reglab/statecodes huggingface dataset:
2023 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, email, the Internet, websites, and employer electronic bulletin boards.
History:
2000 c 410 s 4
2023 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
2023 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
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62R — Health Care Cooperatives › Section 62R.03 — Applicability Of Other Laws.

62R.03 APPLICABILITY OF OTHER LAWS.
Subdivision 1.
Minnesota Cooperative Law.
A health care cooperative is subject to chapter 308A unless otherwise provided in this chapter. After incorporation, a health care cooperative shall enjoy the powers and privileges and shall be subject to the duties and liabilities of other cooperatives organized under chapter 308A, to the extent applicable and except as limited or enlarged by this chapter. If any provision of this chapter conflicts with a provision of chapter 308A, the provision of this chapter takes precedence.
Subd. 2.
Health plan licensure and operation.
A health care network cooperative must be licensed as a health maintenance organization licensed under chapter 62D, a nonprofit health service plan corporation licensed under chapter 62C, or a community integrated service network licensed under chapter 62N, at the election of the health care network cooperative. The health care network cooperative shall be subject to the duties and liabilities of health plans licensed pursuant to the chapter under which the cooperative elects to be licensed, to the extent applicable and except as limited or enlarged by this chapter. If any provision of any chapter under which the cooperative elects to be licensed conflicts with the provisions of this chapter, the provisions of this chapter take precedence. A health care network cooperative, upon licensure as provided in this subdivision, is a contributing member of the Minnesota Comprehensive Health Association, on the same basis as other entities having the same licensure.
Subd. 3.
Health provider cooperatives.
A health provider cooperative shall not be considered a mutual insurance company under chapter 60A, a health maintenance organization under chapter 62D, a nonprofit health services corporation under chapter 62C, or a community integrated service network under chapter 62N. A health provider network shall not be considered to violate any limitations on the corporate practice of medicine. Health care service contracts under section 62R.06 shall not be considered to violate section 62J.23.
History:
1994 c 625 art 11 s 3; 1997 c 225 art 2 s 62
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62R — Health Care Cooperatives › Section 62R.04 — Definitions.

62R.04 DEFINITIONS.
Subdivision 1.
Scope.
For purposes of this chapter, the terms defined in this section have the meanings given.
Subd. 2.
Health care cooperative.
"Health care cooperative" means a health care network cooperative or a health provider cooperative.
Subd. 3.
Health care network cooperative.
"Health care network cooperative" means a corporation organized under this chapter and licensed in accordance with section 62R.03, subdivision 2. A health care network cooperative shall not have more than 50,000 enrollees, unless exceeding the enrollment limit is necessary to comply with guaranteed issue or guaranteed renewal requirements of chapter 62L or section 62A.65.
Subd. 4.
Health provider cooperative.
"Health provider cooperative" means a corporation organized under this chapter and operated on a cooperative plan to market health care services to purchasers of those services.
Subd. 5.
Commissioner.
Unless otherwise specified, "commissioner" means the commissioner of health for a health care network cooperative licensed under chapter 62D or 62N and the commissioner of commerce for a health care network cooperative licensed under chapter 62C.
Subd. 6.
Health carrier.
"Health carrier" has the meaning provided in section 62A.011.
Subd. 7.
Health care providing entity.
"Health care providing entity" means a participating entity that provides health care to enrollees of a health care cooperative.
History:
1994 c 625 art 11 s 4
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62R — Health Care Cooperatives › Section 62R.05 — Powers.

62R.05 POWERS.
In addition to the powers enumerated under section 308A.201, a health care cooperative shall have all of the powers granted a nonprofit corporation under section 317A.161, except to the extent expressly inconsistent with the provisions of chapter 308A.
History:
1994 c 625 art 11 s 5
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62R — Health Care Cooperatives › Section 62R.06 — Health Care Service Contracts.

