Bill Text: MN SF2139 | 2011-2012 | 87th Legislature | Engrossed
Bill Title: Child prenatal care services insurance coverage and continuation coverage upon divorce regulations; health maintenance organizations (HMO) regulatory authority shift from the commissioner of health to the commissioner of commerce
Sponsorship: Partisan Bill (Republican 1)
Status: (Introduced - Dead) 2012-03-14 - Comm report: To pass as amended and re-refer to Finance [SF2139 Detail]
Download: Minnesota-2011-SF2139-Engrossed.html
1.2relating to insurance; regulating coverage for prenatal care services and
1.3continuation coverage upon divorce; shifting regulatory authority over health
1.4maintenance organizations from the commissioner of health to the commissioner
1.5of commerce;amending Minnesota Statutes 2010, sections 62A.047; 62A.21,
1.6subdivision 2a; 62D.02, subdivision 3; 62D.05, subdivision 6; 62D.101,
1.7subdivision 2a; 62D.12, subdivision 1.
1.8BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.9 Section 1. Minnesota Statutes 2010, section 62A.047, is amended to read:
1.1062A.047 CHILDREN'S HEALTH SUPERVISION SERVICES AND
1.11PRENATAL CARE SERVICES.
1.12A policy of individual or group health and accident insurance regulated under this
1.13chapter, or individual or group subscriber contract regulated under chapter 62C, health
1.14maintenance contract regulated under chapter 62D, or health benefit certificate regulated
1.15under chapter 64B, issued, renewed, or continued to provide coverage to a Minnesota
1.16resident, must provide coverage for child health supervision services and prenatal care
1.17services. The policy, contract, or certificate must specifically exempt reasonable and
1.18customary charges for child health supervision services and prenatal care services from a
1.19deductible, co-payment, or other coinsurance or dollar limitation requirement. Nothing
1.20in this section prohibits a health plan company that has a network of providers from
1.21imposing a deductible, co-payment, or other coinsurance or dollar limitation requirement
1.22for child health supervision services and prenatal care services that are delivered by an
1.23out-of-network provider. This section does not prohibit the use of policy waiting periods
1.24or preexisting condition limitations for these services. Minimum benefits may be limited
1.25to one visit payable to one provider for all of the services provided at each visit cited in
2.1this section subject to the schedule set forth in this section.Nothing in this section applies
2.2to a commercial health insurance policy issued as a companion to a health maintenance
2.3organization contract, a policy designed primarily to provide coverage payable on a
2.4per diem, fixed indemnity, or nonexpense incurred basis, or a policy that provides
2.5only accident coverage Nothing in this section prevents a health plan company from
2.6using reasonable medical management techniques to determine the frequency, method,
2.7treatment, or setting for child health supervision services and prenatal care services.
2.8"Child health supervision services" means pediatric preventive services, appropriate
2.9immunizations, developmental assessments, and laboratory services appropriate to the age
2.10of a child from birth to age six, and appropriate immunizations from ages six to 18, as
2.11defined by Standards of Child Health Care issued by the American Academy of Pediatrics.
2.12Reimbursement must be made for at least five child health supervision visits from birth
2.13to 12 months, three child health supervision visits from 12 months to 24 months, once a
2.14year from 24 months to 72 months.
2.15"Prenatal care services" means the comprehensive package of medical and
2.16psychosocial support provided throughout the pregnancy, including risk assessment,
2.17serial surveillance, prenatal education, and use of specialized skills and technology,
2.18when needed, as defined by Standards for Obstetric-Gynecologic Services issued by the
2.19American College of Obstetricians and Gynecologists.
2.20 Sec. 2. Minnesota Statutes 2010, section 62A.21, subdivision 2a, is amended to read:
2.21 Subd. 2a. Continuation privilege. Every policy described in subdivision 1 shall
2.22contain a provision which permits continuation of coverage under the policy for the
2.23insured's former spouse and dependent children upon entry of a valid decree of dissolution
2.24of marriage. The coverage shall be continued until the earlier of the following dates:
2.25(a) the date the insured's former spouse becomes covered under any other group
2.26health plan; or
2.27(b) the date coverage would otherwise terminate under the policy.
2.28If the coverage is provided under a group policy, any required premium contributions
2.29for the coverage shall be paid by the insured on a monthly basis to the group policyholder
2.30for remittance to the insurer. The policy must require the group policyholder to, upon
2.31request, provide the insured with written verification from the insurer of the cost of this
2.32coverage promptly at the time of eligibility for this coverage and at any time during
2.33the continuation period.In no event shall the amount of premium charged exceed 102
2.34percent of the cost to the plan for such period of coverage for other similarly situated
2.35spouses and dependent children with respect to whom the marital relationship has not
3.1dissolved, without regard to whether such cost is paid by the employer or employee The
3.2required premium amount for continuation of the coverage shall be calculated in the same
3.3manner as provided under section 4980B of the Internal Revenue Code, its implementing
3.4regulations and Internal Revenue Service rulings on section 4980B.
