reglab/statecodes huggingface dataset:
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62C — Nonprofit Health Service Plan Corporations › Section 62C.12 — Suspension.

62C.12 SUSPENSION.
A service plan corporation shall be subject to section 60A.052, relating to the denial, suspension or revocation of a certificate of authority, and to chapter 60B. The commissioner also may suspend or revoke a certificate for any violation or noncompliance with Laws 1971, chapter 568 following a hearing under procedures established by rules of the commissioner. The commissioner may suspend or revoke the certificate of authority of a foreign service plan corporation for the same reasons for which a domestic corporation's certificate may be suspended or revoked, and further, may revoke or suspend the certificate of a foreign service plan corporation if its activities outside the state of Minnesota impair its solvency or its ability to meet its obligations in this state.
History:
1971 c 568 s 12; 1985 c 248 s 70; 1986 c 444; 1993 c 13 art 2 s 1
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62C — Nonprofit Health Service Plan Corporations › Section 62C.13 — Authorized Contracts And Agreements.

62C.13 AUTHORIZED CONTRACTS AND AGREEMENTS.
Subdivision 1.
General powers.
A service plan corporation may act for, or as agent of, a provider and may contract with subscribers and others to render or provide health services for the benefit of subscribers. It may enter into service agreements. A subscriber contract may provide for payment to, or reimbursement of, a subscriber for expenses incurred for health services when rendered or furnished by nonparticipating providers.
Subd. 2.
Government units or agencies.
A service plan corporation may contract or make other arrangements with any agency, instrumentality or political subdivision of the United States, or this state, and may accept and administer funds, directly or indirectly, made available thereby provided such agency, instrumentality or political subdivision is authorized by law to make such contracts or arrangements. It may subcontract with any organization which has contracted with any such agency, instrumentality or political subdivision for the administration or furnishing of health services or any publicly supported health service plan.
Subd. 3.
Similar organizations.
A service plan corporation may enter into contracts or other arrangements with similar organizations or corporations domiciled in this or any other state or country, for transfer of subscribers, reciprocal or joint benefits, or for other joint undertakings approved by its board and not inconsistent with the purposes of Laws 1971, chapter 568, provided, however, that in no event shall a service plan corporation enter into any such contract, arrangement or undertaking which would have the effect of relieving such corporation of its duties and obligations to any subscribers unless the corporation has received the prior written consent of the affected subscribers, or a qualified agent or representative of such subscribers.
Subd. 4.
Administrative services.
A service plan corporation may enter into contracts or other arrangements with providers or with any agency, instrumentality or political subdivision of the United States or any state or country or any other organization for administrative, accounting, record keeping, data processing, or planning, facility or service related to rendering or furnishing health services.
Subd. 5.
Construction of section.
Laws 1971, chapter 568 shall not be construed to require a service plan corporation to contract or arrange to remain under contract or arrangement with any provider, subscriber or group of subscribers.
History:
1971 c 568 s 13
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62C — Nonprofit Health Service Plan Corporations › Section 62C.142 — Continuation And Conversion Privileges For Former Spouses And Children.

62C.142 CONTINUATION AND CONVERSION PRIVILEGES FOR FORMER SPOUSES AND CHILDREN.
Subdivision 1.
Termination of coverage.
No subscriber contract of a nonprofit health service plan corporation which, in addition to covering the subscriber, also covers the subscriber's spouse shall contain a provision for termination of coverage for a spouse covered under the subscriber contract solely as a result of a break in the marital relationship except by reason of an entry of a valid decree of dissolution of marriage between the parties.
Subd. 2.
Conversion privilege.
An individual subscriber contract issued as conversion coverage shall be renewable at the option of the former spouse as long as the former spouse is not covered under another qualified plan as defined in section 62E.02, subdivision 4. Any revisions in the table of rate for the individual subscriber contract shall apply to the former spouse's original age at entry and shall apply equally to all similar contracts issued as conversion coverage by the corporation.
Subd. 2a.
Continuation privilege.
Every subscriber contract, other than a contract whose continuance is contingent upon continued employment or membership, shall contain a provision which permits continuation of coverage under the contract for the subscriber's former spouse and children upon entry of a valid decree of dissolution of marriage. The coverage may be continued until the earlier of the following dates:
(a) the subscriber's former spouse becomes covered under any other group health plan; or
(b) the date coverage would otherwise terminate under the subscriber contract.
The contract must require the group contract holder to, upon request, provide the insured with written verification from the insurer of the cost of this coverage promptly at the time of eligibility for this coverage and at any time during the continuation period. In no event shall the amount of premium charged exceed 102 percent of the cost to the plan for such period of coverage for other similarly situated spouses and dependent children with respect to whom the marital relationship has not dissolved, without regard to whether such cost is paid by the employer or employee.
Subd. 3.
Application.
Subdivision 1 applies to every subscriber contract which is delivered, issued for delivery, renewed or amended on or after July 19, 1977.
Subdivisions 2 and 2a apply to every subscriber contract which is delivered, issued for delivery, renewed, or amended on or after March 1, 1983.
History:
1977 c 186 s 2; 1982 c 555 s 9; 1982 c 642 s 15; 1990 c 403 s 9; 1992 c 564 art 4 s 9; 2000 c 483 s 13; 2013 c 84 art 1 s 33
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62C — Nonprofit Health Service Plan Corporations › Section 62C.15 — Subscription Charges.