62R.06 HEALTH CARE SERVICE CONTRACTS.
Subdivision 1.
Provider contracts.
A health provider cooperative and its licensed members may execute marketing and service contracts requiring the provider members to provide some or all of their health care services through the provider cooperative to the enrollees, members, subscribers, or insureds, of a health care network cooperative, community integrated service network, nonprofit health service plan, health maintenance organization, accident and health insurance company, or any other purchaser, including the state of Minnesota and its agencies, instruments, or units of local government. Each purchasing entity is authorized to execute contracts for the purchase of health care services from a health provider cooperative in accordance with this section. A contract between a provider cooperative and a purchaser may provide for payment by the purchaser to the health provider cooperative on a capitated or similar risk-sharing basis, by fee-for-service arrangements, or by other financial arrangements authorized under state law. Each contract between a provider cooperative and a purchaser shall be filed by the provider network cooperative with the commissioner of health and is subject to the provisions of section 62D.19.
Subd. 2.
No network limitation.
A health care network cooperative may contract with any health provider cooperative and may contract with any other licensed health care provider to provide health care services for its enrollees.
Subd. 3.
Restraint of trade.
Subject to section 62R.08, a health care provider cooperative is not a combination in restraint of trade, and any contracts or agreements between a health care provider cooperative and its members regarding the price the cooperative will charge to purchasers of its services, or regarding the prices the members will charge to the cooperative, or regarding the allocation of gains or losses among the members, or regarding the delivery, quality, allocation, or location of services to be provided, are not contracts that unreasonably restrain trade.
History:
1994 c 625 art 11 s 6; 1997 c 225 art 2 s 62; 1999 c 245 art 2 s 14
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62R — Health Care Cooperatives › Section 62R.07 — Relicensure.

62R.07 RELICENSURE.
(a) A health care network cooperative licensed under chapter 62C or 62D may relinquish that license and be granted a new license as a community integrated service network under chapter 62N in accordance with this section, provided that the cooperative meets all requirements for licensure as a network under chapter 62N, to the extent not expressly inconsistent with the provisions of chapter 308A.
(b) The relicensure shall be effective at the time specified in the plan of relicensure, which must not be earlier than the date upon which the previous license is surrendered.
(c) Upon the relicensure of the cooperative as a community integrated service network:
(1) all existing group and individual enrollee benefit contracts in force on the effective date of the relicensure shall continue in effect and with the same terms and conditions, notwithstanding the cooperative's new licensure as a network, until the date of each contract's next renewal or amendment, but no later than one year from the date of the relicensure. At this time, each benefit contract then in force must be amended to comply with all statutory and regulatory requirements for network benefit contracts as of that date; and
(2) all contracts between the cooperative and any health care providing entity, including a health care provider cooperative, in force on the effective date of relicensure shall remain in effect under the cooperative's new licensure as a network until the date of the next renewal or amendment of that contract, but no later than one year from the date of relicensure.
(d) Except as otherwise provided in this section, nothing in the relicensure of a health care network cooperative shall in any way affect its corporate existence or any of its contracts, rights, privileges, immunities, powers or franchises, debts, duties or other obligations or liabilities.
History:
1994 c 625 art 11 s 7; 1997 c 225 art 2 s 62
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62R — Health Care Cooperatives › Section 62R.08 — Prohibited Practices.

62R.08 PROHIBITED PRACTICES.
(a) It shall be unlawful for any person, company, or corporation, or any agent, officer, or employee thereof, to coerce or require any person to agree, either in writing or orally, not to join or become or remain a member of, any health care provider cooperative, as a condition of securing or retaining a contract for health care services with the person, firm, or corporation.
(b) It shall be unlawful for any person, company, or corporation, or any combination of persons, companies, or corporations, or any agents, officers, or employees thereof, to engage in any acts of coercion, intimidation, or boycott of, or any refusal to deal with, any health care providing entity arising from that entity's actual or potential participation in a health care network cooperative or health care provider cooperative.
(c) It shall be unlawful for any health care network cooperative, other than a health care network cooperative operating on an employed, staff model basis, to require that its participating providers provide health care services exclusively to or through the health care network cooperative. It shall be unlawful for any health care provider cooperative to require that its members provide health care services exclusively to or through the health care provider cooperative.
(d) It shall be unlawful for any health care provider cooperative to engage in any acts of coercion, intimidation, or boycott of, or any concerted refusal to deal with, any health plan company seeking to contract with the cooperative on a competitive, reasonable, and nonexclusive basis.
(e) The prohibitions in this section are in addition to any conduct that violates sections 325D.49 to 325D.66.
(f) This section shall be enforced in accordance with sections 325D.56 to 325D.65.
History:
1994 c 625 art 11 s 8
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.02 — Qualified Long-term Care Insurance Policy.

