1.1 	A bill for an act
1.2 	relating to commerce; making changes to health plan requirements;amending 
1.3 	Minnesota Statutes 2010, sections 43A.23, subdivision 1; 43A.317, subdivision 
1.4 	6; 62A.03, subdivision 1; 62A.047; 62A.17, subdivision 2; 62A.21, subdivisions 
1.5 	2a, 2b; 62A.25, subdivision 2; 62A.302; 62A.615; 62A.65, subdivisions 5, 6; 
1.6 	62C.14, subdivision 5; 62D.07, subdivision 3; 62D.105; 62E.06, subdivision 1; 
1.7 	62L.02, subdivisions 11, 14a, 19; 62L.03, subdivision 4; 62L.05, subdivision 
1.8 	9; 62Q.01, by adding subdivisions; 62Q.021; 62Q.23; 62Q.43, subdivision 
1.9 	2; 62Q.52; 62Q.55; 62Q.68, subdivision 1; 62Q.69, subdivision 3; 62Q.70, 
1.10 	subdivision 1; 62Q.71; 62Q.73; 62Q.80, subdivision 2; 471.61, subdivision 
1.11 	1a; proposing coding for new law in Minnesota Statutes, chapters 62Q; 72A; 
1.12 	repealing Minnesota Statutes 2010, section 62E.02, subdivision 7.
1.13 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.14 	Section 1. Minnesota Statutes 2010, section 43A.23, subdivision 1, is amended to read:
1.15 		Subdivision 1.General. (a) The commissioner is authorized to request proposals 
1.16 	or to negotiate and to enter into contracts with parties which in the judgment of the 
1.17 	commissioner are best qualified to provide service to the benefit plans. Contracts entered 
1.18 	into are not subject to the requirements of sections 16C.16 to 16C.19. The commissioner 
1.19 	may negotiate premium rates and coverage. The commissioner shall consider the cost of 
1.20 	the plans, conversion options relating to the contracts, service capabilities, character, 
1.21 	financial position, and reputation of the carriers, and any other factors which the 
1.22 	commissioner deems appropriate. Each benefit contract must be for a uniform term of at 
1.23 	least one year, but may be made automatically renewable from term to term in the absence 
1.24 	of notice of termination by either party. A carrier licensed under chapter 62A is exempt 
1.25 	from the taxes imposed by chapter 297I on premiums paid to it by the state.
1.26 	(b) All self-insured hospital and medical service products must comply with coverage 
1.27 	mandates, data reporting, and consumer protection requirements applicable to the licensed 
2.1 	carrier administering the product, had the product been insured, including chapters 62J, 
2.2 	62M, and 62Q. Any self-insured products that limit coverage to a network of providers 
2.3 	or provide different levels of coverage between network and nonnetwork providers shall 
2.4 	comply with section 62D.123 and geographic access standards for health maintenance 
2.5 	organizations adopted by the commissioner of health in rule under chapter 62D.
2.6 	(c) Notwithstanding paragraph (b), a self-insured hospital and medical product 
2.7 	offered under sections 43A.22 to 43A.30 is not required to extend dependent coverage 
2.8 	to an eligible employee's unmarried child under the age of 25 to the full extent required 
2.9 	under chapters 62A and 62L. Dependent child coverage must, at a minimum, extend to an 
2.10 	eligible employee's unmarrieddependent child who is under the age of 19 or an unmarried 
2.11 	child under the age of 25 who is a full-time student. A person who is at least 19 years of 
2.12 	age but who is under the age of 25 and who is not a full-time student must be permitted 
2.13 	to be enrolled as a dependent of an eligible employee until age 25 if the person: to the 
2.14 	limiting age as defined in section 62Q.01, subdivision 7.
2.15 	(1) was a full-time student immediately prior to being ordered into active military 
2.16 	service, as defined in section 190.05, subdivision 5b or 5c;
2.17 	(2) has been separated or discharged from active military service; and
2.18 	(3) would be eligible to enroll as a dependent of an eligible employee, except that 
2.19 	the person is not a full-time student.
2.20 	The definition of "full-time student" for purposes of this paragraph includes any student 
2.21 	who by reason of illness, injury, or physical or mental disability as documented by 
2.22 	a physician is unable to carry what the educational institution considers a full-time 
2.23 	course load so long as the student's course load is at least 60 percent of what otherwise 
2.24 	is considered by the institution to be a full-time course load. Any notice regarding 
2.25 	termination of coverage due to attainment of the limiting age must include information 
2.26 	about this definition of "full-time student."
2.27 	(d) Beginning January 1, 2010, the health insurance benefit plans offered in the 
2.28 	commissioner's plan under section 43A.18, subdivision 2, and the managerial plan under 
2.29 	section 43A.18, subdivision 3, must include an option for a health plan that is compatible 
2.30 	with the definition of a high-deductible health plan in section 223 of the United States 
2.31 	Internal Revenue Code.

2.32 	Sec. 2. Minnesota Statutes 2010, section 43A.317, subdivision 6, is amended to read:
2.33 		Subd. 6.Individual eligibility. (a) Procedures. The commissioner shall establish 
2.34 	procedures for eligible employees and other eligible individuals to apply for coverage 
2.35 	through the program.
3.1 	(b) Employees. An employer shall determine when it applies to the program the 
3.2 	criteria its employees must meet to be eligible for coverage under its plan. An employer 
3.3 	may subsequently change the criteria annually or at other times with approval of the 
3.4 	commissioner. The criteria must provide that new employees become eligible for coverage 
3.5 	after a probationary period of at least 30 days, but no more than 90 days.
3.6 	(c) Other individuals. An employer may elect to cover under its plan:
3.7 	(1) the spouse, dependent children to the limiting age as defined in section 62Q.01, 
3.8 	subdivision 7, and dependent grandchildren of a covered employee;
3.9 	(2) a retiree who is eligible to receive a pension or annuity from the employer and a 
3.10 	covered retiree's spouse, dependent children to the limiting age as defined in section 
3.11 	62Q.01, subdivision 7, and dependent grandchildren;
3.12 	(3) the surviving spouse, dependent children, and dependent grandchildren of a 
3.13 	deceased employee or retiree, if the spouse, children, or grandchildren were covered 
3.14 	at the time of the death;
3.15 	(4) a covered employee who becomes disabled, as provided in sections 62A.147
3.16 	and 62A.148; or
3.17 	(5) any other categories of individuals for whom group coverage is required by 
3.18 	state or federal law.
3.19 	An employer shall determine when it applies to the program the criteria individuals 
3.20 	in these categories must meet to be eligible for coverage. An employer may subsequently 
3.21 	change the criteria annually, or at other times with approval of the commissioner. The 
3.22 	criteria for dependent children to the limiting age as defined in section 62Q.01, subdivision 
3.23 	7, and dependent grandchildren may be no more inclusive than the criteria under section 
3.24 	43A.18, subdivision 2. This paragraph shall not be interpreted as relieving the program 
3.25 	from compliance with any federal and state continuation of coverage requirements.
3.26 	(d) Waiver and late entrance. An eligible individual may waive coverage at the 
3.27 	time the employer joins the program or when coverage first becomes available. The 
3.28 	commissioner may establish a preexisting condition exclusion of not more than 18 months 
3.29 	for late entrants as defined in section 62L.02, subdivision 19.
3.30 	(e) Continuation coverage. The program shall provide all continuation coverage 
3.31 	required by state and federal law.

