2003 Minnesota Statutes

     62A.02 Policy forms. 

    Subdivision 1.    Filing.  For purposes of this section, 
 "health plan" means a health plan as defined in section 62A.011 
 or a policy of accident and sickness insurance as defined in 
 section 62A.01.  No health plan shall be issued or delivered to 
 any person in this state, nor shall any application, rider, or 
 endorsement be used in connection with the health plan, until a 
 copy of its form and of the classification of risks and the 
 premium rates pertaining to the form have been filed with the 
 commissioner.  The filing for nongroup health plan forms shall 
 include a statement of actuarial reasons and data to support the 
 rate.  For health benefit plans as defined in section 62L.02, 
 and for health plans to be issued to individuals, the health 
 carrier shall file with the commissioner the information 
 required in section 62L.08, subdivision 8.  For group health 
 plans for which approval is sought for sales only outside of the 
 small employer market as defined in section 62L.02, this section 
 applies only to policies or contracts of accident and sickness 
 insurance.  All forms intended for issuance in the individual or 
 small employer market must be accompanied by a statement as to 
 the expected loss ratio for the form.  Premium rates and forms 
 relating to specific insureds or proposed insureds, whether 
 individuals or groups, need not be filed, unless requested by 
 the commissioner. 

    Subd. 2.    Approval.  (a) The health plan form shall 
 not be issued, nor shall any application, rider, endorsement, or 
 rate be used in connection with it, until the expiration of 60 
 days after it has been filed unless the commissioner approves it 
 before that time.  

    (b) Notwithstanding paragraph (a), a rate filed with 
 respect to a policy of accident and sickness insurance as 
 defined in section 62A.01 by an insurer licensed under chapter 
 60A, may be used on or after the date of filing with the 
 commissioner.  Rates that are not approved or disapproved within 
 the 60-day time period are deemed approved.  This paragraph does 
 not apply to Medicare-related coverage as defined in section 
 62A.31, subdivision 3, paragraph (q). 

    Subd. 3.    Standards for disapproval.  The commissioner 
 shall, within 60 days after the filing of any form or rate, 
 disapprove the form or rate: 

    (1) if the benefits provided are not reasonable in relation 
 to the premium charged; 

    (2) if it contains a provision or provisions which are 
 unjust, unfair, inequitable, misleading, deceptive or encourage 
 misrepresentation of the health plan form, or otherwise does not 
 comply with this chapter, chapter 62L, or chapter 72A; 

    (3) if the proposed premium rate is excessive or not 
 adequate; or 

    (4) the actuarial reasons and data submitted do not justify 
 the rate.  

    The party proposing a rate has the burden of proving by a 
 preponderance of the evidence that it does not violate this 
 subdivision.  

    In determining the reasonableness of a rate, the 
 commissioner shall also review all administrative contracts, 
 service contracts, and other agreements to determine the 
 reasonableness of the cost of the contracts or agreement and 
 effect of the contracts on the rate.  If the commissioner 
 determines that a contract or agreement is not reasonable, the 
 commissioner shall disapprove any rate that reflects any 
 unreasonable cost arising out of the contract or agreement.  The 
 commissioner may require any information that the commissioner 
 deems necessary to determine the reasonableness of the cost. 

    For the purposes of this subdivision, the commissioner 
 shall establish by rule a schedule of minimum anticipated loss 
 ratios which shall be based on (i) the type or types of coverage 
 provided, (ii) whether the policy is for group or individual 
 coverage, and (iii) the size of the group for group policies.  
 Except for individual policies of disability or income 
 protection insurance, the minimum anticipated loss ratio shall 
 not be less than 50 percent after the first year that a policy 
 is in force.  All applicants for a policy shall be informed in 
 writing at the time of application of the anticipated loss ratio 
 of the policy.  "Anticipated loss ratio" means the ratio at the 
 time of filing, at the time of notice of withdrawal under 
 subdivision 4a, or at the time of subsequent rate revision of 
 the present value of all expected future benefits, excluding 
 dividends, to the present value of all expected future premiums. 

    If the commissioner notifies a health carrier that has 
 filed any form or rate that it does not comply with this 
 chapter, chapter 62L, or chapter 72A, it shall be unlawful for 
 the health carrier to issue or use the form or rate.  In the 
 notice the commissioner shall specify the reasons for 
 disapproval and state that a hearing will be granted within 20 
 days after request in writing by the health carrier.  

    The 60-day period within which the commissioner is to 
 approve or disapprove the form or rate does not begin to run 
 until a complete filing of all data and materials required by 
 statute or requested by the commissioner has been submitted.  

    However, if the supporting data is not filed within 30 days 
 after a request by the commissioner, the rate is not effective 
 and is presumed to be an excessive rate.  

    Subd. 4.  Repealed, 1992 c 549 art 3 s 23 

    Subd. 4a.    Withdrawal of approval.  The commissioner 
 may, at any time after a 20-day written notice has been given to 
 the insurer, withdraw approval of any form or rate that has 
 previously been approved on any of the grounds stated in this 
 section.  It is unlawful for the health carrier to issue a form 
 or rate or use it in connection with any health plan after the 
 effective date of the withdrawal of approval.  The notice of 
 withdrawal of approval must advise the health carrier of the 
 right to a hearing under the contested case procedures of 
 chapter 14, and must specify the matters to be considered at the 
 hearing.  

    The commissioner may request a health carrier to provide 
 actuarial reasons and data, as well as other information, needed 
 to determine if a previously approved rate continues to satisfy 
 the requirements of this section.  If the requested information 
 is not provided within 30 days after request by the 
 commissioner, the rate is presumed to be an excessive rate.  

    Subd. 5. Repealed, 1992 c 549 art 3 s 23; 1994 c 625 art 
 10 s 49 

    Subd. 5a.    Hearing.  The health carrier must request a 
 hearing before the 20-day notice period has ended, or the 
 commissioner's order is final.  A request for hearing stays the 
 commissioner's order until the commissioner notifies the health 
 carrier of the result of the hearing.  The commissioner's order 
 may require the modification of any rate or form and may require 
 continued coverage to persons covered under a health plan to 
 which the disapproved form or rate applies.  

    Subd. 6.    Appeal.  Any order or decision of the 
 commissioner under this section shall be subject to appeal in 
 accordance with chapter 14. 

    Subd. 7.    Filing by domestic insurers for purposes of 
 complying with another state's filing requirements.  A 
 domestic insurer may file with the commissioner for 
 informational purposes only a policy or certificate of insurance 
 that is not intended to be offered or sold within this state.  
 This subdivision only applies to the filing in Minnesota of a 
 policy or certificate of insurance issued to an insured or 
 certificate holder located outside of this state when the filing 
 is for the express purpose of complying with the law of the 
 state in which the insured or certificate holder resides.  In no 
 event may a policy or certificate of insurance filed under this 
 subdivision for out-of-state use be issued or delivered in 
 Minnesota unless and until the policy or certificate of 
 insurance is approved under subdivision 2. 

    HIST: 1967 c 395 art 3 s 2; 1976 c 296 art 2 s 10,11; 1977 c 
 409 s 1; 1979 c 207 s 1; 1980 c 509 s 18; 1982 c 424 s 130; 1983 
 c 247 s 31; 1986 c 444; 1986 c 455 s 9,10; 1992 c 549 art 3 s 
 3-7; 1993 c 247 art 3 s 5; 1996 c 446 art 1 s 22; 2002 c 330 s 
 8; 2002 c 387 s 1