62C.15 SUBSCRIPTION CHARGES.
Subdivision 1.
Establishment and adjustment.
A service plan corporation shall establish and adjust from time to time subscription charges to be paid by or on behalf of its subscribers. The charges shall be reasonable, and not unfairly discriminatory, in relation to the benefits, considering actuarial projection of the cost of providing or paying for the health services, considering costs of administration, and in relation to reserves and surplus required by law.
Subd. 2.
Nongroup contracts; filing of schedule of charges.
No service plan corporation shall deliver, issue for delivery, extend, continue, or renew any form of nongroup subscriber contract until schedules of charges applicable thereto, including any endorsement, rider, amendment or application which is a part thereof, have been filed with the commissioner; nor shall the corporation deliver, issue for delivery, extend, continue or renew any form of group subscriber contract until a schedule of the rating structures and formulae applicable thereto, including any endorsement, rider, amendment or application which is a part thereof, has been filed with the commissioner. The filing for a nongroup subscriber contract shall include the actuarial data needed to justify any increase in subscriber charges. The commissioner may disapprove the schedule of charges for any group or nongroup subscriber contract if:
(a) the unencumbered reserve or surplus is less than the required minimum or more than the required maximum; or
(b) the schedule charges meet the criteria specified in section 62A.02, subdivision 3.
Subd. 3.
Disapproval.
If subscription charges become subject to disapproval, the commissioner shall within 30 days of filing render an order either disapproving the charges or extending time for review to a specified date, or the charges shall be deemed approved. An order disapproving a charge shall state the reasons therefor and shall be subject to the notice, hearing, and appeal provisions of section 62C.14. The burden of proving and actuarially demonstrating that the charges are not inadequate or excessive shall be on the corporation.
Subd. 4.
Issuance or delivery of disapproved contract.
It shall be unlawful for a service plan corporation to deliver or issue a subscriber's contract with charges which have been disapproved by the commissioner.
History:
1971 c 568 s 15; 1976 c 296 art 2 s 12
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62C — Nonprofit Health Service Plan Corporations › Section 62C.16 — Service Agreements.

62C.16 SERVICE AGREEMENTS.
Subdivision 1.
Agreements with authorized providers.
Service plan corporations, as agents for providers, may enter into service agreements only with providers authorized to practice their profession or conduct their business in this state or the state or foreign country in which the provider is located.
Subd. 2.
Enforcement.
A service plan corporation shall enforce its service agreements, including agreements of providers to accept payment from the corporation as compensation for health service rendered or provided to subscribers who have prepaid for the health service. Provisions for review, by participating providers, of claims shall be a part of each service agreement.
Subd. 3.
Filing.
Each type of service agreement shall be filed with the commissioner, prior to its use and those in effect on August 1, 1971, shall be filed within 60 days thereof.
Subd. 4.
Retaliatory action prohibited.
No service plan corporation may take retaliatory action against a provider solely on the grounds that the provider disseminated accurate information regarding coverage of benefits or accurate benefit limitations of a subscriber's contract or accurate interpretations of the provider agreement that limit the prescribing, providing, or ordering of care.
History:
1971 c 568 s 16; 1993 c 345 art 5 s 5
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62C — Nonprofit Health Service Plan Corporations › Section 62C.18 — Personal Liability.

62C.18 PERSONAL LIABILITY.
Subdivision 1.
Limitation.
No participating provider shall have any right of action against a subscriber for compensation for health services which such provider has rendered, except to the extent that the subscriber's contract does not provide coverage for the services or part of the services rendered.
Subd. 2.
Rights of nonparticipating providers; notice.
Nothing herein shall affect the rights of a nonparticipating provider who gives the subscriber written notice prior to rendering service that the provider will bill the subscriber directly for service, provided that such notice shall not be required if (1) the nonparticipating provider is not informed by the subscriber and does not otherwise have knowledge that such subscriber has a subscriber contract covering such services, or (2) under the existing circumstances it is impossible or impractical for the nonparticipating provider to give such notice, or (3) the services are not provided in this state.
Subd. 3.
Failure of nonparticipating provider to give notice.
A nonparticipating provider who fails to give the notice required in subdivision 2 shall not be entitled to recover compensation from a subscriber for health services rendered to such subscriber in an amount in excess of the aggregate of (1) the amount actually received by the subscriber from the service plan corporation as reimbursement for the costs of such service, and (2) the amount by which such nonparticipating provider's fee or charges for such service exceeds the coverage provided for such service in the subscriber's contract.
History:
1971 c 568 s 18; 1986 c 444
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62C — Nonprofit Health Service Plan Corporations › Section 62C.19 — Unfair Trade Practices.