3.32 	Sec. 3. Minnesota Statutes 2010, section 62A.03, subdivision 1, is amended to read:
3.33 		Subdivision 1.Conditions. No policy of individual accident and sickness insurance 
3.34 	may be delivered or issued for delivery to a person in this state unless:
4.1 	(1) Premium. The entire money and other considerations therefor are expressed 
4.2 	therein.
4.3 	(2) Time effective. The time at which the insurance takes effect and terminates is 
4.4 	expressed therein.
4.5 	(3) One person. It purports to insure only one person, except that a policy may 
4.6 	insure, originally or by subsequent amendment, upon the application of an adult member 
4.7 	of a family deemed the policyholder, any two or more eligible members of that family, 
4.8 	including:
4.9 	(a) husband,
4.10 	(b) wife,
4.11 	(c) dependent children to the limiting age as defined in section 62Q.01, subdivision 
4.12 	7, or
4.13 	(d) any children under a specified age of 19 years or less, or
4.14 	(e) (d) any other person dependent upon the policyholder.
4.15 	(4) Appearance. The style, arrangement, and overall appearance of the policy give 
4.16 	no undue prominence to any portion of the text and every printed portion of the text of the 
4.17 	policy and of any endorsements or attached papers is plainly printed in light-face type 
4.18 	of a style in general use. The type size must be uniform and not less than ten point with 
4.19 	a lowercase unspaced alphabet length not less than 120 point. The "text" includes all 
4.20 	printed matter except the name and address of the insurer, name or title of the policy, the 
4.21 	brief description, if any, the reference to renewal or cancellation by a separate statement, 
4.22 	if any, and the captions and subcaptions.
4.23 	(5) Description of policy. The policy, on the first page, indicates or refers to its 
4.24 	provisions for renewal or cancellation either in the brief description, if any, or by a separate 
4.25 	statement printed in type not smaller than the type used for captions or a separate provision 
4.26 	bearing a caption which accurately describes the renewability or cancelability of the policy.
4.27 	(6) Exceptions in policy. The exceptions and reductions of indemnity are set 
4.28 	forth in the policy and, except those which are set forth in section 62A.04, printed, at 
4.29 	the insurer's option, either with the benefit provision to which they apply, or under an 
4.30 	appropriate caption such as "EXCEPTIONS" or "EXCEPTIONS AND REDUCTIONS." 
4.31 	However, if an exception or reduction specifically applies only to a particular benefit of 
4.32 	the policy, a statement of the exception or reduction must be included with the benefit 
4.33 	provision to which it applies.
4.34 	(7) Form number. Each form, including riders and endorsements, is identified by a 
4.35 	form number in the lower left hand corner of the first page thereof.
5.1 	(8) No incorporation by reference. It contains no provision purporting to make 
5.2 	any portion of the charter, rules, constitution, or bylaws of the insurer a part of the policy 
5.3 	unless the portion is set forth in full in the policy, except in the case of the incorporation 
5.4 	of, or reference to, a statement of rates, classification of risks, or short rate table filed 
5.5 	with the commissioner.
5.6 	(9) Medical benefits. If the policy contains a provision for medical expense benefits, 
5.7 	the term "medical benefits" or similar terms as used therein includes treatments by all 
5.8 	licensed practitioners of the healing arts unless, subject to the qualifications contained in 
5.9 	clause (10), the policy specifically states the practitioners whose services are covered.
5.10 	(10) Osteopath, optometrist, chiropractor, or registered nurse services. With 
5.11 	respect to any policy of individual accident and sickness insurance issued or entered 
5.12 	into subsequent to August 1, 1974, notwithstanding the provisions of the policy, if it 
5.13 	contains a provision providing for reimbursement for any service which is in the lawful 
5.14 	scope of practice of a duly licensed osteopath, optometrist, chiropractor, or registered 
5.15 	nurse meeting the requirements of section 62A.15, subdivision 3a, the person entitled to 
5.16 	benefits or person performing services under the policy is entitled to reimbursement on an 
5.17 	equal basis for the service, whether the service is performed by a physician, osteopath, 
5.18 	optometrist, chiropractor, or registered nurse meeting the requirements of section 62A.15, 
5.19 	subdivision 3a, licensed under the laws of this state.

5.20 	Sec. 4. Minnesota Statutes 2010, section 62A.047, is amended to read:
5.21 	62A.047 CHILDREN'S HEALTH SUPERVISION SERVICES AND 
5.22 	PRENATAL CARE SERVICES.
5.23 	A policy of individual or group health and accident insurance regulated under this 
5.24 	chapter, or individual or group subscriber contract regulated under chapter 62C, health 
5.25 	maintenance contract regulated under chapter 62D, or health benefit certificate regulated 
5.26 	under chapter 64B, issued, renewed, or continued to provide coverage to a Minnesota 
5.27 	resident, must provide coverage for child health supervision services and prenatal care 
5.28 	services. The policy, contract, or certificate must specifically exempt reasonable and 
5.29 	customary charges for child health supervision services and prenatal care services from a 
5.30 	deductible, co-payment, or other coinsurance or dollar limitation requirement. Nothing 
5.31 	in this section prohibits a health plan company that has a network of providers from 
5.32 	imposing a deductible, co-payment, or other coinsurance or dollar limitation requirement 
5.33 	for child health supervision services and prenatal care services that are delivered by an 
5.34 	out-of-network provider. This section does not prohibit the use of policy waiting periods 
5.35 	or preexisting condition limitations for these services. Minimum benefits may be limited 
6.1 	to one visit payable to one provider for all of the services provided at each visit cited in 
6.2 	this section subject to the schedule set forth in this section. Nothing in this section applies 
6.3 	to a commercial health insurance policy issued as a companion to a health maintenance 
6.4 	organization contract, a policy designed primarily to provide coverage payable on a 
6.5 	per diem, fixed indemnity, or nonexpense incurred basis, or a policy that provides 
6.6 	only accident coverage. Nothing in this section prevents a health plan company from 
6.7 	using reasonable medical management techniques to determine the frequency, method, 
6.8 	treatment, or setting for child health supervision services and prenatal care services.
6.9 	A policy, contract, or certificate described under this section may not apply 
6.10 	preexisting condition limitations to individuals under 19 years of age. This paragraph 
6.11 	does not apply to individual coverage that is grandfathered plan coverage, as defined 
6.12 	in section 62Q.01, subdivision 9.
6.13 	"Child health supervision services" means pediatric preventive services, appropriate 
6.14 	immunizations, developmental assessments, and laboratory services appropriate to the age 
6.15 	of a child from birth to age six, and appropriate immunizations from ages six to 18, as 
6.16 	defined by Standards of Child Health Care issued by the American Academy of Pediatrics. 
6.17 	Reimbursement must be made for at least five child health supervision visits from birth 
6.18 	to 12 months, three child health supervision visits from 12 months to 24 months, once a 
6.19 	year from 24 months to 72 months.
6.20 	"Prenatal care services" means the comprehensive package of medical and 
6.21 	psychosocial support provided throughout the pregnancy, including risk assessment, 
6.22 	serial surveillance, prenatal education, and use of specialized skills and technology, 
6.23 	when needed, as defined by Standards for Obstetric-Gynecologic Services issued by the 
6.24 	American College of Obstetricians and Gynecologists.

