2007 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 $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