62C.19 UNFAIR TRADE PRACTICES.
Service plan corporations are subject to sections 72A.17 to 72A.30, regarding regulation of trade practices, and to all rules promulgated by the commissioner regarding advertisements for and marketing of accident and health insurance.
History:
1971 c 568 s 19; 1985 c 248 s 70
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62C — Nonprofit Health Service Plan Corporations › Section 62C.20 — Practice Not Authorized.

62C.20 PRACTICE NOT AUTHORIZED.
Nothing in Laws 1971, chapter 568 shall authorize any person, association or corporation to engage, in any manner, in the practice of a profession required by this state to be licensed.
History:
1971 c 568 s 20
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62C — Nonprofit Health Service Plan Corporations › Section 62C.21 — Penalties.

62C.21 PENALTIES.
If a service plan corporation violates Laws 1971, chapter 568 or other applicable law, the commissioner may suspend or revoke its certificate of authority, and impose a penalty not to exceed $5,000 for each offense. Such action shall be by order and subject to the notice, hearing and appeal provided as to an order disapproving a subscriber's contract.
History:
1971 c 568 s 21
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62C — Nonprofit Health Service Plan Corporations › Section 62C.22 — Violations.

62C.22 VIOLATIONS.
Any person who violates Laws 1971, chapter 568, or who makes a material false statement with respect to a written report or statement required by Laws 1971, chapter 568, shall be punishable, for the first offense, by payment of a fine of not more than $1,000 or imprisonment for not more than 90 days or both and for the second and each subsequent offense by payment of a fine of not more than $3,000 or imprisonment for not more than 364 days or both.
History:
1971 c 568 s 22; 1984 c 628 art 3 s 11; 2004 c 228 art 1 s 72; 2023 c 52 art 6 s 16
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62C — Nonprofit Health Service Plan Corporations › Section 62C.23 — Rules.

62C.23 RULES.
For the purpose of implementing and enforcing Laws 1971, chapter 568, the commissioner may adopt rules pursuant to chapter 14.
History:
1971 c 568 s 23; 1982 c 424 s 130; 1985 c 248 s 70
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62D — Health Maintenance Organizations › Section 62D.01 — Citation And Purpose.

62D.01 CITATION AND PURPOSE.
Subdivision 1.
Title.
Sections 62D.01 to 62D.24 may be cited as the "Health Maintenance Act of 1973."
Subd. 2.
Legislative findings and intent; policy.
(a) Faced with the continuation of mounting costs of health care coupled with its inaccessibility to large segments of the population, the legislature has determined that there is a need to explore alternative methods for the delivery of health care services, with a view toward achieving greater efficiency and economy in providing these services.
(b) It is, therefore, the policy of the state to eliminate the barriers to the organization, promotion, and expansion of health maintenance organizations; to provide for their regulation by the state commissioner of health; and to exempt them from the operation of the insurance and nonprofit health service plan corporation laws of the state except as hereinafter provided.
(c) It is further the intention of the legislature to closely monitor the development of health maintenance organizations in order to assess their impact on the costs of health care to consumers, the accessibility of health care to consumers, and the quality of health care provided to consumers.
History:
1973 c 670 s 1; 1977 c 305 s 45; 1996 c 305 art 1 s 139
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62D — Health Maintenance Organizations › Section 62D.042 — Initial Net Worth Requirement.

62D.042 INITIAL NET WORTH REQUIREMENT.
Subdivision 1.
Definition.
For purposes of this section, if a health maintenance organization offers supplemental benefits as described in section 62D.05, subdivision 6, "expenses" does not include any expenses attributable to the supplemental benefit.
Subd. 2.
Initial net worth requirement.
Beginning organizations shall maintain net worth of at least 8-1/3 percent of the sum of all expenses expected to be incurred in the 12 months following the date the certificate of authority is granted, or $1,500,000, whichever is greater.
Subd. 3.
[Repealed, 1998 c 407 art 8 s 14]
Subd. 4.
Reduction for reinsurance.
In calculating expenses for purposes of the net worth requirement, a health maintenance organization may subtract 90 percent of the cost of premiums it pays for insurance coverage specified in section 62D.04, subdivision 1, clause (f).
Subd. 5.
[Repealed, 2004 c 285 art 3 s 11]
Subd. 6.
[Repealed, 2004 c 285 art 3 s 11]
Subd. 7.
[Repealed, 2004 c 285 art 3 s 11]
History:
1988 c 612 s 14; 1989 c 282 art 2 s 5; 1993 c 345 art 2 s 1; 1995 c 234 art 7 s 7; 1997 c 205 s 5; 1998 c 407 art 8 s 2; 2004 c 285 art 3 s 5,6,10
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62D — Health Maintenance Organizations › Section 62D.06 — Governing Body.