6.25 	Sec. 5. Minnesota Statutes 2010, section 62A.17, subdivision 2, is amended to read:
6.26 		Subd. 2.Responsibility of employee. Every covered employee electing to continue 
6.27 	coverage shall pay the former employer, on a monthly basis, the cost of the continued 
6.28 	coverage. The policy, contract, or plan must require the group policyholder or contract 
6.29 	holder to, upon request, provide the employee with written verification from the insurer 
6.30 	of the cost of this coverage promptly at the time of eligibility for this coverage and at 
6.31 	any time during the continuation period. If the policy, contract, or health care plan is 
6.32 	administered by a trust, every covered employee electing to continue coverage shall pay 
6.33 	the trust the cost of continued coverage according to the eligibility rules established by the 
6.34 	trust. In no event shall the amount of premium charged exceed 102 percent of the cost 
6.35 	to the plan for such period of coverage for similarly situated employees with respect to 
7.1 	whom neither termination nor layoff has occurred, without regard to whether such cost 
7.2 	is paid by the employer or employee. The employee shall be eligible to continue the 
7.3 	coverage until the employee becomes covered under another group health plan, or for a 
7.4 	period of 18 months after the termination of or lay off from employment, whichever is 
7.5 	shorter. For an individual age 19 or older, if the employee becomes covered under another 
7.6 	group policy, contract, or health plan and the new group policy, contract, or health plan 
7.7 	contains any preexisting condition limitations, the employee may, subject to the 18-month 
7.8 	maximum continuation limit, continue coverage with the former employer until the 
7.9 	preexisting condition limitations have been satisfied. The new policy, contract, or health 
7.10 	plan is primary except as to the preexisting condition. In the case of a newborn child who 
7.11 	is a dependent of the employee, the new policy, contract, or health plan is primary upon 
7.12 	the date of birth of the child, regardless of which policy, contract, or health plan coverage 
7.13 	is deemed primary for the mother of the child.

7.14 	Sec. 6. Minnesota Statutes 2010, section 62A.21, subdivision 2a, is amended to read:
7.15 		Subd. 2a.Continuation privilege. Every policy described in subdivision 1 shall 
7.16 	contain a provision which permits continuation of coverage under the policy for the 
7.17 	insured's former spouse and dependent children uponto the limiting age as defined 
7.18 	in section 62Q.01, subdivision 7, who were covered on the day before entry of a valid 
7.19 	decree of dissolution of marriage. The coverage shall be continued until the earlier of 
7.20 	the following dates:
7.21 	(a) the date the insured's former spouse becomes covered under any other group 
7.22 	health plan; or
7.23 	(b) the date coverage would otherwise terminate under the policy.
7.24 	If the coverage is provided under a group policy, any required premium contributions 
7.25 	for the coverage shall be paid by the insured on a monthly basis to the group policyholder 
7.26 	for remittance to the insurer. The policy must require the group policyholder to, upon 
7.27 	request, provide the insured with written verification from the insurer of the cost of this 
7.28 	coverage promptly at the time of eligibility for this coverage and at any time during the 
7.29 	continuation period. In no event shall the amount of premium charged exceed 102 percent 
7.30 	of the cost to the plan for such period of coverage for other similarly situated spouses and 
7.31 	dependent children to the limiting age as defined in section 62Q.01, subdivision 7, with 
7.32 	respect to whom the marital relationship has not dissolved, without regard to whether such 
7.33 	cost is paid by the employer or employee.
7.34 	Upon request by the insured's former spouse or dependent child to the limiting age 
7.35 	as defined in section 62Q.01, subdivision 7, who was covered on the day before entry of 
8.1 	a valid decree of dissolution, a health carrier must provide the instructions necessary to 
8.2 	enable the child or former spouse to elect continuation of coverage.

8.3 	Sec. 7. Minnesota Statutes 2010, section 62A.21, subdivision 2b, is amended to read:
8.4 		Subd. 2b.Conversion privilege. Every policy described in subdivision 1 shall 
8.5 	contain a provision allowing a former spouse and dependent children to the limiting age 
8.6 	as defined in section 62Q.01, subdivision 7, of an insured who were covered on the day 
8.7 	before entry of a valid decree of dissolution, without providing evidence of insurability, to 
8.8 	obtain from the insurer at the expiration of any continuation of coverage required under 
8.9 	subdivision 2a or sections 62A.146 and 62A.20, conversion coverage providing at least 
8.10 	the minimum benefits of a qualified plan as prescribed by section 62E.06 and the option of 
8.11 	a number three qualified plan, a number two qualified plan, a number one qualified plan 
8.12 	as provided by section 62E.06, subdivisions 1 to 3, provided application is made to the 
8.13 	insurer within 30 days following notice of the expiration of the continued coverage and 
8.14 	upon payment of the appropriate premium. The individual policy shall be renewable at the 
8.15 	option of the covered person as long as the covered person is not covered under another 
8.16 	qualified plan as defined in section 62E.02, subdivision 4. Any revisions in the table of 
8.17 	rate for the individual policy shall apply to the covered person's original age at entry and 
8.18 	shall apply equally to all similar policies issued by the insurer. 
8.19 	A policy providing reduced benefits at a reduced premium rate may be accepted by 
8.20 	the covered person in lieu of the optional coverage otherwise required by this subdivision.

8.21 	Sec. 8. Minnesota Statutes 2010, section 62A.25, subdivision 2, is amended to read:
8.22 		Subd. 2.Required coverage. (a) Every policy, plan, certificate or contract to which 
8.23 	this section applies shall provide benefits for reconstructive surgery when such service is 
8.24 	incidental to or follows surgery resulting from injury, sickness or other diseases of the 
8.25 	involved part or when such service is performed on a covered dependent child to the 
8.26 	limiting age as defined in section 62Q.01, subdivision 7, because of congenital disease 
8.27 	or anomaly which has resulted in a functional defect as determined by the attending 
8.28 	physician.
8.29 	(b) The coverage limitations on reconstructive surgery in paragraph (a) do not apply 
8.30 	to reconstructive breast surgery following mastectomies. In these cases, coverage for 
8.31 	reconstructive surgery must be provided if the mastectomy is medically necessary as 
8.32 	determined by the attending physician.
8.33 	(c) Reconstructive surgery benefits include all stages of reconstruction of the breast 
8.34 	on which the mastectomy has been performed, surgery and reconstruction of the other 
9.1 	breast to produce a symmetrical appearance, and prosthesis and physical complications 
9.2 	at all stages of a mastectomy, including lymphedemas, in a manner determined in 
9.3 	consultation with the attending physician and patient. Coverage may be subject to annual 
9.4 	deductible, co-payment, and coinsurance provisions as may be deemed appropriate and 
9.5 	as are consistent with those established for other benefits under the plan or coverage. 
9.6 	Coverage may not:
9.7 	(1) deny to a patient eligibility, or continued eligibility, to enroll or to renew 
9.8 	coverage under the terms of the plan, solely for the purpose of avoiding the requirements 
9.9 	of this section; and
9.10 	(2) penalize or otherwise reduce or limit the reimbursement of an attending provider, 
9.11 	or provide monetary or other incentives to an attending provider to induce the provider 
9.12 	to provide care to an individual participant or beneficiary in a manner inconsistent with 
9.13 	this section.
9.14 	Written notice of the availability of the coverage must be delivered to the participant 
9.15 	upon enrollment and annually thereafter.

