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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

Official Publication of the State of Minnesota
Revisor of Statutes