reglab/statecodes huggingface dataset:
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.303 — Prohibition; Severing Of Groups.

62A.303 PROHIBITION; SEVERING OF GROUPS.
Section 62L.12, subdivisions 3 and 4, apply to all employer group health plans, as defined in section 62A.011, regardless of the size of the group.
History:
1992 c 549 art 3 s 10; 1994 c 625 art 10 s 4
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.304 — Coverage For Port-wine Stain Elimination.

62A.304 COVERAGE FOR PORT-WINE STAIN ELIMINATION.
Subdivision 1.
Scope of coverage.
This section applies to all health plans as defined in section 62A.011 that provide coverage to a Minnesota resident.
Subd. 2.
Required coverage.
Every health plan included in subdivision 1 must cover elimination or maximum feasible treatment of port-wine stains for any covered person who is a Minnesota resident. No health carrier may reduce or eliminate coverage due to this requirement.
Subd. 3.
Rate increases prohibited.
The commissioner of commerce shall not approve any rate increases due to coverage required under subdivision 2. No health maintenance organization, as defined in chapter 62D, shall increase rates due to coverage required under subdivision 2.
History:
1993 c 116 s 1
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.305 — Fibrocystic Condition; Termination Or Reduction Of Coverage.

62A.305 FIBROCYSTIC CONDITION; TERMINATION OR REDUCTION OF COVERAGE.
No health plan shall be terminated, canceled, nonrenewed, or contain any increased premium rate, or exclusion, reduction, or limitation on benefits, nor shall coverage be denied, solely because the covered person has been diagnosed as having a fibrocystic breast condition.
History:
1994 c 442 s 1
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.306 — Use Of Gender Prohibited.

62A.306 USE OF GENDER PROHIBITED.
Subdivision 1.
Applicability.
This section applies to all health plans as defined in section 62A.011 offered, sold, issued, or renewed, by a health carrier on or after January 1, 1995.
Subd. 2.
Prohibition on use of gender.
No health plan described in subdivision 1 shall determine the premium rate or any other underwriting decision, including initial issuance, through a method that is in any way based upon the gender of any person covered or to be covered under the health plan. This subdivision prohibits use of marital status or generalized differences in expected costs between employees and spouses or between principal insureds and their spouses.
History:
1994 c 625 art 10 s 5
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.307 — Prescription Drugs; Equal Treatment Of Prescribers.

62A.307 PRESCRIPTION DRUGS; EQUAL TREATMENT OF PRESCRIBERS.
Subdivision 1.
Scope of requirement.
This section applies to any of the following if issued or renewed to a Minnesota resident or to cover a Minnesota resident:
(1) a health plan, as defined in section 62A.011;
(2) coverage described in section 62A.011, subdivision 3, clause (2), (3), or (6) to (12); and
(3) a policy, contract, or certificate issued by a community integrated service network licensed under chapter 62N.
Subd. 2.
Requirement.
Coverage described in subdivision 1 that covers prescription drugs must provide the same coverage for a prescription written by a health care provider authorized to prescribe the particular drug covered by the health coverage described in subdivision 1, regardless of the type of health care provider that wrote the prescription. This section is intended to prohibit denial of coverage based on the prescription having been written by an advanced practice registered nurse under section 148.235, a physician assistant under section 147A.185, or any other nonphysician health care provider authorized to prescribe the particular drug.
History:
1995 c 69 s 1; 1996 c 305 art 1 s 17; 1997 c 225 art 2 s 62; 2020 c 115 art 2 s 1; 2023 c 25 s 5
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.3075 — Cancer Chemotherapy Treatment Coverage.

62A.3075 CANCER CHEMOTHERAPY TREATMENT COVERAGE.
(a) A health plan company that provides coverage under a health plan for cancer chemotherapy treatment shall not require a higher co-payment, deductible, or coinsurance amount for a prescribed, orally administered anticancer medication that is used to kill or slow the growth of cancerous cells than what the health plan requires for an intravenously administered or injected cancer medication that is provided, regardless of formulation or benefit category determination by the health plan company.
(b) A health plan company must not achieve compliance with this section by imposing an increase in co-payment, deductible, or coinsurance amount for an intravenously administered or injected cancer chemotherapy agent covered under the health plan.
(c) Nothing in this section shall be interpreted to prohibit a health plan company from requiring prior authorization or imposing other appropriate utilization controls in approving coverage for any chemotherapy.
(d) A plan offered by the commissioner of management and budget under section 43A.23 is deemed to be at parity and in compliance with this section.
(e) A health plan company is in compliance with this section if it does not include orally administered anticancer medication in the fourth tier of its pharmacy benefit.
(f) A health plan company that provides coverage under a health plan for cancer chemotherapy treatment must indicate the level of coverage for orally administered anticancer medication within its pharmacy benefit filing with the commissioner.
History:
2010 c 326 s 1; 1Sp2017 c 6 art 5 s 3
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.308 — Hospitalization And Anesthesia For Dental Procedures.