9.16 	Sec. 9. Minnesota Statutes 2010, section 62A.302, is amended to read:
9.17 	62A.302 COVERAGE OF DEPENDENTS.
9.18 		Subdivision 1.Scope of coverage. This section applies to:
9.19 	(1) a health plan as defined in section 62A.011; and
9.20 	(2) coverage described in section 62A.011, subdivision 3, clauses (4), (6), (7), (8), 
9.21 	(9), and (10); and 
9.22 	(3) (2) a policy, contract, or certificate issued by a community integrated service 
9.23 	network licensed under chapter 62N.
9.24 		Subd. 2.Required coverage. Every health plan included in subdivision 1 that 
9.25 	provides dependent coverage must define "dependent" no more restrictively than the 
9.26 	definition provided in section 62L.02. 
9.27 		Subd. 3.Coverage of dependents by plans other than health plans.
 9.28 	Notwithstanding subdivision 2, the following definition of dependent applies to coverage 
9.29 	described in section 62A.011, subdivision 3, clauses (4), (6), (7), (8), (9), and (10); 
9.30 	and plans offered by the Minnesota Comprehensive Health Association. "Dependent" 
9.31 	means an eligible employee's spouse, unmarried child who is under the age of 25 years, 
9.32 	dependent child of any age who is disabled and who meets the eligibility criteria in section 
9.33 	62A.14, subdivision 2, or any other person whom state or federal law requires to be treated 
9.34 	as a dependent. For the purpose of this definition, a child includes a child for whom the 
10.1 	employee or the employee's spouse has been appointed legal guardian and an adoptive 
10.2 	child as provided in section 62A.27.
10.3 		Subd. 4.Grandchildren. Nothing in this section shall be construed to require a 
10.4 	health carrier to make coverage available for a grandchild unless the grandchild meets the 
10.5 	requirements of section 62A.042. Coverage for grandchildren enrolled pursuant to section 
10.6 	62A.042 terminates when the first of the following occurs:
10.7 	(1) the grandchild does not continue to reside with the covered grandparent;
10.8 	(2) the grandparent does not provide the majority of the grandchild's support; or
10.9 	(3) the grandchild reaches age 25, except as provided in section 62A.14.

10.10 	Sec. 10. Minnesota Statutes 2010, section 62A.615, is amended to read:
10.11 	62A.615 PREEXISTING CONDITIONS DISCLOSED AT TIME OF 
10.12 	APPLICATION.
10.13 	No insurer may cancel or rescind a health insurance policy for a preexisting 
10.14 	condition of which the application or other information provided by the insured reasonably 
10.15 	gave the insurer notice. No insurer may restrict coverage for a preexisting condition of 
10.16 	which the application or other information provided by the insured reasonably gave the 
10.17 	insurer notice unless the coverage is restricted at the time the policy is issued and the 
10.18 	restriction is disclosed in writing to the insured at the time the policy is issued.
10.19 	In addition, no health plan may restrict coverage for a preexisting condition for an 
10.20 	individual who is under 19 years of age. This paragraph does not apply to individual 
10.21 	coverage that is grandfathered plan coverage, as defined in section 62Q.01, subdivision 9.

10.22 	Sec. 11. Minnesota Statutes 2010, section 62A.65, subdivision 5, is amended to read:
10.23 		Subd. 5.Portability and conversion of coverage. (a) No individual health plan 
10.24 	may be offered, sold, issued, or with respect to children age 18 or under renewed, to a 
10.25 	Minnesota resident that contains a preexisting condition limitation, preexisting condition 
10.26 	exclusion, or exclusionary rider, unless the limitation or exclusion is permitted under 
10.27 	this subdivision and under chapter 62L, provided that, except for children age 18 or 
10.28 	under, underwriting restrictions may be retained on individual contracts that are issued 
10.29 	without evidence of insurability as a replacement for prior individual coverage that 
10.30 	was sold before May 17, 1993. The. An individual age 19 or older may be subjected 
10.31 	to an 18-month preexisting condition limitation, unless the individual has maintained 
10.32 	continuous coverage as defined in section 62L.02. The individual must not be subjected 
10.33 	to an exclusionary rider. An individual who is age 19 or older and who has maintained 
10.34 	continuous coverage may be subjected to a onetime preexisting condition limitation of 
11.1 	up to 12 months, with credit for time covered under qualifying coverage as defined in 
11.2 	section 62L.02, at the time that the individual first is covered under an individual health 
11.3 	plan by any health carrier. Credit must be given for all qualifying coverage with respect 
11.4 	to all preexisting conditions, regardless of whether the conditions were preexisting with 
11.5 	respect to any previous qualifying coverage. The individual must not be subjected to an 
11.6 	exclusionary rider. Thereafter, the individual who is age 19 or older must not be subject to 
11.7 	any preexisting condition limitation, preexisting condition exclusion, or exclusionary rider 
11.8 	under an individual health plan by any health carrier, except an unexpired portion of a 
11.9 	limitation under prior coverage, so long as the individual maintains continuous coverage 
11.10 	as defined in section 62L.02. The prohibition on preexisting condition limitations for 
11.11 	children age 18 or under does not apply to individual coverage that is grandfathered plan 
11.12 	coverage, as defined in section 62Q.01, subdivision 9.
11.13 	(b) A health carrier must offer an individual health plan to any individual previously 
11.14 	covered under a group health plan issued by that health carrier, regardless of the size of 
11.15 	the group, so long as the individual maintained continuous coverage as defined in section 
11.16 	62L.02. If the individual has available any continuation coverage provided under sections 
11.17 	62A.146; 62A.148; 62A.17, subdivisions 1 and 2; 62A.20; 62A.21; 62C.142; 62D.101; or 
11.18 	62D.105, or continuation coverage provided under federal law, the health carrier need not 
11.19 	offer coverage under this paragraph until the individual has exhausted the continuation 
11.20 	coverage. The offer must not be subject to underwriting, except as permitted under this 
11.21 	paragraph. A health plan issued under this paragraph must be a qualified plan as defined 
11.22 	in section 62E.02 and must not contain any preexisting condition limitation, preexisting 
11.23 	condition exclusion, or exclusionary rider, except for any unexpired limitation or 
11.24 	exclusion under the previous coverage. The individual health plan must cover pregnancy 
11.25 	on the same basis as any other covered illness under the individual health plan. The offer 
11.26 	of coverage by the health carrier must inform the individual that the coverage, including 
11.27 	what is covered and the health care providers from whom covered care may be obtained, 
11.28 	may not be the same as the individual's coverage under the group health plan. The offer 
11.29 	of coverage by the health carrier must also inform the individual that the individual, if 
11.30 	a Minnesota resident, may be eligible to obtain coverage from (i) other private sources 
11.31 	of health coverage, or (ii) the Minnesota Comprehensive Health Association, without a 
11.32 	preexisting condition limitation, and must provide the telephone number used by that 
11.33 	association for enrollment purposes. The initial premium rate for the individual health 
11.34 	plan must comply with subdivision 3. The premium rate upon renewal must comply with 
11.35 	subdivision 2. In no event shall the premium rate exceed 100 percent of the premium 
11.36 	charged for comparable individual coverage by the Minnesota Comprehensive Health 
12.1 	Association, and the premium rate must be less than that amount if necessary to otherwise 
12.2 	comply with this section. An individual health plan offered under this paragraph to a 
12.3 	person satisfies the health carrier's obligation to offer conversion coverage under section 
12.4 	62E.16, with respect to that person. Coverage issued under this paragraph must provide 
12.5 	that it cannot be canceled or nonrenewed as a result of the health carrier's subsequent 
12.6 	decision to leave the individual, small employer, or other group market. Section 72A.20, 
12.7 	subdivision 28, applies to this paragraph. 

12.8 	Sec. 12. Minnesota Statutes 2010, section 62A.65, subdivision 6, is amended to read:
12.9 		Subd. 6.Guaranteed issue not required. Nothing in this section requires a health 
12.10 	carrier to initially issue a health plan to a Minnesota resident who is age 19 or older on 
12.11 	the date the health plan becomes effective, except as otherwise expressly provided in 
12.12 	subdivision 4 or 5.

