1.1.................... moves to amend H.F. No. 978 as follows:
1.2Delete everything after the enacting clause and insert:

1.3    "Section 1. Minnesota Statutes 2012, section 43A.23, subdivision 1, is amended to read:
1.4    Subdivision 1. General. (a) The commissioner is authorized to request proposals
1.5or to negotiate and to enter into contracts with parties which in the judgment of the
1.6commissioner are best qualified to provide service to the benefit plans. Contracts entered
1.7into are not subject to the requirements of sections 16C.16 to 16C.19. The commissioner
1.8may negotiate premium rates and coverage. The commissioner shall consider the cost of
1.9the plans, conversion options relating to the contracts, service capabilities, character,
1.10financial position, and reputation of the carriers, and any other factors which the
1.11commissioner deems appropriate. Each benefit contract must be for a uniform term of at
1.12least one year, but may be made automatically renewable from term to term in the absence
1.13of notice of termination by either party. A carrier licensed under chapter 62A is exempt
1.14from the taxes imposed by chapter 297I on premiums paid to it by the state.
1.15    (b) All self-insured hospital and medical service products must comply with coverage
1.16mandates, data reporting, and consumer protection requirements applicable to the licensed
1.17carrier administering the product, had the product been insured, including chapters 62J,
1.1862M, and 62Q. Any self-insured products that limit coverage to a network of providers
1.19or provide different levels of coverage between network and nonnetwork providers shall
1.20comply with section 62D.123 and geographic access standards for health maintenance
1.21organizations adopted by the commissioner of health in rule under chapter 62D.
1.22    (c) Notwithstanding paragraph (b), a self-insured hospital and medical product
1.23offered under sections 43A.22 to 43A.30 is not required to extend dependent coverage
1.24to an eligible employee's unmarried child under the age of 25 to the full extent required
1.25under chapters 62A and 62L. Dependent child coverage must, at a minimum, extend to an
1.26eligible employee's unmarried dependent child who is under the age of 19 or an unmarried
1.27child under the age of 25 who is a full-time student. A person who is at least 19 years of
2.1age but who is under the age of 25 and who is not a full-time student must be permitted
2.2to be enrolled as a dependent of an eligible employee until age 25 if the person: to the
2.3limiting age as defined in section 62Q.01, subdivision 11, disabled children to the extent
2.4required in sections 62A.14 and 62A.141, and dependent grandchildren to the extent
2.5required in sections 62A.042 and 62A.302.
2.6(1) was a full-time student immediately prior to being ordered into active military
2.7service, as defined in section 190.05, subdivision 5b or 5c;
2.8(2) has been separated or discharged from active military service; and
2.9(3) would be eligible to enroll as a dependent of an eligible employee, except that
2.10the person is not a full-time student.
2.11The definition of "full-time student" for purposes of this paragraph includes any student
2.12who by reason of illness, injury, or physical or mental disability as documented by
2.13a physician is unable to carry what the educational institution considers a full-time
2.14course load so long as the student's course load is at least 60 percent of what otherwise
2.15is considered by the institution to be a full-time course load. Any notice regarding
2.16termination of coverage due to attainment of the limiting age must include information
2.17about this definition of "full-time student."
2.18    (d) Beginning January 1, 2010, the health insurance benefit plans offered in the
2.19commissioner's plan under section 43A.18, subdivision 2, and the managerial plan under
2.20section 43A.18, subdivision 3, must include an option for a health plan that is compatible
2.21with the definition of a high-deductible health plan in section 223 of the United States
2.22Internal Revenue Code.
2.23EFFECTIVE DATE.This section is effective the day following final enactment.

2.24    Sec. 2. Minnesota Statutes 2012, section 43A.317, subdivision 6, is amended to read:
2.25    Subd. 6. Individual eligibility. (a) Procedures. The commissioner shall establish
2.26procedures for eligible employees and other eligible individuals to apply for coverage
2.27through the program.
2.28(b) Employees. An employer shall determine when it applies to the program the
2.29criteria its employees must meet to be eligible for coverage under its plan. An employer
2.30may subsequently change the criteria annually or at other times with approval of the
2.31commissioner. The criteria must provide that new employees become eligible for coverage
2.32after a probationary period of at least 30 days, but no more than 90 days.
2.33(c) Other individuals. An employer may elect to cover under its plan:
2.34(1) the spouse, dependent children to the limiting age as defined in section 62Q.01,
2.35subdivision 11, disabled children to the extent required in sections 62A.14 and 62A.141,
3.1and dependent grandchildren of a covered employee to the extent required in sections
3.262A.042 and 62A.302;
3.3(2) a retiree who is eligible to receive a pension or annuity from the employer and a
3.4covered retiree's spouse, dependent children to the limiting age as defined in section
3.562Q.01, subdivision 11, disabled children to the extent required in sections 62A.14 and
3.662A.141, and dependent grandchildren to the extent required in sections 62A.042 and
3.762A.302;
3.8(3) the surviving spouse, dependent children to the limiting age as defined in section
3.962Q.01, subdivision 11, disabled children, and dependent grandchildren of a deceased
3.10employee or retiree, if the spouse, children, or grandchildren were covered at the time of
3.11the death;
3.12(4) a covered employee who becomes disabled, as provided in sections 62A.147
3.13and 62A.148; or
3.14(5) any other categories of individuals for whom group coverage is required by
3.15state or federal law.
3.16An employer shall determine when it applies to the program the criteria individuals
3.17in these categories must meet to be eligible for coverage. An employer may subsequently
3.18change the criteria annually, or at other times with approval of the commissioner. The
3.19criteria for dependent children to the limiting age as defined in section 62Q.01, subdivision
3.2011, disabled children, and dependent grandchildren may be no more inclusive than the
3.21criteria under section 43A.18, subdivision 2. This paragraph shall not be interpreted
3.22as relieving the program from compliance with any federal and state continuation of
3.23coverage requirements.
3.24(d) Waiver and late entrance. An eligible individual may waive coverage at the
3.25time the employer joins the program or when coverage first becomes available. The
3.26commissioner may establish a preexisting condition exclusion of not more than 18 months
3.27for late entrants as defined in section 62L.02, subdivision 19.
3.28(e) Continuation coverage. The program shall provide all continuation coverage
3.29required by state and federal law.
3.30EFFECTIVE DATE.This section is effective the day following final enactment.

3.31    Sec. 3. Minnesota Statutes 2012, section 60A.08, subdivision 15, is amended to read:
3.32    Subd. 15. Classification of insurance filings data. (a) All forms, rates, and related
3.33information filed with the commissioner under section 61A.02 shall be nonpublic data
3.34until the filing becomes effective.
4.1    (b) All forms, rates, and related information filed with the commissioner under
4.2section 62A.02 shall be nonpublic data until the filing becomes effective.
4.3    (c) All forms, rates, and related information filed with the commissioner under
4.4section 62C.14, subdivision 10, shall be nonpublic data until the filing becomes effective.
4.5    (d) All forms, rates, and related information filed with the commissioner under
4.6section 70A.06 shall be nonpublic data until the filing becomes effective.
4.7    (e) All forms, rates, and related information filed with the commissioner under
4.8section 79.56 shall be nonpublic data until the filing becomes effective.
4.9(f) Notwithstanding paragraphs (b) and (c), for all rate increases subject to review
4.10under section 2794 of the Public Health Services Act and any amendments to, or
4.11regulations, or guidance issued under the act that are filed with the commissioner on or
4.12after September 1, 2011, the commissioner:
4.13(1) may acknowledge receipt of the information;
4.14(2) may acknowledge that the corresponding rate filing is pending review;
4.15(3) must provide public access from the Department of Commerce's Web site to parts
4.16I and II of the Preliminary Justifications of the rate increases subject to review; and
4.17(4) must provide notice to the public on the Department of Commerce's Web site of the
4.18review of the proposed rate, which must include a statement that the public has 30 calendar
4.19days to submit written comments to the commissioner on the rate filing subject to review.
4.20EFFECTIVE DATE.This section is effective the day following final enactment.

4.21    Sec. 4. Minnesota Statutes 2012, section 62A.011, is amended by adding a subdivision
4.22to read:
4.23    Subd. 1a. Affordable Care Act. "Affordable Care Act" means the federal Patient
4.24Protection and Affordable Care Act, Public Law 111-148, as amended, including the
4.25federal Health Care and Education Reconciliation Act of 2010, Public Law 111-152, and
4.26any amendments to, or regulations or guidance issued under these acts.
4.27EFFECTIVE DATE.This section is effective the day following final enactment.

4.28    Sec. 5. Minnesota Statutes 2012, section 62A.011, is amended by adding a subdivision
4.29to read:
4.30    Subd. 1c. Grandfathered plan. "Grandfathered plan" means a health plan in which
4.31an individual was enrolled on March 23, 2010, for as long as it maintains that status in
4.32accordance with the Affordable Care Act. Unless otherwise specified, grandfathered plans
4.33includes both individual and group health plans.
5.1EFFECTIVE DATE.This section is effective the day following final enactment.

5.2    Sec. 6. Minnesota Statutes 2012, section 62A.011, is amended by adding a subdivision
5.3to read:
5.4    Subd. 1d. Group health plan. "Group health plan" means a policy or certificate
5.5issued to an employer or an employee organization that is both:
5.6(1) a health plan as defined in subdivision 3; and
5.7(2) an employee welfare benefit plan as defined in the Employee Retirement Income
5.8Security Act of 1974, United States Code, title 29, section 1002, if the plan provides
5.9payment for medical care to employees, including both current and former employees, or
5.10their dependents, directly or through insurance, reimbursement, or otherwise.
5.11EFFECTIVE DATE.This section is effective the day following final enactment.

5.12    Sec. 7. Minnesota Statutes 2012, section 62A.011, subdivision 3, is amended to read:
5.13    Subd. 3. Health plan. "Health plan" means a policy or certificate of accident and
5.14sickness insurance as defined in section 62A.01 offered by an insurance company licensed
5.15under chapter 60A; a subscriber contract or certificate offered by a nonprofit health
5.16service plan corporation operating under chapter 62C; a health maintenance contract or
5.17certificate offered by a health maintenance organization operating under chapter 62D; a
5.18health benefit certificate offered by a fraternal benefit society operating under chapter
5.1964B; or health coverage offered by a joint self-insurance employee health plan operating
5.20under chapter 62H. Health plan means individual and group coverage, unless otherwise
5.21specified. Health plan does not include coverage that is:
5.22(1) limited to disability or income protection coverage;
5.23(2) automobile medical payment coverage;
5.24(3) supplemental liability insurance, including general liability insurance and
5.25automobile liability insurance, or coverage issued as a supplement to liability insurance;
5.26(4) designed solely to provide payments on a per diem, fixed indemnity, or
5.27non-expense-incurred basis, including coverage only for a specified disease or illness or
5.28hospital indemnity or other fixed indemnity insurance, if the benefits are provided under a
5.29separate policy, certificate, or contract for insurance; there is no coordination between the
5.30provision of benefits and any exclusion of benefits under any group health plan maintained
5.31by the same plan sponsor; and the benefits are paid with respect to an event without regard
5.32to whether benefits are provided with respect to such an event under any group health
5.33plan maintained by the same plan sponsor;
5.34(5) credit accident and health insurance as defined in section 62B.02;
6.1(6) designed solely to provide hearing, dental, or vision care;
6.2(7) blanket accident and sickness insurance as defined in section 62A.11;
6.3(8) accident-only coverage;
6.4(9) a long-term care policy as defined in section 62A.46 or 62S.01;
6.5(10) issued as a supplement to Medicare, as defined in sections 62A.3099 to
6.662A.44 , or policies, contracts, or certificates that supplement Medicare issued by health
6.7maintenance organizations or those policies, contracts, or certificates governed by section
6.81833 or 1876 of the federal Social Security Act, United States Code, title 42, section
6.91395, et seq., as amended;
6.10(11) workers' compensation insurance; or
6.11(12) issued solely as a companion to a health maintenance contract as described in
6.12section 62D.12, subdivision 1a, so long as the health maintenance contract meets the
6.13definition of a health plan.;
6.14(13) coverage for on-site medical clinics; or
6.15(14) coverage supplemental to the coverage provided under United States Code,
6.16title 10, chapter 55, Civilian Health and Medical Program of the Uniformed Services
6.17(CHAMPUS).
6.18EFFECTIVE DATE.This section is effective the day following final enactment.

6.19    Sec. 8. Minnesota Statutes 2012, section 62A.011, is amended by adding a subdivision
6.20to read:
6.21    Subd. 4. Individual health plan. "Individual health plan" means a health plan as
6.22defined in subdivision 3 that is offered to individuals in the individual market as defined
6.23in subdivision 5, but does not mean short-term coverage as defined in section 62A.65,
6.24subdivision 7. For purposes of this chapter, a health carrier shall not be deemed to be
6.25offering individual health plan coverage solely because the carrier offers a conversion
6.26policy in connection with a group health plan.
6.27EFFECTIVE DATE.This section is effective the day following final enactment.

6.28    Sec. 9. Minnesota Statutes 2012, section 62A.011, is amended by adding a subdivision
6.29to read:
6.30    Subd. 5. Individual market. "Individual market" means the market for health
6.31insurance coverage offered to individuals other than in connection with a group health plan.
6.32EFFECTIVE DATE.This section is effective the day following final enactment.

7.1    Sec. 10. Minnesota Statutes 2012, section 62A.011, is amended by adding a
7.2subdivision to read:
7.3    Subd. 6. Minnesota Insurance Marketplace. "Minnesota Insurance Marketplace"
7.4means the Minnesota Insurance Marketplace as defined in section 62V.02, if enacted,
7.5in 2013 H.F. No. 5/S.F. No. 1.

7.6    Sec. 11. Minnesota Statutes 2012, section 62A.011, is amended by adding a
7.7subdivision to read:
7.8    Subd. 7. Qualified health plan. "Qualified health plan" means a health plan that
7.9meets the definition in section 1301(a) of the Affordable Care Act and has been certified
7.10by the Board of the Minnesota Insurance Marketplace in accordance with chapter 62V
7.11if enacted in 2013 H.F. No. 5/S.F. No. 1 to be offered through the Minnesota Insurance
7.12Marketplace.

7.13    Sec. 12. Minnesota Statutes 2012, section 62A.02, is amended by adding a subdivision
7.14to read:
7.15    Subd. 8. Filing by health carriers for purposes of complying with the
7.16certification requirements of the Minnesota Insurance Marketplace. No qualified
7.17health plan shall be offered through the Minnesota Insurance Marketplace until its form
7.18and the premium rates pertaining to the form have been approved by the commissioner of
7.19commerce or health, as appropriate, and the health plan has been determined to comply
7.20with the certification requirements of the Minnesota Insurance Marketplace in accordance
7.21with an agreement between the commissioners of commerce and health and the Minnesota
7.22Insurance Marketplace.
7.23EFFECTIVE DATE.This section is effective January 1, 2014.

7.24    Sec. 13. Minnesota Statutes 2012, section 62A.03, subdivision 1, is amended to read:
7.25    Subdivision 1. Conditions. No policy of individual accident and sickness insurance
7.26may be delivered or issued for delivery to a person in this state unless:
7.27(1) Premium. The entire money and other considerations therefor are expressed
7.28therein.
7.29(2) Time effective. The time at which the insurance takes effect and terminates is
7.30expressed therein.
7.31(3) One person. It purports to insure only one person, except that a policy may
7.32insure, originally or by subsequent amendment, upon the application of an adult member
8.1of a family deemed the policyholder, any two or more eligible members of that family,
8.2including:
8.3(a) husband,
8.4(b) wife,
8.5(c) dependent children as described in sections 62A.302 and 62A.3021, or
8.6(d) any children under a specified age of 19 years or less, or
8.7(e) (d) any other person dependent upon the policyholder.
8.8(4) Appearance. The style, arrangement, and overall appearance of the policy give
8.9no undue prominence to any portion of the text and every printed portion of the text of the
8.10policy and of any endorsements or attached papers is plainly printed in light-face type
8.11of a style in general use. The type size must be uniform and not less than ten point with
8.12a lowercase unspaced alphabet length not less than 120 point. The "text" includes all
8.13printed matter except the name and address of the insurer, name or title of the policy, the
8.14brief description, if any, the reference to renewal or cancellation by a separate statement,
8.15if any, and the captions and subcaptions.
8.16(5) Description of policy. The policy, on the first page, indicates or refers to its
8.17provisions for renewal or cancellation either in the brief description, if any, or by a separate
8.18statement printed in type not smaller than the type used for captions or a separate provision
8.19bearing a caption which accurately describes the renewability or cancelability of the policy.
8.20(6) Exceptions in policy. The exceptions and reductions of indemnity are set
8.21forth in the policy and, except those which are set forth in section 62A.04, printed, at
8.22the insurer's option, either with the benefit provision to which they apply, or under an
8.23appropriate caption such as "EXCEPTIONS" or "EXCEPTIONS AND REDUCTIONS."
8.24However, if an exception or reduction specifically applies only to a particular benefit of
8.25the policy, a statement of the exception or reduction must be included with the benefit
8.26provision to which it applies.
8.27(7) Form number. Each form, including riders and endorsements, is identified by a
8.28form number in the lower left hand corner of the first page thereof.
8.29(8) No incorporation by reference. It contains no provision purporting to make
8.30any portion of the charter, rules, constitution, or bylaws of the insurer a part of the policy
8.31unless the portion is set forth in full in the policy, except in the case of the incorporation
8.32of, or reference to, a statement of rates, classification of risks, or short rate table filed
8.33with the commissioner.
8.34(9) Medical benefits. If the policy contains a provision for medical expense benefits,
8.35the term "medical benefits" or similar terms as used therein includes treatments by all
9.1licensed practitioners of the healing arts unless, subject to the qualifications contained in
9.2clause (10), the policy specifically states the practitioners whose services are covered.
9.3(10) Osteopath, optometrist, chiropractor, or registered nurse services. With
9.4respect to any policy of individual accident and sickness insurance issued or entered
9.5into subsequent to August 1, 1974, notwithstanding the provisions of the policy, if it
9.6contains a provision providing for reimbursement for any service which is in the lawful
9.7scope of practice of a duly licensed osteopath, optometrist, chiropractor, or registered
9.8nurse meeting the requirements of section 62A.15, subdivision 3a, the person entitled to
9.9benefits or person performing services under the policy is entitled to reimbursement on an
9.10equal basis for the service, whether the service is performed by a physician, osteopath,
9.11optometrist, chiropractor, or registered nurse meeting the requirements of section 62A.15,
9.12subdivision 3a , licensed under the laws of this state.
9.13EFFECTIVE DATE.This section is effective the day following final enactment.

