reglab/housing_qa huggingface dataset:
MN Stat § 62Q.71 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.71 — Notice To Enrollees.

62Q.71 NOTICE TO ENROLLEES. Each health plan company shall provide to enrollees a clear and concise description of its complaint resolution procedure, if applicable under section 62Q.68, subdivision 1, and the procedure used for utilization review as defined under chapter 62M as part of the member handbook, subscriber contract, or certificate of coverage. If the health plan company does not issue a member handbook, the health plan company may provide the description in another written document. The description must specifically inform enrollees: (1) how to submit a complaint to the health plan company; (2) if the health plan includes utilization review requirements, how to notify the utilization review organization in a timely manner and how to obtain authorization for health care services; (3) how to request an appeal either through the procedures described in section 62Q.70, if applicable, or through the procedures described in chapter 62M; (4) of the right to file a complaint with either the commissioner of health or commerce at any time during the complaint and appeal process; (5) of the toll-free telephone number of the appropriate commissioner; and (6) of the right, for individual and group coverage, to obtain an external review under section 62Q.73 and a description of when and how that right may be exercised, including that under most circumstances an enrollee must exhaust the internal complaint or appeal process prior to external review. However, an enrollee may proceed to external review without exhausting the internal complaint or appeal process under the following circumstances: (i) the health plan company waives the exhaustion requirement; (ii) the health plan company is considered to have waived the exhaustion requirement by failing to substantially comply with any requirements including, but not limited to, time limits for internal complaints or appeals; or (iii) the enrollee has applied for an expedited external review at the same time the enrollee has applied for internal review under chapter 62M. History:  1999 c 239 s 37; 2003 c 2 art 1 s 8; 2013 c 84 art 1 s 85; 2020 c 114 art 2 s 17
MN Stat § 62Q.72 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.72 — Record Keeping; Reporting.

62Q.72 RECORD KEEPING; REPORTING. Subdivision 1. Record keeping. Each health plan company shall maintain records of all enrollee complaints and their resolutions. These records shall be retained for five years and shall be made available to the appropriate commissioner upon request. An insurance company licensed under chapter 60A may instead comply with section 72A.20, subdivision 30. Subd. 2. Reporting. Each health plan company shall submit to the appropriate commissioner, as part of the company's annual filing, data on the number and type of complaints that are not resolved within 30 days, or 30 business days as provided under section 72A.201, subdivision 4, clause (3), for insurance companies licensed under chapter 60A. The commissioner shall also make this information available to the public upon request. History:   1999 c 239 s 38
MN Stat § 62Q.731 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.731 — Appeal From Adverse Determination.

62Q.731 APPEAL FROM ADVERSE DETERMINATION. Subdivision 1. Definitions. (a) For purposes of this section, the terms defined in this subdivision have the meanings given. (b) "Enrollee" means an eligible person as defined in section 62E.02, subdivision 13, and who meets the eligibility criteria established in section 62E.14. (c) "Board" means the board of directors of the Comprehensive Health Association, as described in section 62E.10, subdivision 2. Subd. 2. Appeal to external review entity. If an enrollee receives an adverse determination as a result of the Comprehensive Health Association's internal appeal process, by which an established enrollee appeal committee renders an adverse determination, the enrollee then has the option of: (1) appealing the adverse determination to the external review entity under section 62Q.73, which shall constitute a final determination subject to the conditions specified in section 62Q.73; or (2) appealing to the commissioner of commerce from an adverse determination as provided by the operating rules of the Comprehensive Health Association, in which case the commissioner has the option of making a determination regarding the appeal, or submitting the appeal to the external review entity retained under section 62Q.73. History:   2002 c 330 s 29
MN Stat § 62Q.732 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.732 — Citation.

62Q.732 CITATION. Sections 62Q.732 to 62Q.75 may be cited as the "Minnesota Health Plan Contracting Act." History:   2004 c 246 s 2
MN Stat § 62Q.733 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.733 — Definitions.

