reglab/housing_qa huggingface dataset:
MN Stat § 62Q.165 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.165 — Universal Coverage.

62Q.165 UNIVERSAL COVERAGE. Subdivision 1. Definition. It is the commitment of the state to achieve universal health coverage for all Minnesotans by the year 2011. Universal coverage is achieved when: (1) every Minnesotan has access to a full range of quality health care services; (2) every Minnesotan is able to obtain affordable health coverage which pays for the full range of services, including preventive and primary care; and (3) every Minnesotan pays into the health care system according to that person's ability. Subd. 2. Goal. It is the goal of the state to make continuous progress toward reducing the number of Minnesotans who do not have health coverage so that by January 1, 2011, all Minnesota residents have access to affordable health care. The goal will be achieved by improving access to private health coverage through insurance reforms and market reforms, by making health coverage more affordable for low-income Minnesotans through purchasing pools and state subsidies, and by reducing the cost of health coverage through cost containment programs and methods of ensuring that all Minnesotans are paying into the system according to their ability. Subd. 3.  [Repealed, 1997 c 225 art 2 s 63] History:  1994 c 625 art 6 s 1; 1995 c 234 art 4 s 1; 2007 c 147 art 15 s 11,12
MN Stat § 62Q.181 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.181 — Written Certification Of Coverage.

62Q.181 WRITTEN CERTIFICATION OF COVERAGE. A health plan company shall provide the written certifications of coverage required under United States Code, title 42, sections 300gg(e) and 300gg-43. This section applies only to coverage that is subject to regulation under state law and only to the extent that the certification of coverage is required under federal law. The commissioner shall enforce this section. History:   1997 c 175 art 4 s 3
MN Stat § 62Q.1841 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.1841 — Prohibition On Use Of Step Therapy For Metastatic Cancer.

62Q.1841 PROHIBITION ON USE OF STEP THERAPY FOR METASTATIC CANCER. Subdivision 1. Definitions. (a) For purposes of this section, the following definitions apply. (b) "Health plan" has the meaning given in section 62Q.01, subdivision 3. Health plan includes health coverage provided by a county-based purchasing plan participating in a public program under chapter 256B or 256L or an integrated health partnership under section 256B.0755. (c) "Stage four advanced metastatic cancer" means cancer that has spread from the primary or original site of the cancer to nearby tissues, lymph nodes, or other parts of the body. (d) "Step therapy protocol" has the meaning given in section 62Q.184, subdivision 1. Subd. 2. Prohibition on use of step therapy protocols. A health plan that provides coverage for the treatment of stage four advanced metastatic cancer or associated conditions must not limit or exclude coverage for a drug approved by the United States Food and Drug Administration that is on the health plan's prescription drug formulary by mandating that an enrollee with stage four advanced metastatic cancer or associated conditions follow a step therapy protocol if the use of the approved drug is consistent with: (1) a United States Food and Drug Administration-approved indication; and (2) a clinical practice guideline published by the National Comprehensive Care Network. History:   1Sp2019 c 9 art 8 s 13
MN Stat § 62Q.185 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.185 — Guaranteed Renewability; Large Employer Group.

62Q.185 GUARANTEED RENEWABILITY; LARGE EMPLOYER GROUP. (a) No health plan company, as defined in section 62Q.01, subdivision 4, shall refuse to renew a health benefit plan, as defined in section 62L.02, subdivision 15, but issued to a large employer, as defined in section 62Q.18, subdivision 1. (b) This section does not require renewal if: (1) the large employer has failed to pay premiums or contributions as required under the terms of the health benefit plan, or the health plan company has not received timely premium payments unless the late payments were received within a grace period provided under state law; (2) the large employer has performed an act or practice that constitutes fraud or misrepresentation of material fact under the terms of the health benefit plan; (3) the large employer has failed to comply with a material plan provision relating to employer contribution or group participation rules not prohibited by state law; (4) the health plan company is ceasing to offer coverage in the large employer market in this state in compliance with United States Code, title 42, section 300gg-12(c), and applicable state law; (5) in the case of a health maintenance organization, there is no longer any enrollee in the large employer's health benefit plan who lives, resides, or works in the approved service area; or (6) in the case of a health benefit plan made available to large employers only through one or more bona fide associations, the membership of the large employer in the association ceases, but only if such coverage is terminated uniformly without regard to any health-related factor relating to any covered individual. (c) This section does not prohibit a health plan company from modifying the premium rate or from modifying the coverage for purposes of renewal. (d) This section does not require renewal of the coverage of individual enrollees under the health benefit plan if the individual enrollee has performed an act or practice that constitutes fraud or misrepresentation of material fact under the terms of the health benefit plan. History:  1997 c 175 art 3 s 3; 1999 c 177 s 57
MN Stat § 62Q.186 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.186 — Prohibition On Rescissions Of Health Plans.