9.14    Sec. 14. Minnesota Statutes 2012, section 62A.04, subdivision 2, is amended to read:
9.15    Subd. 2. Required provisions. Except as provided in subdivision 4 each such
9.16policy delivered or issued for delivery to any person in this state shall contain the
9.17provisions specified in this subdivision in the words in which the same appear in this
9.18section. The insurer may, at its option, substitute for one or more of such provisions
9.19corresponding provisions of different wording approved by the commissioner which are
9.20in each instance not less favorable in any respect to the insured or the beneficiary. Such
9.21provisions shall be preceded individually by the caption appearing in this subdivision or, at
9.22the option of the insurer, by such appropriate individual or group captions or subcaptions
9.23as the commissioner may approve.
9.24(1) A provision as follows:
9.25ENTIRE CONTRACT; CHANGES: This policy, including the endorsements and
9.26the attached papers, if any, constitutes the entire contract of insurance. No change in this
9.27policy shall be valid until approved by an executive officer of the insurer and unless such
9.28approval be endorsed hereon or attached hereto. No agent has authority to change this
9.29policy or to waive any of its provisions.
9.30(2) A provision as follows:
9.31TIME LIMIT ON CERTAIN DEFENSES: (a) After two years from the date of issue
9.32of this policy no misstatements, except fraudulent misstatements, made by the applicant
9.33in the application for such policy shall be used to void the policy or to deny a claim for
9.34loss incurred or disability (as defined in the policy) commencing after the expiration
9.35of such two year period.
10.1The foregoing policy provision shall not be so construed as to affect any legal
10.2requirement for avoidance of a policy or denial of a claim during such initial two year
10.3period, nor to limit the application of clauses (1), (2), (3), (4) and (5), in the event of
10.4misstatement with respect to age or occupation or other insurance. A policy which the
10.5insured has the right to continue in force subject to its terms by the timely payment of
10.6premium (1) until at least age 50 or, (2) in the case of a policy issued after age 44, for at
10.7least five years from its date of issue, may contain in lieu of the foregoing the following
10.8provisions (from which the clause in parentheses may be omitted at the insurer's option)
10.9under the caption "INCONTESTABLE":
10.10After this policy has been in force for a period of two years during the lifetime of
10.11the insured (excluding any period during which the insured is disabled), it shall become
10.12incontestable as to the statements contained in the application.
10.13(b) No claim for loss incurred or disability (as defined in the policy) commencing after
10.14two years from the date of issue of this policy shall be reduced or denied on the ground that
10.15a disease or physical condition not excluded from coverage by name or specific description
10.16effective on the date of loss had existed prior to the effective date of coverage of this policy.
10.17(3) (a) Except as required for health plans offered through the Minnesota Insurance
10.18Marketplace, a provision as follows:
10.19GRACE PERIOD: A grace period of ..... (insert a number not less than "7" for
10.20weekly premium policies, "10" for monthly premium policies and "31" for all other
10.21policies) days will be granted for the payment of each premium falling due after the first
10.22premium, during which grace period the policy shall continue in force.
10.23A policy which contains a cancellation provision may add, at the end of the above
10.24provision,
10.25subject to the right of the insurer to cancel in accordance with the cancellation
10.26provision hereof.
10.27A policy in which the insurer reserves the right to refuse any renewal shall have,
10.28at the beginning of the above provision,
10.29Unless not less than five days prior to the premium due date the insurer has delivered
10.30to the insured or has mailed to the insured's last address as shown by the records of the
10.31insurer written notice of its intention not to renew this policy beyond the period for which
10.32the premium has been accepted.
10.33(b) All qualified health plans offered through the Minnesota Insurance Marketplace
10.34must comply with the Affordable Care Act by including a grace period provision no less
10.35restrictive than the grace period required by the Affordable Care Act.
10.36(4) A provision as follows:
11.1REINSTATEMENT: If any renewal premium be not paid within the time granted the
11.2insured for payment, a subsequent acceptance of premium by the insurer or by any agent
11.3duly authorized by the insurer to accept such premium, without requiring in connection
11.4therewith an application for reinstatement, shall reinstate the policy. If the insurer or
11.5such agent requires an application for reinstatement and issues a conditional receipt for
11.6the premium tendered, the policy will be reinstated upon approval of such application
11.7by the insurer or, lacking such approval, upon the forty-fifth day following the date of
11.8such conditional receipt unless the insurer has previously notified the insured in writing
11.9of its disapproval of such application. For health plans described in section 62A.011,
11.10subdivision 3 , clause (10), an insurer must accept payment of a renewal premium and
11.11reinstate the policy, if the insured applies for reinstatement no later than 60 days after the
11.12due date for the premium payment, unless:
11.13(1) the insured has in the interim left the state or the insurer's service area; or
11.14(2) the insured has applied for reinstatement on two or more prior occasions.
11.15The reinstated policy shall cover only loss resulting from such accidental injury as
11.16may be sustained after the date of reinstatement and loss due to such sickness as may
11.17begin more than ten days after such date. In all other respects the insured and insurer shall
11.18have the same rights thereunder as they had under the policy immediately before the due
11.19date of the defaulted premium, subject to any provisions endorsed hereon or attached
11.20hereto in connection with the reinstatement. Any premium accepted in connection with
11.21a reinstatement shall be applied to a period for which premium has not been previously
11.22paid, but not to any period more than 60 days prior to the date of reinstatement. The last
11.23sentence of the above provision may be omitted from any policy which the insured has
11.24the right to continue in force subject to its terms by the timely payment of premiums
11.25(1) until at least age 50, or, (2) in the case of a policy issued after age 44, for at least
11.26five years from its date of issue.
11.27(5) A provision as follows:
11.28NOTICE OF CLAIM: Written notice of claim must be given to the insurer within
11.2920 days after the occurrence or commencement of any loss covered by the policy, or as
11.30soon thereafter as is reasonably possible. Notice given by or on behalf of the insured or
11.31the beneficiary to the insurer at ..... (insert the location of such office as the insurer may
11.32designate for the purpose), or to any authorized agent of the insurer, with information
11.33sufficient to identify the insured, shall be deemed notice to the insurer.
11.34In a policy providing a loss-of-time benefit which may be payable for at least two
11.35years, an insurer may at its option insert the following between the first and second
11.36sentences of the above provision:
12.1Subject to the qualifications set forth below, if the insured suffers loss of time on
12.2account of disability for which indemnity may be payable for at least two years, the
12.3insured shall, at least once in every six months after having given notice of claim, give to
12.4the insurer notice of continuance of said disability, except in the event of legal incapacity.
12.5The period of six months following any filing of proof by the insured or any payment by
12.6the insurer on account of such claim or any denial of liability in whole or in part by the
12.7insurer shall be excluded in applying this provision. Delay in the giving of such notice
12.8shall not impair the insured's right to any indemnity which would otherwise have accrued
12.9during the period of six months preceding the date on which such notice is actually given.
12.10(6) A provision as follows:
12.11CLAIM FORMS: The insurer, upon receipt of a notice of claim, will furnish to the
12.12claimant such forms as are usually furnished by it for filing proofs of loss. If such forms
12.13are not furnished within 15 days after the giving of such notice the claimant shall be
12.14deemed to have complied with the requirements of this policy as to proof of loss upon
12.15submitting, within the time fixed in the policy for filing proofs of loss, written proof
12.16covering the occurrence, the character and the extent of the loss for which claim is made.
12.17(7) A provision as follows:
12.18PROOFS OF LOSS: Written proof of loss must be furnished to the insurer at its
12.19said office in case of claim for loss for which this policy provides any periodic payment
12.20contingent upon continuing loss within 90 days after the termination of the period for
12.21which the insurer is liable and in case of claim for any other loss within 90 days after the
12.22date of such loss. Failure to furnish such proof within the time required shall not invalidate
12.23nor reduce any claim if it was not reasonably possible to give proof within such time,
12.24provided such proof is furnished as soon as reasonably possible and in no event, except in
12.25the absence of legal capacity, later than one year from the time proof is otherwise required.
12.26(8) A provision as follows:
12.27TIME OF PAYMENT OF CLAIMS: Indemnities payable under this policy for
12.28any loss other than loss for which this policy provides periodic payment will be paid
12.29immediately upon receipt of due written proof of such loss. Subject to due written proof
12.30of loss, all accrued indemnities for loss for which this policy provides periodic payment
12.31will be paid ..... (insert period for payment which must not be less frequently than
12.32monthly) and any balance remaining unpaid upon the termination of liability will be paid
12.33immediately upon receipt of due written proof.
12.34(9) A provision as follows:
12.35PAYMENT OF CLAIMS: Indemnity for loss of life will be payable in accordance
12.36with the beneficiary designation and the provisions respecting such payment which may
13.1be prescribed herein and effective at the time of payment. If no such designation or
13.2provision is then effective, such indemnity shall be payable to the estate of the insured.
13.3Any other accrued indemnities unpaid at the insured's death may, at the option of the
13.4insurer, be paid either to such beneficiary or to such estate. All other indemnities will
13.5be payable to the insured.
13.6The following provisions, or either of them, may be included with the foregoing
13.7provision at the option of the insurer:
13.8If any indemnity of this policy shall be payable to the estate of the insured, or to an
13.9insured or beneficiary who is a minor or otherwise not competent to give a valid release,
13.10the insurer may pay such indemnity, up to an amount not exceeding $..... (insert an amount
13.11which shall not exceed $1,000), to any relative by blood or connection by marriage of the
13.12insured or beneficiary who is deemed by the insurer to be equitably entitled thereto. Any
13.13payment made by the insurer in good faith pursuant to this provision shall fully discharge
13.14the insurer to the extent of such payment.
13.15Subject to any written direction of the insured in the application or otherwise all
13.16or a portion of any indemnities provided by this policy on account of hospital, nursing,
13.17medical, or surgical services may, at the insurer's option and unless the insured requests
13.18otherwise in writing not later than the time of filing proofs of such loss, be paid directly to
13.19the hospital or person rendering such services; but it is not required that the service be
13.20rendered by a particular hospital or person.
13.21(10) A provision as follows:
13.22PHYSICAL EXAMINATIONS AND AUTOPSY: The insurer at its own expense
13.23shall have the right and opportunity to examine the person of the insured when and as
13.24often as it may reasonably require during the pendency of a claim hereunder and to make
13.25an autopsy in case of death where it is not forbidden by law.
13.26(11) A provision as follows:
13.27LEGAL ACTIONS: No action at law or in equity shall be brought to recover on this
13.28policy prior to the expiration of 60 days after written proof of loss has been furnished in
13.29accordance with the requirements of this policy. No such action shall be brought after the
13.30expiration of three years after the time written proof of loss is required to be furnished.
13.31(12) A provision as follows:
13.32CHANGE OF BENEFICIARY: Unless the insured makes an irrevocable designation
13.33of beneficiary, the right to change of beneficiary is reserved to the insured and the consent
13.34of the beneficiary or beneficiaries shall not be requisite to surrender or assignment of
13.35this policy or to any change of beneficiary or beneficiaries, or to any other changes in
14.1this policy. The first clause of this provision, relating to the irrevocable designation of
14.2beneficiary, may be omitted at the insurer's option.
14.3EFFECTIVE DATE.This section is effective January 1, 2014.

14.4    Sec. 15. Minnesota Statutes 2012, section 62A.047, is amended to read:
14.562A.047 CHILDREN'S HEALTH SUPERVISION SERVICES AND
14.6PRENATAL CARE SERVICES.
14.7A policy of individual or group health and accident insurance regulated under this
14.8chapter, or individual or group subscriber contract regulated under chapter 62C, health
14.9maintenance contract regulated under chapter 62D, or health benefit certificate regulated
14.10under chapter 64B, issued, renewed, or continued to provide coverage to a Minnesota
14.11resident, must provide coverage for child health supervision services and prenatal care
14.12services. The policy, contract, or certificate must specifically exempt reasonable and
14.13customary charges for child health supervision services and prenatal care services from a
14.14deductible, co-payment, or other coinsurance or dollar limitation requirement. Nothing
14.15in this section prohibits a health carrier that has a network of providers from imposing
14.16a deductible, co-payment, or other coinsurance or dollar limitation requirement for
14.17child health supervision services and prenatal care services that are delivered by an
14.18out-of-network provider. This section does not prohibit the use of policy waiting periods
14.19or preexisting condition limitations for these services. Minimum benefits may be limited
14.20to one visit payable to one provider for all of the services provided at each visit cited in
14.21this section subject to the schedule set forth in this section. Nothing in this section applies
14.22to a policy designed primarily to provide coverage payable on a per diem, fixed indemnity,
14.23or non-expense-incurred basis, or a policy that provides only accident coverage. A policy,
14.24contract, or certificate described under this section may not apply preexisting condition
14.25limitations to individuals under 19 years of age. This section does not apply to individual
14.26coverage under a grandfathered plan.
14.27"Child health supervision services" means pediatric preventive services, appropriate
14.28immunizations, developmental assessments, and laboratory services appropriate to the age
14.29of a child from birth to age six, and appropriate immunizations from ages six to 18, as
14.30defined by Standards of Child Health Care issued by the American Academy of Pediatrics.
14.31Reimbursement must be made for at least five child health supervision visits from birth
14.32to 12 months, three child health supervision visits from 12 months to 24 months, once a
14.33year from 24 months to 72 months.
15.1"Prenatal care services" means the comprehensive package of medical and
15.2psychosocial support provided throughout the pregnancy, including risk assessment,
15.3serial surveillance, prenatal education, and use of specialized skills and technology,
15.4when needed, as defined by Standards for Obstetric-Gynecologic Services issued by the
15.5American College of Obstetricians and Gynecologists.
15.6EFFECTIVE DATE.This section is effective the day following final enactment.

15.7    Sec. 16. Minnesota Statutes 2012, section 62A.049, is amended to read:
15.862A.049 LIMITATION ON PREAUTHORIZATIONS; EMERGENCIES.
15.9No policy of accident and sickness insurance or group subscriber contract regulated
15.10under chapter 62C issued or renewed in this state may contain a provision that makes an
15.11insured person ineligible to receive full benefits because of the insured's failure to obtain
15.12preauthorization, if that failure occurs because of the need for emergency confinement
15.13or emergency treatment. The insured or an authorized representative of the insured shall
15.14notify the insurer as soon after the beginning of emergency confinement or emergency
15.15treatment as reasonably possible. However, to the extent that the insurer suffers actual
15.16prejudice caused by the failure to obtain preauthorization, the insured may be denied all or
15.17part of the insured's benefits. This provision does not apply to admissions for treatment of
15.18chemical dependency and nervous and mental disorders.
15.19EFFECTIVE DATE.This section is effective January 1, 2014.

15.20    Sec. 17. Minnesota Statutes 2012, section 62A.136, is amended to read:
15.2162A.136 HEARING, DENTAL, AND VISION PLAN COVERAGE.
15.22The following provisions do not apply to health plans as defined in section 62A.011,
15.23subdivision 3 , clause (6), providing hearing, dental, or vision coverage only: sections
15.2462A.041 ; 62A.0411; 62A.047; 62A.149; 62A.151; 62A.152; 62A.154; 62A.155; 62A.17,
15.25subdivision 6 ; 62A.21, subdivision 2b; 62A.26; 62A.28; 62A.285; 62A.30; 62A.304; and
15.26 62A.3093; and 62E.16.
15.27EFFECTIVE DATE.This section is effective January 1, 2014.

15.28    Sec. 18. Minnesota Statutes 2012, section 62A.149, subdivision 1, is amended to read:
15.29    Subdivision 1. Application. The provisions of this section apply to all group
15.30policies of accident and health insurance and group subscriber contracts offered by
15.31nonprofit health service plan corporations regulated under chapter 62C, and to a plan or
16.1policy that is individually underwritten or provided for a specific individual and family
16.2members as a nongroup policy unless the individual elects in writing to refuse benefits
16.3under this subdivision in exchange for an appropriate reduction in premiums or subscriber
16.4charges under the policy or plan, when the policies or subscriber contracts are issued or
16.5delivered in Minnesota or provide benefits to Minnesota residents enrolled thereunder.
16.6    This section does not apply to policies designed primarily to provide coverage
16.7payable on a per diem, fixed indemnity or nonexpense incurred basis or policies that
16.8provide accident only coverage.
16.9    Every insurance policy or subscriber contract included within the provisions of this
16.10subdivision, upon issuance or renewal, shall provide coverage that complies with the
16.11requirements of section 62Q.47, paragraphs (b) and (c), for the treatment of alcoholism,
16.12chemical dependency or drug addiction to any Minnesota resident entitled to coverage.
16.13EFFECTIVE DATE.This section is effective January 1, 2014.

16.14    Sec. 19. Minnesota Statutes 2012, section 62A.17, subdivision 2, is amended to read:
16.15    Subd. 2. Responsibility of employee. Every covered employee electing to continue
16.16coverage shall pay the former employer, on a monthly basis, the cost of the continued
16.17coverage. The policy, contract, or plan must require the group policyholder or contract
16.18holder to, upon request, provide the employee with written verification from the insurer
16.19of the cost of this coverage promptly at the time of eligibility for this coverage and at
16.20any time during the continuation period. If the policy, contract, or health care plan is
16.21administered by a trust, every covered employee electing to continue coverage shall pay
16.22the trust the cost of continued coverage according to the eligibility rules established by the
16.23trust. In no event shall the amount of premium charged exceed 102 percent of the cost
16.24to the plan for such period of coverage for similarly situated employees with respect to
16.25whom neither termination nor layoff has occurred, without regard to whether such cost
16.26is paid by the employer or employee. The employee shall be eligible to continue the
16.27coverage until the employee becomes covered under another group health plan, or for a
16.28period of 18 months after the termination of or lay off from employment, whichever is
16.29shorter. For an individual age 19 or older, if the employee becomes covered under another
16.30group policy, contract, or health plan and the new group policy, contract, or health plan
16.31contains any preexisting condition limitations, the employee may, subject to the 18-month
16.32maximum continuation limit, continue coverage with the former employer until the
16.33preexisting condition limitations have been satisfied. The new policy, contract, or health
16.34plan is primary except as to the preexisting condition. In the case of a newborn child who
16.35is a dependent of the employee, the new policy, contract, or health plan is primary upon
17.1the date of birth of the child, regardless of which policy, contract, or health plan coverage
17.2is deemed primary for the mother of the child.
17.3EFFECTIVE DATE.This section is effective the day following final enactment.

17.4    Sec. 20. Minnesota Statutes 2012, section 62A.17, subdivision 6, is amended to read:
17.5    Subd. 6. Conversion to individual policy. A group insurance policy that provides
17.6posttermination or layoff coverage as required by this section shall also include a
17.7provision allowing a covered employee, surviving spouse, or dependent at the expiration
17.8of the posttermination or layoff coverage provided by subdivision 2 to obtain from the
17.9insurer offering the group policy or group subscriber contract, at the employee's, spouse's,
17.10or dependent's option and expense, without further evidence of insurability and without
17.11interruption of coverage, an individual policy of insurance or an individual subscriber
17.12contract providing at least the minimum benefits of a qualified plan as prescribed by
17.13section 62E.06 and the option of a number three qualified plan, a number two qualified
17.14plan, and a number one qualified plan as provided by section 62E.06, subdivisions 1 to
17.153, provided application is made to the insurer within 30 days following notice of the
17.16expiration of the continued coverage and upon payment of the appropriate premium.
17.17The required conversion contract must treat pregnancy the same as any other covered
17.18illness under the conversion contract. A health maintenance contract issued by a health
17.19maintenance organization that provides posttermination or layoff coverage as required
17.20by this section shall also include a provision allowing a former employee, surviving
17.21spouse, or dependent at the expiration of the posttermination or layoff coverage provided
17.22in subdivision 2 to obtain from the health maintenance organization, at the former
17.23employee's, spouse's, or dependent's option and expense, without further evidence of
17.24insurability and without interruption of coverage, an individual health maintenance
17.25contract. Effective January 1, 1985, enrollees who have become nonresidents of the health
17.26maintenance organization's service area shall be given the option, to be arranged by the
17.27health maintenance organization, of a number three qualified plan, a number two qualified
17.28plan, or a number one qualified plan as provided by section 62E.06, subdivisions 1 to 3.
17.29This option shall be made available at the enrollee's expense, without further evidence of
17.30insurability and without interruption of coverage.
17.31A policy providing reduced benefits at a reduced premium rate may be accepted
17.32by the employee, the spouse, or a dependent in lieu of the optional coverage otherwise
17.33required by this subdivision.
17.34The An individual policy or contract issued as a conversion policy prior to January
17.351, 2014, shall be renewable at the option of the individual as long as the individual is not
18.1covered under another qualified plan as defined in section 62E.02, subdivision 4. Any
18.2revisions in the table of rate for the individual policy shall apply to the covered person's
18.3original age at entry and shall apply equally to all similar conversion policies issued
18.4by the insurer.
18.5EFFECTIVE DATE.This section is effective January 1, 2014.

18.6    Sec. 21. Minnesota Statutes 2012, section 62A.21, subdivision 2b, is amended to read:
18.7    Subd. 2b. Conversion privilege. Every policy described in subdivision 1 shall
18.8contain a provision allowing a former spouse and dependent children of an insured,
18.9without providing evidence of insurability, to obtain from the insurer at the expiration of
18.10any continuation of coverage required under subdivision 2a or sections 62A.146 and
18.1162A.20, conversion coverage providing at least the minimum benefits of a qualified
18.12plan as prescribed by section 62E.06 and the option of a number three qualified plan, a
18.13number two qualified plan, a number one qualified plan as provided by section 62E.06,
18.14subdivisions 1 to 3, provided application is made to the insurer within 30 days following
18.15notice of the expiration of the continued coverage and upon payment of the appropriate
18.16premium. The An individual policy or contract issued as a conversion policy prior to
18.17January 1, 2014 shall be renewable at the option of the covered person as long as the
18.18covered person is not covered under another qualified plan as defined in section 62E.02,
18.19subdivision 4 . Any revisions in the table of rate for the individual policy shall apply to the
18.20covered person's original age at entry and shall apply equally to all similar conversion
18.21 policies issued by the insurer.
18.22A policy providing reduced benefits at a reduced premium rate may be accepted by
18.23the covered person in lieu of the optional coverage otherwise required by this subdivision.
18.24EFFECTIVE DATE.This section is effective January 1, 2014.

18.25    Sec. 22. Minnesota Statutes 2012, section 62A.28, subdivision 2, is amended to read:
18.26    Subd. 2. Required coverage. Every policy, plan, certificate, or contract referred to
18.27in subdivision 1 issued or renewed after August 1, 1987, must provide coverage for scalp
18.28hair prostheses worn for hair loss suffered as a result of alopecia areata.
18.29The coverage required by this section is subject to the co-payment, coinsurance,
18.30deductible, and other enrollee cost-sharing requirements that apply to similar types of
18.31items under the policy, plan, certificate, or contract, and is limited to a maximum of $350
18.32in any benefit year and may be limited to one prosthesis per benefit year.
18.33EFFECTIVE DATE.This section is effective January 1, 2014.

19.1    Sec. 23. Minnesota Statutes 2012, section 62A.302, is amended to read:
19.262A.302 COVERAGE OF DEPENDENTS.
19.3    Subdivision 1. Scope of coverage. This section applies to:
19.4(1) a health plan as defined in section 62A.011; and
19.5(2) coverage described in section 62A.011, subdivision 3, clauses (4), (6), (7), (8),
19.6(9), and (10); and
19.7(3) (2) a policy, contract, or certificate issued by a community integrated service
19.8network licensed under chapter 62N.
19.9    Subd. 2. Required coverage. Every health plan included in subdivision 1 that
19.10provides dependent coverage must define "dependent" no more restrictively than the
19.11definition provided in section 62L.02, subdivision 11.
19.12    Subd. 3. No additional restrictions permitted. Any health plan included in
19.13subdivision 1 that provides dependent coverage of children shall make that coverage
19.14available to children until the child attains 26 years of age. A health carrier must not place
19.15restrictions on this coverage and must comply with the following requirements:
19.16(1) with respect to a child who has not attained 26 years of age, a health carrier shall
19.17not define dependent for purposes of eligibility for dependent coverage of children other
19.18than the terms of a relationship between a child and the enrollee or spouse of the enrollee;
19.19(2) a health carrier must not deny or restrict coverage for a child who has not attained
19.2026 years of age based on (i) the presence or absence of the child's financial dependency upon
19.21the participant, primary subscriber, or any other person; (ii) residency with the participant
19.22and in the individual market the primary subscriber, or with any other person; (iii) marital
19.23status; (iv) student status; (v) employment; or (vi) any combination of those factors; and
19.24(3) a health carrier must not deny or restrict coverage of a child based on eligibility
19.25for other coverage, except as provided in subdivision 5.
19.26    Subd. 4. Grandchildren. Nothing in this section requires a health carrier to make
19.27coverage available for a grandchild, unless the grandparent becomes the legal guardian
19.28or adoptive parent of that grandchild or unless the grandchild meets the requirements
19.29of section 62A.042. For grandchildren included under a grandparent's policy pursuant
19.30to section 62A.042, coverage for the grandchild may terminate if the grandchild does
19.31not continue to reside with the covered grandparent continuously from birth, if the
19.32grandchild does not remain financially dependent upon the covered grandparent, or when
19.33the grandchild reaches age 25, except as provided in section 62A.14 or if coverage is
19.34continued under section 62A.20.
20.1    Subd. 5. Terms of coverage of dependents. The terms of coverage in a health plan
20.2offered by a health carrier providing dependent coverage of children cannot vary based on
20.3age except for children who are 26 years of age or older.
20.4    Subd. 6. Opportunity to enroll. A health carrier must comply with all provisions
20.5of the Affordable Care Act in regards to providing an opportunity to enroll in coverage to
20.6any child whose coverage ended, or was not eligible for coverage under a group health
20.7plan or individual health plan because, under the terms of the coverage, the availability
20.8of dependent coverage of a child ended before age 26. This section does not require
20.9compliance with any provision of the Affordable Care Act before the effective date
20.10provided for that provision in the Affordable Care Act. The commissioner shall enforce
20.11this section.
20.12    Subd. 7. Grandfathered plan coverage. (a) For plan years beginning before
20.13January 1, 2014, a group health plan that is a grandfathered plan and makes available
20.14dependent coverage of children may exclude an adult child who has not attained 26
20.15years of age from coverage only if the adult child is eligible to enroll in an eligible
20.16employer-sponsored health benefit plan, as defined in section 5000A(f)(2) of the Internal
20.17Revenue Code, other than the group health plan of a parent.
20.18(b) For plan years beginning on or after January 1, 2014, a group health plan that is
20.19grandfathered plan coverage shall comply with all requirements of this section.
20.20EFFECTIVE DATE.This section is effective the day following final enactment.