62Q.733 DEFINITIONS. Subdivision 1. Applicability. For purposes of sections 62Q.732 to 62Q.739, the following definitions apply. Subd. 2. Contract. "Contract" means a written agreement between a health care provider and a health plan company to provide health care services. Subd. 3. Health care provider or provider. "Health care provider" or "provider" means a physician, advanced practice registered nurse, chiropractor, dentist, podiatrist, or other provider as defined under section 62J.03, other than hospitals, ambulatory surgical centers, or freestanding emergency rooms. Subd. 4. Health plan company. (a) "Health plan company" means: (1) a health maintenance organization operating under chapter 62D; (2) a community integrated service network operating under chapter 62N; (3) a preferred provider organization as defined in section 145.61, subdivision 4c; or (4) an insurance company licensed under chapter 60A, nonprofit health service corporation operating under chapter 62C, fraternal benefit society operating under chapter 64B, or any other entity that establishes, operates, or maintains a health benefit plan or network of health care providers where the providers have entered into a contract with the entity to provide health care services. (b) This subdivision does not apply to a health plan company with respect to coverage described in section 62A.011, subdivision 3, clauses (1) to (5) and (7) to (12). Subd. 5. Fee schedule. "Fee schedule" means the total expected financial compensation paid to a health care provider for providing a health care service as determined by the contract between the health plan company and the provider, inclusive of withhold amounts and any amount for which the patient or other third party may be obligated to pay under the contract. History:  2004 c 246 s 3; 2020 c 115 art 4 s 14
MN Stat § 62Q.734 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.734 — Exemption.

62Q.734 EXEMPTION. Sections 62Q.735 to 62Q.739 and 62Q.74 do not apply to health plan companies whose annual Minnesota health premium revenues are less than three percent of the total annual Minnesota health premium revenues, as measured by the assessment base of the Minnesota Comprehensive Health Association. For purposes of this percentage calculation, a health plan company's premiums include the Minnesota health premium revenues of its affiliates. History:   2004 c 246 s 4
MN Stat § 62Q.736 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.736 — Payment Rates.

62Q.736 PAYMENT RATES. A contract between a health plan company and a provider shall comply with section 62A.64. History:   2004 c 246 s 6
MN Stat § 62Q.737 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.737 — Service Code Changes.

62Q.737 SERVICE CODE CHANGES. (a) For purposes of this section, "service code" means current procedural terminology (CPT), current dental terminology (CDT), ICD-CM, diagnosis-related groups (DRGs), or other coding system. (b) The health plan company shall determine the manner in which it adjudicates claims. The provider may request a description of the general coding guidelines applicable to the health care services the provider is reasonably expected to render pursuant to the contract. The health plan company or its designee shall provide the coding guidelines not later than 30 days after the date the health plan receives the request. The health plan company shall provide notice of material changes to the coding guidelines not later than 45 days prior to the date the changes take effect and shall not make retroactive revision to the coding guidelines, but may issue new guidelines. A provider who receives information under this section may use or disclose the information only for the purpose of practice management, billing activities, or other business operations and may not disclose the information to third parties without the consent of the health plan company. (c) The health plan company may correct an error in a submitted claim that prevents the claim from being processed, provided that the health plan company: (1) notifies the provider of the change and reason for the change according to federal Health Insurance Portability and Accountability Act (HIPAA) transaction standards; and (2) offers the provider the opportunity to appeal any changes. (d) Nothing in this section shall be interpreted to require a health plan company to violate copyright or other law by disclosing proprietary licensed software. In addition to the above, the health plan company shall, upon request of a contracted provider, disclose the name, edition, and model version of the software that the health plan company uses to determine bundling and unbundling of claims. (e) This section does not apply to government programs, including state public programs, Medicare, and Medicare-related coverage. History:   2004 c 246 s 7
MN Stat § 62Q.739 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.739 — Unilateral Terms Prohibited.

62Q.739 UNILATERAL TERMS PROHIBITED. (a) A contract between a health plan company and a health care provider shall not contain or require unilateral terms regarding indemnification or arbitration. Notwithstanding any prohibitions in this section, a contract between a health plan company and a health care provider may be unilaterally terminated by either party in accordance with the terms of the contract. (b) A health plan company may not terminate or fail to renew a health care provider's contract without cause unless the company has given the provider a written notice of the termination or nonrenewal 120 days before the effective date. History:   2004 c 246 s 8
MN Stat § 62Q.746 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.746 — Access To Certain Information Regarding Providers.