62S.02 QUALIFIED LONG-TERM CARE INSURANCE POLICY.
Subdivision 1.
Requirements.
A qualified long-term care insurance policy may not be offered, issued, delivered, or renewed in this state unless the policy satisfies the requirements of this chapter and the filing provisions of section 62A.02. A qualified long-term care insurance policy must cover qualified long-term care services.
Subd. 2.
Nonforfeiture requirement.
An insurer shall offer a nonforfeiture provision available in the event of default in the payment of any premiums. The amount of the benefit may be adjusted after being initially granted, if necessary, to reflect changes in claims, persistency, and interest as reflected in changes in rates for premium paying contracts. The nonforfeiture provision must provide at least one of the following:
(1) reduced paid-up insurance;
(2) extended term insurance; or
(3) shortened benefit period.
Subd. 3.
Refund restrictions.
A qualified long-term care insurance policy shall not provide for a cash surrender value or other money that can be paid, assigned, pledged as collateral for a loan, or borrowed. The aggregate premium paid under the policy may be refunded in the event of death of the insured or a complete surrender or cancellation of the policy.
Subd. 4.
Nonreimbursable expenses.
A qualified long-term care insurance policy shall not pay or reimburse expenses incurred for services or items if the expenses are reimbursable under Medicare or would be reimbursable if a deductible or coinsurance amount was not applied. This subdivision does not apply to expenses which are reimbursable under Medicare only as a secondary payor and does not prohibit the offering of a qualified long-term care insurance policy on the basis that the policy coordinates its benefits with those provided under Medicare. Notwithstanding this subdivision, payments may be made under a long-term care insurance policy on a per diem or other periodic basis without regard to the expenses incurred during the period to which the payments relate.
Subd. 5.
Activities of daily living.
A qualified long-term care insurance policy shall take into account at least five of the activities of daily living in making the determination of whether an individual is chronically ill. Assessments of activities of daily living and cognitive impairment must be performed by a licensed or certified professional, such as a physician, physician assistant, nurse, or social worker.
Subd. 6.
Appeals process.
A qualified long-term care insurance policy must include a clear description of the process for appealing and resolving benefit determinations.
History:
1997 c 71 art 1 s 2; 2000 c 483 s 17; 2022 c 58 s 16
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.03 — Extraterritorial Jurisdiction.

62S.03 EXTRATERRITORIAL JURISDICTION.
Group long-term care insurance coverage may not be offered to a resident of this state under a group policy issued in another state to a group described in section 62S.01, subdivision 15, clause (4), unless this state or another state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in this state has made a determination that the requirements have been met.
History:
1997 c 71 art 1 s 3
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.04 — Prohibitions.

62S.04 PROHIBITIONS.
A long-term care insurance policy may not:
(1) be canceled, nonrenewed, or otherwise terminated on the grounds of the age or the deterioration of the mental or physical health of the insured individual or certificate holder;
(2) contain a provision establishing a new waiting period in the event existing coverage is converted to or replaced by a new or other form within the same company, except with respect to an increase in benefits voluntarily selected by the insured individual or group policyholder; or
(3) provide coverage for skilled nursing care only, or provide significantly more coverage for skilled care in a facility than coverage for lower levels of care in the same facility.
History:
1997 c 71 art 1 s 4
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.05 — Preexisting Condition.

62S.05 PREEXISTING CONDITION.
Subdivision 1.
Authorized definition.
A long-term care insurance policy or certificate, other than a policy or certificate issued to a group as defined in section 62S.01, subdivision 15, clause (1), may not use a definition of preexisting condition that is more restrictive than the definition in this subdivision. "Preexisting condition" means a condition for which medical advice or treatment was recommended by, or received from a provider of health care services, within six months before the effective date of coverage of an insured person.
Subd. 2.
Prohibited exclusion.
A long-term care insurance policy or certificate, other than a policy or certificate issued to a group as defined in section 62S.01, subdivision 15, clause (1), may not exclude coverage for a loss or confinement that is the result of a preexisting condition more than six months following the effective date of coverage of an insured person.
Subd. 3.
Underwriting standards.
The definition of preexisting condition does not prohibit an insurer from using an application form designed to elicit the complete health history of an applicant and, on the basis of the answers on that application, from underwriting according to that insurer's established underwriting standards. Unless otherwise provided in the policy or certificate, a preexisting condition, regardless of whether it is disclosed on the application, need not be covered until the waiting period described in subdivision 2 expires. A long-term care insurance policy or certificate may not exclude or use waivers of any kind to exclude, limit, or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions beyond the waiting period described in subdivision 2.
Subd. 4.
Extension of limitation periods.
The commissioner may extend the limitation periods set forth in subdivisions 1 and 2 as to specific age group categories in specific policy forms upon finding that the extension is in the best interest of the public.
History:
1997 c 71 art 1 s 5; 1999 c 177 s 60; 2006 c 255 s 36; 2006 c 282 art 17 s 2
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.06 — Prior Hospitalization Or Institutionalization.