20.21    Sec. 24. [62A.3021] COVERAGE OF DEPENDENTS BY PLANS OTHER THAN
20.22HEALTH PLANS.
20.23    Subdivision 1. Scope of coverage. This section applies to coverage described in
20.24section 62A.011, subdivision 3, clauses (4), (6), (7), (8), (9), and (10).
20.25    Subd. 2. Dependent. "Dependent" means an eligible employee's spouse, unmarried
20.26child who is under the age of 25 years, dependent child of any age who is disabled and
20.27who meets the eligibility criteria in section 62A.14, subdivision 2, or any other person
20.28whom state or federal law requires to be treated as a dependent for purposes of health
20.29plans. For the purpose of this definition, a child includes a child for whom the employee or
20.30the employee's spouse has been appointed legal guardian and an adoptive child as provided
20.31in section 62A.27. A child also includes grandchildren as provided in section 62A.042
20.32with continued eligibility of grandchildren as provided in section 62A.302, subdivision 4.
20.33EFFECTIVE DATE.This section is effective the day following final enactment.

21.1    Sec. 25. Minnesota Statutes 2012, section 62A.615, is amended to read:
21.262A.615 PREEXISTING CONDITIONS DISCLOSED AT TIME OF
21.3APPLICATION.
21.4No insurer may cancel or rescind a health insurance policy for a preexisting condition
21.5of which the application or other information provided by the insured reasonably gave
21.6the insurer notice. No insurer may restrict coverage for a preexisting condition of which
21.7the application or other information provided by the insured reasonably gave the insurer
21.8notice unless the coverage is restricted at the time the policy is issued and the restriction is
21.9disclosed in writing to the insured at the time the policy is issued. In addition, no health plan
21.10may restrict coverage for a preexisting condition for an individual who is under 19 years
21.11of age. This section does not apply to individual health plans that are grandfathered plans.
21.12EFFECTIVE DATE.This section is effective the day following final enactment.

21.13    Sec. 26. Minnesota Statutes 2012, section 62A.65, subdivision 3, is amended to read:
21.14    Subd. 3. Premium rate restrictions. No individual health plan may be offered,
21.15sold, issued, or renewed to a Minnesota resident unless the premium rate charged is
21.16determined in accordance with the following requirements:
21.17(a) Premium rates must be no more than 25 percent above and no more than 25
21.18percent below the index rate charged to individuals for the same or similar coverage,
21.19adjusted pro rata for rating periods of less than one year. The premium variations
21.20permitted by this paragraph must be based only upon health status, claims experience,
21.21and occupation. For purposes of this paragraph, health status includes refraining from
21.22tobacco use or other actuarially valid lifestyle factors associated with good health,
21.23provided that the lifestyle factor and its effect upon premium rates have been determined
21.24by the commissioner to be actuarially valid and have been approved by the commissioner.
21.25Variations permitted under this paragraph must not be based upon age or applied
21.26differently at different ages. This paragraph does not prohibit use of a constant percentage
21.27adjustment for factors permitted to be used under this paragraph.
21.28(b) (a) Premium rates may vary based upon the ages of covered persons only as
21.29provided in this paragraph. In addition to the variation permitted under paragraph (a), each
21.30health carrier may use an additional premium variation based upon age of up to plus or
21.31minus 50 percent of the index rate in accordance with the provisions of the Affordable
21.32Care Act.
22.1(c) A health carrier may request approval by the commissioner to establish separate
22.2geographic regions determined by the health carrier and to establish separate index rates
22.3for each such region.
22.4(b) Premium rates may vary based upon geographic rating area. The commissioner
22.5shall grant approval if the following conditions are met:
22.6(1) the geographic regions must be applied uniformly by the health carrier the areas
22.7are established in accordance with the Affordable Care Act;
22.8(2) each geographic region must be composed of no fewer than seven counties that
22.9create a contiguous region; and
22.10(3) the health carrier provides actuarial justification acceptable to the commissioner
22.11for the proposed geographic variations in index rates premium rates for each area,
22.12establishing that the variations are based upon differences in the cost to the health carrier
22.13of providing coverage.
22.14(d) Health carriers may use rate cells and must file with the commissioner the rate
22.15cells they use. Rate cells must be based upon the number of adults or children covered
22.16under the policy and may reflect the availability of Medicare coverage. The rates for
22.17different rate cells must not in any way reflect generalized differences in expected costs
22.18between principal insureds and their spouses.
22.19(c) Premium rates may vary based upon tobacco use, in accordance with the
22.20provisions of the Affordable Care Act.
22.21(e) (d) In developing its index rates and premiums for a health plan, a health carrier
22.22shall take into account only the following factors:
22.23(1) actuarially valid differences in rating factors permitted under paragraphs (a)
22.24and (b) (c); and
22.25(2) actuarially valid geographic variations if approved by the commissioner as
22.26provided in paragraph (c) (b).
22.27(e) The premium charged with respect to any particular individual health plan shall
22.28not be adjusted more frequently than annually or January 1 of the year following initial
22.29enrollment, except that the premium rates may be changed to reflect:
22.30(1) changes to the family composition of the policyholder;
22.31(2) changes in geographic rating area of the policyholder, as provided in paragraph
22.32(b);
22.33(3) changes in age, as provided in paragraph (a);
22.34(4) changes in tobacco use, as provided in paragraph (c);
22.35(5) transfer to a new health plan requested by the policyholder; or
23.1(6) other changes required by or otherwise expressly permitted by state or federal
23.2law or regulations.
23.3(f) A health carrier shall consider all enrollees in all health plans, other than
23.4short-term and grandfathered plan coverage, offered by the health carrier in the individual
23.5market, including those enrollees who enroll in qualified health plans offered through the
23.6Minnesota Insurance Marketplace to be members of a single risk pool.
23.7(g) The commissioner may establish regulations to implement the provisions of
23.8this section.
23.9(h) In connection with the offering for sale of a health plan in the individual market,
23.10a health carrier shall make a reasonable disclosure, as part of its solicitation and sales
23.11materials, of all of the following:
23.12(1) the provisions of the coverage concerning the health carrier's right to change
23.13premium rates and the factors that may affect changes in premium rates; and
23.14(2) a listing of and descriptive information, including benefits and premiums,
23.15about all individual health plans offered by the health carrier and the availability of the
23.16individual health plans for which the individual is qualified.
23.17(i) All premium variations must be justified in initial rate filings and upon request of
23.18the commissioner in rate revision filings. All rate variations are subject to approval by
23.19the commissioner.
23.20(g) (j) The loss ratio must comply with the section 62A.021 requirements for
23.21individual health plans.
23.22(h) (k) The rates must not be approved, unless the commissioner has determined that
23.23the rates are reasonable. In determining reasonableness, the commissioner shall consider
23.24the growth rates applied under section 62J.04, subdivision 1, paragraph (b), to the calendar
23.25year or years that the proposed premium rate would be in effect, and actuarially valid
23.26changes in risks associated with the enrollee populations, and actuarially valid changes as
23.27a result of statutory changes in Laws 1992, chapter 549.
23.28(i) (l) An insurer may, as part of a minimum lifetime loss ratio guarantee filing under
23.29section 62A.02, subdivision 3a, include a rating practices guarantee as provided in this
23.30paragraph. The rating practices guarantee must be in writing and must guarantee that
23.31the policy form will be offered, sold, issued, and renewed only with premium rates and
23.32premium rating practices that comply with subdivisions 2, 3, 4, and 5. The rating practices
23.33guarantee must be accompanied by an actuarial memorandum that demonstrates that the
23.34premium rates and premium rating system used in connection with the policy form will
23.35satisfy the guarantee. The guarantee must guarantee refunds of any excess premiums to
23.36policyholders charged premiums that exceed those permitted under subdivision 2, 3, 4,
24.1or 5. An insurer that complies with this paragraph in connection with a policy form is
24.2exempt from the requirement of prior approval by the commissioner under paragraphs
24.3(c), (f), and (h).
24.4EFFECTIVE DATE.This section is effective January 1, 2014.

24.5    Sec. 27. Minnesota Statutes 2012, section 62A.65, subdivision 5, is amended to read:
24.6    Subd. 5. Portability and conversion of coverage. (a) For plan years beginning
24.7on or after January 1, 2014, no individual health plan may be offered, sold, issued, or
24.8with respect to children age 18 or under renewed, to a Minnesota resident that contains a
24.9preexisting condition limitation, preexisting condition exclusion, or exclusionary rider,
24.10unless the limitation or exclusion is permitted under this subdivision and under chapter
24.1162L, provided that, except for children age 18 or under, underwriting restrictions may
24.12be retained on individual contracts that are issued without evidence of insurability as a
24.13replacement for prior individual coverage that was sold before May 17, 1993. The An
24.14 individual age 19 or older may be subjected to an 18-month preexisting condition limitation
24.15 during plan years beginning prior to January 1, 2014, unless the individual has maintained
24.16continuous coverage as defined in section 62L.02. The individual must not be subjected to
24.17an exclusionary rider. During plan years beginning prior to January 1, 2014, an individual
24.18who is age 19 or older and who has maintained continuous coverage may be subjected to a
24.19onetime preexisting condition limitation of up to 12 months, with credit for time covered
24.20under qualifying coverage as defined in section 62L.02, at the time that the individual first
24.21is covered under an individual health plan by any health carrier. Credit must be given for
24.22all qualifying coverage with respect to all preexisting conditions, regardless of whether
24.23the conditions were preexisting with respect to any previous qualifying coverage. The
24.24individual must not be subjected to an exclusionary rider. Thereafter, the individual who is
24.25age 19 or older must not be subject to any preexisting condition limitation, preexisting
24.26condition exclusion, or exclusionary rider under an individual health plan by any health
24.27carrier, except an unexpired portion of a limitation under prior coverage, so long as the
24.28individual maintains continuous coverage as defined in section 62L.02. The prohibition on
24.29preexisting condition limitations for children age 18 or under does not apply to individual
24.30health plans that are grandfathered plans. The prohibition on preexisting condition
24.31limitations for adults age 19 and over beginning for plan years on or after January 1, 2014
24.32does not apply to individual health plans that are grandfathered plans.
24.33(b) A health carrier must offer an individual health plan to any individual previously
24.34covered under a group health plan issued by that health carrier, regardless of the size of
24.35the group, so long as the individual maintained continuous coverage as defined in section
25.162L.02 . If the individual has available any continuation coverage provided under sections
25.262A.146 ; 62A.148; 62A.17, subdivisions 1 and 2; 62A.20; 62A.21; 62C.142; 62D.101; or
25.362D.105 , or continuation coverage provided under federal law, the health carrier need not
25.4offer coverage under this paragraph until the individual has exhausted the continuation
25.5coverage. The offer must not be subject to underwriting, except as permitted under this
25.6paragraph. A health plan issued under this paragraph must be a qualified plan as defined
25.7in section 62E.02 and must not contain any preexisting condition limitation, preexisting
25.8condition exclusion, or exclusionary rider, except for any unexpired limitation or
25.9exclusion under the previous coverage. The individual health plan must cover pregnancy
25.10on the same basis as any other covered illness under the individual health plan. The offer
25.11of coverage by the health carrier must inform the individual that the coverage, including
25.12what is covered and the health care providers from whom covered care may be obtained,
25.13may not be the same as the individual's coverage under the group health plan. The offer
25.14of coverage by the health carrier must also inform the individual that the individual, if
25.15a Minnesota resident, may be eligible to obtain coverage from (i) other private sources
25.16of health coverage, or (ii) the Minnesota Comprehensive Health Association, without a
25.17preexisting condition limitation, and must provide the telephone number used by that
25.18association for enrollment purposes. The initial premium rate for the individual health
25.19plan must comply with subdivision 3. The premium rate upon renewal must comply with
25.20subdivision 2. In no event shall the premium rate exceed 100 percent of the premium
25.21charged for comparable individual coverage by the Minnesota Comprehensive Health
25.22Association, and the premium rate must be less than that amount if necessary to otherwise
25.23comply with this section. An individual health plan offered under this paragraph to a
25.24person satisfies the health carrier's obligation to offer conversion coverage under section
25.2562E.16, with respect to that person. Coverage issued under this paragraph must provide
25.26that it cannot be canceled or nonrenewed as a result of the health carrier's subsequent
25.27decision to leave the individual, small employer, or other group market. Section 72A.20,
25.28subdivision 28 , applies to this paragraph.
25.29EFFECTIVE DATE.This section is effective the day following final enactment,
25.30except that the amendment made to paragraph (b) is effective January 1, 2014.

25.31    Sec. 28. Minnesota Statutes 2012, section 62A.65, subdivision 6, is amended to read:
25.32    Subd. 6. Guaranteed issue not required. (a) Nothing in this section requires a
25.33health carrier to initially issue a health plan to a Minnesota resident who is age 19 or older
25.34on the date the health plan becomes effective if the effective date is prior to January 1,
25.352014, except as otherwise expressly provided in subdivision 4 or 5.
26.1(b) Guaranteed issue is required for all health plans, except grandfathered plans,
26.2beginning January 1, 2014.
26.3EFFECTIVE DATE.This section is effective the day following final enactment.

26.4    Sec. 29. Minnesota Statutes 2012, section 62A.65, subdivision 7, is amended to read:
26.5    Subd. 7. Short-term coverage. (a) For purposes of this section, "short-term
26.6coverage" means an individual health plan that:
26.7(1) is issued to provide coverage for a period of 185 days or less, except that the
26.8health plan may permit coverage to continue until the end of a period of hospitalization
26.9for a condition for which the covered person was hospitalized on the day that coverage
26.10would otherwise have ended;
26.11(2) is nonrenewable, provided that the health carrier may provide coverage for one or
26.12more subsequent periods that satisfy clause (1), if the total of the periods of coverage do not
26.13exceed a total of 365 days out of any 555-day period, plus any additional days covered as a
26.14result of hospitalization on the day that a period of coverage would otherwise have ended;
26.15(3) does not cover any preexisting conditions, including ones that originated during
26.16a previous identical policy or contract with the same health carrier where coverage was
26.17continuous between the previous and the current policy or contract; and
26.18(4) is available with an immediate effective date without underwriting upon receipt
26.19of a completed application indicating eligibility under the health carrier's eligibility
26.20requirements, provided that coverage that includes optional benefits may be offered on a
26.21basis that does not meet this requirement.
26.22(b) Short-term coverage is not subject to subdivisions 2 and 5. Short-term coverage
26.23may exclude as a preexisting condition any injury, illness, or condition for which the
26.24covered person had medical treatment, symptoms, or any manifestations before the
26.25effective date of the coverage, but dependent children born or placed for adoption during
26.26the policy period must not be subject to this provision.
26.27(c) Notwithstanding subdivision 3, and section 62A.021, a health carrier may
26.28combine short-term coverage with its most commonly sold individual qualified plan, as
26.29defined in section 62E.02, other than short-term coverage, for purposes of complying
26.30with the loss ratio requirement.
26.31(d) The 365-day coverage limitation provided in paragraph (a) applies to the total
26.32number of days of short-term coverage that covers a person, regardless of the number of
26.33policies, contracts, or health carriers that provide the coverage. A written application for
26.34short-term coverage must ask the applicant whether the applicant has been covered by
26.35short-term coverage by any health carrier within the 555 days immediately preceding the
27.1effective date of the coverage being applied for. Short-term coverage issued in violation
27.2of the 365-day limitation is valid until the end of its term and does not lose its status as
27.3short-term coverage, in spite of the violation. A health carrier that knowingly issues
27.4short-term coverage in violation of the 365-day limitation is subject to the administrative
27.5penalties otherwise available to the commissioner of commerce or the commissioner
27.6of health, as appropriate.
27.7(e) Time spent under short-term coverage counts as time spent under a preexisting
27.8condition limitation for purposes of group or individual health plans, other than short-term
27.9coverage, subsequently issued to that person, or to cover that person, by any health carrier,
27.10if the person maintains continuous coverage as defined in section 62L.02. Short-term
27.11coverage is a health plan and is qualifying coverage as defined in section 62L.02.
27.12Notwithstanding any other law to the contrary, a health carrier is not required under any
27.13circumstances to provide a person covered by short-term coverage the right to obtain
27.14coverage on a guaranteed issue basis under another health plan offered by the health
27.15carrier, as a result of the person's enrollment in short-term coverage.
27.16EFFECTIVE DATE.This section is effective the day following final enactment.

27.17    Sec. 30. [62A.67] ESSENTIAL HEALTH BENEFIT PACKAGE
27.18REQUIREMENTS.
27.19    Subdivision 1. Essential health benefits package. (a) Health carriers offering an
27.20individual health plan must include the essential health benefits package as required under
27.21the Affordable Care Act, and as described in this subdivision.
27.22(b) The essential health benefits package means coverage that:
27.23(1) provides essential health benefits as outlined in the Affordable Care Act;
27.24(2) limits cost-sharing for such coverage in accordance with the Affordable Care
27.25Act; and
27.26(3) subject to subdivision 3, provides bronze, silver, gold, or platinum level of
27.27coverage described in the Affordable Care Act.
27.28    Subd. 2. Coverage for enrollees under the age of 21. If a health carrier offers
27.29health coverage in any level specified under section 1302(d) of the Affordable Care Act, as
27.30described in subdivision 1, clause (3), the carrier shall also offer coverage in that level in a
27.31health plan in which the only enrollees are children who, as of the beginning of a policy
27.32year, have not attained the age of 21 years.
27.33    Subd. 3. Alternative compliance for catastrophic plans. A health carrier not
27.34providing a bronze, silver, gold, or platinum level of coverage, as described in subdivision
27.351, paragraph (b), clause (3), shall be treated as meeting the requirements of the Affordable
28.1Care Act with respect to any policy year if the health carrier provides a catastrophic plan
28.2that meets the requirements of the Affordable Care Act.
28.3    Subd. 4. Essential health benefits; definition. For purposes of this section,
28.4"essential health benefits" has the meaning given under the Affordable Care Act, and
28.5include:
28.6(1) ambulatory patient services;
28.7(2) emergency services;
28.8(3) hospitalization;
28.9(4) laboratory services;
28.10(5) maternity and newborn care;
28.11(6) mental health and substance abuse disorder services, including behavioral health
28.12treatment;
28.13(7) pediatric services, including oral and vision care;
28.14(8) prescription drugs;
28.15(9) preventative and wellness services and chronic disease management;
28.16(10) rehabilitative and habilitative services and devices; and
28.17(11) other services defined as essential health benefits under the Affordable Care Act.
28.18    Subd. 5. Exception. This section does not apply to a dental plan as described in
28.19the Affordable Care Act.
28.20EFFECTIVE DATE.This section is effective January 1, 2014.

28.21    Sec. 31. Minnesota Statutes 2012, section 62C.14, subdivision 5, is amended to read:
28.22    Subd. 5. Disabled dependents. A subscriber's individual contract or any group
28.23contract delivered or issued for delivery in this state and providing that coverage of
28.24a dependent child of the subscriber or a dependent child of a covered group member
28.25shall terminate upon attainment of a specified limiting age as defined in section 62Q.01,
28.26subdivision 11, shall also provide in substance that attainment of that age shall not terminate
28.27coverage while the child is (a) incapable of self-sustaining employment by reason of
28.28developmental disability, mental illness or disorder, or physical disability, and (b) chiefly
28.29dependent upon the subscriber or employee for support and maintenance, provided proof
28.30of incapacity and dependency is furnished by the subscriber within 31 days of attainment
28.31of the limiting age as defined in section 62Q.01, subdivision 11, and subsequently as
28.32required by the corporation, but not more frequently than annually after a two-year period
28.33following attainment of the age. Any notice regarding termination of coverage due to
28.34attainment of the limiting age must include information about this provision.
29.1EFFECTIVE DATE.This section is effective the day following final enactment.

29.2    Sec. 32. Minnesota Statutes 2012, section 62C.142, subdivision 2, is amended to read:
29.3    Subd. 2. Conversion privilege. Every subscriber contract, other than a contract
29.4whose continuance is contingent upon continued employment or membership, which
29.5contains a provision for termination of coverage of the spouse upon dissolution of
29.6marriage shall contain a provision allowing a former spouse and dependent children of a
29.7subscriber, without providing evidence of insurability, to obtain from the corporation at
29.8the expiration of any continuation of coverage required under subdivision 2a or section
29.962A.146, or upon termination of coverage by reason of an entry of a valid decree of
29.10dissolution which does not require the insured to provide continued coverage for the
29.11former spouse, an individual subscriber contract providing at least the minimum benefits
29.12of a qualified plan as prescribed by section 62E.06 and the option of a number three
29.13qualified plan, a number two qualified plan, a number one qualified plan as provided by
29.14section 62E.06, subdivisions 1 to 3, provided application is made to the corporation within
29.1530 days following notice of the expiration of the continued coverage and upon payment of
29.16the appropriate fee. A subscriber contract providing reduced benefits at a reduced fee may
29.17be accepted by the former spouse and dependent children in lieu of the optional coverage
29.18otherwise required by this subdivision. The An individual subscriber contract issued as
29.19conversion coverage shall be renewable at the option of the former spouse as long as the
29.20former spouse is not covered under another qualified plan as defined in section 62E.02,
29.21subdivision 4 . Any revisions in the table of rate for the individual subscriber contract shall
29.22apply to the former spouse's original age at entry and shall apply equally to all similar
29.23contracts issued as conversion coverage by the corporation.
29.24EFFECTIVE DATE.This section is effective January 1, 2014.