62Q.746 ACCESS TO CERTAIN INFORMATION REGARDING PROVIDERS. Upon request of the commissioner, a health plan company licensed under chapters 62C and 62D must provide the following information: (1) a detailed description of the health plan company's methods and procedures, standards, qualifications, criteria, and credentialing requirements for designating the providers who are eligible to participate in the health plan company's provider network, including any limitations on the numbers of providers to be included in the network; (2) the number of full-time equivalent physicians, by specialty, nonphysician providers, and allied health providers used to provide services; and (3) summary data that is broken down by type of provider, reflecting actual utilization of network and non-network practitioners and allied professionals by enrollees of the health plan company. History:   2001 c 170 s 7
MN Stat § 62Q.751 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.751 — Collecting Deductibles And Coinsurance.

62Q.751 COLLECTING DEDUCTIBLES AND COINSURANCE. A health plan company shall not prohibit providers from collecting deductibles and coinsurance from patients at or prior to the time of service. Providers may not withhold a service to a health plan company enrollee based on a patient's failure to pay a deductible or coinsurance at or prior to the time of service. Overpayments by patients to providers must be returned to the patient by the provider by check or electronic payment within 30 days of the date in which the claim adjudication is received by the provider. History:   2010 c 331 s 6
MN Stat § 62Q.76 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.76 — Definitions.

62Q.76 DEFINITIONS. Subdivision 1. Applicability. For purposes of sections 62Q.76 to 62Q.79, the terms defined in this section have the meanings given them. Subd. 2. Dental care services. "Dental care services" means services performed by a licensed dentist or any person working under the dentist's supervision as permitted under chapter 150A, which an enrollee might reasonably require to maintain good dental health, including preventive services, diagnostic services, emergency dental care, and restorative services. Subd. 3. Dental plan. "Dental plan" means a policy, contract, or certificate offered by a dental organization for the coverage of dental care services. Dental plan means individual or group coverage. Subd. 4. Dentist. "Dentist" means a person licensed to practice dentistry under chapter 150A. Subd. 5. Emergency dental care. "Emergency dental care" means the provision of dental care services for a sudden, acute dental condition that would lead a prudent layperson to reasonably expect that the absence of immediate care would result in serious impairment to the dentition or would place the person's oral health in serious jeopardy. Subd. 6. Enrollee. "Enrollee" means an individual covered by a dental organization and includes an insured, policyholder, subscriber, contract holder, member, covered person, or certificate holder. Subd. 7. Dental organization. "Dental organization" means a health insurer licensed under chapter 60A; a health service plan corporation licensed under chapter 62C; a health maintenance organization licensed under chapter 62D; a community integrated service network licensed under chapter 62N; or a third-party administrator that: (1) provides, either directly or through contracts with providers or other persons, dental care services; (2) arranges for the provision of these services to enrollees on the basis of a fixed, prepaid sum without regard to the frequency or extent of services furnished to any particular enrollee; or (3) administers dental plans. Subd. 8. Dental provider contract. "Dental provider contract" means a written agreement between a dentist or dental clinic and dental organization to provide dental care services. History:  2000 c 410 s 1; 2011 c 64 s 1
MN Stat § 62Q.77 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.77 — Terms Of Coverage Disclosure.

62Q.77 TERMS OF COVERAGE DISCLOSURE. A dental organization shall make available to an enrollee, upon request, a clear and concise description of the following terms of coverage: (1) the dental care services and other benefits to which the enrollee is entitled under the dental plan; (2) any exclusions or limitation on the services, kind of services, benefits, or kind of benefits to be provided, including any deductible or co-payment features and any requirements for referrals to specialists; (3) a description as to how services, including emergency dental care and out-of-area service, may be obtained; (4) a general description of payment and co-payment amounts, if any, for dental care services, which the enrollee is obligated to pay; and (5) a telephone number by which the enrollee may obtain additional information regarding coverage. History:   2000 c 410 s 2
MN Stat § 62Q.79 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.79 — Limitations.

62Q.79 LIMITATIONS. (a) The provisions contained in section 62Q.77 shall not require a dental organization to disclose information which the dental organization is already obligated to disclose under applicable Minnesota law governing the operation of the dental organization. (b) Any information a dental organization is required to disclose or communicate under section 62Q.77 to its subscribers, enrollees, participating providers, contracting groups, or dentists may be accomplished by electronic communication including, but not limited to, e-mail, the Internet, websites, and employer electronic bulletin boards. History:   2000 c 410 s 4
MN Stat § 62Q.81 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.81 — Essential Health Benefit Package Requirements.