62S.06 PRIOR HOSPITALIZATION OR INSTITUTIONALIZATION.
Subdivision 1.
Prohibited conditions.
A long-term care insurance policy may not be delivered or issued for delivery in this state if the policy conditions eligibility for any benefits:
(1) on a prior hospitalization requirement;
(2) provided in an institutional care setting on the receipt of a higher level of institutional care; or
(3) other than waiver of premium, postconfinement, postacute care, or recuperative benefits on a prior institutionalization requirement.
Subd. 2.
Benefit labeling.
A long-term care insurance policy containing postconfinement, postacute care, or recuperative benefits must clearly label in a separate paragraph of the policy or certificate entitled "limitations or conditions on eligibility for benefits" the limitations or conditions, including any required number of days of confinement.
Subd. 3.
Benefit conditions.
(a) A long-term care insurance policy or rider that conditions eligibility of noninstitutional benefits on the prior receipt of institutional care may not require a prior institutional stay of more than 30 days.
(b) A long-term care insurance policy or rider that provides benefits only following institutionalization may not condition the benefits upon admission to a facility for the same or related conditions within a period of less than 30 days after discharge from the institution.
History:
1997 c 71 art 1 s 6
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.07 — Right To Return; Refund.

62S.07 RIGHT TO RETURN; REFUND.
Subdivision 1.
Right to return.
A long-term care insurance applicant may return the policy or certificate within 30 days of its delivery and is entitled to a refund of the premium if, after examination of the policy or certificate, the applicant is not satisfied for any reason. Long-term care insurance policies and certificates must include a notice prominently printed on the first page or attached to the first page stating in substance that the applicant may return the policy or certificate within 30 days of its delivery and have the premium refunded if for any reason, after examination of the policy or certificate, other than a certificate issued under a policy issued to a group as defined in section 62S.01, subdivision 15, clause (1), the applicant is not satisfied.
Subd. 2.
Refund.
If an application for a qualified long-term care insurance policy is denied, the issuer shall refund to the applicant any premium and fees submitted by the applicant within 30 days of the denial.
History:
1997 c 71 art 1 s 7
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.09 — Certificate Requirements.

62S.09 CERTIFICATE REQUIREMENTS.
Subdivision 1.
Content.
A certificate issued under a group long-term care insurance policy delivered or issued for delivery in this state must include:
(1) a description of the principal benefits and coverage provided in the policy;
(2) a statement of the exclusions, reductions, and limitations contained in the policy; and
(3) a statement that the group master policy determines governing contractual provisions.
Subd. 2.
Delivery.
The issuer of a qualified long-term care insurance policy shall deliver to the applicant, policyholder, or certificate holder the contract or certificate no later than 30 days after the date of approval.
History:
1997 c 71 art 1 s 9
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.10 — Policy Summary.

62S.10 POLICY SUMMARY.
Subdivision 1.
Delivery.
At the time of policy delivery, a policy summary must be delivered for an individual life insurance policy that provides long-term care benefits within the policy or by rider. In the case of direct response solicitations, the insurer must deliver the policy summary upon the applicant's request, but regardless of request, must make the delivery no later than at the time of policy delivery.
Subd. 2.
Contents.
The summary must include the following information:
(1) an explanation of how the long-term care benefit interacts with other components of the policy, including deductions from death benefits;
(2) an illustration of the amount of benefits, the length of benefits, and the guaranteed lifetime benefits, if any, for each covered person;
(3) any exclusions, reductions, and limitations on benefits of long-term care; and
(4) a statement that any long-term care inflation protection option required by section 62S.23 is not available under this policy.
Subd. 3.
Additional information required.
If applicable to the policy type, the summary must include the following information:
(1) a disclosure of the effects of exercising other rights under the policy;
(2) a disclosure of guarantees related to long-term care costs of insurance charges; and
(3) current and projected maximum lifetime benefits.
History:
1997 c 71 art 1 s 10; 2006 c 255 s 39; 2006 c 282 art 17 s 5
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.11 — Monthly Report.