62A.308 HOSPITALIZATION AND ANESTHESIA FOR DENTAL PROCEDURES.
Subdivision 1.
Scope of coverage.
This section applies to a health plan as defined in section 62A.011 that provides coverage to a Minnesota resident.
Subd. 2.
Required coverages.
(a) A health plan included in subdivision 1 must cover anesthesia and hospital charges for dental care provided to a covered person who: (1) is a child under age five; or (2) is severely disabled; or (3) has a medical condition and who requires hospitalization or general anesthesia for dental care treatment. A health carrier may require prior authorization of hospitalization for dental care procedures in the same manner that prior authorization is required for hospitalization for other covered diseases or conditions.
(b) A health plan included in subdivision 1 must also provide coverage for general anesthesia and treatment rendered by a dentist for a medical condition covered by the health plan, regardless of whether the services are provided in a hospital or a dental office.
History:
1995 c 91 s 1
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.3091 — Nondiscriminate Coverage Of Tests.

62A.3091 NONDISCRIMINATE COVERAGE OF TESTS.
Subdivision 1.
Scope of requirement.
This section applies to any of the following if issued or renewed to a Minnesota resident or to cover a Minnesota resident:
(1) a health plan, as defined in section 62A.011;
(2) coverage described in section 62A.011, subdivision 3, clauses (2), (3), or (6) to (12); and
(3) a policy, contract, or certificate issued by a community integrated service network licensed under chapter 62N.
Subd. 2.
Requirement.
Coverage described in subdivision 1 that covers laboratory tests, diagnostic tests, and x-rays must provide the same coverage, without requiring additional signatures, for all such tests ordered by an advanced practice registered nurse operating pursuant to chapter 148 or a physician assistant practicing pursuant to chapter 147A. Nothing in this section shall be construed to interfere with any written agreement between a physician and an advanced practice registered nurse or between a physician and a physician assistant.
History:
1996 c 446 art 1 s 24; 1997 c 225 art 2 s 62; 2022 c 58 s 4; 2023 c 25 s 6
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.3092 — Equal Treatment Of Surgical First Assisting Services.

62A.3092 EQUAL TREATMENT OF SURGICAL FIRST ASSISTING SERVICES.
Subdivision 1.
Scope of requirement.
This section applies to any of the following if issued or renewed to a Minnesota resident or to cover a Minnesota resident:
(1) a health plan, as defined in section 62A.011;
(2) coverage described in section 62A.011, subdivision 3, clauses (2), (3), or (6) to (12); and
(3) a policy, contract, or certificate issued by a community integrated service network licensed under chapter 62N.
Subd. 2.
Requirement.
Coverage described in subdivision 1 that provides for payment for surgical first assisting benefits or services shall be construed as providing for payment for a registered nurse who performs first assistant functions and services that are within the scope of practice of a registered nurse.
History:
1996 c 446 art 1 s 25; 1997 c 225 art 2 s 62
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.3093 — Coverage For Diabetes.

62A.3093 COVERAGE FOR DIABETES.
Subdivision 1.
Required coverage.
A health plan, including a plan providing the coverage specified in section 62A.011, subdivision 3, clause (10), must provide coverage for: (1) all physician prescribed medically appropriate and necessary equipment and supplies used in the management and treatment of diabetes; and (2) diabetes outpatient self-management training and education, including medical nutrition therapy, that is provided by a certified, registered, or licensed health care professional working in a program consistent with the national standards of diabetes self-management education as established by the American Diabetes Association. Coverage must include persons with gestational, type I or type II diabetes. Coverage required under this section is subject to the same deductible or coinsurance provisions applicable to the plan's hospital, medical expense, medical equipment, or prescription drug benefits. A health carrier may not reduce or eliminate coverage due to this requirement.
Subd. 2.
Medicare Part D exception.
A health plan providing the coverage specified in section 62A.011, subdivision 3, clause (10), is not subject to the requirements of subdivision 1, clause (1), with respect to equipment and supplies covered under the Medicare Part D Prescription Drug program, whether or not the covered person is enrolled in a Medicare Part D plan.
This subdivision does not apply to a health plan providing the coverage specified in section 62A.011, subdivision 3, clause (10), that was in effect on December 31, 2005, if the covered person remains enrolled in the plan and does not enroll in a Medicare Part D plan.
History:
1994 c 538 s 1; 1995 c 52 s 1; 1997 c 57 s 1; 2006 c 255 s 12
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.3095 — Prescription Eye Drops Coverage.