62Q.186 PROHIBITION ON RESCISSIONS OF HEALTH PLANS. Subdivision 1. Definitions. (a) "Rescission" means a cancellation or discontinuance of coverage under a health plan that has a retroactive effect. (b) "Rescission" does not include: (1) a cancellation or discontinuance of coverage under a health plan if: (i) the cancellation or discontinuance of coverage has only a prospective effect; or (ii) the cancellation or discontinuance of coverage is effective retroactively to the extent it is attributable to a failure to timely pay required premiums or contributions toward the cost of coverage; or (2) when the health plan covers only active employees and, if applicable, dependents and those covered under continuation coverage provisions, the employee pays no premiums for coverage after termination of employment and the cancellation or discontinuance of coverage is effective retroactively back to the date of termination of employment due to a delay in administrative record keeping. Subd. 2. Prohibition on rescissions. (a) A health plan company shall not rescind coverage under a health plan with respect to an individual, including a group to which the individual belongs or family coverage in which the individual is included, after the individual is covered under the health plan, unless: (1) the individual, or a person seeking coverage on behalf of the individual, performs an act, practice, or omission that constitutes fraud; or (2) the individual makes an intentional misrepresentation or omission of material fact, as prohibited by the terms of the health plan. For purposes of this section, a person seeking coverage on behalf of an individual does not include an insurance producer or employee or authorized representative of the health carrier. (b) This section does not apply to any benefits classified as excepted benefits under United States Code, title 42, section 300gg-91(c), or regulations enacted thereunder from time to time. Subd. 3. Notice required. A health plan company shall provide at least 30 days' advance written notice to each individual who would be affected by the proposed rescission of coverage before coverage under the health plan may be terminated retroactively. Subd. 4. Compliance with other restrictions on rescissions. Nothing in this section allows rescission if rescission would otherwise be prohibited under section 62A.04, subdivision 2, clause (2). History:  2013 c 84 art 1 s 71; 2014 c 275 art 1 s 8
MN Stat § 62Q.188 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.188 — Flexible Benefits Plans.

62Q.188 FLEXIBLE BENEFITS PLANS. Subdivision 1. Definitions. For the purposes of this section, the terms used in this section have the meanings defined in section 62Q.01, except that "health plan" includes individual coverage and group coverage for employer plans with up to 100 employees. Subd. 2. Flexible benefits plan. Notwithstanding any provision of this chapter, chapter 363A, or any other law to the contrary, a health plan company may offer, sell, issue, and renew a health plan that is a flexible benefits plan under this section if the following requirements are satisfied: (1) the health plan must be offered in compliance with the laws of this state, except as otherwise permitted in this section; (2) the health plan must be designed to enable covered persons to better manage costs and coverage options through the use of co-pays, deductibles, and other cost-sharing arrangements; (3) the health plan may modify or exclude any or all coverages of benefits that would otherwise be required by law, except for maternity benefits and other benefits required under federal law; (4) each health plan and plan's premiums must be approved by the commissioner of health or commerce, whichever is appropriate under section 62Q.01, subdivision 2, but neither commissioner may disapprove a plan on the grounds of a modification or exclusion permitted under clause (3); and (5) prior to the sale of the health plan, the purchaser must be given a written list of the coverages otherwise required by law that are modified or excluded in the health plan. The list must include a description of each coverage in the list and indicate whether the coverage is modified or excluded. If coverage is modified, the list must describe the modification. The list may, but is not required to, also list any or all coverages otherwise required by law that are included in the health plan and indicate that they are included. The health plan company must require that a copy of this written list be provided, prior to the effective date of the health plan, to each enrollee or employee who is eligible for health coverage under the plan. Subd. 3. Employer health plan. An employer may provide a health plan permitted under this section to its employees, the employees' dependents, and other persons eligible for coverage under the employer's plan, notwithstanding chapter 363A or any other law to the contrary. History:   2010 c 384 s 24
MN Stat § 62Q.23 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.23 — General Services.

62Q.23 GENERAL SERVICES. (a) Health plan companies shall comply with all continuation and conversion of coverage requirements applicable to health maintenance organizations under state or federal law. (b) Health plan companies shall comply with sections 62A.047, 62A.27, and any other coverage required under chapter 62A of newborn infants, dependent children to the limiting age as defined in section 62Q.01, subdivision 2a, disabled dependent children, and adopted children. A health plan company providing dependent coverage shall comply with section 62A.302. (c) Health plan companies shall comply with the equal access requirements of section 62A.15. History:  1994 c 625 art 4 s 8; 2005 c 56 s 1; 2013 c 84 art 1 s 72; 2017 c 99 s 1
MN Stat § 62Q.32 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.32 — Local Ombudsperson.