62S.11 MONTHLY REPORT.
Subdivision 1.
Required report.
Any time a long-term care benefit, funded through a life insurance vehicle by the acceleration of the death benefit, is in benefit payment status, a monthly report must be provided to the policyholder.
Subd. 2.
Contents.
The report must include the following information:
(1) long-term care benefits paid out during the month;
(2) an explanation of changes in the policy, such as death benefits or cash values, due to long-term care benefits being paid out; and
(3) the amount of long-term care benefits existing or remaining.
History:
1997 c 71 art 1 s 11
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.12 — Claim Denial.

62S.12 CLAIM DENIAL.
If a claim under a qualified long-term care insurance contract is denied, the issuer shall provide a written explanation of the reasons for the denial and make available all information directly related to the denial within 60 days of the date of a written request by the policyholder or certificate holder, or a representative of the policyholder or certificate holder.
History:
1997 c 71 art 1 s 12
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.13 — Incontestability Period.

62S.13 INCONTESTABILITY PERIOD.
Subdivision 1.
Rescission before six months.
For a policy or certificate that has been in force for less than six months, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is material to acceptance for coverage.
Subd. 2.
Rescission after six months.
For a policy or certificate that has been in force for at least six months, but less than two years, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is both material to the acceptance for coverage and that pertains to the condition for which benefits are sought.
Subd. 3.
Contested policy after two years.
After a policy or certificate has been in force for two years, it is not contestable upon the grounds of misrepresentation alone. The policy or certificate may be contested only upon a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured's health.
Subd. 4.
Field issue prohibition.
A long-term care insurance policy or certificate may not be field issued based on medical or health status. For purposes of this section, "field issued" means a policy or certificate issued by an agent or a third-party administrator under the underwriting authority granted to the agent or third-party administrator by an insurer and using the insurer's underwriting guidelines.
Subd. 5.
Benefit payments not recoverable.
If an insurer has paid benefits under the long-term care insurance policy or certificate, the benefit payments may not be recovered by the insurer in the event that the policy or certificate is rescinded.
Subd. 6.
Death of insured.
In the event of the death of the insured, this section shall not apply to the remaining death benefit of a life insurance policy that accelerates benefits for long-term care. In this situation, the remaining death benefits under these policies shall be governed by section 61A.03, subdivision 1, paragraph (c). In all other situations, this section shall apply to life insurance policies that accelerate benefits for long-term care.
History:
1997 c 71 art 1 s 13; 2006 c 255 s 40; 2006 c 282 art 17 s 6; 2008 c 344 s 22
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.14 — Renewability.

62S.14 RENEWABILITY.
Subdivision 1.
Guaranteed renewable.
A qualified long-term care insurance policy must be guaranteed renewable.
Subd. 2.
Terms.
The terms "guaranteed renewable" and "noncancelable" may not be used in an individual long-term care insurance policy without further explanatory language that complies with the disclosure requirements of section 62S.20. The term "level premium" may only be used when the insurer does not have the right to change the premium.
Subd. 3.
Authorized renewal provisions.
A policy issued to an individual may not contain renewal provisions other than guaranteed renewable or noncancelable.
History:
1997 c 71 art 1 s 14; 2006 c 255 s 41; 2006 c 282 art 17 s 7
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.15 — Authorized Limitations And Exclusions.