62D.06 GOVERNING BODY.
Subdivision 1.
Governing body composition; enrollee advisory body.
The governing body of any health maintenance organization which is a corporation may include enrollees, providers, or other individuals; provided, however, that after a health maintenance organization which is a corporation has been authorized under sections 62D.01 to 62D.30 for one year, at least 40 percent of the governing body shall be composed of enrollees and members elected by the enrollees and members from among the enrollees and members. For purposes of this section, "member" means a consumer who receives health care services through a self-insured contract that is administered by the health maintenance organization or its related third-party administrator. The number of members elected to the governing body shall not exceed the number of enrollees elected to the governing body. An enrollee or member elected to the governing board may not be a person:
(1) whose occupation involves, or before retirement involved, the administration of health activities or the provision of health services;
(2) who is or was employed by a health care facility as a licensed health professional; or
(3) who has or had a direct substantial financial or managerial interest in the rendering of a health service, other than the payment of a reasonable expense reimbursement or compensation as a member of the board of a health maintenance organization.
After a health maintenance organization which is a local governmental unit has been authorized under sections 62D.01 to 62D.30 for one year, an enrollee advisory body shall be established. The enrollees who make up this advisory body shall be elected by the enrollees from among the enrollees.
Subd. 2.
Enrollee input.
The governing body shall establish a mechanism to afford the enrollees an opportunity to express their opinions in matters of policy and operation through the establishment of advisory panels, by the use of advisory referenda on major policy decisions, or through the use of other mechanisms as may be prescribed or permitted by the commissioner of health.
History:
1973 c 670 s 6; 1974 c 284 s 10; 1977 c 305 s 45; 1983 c 205 s 6; 1987 c 384 art 2 s 1; 1988 c 592 s 1; 1997 c 205 s 6; 2017 c 2 art 2 s 7
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62D — Health Maintenance Organizations › Section 62D.095 — Enrollee Cost Sharing.

62D.095 ENROLLEE COST SHARING.
Subdivision 1.
General application.
A health maintenance contract may contain enrollee cost-sharing provisions as specified in this section. Co-payment and deductible provisions in a group contract must not discriminate on the basis of age, sex, race, disability, economic status, or length of enrollment in the health plan. During an open enrollment period in which all offered health plans fully participate without any underwriting restrictions, co-payment and deductible provisions must not discriminate on the basis of preexisting health status.
Subd. 2.
Co-payments.
A health maintenance contract may impose a co-payment and coinsurance consistent with the provisions of the Affordable Care Act as defined under section 62A.011, subdivision 1a, and for items and services that are not preventive items and services.
Subd. 3.
Deductibles.
A health maintenance contract must not impose a deductible for preventive items and services.
Subd. 4.
Annual out-of-pocket maximums.
A health maintenance contract may impose an annual out-of-pocket maximum consistent with the provisions of the Affordable Care Act as defined under section 62A.011, subdivision 1a.
Subd. 5.
Exceptions.
Co-payments or deductibles must not be imposed on preventive items and services.
Subd. 6.
Public programs.
This section does not apply to the prepaid medical assistance program, the MinnesotaCare program, the federal Medicare program, or the health plans provided through any of those programs.
History:
2002 c 387 s 3; 1Sp2003 c 14 art 7 s 8,9; 2013 c 84 art 1 s 35; 2023 c 57 art 2 s 17-19
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62D — Health Maintenance Organizations › Section 62D.10 — Provisions Applicable To All Health Plans.

62D.10 PROVISIONS APPLICABLE TO ALL HEALTH PLANS.
Subdivision 1.
Applicability.
The provisions of this section shall be applicable to nonprofit prepaid health care plans regulated under chapter 317A, and health maintenance organizations regulated pursuant to sections 62D.01 to 62D.30, both of which for purposes of this section shall be known as "health plans."
Subd. 2.
[Repealed, 1984 c 464 s 46]
Subd. 3.
Open enrollment.
A health plan providing health maintenance services or reimbursement for health care costs to a specified group or groups may limit the open enrollment in each group plan to members of such group or groups, but after it has been in operation 24 months shall have an annual open enrollment period of at least 14 days during which it shall accept all otherwise eligible individuals in the order in which they apply for enrollment in a manner which does not discriminate on the basis of age, sex, race, health, or economic status. The health maintenance organization shall notify potential enrollees of any limitations on the number of new enrollees to be accepted. "Specified groups" may include, but shall not be limited to:
(1) employees of one or more specified employers;
(2) members of one or more specified labor unions;
(3) members of one or more specified associations;
(4) patients of physicians providing services through a health care plan who had previously provided services outside the health care plan; and
(5) members of an existing group insurance policy.
Subd. 4.
Waivers.
A health plan may apply to the commissioner of health for a waiver of the requirements of this section or for authorization to impose such underwriting restrictions upon open enrollment as are necessary (1) to preserve its financial stability, (2) to prevent excessive adverse selection by prospective enrollees, or (3) to avoid unreasonably high or unmarketable charges for enrollee coverage for health care services. The commissioner of health upon a showing of good cause, shall approve or upon failure to show good cause shall deny such application within 30 days of the receipt thereof from the health plan. The commissioner of health may, in accordance with chapter 14, promulgate rules to implement this section.
Subd. 5.
Application fee.
Any fee charged by a health maintenance organization for the process of determining an applicant's eligibility, and any other application fee charged, shall be refunded with interest to the applicant if the applicant is not accepted for enrollment in the health maintenance organization, or credited with interest to the applicant's premiums due if the applicant is accepted for enrollment in the organization.
Subd. 6.
Statement of risk sharing.
Health maintenance organization contracts under section 62D.04, subdivision 1, shall include a clear statement of the risk sharing arrangement.
History:
1973 c 670 s 10; 1974 c 284 s 3,4; 1977 c 305 s 45; 1977 c 409 s 3; 1982 c 424 s 130; 1984 c 464 s 25,26; 1987 c 130 s 3; 1987 c 384 art 2 s 1; 1989 c 304 s 137
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62D — Health Maintenance Organizations › Section 62D.102 — Family Therapy.

