62E.11 OPERATION OF COMPREHENSIVE PLAN.
Subdivision 1. Enrollment.
Upon certification as an eligible person in the manner provided
, 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
, 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.
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
; 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
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.
contributing members who have terminated individual health plans and do not provide or arrange
for replacement coverage that meets the requirements of section
, 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
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
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