62S.15 AUTHORIZED LIMITATIONS AND EXCLUSIONS.
(a) No policy may be delivered or issued for delivery in this state as long-term care insurance if the policy limits or excludes coverage by type of illness, treatment, medical condition, or accident, except as follows:
(1) preexisting conditions or diseases;
(2) mental or nervous disorders; except that the exclusion or limitation of benefits on the basis of Alzheimer's disease is prohibited;
(3) alcoholism and drug addiction;
(4) illness, treatment, or medical condition arising out of war or act of war; participation in a felony, riot, or insurrection; service in the armed forces or auxiliary units; suicide, attempted suicide, or intentionally self-inflicted injury; or non-fare-paying aviation;
(5) treatment provided in a government facility unless otherwise required by law, services for which benefits are available under Medicare or other government program except Medicaid, state or federal workers' compensation, employer's liability or occupational disease law, motor vehicle no-fault law; services provided by a member of the covered person's immediate family; and services for which no charge is normally made in the absence of insurance;
(6) expenses for services or items available or paid under another long-term care insurance or health insurance policy; and
(7) in the case of a qualified long-term care insurance contract, expenses for services or items to the extent that the expenses are reimbursable under title XVIII of the Social Security Act or would be so reimbursable but for the application of a deductible or coinsurance amount.
(b) This subdivision does not prohibit exclusions and limitations by type of provider or territorial limitations. However, no long-term care issuer may deny a claim because services are provided in a state other than the state of policy issued under the following conditions:
(1) when the state other than the state of policy issue does not have the provider licensing, certification, or registration required in the policy, but where the provider satisfies the policy requirements outlined for providers in lieu of licensure, certification, or registration; or
(2) when the state other than the state of policy issue licenses, certifies, or registers the provider under another name.
For purposes of this paragraph, "state of policy issue" means the state in which the individual policy or certificate was originally issued.
History:
1997 c 71 art 1 s 15; 2006 c 255 s 42; 2006 c 282 art 17 s 8; 2008 c 344 s 23
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.16 — Extension Of Benefits.

62S.16 EXTENSION OF BENEFITS.
Termination of long-term care insurance must be without prejudice to any benefits payable for institutionalization if the institutionalization began while the long-term care insurance was in force and continues without interruption after termination. The extension of benefits beyond the period the long-term care insurance was in force may be limited to the duration of the benefit period or to payment of the maximum benefits and may be subject to a policy waiting period, and all other applicable provisions of the policy.
History:
1997 c 71 art 1 s 16
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.18 — Discontinuance And Replacement.

62S.18 DISCONTINUANCE AND REPLACEMENT.
Subdivision 1.
Required coverage.
If a group long-term care policy is replaced by another group long-term care policy issued to the same policyholder, the succeeding insurer shall offer coverage to all persons covered under the previous group policy on its date of termination. Coverage provided or offered to individuals by the insurer and premiums charged to persons under the new group policy shall not result in any exclusion for preexisting conditions that would have been covered under the group policy being replaced and shall not vary or otherwise depend on the individual's health or disability status, claim experience, or use of long-term care services.
Subd. 2.
Premiums.
(a) The premiums charged to an insured for long-term care insurance replaced under subdivision 1 shall not increase due to either the increasing age of the insured at ages beyond 65 or the duration the insured has been covered under this policy.
(b) The purchase of additional coverage must not be considered a premium rate increase, but for purposes of the calculation required under section 62S.291, the portion of the premium attributable to the additional coverage must be added to and considered part of the initial annual premium.
(c) A reduction in benefits must not be considered a premium change, but for purpose of the calculation required under section 62S.291, the initial annual premium must be based on the reduced benefits.
History:
1997 c 71 art 1 s 18; 2008 c 344 s 24
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.181 — Electronic Enrollment For Group Policies.

62S.181 ELECTRONIC ENROLLMENT FOR GROUP POLICIES.
Subdivision 1.
Employers or labor unions.
In the case of a group defined in section 62S.01, subdivision 15, clause (1), any requirement that a signature of an insured be obtained by an agent or insurer is satisfied if:
(1) the consent is obtained by telephonic or electronic enrollment by the group policyholder or insurer. A verification of enrollment information must be provided to the enrollee;
(2) the telephonic or electronic enrollment provides necessary and reasonable safeguards to ensure the accuracy, retention, and prompt retrieval of records; and
(3) the telephonic or electronic enrollment provides necessary and reasonable safeguards to ensure that the confidentiality of individually identifiable information and "privileged information" as defined by section 72A.491, subdivision 19, is maintained.
Subd. 2.
Availability of insurer records.
The insurer shall make available, upon request of the commissioner, records that will demonstrate the insurer's ability to confirm enrollment and coverage amounts.
History:
2008 c 344 s 25
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.22 — Minimum Standards For Home Health And Community Care Benefits.