62D.102 FAMILY THERAPY.
Covered treatment for a minor includes treatment for the family if family therapy is recommended by a health maintenance organization provider. For purposes of determining benefits under this section, "hours of treatment" means treatment rendered on an individual or single-family basis. If treatment is rendered on a group basis, the hours of covered group treatment must be provided at a ratio of no less than two group treatment sessions to one individual treatment hour. For a health maintenance contract that is offered as a companion to a health insurance subscriber contract, the benefits for mental or nervous disorders must be calculated in aggregate for the health maintenance contract and the health insurance subscriber contract.
History:
1984 c 641 s 3; 1987 c 337 s 65; 1988 c 689 art 2 s 12; 1997 c 205 s 11
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62D — Health Maintenance Organizations › Section 62D.103 — Second Opinion Related To Substance Use Disorder And Mental Health.

62D.103 SECOND OPINION RELATED TO SUBSTANCE USE DISORDER AND MENTAL HEALTH.
A health maintenance organization shall promptly evaluate the treatment needs of any enrollee who is seeking treatment for a problem related to substance use disorder or mental health conditions. In the event that the health maintenance organization or a participating provider determines that no type of structured treatment is necessary, the enrollee shall be immediately entitled to a second opinion paid for by the health maintenance organization, by a health care professional qualified in diagnosis and treatment of the problem and not affiliated with the health maintenance organization. The health maintenance organization or participating provider shall consider the second opinion but is not obligated to accept the conclusion of the second opinion. The health maintenance organization or participating provider shall document its consideration of the second opinion.
History:
1984 c 641 s 4; 2022 c 98 art 4 s 51
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62D — Health Maintenance Organizations › Section 62D.104 — Required Out-of-area Conversion.

62D.104 REQUIRED OUT-OF-AREA CONVERSION.
Enrollees who have individual health maintenance organization contracts and who have become nonresidents of the health maintenance organization's service area but remain residents of the state of Minnesota shall be given the option, to be arranged by the health maintenance organization if an agreement with an insurer can reasonably be made, of a number three qualified plan, a number two qualified plan, or a number one qualified plan as provided by section 62E.06, subdivisions 1 to 3, or, if such enrollees are covered by title XVIII of the Social Security Act (Medicare), they shall be given the option of a Medicare supplement plan as provided by chapter 62A.
This option shall be made available at the enrollee's expense, without further evidence of insurability and without interruption of coverage.
If a health maintenance organization cannot make arrangements for conversion coverage, the health maintenance organization shall notify enrollees of health plans available in other service areas.
History:
1988 c 434 s 8; 1989 c 258 s 9
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62D — Health Maintenance Organizations › Section 62D.105 — Coverage Of Current Spouse, Former Spouse, And Children.

62D.105 COVERAGE OF CURRENT SPOUSE, FORMER SPOUSE, AND CHILDREN.
Subdivision 1.
Requirement.
Every health maintenance contract, which in addition to covering the enrollee also provides coverage to the spouse, dependent children, which is defined as required by section 62A.302, and former spouse who was covered on the day before the entry of a valid decree of dissolution of marriage, of the enrollee shall: (1) permit the spouse, former spouse, and dependent children to elect to continue coverage when the enrollee becomes enrolled for benefits under title XVIII of the Social Security Act (Medicare); and (2) permit the dependent children to continue coverage when they cease to be dependent children under the generally applicable requirement of the plan.
Subd. 2.
Continuation privilege.
The coverage described in subdivision 1 may be continued until the earlier of the following dates:
(1) the date coverage would otherwise terminate under the contract;
(2) 36 months after continuation by the spouse, former spouse, or dependent was elected; or
(3) the date the spouse, former spouse, or dependent children become covered under another group health plan or Medicare.
If coverage is provided under a group policy, any required fees for the coverage shall be paid by the enrollee on a monthly basis to the group contract holder for remittance to the health maintenance organization. In no event shall the fee charged exceed 102 percent of the cost to the plan for such coverage for other similarly situated spouse and dependent children to whom subdivision 1 is not applicable, without regard to whether such cost is paid by the employer or employee.
History:
1988 c 434 s 9; 1Sp2017 c 6 art 5 s 4
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62D — Health Maintenance Organizations › Section 62D.107 — Equal Access To Acupuncture Services.