62Q.32 LOCAL OMBUDSPERSON. County board or community health service agencies may establish an office of ombudsperson to provide a system of consumer advocacy for persons receiving health care services through a health plan company. The ombudsperson's functions may include, but are not limited to: (1) mediation or advocacy on behalf of a person accessing the complaint and appeal procedures to ensure that necessary medical services are provided by the health plan company; and (2) investigation of the quality of services provided to a person and determine the extent to which quality assurance mechanisms are needed or any other system change may be needed. History:  1994 c 625 art 7 s 2; 1995 c 234 art 8 s 18; 1Sp2011 c 9 art 6 s 14
MN Stat § 62Q.43 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.43 — Geographic Access.

62Q.43 GEOGRAPHIC ACCESS. Subdivision 1. Closed-panel health plan. For purposes of this section, "closed-panel health plan" means a health plan as defined in section 62Q.01 that requires an enrollee to receive all or a majority of primary care services from a specific clinic or primary care provider designated by the enrollee that is within the health plan company's clinic or provider network. Subd. 2. Access requirement. Every closed-panel health plan must allow enrollees under the age of 26 years to change their designated clinic or primary care provider at least once per month, as long as the clinic or provider is part of the health plan company's statewide clinic or provider network. A health plan company shall not charge enrollees who choose this option higher premiums or cost sharing than would otherwise apply to enrollees who do not choose this option. A health plan company may require enrollees to provide 15 days' written notice of intent to change their designated clinic or primary care provider. History:  1995 c 234 art 2 s 27; 2013 c 84 art 1 s 73; 2020 c 115 art 4 s 9,10
MN Stat § 62Q.45 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.45 — Coverage For Out-of-area Primary Care.

62Q.45 COVERAGE FOR OUT-OF-AREA PRIMARY CARE. Subdivision 1. Study. The commissioner of health shall develop methods to allow enrollees of managed care organizations to obtain primary care health services outside of the service area of their managed care organization, from health care providers who are employed by or under contract with another managed care organization. The commissioner shall make recommendations on: (1) whether this out-of-area primary care coverage should be available to students and/or other enrollees without additional premium charges or cost sharing; (2) methods to coordinate the services provided by different managed care organizations; (3) methods to manage the quality of care provided by different managed care organizations and monitor health care outcomes; (4) methods to reimburse managed care organizations for care provided to enrollees of other managed care organizations; and (5) other issues relevant to the design and administration of out-of-area primary care coverage. The commissioner shall present recommendations to the legislature by January 15, 1996. Subd. 2. Definition. For purposes of this section, "managed care organization" means: (1) a health maintenance organization operating under chapter 62D; (2) a community integrated service network as defined under section 62N.02, subdivision 4a; or (3) an insurance company licensed under chapter 60A, nonprofit health service plan corporation operating under chapter 62C, fraternal benefit society operating under chapter 64B, or any other health plan company, to the extent that it covers health care services delivered to Minnesota residents through a preferred provider organization or a network of selected providers. History:  1995 c 234 art 2 s 28; 1997 c 225 art 2 s 44
MN Stat § 62Q.471 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.471 — Exclusion For Suicide Attempts Prohibited.

62Q.471 EXCLUSION FOR SUICIDE ATTEMPTS PROHIBITED. (a) No health plan may exclude or reduce coverage for health care for an enrollee who is otherwise covered under the health plan on the basis that the need for the health care arose out of a suicide or suicide attempt by the enrollee. (b) For purposes of this section, "health plan" has the meaning given in section 62Q.01, subdivision 3, but includes the coverages described in section 62A.011, subdivision 3, clauses (4), (6), and (7) through (10). History:  1Sp2001 c 9 art 9 s 1; 2002 c 379 art 1 s 113; 2005 c 132 s 16; 2014 c 275 art 1 s 9
MN Stat § 62Q.472 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.472 — Screening And Testing For Opioids.

62Q.472 SCREENING AND TESTING FOR OPIOIDS. (a) A health plan company shall not place a lifetime or annual limit on screenings and urinalysis testing for opioids for an enrollee in an inpatient or outpatient substance use disorder treatment program when the screening or testing is ordered by a health care provider and performed by an accredited clinical laboratory. A health plan company is not prohibited from conducting a medical necessity review when screenings or urinalysis testing for an enrollee exceeds 24 tests in any 12-month period. (b) This section does not apply to managed care plans or county-based purchasing plans when the plan provides coverage to public health care program enrollees under chapter 256B or 256L. History:   1Sp2021 c 4 art 3 s 16
MN Stat § 62Q.48 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.48 — Cost-sharing In Prescription Insulin Drugs.