3.5Upon request by the insured's former spouse or dependent child, a health carrier
3.6must provide the instructions necessary to enable the child or former spouse to elect
3.7continuation of coverage.
3.8 Sec. 3. Minnesota Statutes 2010, section 62D.02, subdivision 3, is amended to read:
3.9 Subd. 3. Commissioner ofhealth commerce or commissioner. "Commissioner of
3.10health commerce" or "commissioner" means the state commissioner of health commerce
3.11or a designee.
3.12 Sec. 4. Minnesota Statutes 2010, section 62D.05, subdivision 6, is amended to read:
3.13 Subd. 6. Supplemental benefits. (a) A health maintenance organization may, as
3.14a supplemental benefit, provide coverage to its enrollees for health care services and
3.15supplies received from providers who are not employed by, under contract with, or
3.16otherwise affiliated with the health maintenance organization. Supplemental benefits may
3.17be provided if the following conditions are met:
3.18(1) a health maintenance organization desiring to offer supplemental benefits must at
3.19all times comply with the requirements of sections62D.041 and
62D.042 ;
3.20(2) a health maintenance organization offering supplemental benefits must maintain
3.21an additional surplus in the first year supplemental benefits are offered equal to the
3.22lesser of $500,000 or 33 percent of the supplemental benefit expenses. At the end of
3.23the second year supplemental benefits are offered, the health maintenance organization
3.24must maintain an additional surplus equal to the lesser of $1,000,000 or 33 percent of the
3.25supplemental benefit expenses. At the end of the third year benefits are offered and every
3.26year after that, the health maintenance organization must maintain an additional surplus
3.27equal to the greater of $1,000,000 or 33 percent of the supplemental benefit expenses.
3.28When in the judgment of the commissioner the health maintenance organization's surplus
3.29is inadequate, the commissioner may require the health maintenance organization to
3.30maintain additional surplus;
3.31(3) claims relating to supplemental benefits must be processed in accordance with
3.32the requirements of section72A.201 ; and
3.33(4) in marketing supplemental benefits, the health maintenance organization shall
3.34fully disclose and describe to enrollees and potential enrollees the nature and extent of the
4.1supplemental coverage, and any claims filing and other administrative responsibilities in
4.2regard to supplemental benefits.
4.3(b) The commissioner may, pursuant to chapter 14, adopt, enforce, and administer
4.4rules relating to this subdivision, including: rules insuring that these benefits are
4.5supplementary and not substitutes for comprehensive health maintenance services by
4.6addressing percentage of out-of-plan coverage; rules relating to the establishment of
4.7necessary financial reserves; rules relating to marketing practices; and other rules necessary
4.8for the effective and efficient administration of this subdivision.The commissioner, in
4.9adopting rules, shall give consideration to existing laws and rules administered and
4.10enforced by the Department of Commerce relating to health insurance plans.
4.11 Sec. 5. Minnesota Statutes 2010, section 62D.101, subdivision 2a, is amended to read:
4.12 Subd. 2a. Continuation privilege. Every health maintenance contract as described
4.13in subdivision 1 shall contain a provision which permits continuation of coverage under
4.14the contract for the enrollee's former spouse and children upon entry of a valid decree of
4.15dissolution of marriage. The coverage shall be continued until the earlier of the following
4.16dates:
4.17(a) the date the enrollee's former spouse becomes covered under another group
4.18plan or Medicare; or
4.19(b) the date coverage would otherwise terminate under the health maintenance
4.20contract.
4.21If coverage is provided under a group policy, any required premium contributions
4.22for the coverage shall be paid by the enrollee on a monthly basis to the group contract
4.23holder to be paid to the health maintenance organization. The contract must require the
4.24group contract holder to, upon request, provide the enrollee with written verification from
4.25the insurer of the cost of this coverage promptly at the time of eligibility for this coverage
4.26and at any time during the continuation period.In no event shall the fee charged exceed
4.27102 percent of the cost to the plan for the period of coverage for other similarly situated
4.28spouses and dependent children when the marital relationship has not dissolved, regardless
4.29of whether the cost is paid by the employer or employee The required premium amount
4.30for continuation of the coverage shall be calculated in the same manner as provided under
4.31section 4980B in the Internal Revenue Code, its implementing regulations and Internal
4.32Revenue Service rulings on section 4980B.
4.33 Sec. 6. Minnesota Statutes 2010, section 62D.12, subdivision 1, is amended to read:
5.1 Subdivision 1. False representations. No health maintenance organization or
5.2representative thereof may cause or knowingly permit the use of advertising or solicitation
5.3which is untrue or misleading, or any form of evidence of coverage which is deceptive.