12.13 	Sec. 13. Minnesota Statutes 2010, section 62C.14, subdivision 5, is amended to read:
12.14 		Subd. 5.Disabled dependents. A subscriber's individual contract or any group 
12.15 	contract delivered or issued for delivery in this state and providing that coverage of 
12.16 	a dependent child of the subscriber or a dependent child of a covered group member 
12.17 	shall terminate upon attainment of a specified limiting age as defined in section 62Q.01, 
12.18 	subdivision 7, shall also provide in substance that attainment of that age shall not terminate 
12.19 	coverage while the child is (a) incapable of self-sustaining employment by reason of 
12.20 	developmental disability, mental illness or disorder, or physical disability, and (b) chiefly 
12.21 	dependent upon the subscriber or employee for support and maintenance, provided proof 
12.22 	of incapacity and dependency is furnished by the subscriber within 31 days of attainment 
12.23 	of the limiting age as defined in section 62Q.01, subdivision 7, and subsequently as 
12.24 	required by the corporation, but not more frequently than annually after a two-year period 
12.25 	following attainment of the age. Any notice regarding termination of coverage due to 
12.26 	attainment of the limiting age must include information about this provision.

12.27 	Sec. 14. Minnesota Statutes 2010, section 62D.07, subdivision 3, is amended to read:
12.28 		Subd. 3.Required provisions. Contracts and evidences of coverage shall contain:
12.29 	(a) no provisions or statements which are unjust, unfair, inequitable, misleading, 
12.30 	deceptive, or which are untrue, misleading, or deceptive as defined in section 62D.12, 
12.31 	subdivision 1; 
12.32 	(b) a clear, concise and complete statement of:
13.1 	(1) the health care services and the insurance or other benefits, if any, to which the 
13.2 	enrollee is entitled under the health maintenance contract;
13.3 	(2) any exclusions or limitations on the services, kind of services, benefits, or kind of 
13.4 	benefits, to be provided, including any deductible or co-payment feature and requirements 
13.5 	for referrals, prior authorizations, and second opinions;
13.6 	(3) where and in what manner information is available as to how services, including 
13.7 	emergency and out of area services, may be obtained;
13.8 	(4) the total amount of payment and co-payment, if any, for health care services 
13.9 	and the indemnity or service benefits, if any, which the enrollee is obligated to pay 
13.10 	with respect to individual contracts, or an indication whether the plan is contributory or 
13.11 	noncontributory with respect to group certificates; and
13.12 	(5) a description of the health maintenance organization's method for resolving 
13.13 	enrollee complaints and a statement identifying the commissioner as an external source 
13.14 	with whom complaints may be registered; and
13.15 	(c) on the cover page of the evidence of coverage and contract, a clear and complete 
13.16 	statement of enrollees' rights. The statement must be in bold print and captioned 
13.17 	"Important Enrollee Information and Enrollee Bill of Rights" and must include but not be 
13.18 	limited to the following provisions in the following language or in substantially similar 
13.19 	language approved in advance by the commissioner, except that paragraph (8) does not 
13.20 	apply to prepaid health plans providing coverage for programs administered by the 
13.21 	commissioner of human services:
13.22 	ENROLLEE INFORMATION
13.23 	(1) COVERED SERVICES: Services provided by (name of health maintenance 
13.24 	organization) will be covered only if services are provided by participating (name of 
13.25 	health maintenance organization) providers or authorized by (name of health maintenance 
13.26 	organization). Your contract fully defines what services are covered and describes 
13.27 	procedures you must follow to obtain coverage.
13.28 	(2) PROVIDERS: Enrolling in (name of health maintenance organization) does not 
13.29 	guarantee services by a particular provider on the list of providers. When a provider is 
13.30 	no longer part of (name of health maintenance organization), you must choose among 
13.31 	remaining (name of the health maintenance organization) providers.
13.32 	(3) REFERRALS: Certain services are covered only upon referral. See section 
13.33 	(section number) of your contract for referral requirements. All referrals to non-(name of 
13.34 	health maintenance organization) providers and certain types of health care providers must 
13.35 	be authorized by (name of health maintenance organization).
14.1 	(4) EMERGENCY SERVICES: Emergency services from providers who are not 
14.2 	affiliated with (name of health maintenance organization) will be covered only if proper 
14.3 	procedures are followed. Your contract explains the procedures and benefits associated 
14.4 	with emergency care from (name of health maintenance organization) and non-(name of 
14.5 	health maintenance organization) providers.
14.6 	(5) EXCLUSIONS: Certain services or medical supplies are not covered. You 
14.7 	should read the contract for a detailed explanation of all exclusions.
14.8 	(6) CONTINUATION: You may convert to an individual health maintenance 
14.9 	organization contract or continue coverage under certain circumstances. These 
14.10 	continuation and conversion rights are explained fully in your contract.
14.11 	(7) CANCELLATION: Your coverage may be canceled by you or (name of health 
14.12 	maintenance organization) only under certain conditions. Your contract describes all 
14.13 	reasons for cancellation of coverage.
14.14 	(8) NEWBORN COVERAGE: If your health plan provides for dependent coverage, 
14.15 	a newborn infant is covered from birth, but only if services are provided by participating 
14.16 	(name of health maintenance organization) providers or authorized by (name of health 
14.17 	maintenance organization). Certain services are covered only upon referral. (Name 
14.18 	of health maintenance organization) will not automatically know of the infant's birth 
14.19 	or that you would like coverage under your plan. You should notify (name of health 
14.20 	maintenance organization) of the infant's birth and that you would like coverage. If your 
14.21 	contract requires an additional premium for each dependent, (name of health maintenance 
14.22 	organization) is entitled to all premiums due from the time of the infant's birth until the 
14.23 	time you notify (name of health maintenance organization) of the birth. (Name of health 
14.24 	maintenance organization) may withhold payment of any health benefits for the newborn 
14.25 	infant until any premiums you owe are paid.
14.26 	(9) PRESCRIPTION DRUGS AND MEDICAL EQUIPMENT: Enrolling in (name 
14.27 	of health maintenance organization) does not guarantee that any particular prescription 
14.28 	drug will be available nor that any particular piece of medical equipment will be available, 
14.29 	even if the drug or equipment is available at the start of the contract year.
14.30 	ENROLLEE BILL OF RIGHTS
14.31 	(1) Enrollees have the right to available and accessible services including emergency 
14.32 	services, as defined in your contract, 24 hours a day and seven days a week;
14.33 	(2) Enrollees have the right to be informed of health problems, and to receive 
14.34 	information regarding treatment alternatives and risks which is sufficient to assure 
14.35 	informed choice;
15.1 	(3) Enrollees have the right to refuse treatment, and the right to privacy of medical 
15.2 	and financial records maintained by the health maintenance organization and its health 
15.3 	care providers, in accordance with existing law;
15.4 	(4) Enrollees have the right to file a complaint with the health maintenance 
15.5 	organization and the commissioner of health and the right to initiate a legal proceeding 
15.6 	when experiencing a problem with the health maintenance organization or its health 
15.7 	care providers;
15.8 	(5) Enrollees have the right to a grace period of 31 days for the payment of each 
15.9 	premium for an individual health maintenance contract falling due after the first premium 
15.10 	during which period the contract shall continue in force;
15.11 	(6) Medicare enrollees have the right to voluntarily disenroll from the health 
15.12 	maintenance organization and the right not to be requested or encouraged to disenroll 
15.13 	except in circumstances specified in federal law; and
15.14 	(7) Medicare enrollees have the right to a clear description of nursing home and 
15.15 	home care benefits covered by the health maintenance organization.