62S.22 MINIMUM STANDARDS FOR HOME HEALTH AND COMMUNITY CARE BENEFITS.
Subdivision 1.
Prohibited limitations.
A long-term care insurance policy or certificate shall not, if it provides benefits for home health care or community care services, limit or exclude benefits by:
(1) requiring that the insured would need care in a skilled nursing facility if home health care services were not provided;
(2) requiring that the insured first or simultaneously receive nursing or therapeutic services in a home, community, or institutional setting before home health care services are covered;
(3) limiting eligible services to services provided by a registered nurse or licensed practical nurse;
(4) requiring that a nurse or therapist provide services covered by the policy that can be provided by a home health aide or other licensed or certified home care worker acting within the scope of licensure or certification;
(5) excluding coverage for personal care services provided by a home health aide;
(6) requiring that the provision of home health care services be at a level of certification or licensure greater than that required by the eligible service;
(7) requiring that the insured have an acute condition before home health care services are covered;
(8) limiting benefits to services provided by Medicare-certified agencies or providers;
(9) excluding coverage for adult day care services; or
(10) excluding coverage based upon location or type of residence in which the home health care services would be provided.
Subd. 2.
Required coverage amount.
A long-term care insurance policy or certificate, if it provides for home health or community care services, must provide total home health or community care coverage that is a dollar amount equivalent to at least one-half of one year's coverage available for nursing home benefits under the policy or certificate, at the time covered home health or community care services are being received. This requirement does not apply to policies or certificates issued to residents of continuing care retirement communities.
Subd. 3.
Application of home health care coverage.
Home health care coverage may be applied to the nonhome health care benefits provided in the policy or certificate when determining maximum coverage under the terms of the policy or certificate.
History:
1997 c 71 art 1 s 22; 1Sp2003 c 14 art 2 s 5
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.25 — Reporting Requirements.

62S.25 REPORTING REQUIREMENTS.
Subdivision 1.
Insurer records.
Each insurer shall maintain records for each agent of that agent's amount of replacement sales as a percent of the agent's total annual sales and the amount of lapses of long-term care insurance policies sold by the agent as a percent of the agent's total annual sales.
Subd. 2.
Required information on agents.
Each insurer shall report annually by June 30 the ten percent of its agents with the greatest percentages of lapses and replacements as measured under subdivision 1.
Subd. 3.
Intent.
Reported replacement and lapse rates do not alone constitute a violation of insurance laws or necessarily imply wrongdoing. The reports are for the purpose of reviewing more closely agent activities regarding the sale of long-term care insurance.
Subd. 4.
Lapsed policies.
Each insurer shall report annually by June 30 the number of lapsed long-term care insurance policies as a percent of its total annual sales and as a percent of its total number of long-term care insurance policies in force as of the end of the preceding calendar year.
Subd. 5.
Replacement policies.
Each insurer shall report annually by June 30 the number of replacement long-term care insurance policies sold as a percent of its total annual sales and as a percent of its total number of long-term care insurance policies in force as of the preceding calendar year.
Subd. 6.
Claims denied.
Each insurer shall report annually by June 30 the number of claims denied for any reason during the reporting period for each class of business, expressed as a percentage of claims denied, other than claims denied for failure to meet the waiting period or because of any applicable preexisting condition. For purposes of this subdivision, "claim" means a request for payment of benefits under an in-force policy regardless of whether the benefit claimed is covered under the policy or any terms or conditions of the policy have been met.
Subd. 7.
Reports.
Reports under this section shall be done on a statewide basis and filed with the commissioner. They shall include, at a minimum, the information in the format contained in Appendix E (Claim Denial Reporting Form) and in Appendix G (Replacement and Lapse Reporting Form) of the Long-Term Care Model Regulation adopted by the National Association of Insurance Commissioners.
History:
1997 c 71 art 1 s 25; 2006 c 255 s 50,51; 2006 c 282 art 17 s 16,17
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.251 — Reserve Standards.