5.4Each health maintenance organization shall be subject to sections72A.17 to
72A.32 ,
5.5relating to the regulation of trade practices, except(a) to the extent that the nature of a
5.6health maintenance organization renders such sections clearly inappropriateand (b) that
5.7enforcement shall be by the commissioner of health and not by the commissioner of
5.8commerce. Every health maintenance organization shall be subject to sections
8.31 and
5.9325F.69
.
5.10 Sec. 7. REVISOR'S INSTRUCTION.
5.11The revisor of statutes shall, in conforming with section 3, change the terms
5.12"commissioner of health" or similar term to "commissioner of commerce" or similar term
5.13and "department of health" or similar term to "department of commerce" or similar term in
5.14each place it occurs in Minnesota Statutes, chapter 62D.
5.15 Sec. 8. EFFECTIVE DATE.
5.16Sections 1 to 7 are effective August 1, 2012.
1.3continuation coverage upon divorce; shifting regulatory authority over health
1.4maintenance organizations from the commissioner of health to the commissioner
1.5of commerce;amending Minnesota Statutes 2010, sections 62A.047; 62A.21,
1.6subdivision 2a; 62D.02, subdivision 3; 62D.05, subdivision 6; 62D.101,
1.7subdivision 2a; 62D.12, subdivision 1.
1.8BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.9 Section 1. Minnesota Statutes 2010, section 62A.047, is amended to read:
1.1062A.047 CHILDREN'S HEALTH SUPERVISION SERVICES AND
1.11PRENATAL CARE SERVICES.
1.12A policy of individual or group health and accident insurance regulated under this
1.13chapter, or individual or group subscriber contract regulated under chapter 62C, health
1.14maintenance contract regulated under chapter 62D, or health benefit certificate regulated
1.15under chapter 64B, issued, renewed, or continued to provide coverage to a Minnesota
1.16resident, must provide coverage for child health supervision services and prenatal care
1.17services. The policy, contract, or certificate must specifically exempt reasonable and
1.18customary charges for child health supervision services and prenatal care services from a
1.19deductible, co-payment, or other coinsurance or dollar limitation requirement. Nothing
1.20in this section prohibits a health plan company that has a network of providers from
1.21imposing a deductible, co-payment, or other coinsurance or dollar limitation requirement
1.22for child health supervision services and prenatal care services that are delivered by an
1.23out-of-network provider. This section does not prohibit the use of policy waiting periods
1.24or preexisting condition limitations for these services. Minimum benefits may be limited
1.25to one visit payable to one provider for all of the services provided at each visit cited in
2.1this section subject to the schedule set forth in this section.
2.2
2.3
2.4
2.5
2.6using reasonable medical management techniques to determine the frequency, method,
2.7treatment, or setting for child health supervision services and prenatal care services.
2.8"Child health supervision services" means pediatric preventive services, appropriate
2.9immunizations, developmental assessments, and laboratory services appropriate to the age
2.10of a child from birth to age six, and appropriate immunizations from ages six to 18, as
2.11defined by Standards of Child Health Care issued by the American Academy of Pediatrics.
2.12Reimbursement must be made for at least five child health supervision visits from birth
2.13to 12 months, three child health supervision visits from 12 months to 24 months, once a
2.14year from 24 months to 72 months.
2.15"Prenatal care services" means the comprehensive package of medical and
2.16psychosocial support provided throughout the pregnancy, including risk assessment,
2.17serial surveillance, prenatal education, and use of specialized skills and technology,
2.18when needed, as defined by Standards for Obstetric-Gynecologic Services issued by the
2.19American College of Obstetricians and Gynecologists.
2.20 Sec. 2. Minnesota Statutes 2010, section 62A.21, subdivision 2a, is amended to read:
2.21 Subd. 2a. Continuation privilege. Every policy described in subdivision 1 shall
2.22contain a provision which permits continuation of coverage under the policy for the
2.23insured's former spouse and dependent children upon entry of a valid decree of dissolution
2.24of marriage. The coverage shall be continued until the earlier of the following dates:
2.25(a) the date the insured's former spouse becomes covered under any other group
2.26health plan; or
2.27(b) the date coverage would otherwise terminate under the policy.
2.28If the coverage is provided under a group policy, any required premium contributions
2.29for the coverage shall be paid by the insured on a monthly basis to the group policyholder
2.30for remittance to the insurer. The policy must require the group policyholder to, upon
2.31request, provide the insured with written verification from the insurer of the cost of this
2.32coverage promptly at the time of eligibility for this coverage and at any time during
2.33the continuation period.
2.34
2.35
3.1
3.2required premium amount for continuation of the coverage shall be calculated in the same
3.3manner as provided under section 4980B of the Internal Revenue Code, its implementing
3.4regulations and Internal Revenue Service rulings on section 4980B.