15.16 	Sec. 15. Minnesota Statutes 2010, section 62D.105, is amended to read:
15.17 	62D.105 COVERAGE OF CURRENT SPOUSE AND CHILDREN.
15.18 		Subdivision 1.Requirement. Every health maintenance contract, which in addition 
15.19 	to covering the enrollee also provides coverage to the spouse and dependent children to the 
15.20 	limiting age as defined in section 62Q.01, subdivision 7, of the enrollee who were covered 
15.21 	on the day before entry of a valid decree of dissolution shall: (1) permit the spouse and 
15.22 	dependent children to the limiting age as defined in section 62Q.01, subdivision 7, to 
15.23 	elect to continue coverage when the enrollee becomes enrolled for benefits under title 
15.24 	XVIII of the Social Security Act (Medicare); and (2) permit the dependent children to 
15.25 	continue coverage when they cease to be dependent children to the limiting age as defined 
15.26 	in section 62Q.01, subdivision 7, under the generally applicable requirement of the plan.
15.27 		Subd. 2.Continuation privilege. The coverage described in subdivision 1 may be 
15.28 	continued until the earlier of the following dates:
15.29 	(1) the date coverage would otherwise terminate under the contract;
15.30 	(2) 36 months after continuation by the spouse or dependent was elected; or
15.31 	(3) the date the spouse or dependent children become covered under another group 
15.32 	health plan or Medicare.
15.33 	If coverage is provided under a group policy, any required fees for the coverage shall 
15.34 	be paid by the enrollee on a monthly basis to the group contract holder for remittance 
15.35 	to the health maintenance organization. In no event shall the fee charged exceed 102 
16.1 	percent of the cost to the plan for such coverage for other similarly situated spouse and 
16.2 	dependent children to the limiting age as defined in section 62Q.01, subdivision 7, to 
16.3 	whom subdivision 1 is not applicable, without regard to whether such cost is paid by the 
16.4 	employer or employee.

16.5 	Sec. 16. Minnesota Statutes 2010, section 62E.06, subdivision 1, is amended to read:
16.6 		Subdivision 1.Number three plan. A plan of health coverage shall be certified as a 
16.7 	number three qualified plan if it otherwise meets the requirements established by chapters 
16.8 	62A, 62C, and 62Q, and the other laws of this state, whether or not the policy is issued in 
16.9 	Minnesota, and meets or exceeds the following minimum standards:
16.10 	(a) The minimum benefits for a covered individual shall, subject to the other 
16.11 	provisions of this subdivision, be equal to at least 80 percent of the cost of covered 
16.12 	services in excess of an annual deductible which does not exceed $150 per person. The 
16.13 	coverage shall include a limitation of $3,000 per person on total annual out-of-pocket 
16.14 	expenses for services covered under this subdivision. The coverage shall be subject to 
16.15 	a maximum lifetime benefit of not less than $1,000,000.
16.16 	The $3,000 limitation on total annual out-of-pocket expenses and the $1,000,000 
16.17 	maximum lifetime benefit shall not be subject to change or substitution by use of an 
16.18 	actuarially equivalent benefit.
16.19 	(b) Covered expenses shall be the usual and customary charges for the following 
16.20 	services and articles when prescribed by a physician:
16.21 	(1) hospital services;
16.22 	(2) professional services for the diagnosis or treatment of injuries, illnesses, or 
16.23 	conditions, other than dental, which are rendered by a physician or at the physician's 
16.24 	direction;
16.25 	(3) drugs requiring a physician's prescription;
16.26 	(4) services of a nursing home for not more than 120 days in a year if the services 
16.27 	would qualify as reimbursable services under Medicare;
16.28 	(5) services of a home health agency if the services would qualify as reimbursable 
16.29 	services under Medicare;
16.30 	(6) use of radium or other radioactive materials;
16.31 	(7) oxygen;
16.32 	(8) anesthetics;
16.33 	(9) prostheses other than dental but including scalp hair prostheses worn for hair 
16.34 	loss suffered as a result of alopecia areata;
17.1 	(10) rental or purchase, as appropriate, of durable medical equipment other than 
17.2 	eyeglasses and hearing aids, unless coverage is required under section 62Q.675; 
17.3 	(11) diagnostic x-rays and laboratory tests;
17.4 	(12) oral surgery for partially or completely unerupted impacted teeth, a tooth root 
17.5 	without the extraction of the entire tooth, or the gums and tissues of the mouth when not 
17.6 	performed in connection with the extraction or repair of teeth;
17.7 	(13) services of a physical therapist;
17.8 	(14) transportation provided by licensed ambulance service to the nearest facility 
17.9 	qualified to treat the condition; or a reasonable mileage rate for transportation to a kidney 
17.10 	dialysis center for treatment; and
17.11 	(15) services of an occupational therapist.
17.12 	(c) Covered expenses for the services and articles specified in this subdivision do 
17.13 	not include the following:
17.14 	(1) any charge for care for injury or disease either (i) arising out of an injury in the 
17.15 	course of employment and subject to a workers' compensation or similar law, (ii) for 
17.16 	which benefits are payable without regard to fault under coverage statutorily required 
17.17 	to be contained in any motor vehicle, or other liability insurance policy or equivalent 
17.18 	self-insurance, or (iii) for which benefits are payable under another policy of accident and 
17.19 	health insurance, Medicare, or any other governmental program except as otherwise 
17.20 	provided by section 62A.04, subdivision 3, clause (4); 
17.21 	(2) any charge for treatment for cosmetic purposes other than for reconstructive 
17.22 	surgery when such service is incidental to or follows surgery resulting from injury, 
17.23 	sickness, or other diseases of the involved part or when such service is performed on a 
17.24 	covered dependent child to the limiting age as defined in section 62Q.01, subdivision 
17.25 	7, because of congenital disease or anomaly which has resulted in a functional defect 
17.26 	as determined by the attending physician;
17.27 	(3) care which is primarily for custodial or domiciliary purposes which would not 
17.28 	qualify as eligible services under Medicare;
17.29 	(4) any charge for confinement in a private room to the extent it is in excess of 
17.30 	the institution's charge for its most common semiprivate room, unless a private room is 
17.31 	prescribed as medically necessary by a physician, provided, however, that if the institution 
17.32 	does not have semiprivate rooms, its most common semiprivate room charge shall be 
17.33 	considered to be 90 percent of its lowest private room charge;
17.34 	(5) that part of any charge for services or articles rendered or prescribed by a 
17.35 	physician, dentist, or other health care personnel which exceeds the prevailing charge in 
17.36 	the locality where the service is provided; and
18.1 	(6) any charge for services or articles the provision of which is not within the scope 
18.2 	of authorized practice of the institution or individual rendering the services or articles.
18.3 	(d) The minimum benefits for a qualified plan shall include, in addition to those 
18.4 	benefits specified in clauses (a) and (e), benefits for well baby care, effective July 1, 
18.5 	1980, subject to applicable deductibles, coinsurance provisions, and maximum lifetime 
18.6 	benefit limitations.
18.7 	(e) Effective July 1, 1979, the minimum benefits of a qualified plan shall include, in 
18.8 	addition to those benefits specified in clause (a), a second opinion from a physician on 
18.9 	all surgical procedures expected to cost a total of $500 or more in physician, laboratory, 
18.10 	and hospital fees, provided that the coverage need not include the repetition of any 
18.11 	diagnostic tests.
18.12 	(f) Effective August 1, 1985, the minimum benefits of a qualified plan must include, 
18.13 	in addition to the benefits specified in clauses (a), (d), and (e), coverage for special dietary 
18.14 	treatment for phenylketonuria when recommended by a physician.
18.15 	(g) Outpatient mental health coverage is subject to section 62A.152, subdivision 2. 