29.25    Sec. 33. Minnesota Statutes 2012, section 62D.07, subdivision 3, is amended to read:
29.26    Subd. 3. Required provisions. Contracts and evidences of coverage shall contain:
29.27(a) no provisions or statements which are unjust, unfair, inequitable, misleading,
29.28deceptive, or which are untrue, misleading, or deceptive as defined in section 62D.12,
29.29subdivision 1 ;
29.30(b) a clear, concise and complete statement of:
29.31(1) the health care services and the insurance or other benefits, if any, to which the
29.32enrollee is entitled under the health maintenance contract;
30.1(2) any exclusions or limitations on the services, kind of services, benefits, or kind of
30.2benefits, to be provided, including any deductible or co-payment feature and requirements
30.3for referrals, prior authorizations, and second opinions;
30.4(3) where and in what manner information is available as to how services, including
30.5emergency and out of area services, may be obtained;
30.6(4) the total amount of payment and co-payment, if any, for health care services
30.7and the indemnity or service benefits, if any, which the enrollee is obligated to pay
30.8with respect to individual contracts, or an indication whether the plan is contributory or
30.9noncontributory with respect to group certificates; and
30.10(5) a description of the health maintenance organization's method for resolving
30.11enrollee complaints and a statement identifying the commissioner as an external source
30.12with whom complaints may be registered; and
30.13(c) on the cover page of the evidence of coverage and contract, a clear and complete
30.14statement of enrollees' rights. The statement must be in bold print and captioned
30.15"Important Enrollee Information and Enrollee Bill of Rights" and must include but not be
30.16limited to the following provisions in the following language or in substantially similar
30.17language approved in advance by the commissioner, except that paragraph (8) does not
30.18apply to prepaid health plans providing coverage for programs administered by the
30.19commissioner of human services:
30.21(1) COVERED SERVICES: Services provided by (name of health maintenance
30.22organization) will be covered only if services are provided by participating (name of
30.23health maintenance organization) providers or authorized by (name of health maintenance
30.24organization). Your contract fully defines what services are covered and describes
30.25procedures you must follow to obtain coverage.
30.26(2) PROVIDERS: Enrolling in (name of health maintenance organization) does not
30.27guarantee services by a particular provider on the list of providers. When a provider is
30.28no longer part of (name of health maintenance organization), you must choose among
30.29remaining (name of the health maintenance organization) providers.
30.30(3) REFERRALS: Certain services are covered only upon referral. See section
30.31(section number) of your contract for referral requirements. All referrals to non-(name of
30.32health maintenance organization) providers and certain types of health care providers must
30.33be authorized by (name of health maintenance organization).
30.34(4) EMERGENCY SERVICES: Emergency services from providers who are not
30.35affiliated with (name of health maintenance organization) will be covered only if proper
30.36procedures are followed. Your contract explains the procedures and benefits associated
31.1with emergency care from (name of health maintenance organization) and non-(name of
31.2health maintenance organization) providers.
31.3(5) EXCLUSIONS: Certain services or medical supplies are not covered. You
31.4should read the contract for a detailed explanation of all exclusions.
31.5(6) CONTINUATION: You may convert to an individual health maintenance
31.6organization contract or continue coverage under certain circumstances. These
31.7continuation and conversion rights are explained fully in your contract.
31.8(7) CANCELLATION: Your coverage may be canceled by you or (name of health
31.9maintenance organization) only under certain conditions. Your contract describes all
31.10reasons for cancellation of coverage.
31.11(8) NEWBORN COVERAGE: If your health plan provides for dependent coverage,
31.12a newborn infant is covered from birth, but only if services are provided by participating
31.13(name of health maintenance organization) providers or authorized by (name of health
31.14maintenance organization). Certain services are covered only upon referral. (Name
31.15of health maintenance organization) will not automatically know of the infant's birth
31.16or that you would like coverage under your plan. You should notify (name of health
31.17maintenance organization) of the infant's birth and that you would like coverage. If your
31.18contract requires an additional premium for each dependent, (name of health maintenance
31.19organization) is entitled to all premiums due from the time of the infant's birth until the
31.20time you notify (name of health maintenance organization) of the birth. (Name of health
31.21maintenance organization) may withhold payment of any health benefits for the newborn
31.22infant until any premiums you owe are paid.
31.23(9) PRESCRIPTION DRUGS AND MEDICAL EQUIPMENT: Enrolling in (name
31.24of health maintenance organization) does not guarantee that any particular prescription
31.25drug will be available nor that any particular piece of medical equipment will be available,
31.26even if the drug or equipment is available at the start of the contract year.
31.28(1) Enrollees have the right to available and accessible services including emergency
31.29services, as defined in your contract, 24 hours a day and seven days a week;
31.30(2) Enrollees have the right to be informed of health problems, and to receive
31.31information regarding treatment alternatives and risks which is sufficient to assure
31.32informed choice;
31.33(3) Enrollees have the right to refuse treatment, and the right to privacy of medical
31.34and financial records maintained by the health maintenance organization and its health
31.35care providers, in accordance with existing law;
32.1(4) Enrollees have the right to file a complaint with the health maintenance
32.2organization and the commissioner of health and the right to initiate a legal proceeding
32.3when experiencing a problem with the health maintenance organization or its health
32.4care providers;
32.5(5) Enrollees have the right to a grace period of 31 days for the payment of each
32.6premium for an individual health maintenance contract falling due after the first premium
32.7during which period the contract shall continue in force;
32.8(6) Medicare enrollees have the right to voluntarily disenroll from the health
32.9maintenance organization and the right not to be requested or encouraged to disenroll
32.10except in circumstances specified in federal law; and
32.11(7) Medicare enrollees have the right to a clear description of nursing home and
32.12home care benefits covered by the health maintenance organization.
32.13EFFECTIVE DATE.This section is effective the day following final enactment.

32.14    Sec. 34. Minnesota Statutes 2012, section 62D.095, is amended to read:
32.1562D.095 ENROLLEE COST SHARING.
32.16    Subdivision 1. General application. A health maintenance contract may contain
32.17enrollee cost-sharing provisions as specified in this section. Co-payment and deductible
32.18provisions in a group contract must not discriminate on the basis of age, sex, race,
32.19disability, economic status, or length of enrollment in the health plan. During an
32.20open enrollment period in which all offered health plans fully participate without any
32.21underwriting restrictions, co-payment and deductible provisions must not discriminate
32.22on the basis of preexisting health status.
32.23    Subd. 2. Co-payments. (a) A health maintenance contract may impose a
32.24co-payment as authorized under Minnesota Rules, part 4685.0801, or under this section
32.25 and coinsurance consistent with the provisions of the Affordable Care Act as defined
32.26under section 62A.011, subdivision 1a.
32.27(b) A health maintenance organization may impose a flat fee co-payment on
32.28outpatient office visits not to exceed 40 percent of the median provider's charges for
32.29similar services or goods received by the enrollees as calculated under Minnesota Rules,
32.30part 4685.0801. A health maintenance organization may impose a flat fee co-payment on
32.31outpatient prescription drugs not to exceed 50 percent of the median provider's charges
32.32for similar services or goods received by the enrollees as calculated under Minnesota
32.33Rules, part 4685.0801.
33.1(c) If a health maintenance contract is permitted to impose a co-payment for
33.2preexisting health status under sections 62D.01 to 62D.30, these provisions may vary with
33.3respect to length of enrollment in the health plan.
33.4    Subd. 3. Deductibles. (a) A health maintenance contract issued by a health
33.5maintenance organization that is assessed less than three percent of the total annual amount
33.6assessed by the Minnesota comprehensive health association may impose deductibles not
33.7to exceed $3,000 per person, per year and $6,000 per family, per year. For purposes of
33.8the percentage calculation, a health maintenance organization's assessments include those
33.9of its affiliates may impose a deductible consistent with the provisions of the Affordable
33.10Care Act as defined under section 62A.011, subdivision 1a.
33.11(b) All other health maintenance contracts may impose deductibles not to exceed
33.12$2,250 per person, per year and $4,500 per family, per year.
33.13    Subd. 4. Annual out-of-pocket maximums. (a) A health maintenance contract
33.14issued by a health maintenance organization that is assessed less than three percent of the
33.15total annual amount assessed by the Minnesota comprehensive health association must
33.16include a limitation not to exceed $4,500 per person and $7,500 per family on total annual
33.17out-of-pocket enrollee cost-sharing expenses. For purposes of the percentage calculation,
33.18a health maintenance organization's assessments include those of its affiliates may impose
33.19an annual out-of-pocket maximum consistent with the provisions of the Affordable Care
33.20Act as defined under section 62A.011, subdivision 1a.
33.21(b) All other health maintenance contracts must include a limitation not to
33.22exceed $3,000 per person and $6,000 per family on total annual out-of-pocket enrollee
33.23cost-sharing expenses.
33.24    Subd. 5. Exceptions. No co-payments or deductibles may be imposed on preventive
33.25health care services as described in Minnesota Rules, part 4685.0801, subpart 8 consistent
33.26with the provisions of the Affordable Care Act as defined under section 62A.011,
33.27subdivision 1a.
33.28    Subd. 6. Public programs. This section does not apply to the prepaid medical
33.29assistance program, the MinnesotaCare program, the prepaid general assistance program,
33.30the federal Medicare program, or the health plans provided through any of those programs.
33.31EFFECTIVE DATE.This section is effective January 1, 2014.

33.32    Sec. 35. Minnesota Statutes 2012, section 62D.181, subdivision 7, is amended to read:
33.33    Subd. 7. Replacement coverage; limitations. The association is not obligated
33.34to offer replacement coverage under this chapter or conversion coverage under section
33.3562E.16 at the end of the periods specified in subdivision 6. Any continuation obligation
34.1arising under this chapter or chapter 62A will cease at the end of the periods specified in
34.2subdivision 6.
34.3EFFECTIVE DATE.This section is effective January 1, 2014.

34.4    Sec. 36. Minnesota Statutes 2012, section 62E.02, is amended by adding a subdivision
34.5to read:
34.6    Subd. 2a. Essential health benefits. "Essential health benefits" has the meaning
34.7given under section 1302(b) of the Affordable Care Act, as defined under section 62A.011,
34.8subdivision 1a. Essential health benefits include:
34.9(1) ambulatory patient services;
34.10(2) emergency services;
34.11(3) hospitalization;
34.12(4) laboratory services;
34.13(5) maternity and newborn care;
34.14(6) mental health and substance abuse disorder services, including behavioral health
34.15treatment;
34.16(7) pediatric services, including oral and vision care;
34.17(8) prescription drugs;
34.18(9) preventive and wellness services and chronic disease management;
34.19(10) rehabilitative and habilitative services and devices; and
34.20(11) other services defined as essential health benefits under the Affordable Care Act
34.21as defined in section 62A.011, subdivision 1a.
34.22EFFECTIVE DATE.This section is effective January 1, 2014.

34.23    Sec. 37. Minnesota Statutes 2012, section 62E.04, subdivision 4, is amended to read:
34.24    Subd. 4. Major medical coverage. Each insurer and fraternal shall affirmatively
34.25offer coverage of major medical expenses to every applicant who applies to the insurer
34.26or fraternal for a new unqualified policy, which has a lifetime benefit limit of less than
34.27$1,000,000, at the time of application and annually to every holder of such an unqualified
34.28policy of accident and health insurance renewed by the insurer or fraternal. The coverage
34.29shall provide that when a covered individual incurs out-of-pocket expenses of $5,000
34.30or more within a calendar year for services covered in section 62E.06, subdivision 1,
34.31benefits shall be payable, subject to any co-payment authorized by the commissioner, up
34.32to a maximum lifetime limit of not less than $1,000,000 and shall not contain a lifetime
34.33maximum on essential health benefits. The offer of coverage of major medical expenses
35.1may consist of the offer of a rider on an existing unqualified policy or a new policy which
35.2is a qualified plan.
35.3EFFECTIVE DATE.This section is effective the day following final enactment.

35.4    Sec. 38. Minnesota Statutes 2012, section 62E.06, subdivision 1, is amended to read:
35.5    Subdivision 1. Number three plan. A plan of health coverage shall be certified as a
35.6number three qualified plan if it otherwise meets the requirements established by chapters
35.762A, 62C, and 62Q, and the other laws of this state, whether or not the policy is issued in
35.8Minnesota, and meets or exceeds the following minimum standards:
35.9(a) The minimum benefits for a covered individual shall, subject to the other
35.10provisions of this subdivision, be equal to at least 80 percent of the cost of covered services
35.11in excess of an annual deductible which does not exceed $150 per person. The coverage
35.12shall include a limitation of $3,000 per person on total annual out-of-pocket expenses for
35.13services covered under this subdivision. The coverage shall not be subject to a maximum
35.14lifetime benefit of not less than $1,000,000 lifetime maximum on essential health benefits.
35.15The prohibition on lifetime maximums for essential health benefits and $3,000
35.16limitation on total annual out-of-pocket expenses and the $1,000,000 maximum lifetime
35.17benefit shall not be subject to change or substitution by use of an actuarially equivalent
35.18benefit.
35.19(b) Covered expenses shall be the usual and customary charges for the following
35.20services and articles when prescribed by a physician:
35.21(1) hospital services;
35.22(2) professional services for the diagnosis or treatment of injuries, illnesses, or
35.23conditions, other than dental, which are rendered by a physician or at the physician's
35.24direction;
35.25(3) drugs requiring a physician's prescription;
35.26(4) services of a nursing home for not more than 120 days in a year if the services
35.27would qualify as reimbursable services under Medicare;
35.28(5) services of a home health agency if the services would qualify as reimbursable
35.29services under Medicare;
35.30(6) use of radium or other radioactive materials;
35.31(7) oxygen;
35.32(8) anesthetics;
35.33(9) prostheses other than dental but including scalp hair prostheses worn for hair
35.34loss suffered as a result of alopecia areata;
36.1(10) rental or purchase, as appropriate, of durable medical equipment other than
36.2eyeglasses and hearing aids, unless coverage is required under section 62Q.675;
36.3(11) diagnostic x-rays and laboratory tests;
36.4(12) oral surgery for partially or completely unerupted impacted teeth, a tooth root
36.5without the extraction of the entire tooth, or the gums and tissues of the mouth when not
36.6performed in connection with the extraction or repair of teeth;
36.7(13) services of a physical therapist;
36.8(14) transportation provided by licensed ambulance service to the nearest facility
36.9qualified to treat the condition; or a reasonable mileage rate for transportation to a kidney
36.10dialysis center for treatment; and
36.11(15) services of an occupational therapist.
36.12(c) Covered expenses for the services and articles specified in this subdivision do
36.13not include the following:
36.14(1) any charge for care for injury or disease either (i) arising out of an injury in the
36.15course of employment and subject to a workers' compensation or similar law, (ii) for
36.16which benefits are payable without regard to fault under coverage statutorily required
36.17to be contained in any motor vehicle, or other liability insurance policy or equivalent
36.18self-insurance, or (iii) for which benefits are payable under another policy of accident and
36.19health insurance, Medicare, or any other governmental program except as otherwise
36.20provided by section 62A.04, subdivision 3, clause (4);
36.21(2) any charge for treatment for cosmetic purposes other than for reconstructive
36.22surgery when such service is incidental to or follows surgery resulting from injury,
36.23sickness, or other diseases of the involved part or when such service is performed on a
36.24covered dependent child because of congenital disease or anomaly which has resulted in a
36.25functional defect as determined by the attending physician;
36.26(3) care which is primarily for custodial or domiciliary purposes which would not
36.27qualify as eligible services under Medicare;
36.28(4) any charge for confinement in a private room to the extent it is in excess of
36.29the institution's charge for its most common semiprivate room, unless a private room is
36.30prescribed as medically necessary by a physician, provided, however, that if the institution
36.31does not have semiprivate rooms, its most common semiprivate room charge shall be
36.32considered to be 90 percent of its lowest private room charge;
36.33(5) that part of any charge for services or articles rendered or prescribed by a
36.34physician, dentist, or other health care personnel which exceeds the prevailing charge in
36.35the locality where the service is provided; and
37.1(6) any charge for services or articles the provision of which is not within the scope
37.2of authorized practice of the institution or individual rendering the services or articles.
37.3(d) The minimum benefits for a qualified plan shall include, in addition to those
37.4benefits specified in clauses (a) and (e), benefits for well baby care, effective July 1,
37.51980, subject to applicable deductibles, coinsurance provisions, and maximum lifetime
37.6benefit limitations.
37.7(e) Effective July 1, 1979, the minimum benefits of a qualified plan shall include, in
37.8addition to those benefits specified in clause (a), a second opinion from a physician on
37.9all surgical procedures expected to cost a total of $500 or more in physician, laboratory,
37.10and hospital fees, provided that the coverage need not include the repetition of any
37.11diagnostic tests.
37.12(f) Effective August 1, 1985, the minimum benefits of a qualified plan must include,
37.13in addition to the benefits specified in clauses (a), (d), and (e), coverage for special dietary
37.14treatment for phenylketonuria when recommended by a physician.
37.15(g) Outpatient mental health coverage is subject to section 62A.152, subdivision 2.
37.16EFFECTIVE DATE.This section is effective the day following final enactment.

37.17    Sec. 39. Minnesota Statutes 2012, section 62E.09, is amended to read:
37.1862E.09 DUTIES OF COMMISSIONER.
37.19The commissioner may:
37.20(a) formulate general policies to advance the purposes of sections 62E.01 to 62E.19;
37.21(b) supervise the creation of the Minnesota Comprehensive Health Association
37.22within the limits described in section 62E.10;
37.23(c) approve the selection of the writing carrier by the association, approve the
37.24association's contract with the writing carrier, and approve the state plan coverage;
37.25(d) appoint advisory committees;
37.26(e) conduct periodic audits to assure the general accuracy of the financial data
37.27submitted by the writing carrier and the association;
37.28(f) contract with the federal government or any other unit of government to ensure
37.29coordination of the state plan with other governmental assistance programs;
37.30(g) undertake directly or through contracts with other persons studies or
37.31demonstration programs to develop awareness of the benefits of sections 62E.01 to 62E.16
37.32 62E.15, so that the residents of this state may best avail themselves of the health care
37.33benefits provided by these sections;
37.34(h) contract with insurers and others for administrative services; and
38.1(i) adopt, amend, suspend and repeal rules as reasonably necessary to carry out and
38.2make effective the provisions and purposes of sections 62E.01 to 62E.19.
38.3EFFECTIVE DATE.This section is effective January 1, 2014.

38.4    Sec. 40. Minnesota Statutes 2012, section 62E.10, subdivision 7, is amended to read:
38.5    Subd. 7. General powers. The association may:
38.6(a) Exercise the powers granted to insurers under the laws of this state;
38.7(b) Sue or be sued;
38.8(c) Enter into contracts with insurers, similar associations in other states or with
38.9other persons for the performance of administrative functions including the functions
38.10provided for in clauses (e) and (f);
38.11(d) Establish administrative and accounting procedures for the operation of the
38.12association;
38.13(e) Provide for the reinsuring of risks incurred as a result of issuing the coverages
38.14required by sections section 62E.04 and 62E.16 by members of the association. Each
38.15member which elects to reinsure its required risks shall determine the categories of
38.16coverage it elects to reinsure in the association. The categories of coverage are:
38.17(1) individual qualified plans, excluding group conversions;
38.18(2) group conversions;
38.19(3) group qualified plans with fewer than 50 employees or members; and
38.20(4) major medical coverage.
38.21A separate election may be made for each category of coverage. If a member elects
38.22to reinsure the risks of a category of coverage, it must reinsure the risk of the coverage
38.23of every life covered under every policy issued in that category. A member electing to
38.24reinsure risks of a category of coverage shall enter into a contract with the association
38.25establishing a reinsurance plan for the risks. This contract may include provision for
38.26the pooling of members' risks reinsured through the association and it may provide for
38.27assessment of each member reinsuring risks for losses and operating and administrative
38.28expenses incurred, or estimated to be incurred in the operation of the reinsurance plan. This
38.29reinsurance plan shall be approved by the commissioner before it is effective. Members
38.30electing to administer the risks which are reinsured in the association shall comply with the
38.31benefit determination guidelines and accounting procedures established by the association.
38.32The fee charged by the association for the reinsurance of risks shall not be less than 110
38.33percent of the total anticipated expenses incurred by the association for the reinsurance; and
38.34(f) Provide for the administration by the association of policies which are reinsured
38.35pursuant to clause (e). Each member electing to reinsure one or more categories of
39.1coverage in the association may elect to have the association administer the categories of
39.2coverage on the member's behalf. If a member elects to have the association administer
39.3the categories of coverage, it must do so for every life covered under every policy issued
39.4in that category. The fee for the administration shall not be less than 110 percent of the
39.5total anticipated expenses incurred by the association for the administration.
39.6EFFECTIVE DATE.This section is effective January 1, 2014.

39.7    Sec. 41. Minnesota Statutes 2012, section 62H.04, is amended to read:
39.862H.04 COMPLIANCE WITH OTHER LAWS.
39.9(a) A joint self-insurance plan is subject to the requirements of chapters 62A, 62E,
39.1062L, and 62Q, and sections 72A.17 to 72A.32 unless otherwise specifically exempt. A
39.11joint self-insurance plan must pay assessments made by the Minnesota Comprehensive
39.12Health Association, as required under section 62E.11.
39.13(b) A joint self-insurance plan is exempt from providing the mandated health
39.14benefits described in chapters 62A, 62E, 62L, and 62Q if it otherwise provides the benefits
39.15required under the Employee Retirement Income Security Act of 1974, United States
39.16Code, title 29, sections 1001, et seq., for all employers and not just for the employers with
39.1750 or more employees who are covered by that federal law.
39.18(c) A joint self-insurance plan is exempt from section 62L.03, subdivision 1, if the
39.19plan offers an annual open enrollment period of no less than 15 days during which all
39.20employers that qualify for membership may enter the plan without preexisting condition
39.21limitations or exclusions except those permitted under chapter 62L.
39.22(d) A joint self-insurance plan is exempt from sections 62A.146, 62A.16, 62A.17,
39.2362A.20 , 62A.21, and 62A.65, subdivision 5, paragraph (b), and 62E.16 if the joint
39.24self-insurance plan complies with the continuation requirements under the Employee
39.25Retirement Income Security Act of 1974, United States Code, title 29, sections 1001, et
39.26seq., for all employers and not just for the employers with 20 or more employees who
39.27are covered by that federal law.
39.28(e) A joint self-insurance plan must provide to all employers the maternity coverage
39.29required by federal law for employers with 15 or more employees.
39.30(f) A joint self-insurance plan must comply with all the provisions and requirements
39.31of the Affordable Care Act as defined under section 62A.011, subdivision 1a, to the extent
39.32that they apply to such plans.
39.33EFFECTIVE DATE.This section is effective the day following final enactment,
39.34except that the amendment made to paragraph (d) is effective January 1, 2014.