62A.3095 PRESCRIPTION EYE DROPS COVERAGE.
Subdivision 1.
Scope of coverage.
This section applies to all health plans, as defined in section 62A.011, subdivision 3, that provide coverage to Minnesota residents.
Subd. 2.
Required coverage.
(a) Every health plan included in subdivision 1 that provides coverage for prescription eye drops shall not deny coverage for a refill of the prescription eye drops if the refill is requested by the person insured by the health plan, pursuant to paragraph (b), and if the prescribing practitioner indicated on the original prescription that additional quantities are needed and the refill requested by the insured does not exceed the number of additional quantities needed.
(b) Coverage shall only be provided pursuant to paragraph (a) if the insured makes a refill request for:
(1) a 30-day refill supply and the request is made between 21 and 30 days from the later of:
(i) the original date that the prescription was distributed to the insured; or
(ii) the date the most recent refill was distributed to the insured; or
(2) a 90-day refill supply and the request is made between 75 and 90 days from the later of:
(i) the original date that the prescription was distributed to the insured; or
(ii) the date the most recent refill was distributed to the insured.
History:
2017 c 47 s 1
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.3097 — Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (pandas) And Pediatric Acute-onset Neuropsychiatric Syndrome (pans) Treatment; Coverage.

62A.3097 PEDIATRIC AUTOIMMUNE NEUROPSYCHIATRIC DISORDERS ASSOCIATED WITH STREPTOCOCCAL INFECTIONS (PANDAS) AND PEDIATRIC ACUTE-ONSET NEUROPSYCHIATRIC SYNDROME (PANS) TREATMENT; COVERAGE.
Subdivision 1.
Definitions.
(a) The definitions in this subdivision apply to this section.
(b) "Pediatric acute-onset neuropsychiatric syndrome" means a class of acute-onset obsessive compulsive or tic disorders or other behavioral changes presenting in children and adolescents that are not otherwise explained by another known neurologic or medical disorder.
(c) "Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections" means a condition in which a streptococcal infection in a child or adolescent causes the abrupt onset of clinically significant obsessions, compulsions, tics, or other neuropsychiatric symptoms or behavioral changes, or a relapsing and remitting course of symptom severity.
Subd. 2.
Scope of coverage.
This section applies to all health plans that provide coverage to Minnesota residents.
Subd. 3.
Required coverage.
Every health plan included in subdivision 2 must provide coverage for treatment for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and for treatment for pediatric acute-onset neuropsychiatric syndrome (PANS). Treatments that must be covered under this section must be recommended by the insured's licensed health care professional and include but are not limited to antibiotics, medication and behavioral therapies to manage neuropsychiatric symptoms, plasma exchange, and immunoglobulin.
Subd. 4.
Reimbursement.
The commissioner of commerce shall reimburse health carriers for coverage under this section. Reimbursement is available only for coverage that would not have been provided by the health carrier without the requirements of this section. Each fiscal year an amount necessary to make payments to health carriers to defray the cost of providing coverage under this section is appropriated to the commissioner of commerce. Health carriers shall report to the commissioner quantified costs attributable to the additional benefit under this section in a format developed by the commissioner. The commissioner shall evaluate submissions and make payments to health carriers as provided in Code of Federal Regulations, title 45, section 155.170.
History:
1Sp2019 c 9 art 8 s 2
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.3161 — Medicare Supplement Plan With 50 Percent Coverage.

62A.3161 MEDICARE SUPPLEMENT PLAN WITH 50 PERCENT COVERAGE.
(a) The Medicare supplement plan with 50 percent coverage must have a level of coverage that will provide:
(1) 100 percent of Medicare Part A hospitalization coinsurance plus coverage for 365 days after Medicare benefits end;
(2) coverage for 50 percent of the Medicare Part A inpatient hospital deductible amount per benefit period until the out-of-pocket limitation is met as described in clause (8);
(3) coverage for 50 percent of the coinsurance amount for each day used from the 21st through the 100th day in a Medicare benefit period for posthospital skilled nursing care eligible under Medicare Part A until the out-of-pocket limitation is met as described in clause (8);
(4) coverage for 50 percent of cost sharing for all Medicare Part A eligible expenses and respite care until the out-of-pocket limitation is met as described in clause (8);
(5) coverage for 50 percent, under Medicare Part A or B, of the reasonable cost of the first three pints of blood, or equivalent quantities of packed red blood cells, as defined under federal regulations, unless replaced according to federal regulations, until the out-of-pocket limitation is met as described in clause (8);
(6) except for coverage provided in this clause, coverage for 50 percent of the cost sharing otherwise applicable under Medicare Part B, after the policyholder pays the Medicare Part B deductible, until the out-of-pocket limitation is met as described in clause (8);
(7) coverage of 100 percent of the cost sharing for Medicare Part B preventive services and diagnostic procedures for cancer screening described in section 62A.30 after the policyholder pays the Medicare Part B deductible; and
(8) coverage of 100 percent of all cost sharing under Medicare Parts A and B for the balance of the calendar year after the individual has reached the out-of-pocket limitation on annual expenditures under Medicare Parts A and B of $4,000 in 2006, indexed each year by the appropriate inflation adjustment by the secretary of the United States Department of Health and Human Services.
(b) A Medicare supplement plan with 50 percent coverage must provide the benefits contained in this section, but must not provide coverage for 100 percent or any portion of the Medicare Part B deductible to a newly eligible individual.
History:
2006 c 255 s 14; 2019 c 26 art 5 s 6,13
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.3162 — Medicare Supplement Plan With 75 Percent Coverage.