3.5Upon request by the insured's former spouse or dependent child, a health carrier
3.6must provide the instructions necessary to enable the child or former spouse to elect
3.7continuation of coverage.
3.8 Sec. 3. Minnesota Statutes 2010, section 62D.02, subdivision 3, is amended to read:
3.9 Subd. 3. Commissioner of
3.10
3.11or a designee.
3.12 Sec. 4. Minnesota Statutes 2010, section 62D.05, subdivision 6, is amended to read:
3.13 Subd. 6. Supplemental benefits. (a) A health maintenance organization may, as
3.14a supplemental benefit, provide coverage to its enrollees for health care services and
3.15supplies received from providers who are not employed by, under contract with, or
3.16otherwise affiliated with the health maintenance organization. Supplemental benefits may
3.17be provided if the following conditions are met:
3.18(1) a health maintenance organization desiring to offer supplemental benefits must at
3.19all times comply with the requirements of sections
3.20(2) a health maintenance organization offering supplemental benefits must maintain
3.21an additional surplus in the first year supplemental benefits are offered equal to the
3.22lesser of $500,000 or 33 percent of the supplemental benefit expenses. At the end of
3.23the second year supplemental benefits are offered, the health maintenance organization
3.24must maintain an additional surplus equal to the lesser of $1,000,000 or 33 percent of the
3.25supplemental benefit expenses. At the end of the third year benefits are offered and every
3.26year after that, the health maintenance organization must maintain an additional surplus
3.27equal to the greater of $1,000,000 or 33 percent of the supplemental benefit expenses.
3.28When in the judgment of the commissioner the health maintenance organization's surplus
3.29is inadequate, the commissioner may require the health maintenance organization to
3.30maintain additional surplus;
3.31(3) claims relating to supplemental benefits must be processed in accordance with
3.32the requirements of section
3.33(4) in marketing supplemental benefits, the health maintenance organization shall
3.34fully disclose and describe to enrollees and potential enrollees the nature and extent of the
4.1supplemental coverage, and any claims filing and other administrative responsibilities in
4.2regard to supplemental benefits.
4.3(b) The commissioner may, pursuant to chapter 14, adopt, enforce, and administer
4.4rules relating to this subdivision, including: rules insuring that these benefits are
4.5supplementary and not substitutes for comprehensive health maintenance services by
4.6addressing percentage of out-of-plan coverage; rules relating to the establishment of
4.7necessary financial reserves; rules relating to marketing practices; and other rules necessary
4.8for the effective and efficient administration of this subdivision.
4.9
4.10
4.11 Sec. 5. Minnesota Statutes 2010, section 62D.101, subdivision 2a, is amended to read:
4.12 Subd. 2a. Continuation privilege. Every health maintenance contract as described
4.13in subdivision 1 shall contain a provision which permits continuation of coverage under
4.14the contract for the enrollee's former spouse and children upon entry of a valid decree of
4.15dissolution of marriage. The coverage shall be continued until the earlier of the following
4.16dates:
4.17(a) the date the enrollee's former spouse becomes covered under another group
4.18plan or Medicare; or
4.19(b) the date coverage would otherwise terminate under the health maintenance
4.20contract.
4.21If coverage is provided under a group policy, any required premium contributions
4.22for the coverage shall be paid by the enrollee on a monthly basis to the group contract
4.23holder to be paid to the health maintenance organization. The contract must require the
4.24group contract holder to, upon request, provide the enrollee with written verification from
4.25the insurer of the cost of this coverage promptly at the time of eligibility for this coverage
4.26and at any time during the continuation period.
4.27
4.28
4.29
4.30for continuation of the coverage shall be calculated in the same manner as provided under
4.31section 4980B in the Internal Revenue Code, its implementing regulations and Internal
4.32Revenue Service rulings on section 4980B.
4.33 Sec. 6. Minnesota Statutes 2010, section 62D.12, subdivision 1, is amended to read:
5.1 Subdivision 1. False representations. No health maintenance organization or
5.2representative thereof may cause or knowingly permit the use of advertising or solicitation
5.3which is untrue or misleading, or any form of evidence of coverage which is deceptive.
5.4Each health maintenance organization shall be subject to sections
5.5relating to the regulation of trade practices, except
5.6health maintenance organization renders such sections clearly inappropriate
5.7
5.8
5.10 Sec. 7. REVISOR'S INSTRUCTION.
5.11The revisor of statutes shall, in conforming with section 3, change the terms
5.12"commissioner of health" or similar term to "commissioner of commerce" or similar term
5.13and "department of health" or similar term to "department of commerce" or similar term in
5.14each place it occurs in Minnesota Statutes, chapter 62D.
5.15 Sec. 8. EFFECTIVE DATE.
5.16Sections 1 to 7 are effective August 1, 2012.