18.16 	Sec. 17. Minnesota Statutes 2010, section 62L.02, subdivision 11, is amended to read:
18.17 		Subd. 11.Dependent. "Dependent" means an eligible employee's spouse, unmarried 
18.18 	child who is under the age of 25 years dependent child to the limiting age as defined in 
18.19 	section 62Q.01, subdivision 7, dependent child of any age who is disabled and who meets 
18.20 	the eligibility criteria in section 62A.14, subdivision 2, or any other person whom state 
18.21 	or federal law requires to be treated as a dependent for purposes of health plans. For the 
18.22 	purpose of this definition, a dependent child to the limiting age as defined in section 
18.23 	62Q.01, subdivision 7, includes a child for whom the employee or the employee's spouse 
18.24 	has been appointed legal guardian and an adoptive child as provided in section 62A.27.

18.25 	Sec. 18. Minnesota Statutes 2010, section 62L.02, subdivision 14a, is amended to read:
18.26 		Subd. 14a.Guaranteed issue. "Guaranteed issue" means that a health carrier shall 
18.27 	not decline an application by a small employer for any health benefit plan offered by 
18.28 	that health carrier and shall not decline to cover under a health benefit plan any eligible 
18.29 	employee or eligible dependent, including persons who become eligible employees or 
18.30 	eligible dependents after initial issuance of the health benefit plan, subject to the health 
18.31 	carrier's right to impose preexisting condition limitations permitted under this chapter and 
18.32 	the federal act as defined in section 62Q.01, subdivision 8.

18.33 	Sec. 19. Minnesota Statutes 2010, section 62L.02, subdivision 19, is amended to read:
19.1 		Subd. 19.Late entrant. "Late entrant" means an eligible employee or dependent 
19.2 	who requests enrollment in a health benefit plan of a small employer following the initial 
19.3 	enrollment period applicable to the employee or dependent under the terms of the health 
19.4 	benefit plan, provided that the initial enrollment period must be a period of at least 30 
19.5 	days. However, an eligible employee or dependent must not be considered a late entrant if:
19.6 	(1) the individual was covered under qualifying coverage at the time the individual 
19.7 	was eligible to enroll in the health benefit plan, declined enrollment on that basis, and 
19.8 	presents to the health carrier a certificate of termination of the qualifying coverage, due to 
19.9 	loss of eligibility for that coverage, or proof of the termination of employer contributions 
19.10 	toward that coverage, provided that the individual maintains continuous coverage and 
19.11 	requests enrollment within 30 days of termination of qualifying coverage or termination 
19.12 	of the employer's contribution toward that coverage. For purposes of this clause, loss 
19.13 	of eligibility includes loss of eligibility as a result of legal separation, divorce, death, 
19.14 	termination of employment, or reduction in the number of hours of employment. For 
19.15 	purposes of this clause, an individual is not a late entrant if the individual elects coverage 
19.16 	under the health benefit plan rather than accepting continuation coverage for which the 
19.17 	individual is eligible under state or federal law with respect to the individual's previous 
19.18 	qualifying coverage;
19.19 	(2) the individual has lost coverage under another group health plan due to the 
19.20 	expiration of benefits available under the Consolidated Omnibus Budget Reconciliation 
19.21 	Act of 1985, Public Law 99-272, as amended, and any state continuation laws applicable 
19.22 	to the employer or health carrier, provided that the individual maintains continuous 
19.23 	coverage and requests enrollment within 30 days of the loss of coverage;
19.24 	(3) the individual is a new spouse of an eligible employee, provided that enrollment 
19.25 	is requested within 30 days of becoming legally married;
19.26 	(4) the individual is a new dependent child to the limiting age as defined in section 
19.27 	62Q.01, subdivision 7, of an eligible employee, provided that enrollment is requested 
19.28 	within 30 days of becoming a dependent;
19.29 	(5) the individual is employed by an employer that offers multiple health benefit 
19.30 	plans and the individual elects a different plan during an open enrollment period; or
19.31 	(6) a court has ordered that coverage be provided for a former spouse or dependent 
19.32 	child under a covered employee's health benefit plan and request for enrollment is made 
19.33 	within 30 days after issuance of the court order.; or
19.34 	(7) the individual has enrolled according to the requirements of the federal act, as 
19.35 	defined in section 62Q.01, subdivision 8.

20.1 	Sec. 20. Minnesota Statutes 2010, section 62L.03, subdivision 4, is amended to read:
20.2 		Subd. 4.Underwriting restrictions. (a) Health carriers may apply underwriting 
20.3 	restrictions to coverage for health benefit plans for small employers, including any 
20.4 	preexisting condition limitations, only as expressly permitted under this chapter and the 
20.5 	federal act, as defined in section 62Q.01, subdivision 8. For purposes of this section, 
20.6 	"underwriting restrictions" means any refusal of the health carrier to issue or renew 
20.7 	coverage, any premium rate higher than the lowest rate charged by the health carrier for 
20.8 	the same coverage, any preexisting condition limitation, preexisting condition exclusion, 
20.9 	or any exclusionary rider.
20.10 	(b) Health carriers may collect information relating to the case characteristics and 
20.11 	demographic composition of small employers, as well as health status and health history 
20.12 	information about employees, and dependents of employees, of small employers.
20.13 	(c) Except as otherwise authorized for late entrants, preexisting conditions may be 
20.14 	excluded by a health carrier for an individual age 19 or older for a period not to exceed 12 
20.15 	months from the enrollment date of an eligible employee or dependent, but exclusionary 
20.16 	riders must not be used. Late entrants who are age 19 or older may be subject to a 
20.17 	preexisting condition limitation not to exceed 18 months from the enrollment date of the 
20.18 	late entrant, but must not be subject to any exclusionary rider or preexisting condition 
20.19 	exclusion. When calculating any length of preexisting condition limitation, a health carrier 
20.20 	shall credit the time period an eligible employee or dependent was previously covered 
20.21 	by qualifying coverage, provided that the individual maintains continuous coverage. The 
20.22 	credit must be given for all qualifying coverage with respect to all preexisting conditions, 
20.23 	regardless of whether the conditions were preexisting with respect to any previous 
20.24 	qualifying coverage. Section 60A.082, relating to replacement of group coverage, and the 
20.25 	rules adopted under that section apply to this chapter, and this chapter's requirements are 
20.26 	in addition to the requirements of that section and the rules adopted under it. A health 
20.27 	carrier shall, at the time of first issuance or renewal of a health benefit plan on or after July 
20.28 	1, 1993, credit against any preexisting condition limitation or exclusion permitted under 
20.29 	this section, the time period prior to July 1, 1993, during which an eligible employee or 
20.30 	dependent was covered by qualifying coverage, if the person has maintained continuous 
20.31 	coverage. 
20.32 	(d) Health carriers shall not use pregnancy as a preexisting condition under this 
20.33 	chapter.