62A.3162 MEDICARE SUPPLEMENT PLAN WITH 75 PERCENT COVERAGE.
(a) The basic Medicare supplement plan with 75 percent coverage must have a level of coverage that will provide:
(1) 100 percent of Medicare Part A hospitalization coinsurance plus coverage for 365 days after Medicare benefits end;
(2) coverage for 75 percent of the Medicare Part A inpatient hospital deductible amount per benefit period until the out-of-pocket limitation is met as described in clause (8);
(3) coverage for 75 percent of the coinsurance amount for each day used from the 21st through the 100th day in a Medicare benefit period for posthospital skilled nursing care eligible under Medicare Part A until the out-of-pocket limitation is met as described in clause (8);
(4) coverage for 75 percent of cost sharing for all Medicare Part A eligible expenses and respite care until the out-of-pocket limitation is met as described in clause (8);
(5) coverage for 75 percent, under Medicare Part A or B, of the reasonable cost of the first three pints of blood, or equivalent quantities of packed red blood cells, as defined under federal regulations, unless replaced according to federal regulations until the out-of-pocket limitation is met as described in clause (8);
(6) except for coverage provided in this clause, coverage for 75 percent of the cost sharing otherwise applicable under Medicare Part B after the policyholder pays the Medicare Part B deductible until the out-of-pocket limitation is met as described in clause (8);
(7) coverage of 100 percent of the cost sharing for Medicare Part B preventive services and diagnostic procedures for cancer screening described in section 62A.30 after the policyholder pays the Medicare Part B deductible; and
(8) coverage of 100 percent of all cost sharing under Medicare Parts A and B for the balance of the calendar year after the individual has reached the out-of-pocket limitation on annual expenditures under Medicare Parts A and B of $2,000 in 2006, indexed each year by the appropriate inflation adjustment by the Secretary of the United States Department of Health and Human Services.
(b) A Medicare supplement plan with 75 percent coverage must provide the benefits contained in this section, but must not provide coverage for 100 percent or any portion of the Medicare Part B deductible to a newly eligible individual.
History:
2006 c 255 s 15; 2019 c 26 art 5 s 7,13
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.3163 — Medicare Supplement Plan With 50 Percent Part A Deductible Coverage.

62A.3163 MEDICARE SUPPLEMENT PLAN WITH 50 PERCENT PART A DEDUCTIBLE COVERAGE.
(a) The Medicare supplement plan with 50 percent Medicare Part A deductible coverage must have a level of coverage that will provide:
(1) 100 percent of Medicare Part A hospitalization coinsurance plus coverage for 365 days after Medicare benefits end;
(2) coverage for 50 percent of the Medicare Part A inpatient hospital deductible amount per benefit period;
(3) coverage for the coinsurance amount for each day used from the 21st through the 100th day in a Medicare benefit period for posthospital skilled nursing care eligible under Medicare Part A;
(4) coverage for cost sharing for all Medicare Part A eligible hospice and respite care expenses;
(5) coverage under Medicare Part A or B for the reasonable cost of the first three pints of blood, or equivalent quantities of packed red blood cells, as defined under federal regulations;
(6) coverage for 100 percent of the cost sharing otherwise applicable under Medicare Part B, after the policyholder pays the Medicare Part B deductible;
(7) coverage of 100 percent of the cost sharing for Medicare Part B preventive services and diagnostic procedures for cancer screening described in section 62A.30 after the policyholder pays the Medicare Part B deductible;
(8) coverage of 80 percent of the hospital and medical expenses and supplies incurred during travel outside of the United States as a result of a medical emergency; and
(9) coverage for 100 percent of the Medicare Part A or B home health care services and medical supplies after the policyholder pays the Medicare Part B deductible.
(b) A Medicare supplement plan with 50 percent Part A deductible coverage must provide the benefits contained in this section, but must not provide coverage for 100 percent or any portion of the Medicare Part B deductible to a newly eligible individual.
History:
2009 c 178 art 1 s 28,70; 2019 c 26 art 5 s 8,13
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.3164 — Medicare Supplement Plan With $20 And $50 Co-payment Medicare Part B Coverage.