62D.107 EQUAL ACCESS TO ACUPUNCTURE SERVICES.
Subdivision 1.
Coverage.
All benefits provided by a health maintenance contract relating to expenses incurred for acupuncture services that are provided by a physician must also include acupuncture treatment and services of a licensed acupuncture practitioner to the extent that the acupuncture services and treatment are within the scope of acupuncture practitioner licensure. This subdivision ensures equal access to benefits for enrollees who choose to directly obtain treatment for illness and injury from a licensed acupuncture practitioner, as long as the treatment falls within the scope of practice of the licensed acupuncture practitioner.
This subdivision is not intended to change or add to the benefits provided for in these policies or contracts.
Subd. 2.
Denial of benefits.
(a) In the payment of claims for enrollees in this state, no health maintenance organization may deny payment for acupuncture services covered by an enrollee's health maintenance contract if the services are lawfully performed by a licensed acupuncture practitioner.
(b) When a health maintenance organization makes a denial of payment claim determination concerning the appropriateness, quality, or utilization of acupuncture services for enrollees in this state performed by a licensed acupuncture practitioner, the determination must be made by, under the direction of, or subject to the review of a licensed acupuncture practitioner.
History:
2009 c 45 s 3
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62D — Health Maintenance Organizations › Section 62D.109 — Services Associated With Clinical Trials.

62D.109 SERVICES ASSOCIATED WITH CLINICAL TRIALS.
A health maintenance organization must inform an enrollee who is a participant in a clinical trial upon inquiry by the enrollee that coverage shall be provided as required under the enrollee's health maintenance contract or under state or federal rule or statute.
History:
1Sp2001 c 9 art 16 s 2; 2002 c 379 art 1 s 113
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62D — Health Maintenance Organizations › Section 62D.11 — Complaint System.

62D.11 COMPLAINT SYSTEM.
Subdivision 1.
Enrollee complaint system.
Every health maintenance organization shall establish and maintain a complaint system, as required under sections 62Q.68 to 62Q.72 to provide reasonable procedures for the resolution of written complaints initiated by or on behalf of enrollees concerning the provision of health care services.
Subd. 1a.
Service coverage.
Where a complaint involves a dispute about a health maintenance organization's coverage of a service, the commissioner may review the complaint and any information and testimony necessary in order to make a determination and order the appropriate remedy pursuant to sections 62D.15 to 62D.17.
Subd. 1b.
[Repealed, 1999 c 239 s 43 para (a)]
Subd. 2.
[Repealed, 1999 c 239 s 43 para (a)]
Subd. 3.
Denial of coverage.
Within a reasonable time after receiving an enrollee's written or oral communication to the health maintenance organization concerning a denial of coverage or inadequacy of services, the health maintenance organization shall provide the enrollee with a written statement of the reason for the denial of coverage, and a statement approved by the commissioner of health which explains the health maintenance organization complaint procedures, and in the case of Medicare enrollees, which also explains Medicare appeal procedures.
Subd. 4.
[Repealed, 1997 c 205 s 40]
History:
1973 c 670 s 11; 1974 c 284 s 5; 1977 c 305 s 45; 1986 c 444; 1988 c 434 s 10; 1988 c 592 s 6,7; 1990 c 538 s 22-24; 1995 c 234 art 2 s 1; 1997 c 205 s 12-14; 1998 c 407 art 2 s 2; 1999 c 239 s 1
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62D — Health Maintenance Organizations › Section 62D.123 — Provider Contracts.

62D.123 PROVIDER CONTRACTS.
Subdivision 1.
Provider agreement.
Except for an employment agreement between a provider and health maintenance organization, an agreement to provide health care services between a provider and a health maintenance organization entered into or renewed after April 25, 1988, must contain the following provision:
PROVIDER AGREES NOT TO BILL, CHARGE, COLLECT A DEPOSIT FROM, SEEK REMUNERATION FROM, OR HAVE ANY RECOURSE AGAINST AN ENROLLEE OR PERSONS ACTING ON THEIR BEHALF FOR SERVICES PROVIDED UNDER THIS AGREEMENT. THIS PROVISION APPLIES TO BUT IS NOT LIMITED TO THE FOLLOWING EVENTS: (1) NONPAYMENT BY THE HEALTH MAINTENANCE ORGANIZATION OR (2) BREACH OF THIS AGREEMENT. THIS PROVISION DOES NOT PROHIBIT THE PROVIDER FROM COLLECTING CO-PAYMENTS OR FEES FOR UNCOVERED SERVICES.
THIS PROVISION SURVIVES THE TERMINATION OF THIS AGREEMENT FOR AUTHORIZED SERVICES PROVIDED BEFORE THIS AGREEMENT TERMINATES, REGARDLESS OF THE REASON FOR TERMINATION. THIS PROVISION IS FOR THE BENEFIT OF THE HEALTH MAINTENANCE ORGANIZATION ENROLLEES. THIS PROVISION DOES NOT APPLY TO SERVICES PROVIDED AFTER THIS AGREEMENT TERMINATES.
THIS PROVISION SUPERSEDES ANY CONTRARY ORAL OR WRITTEN AGREEMENT EXISTING NOW OR ENTERED INTO IN THE FUTURE BETWEEN THE PROVIDER AND THE ENROLLEE OR PERSONS ACTING ON THEIR BEHALF REGARDING LIABILITY FOR PAYMENT FOR SERVICES PROVIDED UNDER THIS AGREEMENT.
Subd. 2.
Cooperation required.
An agreement to provide health care services between a provider and a health maintenance organization must require the provider to cooperate with and participate in the health maintenance organization's quality assurance program, dispute resolution procedure, and utilization review program.
Subd. 3.
Notice of termination.
An agreement to provide health care services between a provider and a health maintenance organization must require that if the provider terminates the agreement, without cause, the provider shall give the organization 120 days' advance notice of termination.
Subd. 4.
Late payments.
If a health maintenance organization's payments to a provider are delayed beyond the payment date in the contract, the provider may notify the commissioner who shall consider that information in assessing the financial solvency of the health maintenance organization.
History:
1988 c 612 s 21
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62D — Health Maintenance Organizations › Section 62D.13 — Powers Of Insurers And Nonprofit Health Service Plans.