40.1    Sec. 42. Minnesota Statutes 2012, section 62L.02, subdivision 11, is amended to read:
40.2    Subd. 11. Dependent. "Dependent" means an eligible employee's spouse,
40.3unmarried child who is under the age of 25 years dependent child to the limiting age as
40.4defined in section 62Q.01, subdivision 11, dependent child of any age who is disabled and
40.5who meets the eligibility criteria in section 62A.14, subdivision 2, or any other person
40.6whom state or federal law requires to be treated as a dependent for purposes of health
40.7plans. For the purpose of this definition, a dependent child to the limiting age as defined in
40.8section 62Q.01, subdivision 11, includes a child for whom the employee or the employee's
40.9spouse has been appointed legal guardian and an adoptive child as provided in section
40.1062A.27 . A child also means a grandchild as provided in section 62A.042 with continued
40.11eligibility of grandchildren as provided in section 62A.302, subdivision 4.
40.12EFFECTIVE DATE.This section is effective the day following final enactment.

40.13    Sec. 43. Minnesota Statutes 2012, section 62L.02, subdivision 14a, is amended to read:
40.14    Subd. 14a. Guaranteed issue. "Guaranteed issue" means that a health carrier shall
40.15not decline an application by a small employer for any health benefit plan offered by
40.16that health carrier and shall not decline to cover under a health benefit plan any eligible
40.17employee or eligible dependent, including persons who become eligible employees or
40.18eligible dependents after initial issuance of the health benefit plan, subject to the health
40.19carrier's right to impose preexisting condition limitations permitted under this chapter.
40.20EFFECTIVE DATE.This section is effective January 1, 2014.

40.21    Sec. 44. Minnesota Statutes 2012, section 62L.02, is amended by adding a subdivision
40.22to read:
40.23    Subd. 17a. Individual health plan. "Individual health plan" means a health plan
40.24as defined under section 62A.011, subdivision 3, that is offered to individuals in the
40.25individual market, other than conversion policies or short-term coverage. Small group
40.26market health plans offered though the Minnesota Insurance Marketplace to employees of
40.27a small employer are not considered individual health plans, regardless of whether the
40.28health plan is purchased using a defined contribution from the employer.
40.29EFFECTIVE DATE.This section is effective January 1, 2014.

40.30    Sec. 45. Minnesota Statutes 2012, section 62L.02, subdivision 26, is amended to read:
40.31    Subd. 26. Small employer. (a) "Small employer" means, with respect to a calendar
40.32year and a plan year, a person, firm, corporation, partnership, association, or other entity
41.1actively engaged in business in Minnesota, including a political subdivision of the state, that
41.2employed an average of no fewer than two nor at least one, not including a sole proprietor,
41.3but not more than 50 current employees on business days during the preceding calendar
41.4year and that employs at least two one current employees employee, not including a sole
41.5proprietor, on the first day of the plan year. If an employer has only one eligible employee
41.6who has not waived coverage, the sale of a health plan to or for that eligible employee
41.7is not a sale to a small employer and is not subject to this chapter and may be treated as
41.8the sale of an individual health plan. A small employer plan may be offered through a
41.9domiciled association to self-employed individuals and small employers who are members
41.10of the association, even if the self-employed individual or small employer has fewer than
41.11two current employees. Entities that are treated as a single employer under subsection (b),
41.12(c), (m), or (o) of section 414 of the federal Internal Revenue Code are considered a single
41.13employer for purposes of determining the number of current employees. Small employer
41.14status must be determined on an annual basis as of the renewal date of the health benefit
41.15plan. The provisions of this chapter continue to apply to an employer who no longer meets
41.16the requirements of this definition until the annual renewal date of the employer's health
41.17benefit plan. If an employer was not in existence throughout the preceding calendar year,
41.18the determination of whether the employer is a small employer is based upon the average
41.19number of current employees that it is reasonably expected that the employer will employ
41.20on business days in the current calendar year. For purposes of this definition, the term
41.21employer includes any predecessor of the employer. An employer that has more than 50
41.22current employees but has 50 or fewer employees, as "employee" is defined under United
41.23States Code, title 29, section 1002(6), is a small employer under this subdivision.
41.24(b) Where an association, as defined in section 62L.045, comprised of employers
41.25contracts with a health carrier to provide coverage to its members who are small employers,
41.26the association and health benefit plans it provides to small employers, are subject to
41.27section 62L.045, with respect to small employers in the association, even though the
41.28association also provides coverage to its members that do not qualify as small employers.
41.29(c) If an employer has employees covered under a trust specified in a collective
41.30bargaining agreement under the federal Labor-Management Relations Act of 1947,
41.31United States Code, title 29, section 141, et seq., as amended, or employees whose health
41.32coverage is determined by a collective bargaining agreement and, as a result of the
41.33collective bargaining agreement, is purchased separately from the health plan provided
41.34to other employees, those employees are excluded in determining whether the employer
41.35qualifies as a small employer. Those employees are considered to be a separate small
42.1employer if they constitute a group that would qualify as a small employer in the absence
42.2of the employees who are not subject to the collective bargaining agreement.
42.3EFFECTIVE DATE.This section is effective January 1, 2014.

42.4    Sec. 46. Minnesota Statutes 2012, section 62L.03, subdivision 1, is amended to read:
42.5    Subdivision 1. Guaranteed issue and reissue. (a) Every health carrier shall, as a
42.6condition of authority to transact business in this state in the small employer market,
42.7affirmatively market, offer, sell, issue, and renew any of its health benefit plans, on a
42.8guaranteed issue basis, to any small employer, including a small employer covered by
42.9paragraph (b), that meets the participation and contribution requirements of subdivision 3,
42.10as provided in this chapter.
42.11(b) A small employer that has its no longer meets the definition of small employer
42.12because of a reduction in workforce reduced to one employee may continue coverage as a
42.13small employer for 12 months from the date the group is reduced to one employee.
42.14(c) Notwithstanding paragraph (a), a health carrier may, at the time of coverage
42.15renewal, modify the health coverage for a product offered in the small employer market if
42.16the modification is consistent with state law, approved by the commissioner, and effective
42.17on a uniform basis for all small employers purchasing that product other than through a
42.18qualified association in compliance with section 62L.045, subdivision 2.
42.19Paragraph (a) does not apply to a health benefit plan designed for a small employer
42.20to comply with a collective bargaining agreement, provided that the health benefit plan
42.21otherwise complies with this chapter and is not offered to other small employers, except
42.22for other small employers that need it for the same reason. This paragraph applies only
42.23with respect to collective bargaining agreements entered into prior to August 21, 1996,
42.24and only with respect to plan years beginning before the later of July 1, 1997, or the date
42.25upon which the last of the collective bargaining agreements relating to the plan terminates
42.26determined without regard to any extension agreed to after August 21, 1996.
42.27(d) Every health carrier participating in the small employer market shall make
42.28available both of the plans described in section 62L.05 to small employers and shall fully
42.29comply with the underwriting and the rate restrictions specified in this chapter for all
42.30health benefit plans issued to small employers.
42.31(e) (d) A health carrier may cease to transact business in the small employer market
42.32as provided under section 62L.09.
42.33EFFECTIVE DATE.This section is effective January 1, 2014.

43.1    Sec. 47. Minnesota Statutes 2012, section 62L.03, subdivision 3, is amended to read:
43.2    Subd. 3. Minimum participation and contribution. (a) A small employer that has
43.3at least 75 percent of its eligible employees who have not waived coverage participating in
43.4a health benefit plan and that contributes at least 50 percent toward the cost of coverage of
43.5each eligible employee must be guaranteed coverage on a guaranteed issue basis from
43.6any health carrier participating in the small employer market. The participation level
43.7of eligible employees must be determined at the initial offering of coverage and at the
43.8renewal date of coverage. A health carrier must not increase the participation requirements
43.9applicable to a small employer at any time after the small employer has been accepted for
43.10coverage. For the purposes of this subdivision, waiver of coverage includes only waivers
43.11due to: (1) coverage under another group health plan; (2) unaffordability as specified by
43.12the Affordable Care Act as defined under section 62A.011, subdivision 1a; (3) coverage
43.13under Medicare Parts A and B; or (3) (4) coverage under medical assistance under chapter
43.14256B or general assistance medical care under chapter 256D.
43.15    (b) If a small employer does not satisfy the contribution or participation requirements
43.16under this subdivision, a health carrier may voluntarily issue or renew individual health
43.17plans, or a health benefit plan which must fully comply with this chapter. A health carrier
43.18that provides a health benefit plan to a small employer that does not meet the contribution
43.19or participation requirements of this subdivision must maintain this information in its files
43.20for audit by the commissioner. A health carrier may not offer an individual health plan,
43.21purchased through an arrangement between the employer and the health carrier, to any
43.22employee unless the health carrier also offers the individual health plan, on a guaranteed
43.23issue basis, to all other employees of the same employer. An arrangement permitted under
43.24section 62L.12, subdivision 2, paragraph (k), is not an arrangement between the employer
43.25and the health carrier for purposes of this paragraph.
43.26    (c) Nothing in this section obligates a health carrier to issue coverage to a small
43.27employer that currently offers coverage through a health benefit plan from another health
43.28carrier, unless the new coverage will replace the existing coverage and not serve as one
43.29of two or more health benefit plans offered by the employer. This paragraph does not
43.30apply if the small employer will meet the required participation level with respect to
43.31the new coverage.
43.32(d) This section does not apply to health plans offered through the Minnesota
43.33Insurance Marketplace under chapter 62V.
43.34EFFECTIVE DATE.This section is effective January 1, 2014.

43.35    Sec. 48. Minnesota Statutes 2012, section 62L.03, subdivision 4, is amended to read:
44.1    Subd. 4. Underwriting restrictions. (a) Health carriers may apply underwriting
44.2restrictions to coverage for health benefit plans for small employers, including any
44.3preexisting condition limitations, only as expressly permitted under this chapter. For
44.4purposes of this section, "underwriting restrictions" means any refusal of the health carrier
44.5to issue or renew coverage, any premium rate higher than the lowest rate charged by the
44.6health carrier for the same coverage, any preexisting condition limitation, preexisting
44.7condition exclusion, or any exclusionary rider.
44.8(b) Health carriers may collect information relating to the case characteristics and
44.9demographic composition of small employers, as well as health status and health history
44.10information about employees, and dependents of employees, of small employers.
44.11(c) Except as otherwise authorized for late entrants, preexisting conditions may be
44.12excluded by a health carrier for a period not to exceed 12 months from the enrollment
44.13date of an eligible employee or dependent, but exclusionary riders must not be used. Late
44.14entrants may be subject to a preexisting condition limitation not to exceed 18 months from
44.15the enrollment date of the late entrant, but must not be subject to any exclusionary rider or
44.16preexisting condition exclusion. When calculating any length of preexisting condition
44.17limitation, a health carrier shall credit the time period an eligible employee or dependent
44.18was previously covered by qualifying coverage, provided that the individual maintains
44.19continuous coverage. The credit must be given for all qualifying coverage with respect
44.20to all preexisting conditions, regardless of whether the conditions were preexisting with
44.21respect to any previous qualifying coverage. Section 60A.082, relating to replacement of
44.22group coverage, and the rules adopted under that section apply to this chapter, and this
44.23chapter's requirements are in addition to the requirements of that section and the rules
44.24adopted under it. A health carrier shall, at the time of first issuance or renewal of a health
44.25benefit plan on or after July 1, 1993, credit against any preexisting condition limitation
44.26or exclusion permitted under this section, the time period prior to July 1, 1993, during
44.27which an eligible employee or dependent was covered by qualifying coverage, if the
44.28person has maintained continuous coverage.
44.29(d) Health carriers shall not use pregnancy as a preexisting condition under this
44.30chapter.
44.31EFFECTIVE DATE.This section is effective January 1, 2014.

44.32    Sec. 49. Minnesota Statutes 2012, section 62L.03, subdivision 6, is amended to read:
44.33    Subd. 6. MCHA enrollees. Health carriers shall offer coverage to any eligible
44.34employee or dependent enrolled in MCHA at the time of the health carrier's issuance or
44.35renewal of a health benefit plan to a small employer. The health benefit plan must require
45.1that the employer permit MCHA enrollees to enroll in the small employer's health benefit
45.2plan as of the first date of renewal of a health benefit plan occurring on or after July
45.31, 1993, and as of each date of renewal after that, or, in the case of a new group, as of
45.4the initial effective date of the health benefit plan and as of each date of renewal after
45.5that. Unless otherwise permitted by this chapter, Health carriers must not impose any
45.6underwriting restrictions, including any preexisting condition limitations or exclusions, on
45.7any eligible employee or dependent previously enrolled in MCHA and transferred to a
45.8health benefit plan so long as continuous coverage is maintained, provided that the health
45.9carrier may impose any unexpired portion of a preexisting condition limitation under the
45.10person's MCHA coverage. An MCHA enrollee is not a late entrant, so long as the enrollee
45.11has maintained continuous coverage.
45.12EFFECTIVE DATE.This section is effective January 1, 2014.

45.13    Sec. 50. Minnesota Statutes 2012, section 62L.045, subdivision 2, is amended to read:
45.14    Subd. 2. Qualified associations. (a) A qualified association, as defined in this
45.15section, and health coverage offered by it, to it, or through it, to a small employer in
45.16this state must comply with the requirements of this chapter regarding guaranteed issue,
45.17guaranteed renewal, preexisting condition limitations, credit against preexisting condition
45.18limitations for continuous coverage, treatment of MCHA enrollees, and the definition of
45.19dependent, and with section 62A.65, subdivision 5, paragraph (b). They must also comply
45.20with all other requirements of this chapter not specifically exempted in paragraph (b) or (c).
45.21(b) A qualified association and a health carrier offering, selling, issuing, or renewing
45.22health coverage to, or to cover, a small employer in this state through the qualified
45.23association, may, but are not, in connection with that health coverage, required to:
45.24(1) offer the two small employer plans described in section 62L.05; and
45.25(2) offer to small employers that are not members of the association, health coverage
45.26offered to, by, or through the qualified association.
45.27(c) A qualified association, and a health carrier offering, selling, issuing, and
45.28renewing health coverage to, or to cover, a small employer in this state must comply
45.29with section 62L.08, except that:
45.30(1) a separate index rate may be applied by a health carrier to each qualified
45.31association, provided that:
45.32(i) the premium rate applied to participating small employer members of the
45.33qualified association is no more than 25 percent above and no more than 25 percent below
45.34the index rate applied to the qualified association, irrespective of when members applied
45.35for health coverage; and
46.1(ii) the index rate applied by a health carrier to a qualified association is no more
46.2than 20 percent above and no more than 20 percent below the index rate applied by the
46.3health carrier to any other qualified association or to any small employer. In comparing
46.4index rates for purposes of this clause, the 20 percent shall be calculated as a percent of
46.5the larger index rate; and
46.6(2) a qualified association described in subdivision 1, paragraph (a), clauses (2)
46.7to (4), providing health coverage through a health carrier, or on a self-insured basis in
46.8compliance with section 471.617 and the rules adopted under that section, may cover
46.9small employers and other employers within the same pool and may charge premiums
46.10to small employer members on the same basis as it charges premiums to members that
46.11are not small employers, if the premium rates charged to small employers do not have
46.12greater variation than permitted under section 62L.08. A qualified association operating
46.13under this clause shall annually prove to the commissioner of commerce that it complies
46.14with this clause through a sampling procedure acceptable to the commissioner. If the
46.15qualified association fails to prove compliance to the satisfaction of the commissioner,
46.16the association shall agree to a written plan of correction acceptable to the commissioner.
46.17The qualified association is considered to be in compliance under this clause if there is
46.18a premium rate that would, if used as an index rate, result in all premium rates in the
46.19sample being in compliance with section 62L.08. This clause does not exempt a qualified
46.20association or a health carrier providing coverage through the qualified association from
46.21the loss ratio requirement of section 62L.08, subdivision 11.
46.22EFFECTIVE DATE.This section is effective January 1, 2014.

46.23    Sec. 51. Minnesota Statutes 2012, section 62L.045, subdivision 4, is amended to read:
46.24    Subd. 4. Principles; association coverage. (a) This subdivision applies to
46.25associations as defined in this section, whether qualified associations or not, and is
46.26intended to clarify subdivisions 1 to 3.
46.27(b) This section applies only to associations that provide health coverage to small
46.28employers.
46.29(c) A health carrier is not required under this chapter to comply with guaranteed
46.30issue and guaranteed renewal with respect to its relationship with the association itself.
46.31 An arrangement between the health carrier and the association, once entered into, must
46.32comply with guaranteed issue and guaranteed renewal with respect to members of the
46.33association that are small employers and persons covered through them.
47.1(d) When an arrangement between a health carrier and an association has validly
47.2terminated, the health carrier has no continuing obligation to small employers and persons
47.3covered through them, except as otherwise provided in:
47.4(1) section 62A.65, subdivision 5, paragraph (b);
47.5(2) any other continuation or conversion rights applicable under state or federal
47.6law; and
47.7(3) section 60A.082, relating to group replacement coverage, and rules adopted
47.8under that section.
47.9(e) When an association's arrangement with a health carrier has terminated and the
47.10association has entered into a new arrangement with that health carrier or a different
47.11health carrier, the new arrangement is subject to section 60A.082 and rules adopted under
47.12it, with respect to members of the association that are small employers and persons
47.13covered through them.
47.14(f) An association that offers its members more than one plan of health coverage
47.15may have uniform rules restricting movement between the plans of health coverage, if the
47.16rules do not discriminate against small employers.
47.17(g) This chapter does not require or prohibit separation of an association's members
47.18into one group consisting only of small employers and another group or other groups
47.19consisting of all other members. The association must comply with this section with
47.20respect to the small employer group.
47.21(h) For purposes of this section, "member" of an association includes an employer
47.22participant in the association.
47.23(i) For purposes of this section, health coverage issued to, or to cover, a small
47.24employer includes a certificate of coverage issued directly to the employer's employees
47.25and dependents, rather than to the small employer.
47.26EFFECTIVE DATE.This section is effective January 1, 2014.

47.27    Sec. 52. Minnesota Statutes 2012, section 62L.05, subdivision 10, is amended to read:
47.28    Subd. 10. Medical expense reimbursement. Health carriers may reimburse
47.29or pay for medical services, supplies, or articles provided under a small employer plan
47.30in accordance with the health carrier's provider contract requirements including, but
47.31not limited to, salaried arrangements, capitation, the payment of usual and customary
47.32charges, fee schedules, discounts from fee-for-service, per diems, diagnosis-related
47.33groups (DRGs), and other payment arrangements. Nothing in this chapter requires a
47.34health carrier to develop, implement, or change its provider contract requirements for
47.35a small employer plan. Coinsurance, deductibles, and out-of-pocket maximums, and
48.1maximum lifetime benefits must be calculated and determined in accordance with each
48.2health carrier's standard business practices.
48.3EFFECTIVE DATE.This section is effective the day following final enactment.

48.4    Sec. 53. Minnesota Statutes 2012, section 62L.06, is amended to read:
48.562L.06 DISCLOSURE OF UNDERWRITING RATING PRACTICES.
48.6When offering or renewing a health benefit plan, health carriers shall disclose in all
48.7solicitation and sales materials:
48.8(1) the case characteristics and other rating factors used to determine initial and
48.9renewal rates;
48.10(2) the extent to which premium rates for a small employer are established or
48.11adjusted based upon actual or expected variation in claim experience;
48.12(3) provisions concerning the health carrier's right to change premium rates and the
48.13factors other than claim experience that affect changes in premium rates;
48.14(4) (2) provisions relating to renewability of coverage;
48.15(5) the use and effect of any preexisting condition provisions, if permitted;
48.16(6) (3) the application of any provider network limitations and their effect on
48.17eligibility for benefits; and
48.18(7) (4) the ability of small employers to insure eligible employees and dependents
48.19currently receiving coverage from the Comprehensive Health Association through health
48.20benefit plans.
48.21EFFECTIVE DATE.This section is effective January 1, 2014.

