2003 Minnesota Statutes

     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 
 $2,800,000; and an extended basic Medicare supplement plan and a 
 basic Medicare supplement plan as described in sections 62A.31 
 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 $2,800,000 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 $2,800,000 maximum lifetime benefit. 

    (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. 

    HIST: 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