62D.13 POWERS OF INSURERS AND NONPROFIT HEALTH SERVICE PLANS.
Notwithstanding any law to the contrary, an insurer or a hospital or medical service plan corporation may contract with a health maintenance organization to provide insurance or similar protection against the cost of care provided through health maintenance organizations and to provide coverage in the event of the failure of the health maintenance organization to meet its obligations. The enrollees of a health maintenance organization constitute a permissible group for group coverage under the insurance laws and the Nonprofit Health Service Plan Corporations Act. Under such contracts, the insurer or nonprofit health service plan corporation may make benefit payments to health maintenance organizations for health care services rendered, or to be rendered, by providers pursuant to the health care plan. Any insurer, or nonprofit health service plan corporation, licensed to do business in this state, is authorized to provide the types of coverages described in section 62D.05, subdivision 3.
History:
1973 c 670 s 13
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62D — Health Maintenance Organizations › Section 62D.145 — Disclosure Of Information Held By Health Maintenance Organizations.

62D.145 DISCLOSURE OF INFORMATION HELD BY HEALTH MAINTENANCE ORGANIZATIONS.
Subdivision 1.
Personal and privileged information.
The ability of a health maintenance organization to disclose personal information, as defined in section 72A.491, subdivision 17, and privileged information, as defined in section 72A.491, subdivision 19, is governed by sections 72A.497, 72A.499, and 72A.502.
Subd. 2.
Health data or information.
(a) A health maintenance organization is prohibited from disclosing to any person any individually identifiable data or information held by the health maintenance organization pertaining to the diagnosis, treatment, or health of any enrollee, or any application obtained from any person, except:
(1) to the extent necessary to carry out the purposes of this chapter, the commissioner and a designee shall have access to the above data or information but the data removed from the health maintenance organization or participating entity shall not identify any particular patient or client by name or contain any other unique personal identifier;
(2) upon the express consent of the enrollee or applicant;
(3) pursuant to statute or court order for the production of evidence or the discovery thereof;
(4) in the event of claim or litigation between the person and the provider or health maintenance organization wherein such data or information is pertinent;
(5) to meet the requirements of contracts for prepaid medical services with the commissioner of human services authorized under chapter 256B, 256D, or 256L;
(6) to meet the requirements of contracts for benefit plans with the commissioner of management and budget under chapter 43A; or
(7) as otherwise authorized pursuant to statute.
No provision in a contract for a benefit plan under chapter 43A shall authorize dissemination of individually identifiable health records, unless the dissemination of the health records is required to carry out the requirements of the contract and employees whose health records will be disseminated are fully informed of the dissemination by the Department of Management and Budget at the time the employees are enrolling for or changing insurance coverage.
(b) In any case involving a suspected violation of a law applicable to health maintenance organizations in which access to health data maintained by the health maintenance organization or participating entity is necessary, the commissioner and agents, while maintaining the privacy rights of individuals and families, shall be permitted to obtain data that identifies any particular patient or client by name. A health maintenance organization shall be entitled to claim any statutory privileges against such disclosure which the provider who furnished the information to the health maintenance organization is entitled to claim.
History:
2000 c 468 s 19; 2008 c 204 s 42; 2009 c 101 art 2 s 109
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62D — Health Maintenance Organizations › Section 62D.16 — Denial, Suspension, And Revocation; Administrative Procedures.

62D.16 DENIAL, SUSPENSION, AND REVOCATION; ADMINISTRATIVE PROCEDURES.
Subdivision 1.
Notice and hearing.
When the commissioner of health has cause to believe that grounds for the denial, suspension or revocation of a certificate of authority exists, the commissioner shall notify the health maintenance organization in writing specifically stating the grounds for denial, suspension or revocation and fixing a time of at least 20 days thereafter for a hearing on the matter, except in summary proceedings as provided in section 62D.18.
Subd. 2.
Written findings.
After such hearing, or upon the failure of the health maintenance organization to appear at the hearing, the commissioner of health shall take action as is deemed advisable and shall issue written findings which shall be mailed to the health maintenance organization. The action of the commissioner of health shall be subject to judicial review pursuant to chapter 14.
History:
1973 c 670 s 16; 1977 c 305 s 45; 1982 c 424 s 130; 1986 c 444
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62D — Health Maintenance Organizations › Section 62D.182 — Liabilities.