62A.3164 MEDICARE SUPPLEMENT PLAN WITH $20 AND $50 CO-PAYMENT MEDICARE PART B COVERAGE.
(a) The Medicare supplement plan with $20 and $50 co-payment Medicare Part B coverage must have a level of coverage that will provide:
(1) 100 percent of Medicare Part A hospitalization coinsurance plus coverage for 365 days after Medicare benefits end;
(2) coverage for the Medicare Part A inpatient hospital deductible amount per benefit period;
(3) coverage for the coinsurance amount for each day used from the 21st through the 100th day in a Medicare benefit period for posthospital skilled nursing care eligible under Medicare Part A;
(4) coverage for the cost sharing for all Medicare Part A eligible hospice and respite care expenses;
(5) coverage for Medicare Part A or B of the reasonable cost of the first three pints of blood, or equivalent quantities of packed red blood cells, as defined under federal regulations, unless replaced according to federal regulations;
(6) coverage for 100 percent of the cost sharing otherwise applicable under Medicare Part B except for the lesser of $20 or the Medicare Part B coinsurance or co-payment for each covered health care provider office visit and the lesser of $50 or the Medicare Part B coinsurance or co-payment for each covered emergency room visit; however, this co-payment shall be waived if the insured is admitted to any hospital and the emergency visit is subsequently covered as a Medicare Part A expense;
(7) coverage of 100 percent of the cost sharing for Medicare Part B preventive services and diagnostic procedures for cancer screening described in section 62A.30 after the policyholder pays the Medicare Part B deductible;
(8) coverage of 80 percent of the hospital and medical expenses and supplies incurred during travel outside of the United States as a result of a medical emergency; and
(9) coverage for Medicare Part A or B home health care services and medical supplies after the policyholder pays the Medicare Part B deductible.
(b) A Medicare supplement plan with $20 and $50 co-payment Medicare Part B coverage must provide the benefits contained in this section, but must not provide coverage for 100 percent or any portion of the Medicare Part B deductible to a newly eligible individual. No portion of the co-payment referenced in this paragraph may be applied to a Medicare Part B deductible.
History:
2009 c 178 art 1 s 29,70; 2019 c 26 art 5 s 9,13
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.3165 — Medicare Supplement Plan With High Deductible Coverage.

62A.3165 MEDICARE SUPPLEMENT PLAN WITH HIGH DEDUCTIBLE COVERAGE.
(a) The Medicare supplement plan will pay 100 percent coverage upon payment of the annual high deductible. The annual deductible shall consist of out-of-pocket expenses, other than premiums, for services covered. This plan must have a level of coverage that will provide:
(1) 100 percent of Medicare Part A hospitalization coinsurance plus coverage for 365 days after Medicare benefits end;
(2) coverage for 100 percent of the Medicare Part A inpatient hospital deductible amount per benefit period;
(3) coverage for 100 percent of the coinsurance amount for each day used from the 21st through the 100th day in a Medicare benefit period for posthospital skilled nursing care eligible under Medicare Part A;
(4) coverage for 100 percent of cost sharing for all Medicare Part A eligible expenses and respite care;
(5) coverage for 100 percent, under Medicare Part A or B, of the reasonable cost of the first three pints of blood, or equivalent quantities of packed red blood cells, as defined under federal regulations, unless replaced according to federal regulations;
(6) except for coverage provided in this clause, coverage for 100 percent of the cost sharing otherwise applicable under Medicare Part B;
(7) coverage of 100 percent of the cost sharing for Medicare Part B preventive services and diagnostic procedures for cancer screening described in section 62A.30 after the policyholder pays the Medicare Part B deductible;
(8) coverage of 100 percent of the hospital and medical expenses and supplies incurred during travel outside of the United States as a result of a medical emergency;
(9) coverage for 100 percent of Medicare Part A and B home health care services and medical supplies; and
(10) the basis for the deductible shall be $1,860 and shall be adjusted annually from 2010 by the secretary of the United States Department of Health and Human Services to reflect the change in the Consumer Price Index for all urban consumers for the 12-month period ending with August of the preceding year, and rounded to the nearest multiple of $10.
(b) A Medicare supplement plan with high deductible coverage must provide the benefits contained in this section, but must not provide coverage for 100 percent or any portion of the Medicare Part B deductible to a newly eligible individual.
History:
2009 c 178 art 1 s 30,70; 2019 c 26 art 5 s 10,13
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.317 — Standards For Claims Payment.

62A.317 STANDARDS FOR CLAIMS PAYMENT.
(a) An issuer shall comply with section 1882(c)(3) of the federal Social Security Act, as enacted by section 4081(b)(2)(C) of the Omnibus Budget Reconciliation Act of 1987 (OBRA), Public Law 100-203, by:
(1) accepting a notice from a Medicare carrier on duly assigned claims submitted by Medicare participating physicians and suppliers as a claim for benefits in place of any other claim form otherwise required and making a payment determination on the basis of the information contained in that notice;
(2) notifying the Medicare participating physician or supplier and the beneficiary of the payment determination;
(3) paying the Medicare participating physician or supplier directly;
(4) furnishing, at the time of enrollment, each enrollee with a card listing the policy or certificate name, number, and a central mailing address to which notices from a Medicare carrier may be sent;
(5) paying user fees for claim notices that are transmitted electronically or otherwise; and
(6) providing to the secretary of health and human services, at least annually, a central mailing address to which all claims may be sent by Medicare carriers.
(b) Compliance with the requirements in paragraph (a) shall be certified on the Medicare supplement insurance experience reporting form.
History:
1992 c 554 art 1 s 6
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.37 — Government Certifications, Approvals, And Endorsements.