62Q.48 COST-SHARING IN PRESCRIPTION INSULIN DRUGS. Subdivision 1. Scope of coverage. This section applies to all health plans issued or renewed to a Minnesota resident. Subd. 2. Definitions. (a) For the purposes of this section, the terms defined in this subdivision have the meanings given them. (b) "Cost-sharing" means a deductible payment, co-payment, or coinsurance amount imposed on an enrollee for a covered prescription drug in accordance with the terms and conditions of the enrollee's health plan. (c) "Legend drug" has the same meaning as in section 151.01, subdivision 17. (d) "Prescription insulin drug" means a legend drug that contains insulin and is used to treat diabetes. (e) "Net price" means the health plan company's cost for a prescription insulin drug, including any rebates or discounts received by or accrued directly or indirectly to the health plan company from a drug manufacturer or pharmacy benefit manager. Subd. 3. Cost-sharing limits. (a) A health plan that imposes a cost-sharing requirement on the coverage of a prescription insulin drug shall limit the total amount of cost-sharing that an enrollee is required to pay at point of sale, including deductible payments and the cost-sharing amounts charged once the deductible is met at an amount that does not exceed the net price of the prescription insulin drug. (b) Nothing in this section shall prevent a health plan company from imposing a cost-sharing requirement that is less than the amount specified in paragraph (a). History:   1Sp2019 c 9 art 8 s 15
MN Stat § 62Q.49 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.49 — Enrollee Cost Sharing; Negotiated Provider Payments.

62Q.49 ENROLLEE COST SHARING; NEGOTIATED PROVIDER PAYMENTS. Subdivision 1. Applicability. This section applies to all health plans, as defined in section 62Q.01, subdivision 3, that provide coverage for health care to be provided entirely or partially: (1) through contracts in which health care providers agree to accept discounted charges, negotiated charges, or other limits on health care provider charges; (2) by employees of, or facilities or entities owned by, the issuer of the health plan; or (3) through contracts with health care providers that provide for payment to the providers on a fully or partially capitated basis or on any other non-fee-for-service basis. Subd. 2. Disclosure required. (a) All health plans included in subdivision 1 must clearly specify how the cost of health care used to calculate any co-payments, coinsurance, or lifetime benefits will be affected by the arrangements described in subdivision 1. (b) Any summary or other marketing material used in connection with marketing of a health plan that is subject to this section must prominently disclose and clearly explain the provisions required under paragraph (a), if the summary or other marketing material refers to co-payments, coinsurance, or maximum lifetime benefits. (c) A health plan that is subject to paragraph (a) must not be used in this state if the commissioner of commerce or health, as appropriate, has determined that it does not comply with this section. History:   1996 c 446 art 1 s 50
MN Stat § 62Q.50 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.50 — Prostate Cancer Screening.

62Q.50 PROSTATE CANCER SCREENING. A health plan must cover prostate cancer screening for men 40 years of age or over who are symptomatic or in a high-risk category and for all men 50 years of age or older. The screening must consist at a minimum of a prostate-specific antigen blood test and a digital rectal examination. This coverage is subject to any deductible, coinsurance, co-payment, or other limitation on coverage applicable to other coverages under the plan. For purposes of this section, "health plan" includes coverage that is excluded under section 62A.011, subdivision 3, clauses (7) and (10). History:  1996 c 446 art 1 s 51,72,73; 1998 c 339 s 12
MN Stat § 62Q.51 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.51 — Point-of-service Option.

62Q.51 POINT-OF-SERVICE OPTION. Subdivision 1. Definition. For purposes for this section, "point-of-service option" means a health plan under which the health plan company will reimburse an appropriately licensed or registered provider for providing covered services to an enrollee, without regard to whether the provider belongs to a particular network and without regard to whether the enrollee was referred to the provider by another provider. Subd. 2. Required point-of-service option. Each health plan company operating in the small group or large group market shall offer at least one point-of-service option in each such market in which it operates. Subd. 3. Rate approval. The premium rates and cost sharing requirements for each option must be submitted to the commissioner of health or the commissioner of commerce as required by law. A health plan that includes lower enrollee cost sharing for services provided by network providers than for services provided by out-of-network providers, or lower enrollee cost sharing for services provided with prior authorization or second opinion than for services provided without prior authorization or second opinion, qualifies as a point-of-service option. Subd. 4. Exemption. This section does not apply to a health plan company with fewer than 50,000 enrollees in its commercial health plan products. History:  1996 c 446 art 1 s 52; 1999 c 181 s 6