62S.251 RESERVE STANDARDS.
Subdivision 1.
Benefits provided through acceleration of benefits under life policies.
When long-term care benefits are provided through the acceleration of benefits under group or individual life policies or riders to these policies, policy reserves for the benefits must be determined in accordance with section 61A.25. Claim reserves must also be established in the case when the policy or rider is in claim status.
Reserves for policies and riders subject to this section must be based on the multiple decrement model utilizing all relevant decrements except for voluntary termination rates. Single decrement approximations are acceptable if the calculation produces essentially similar reserves, if the reserve is clearly more conservative, or if the reserve is immaterial. The calculations may take into account the reduction in life insurance benefits due to the payment of long-term care benefits. However, in no event must the reserves for the long-term care benefit and the life insurance benefit be less than the reserves for the life insurance benefit assuming no long-term care benefit.
In the development and calculation of reserves for policies and riders subject to this subdivision, due regard must be given to the applicable policy provisions, marketing methods, administrative procedures, and all other considerations which have an impact on projected claim costs, including, but not limited to, the following:
(1) definition of insured events;
(2) covered long-term care facilities;
(3) existence of home convalescence care coverage;
(4) definition of facilities;
(5) existence or absence of barriers to eligibility;
(6) premium waiver provision;
(7) renewability;
(8) ability to raise premiums;
(9) marketing method;
(10) underwriting procedures;
(11) claims adjustment procedures;
(12) waiting period;
(13) maximum benefit;
(14) availability of eligible facilities;
(15) margins in claim costs;
(16) optional nature of benefit;
(17) delay in eligibility for benefit;
(18) inflation protection provisions; and
(19) guaranteed insurability option.
Any applicable valuation morbidity table shall be certified as appropriate as a statutory valuation table by a member of the American Academy of Actuaries.
Subd. 2.
Benefits provided otherwise.
When long-term care benefits are provided other than as in subdivision 1, reserves must be determined in accordance with sections 60A.76 to 60A.768.
History:
2008 c 344 s 30
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.267 — Standards For Benefit Triggers.

62S.267 STANDARDS FOR BENEFIT TRIGGERS.
Subdivision 1.
Benefit payment determinations.
A long-term care insurance policy must condition the payment of benefits on a determination of the insured's ability to perform activities of daily living and on cognitive impairment. Eligibility for the payment of benefits must not be more restrictive than requiring either a deficiency in the ability to perform not more than two of the activities of daily living or the presence of cognitive impairment.
Activities of daily living include at least the following as defined in section 62S.01 and in the policy: bathing, continence, dressing, eating, toileting, and transferring.
Insurers may use activities of daily living to trigger covered benefits in addition to those contained in this subdivision as long as they are defined in the policy.
Subd. 2.
Additional provisions for determining benefit payments.
An insurer may use additional provisions for the determination of when benefits are payable under a policy or certificate if the provisions do not restrict, and are not in lieu of, the requirements contained in subdivision 1.
Subd. 3.
Deficiency determination.
For purposes of this section, the determination of a deficiency must not be more restrictive than requiring the hands-on assistance of another person to perform the prescribed activities of daily living, or if the deficiency is due to the presence of a cognitive impairment, supervision or verbal cueing by another person is needed in order to protect the insured or others.
Subd. 4.
Assessments.
Assessments of activities if daily living and cognitive impairment must be performed by licensed or certified professionals, such as physicians, nurses, or social workers.
Subd. 5.
Appeal process.
Long-term care insurance policies must include a clear description of the process for appealing and resolving benefit determinations.
History:
2008 c 344 s 34
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.27 — Filing Requirement.

62S.27 FILING REQUIREMENT.
Before an insurer or similar organization offers group long-term care insurance to a resident of this state under section 62S.03, it must file with the commissioner evidence that the group policy or certificate has been approved by a state having statutory or regulatory long-term care insurance requirements substantially similar to those adopted in this state.
History:
1997 c 71 art 1 s 27
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62S — Qualified Long-term Care Insurance Policies › Section 62S.28 — Filing Requirements For Advertising.

62S.28 FILING REQUIREMENTS FOR ADVERTISING.
Subdivision 1.
Advertisement copy.
An insurer or other entity providing long-term care insurance or benefits in this state shall provide a copy of any long-term care insurance advertisement intended for use in this state whether through written, radio, or television medium to the commissioner for review or approval by the commissioner, to the extent it may be required under state law. All advertisements must be retained by the insurer or other entity for at least three years from the date the advertisement was first used.
Subd. 2.
Exemption.
The commissioner may exempt from these requirements any advertising form or material when, in the commissioner's opinion, this requirement may not be reasonably applied.
History:
1997 c 71 art 1 s 28