62Q.81 ESSENTIAL HEALTH BENEFIT PACKAGE REQUIREMENTS. Subdivision 1. Essential health benefits package. (a) Health plan companies offering individual and small group health plans must include the essential health benefits package required under section 1302(a) of the Affordable Care Act and as described in this subdivision. (b) The essential health benefits package means coverage that: (1) provides essential health benefits as outlined in the Affordable Care Act; (2) limits cost-sharing for such coverage in accordance with the Affordable Care Act, as described in subdivision 2; and (3) subject to subdivision 3, provides bronze, silver, gold, or platinum level of coverage in accordance with the Affordable Care Act. Subd. 2. Coverage for enrollees under the age of 21. If a health plan company offers health plans in any level of coverage specified under section 1302(d) of the Affordable Care Act, as described in subdivision 1, paragraph (b), clause (3), the health plan company shall also offer coverage in that level to individuals who have not attained 21 years of age as of the beginning of a policy year. Subd. 3. Alternative compliance for catastrophic plans. A health plan company that does not provide an individual or small group health plan in the bronze, silver, gold, or platinum level of coverage, as described in subdivision 1, paragraph (b), clause (3), shall be treated as meeting the requirements of section 1302(d) of the Affordable Care Act with respect to any policy year if the health plan company provides a catastrophic plan that meets the requirements of section 1302(e) of the Affordable Care Act. Subd. 4. Essential health benefits; definition. For purposes of this section, "essential health benefits" has the meaning given under section 1302(b) of the Affordable Care Act and includes: (1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) laboratory services; (5) maternity and newborn care; (6) mental health and substance use disorder services, including behavioral health treatment; (7) pediatric services, including oral and vision care; (8) prescription drugs; (9) preventive and wellness services and chronic disease management; (10) rehabilitative and habilitative services and devices; and (11) additional essential health benefits included in the EHB-benchmark plan, as defined under the Affordable Care Act. Subd. 5. Exception. This section does not apply to a dental plan described in section 1311(d)(2)(B)(ii) of the Affordable Care Act. History:   2013 c 84 art 1 s 89
MN Stat § 62Q.82 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.82 — Benefits And Coverage Explanation.

62Q.82 BENEFITS AND COVERAGE EXPLANATION. Subdivision 1. Summary. Health plan companies offering health plans shall provide a summary of benefits and coverage explanation as required by the Affordable Care Act to: (1) an applicant at the time of application; (2) an enrollee prior to the time of enrollment or reenrollment, as applicable; and (3) a policyholder at the time of issuance of the policy. Subd. 2. Compliance. A health plan company described in subdivision 1 shall be deemed to have complied with subdivision 1 if the summary of benefits and coverage explanation is provided in paper or electronic form as required under the Affordable Care Act. Subd. 3. Notice of modification. Except in connection with a policy renewal or reissuance, if a health plan company makes any material modifications in any of the terms of the coverage, as defined for purposes of section 102 of the federal Employee Retirement Income Security Act of 1974, as amended, that is not reflected in the most recently provided summary of benefits and coverage explanation, the health plan company shall provide notice of the modification to enrollees not later than 60 days prior to the date on which the modification will become effective. History:   2013 c 84 art 1 s 90
MN Stat § 62R.01 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62R — Health Care Cooperatives|Section 62R.01 — Statement Of Legislative Purpose And Intent.

62R.01 STATEMENT OF LEGISLATIVE PURPOSE AND INTENT. The legislature finds that the goals of containing health care costs, improving the quality of health care, and increasing the access of Minnesota citizens to health care services reflected under chapters 62J and 62N may be further enhanced through the promotion of health care cooperatives. The legislature further finds that locally based and controlled efforts among health care providers, local businesses, units of local government, and health care consumers, can promote the attainment of the legislature's goals of health care reform, and takes notice of the long history of successful operations of cooperative organizations in this state. Therefore, in order to encourage cooperative efforts which are consistent with the goals of health care reform, including efforts among health care providers as sellers of health care services and efforts of consumers as buyers of health care services and health plan coverage, and to encourage the formation of and increase the competition among health plans in Minnesota, the legislature enacts the Minnesota Health Care Cooperative Act. History:   1994 c 625 art 11 s 1
MN Stat § 62R.02 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62R — Health Care Cooperatives|Section 62R.02 — Citation.

62R.02 CITATION. This chapter may be cited as the "Minnesota Health Care Cooperative Act." History:   1994 c 625 art 11 s 2