62A.37 GOVERNMENT CERTIFICATIONS, APPROVALS, AND ENDORSEMENTS.
Subdivision 1.
Display of seal or emblem prohibited.
No graphic seal or emblem shall be displayed on any policy or promotional literature to indicate or give the impression that there is any connection, certification, approval or endorsement from Medicare or any governmental body of this state or any agency thereof or of the United States of America or any agency thereof.
Subd. 2.
Display of false statement or representation prohibited.
Any false statement or representation printed on the policy or on promotional literature that indicates the policy has a connection with, is certified by, or has the approval or endorsement of any agency of this state or of the United States of America shall be unlawful.
History:
1981 c 318 s 7
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.38 — Notice Of Free Examination.

62A.38 NOTICE OF FREE EXAMINATION.
Medicare supplement policies or certificates, other than those issued pursuant to direct response solicitation, shall have a notice prominently printed on the first page of the policy or attached thereto stating in substance that the policyholder or certificate holder shall have the right to return the policy or certificate within 30 days of its delivery and to have the premium refunded in full if, after examination of the policy or certificate, the insured person is not satisfied for any reason. Medicare supplement policies or certificates, issued pursuant to a direct response solicitation to persons eligible for Medicare by reason of age, shall have a notice prominently printed on the first page or attached thereto stating in substance that the policyholder or certificate holder shall have the right to return the policy or certificate within 30 days of its delivery and to have the premium refunded within ten days after receipt of the returned policy or certificate to the insurer if, after examination, the insured person is not satisfied for any reason.
History:
1981 c 318 s 8; 1992 c 554 art 1 s 9
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.40 — Replacement Regulated.

62A.40 REPLACEMENT REGULATED.
No insurer or agent shall replace a Medicare supplement plan with another Medicare supplement plan of the same category unless there is a substantial difference in cost favorable to the policyholder, or the insured has previously demonstrated a dissatisfaction with the service presently being received from the current insurer. An insurer or agent may replace a Medicare supplement plan with a less comprehensive plan only if the prospective insured signs an acknowledgment that it is understood that the prospective insured will receive less benefits under the new policy than under the policy presently in force.
History:
1981 c 318 s 10; 1986 c 444
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.41 — Penalties.

62A.41 PENALTIES.
Subdivision 1.
Generally.
Any insurer, general agent, agent, or other person who knowingly or willfully, either directly or indirectly, makes or causes to be made or induces or seeks to induce the making of any false statement or representation of a material fact with respect to compliance of any policy with the standards and requirements set forth in this section; falsely assumes or pretends to be acting, or misrepresents in any way, including a violation of section 62A.37, that the person is acting, under the authority or in association with Medicare, or any federal agency, for the purpose of selling or attempting to sell insurance, or in such pretended character demands, or obtains money, paper, documents, or anything of value; or knowingly sells a health insurance policy to an individual entitled to benefits under part A or part B of Medicare with the knowledge that such policy substantially duplicates health benefits to which such individual is otherwise entitled under a requirement of state or federal law other than under Medicare shall be guilty of a felony and subject to a civil penalty of not more than $5,000 per violation, and the commissioner may revoke or suspend the license of any company, association, society, other insurer, or agent thereof.
Subd. 2.
Sales of replacement policies.
An insurer or general agent, agent, manager's general agent, or other representative, who knowingly or willfully violates section 62A.40 is guilty of a felony and is subject to a civil penalty of not more than $5,000 per violation.
Subd. 3.
Sales of duplicate policies.
An agent who knowingly or willfully violates section 62A.43, subdivision 1, is guilty of a felony and is subject to a civil penalty of not more than $5,000 per violation.
Subd. 4.
Unlicensed sales.
Notwithstanding section 60K.32, a person who acts or assumes to act as an insurance producer without a valid license for the purpose of selling or attempting to sell Medicare supplement insurance, and the person who aids or abets the actor, is guilty of a felony and is subject to a civil penalty of not more than $5,000 per violation.
History:
1981 c 318 s 11; 1986 c 444; 1989 c 258 s 7; 1992 c 564 art 3 s 21; 2001 c 117 art 2 s 7
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.42 — Rulemaking Authority.