48.22    Sec. 54. Minnesota Statutes 2012, section 62L.08, is amended to read:
48.2362L.08 RESTRICTIONS RELATING TO PREMIUM RATES.
48.24    Subdivision 1. Rate restrictions. Premium rates for all health benefit plans sold or
48.25issued to small employers are subject to the restrictions specified in this section.
48.26    Subd. 2. General premium variations. Beginning July 1, 1993, each health carrier
48.27must offer premium rates to small employers that are no more than 25 percent above
48.28and no more than 25 percent below the index rate charged to small employers for the
48.29same or similar coverage, adjusted pro rata for rating periods of less than one year. The
48.30premium variations permitted by this subdivision must be based only on health status,
48.31claims experience, industry of the employer, and duration of coverage from the date of
48.32issue. For purposes of this subdivision, health status includes refraining from tobacco use
48.33or other actuarially valid lifestyle factors associated with good health, provided that the
49.1lifestyle factor and its effect upon premium rates have been determined to be actuarially
49.2valid and approved by the commissioner. Variations permitted under this subdivision must
49.3not be based upon age or applied differently at different ages. This subdivision does not
49.4prohibit use of a constant percentage adjustment for factors permitted to be used under
49.5this subdivision.
49.6    Subd. 2a. Renewal premium increases limited. (a) Beginning January 1, 2003,
49.7the percentage increase in the premium rate charged to a small employer for a new rating
49.8period must not exceed the sum of the following:
49.9(1) the percentage change in the index rate measured from the first day of the prior
49.10rating period to the first day of the new rating period;
49.11(2) an adjustment, not to exceed 15 percent annually and adjusted pro rata for rating
49.12periods of less than one year, due to the claims experience, health status, or duration of
49.13coverage of the employees or dependents of the employer; and
49.14(3) any adjustment due to change in coverage or in the case characteristics of the
49.15employer.
49.16(b) This subdivision does not apply if the employer, employee, or any applicant
49.17provides the health carrier with false, incomplete, or misleading information.
49.18    Subd. 3. Age-based premium variations. Beginning July 1, 1993, Each health
49.19carrier may offer premium rates to small employers that vary based upon the ages of
49.20the eligible employees and dependents of the small employer only as provided in this
49.21subdivision. In addition to the variation permitted by subdivision 2, each health carrier
49.22may use an additional premium variation based upon age of up to plus or minus 50 percent
49.23of the index rate. Premium rates may vary based upon the ages of the eligible employees
49.24and dependents of the small employer in accordance with the provisions of the Affordable
49.25Care Act as defined in section 62A.011, subdivision 1a.
49.26    Subd. 4. Geographic premium variations. A health carrier may request approval
49.27by the commissioner to establish separate geographic regions determined by the health
49.28carrier and to establish separate index rates for each such region Premium rates may vary
49.29based on geographic rating areas set by the commissioner. The commissioner shall grant
49.30approval if the following conditions are met:
49.31(1) the geographic regions must be applied uniformly by the health carrier;
49.32(2) each geographic region must be composed of no fewer than seven counties that
49.33create a contiguous region; and
49.34(3) the health carrier provides actuarial justification acceptable to the commissioner
49.35for the proposed geographic variations in index rates, establishing that the variations are
49.36based upon differences in the cost to the health carrier of providing coverage.
50.1    Subd. 5. Gender-based rates prohibited. Beginning July 1, 1993, No health carrier
50.2may determine premium rates through a method that is in any way based upon the gender
50.3of eligible employees or dependents. Rates must not in any way reflect marital status or
50.4generalized differences in expected costs between employees and spouses.
50.5    Subd. 6. Rate cells permitted Tobacco rating. Health carriers may use rate cells
50.6and must file with the commissioner the rate cells they use. Rate cells must be based on
50.7the number of adults and children covered under the policy and may reflect the availability
50.8of Medicare coverage. The rates for different rate cells must not in any way reflect marital
50.9status or differences in expected costs between employees and spouses Premium rates
50.10may vary based upon tobacco use in accordance with the provisions of the Affordable
50.11Care Act as defined in section 62A.011, subdivision 1a.
50.12    Subd. 7. Index and Premium rate development. (a) In developing its index rates
50.13and premiums, a health carrier may take into account only the following factors:
50.14(1) actuarially valid differences in benefit designs of health benefit plans; and
50.15(2) actuarially valid differences in the rating factors permitted in subdivisions 2 and 3;
50.16(3) (2) actuarially valid geographic variations if approved by the commissioner as
50.17provided in subdivision 4.
50.18(b) All premium variations permitted under this section must be based upon
50.19actuarially valid differences in expected cost to the health carrier of providing coverage.
50.20The variation must be justified in initial rate filings and upon request of the commissioner in
50.21rate revision filings. All premium variations are subject to approval by the commissioner.
50.22    Subd. 8. Filing requirement. A health carrier that offers, sells, issues, or renews a
50.23health benefit plan for small employers shall file with the commissioner the index rates and
50.24must demonstrate that all rates shall be within the rating restrictions defined in this chapter.
50.25Such demonstration must include the allowable range of rates from the index rates and a
50.26description of how the health carrier intends to use demographic factors including case
50.27characteristics in calculating the premium rates. The rates shall not be approved, unless the
50.28commissioner has determined that the rates are reasonable. In determining reasonableness,
50.29the commissioner shall consider the growth rates applied under section 62J.04, subdivision
50.301 , paragraph (b), to the calendar year or years that the proposed premium rate would be in
50.31effect, and actuarially valid changes in risk associated with the enrollee population, and
50.32actuarially valid changes as a result of statutory changes in Laws 1992, chapter 549.
50.33    Subd. 9. Effect of assessments. Premium rates must comply with the rating
50.34requirements of this section, notwithstanding the imposition of any assessments or
50.35premiums paid by health carriers as provided under sections 62L.13 to 62L.22.
51.1    Subd. 10. Rating report. Beginning January 1, 1995, and annually thereafter, the
51.2commissioners of health and commerce shall provide a joint report to the legislature
51.3on the effect of the rating restrictions required by this section and the appropriateness
51.4of proceeding with additional rate reform. Each report must include an analysis of the
51.5availability of health care coverage due to the rating reform, the equitable and appropriate
51.6distribution of risk and associated costs, the effect on the self-insurance market, and any
51.7resulting or anticipated change in health plan design and market share and availability of
51.8health carriers.
51.9    Subd. 11. Loss ratio standards. Notwithstanding section 62A.02, subdivision 3,
51.10relating to loss ratios, each policy or contract form used with respect to a health benefit
51.11plan offered, or issued in the small employer market, is subject, beginning July 1, 1993,
51.12to section 62A.021. The commissioner of health has, with respect to carriers under that
51.13commissioner's jurisdiction, all of the powers of the commissioner of commerce under
51.14that section.
51.15EFFECTIVE DATE.This section is effective January 1, 2014.

51.16    Sec. 55. Minnesota Statutes 2012, section 62L.12, subdivision 2, is amended to read:
51.17    Subd. 2. Exceptions. (a) A health carrier may sell, issue, or renew individual
51.18conversion policies to eligible employees otherwise eligible for conversion coverage under
51.19section 62D.104 as a result of leaving a health maintenance organization's service area.
51.20(b) A health carrier may sell, issue, or renew individual conversion policies to
51.21eligible employees otherwise eligible for conversion coverage as a result of the expiration
51.22of any continuation of group coverage required under sections 62A.146, 62A.17, 62A.21,
51.2362C.142 , 62D.101, and 62D.105.
51.24(c) A health carrier may sell, issue, or renew conversion policies under section
51.2562E.16 to eligible employees.
51.26(d) A health carrier may sell, issue, or renew individual continuation policies to
51.27eligible employees as required.
51.28(e) A health carrier may sell, issue, or renew individual health plans if the coverage
51.29is appropriate due to an unexpired preexisting condition limitation or exclusion applicable
51.30to the person under the employer's group health plan or due to the person's need for health
51.31care services not covered under the employer's group health plan.
51.32(f) A health carrier may sell, issue, or renew an individual health plan, if the
51.33individual has elected to buy the individual health plan not as part of a general plan to
51.34substitute individual health plans for a group health plan nor as a result of any violation of
51.35subdivision 3 or 4.
52.1(g) A health carrier may sell, issue, or renew an individual health plan if coverage
52.2provided by the employer is determined to be unaffordable under the provisions of the
52.3Affordable Care Act as defined in section 62A.011, subdivision 1a.
52.4(h) Nothing in this subdivision relieves a health carrier of any obligation to provide
52.5continuation or conversion coverage otherwise required under federal or state law.
52.6(h) (i) Nothing in this chapter restricts the offer, sale, issuance, or renewal of
52.7coverage issued as a supplement to Medicare under sections 62A.3099 to 62A.44, or
52.8policies or contracts that supplement Medicare issued by health maintenance organizations,
52.9or those contracts governed by sections 1833, 1851 to 1859, 1860D, or 1876 of the federal
52.10Social Security Act, United States Code, title 42, section 1395 et seq., as amended.
52.11(i) (j) Nothing in this chapter restricts the offer, sale, issuance, or renewal of
52.12individual health plans necessary to comply with a court order.
52.13(j) (k) A health carrier may offer, issue, sell, or renew an individual health plan to
52.14persons eligible for an employer group health plan, if the individual health plan is a high
52.15deductible health plan for use in connection with an existing health savings account, in
52.16compliance with the Internal Revenue Code, section 223. In that situation, the same or
52.17a different health carrier may offer, issue, sell, or renew a group health plan to cover
52.18the other eligible employees in the group.
52.19(k) (l) A health carrier may offer, sell, issue, or renew an individual health plan to
52.20one or more employees of a small employer if the individual health plan is marketed
52.21directly to all employees of the small employer and the small employer does not contribute
52.22directly or indirectly to the premiums or facilitate the administration of the individual
52.23health plan. The requirement to market an individual health plan to all employees does not
52.24require the health carrier to offer or issue an individual health plan to any employee. For
52.25purposes of this paragraph, an employer is not contributing to the premiums or facilitating
52.26the administration of the individual health plan if the employer does not contribute to the
52.27premium and merely collects the premiums from an employee's wages or salary through
52.28payroll deductions and submits payment for the premiums of one or more employees in a
52.29lump sum to the health carrier. Except for coverage under section 62A.65, subdivision 5,
52.30paragraph (b), or 62E.16, at the request of an employee, the health carrier may bill the
52.31employer for the premiums payable by the employee, provided that the employer is not
52.32liable for payment except from payroll deductions for that purpose. If an employer is
52.33submitting payments under this paragraph, the health carrier shall provide a cancellation
52.34notice directly to the primary insured at least ten days prior to termination of coverage for
52.35nonpayment of premium. Individual coverage under this paragraph may be offered only
53.1if the small employer has not provided coverage under section 62L.03 to the employees
53.2within the past 12 months.
53.3The employer must provide a written and signed statement to the health carrier that
53.4the employer is not contributing directly or indirectly to the employee's premiums. The
53.5health carrier may rely on the employer's statement and is not required to guarantee-issue
53.6individual health plans to the employer's other current or future employees.
53.7EFFECTIVE DATE.This section is effective January 1, 2014.

53.8    Sec. 56. Minnesota Statutes 2012, section 62M.05, subdivision 3a, is amended to read:
53.9    Subd. 3a. Standard review determination. (a) Notwithstanding subdivision 3b, an
53.10initial determination on all requests for utilization review must be communicated to the
53.11provider and enrollee in accordance with this subdivision within ten business days of the
53.12request, provided that all information reasonably necessary to make a determination on the
53.13request has been made available to the utilization review organization.
53.14(b) When an initial determination is made to certify, notification must be provided
53.15promptly by telephone to the provider. The utilization review organization shall send
53.16written notification to the provider or shall maintain an audit trail of the determination
53.17and telephone notification. For purposes of this subdivision, "audit trail" includes
53.18documentation of the telephone notification, including the date; the name of the person
53.19spoken to; the enrollee; the service, procedure, or admission certified; and the date of
53.20the service, procedure, or admission. If the utilization review organization indicates
53.21certification by use of a number, the number must be called the "certification number."
53.22For purposes of this subdivision, notification may also be made by facsimile to a verified
53.23number or by electronic mail to a secure electronic mailbox. These electronic forms of
53.24notification satisfy the "audit trail" requirement of this paragraph.
53.25(c) When an initial determination is made not to certify, notification must be
53.26provided by telephone, by facsimile to a verified number, or by electronic mail to a secure
53.27electronic mailbox within one working day after making the determination to the attending
53.28health care professional and hospital as applicable. Written notification must also be sent
53.29to the hospital as applicable and attending health care professional if notification occurred
53.30by telephone. For purposes of this subdivision, notification may be made by facsimile to a
53.31verified number or by electronic mail to a secure electronic mailbox. Written notification
53.32must be sent to the enrollee and may be sent by United States mail, facsimile to a verified
53.33number, or by electronic mail to a secure mailbox. The written notification must include
53.34the principal reason or reasons for the determination and the process for initiating an appeal
53.35of the determination. Upon request, the utilization review organization shall provide the
54.1provider or enrollee with the criteria used to determine the necessity, appropriateness,
54.2and efficacy of the health care service and identify the database, professional treatment
54.3parameter, or other basis for the criteria. Reasons for a determination not to certify may
54.4include, among other things, the lack of adequate information to certify after a reasonable
54.5attempt has been made to contact the provider or enrollee.
54.6(d) When an initial determination is made not to certify, the written notification must
54.7inform the enrollee and the attending health care professional of the right to submit an
54.8appeal to the internal appeal process described in section 62M.06 and the procedure for
54.9initiating the internal appeal. The written notice shall be provided in a culturally and
54.10linguistically appropriate manner consistent with the provisions of the Affordable Care
54.11Act as defined under section 62A.011, subdivision 1a.
54.12EFFECTIVE DATE.This section is effective the day following final enactment.

54.13    Sec. 57. Minnesota Statutes 2012, section 62M.06, subdivision 1, is amended to read:
54.14    Subdivision 1. Procedures for appeal. A utilization review organization must have
54.15written procedures for appeals of determinations not to certify. The right to appeal must
54.16be available to the enrollee and to the attending health care professional. The enrollee
54.17shall be allowed to review the information relied upon in the course of the appeal, present
54.18evidence and testimony as part of the appeals process, and receive continued coverage
54.19pending the outcome of the appeals process.
54.20EFFECTIVE DATE.This section is effective the day following final enactment.

54.21    Sec. 58. Minnesota Statutes 2012, section 62Q.01, is amended by adding a subdivision
54.22to read:
54.23    Subd. 1a. Affordable Care Act. "Affordable Care Act" means the Affordable Care
54.24Act as defined in section 62A.011, subdivision 1a.
54.25EFFECTIVE DATE.This section is effective the day following final enactment.

54.26    Sec. 59. Minnesota Statutes 2012, section 62Q.01, is amended by adding a subdivision
54.27to read:
54.28    Subd. 1b. Bona fide association. "Bona fide association" means an association that
54.29meets all of the following criteria:
54.30(1) serves a single profession that requires a significant amount of education, training
54.31or experience, or a license or certificate from a state authority to practice that profession;
54.32(2) has been actively in existence for five years;
55.1(3) has a constitution and bylaws or other analogous governing documents;
55.2(4) has been formed and maintained in good faith for purposes other than obtaining
55.3insurance;
55.4(5) is not owned or controlled by a health plan company or affiliated with a health
55.5plan company;
55.6(6) does not condition membership in the association on any health status related
55.7factor;
55.8(7) has at least 1,000 members if it is a national association, 500 members if it is a
55.9state association, or 200 members if it is a local association;
55.10(8) all members and dependents of members are eligible for coverage regardless of
55.11any health status related factor;
55.12(9) does not make health plans offered through the association available other than
55.13in connection with a member of the association;
55.14(10) is governed by a board of directors and sponsors annual meeting of its
55.15members; and
55.16(11) produces only market association memberships, accepts applications for
55.17membership, or signs up members in the professional association where the subject
55.18individuals are actively engaged in, or directly related to, the profession represented
55.19by the association.
55.20EFFECTIVE DATE.This section is effective the day following final enactment.

55.21    Sec. 60. Minnesota Statutes 2012, section 62Q.01, is amended by adding a subdivision
55.22to read:
55.23    Subd. 2b. Grandfathered health plan. "Grandfathered health plan" means a
55.24grandfathered health plan as defined in section 62A.011, subdivision 1c.

55.25    Sec. 61. Minnesota Statutes 2012, section 62Q.01, is amended by adding a subdivision
55.26to read:
55.27    Subd. 2c. Group health plan. "Group health plan" means a group health plan as
55.28defined in section 62A.011, subdivision 1d.

55.29    Sec. 62. Minnesota Statutes 2012, section 62Q.01, is amended by adding a subdivision
55.30to read:
55.31    Subd. 4b. Individual health plan. "Individual health plan" means an individual
55.32health plan as defined in section 62A.011, subdivision 4.

56.1    Sec. 63. Minnesota Statutes 2012, section 62Q.01, is amended by adding a subdivision
56.2to read:
56.3    Subd. 7. Life-threatening condition. "Life-threatening condition" means a disease
56.4or condition from which the likelihood of death is probable unless the course of the
56.5disease or condition is interrupted.
56.6EFFECTIVE DATE.This section is effective the day following final enactment.

56.7    Sec. 64. Minnesota Statutes 2012, section 62Q.01, is amended by adding a subdivision
56.8to read:
56.9    Subd. 10. Primary care provider. "Primary care provider" means a health care
56.10professional designated by an enrollee to supervise, coordinate, or provide initial care or
56.11continuing care to the enrollee, and who may be required by the health plan company
56.12to initiate a referral for specialty care and maintain supervision of health care services
56.13rendered to the enrollee.
56.14EFFECTIVE DATE.This section is effective the day following final enactment.

56.15    Sec. 65. Minnesota Statutes 2012, section 62Q.01, is amended by adding a subdivision
56.16to read:
56.17    Subd. 11. Dependent child to the limiting age. "Dependent child to the limiting
56.18age" or "dependent children to the limiting age" means those individuals who are eligible
56.19and covered as a dependent child under the terms of a health plan who have not yet
56.20attained 26 years of age. A health plan company must not deny or restrict eligibility
56.21for a dependent child to the limiting age based on financial dependency, residency,
56.22marital status, or student status. For coverage under plans offered by the Minnesota
56.23Comprehensive Health Association, dependent to the limiting age means dependent
56.24as defined in section 62A.302, subdivision 3. Notwithstanding the provisions in this
56.25subdivision, a health plan may include:
56.26(1) eligibility requirements regarding the absence of other health plan coverage as
56.27permitted by the Affordable Care Act for grandfathered plan coverage; or
56.28(2) an age greater than 26 in its policy, contract, or certificate of coverage.
56.29EFFECTIVE DATE.This section is effective the day following final enactment.

56.30    Sec. 66. Minnesota Statutes 2012, section 62Q.021, is amended to read:
56.3162Q.021 FEDERAL ACT; COMPLIANCE REQUIRED.
57.1    Subdivision 1. Compliance with 1996 federal law. Each health plan company shall
57.2comply with the federal Health Insurance Portability and Accountability Act of 1996,
57.3including any federal regulations adopted under that act, to the extent that it imposes a
57.4requirement that applies in this state and that is not also required by the laws of this state.
57.5This section does not require compliance with any provision of the federal act prior to
57.6the effective date provided for that provision in the federal act. The commissioner shall
57.7enforce this section subdivision.
57.8    Subd. 2. Compliance with 2010 federal law. Each health plan company shall
57.9comply with the Affordable Care Act to the extent that it imposes a requirement that
57.10applies in this state but is not required under the laws of this state. This section does not
57.11require compliance with any provision of the Affordable Care Act before the effective
57.12date provided for that provision in the Affordable Care Act. The commissioner shall
57.13enforce this subdivision.
57.14EFFECTIVE DATE.This section is effective the day following final enactment.

57.15    Sec. 67. Minnesota Statutes 2012, section 62Q.17, subdivision 6, is amended to read:
57.16    Subd. 6. Employer-based purchasing pools. Employer-based purchasing
57.17pools must, with respect to small employers as defined in section 62L.02, meet all the
57.18requirements of chapter 62L. The experience of the pool must be pooled and the rates
57.19blended across all groups. Pools may decide to create tiers within the pool, based on
57.20experience of group members. These tiers must be designed within the requirements
57.21of section 62L.08. The governing structure may establish criteria limiting movement
57.22between tiers. Tiers must be phased out within two years of the pool's creation.
57.23EFFECTIVE DATE.This section is effective January 1, 2014.

57.24    Sec. 68. Minnesota Statutes 2012, section 62Q.18, is amended by adding a subdivision
57.25to read:
57.26    Subd. 8. Guaranteed issue. No health plan company shall offer, sell, or issue
57.27any health plan that does not make coverage available on a guaranteed issue basis in
57.28accordance with the Affordable Care Act.
57.29EFFECTIVE DATE.This section is effective January 1, 2014.

57.30    Sec. 69. [62Q.186] PROHIBITION ON RESCISSIONS OF HEALTH PLANS.
57.31    Subdivision 1. Definitions.
58.1    Subdivision 1. Definitions. (a) "Rescission" means a cancellation or discontinuance
58.2of coverage under a health plan that has a retroactive effect.
58.3(b) "Rescission" does not include:
58.4(1) a cancellation or discontinuance of coverage under a health plan if:
58.5(i) the cancellation or discontinuance of coverage has only a prospective effect; or
58.6(ii) the cancellation or discontinuance of coverage is effective retroactively to the
58.7extent it is attributable to a failure to timely pay required premiums or contributions
58.8toward the cost of coverage; or
58.9(2) when the health plan covers only active employees and, if applicable,
58.10dependents and those covered under continuation coverage provisions, the employee
58.11pays no premiums for coverage after termination of employment and the cancellation or
58.12discontinuance of coverage is effective retroactively back to the date of termination of
58.13employment due to a delay in administrative record-keeping.
58.14    Subd. 2. Prohibition on rescissions. (a) A health plan company shall not rescind
58.15coverage under a health plan with respect to an individual, including a group to which
58.16the individual belongs or family coverage in which the individual is included, after the
58.17individual is covered under the health plan, unless:
58.18(1) the individual or a person seeking coverage on behalf of the individual, performs
58.19an act, practice, or omission that constitutes fraud; or
58.20(2) the individual makes an intentional misrepresentation or omission of material
58.21fact, as prohibited by the terms of the health plan.
58.22For purposes of this section, a person seeking coverage on behalf of an individual
58.23does not include an insurance producer or employee or authorized representative of the
58.24health carrier.
58.25(b) This section does not apply to any benefits classified as excepted benefits under
58.26United States Code, title 42, section 300gg-91(c), or regulations enacted thereunder
58.27from time to time.
58.28    Subd. 3. Notice required. A health plan company shall provide at least 30 days
58.29advance written notice to each individual who would be affected by the proposed rescission
58.30of coverage before coverage under the health plan may be terminated retroactively.
58.31    Subd. 4. Compliance with other restrictions on rescissions. Nothing in this
58.32section allows rescission if rescission would otherwise be prohibited under section
58.3362A.04, subdivision 2, clause (2), or 62A.615.
58.34EFFECTIVE DATE.This section is effective the day following final enactment.

58.35    Sec. 70. Minnesota Statutes 2012, section 62Q.23, is amended to read:
59.162Q.23 GENERAL SERVICES.
59.2(a) Health plan companies shall comply with all continuation and conversion of
59.3coverage requirements applicable to health maintenance organizations under state or
59.4federal law.
59.5(b) Health plan companies shall comply with sections 62A.047, 62A.27, and any
59.6other coverage required under chapter 62A of newborn infants, dependent children who
59.7do not reside with a covered person to the limiting age as defined in section 62Q.01,
59.8subdivision 11, disabled children and dependents dependent children, and adopted children.
59.9A health plan company providing dependent coverage shall comply with section 62A.302.
59.10(c) Health plan companies shall comply with the equal access requirements of
59.11section 62A.15.
59.12EFFECTIVE DATE.This section is effective the day following final enactment.

