1.1                          A bill for an act 
  1.2             relating to health; permitting health maintenance 
  1.3             organizations to offer greater flexibility in enrollee 
  1.4             cost-sharing; amending Minnesota Statutes 2000, 
  1.5             section 62D.02, subdivision 8; proposing coding for 
  1.6             new law in Minnesota Statutes, chapter 62D. 
  1.7   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.8      Section 1.  Minnesota Statutes 2000, section 62D.02, 
  1.9   subdivision 8, is amended to read: 
  1.10     Subd. 8.  [HEALTH MAINTENANCE CONTRACT.] "Health 
  1.11  maintenance contract" means any contract whereby a health 
  1.12  maintenance organization agrees to provide comprehensive health 
  1.13  maintenance services to enrollees, provided that the contract 
  1.14  may contain ~~reasonable~~ enrollee ~~copayment~~ cost-sharing 
  1.15  provisions that comply with section 62D.099.  ~~An individual or~~ 
  1.16  ~~group health maintenance contract may contain the copayment and~~ 
  1.17  ~~deductible provisions specified in this subdivision.~~  Copayment 
  1.18  and deductible provisions in group contracts shall not 
  1.19  discriminate on the basis of age, sex, race, length of 
  1.20  enrollment in the plan, or economic status; and during every 
  1.21  open enrollment period in which all offered health benefit 
  1.22  plans, including those subject to the jurisdiction of the 
  1.23  commissioners of commerce or health, fully participate without 
  1.24  any underwriting restrictions, copayment and deductible 
  1.25  provisions shall not discriminate on the basis of preexisting 
  1.26  health status.  ~~In no event shall the sum of the annual~~ 
  2.1   ~~copayments and deductible exceed the maximum out-of-pocket~~ 
  2.2   ~~expenses allowable for a number three qualified plan under~~ 
  2.3   ~~section 62E.06, nor shall that sum exceed $5,000 per family.~~  
  2.4   ~~The annual deductible must not exceed $1,000 per person.  The~~ 
  2.5   ~~annual deductible must not apply to preventive health services~~ 
  2.6   ~~as described in Minnesota Rules, part 4685.0801, subpart 8.~~  
  2.7   Where sections 62D.01 to 62D.30 permit a health maintenance 
  2.8   organization to contain reasonable copayment provisions for 
  2.9   preexisting health status, these provisions may vary with 
  2.10  respect to length of enrollment in the plan.  Any contract may 
  2.11  provide for health care services in addition to those set forth 
  2.12  in subdivision 7. 
  2.13     Sec. 2.  [62D.099] [ENROLLEE COST-SHARING.] 
  2.14     Subdivision 1.  [COPAYMENTS.] (a) A health maintenance 
  2.15  contract may provide for copayments that do not exceed 50 
  2.16  percent.  
  2.17     (b) Notwithstanding paragraph (a), a health maintenance 
  2.18  contract may provide for copayments that exceed 50 percent for 
  2.19  noncovered benefits.  Noncovered benefits include covered 
  2.20  services that the enrollee elects without prior approval to 
  2.21  receive out-of-network or from a broader network and 
  2.22  nonformulary prescription drugs.  
  2.23     (c) Copayments may be expressed as percentages or flat fees 
  2.24  as provided in Minnesota Rules, part 4685.0801. 
  2.25     Subd. 2.  [DEDUCTIBLES.] A health maintenance contract may 
  2.26  provide for deductibles of up to: 
  2.27     (1) $4,000 per person per year and $9,000 per family per 
  2.28  year for group contracts; or 
  2.29     (2) $10,000 per person per year and $20,000 per family per 
  2.30  year for individual contracts.  
  2.31     Subd. 3.  [ANNUAL OUT-OF-POCKET MAXIMUMS.] A health 
  2.32  maintenance contract may provide for an out-of-pocket maximum on 
  2.33  enrollee cost-sharing not to exceed $10,000 per person per year 
  2.34  on group contracts and $15,000 per person per year on individual 
  2.35  contracts. 
  2.36     Subd. 4.  [LIFETIME MAXIMUM BENEFITS.] A health maintenance 
  3.1   contract may provide for a lifetime maximum benefit limit, which 
  3.2   must not be less than $2,500,000. 
  3.3      Subd. 5.  [EXCEPTIONS.] (a) Subdivisions 1 and 2 do not 
  3.4   apply to the extent that another law requires lower enrollee 
  3.5   cost-sharing for specific services than that specified in 
  3.6   subdivisions 1 and 2 or to preventive services as defined in 
  3.7   Minnesota Rules, part 4685.0801, subpart 8. 
  3.8      (b) This section does not apply to the small employer plans 
  3.9   described in section 62L.05 or to plans described in section 
  3.10  62L.055. 
  3.11     Subd. 6.  [INFLATION ADJUSTMENT.] (a) The dollar amounts 
  3.12  stated in subdivisions 1 and 2 must be adjusted for inflation 
  3.13  annually by the commissioner under this subdivision. 
  3.14     (b) The commissioner shall, no later than June 1 of each 
  3.15  year, publish in the State Register a notice stating the 
  3.16  adjusted dollar amounts to become effective on the following 
  3.17  January 1.  If no adjustment is required under this section, the 
  3.18  notice shall so state. 
  3.19     (c) The commissioner shall calculate the inflation 
  3.20  adjustment based upon the consumer price index for all urban 
  3.21  consumers issued by the United States Bureau of Labor Statistics 
  3.22  for the first quarter of the year in which the notice required 
  3.23  under paragraph (b) is to be published.  For purposes of this 
  3.24  calculation, the base period is the first quarter of 2002.  The 
  3.25  dollar amounts calculated must be rounded to the nearest $100.  
  3.26  The first adjustment shall be made by means of a notice 
  3.27  published in 2003. 
  3.28     Sec. 3.  [EFFECTIVE DATE.] 
  3.29     Sections 1 and 2 are effective the day following final 
  3.30  enactment and apply to contracts issued or renewed on or after 
  3.31  that date.