62A.42 RULEMAKING AUTHORITY.
To carry out the purposes of sections 62A.3099 to 62A.44, the commissioner may promulgate rules pursuant to chapter 14. These rules may:
(a) prescribe additional disclosure requirements for Medicare supplement plans, designed to adequately inform the prospective insured of the need and extent of coverage offered;
(b) prescribe uniform policy forms in order to give the insurance purchaser a reasonable opportunity to compare the cost of insuring with various insurers and may prescribe reasonable measures as necessary to conform Medicare supplement policies and certificates to the requirements of federal law and regulations; and
(c) establish other reasonable standards to further the purpose of sections 62A.3099 to 62A.44.
History:
1981 c 318 s 12; 1982 c 424 s 130; 1983 c 263 s 12; 1992 c 554 art 1 s 11; 2005 c 17 art 1 s 14
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.436 — Commissions.

62A.436 COMMISSIONS.
The commission, sales allowance, service fee, or compensation to an agent for the sale of a Medicare supplement plan must be the same for each of the first four years of the policy.
In no event may the rate of commission, sales allowance, service fee, or compensation for the sale of a basic Medicare supplement plan exceed that which applies to the sale of an extended basic Medicare supplement plan.
For purposes of this section, "compensation" includes pecuniary or nonpecuniary remuneration of any kind relating to the sale or renewal of the policy or certificate, including but not limited to bonuses, gifts, prizes, awards, and finder's fees.
This section also applies to sales of replacement policies.
History:
1989 c 258 s 8; 1992 c 554 art 1 s 12; 1993 c 330 s 9
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.451 — Definitions.

62A.451 DEFINITIONS.
Subdivision 1.
Applicability.
For purposes of sections 62A.451 to 62A.4528, the terms defined in this section have the meanings given.
Subd. 2.
Commissioner.
"Commissioner" means the commissioner of commerce.
Subd. 3.
Enrollee.
"Enrollee" means an individual who is entitled to limited health services under a contract with an entity authorized to provide or arrange for such services under sections 62A.451 to 62A.4528.
Subd. 4.
Evidence of coverage.
"Evidence of coverage" means the certificate, agreement, or contract issued under section 62A.4516 setting forth the coverage to which an enrollee is entitled.
Subd. 5.
Limited health service.
"Limited health service" means pharmaceutical services covered under Medicare Part D. Limited health service does not include hospital, medical, surgical, or emergency services.
Subd. 6.
Prepaid limited health service organization.
"Prepaid limited health service organization" means any corporation, partnership, or other entity that, in return for a prepayment, undertakes to provide or arrange for the provision of limited health services to enrollees. Prepaid limited health service organization does not include:
(1) an entity otherwise authorized under the laws of this state either to provide any limited health service on a prepayment or other basis or to indemnify for any limited health service;
(2) an entity that meets the requirements of section 62A.4514; or
(3) a provider or entity when providing or arranging for the provision of limited health services under a contract with a prepaid limited health service organization or with an entity described in clause (1) or (2).
Subd. 7.
Provider.
"Provider" means a physician, pharmacist, health facility, or other person or institution that is licensed or otherwise authorized to deliver or furnish limited health services under sections 62A.451 to 62A.4528.
Subd. 8.
Subscriber.
"Subscriber" means the person whose employment or other status, except for family dependency, is the basis for entitlement to limited health services under a contract with an entity authorized to provide or arrange for such services under sections 62A.451 to 62A.4528.
History:
2005 c 17 art 2 s 1
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.4511 — Certificate Of Authority Required.

62A.4511 CERTIFICATE OF AUTHORITY REQUIRED.
No person, corporation, partnership, or other entity may operate a prepaid limited health service organization in this state without obtaining and maintaining a certificate of authority from the commissioner under sections 62A.451 to 62A.4528.
History:
2005 c 17 art 2 s 2
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.4513 — Issuance Of Certificate Of Authority; Denial.

62A.4513 ISSUANCE OF CERTIFICATE OF AUTHORITY; DENIAL.
Subdivision 1.
Issuance.
Following receipt of an application filed under section 62A.4512, the commissioner shall review the application and notify the applicant of any deficiencies. The commissioner must approve or deny an application within 90 days after receipt of a substantially complete application, or the application is deemed approved. The commissioner shall issue a certificate of authority to an applicant provided that the following conditions are met:
(1) the requirements of section 62A.4512 have been fulfilled;
(2) the individuals responsible for conducting the applicant's affairs are competent, trustworthy, and possess good reputations, and have had appropriate experience, training, or education;
(3) the applicant is financially responsible and may reasonably be expected to meet its obligations to enrollees and to prospective enrollees. In making this determination, the commissioner may consider:
(i) the financial soundness of the applicant's arrangements for limited health services;
(ii) the adequacy of working capital, other sources of funding, and provisions for contingencies;
(iii) any agreement for paying the cost of the limited health services or for alternative coverage in the event of insolvency of the prepaid limited health service organization; and
(iv) the manner in which the requirements of section 62A.4523 have been fulfilled; and
(4) any deficiencies identified by the commissioner have been corrected.
Subd. 2.
Denials.
If the certificate of authority is denied, the commissioner shall notify the applicant and shall specify the reasons for denial in the notice. The prepaid limited health service organization has 30 days from the date of receipt of the notice to request a hearing before the commissioner under chapter 14.
History:
2005 c 17 art 2 s 4
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.4514 — Filing Requirements For Authorized Entities.