59.13    Sec. 71. Minnesota Statutes 2012, section 62Q.43, subdivision 2, is amended to read:
59.14    Subd. 2. Access requirement. Every closed-panel health plan must allow enrollees
59.15who are full-time students under the age of 25 26 years to change their designated clinic or
59.16physician at least once per month, as long as the clinic or physician is part of the health
59.17plan company's statewide clinic or physician network. A health plan company shall not
59.18charge enrollees who choose this option higher premiums or cost sharing than would
59.19otherwise apply to enrollees who do not choose this option. A health plan company may
59.20require enrollees to provide 15 days' written notice of intent to change their designated
59.21clinic or physician.
59.22EFFECTIVE DATE.This section is effective the day following final enactment.

59.23    Sec. 72. [62Q.46] PREVENTIVE ITEMS AND SERVICES.
59.24    Subdivision 1. Coverage for preventive items and services. (a) "Preventive items
59.25and services" as specified in the Affordable Care Act.
59.26(b) A health plan company must provide coverage for preventive items and services
59.27at a participating provider without imposing cost-sharing requirements, including a
59.28deductible, coinsurance, or co-payment. Nothing in this section prohibits a health
59.29plan company that has a network of providers from excluding coverage or imposing
59.30cost-sharing requirements for preventive items or services that are delivered by an
59.31out-of-network provider.
59.32(c) A health plan company is not required to provide coverage for any items or
59.33services specified in any recommendation or guideline described in paragraph (a) if the
60.1recommendation or guideline is no longer included as a preventive item or service as
60.2defined in paragraph (a). Annually, a health plan company must determine whether any
60.3additional items or services must be covered without cost-sharing requirements or whether
60.4any items or services are no longer required to be covered.
60.5(d) Nothing in this section prevents a health plan company from using reasonable
60.6medical management techniques to determine the frequency, method, treatment, or setting
60.7for a preventive item or service to the extent not specified in the recommendation or
60.8guideline.
60.9(e) This section does not apply to grandfathered plan coverage. This section does
60.10not apply to plans offered by the Minnesota Comprehensive Health Association.
60.11    Subd. 2. Coverage for office visits in conjunction with preventive items and
60.12services. (a) A health plan company may impose cost-sharing requirements with respect
60.13to an office visit if a preventive item or service is billed separately or is tracked separately
60.14as individual encounter data from the office visit.
60.15(b) A health plan company must not impose cost-sharing requirements with respect
60.16to an office visit if a preventive item or service is not billed separately or is not tracked
60.17separately as individual encounter data from the office visit and the primary purpose of the
60.18office visit is the delivery of the preventive item or service.
60.19(c) A health plan company may impose cost-sharing requirements with respect to
60.20an office visit if a preventive item or service is not billed separately or is not tracked
60.21separately as individual encounter data from the office visit and the primary purpose of the
60.22office visit is not the delivery of the preventive item or service.
60.23    Subd. 3. Additional services not prohibited. Nothing in these sections prohibits a
60.24health plan company from providing coverage for items and services in addition to those
60.25specified in the Affordable Care Act. A health plan company may impose cost-sharing
60.26requirements for a treatment not described in the Affordable Care Act even if the treatment
60.27results from an item or service described in the Affordable Care Act.
60.28EFFECTIVE DATE.This section is effective the day following final enactment.

60.29    Sec. 73. Minnesota Statutes 2012, section 62Q.47, is amended to read:
60.3062Q.47 ALCOHOLISM, MENTAL HEALTH, AND CHEMICAL
60.31DEPENDENCY SERVICES.
60.32    (a) All health plans, as defined in section 62Q.01, that provide coverage for
60.33alcoholism, mental health, or chemical dependency services, must comply with the
60.34requirements of this section.
61.1    (b) Cost-sharing requirements and benefit or service limitations for outpatient
61.2mental health and outpatient chemical dependency and alcoholism services, except for
61.3persons placed in chemical dependency services under Minnesota Rules, parts 9530.6600
61.4to 9530.6660, must not place a greater financial burden on the insured or enrollee, or be
61.5more restrictive than those requirements and limitations for outpatient medical services.
61.6    (c) Cost-sharing requirements and benefit or service limitations for inpatient hospital
61.7mental health and inpatient hospital and residential chemical dependency and alcoholism
61.8services, except for persons placed in chemical dependency services under Minnesota
61.9Rules, parts 9530.6600 to 9530.6660, must not place a greater financial burden on the
61.10insured or enrollee, or be more restrictive than those requirements and limitations for
61.11inpatient hospital medical services.
61.12    (d) All health plans must meet the requirements of the federal Mental Health Parity
61.13Act of 1996, Public Law 104-204, Paul Wellstone and Pete Domenici Mental Health
61.14Parity and Addiction Equity Act of 2008, the Affordable Care Act, and any amendments
61.15to, or guidance, or regulations issued under these acts.
61.16EFFECTIVE DATE.This section is effective the day following final enactment.

61.17    Sec. 74. Minnesota Statutes 2012, section 62Q.52, is amended to read:
61.1862Q.52 DIRECT ACCESS TO OBSTETRIC AND GYNECOLOGIC
61.19SERVICES.
61.20    Subdivision 1. Direct access. (a) Health plan companies shall allow female
61.21enrollees direct access to obstetricians and gynecologists providers who specialize in
61.22obstetrics and gynecology for the following services:
61.23(1) annual preventive health examinations, which shall include a gynecologic
61.24examination, and any subsequent obstetric or gynecologic visits determined to be medically
61.25necessary by the examining obstetrician or gynecologist, based upon the findings of the
61.26examination evaluation and necessary treatment for obstetric conditions or emergencies;
61.27(2) maternity care; and
61.28(3) evaluation and necessary treatment for acute gynecologic conditions or
61.29emergencies, including annual preventive health examinations.
61.30(b) For purposes of this section, "direct access" means that a female enrollee may
61.31obtain the obstetric and gynecologic services specified in paragraph (a) from obstetricians
61.32and gynecologists providers who specialize in obstetrics and gynecology in the enrollee's
61.33network without a referral from, or prior approval through a primary care provider,
61.34another physician, the health plan company, or its representatives.
62.1(c) The health plan company shall treat the provision of obstetrical and gynecological
62.2care and the ordering of related obstetrical and gynecological items and services, pursuant
62.3to paragraph (a), by a participating health care provider who specializes in obstetrics or
62.4gynecology as the authorization of a primary care provider.
62.5(d) The health plan company may require the health care provider to agree to
62.6otherwise adhere to the health plan company's policies and procedures, including
62.7procedures for obtaining prior authorization and for providing services in accordance with
62.8a treatment plan, if any, approved by the health plan company.
62.9(c)(e) Health plan companies shall not require higher co-payments, coinsurance,
62.10deductibles, or other enrollee cost-sharing for direct access.
62.11(d) (f) This section applies only to services described in paragraph (a) that are
62.12covered by the enrollee's coverage, but coverage of a preventive health examination for
62.13female enrollees must not exclude coverage of a gynecologic examination.
62.14(g) For purposes of this section, a health care provider who specializes in obstetrics
62.15or gynecology means any individual, including an individual other than a physician, who
62.16is authorized under state law to provide obstetrical or gynecological care.
62.17(h) This section does not:
62.18(1) waive any exclusions of coverage under the terms and conditions of the health
62.19plan with respect to coverage of obstetrical or gynecological care; or
62.20(2) preclude the health plan company from requiring that the participating health
62.21care provider providing obstetrical or gynecological care notify the primary care provider
62.22or the health plan company of treatment decisions.
62.23    Subd. 2. Notice. A health plan company shall provide notice to enrollees of the
62.24provisions of subdivision 1 in accordance with the requirements of the Affordable Care Act.
62.25    Subd. 3. Enforcement. The commissioner of health shall enforce this section.
62.26EFFECTIVE DATE.This section is effective the day following final enactment.

62.27    Sec. 75. [62Q.526] COVERAGE FOR PARTICIPATION IN APPROVED
62.28CLINICAL TRIALS.
62.29    Subdivision 1. Definitions. As used in this section, the following definitions apply:
62.30(a) "Approved clinical trial" means phase I, phase II, phase III, or phase IV clinical
62.31trial that is conducted in relation to the prevention, detection, or treatment of cancer or
62.32a life-threatening condition and is not designed exclusively to test toxicity or disease
62.33pathophysiology and must be:
62.34(1) conducted under an investigational new drug application reviewed by the United
62.35States Food and Drug Administration (FDA);
63.1(2) exempt from obtaining an investigational new drug application; or
63.2(3) approved or funded by:
63.3(i) the National Institutes of Health (NIH), the Centers for Disease Control and
63.4Prevention; the Agency for Health Care Research and Quality, the Centers for Medicare
63.5and Medicaid Services, or a cooperating group or center of any of the entities described in
63.6this item;
63.7(ii) a cooperative group or center of the United States Department of Defense or the
63.8United States Department of Veterans Affairs;
63.9(iii) a qualified nongovernmental research entity identified in the guidelines issued
63.10by the NIH for center support grants; or
63.11(iv) the United States Departments of Veterans Affairs, Defense, or Energy if the
63.12trial has been reviewed or approved through a system of peer review determined by the
63.13secretary to:
63.14(A) be comparable to the system of peer review of studies and investigations used by
63.15the NIH; and
63.16(B) provide an unbiased scientific review by qualified individuals who have no
63.17interest in the outcome of the review.
63.18(b) "Qualified individual" means an individual with health plan coverage who is
63.19eligible to participate in an approved clinical trial according to the trial protocol for the
63.20treatment of cancer or a life-threatening condition because:
63.21(1) the referring health care professional is participating in the trial and has
63.22concluded that the individual's participation in the trial would be appropriate; or
63.23(2) the individual provides medical and scientific information establishing that
63.24the individual's participation in the trial is appropriate because the individual meets the
63.25conditions described in the trial protocol.
63.26(c)(1) "Routine patient costs" includes all items and services covered by the health
63.27benefit plan of individual market health insurance coverage when the items or services
63.28are typically covered for an enrollee who is not a qualified individual enrolled in an
63.29approved clinical trial.
63.30(2) Routine patient costs does not include:
63.31(i) an investigational item, device, or service that is part of the trial;
63.32(ii) an item or service provided solely to satisfy data collection and analysis needs for
63.33the trial if the item or service is not used in the direct clinical management of the patient;
63.34(iii) a service that is clearly inconsistent with widely accepted and established
63.35standards of care for the individual's diagnosis; or
63.36(iv) an item or service customarily provided and paid for by the sponsor of a trial.
64.1    Subd. 2. Prohibited acts. A health plan company that offers a health plan to a
64.2Minnesota resident may not:
64.3(1) deny participation by a qualified individual in an approved clinical trial;
64.4(2) deny, limit, or impose additional conditions on the coverage of routine patient
64.5costs for items or services furnished in connection with participation in the trial; or
64.6(3) discriminate against an individual on the basis of an individual's participation in
64.7an approved clinical trial.
64.8    Subd. 3. Network plan conditions. A health plan company that designates a
64.9network or networks of contracted providers may require a qualified individual who
64.10wishes to participate in an approved clinical trial to participate in a trial that is offered
64.11through a health care provider who is part of the plan's network if the provider is
64.12participating in the trial and the provider accepts the individual as a participant in the trial.
64.13    Subd. 4. Application to clinical trials outside of the state. This section applies
64.14to a qualified individual residing in this state who participates in an approved clinical
64.15trial that is conducted outside of this state.
64.16    Subd. 5. Construction. (a) This section shall not be construed to require a health
64.17plan company offering health plan coverage through a network or networks of contracted
64.18providers to provide benefits for routine patient costs if the services are provided outside
64.19of the plan's network unless the out-of-network benefits are otherwise provided under
64.20the coverage.
64.21(b) This section shall not be construed to limit a health plan company's coverage
64.22with respect to clinical trials.
64.23(c) This section shall apply to all health plan companies offering a health plan to a
64.24Minnesota resident, unless otherwise amended by federal regulations under the Affordable
64.25Care Act.
64.26EFFECTIVE DATE.This section is effective January 1, 2014.

64.27    Sec. 76. Minnesota Statutes 2012, section 62Q.55, is amended to read:
64.2862Q.55 EMERGENCY SERVICES.
64.29    Subdivision 1. Access to emergency services. (a) Enrollees have the right to
64.30available and accessible emergency services, 24 hours a day and seven days a week.
64.31The health plan company shall inform its enrollees how to obtain emergency care and,
64.32if prior authorization for emergency services is required, shall make available a toll-free
64.33number, which is answered 24 hours a day, to answer questions about emergency services
64.34and to receive reports and provide authorizations, where appropriate, for treatment of
65.1emergency medical conditions. Emergency services shall be covered whether provided by
65.2participating or nonparticipating providers and whether provided within or outside the
65.3health plan company's service area. In reviewing a denial for coverage of emergency
65.4services, the health plan company shall take the following factors into consideration:
65.5(1) a reasonable layperson's belief that the circumstances required immediate medical
65.6care that could not wait until the next working day or next available clinic appointment;
65.7(2) the time of day and day of the week the care was provided;
65.8(3) the presenting symptoms, including, but not limited to, severe pain, to ensure
65.9that the decision to reimburse the emergency care is not made solely on the basis of the
65.10actual diagnosis;
65.11(4) the enrollee's efforts to follow the health plan company's established procedures
65.12for obtaining emergency care; and
65.13(5) any circumstances that precluded use of the health plan company's established
65.14procedures for obtaining emergency care.
65.15(b) The health plan company may require enrollees to notify the health plan
65.16company of nonreferred emergency care as soon as possible, but not later than 48 hours,
65.17after the emergency care is initially provided. However, emergency care which would
65.18have been covered under the contract had notice been provided within the set time frame
65.19must be covered.
65.20(c) Notwithstanding paragraphs (a) and (b), a health plan company, health insurer, or
65.21health coverage plan that is in compliance with the rules regarding accessibility of services
65.22adopted under section 62D.20 is in compliance with this section.
65.23    Subd. 2. Emergency medical condition. For purposes of this section, "emergency
65.24medical condition" means a medical condition manifesting itself by acute symptoms of
65.25sufficient severity, including severe pain, such that a prudent layperson, who possesses
65.26an average knowledge of health and medicine, could reasonably expect the absence of
65.27immediate medical attention to result in a condition described in clause (i), (ii), or (iii), of
65.28section 1867(e)(1)(A) of the Social Security Act.
65.29    Subd. 3. Emergency services. As used in this section, "emergency services" means,
65.30with respect to an emergency medical condition:
65.31(1) a medical screening examination, as required under section 1867 of the Social
65.32Security Act, that is within the capability of the emergency department of a hospital,
65.33including ancillary services routinely available to the emergency department to evaluate
65.34such emergency medical condition; and
66.1(2) within the capabilities of the staff and facilities available at the hospital, such
66.2further medical examination and treatment as are required under section 1867 of the
66.3act to stabilize the patient.
66.4    Subd. 4. Stabilize. For purposes of this section, "stabilize" means, with respect to
66.5an emergency medical condition has the meaning given in section 1867(e)(3) of the Social
66.6Security Act, United States Code, title 42, section 1395dd(e)(3).
66.7    Subd. 5. Coverage restrictions or limitations. If emergency services are provided
66.8by a nonparticipating provider, with or without prior authorization, the health plan
66.9company shall not impose coverage restrictions or limitations that are more restrictive
66.10than apply to emergency services received from a participating provider. Cost-sharing
66.11requirements that apply to emergency services received out-of-network must be the same
66.12as the cost-sharing requirements that apply to services received in-network.
66.13EFFECTIVE DATE.This section is effective the day following final enactment.

66.14    Sec. 77. [62Q.57] DESIGNATION OF PRIMARY CARE PROVIDER.
66.15    Subdivision 1. Choice of primary care provider. (a) If a health plan company
66.16offering a group health plan, or an individual health plan that is not a grandfathered plan
66.17requires or provides for the designation by a enrollee of a participating primary care
66.18provider, the health plan company shall permit each enrollee to:
66.19(1) designate any participating primary care provider who is available to accept the
66.20enrollee; and
66.21(2) for a child, designate any participating physician who specializes in pediatrics as
66.22the child's primary care provider and is available to accept the child.
66.23(b) This section does not waive any exclusions of coverage under the terms and
66.24conditions of the health plan with respect to coverage of pediatric care.
66.25    Subd. 2. Notice. A health plan company shall provide notice to enrollees of the
66.26provisions of subdivision 1 in accordance with the requirements of the Affordable Care Act.
66.27    Subd. 3. Enforcement. The commissioner shall enforce this section.
66.28EFFECTIVE DATE.This section is effective the day following final enactment.

66.29    Sec. 78. [62Q.677] LIFETIME AND ANNUAL LIMITS.
66.30    Subdivision 1. Applicability and scope. Except as provided in subdivision 2,
66.31this section applies to a health plan company providing coverage under an individual or
66.32group health plan. For purposes of this section, essential health benefits means as defined
66.33under section 62Q.81.
67.1    Subd. 2. Grandfathered plan limits. (a) The prohibition on lifetime limits applies
67.2to grandfathered plans providing individual health plan coverage or group health plan
67.3coverage.
67.4(b) The prohibition and limits on annual limits applies to grandfathered plans
67.5providing group health plan coverage, but it does not apply to grandfathered plans
67.6providing individual health plan coverage.
67.7    Subd. 3. Prohibition on lifetime and annual limits. (a) Except as provided in
67.8subdivisions 4 and 5, a health plan company offering coverage under an individual or
67.9group health plan shall not establish a lifetime limit on the dollar amount of essential
67.10health benefits for any individual.
67.11(b) Except as provided in subdivisions 4, 5, and 6, a health plan company shall
67.12not establish any annual limit on the dollar amount of essential health benefits for any
67.13individual.
67.14    Subd. 4. Nonessential benefits; out-of-network providers. (a) Subdivision 3 does
67.15not prevent a health plan company from placing annual or lifetime dollar limits for any
67.16individual on specific covered benefits that are not essential health benefits as defined
67.17in section 62E.02 to the extent that the limits are otherwise permitted under applicable
67.18federal or state law.
67.19(b) Subdivision 3 does not prevent a health plan company from placing an annual or
67.20lifetime limit for services provided by out-of-network providers.
67.21    Subd. 5. Excluded benefits. This section does not prohibit a health plan company
67.22from excluding all benefits for a given condition.
67.23    Subd. 6. Annual limits prior to January 1, 2014. For plan or policy years
67.24beginning before January 1, 2014, for any individual, a health plan company may establish
67.25an annual limit on the dollar amount of benefits that are essential health benefits provided
67.26the limit is no less than the following:
67.27(1) for a plan or policy year beginning after September 22, 2010, but before
67.28September 23, 2011, $750,000;
67.29(2) for a plan or policy year beginning after September 22, 2011, but before
67.30September 23, 2012, $1,250,000; and
67.31(3) for a plan or policy year beginning after September 22, 2012, but before January
67.321, 2014, $2,000,000.
67.33In determining whether an individual has received benefits that meet or exceed the
67.34allowable limits, a health plan company shall take into account only essential health
67.35benefits.
68.1    Subd. 7. Waivers. For plan or policy years beginning before January 1, 2014, a
68.2health plan is exempt from the annual limit requirements if the health plan is approved for
68.3a waiver from the requirements by the United States Department of Health and Human
68.4Services, but the exemption only applies for the specified period of time that the waiver
68.5from the United States Department of Health and Human Services is applicable.
68.6    Subd. 8. Notices. (a) At the time a health plan company receives a waiver from the
68.7United States Department of Health and Human Services, the health plan company shall
68.8notify prospective applicants and affected policyholders and the commissioner in each
68.9state where prospective applicants and any affected insured are known to reside.
68.10(b) At the time the waiver expires or is otherwise no longer in effect, the health plan
68.11company shall notify affected policyholders and the commissioner in each state where
68.12any affected insured is known to reside.
68.13    Subd. 9. Reinstatement. A health plan company shall comply with all provisions of
68.14the Affordable Care Act with regard to reinstatement of coverage for individuals whose
68.15coverage or benefits under a health plan ended by reason of reaching a lifetime dollar limit
68.16on the dollar value of all benefits for the individual.
68.17    Subd. 10. Compliance. This section does not require compliance with any
68.18provision of the Affordable Care Act before the effective date provided for that provision
68.19in the Affordable Care Act. The commissioner shall enforce this section.
68.20EFFECTIVE DATE.This section is effective the day following final enactment.

68.21    Sec. 79. Minnesota Statutes 2012, section 62Q.68, subdivision 1, is amended to read:
68.22    Subdivision 1. Application. For purposes of sections 62Q.68 to 62Q.72, the terms
68.23defined in this section have the meanings given them. For purposes of sections 62Q.69
68.24and 62Q.70, the term "health plan company" does not include an insurance company
68.25licensed under chapter 60A to offer, sell, or issue a policy of accident and sickness
68.26insurance as defined in section 62A.01 or a nonprofit health service plan corporation
68.27regulated under chapter 62C that only provides dental coverage or vision coverage. For
68.28purposes of sections 62Q.69 through 62Q.73, the term "health plan company" does
68.29not include the Comprehensive Health Association created under chapter 62E. Section
68.3062Q.70 does not apply to individual coverage. However, a health plan company offering
68.31individual coverage may, pursuant to section 62Q.69, subdivision 3, paragraph (c), follow
68.32the process outlined in section 62Q.70.
68.33EFFECTIVE DATE.This section is effective the day following final enactment.

