termination or layoff of an employee; and
(ii) the employer's former employees or their dependents enroll in the state comprehensive
health insurance plan with a waiver of the preexisting condition limitation under section 62E.14,
subdivision 4a
or 5.
The employer shall pay a special assessment to the association for the costs of the preexisting
conditions. The special assessment may be assessed before the association makes the annual
determination of each contributing member's liability as required under this chapter. The
association may enforce the obligation to pay the special assessment by action, as a claim in an
insolvency proceeding, or by any other method not prohibited by law.
If the association makes the special assessment permitted by this subdivision, the association
may also make any assessment of contributing members otherwise permitted by law, without
regard to the special assessment permitted by this subdivision. Contributing members must pay
the assessment, subject to refund or adjustment in the event of receipt by the association of any
portion of the special assessment.
    Subd. 2. Exemption. Subdivision 1 does not apply to a termination of or failure to implement
an employee health benefit plan which results from or occurs during a strike or lockout, nor does
it apply to employee health benefit plans separately provided by an employee organization or
bargaining agent, regardless of any financial contribution to the plan by the employer.
History: 1990 c 523 s 7; 1991 c 199 art 1 s 11; 1994 c 485 s 35; 2004 c 206 s 52
62E.51 [Repealed, 1994 c 625 art 10 s 49]
62E.52 [Repealed, 1994 c 625 art 10 s 49]
62E.53 [Repealed, 1994 c 625 art 10 s 49]
62E.531 [Repealed, 1994 c 625 art 10 s 49]
62E.54 [Repealed, 1994 c 625 art 10 s 49]
62E.55 [Repealed, 1994 c 625 art 10 s 49]