62D.182 LIABILITIES.
Every health maintenance organization shall maintain liabilities estimated in the aggregate to be sufficient to pay all reported or unreported claims incurred that are unpaid and for which the organization is liable. Liabilities are computed under rules adopted by the commissioner.
History:
1988 c 612 s 25
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62D — Health Maintenance Organizations › Section 62D.19 — Unreasonable Expenses.

62D.19 UNREASONABLE EXPENSES.
No health maintenance organization shall incur or pay for any expense of any nature which is unreasonably high in relation to the value of the service or goods provided. The commissioner of health shall implement and enforce this section by rules adopted under this section.
In an effort to achieve the stated purposes of sections 62D.01 to 62D.30 and to ensure that the payment of health maintenance organization money to major participating entities results in a corresponding benefit to the health maintenance organization and its enrollees, when determining whether an organization has incurred an unreasonable expense in relation to a major participating entity, due consideration shall be given to, in addition to any other appropriate factors, whether the officers and trustees of the health maintenance organization have acted with good faith and in the best interests of the health maintenance organization in entering into, and performing under, a contract under which the health maintenance organization has incurred an expense. The commissioner has standing to sue, on behalf of a health maintenance organization, officers or trustees of the health maintenance organization who have breached their fiduciary duty in entering into and performing such contracts.
History:
1973 c 670 s 19; 1983 c 289 s 114 subd 1; 1984 c 464 s 41; 1984 c 655 art 1 s 92; 1Sp1985 c 10 s 62; 1987 c 384 art 2 s 1; 1988 c 612 s 26; 2017 c 2 art 2 s 8
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62D — Health Maintenance Organizations › Section 62D.20 — Rules.

62D.20 RULES.
Subdivision 1.
Rulemaking.
The commissioner of health may, pursuant to chapter 14, promulgate such reasonable rules as are necessary or proper to carry out the provisions of sections 62D.01 to 62D.30. Included among such rules shall be those which provide minimum requirements for the provision of comprehensive health maintenance services, as defined in section 62D.02, subdivision 7, and reasonable exclusions therefrom. Nothing in such rules shall force or require a health maintenance organization to provide elective, induced abortions, except as medically necessary to prevent the death of the mother, whether performed in a hospital, other abortion facility, or the office of a physician; the rules shall provide every health maintenance organization the option of excluding or including elective, induced abortions, except as medically necessary to prevent the death of the mother, as part of its comprehensive health maintenance services.
Subd. 2.
Prior authorization.
The commissioner shall adopt rules that address the issue of appropriate prior authorization requirements, considering enrollee needs, administrative concerns, and the nature of the benefit.
History:
1973 c 670 s 20; 1977 c 305 s 45; 1981 c 122 s 2; 1982 c 424 s 130; 1985 c 248 s 70; 1987 c 384 art 2 s 1; 1988 c 434 s 16; 1988 c 592 s 10; 1997 c 205 s 16
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62D — Health Maintenance Organizations › Section 62D.21 — Fees.

62D.21 FEES.
Every health maintenance organization subject to sections 62D.01 to 62D.30 shall pay to the commissioner of health fees as prescribed by the commissioner of health pursuant to section 144.122 for the following:
(1) filing an application for a certificate of authority;
(2) filing an amendment to a certificate of authority;
(3) filing each annual report; and
(4) other filings, as specified by rule.
History:
1973 c 670 s 21; 1975 c 310 s 1; 1977 c 305 s 45; 1985 c 248 s 70; 1987 c 384 art 2 s 1
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62D — Health Maintenance Organizations › Section 62D.211 — Renewal Fee.

62D.211 RENEWAL FEE.
Each health maintenance organization subject to sections 62D.01 to 62D.30 shall submit to the commissioner of health each year before June 15 a certificate of authority renewal fee in the amount of $10,000 each plus 20 cents per person enrolled in the health maintenance organization on December 31 of the preceding year. The commissioner may adjust the renewal fee in rule under the provisions of chapter 14.
History:
1987 c 384 art 2 s 1; 1987 c 403 art 2 s 2; 1990 c 538 s 30
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62D — Health Maintenance Organizations › Section 62D.23 — Filings And Reports As Public Documents.

62D.23 FILINGS AND REPORTS AS PUBLIC DOCUMENTS.
All applications, filings, and reports required under sections 62D.01 to 62D.30 shall be treated as public documents.
History:
1973 c 670 s 23; 1987 c 384 art 2 s 1
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62D — Health Maintenance Organizations › Section 62D.24 — Commissioner Of Health's Authority To Contract.

62D.24 COMMISSIONER OF HEALTH'S AUTHORITY TO CONTRACT.
The commissioner of health, in carrying out the obligations under sections 62D.01 to 62D.30, may contract with the commissioner of commerce or other qualified persons to make recommendations concerning the determinations required to be made. Such recommendations may be accepted in full or in part by the commissioner of health.
History:
1973 c 670 s 24; 1977 c 305 s 45; 1983 c 289 s 114 subd 1; 1984 c 655 art 1 s 92; 1986 c 444; 1987 c 384 art 2 s 1