69.1    Sec. 80. Minnesota Statutes 2012, section 62Q.69, subdivision 3, is amended to read:
69.2    Subd. 3. Notification of complaint decisions. (a) The health plan company must
69.3notify the complainant in writing of its decision and the reasons for it as soon as practical
69.4but in no case later than 30 days after receipt of a written complaint. If the health plan
69.5company cannot make a decision within 30 days due to circumstances outside the control
69.6of the health plan company, the health plan company may take up to 14 additional days to
69.7notify the complainant of its decision. If the health plan company takes any additional
69.8days beyond the initial 30-day period to make its decision, it must inform the complainant,
69.9in advance, of the extension and the reasons for the extension.
69.10(b) For group health plans, if the decision is partially or wholly adverse to the
69.11complainant, the notification must inform the complainant of the right to appeal the
69.12decision to the health plan company's internal appeal process described in section 62Q.70
69.13and the procedure for initiating an appeal.
69.14(c) For individual health plans, if the decision is partially or wholly adverse to
69.15the complainant, the notification must inform the complainant of the right to submit the
69.16complaint decision to the external review process described in section 62Q.73 and the
69.17procedure for initiating the external process. Notwithstanding the provisions in this
69.18subdivision, a health plan company offering individual coverage may instead follow the
69.19process for group health plans outlined in paragraph (b).
69.20(c) (d) The notification must also inform the complainant of the right to submit the
69.21complaint at any time to either the commissioner of health or commerce for investigation
69.22and the toll-free telephone number of the appropriate commissioner.
69.23EFFECTIVE DATE.This section is effective the day following final enactment.

69.24    Sec. 81. Minnesota Statutes 2012, section 62Q.70, subdivision 1, is amended to read:
69.25    Subdivision 1. Establishment. (a) Each health plan company shall establish an
69.26internal appeal process for reviewing a health plan company's decision regarding a
69.27complaint filed in accordance with section 62Q.69. The appeal process must meet the
69.28requirements of this section. This section applies only to group health plans. However,
69.29a health plan company offering individual coverage may, pursuant to section 62Q.69,
69.30subdivision 3, paragraph (c), follow the process outlined in this section.
69.31(b) The person or persons with authority to resolve or recommend the resolution of
69.32the internal appeal must not be solely the same person or persons who made the complaint
69.33decision under section 62Q.69.
69.34(c) The internal appeal process must permit the enrollee to review the information
69.35relied upon in the course of the appeal and the receipt of testimony, correspondence,
70.1explanations, or other information from the complainant, staff persons, administrators,
70.2providers, or other persons as deemed necessary by the person or persons investigating or
70.3presiding over the appeal.
70.4(d) The enrollee must be allowed to receive continued coverage pending the
70.5outcome of the appeals process.
70.6EFFECTIVE DATE.This section is effective the day following final enactment.

70.7    Sec. 82. Minnesota Statutes 2012, section 62Q.70, subdivision 2, is amended to read:
70.8    Subd. 2. Procedures for filing an appeal. The health plan company must provide
70.9notice to enrollees of its internal appeals process, in a culturally and linguistically
70.10appropriate manner consistent with the provisions of the Affordable Care Act. If a
70.11complainant notifies the health plan company of the complainant's desire to appeal the
70.12health plan company's decision regarding the complaint through the internal appeal
70.13process, the health plan company must provide the complainant the option for the appeal
70.14to occur either in writing or by hearing.
70.15EFFECTIVE DATE.This section is effective the day following final enactment.

70.16    Sec. 83. Minnesota Statutes 2012, section 62Q.71, is amended to read:
70.1762Q.71 NOTICE TO ENROLLEES.
70.18Each health plan company shall provide to enrollees a clear and concise description
70.19of its complaint resolution procedure, if applicable under section 62Q.68, subdivision 1,
70.20and the procedure used for utilization review as defined under chapter 62M as part of
70.21the member handbook, subscriber contract, or certificate of coverage. If the health plan
70.22company does not issue a member handbook, the health plan company may provide
70.23the description in another written document. The description must specifically inform
70.24enrollees:
70.25(1) how to submit a complaint to the health plan company;
70.26(2) if the health plan includes utilization review requirements, how to notify the
70.27utilization review organization in a timely manner and how to obtain certification for
70.28health care services;
70.29(3) how to request an appeal either through the procedures described in sections
70.3062Q.69 and section 62Q.70 if applicable, or through the procedures described in chapter
70.3162M;
70.32(4) of the right to file a complaint with either the commissioner of health or
70.33commerce at any time during the complaint and appeal process;
71.1(5) of the toll-free telephone number of the appropriate commissioner; and
71.2(6) of the right, for individual and group coverage, to obtain an external review
71.3under section 62Q.73 and a description of when and how that right may be exercised.,
71.4including that under most circumstances an enrollee must exhaust the internal complaint
71.5or appeal process prior to external review. However, an enrollee may proceed to external
71.6review without exhausting the internal complaint or appeal process under the following
71.7circumstances:
71.8(i) the health plan company waives the exhaustion requirement;
71.9(ii) the health plan company is considered to have waived the exhaustion requirement
71.10by failing to substantially comply with any requirements including, but not limited to,
71.11time limits for internal complaints or appeals; or
71.12(iii) the enrollee has applied for an expedited external review at the same time the
71.13enrollee qualifies for and has applied for an expedited internal review under chapter 62M.
71.14EFFECTIVE DATE.This section is effective the day following final enactment.

71.15    Sec. 84. Minnesota Statutes 2012, section 62Q.73, is amended to read:
71.1662Q.73 EXTERNAL REVIEW OF ADVERSE DETERMINATIONS.
71.17    Subdivision 1. Definition. For purposes of this section, "adverse determination"
71.18means:
71.19(1) for individual health plans, a complaint decision relating to a health care service
71.20or claim that is partially or wholly adverse to the complainant;
71.21(2) an individual health plan that is grandfathered plan coverage may instead apply
71.22the definition of adverse determination for group coverage in clause (3);
71.23(3) for group health plans, a complaint decision relating to a health care service or
71.24claim that has been appealed in accordance with section 62Q.70 and the appeal decision is
71.25partially or wholly adverse to the complainant;
71.26(2) (4) any initial determination not to certify that has been appealed in accordance
71.27with section 62M.06 and the appeal did not reverse the initial determination not to certify; or
71.28(3) (5) a decision relating to a health care service made by a health plan company
71.29licensed under chapter 60A that denies the service on the basis that the service was not
71.30medically necessary.; or
71.31(6) the enrollee has met the requirements of subdivision 6, paragraph (e).
71.32An adverse determination does not include complaints relating to fraudulent marketing
71.33practices or agent misrepresentation.
72.1    Subd. 2. Exception. (a) This section does not apply to governmental programs
72.2except as permitted under paragraph (b). For purposes of this subdivision, "governmental
72.3programs" means the prepaid medical assistance program, the MinnesotaCare program,
72.4the prepaid general assistance medical care program, the demonstration project for people
72.5with disabilities, and the federal Medicare program.
72.6(b) In the course of a recipient's appeal of a medical determination to the
72.7commissioner of human services under section 256.045, the recipient may request an
72.8expert medical opinion be arranged by the external review entity under contract to provide
72.9independent external reviews under this section. If such a request is made, the cost of the
72.10review shall be paid by the commissioner of human services. Any medical opinion obtained
72.11under this paragraph shall only be used by a state human services referee as evidence in
72.12the recipient's appeal to the commissioner of human services under section 256.045.
72.13(c) Nothing in this subdivision shall be construed to limit or restrict the appeal rights
72.14provided in section 256.045 for governmental program recipients.
72.15    Subd. 3. Right to external review. (a) Any enrollee or anyone acting on behalf
72.16of an enrollee who has received an adverse determination may submit a written request
72.17for an external review of the adverse determination, if applicable under section 62Q.68,
72.18subdivision 1 , or 62M.06, to the commissioner of health if the request involves a health
72.19plan company regulated by that commissioner or to the commissioner of commerce if the
72.20request involves a health plan company regulated by that commissioner. Notification of
72.21the enrollee's right to external review must accompany the denial issued by the insurer.
72.22The written request must be accompanied by a filing fee of $25. The fee may be waived
72.23by the commissioner of health or commerce in cases of financial hardship and must be
72.24refunded if the adverse determination is completely reversed. No enrollee may be subject
72.25to filing fees totaling more than $75 during a plan year for group coverage or policy year
72.26for individual coverage.
72.27(b) Nothing in this section requires the commissioner of health or commerce to
72.28independently investigate an adverse determination referred for independent external
72.29review.
72.30(c) If an enrollee requests an external review, the health plan company must
72.31participate in the external review. The cost of the external review in excess of the filing
72.32fee described in paragraph (a) shall be borne by the health plan company.
72.33(d) The enrollee must request external review within six months from the date of
72.34the adverse determination.
72.35    Subd. 4. Contract. Pursuant to a request for proposal, the commissioner of
72.36administration, in consultation with the commissioners of health and commerce, shall
73.1contract with an organization at least three organizations or business entity entities to
73.2provide independent external reviews of all adverse determinations submitted for external
73.3review. The contract shall ensure that the fees for services rendered in connection with the
73.4reviews be are reasonable.
73.5    Subd. 5. Criteria. (a) The request for proposal must require that the entity
73.6demonstrate:
73.7(1) no conflicts of interest in that it is not owned, a subsidiary of, or affiliated
73.8with a health plan company or, utilization review organization, or a trade organization
73.9of health care providers;
73.10(2) an expertise in dispute resolution;
73.11(3) an expertise in health-related law;
73.12(4) an ability to conduct reviews using a variety of alternative dispute resolution
73.13procedures depending upon the nature of the dispute;
73.14(5) an ability to maintain written records, for at least three years, regarding reviews
73.15conducted and provide data to the commissioners of health and commerce upon request on
73.16reviews conducted; and
73.17(6) an ability to ensure confidentiality of medical records and other enrollee
73.18information.;
73.19(7) accreditation by nationally recognized private accrediting organization; and
73.20(8) the ability to provide an expedited external review process.
73.21(b) The commissioner of administration shall take into consideration, in awarding
73.22the contract according to subdivision 4, any national accreditation standards that pertain to
73.23an external review entity.
73.24    Subd. 6. Process. (a) Upon receiving a request for an external review, the
73.25 commissioner shall assign an external review entity on a random basis. The assigned
73.26 external review entity must provide immediate notice of the review to the enrollee and to
73.27the health plan company. Within ten business days of receiving notice of the review, the
73.28health plan company and the enrollee must provide the assigned external review entity
73.29with any information that they wish to be considered. Each party shall be provided an
73.30opportunity to present its version of the facts and arguments. The assigned external review
73.31entity must furnish to the health plan company any additional information submitted by
73.32the enrollee within one business day of receipt. An enrollee may be assisted or represented
73.33by a person of the enrollee's choice.
73.34(b) As part of the external review process, any aspect of an external review involving
73.35a medical determination must be performed by a health care professional with expertise in
73.36the medical issue being reviewed.
74.1(c) An external review shall be made as soon as practical but in no case later than 40
74.2 45 days after receiving the request for an external review and must promptly send written
74.3notice of the decision and the reasons for it to the enrollee, the health plan company, and
74.4the commissioner who is responsible for regulating the health plan company.
74.5(d) The external review entity and the clinical reviewer assigned must not have a
74.6material professional, familial, or financial conflict of interest with:
74.7(1) the health plan company that is the subject of the external review;
74.8(2) the enrollee, or any parties related to the enrollee, whose treatment is the subject
74.9of the external review;
74.10(3) any officer, director, or management employee of the health plan company;
74.11(4) a plan administrator, plan fiduciaries, or plan employees;
74.12(5) the health care provider, the health care provider's group, or practice association
74.13recommending treatment that is the subject of the external review;
74.14(6) the facility at which the recommended treatment would be provided; or
74.15(7) the developer or manufacturer of the principle drug, device, procedure, or other
74.16therapy being recommended.
74.17(e)(1) An expedited external review must be provided if the enrollee requests it
74.18after receiving:
74.19(i) an adverse determination that involves a medical condition for which the time
74.20frame for completion of an expedited internal appeal would seriously jeopardize the life
74.21or health of the enrollee or would jeopardize the enrollee's ability to regain maximum
74.22function and the enrollee has simultaneously requested an expedited internal appeal;
74.23(ii) an adverse determination that concerns an admission, availability of care,
74.24continued stay, or health care service for which the enrollee received emergency services
74.25but has not been discharged from a facility; or
74.26(iii) an adverse determination that involves a medical condition for which the
74.27standard external review time would seriously jeopardize the life or health of the enrollee
74.28or jeopardize the enrollee's ability to regain maximum function.
74.29(2) The external review entity must make its expedited determination to uphold or
74.30reverse the adverse determination as expeditiously as possible but within no more than 72
74.31hours after the receipt of the request for expedited review and notify the enrollee and the
74.32health plan company of the determination.
74.33(3) If the external review entity's notification is not in writing, the external review
74.34entity must provide written confirmation of the determination within 48 hours of the
74.35notification.
75.1    Subd. 7. Standards of review. (a) For an external review of any issue in an adverse
75.2determination that does not require a medical necessity determination, the external review
75.3must be based on whether the adverse determination was in compliance with the enrollee's
75.4health benefit plan.
75.5(b) For an external review of any issue in an adverse determination by a health plan
75.6company licensed under chapter 62D that requires a medical necessity determination, the
75.7external review must determine whether the adverse determination was consistent with the
75.8definition of medically necessary care in Minnesota Rules, part 4685.0100, subpart 9b.
75.9(c) For an external review of any issue in an adverse determination by a health plan
75.10company, other than a health plan company licensed under chapter 62D, that requires a
75.11medical necessity determination, the external review must determine whether the adverse
75.12determination was consistent with the definition of medically necessary care in section
75.1362Q.53, subdivision 2 .
75.14(d) For an external review of an adverse determination involving experimental
75.15or investigational treatment, the external review entity must base its decision on all
75.16documents submitted by the health plan company and enrollee, including medical
75.17records the attending physician or health care professional's recommendation, consulting
75.18reports from health care professionals, the terms of coverage, federal Food and Drug
75.19Administration approval, and medical or scientific evidence or evidence-based standards.
75.20    Subd. 8. Effects of external review. A decision rendered under this section shall
75.21be nonbinding on the enrollee and binding on the health plan company. The health plan
75.22company may seek judicial review of the decision on the grounds that the decision was
75.23arbitrary and capricious or involved an abuse of discretion.
75.24    Subd. 9. Immunity from civil liability. A person who participates in an external
75.25review by investigating, reviewing materials, providing technical expertise, or rendering a
75.26decision shall not be civilly liable for any action that is taken in good faith, that is within
75.27the scope of the person's duties, and that does not constitute willful or reckless misconduct.
75.28    Subd. 10. Data reporting. The commissioners shall make available to the public,
75.29upon request, summary data on the decisions rendered under this section, including the
75.30number of reviews heard and decided and the final outcomes. Any data released to the
75.31public must not individually identify the enrollee initiating the request for external review.
75.32EFFECTIVE DATE.This section is effective the day following final enactment.

75.33    Sec. 85. Minnesota Statutes 2012, section 62Q.75, subdivision 1, is amended to read:
75.34    Subdivision 1. Definitions. (a) For purposes of this section, the following terms
75.35have the meanings given to them.
76.1(b) "Clean claim" means a claim that has no defect or impropriety, including any lack
76.2of any required substantiating documentation, including, but not limited to, coordination
76.3of benefits information, or particular circumstance requiring special treatment that
76.4prevents timely payment from being made on a claim under this section. A special
76.5circumstance includes, but is not limited to, a claim held pending payment of an overdue
76.6premium for the time period during which the expense was incurred as allowed by the
76.7Affordable Care Act. Nothing in this section alters an enrollee's obligation to disclose
76.8information as required by law.
76.9(c) "Third-party administrator" means a third-party administrator or other entity
76.10subject to section 60A.23, subdivision 8, and Minnesota Rules, chapter 2767.
76.11EFFECTIVE DATE.This section is effective January 1, 2014.

76.12    Sec. 86. Minnesota Statutes 2012, section 62Q.80, subdivision 2, is amended to read:
76.13    Subd. 2. Definitions. For purposes of this section, the following definitions apply:
76.14(a) "Community-based" means located in or primarily relating to the community,
76.15as determined by the board of a community-based health initiative that is served by the
76.16community-based health care coverage program.
76.17(b) "Community-based health care coverage program" or "program" means a
76.18program administered by a community-based health initiative that provides health care
76.19services through provider members of a community-based health network or combination
76.20of networks to eligible individuals and their dependents who are enrolled in the program.
76.21(c) "Community-based health initiative" or "initiative" means a nonprofit corporation
76.22that is governed by a board that has at least 80 percent of its members residing in the
76.23community and includes representatives of the participating network providers and
76.24employers, or a county-based purchasing organization as defined in section 256B.692.
76.25(d) "Community-based health network" means a contract-based network of health
76.26care providers organized by the community-based health initiative to provide or support
76.27the delivery of health care services to enrollees of the community-based health care
76.28coverage program on a risk-sharing or nonrisk-sharing basis.
76.29(e) "Dependent" means an eligible employee's spouse or unmarried child who
76.30is under the age of 19 26 years.
76.31EFFECTIVE DATE.This section is effective the day following final enactment.

76.32    Sec. 87. [62Q.81] ESSENTIAL HEALTH BENEFIT PACKAGE
76.33REQUIREMENTS.
77.1    Subdivision 1. Essential health benefits package. (a) Health plan companies
77.2offering individual and small group health plans must include the essential health benefits
77.3package required under section 1302(a) of the Affordable Care Act and as described
77.4in this subdivision.
77.5    (b) The essential health benefits package means coverage that:
77.6    (1) provides essential health benefits as outlined in the Affordable Care Act;
77.7    (2) limits cost-sharing for such coverage in accordance with the Affordable Care
77.8Act, as described in subdivision 2; and
77.9    (3) subject to subdivision 3, provides bronze, silver, gold, or platinum level of
77.10coverage in accordance with the Affordable Care Act.
77.11    Subd. 2. Coverage for enrollees under the age of 21. If a health plan company
77.12offers any level of coverage specified under section 1302(d) of the Affordable Care Act,
77.13as described in subdivision 1, paragraph (c), the health plan company shall also offer
77.14coverage in that level in a health plan in which the only enrollees are children who, as of
77.15the beginning of a policy year, have not attained the age of 21 years.
77.16    Subd. 3. Alternative compliance for catastrophic plans. A health plan company
77.17that does not provide an individual or small group health plan in the bronze, silver, gold,
77.18or platinum level of coverage, as described in subdivision 1, paragraph (b), clause (3),
77.19shall be treated as meeting the requirements of section 1302(d) of the Affordable Care Act
77.20with respect to any policy year if the health plan company provides a catastrophic plan
77.21that meets the requirements of section 1302(e) of the Affordable Care Act.
77.22    Subd. 4. Essential health benefits; definition. For purposes of this section,
77.23"essential health benefits" has the meaning given under section 1302(b) of the Affordable
77.24Care Act, and includes:
77.25    (1) ambulatory patient services;
77.26    (2) emergency services;
77.27    (3) hospitalization;
77.28    (4) laboratory services;
77.29    (5) maternity and newborn care;
77.30    (6) mental health and substance abuse disorder services, including behavioral health
77.31treatment;
77.32    (7) pediatric services, including oral and vision care;
77.33    (8) prescription drugs;
77.34    (9) preventive and wellness services and chronic disease management;
77.35    (10) rehabilitative and habilitative services and devices; and
78.1    (11) any other services or items defined as essential health benefits under the
78.2Affordable Care Act.
78.3    Subd. 5. Exception. This section does not apply to a dental plan described in
78.4section 1311(d)(2)(B)(ii) of the Affordable Care Act.
78.5EFFECTIVE DATE.This section is effective January 1, 2014.

78.6    Sec. 88. [62Q.82] BENEFITS AND COVERAGE EXPLANATION.
78.7    Subdivision 1. Summary. Health plan companies offering health plans shall provide
78.8a summary of benefits and coverage explanation as required by the Affordable Care Act to:
78.9(1) an applicant at the time of application;
78.10(2) an enrollee prior to the time of enrollment or reenrollment, as applicable; and
78.11(3) a policyholder at the time of issuance of the policy.
78.12    Subd. 2. Compliance. A health plan company described in subdivision 1 shall be
78.13deemed to have complied with subdivision 1 if the summary of benefits and coverage is
78.14provided in paper or electronic form.
78.15    Subd. 3. Notice of modification. Except in connection with a policy renewal or
78.16reissuance, if a health plan company makes any material modifications in any of the
78.17terms of the coverage, as defined for purposes of section 102 of the federal Employee
78.18Retirement Income Security Act of 1974, as amended, that is not reflected in the most
78.19recently provided summary of benefits and coverage, the health plan company shall
78.20provide notice of the modification to enrollees not later than 60 days prior to the date on
78.21which the modification will become effective.
78.22EFFECTIVE DATE.This section is effective the day following final enactment.

78.23    Sec. 89. Minnesota Statutes 2012, section 72A.20, subdivision 35, is amended to read:
78.24    Subd. 35. Determination of health plan policy limits. Any health plan under
78.25section 62A.011, subdivision 3, that includes a specific policy limit within its insurance
78.26policy, certificate, or subscriber agreement shall calculate the policy limit by using the
78.27amount actually paid on behalf of the insured, subscriber, or dependents for services
78.28covered under the policy, subscriber agreement, or certificate unless the amount paid is
78.29greater than the billed charge. This provision does not permit the application of a specific
78.30policy limit within a health plan where the limit is prohibited under the Affordable Care
78.31Act as defined in section 62A.011, subdivision 1a.
78.32EFFECTIVE DATE.This section is effective the day following final enactment.

79.1    Sec. 90. [72A.328] PROHIBITION ON RESCISSIONS OF HEALTH PLANS.

79.2    Sec. 91. Minnesota Statutes 2012, section 471.61, subdivision 1a, is amended to read:
79.3    Subd. 1a. Dependents. Notwithstanding the provisions of Minnesota Statutes 1969,
79.4section 471.61, as amended by Laws 1971, chapter 451, section 1, the word "dependents" as
79.5used therein shall mean spouse and minor unmarried children under the age of 18 26 years
79.6and dependent students under the age of 25 years actually dependent upon the employee.
79.7EFFECTIVE DATE.This section is effective the day following final enactment.

79.8    Sec. 92. REPEALER.
79.9Minnesota Statutes 2012, section 62E.02, subdivision 7, is repealed effective the
79.10day following final enactment.
79.11Minnesota Statutes 2012, sections 62A.65, subdivision 6; 62E.16; 62E.20; 62L.02,
79.12subdivisions 4, 18, 19, 23, and 24; 62L.05, subdivisions 1, 2, 3, 4, 4a, 5, 6, 7, 11, 12, and
79.1313; 62L.081; 62L.10, subdivision 5; and 62Q.37, subdivision 5, are repealed effective
79.14January 1, 2014."
79.15Amend the title accordingly