62A.4514 FILING REQUIREMENTS FOR AUTHORIZED ENTITIES.
(a) An entity authorized under the laws of this state to operate a health maintenance organization, an accident and health insurance company, a nonprofit health service plan corporation, a fraternal benefit society, or a multiple employer welfare arrangement, and that is not otherwise authorized under the laws of this state to offer limited health services on a per capita or fixed prepayment basis, may do so by filing for approval with the commissioner the information requested by section 62A.4512, clauses (4), (5), (7), (8), and (10), and any subsequent material modification or addition to those provisions.
(b) If the commissioner disapproves the filing, the procedures provided in section 62A.4513, subdivision 2, must be followed.
History:
2005 c 17 art 2 s 5
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.4515 — Material Modifications.

62A.4515 MATERIAL MODIFICATIONS.
Subdivision 1.
Material modifications.
A prepaid limited health service organization shall file with the commissioner prior to use, a notice of any material modification of any matter or document furnished under section 62A.4512, together with supporting documents necessary to fully explain the modification. If the commissioner does not disapprove the filing within 60 days of its filing, the filing is deemed approved.
Subd. 2.
Procedure for disapproval.
If a filing under this section is disapproved, the commissioner shall notify the prepaid limited health service organization and specify the reasons for disapproval in the notice. The prepaid limited health service organization has 30 days from the date of receipt of notice to request a hearing before the commissioner under chapter 14.
History:
2005 c 17 art 2 s 6
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.4517 — Construction With Other Laws.

62A.4517 CONSTRUCTION WITH OTHER LAWS.
Subdivision 1.
Application of other insurance laws.
(a) A prepaid limited health service organization organized under the laws of this state is deemed to be a domestic insurer for purposes of chapter 60D unless specifically exempted in writing from one or more of the provisions of that chapter by the commissioner, based upon a determination that the provision is not applicable to the organization or to providing coverage under Medicare Part D.
(b) No other provision of chapters 60 to 72C applies to a prepaid limited health service organization unless such an organization is specifically mentioned in the provision.
Subd. 2.
Not a healing art.
The provision of limited health services by a prepaid limited health service organization or other entity under sections 62A.451 to 62A.4528 must not be deemed to be the practice of medicine or other healing arts.
Subd. 3.
Solicitation and advertising.
Solicitation to arrange for or provide limited health services in accordance with sections 62A.451 to 62A.4528 shall not be construed to violate any provision of law relating to solicitation or advertising by health professionals.
History:
2005 c 17 art 2 s 8
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.4518 — Nonduplication Of Coverage.

62A.4518 NONDUPLICATION OF COVERAGE.
Notwithstanding any other law of this state, a prepaid limited health service organization, health maintenance organization, accident and health insurance company, nonprofit health service plan corporation, or fraternal benefit society may exclude, in any contract or policy issued to a group, any coverage that would duplicate the coverage for limited health services, whether in the form of services, supplies, or reimbursement, insofar as the coverage or service is provided in accordance with sections 62A.451 to 62A.4528 under a contract or policy issued to the same group or to a part of that group by a prepaid limited health service organization, a health maintenance organization, an accident and health insurance company, a nonprofit health service corporation, or a fraternal benefit society.
History:
2005 c 17 art 2 s 9
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.4519 — Complaint System.

62A.4519 COMPLAINT SYSTEM.
Every prepaid limited health service organization shall establish and maintain a complaint system providing reasonable procedures for resolving written complaints initiated by enrollees and providers, consistent with the requirements of Medicare Part D.
History:
2005 c 17 art 2 s 10
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.4520 — Examination Of Organization.

62A.4520 EXAMINATION OF ORGANIZATION.
(a) The commissioner may examine the affairs of any prepaid limited health service organization as often as is reasonably necessary to protect the interests of the people of this state, but not less frequently than once every three years.
(b) Every prepaid limited health service organization shall make its relevant books and records available for an examination and in every way cooperate with the commissioner to facilitate an examination.
(c) In lieu of an examination, the commissioner may accept the report of an examination made by the commissioner of another state.
History:
2005 c 17 art 2 s 11
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.4521 — Investments.

62A.4521 INVESTMENTS.
The funds of a prepaid limited health service organization shall be invested only in accordance with the guidelines under chapter 62D for investments by health maintenance organizations.
History:
2005 c 17 art 2 s 12
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62A — Accident And Health Insurance › Section 62A.4522 — Agents.

62A.4522 AGENTS.
No individual may apply, procure, negotiate, or place for others any policy or contract of a prepaid limited health service organization unless that individual holds a license or is otherwise authorized to sell accident and health insurance policies, nonprofit health service plan contracts, or health maintenance organization contracts.
History:
2005 c 17 art 2 s 13