20.34 	Sec. 21. Minnesota Statutes 2010, section 62L.05, subdivision 9, is amended to read:
21.1 		Subd. 9.Dependent coverage. Other state law and rules applicable to health plan 
21.2 	coverage of newborn infants, dependent children who do not reside with the eligible 
21.3 	employee to the limiting age as defined in section 62Q.01, subdivision 7, disabled children 
21.4 	and dependents dependent children, and adopted children apply to a small employer plan. 
21.5 	Health benefit plans that provide dependent coverage must define "dependent" no more 
21.6 	restrictively than the definition provided in section 62L.02.

21.7 	Sec. 22. Minnesota Statutes 2010, section 62Q.01, is amended by adding a subdivision 
21.8 	to read:
21.9 		Subd. 7.Dependent child to the limiting age. For purposes of chapters 60A, 62A 
21.10 	to 62U, and 43A, the term "dependent child to the limiting age" or "dependent children to 
21.11 	the limiting age" means those individuals who are eligible and covered as a dependent 
21.12 	child under the terms of a health plan who have not yet attained 26 years of age. A health 
21.13 	plan shall not deny or restrict eligibility for a dependent child to the limiting age based on 
21.14 	financial dependency, residency, martial status, or student status. For coverage under plans 
21.15 	offered by the Minnesota Comprehensive Health Association, dependent to the limiting 
21.16 	age means dependent as defined in section 62A.302, subdivision 3. Notwithstanding the 
21.17 	provisions in this subdivision, a health plan may include:
21.18 	(1) eligibility requirements regarding the absence of other health plan coverage as 
21.19 	permitted by the federal act as defined in section 62Q.01, subdivision 8, for grandfathered 
21.20 	plan coverage as defined in section 62Q.01, subdivision 9; or
21.21 	(2) an age greater than 26 in its policy, contract, or certificate of coverage.

21.22 	Sec. 23. Minnesota Statutes 2010, section 62Q.01, is amended by adding a subdivision 
21.23 	to read:
21.24 		Subd. 8.Federal act. "Federal act" means the federal Public Law 111-148, 124 
21.25 	Stat. 119, as amended by the federal Public Law 111-152, 124 Stat. 1029, to be codified as 
21.26 	amended in scattered sections of United States Code, titles 26 and 42, and all amendments 
21.27 	thereto from time to time, or implementing regulations issued thereunder.

21.28 	Sec. 24. Minnesota Statutes 2010, section 62Q.01, is amended by adding a subdivision 
21.29 	to read:
21.30 		Subd. 9.Grandfathered plan coverage. "Grandfathered plan coverage" means a 
21.31 	group or individual health plan in which an individual was enrolled on March 23, 2010, 
21.32 	for as long as it maintains that status in accordance with the requirements of the federal 
21.33 	act, as defined in section 62Q.01, subdivision 8.

22.1 	Sec. 25. Minnesota Statutes 2010, section 62Q.021, is amended to read:
22.2 	62Q.021 FEDERAL ACT; COMPLIANCE REQUIRED.
22.3 		Subdivision 1.Compliance with 1996 federal law. Each health plan company shall 
22.4 	comply with the federal Health Insurance Portability and Accountability Act of 1996, 
22.5 	including any federal regulations adopted under that act, to the extent that it imposes a 
22.6 	requirement that applies in this state and that is not also required by the laws of this state. 
22.7 	This section does not require compliance with any provision of the federal act prior to 
22.8 	the effective date provided for that provision in the federal act. The commissioner shall 
22.9 	enforce this section.
22.10 		Subd. 2.Compliance with 2010 federal law. Each health plan company shall 
22.11 	comply with the federal act as defined in section 62Q.01, subdivision 8, to the extent that 
22.12 	it imposes a requirement that applies in this state and that is not also required by the 
22.13 	laws of this state. This section does not require compliance with any provision of the 
22.14 	federal act prior to the effective date provided for that provision in the federal act. The 
22.15 	commissioner shall enforce this section.

22.16 	EFFECTIVE DATE. This section is effective the day following final enactment.

22.17 	Sec. 26. Minnesota Statutes 2010, section 62Q.23, is amended to read:
22.18 	62Q.23 GENERAL SERVICES.
22.19 	(a) Health plan companies shall comply with all continuation and conversion of 
22.20 	coverage requirements applicable to health maintenance organizations under state or 
22.21 	federal law.
22.22 	(b) Health plan companies shall comply with sections 62A.047, 62A.27, and any 
22.23 	other coverage required under chapter 62A of newborn infants, dependent children who 
22.24 	do not reside with a covered person to the limiting age as defined in section 62Q.01, 
22.25 	subdivision 7, disabled children and dependents dependent children, and adopted children. 
22.26 	A health plan company providing dependent coverage shall comply with section 62A.302.
22.27 	(c) Health plan companies shall comply with the equal access requirements of 
22.28 	section 62A.15.

22.29 	Sec. 27. Minnesota Statutes 2010, section 62Q.43, subdivision 2, is amended to read:
22.30 		Subd. 2.Access requirement. Every closed-panel health plan must allow enrollees 
22.31 	who are full-time students under the age of 2526 years to change their designated clinic or 
22.32 	physician at least once per month, as long as the clinic or physician is part of the health 
22.33 	plan company's statewide clinic or physician network. A health plan company shall not 
23.1 	charge enrollees who choose this option higher premiums or cost sharing than would 
23.2 	otherwise apply to enrollees who do not choose this option. A health plan company may 
23.3 	require enrollees to provide 15 days' written notice of intent to change their designated 
23.4 	clinic or physician.

23.5 	Sec. 28. [62Q.46] PREVENTIVE ITEMS AND SERVICES.
23.6 		Subdivision 1.Coverage for preventive items and services. (a) "Preventive items 
23.7 	and services" means:
23.8 	(1) evidence-based items or services that have in effect a rating of A or B in the 
23.9 	recommendations of the United States Preventive Services Task Force as of September 
23.10 	23, 2010, with respect to the individual involved. For purposes of this paragraph, the 
23.11 	United States Preventive Services Task Force recommendations regarding breast cancer 
23.12 	screening, mammography, and prevention issued in or around November 2009 are not 
23.13 	considered to be current;
23.14 	(2) immunizations for routine use in children, adolescents, and adults that have in 
23.15 	effect a recommendation from the Advisory Committee on Immunization Practices of 
23.16 	the Centers for Disease Control and Prevention with respect to the individual involved. 
23.17 	For purposes of this paragraph, a recommendation from the Advisory Committee on 
23.18 	Immunization Practices of the Centers for Disease Control and Prevention, is considered 
23.19 	in effect after it has been adopted by the Director of the Centers for Disease Control and 
23.20 	Prevention, and a recommendation is considered to be for routine use if it is listed on the 
23.21 	Immunization Schedules of the Centers for Disease Control and Prevention;
23.22 	(3) evidence-informed preventive care and screenings provided for in comprehensive 
23.23 	guidelines supported by the Health Resources and Services Administration for infants, 
23.24 	children, and adolescents; and
23.25 	(4) evidence-informed preventive care and screenings provided for in comprehensive 
23.26 	guidelines supported by the Health Resources and Services Administration for women.
23.27 	(b) A health plan must provide coverage for preventive items and services at a 
23.28 	participating provider without imposing cost-sharing requirements, including a deductible, 
23.29 	coinsurance, or co-payment. Nothing in this section prohibits a health plan company that 
23.30 	has a network of providers from excluding coverage or imposing cost-sharing requirements 
23.31 	for preventive items or services that are delivered by an out-of-network provider.
23.32 	(c) A health plan is not required to provide coverage for any items or services 
23.33 	specified in any recommendation or guideline described in paragraph (a) after the 
23.34 	recommendation or guideline is no longer included as a preventive item or service as 
23.35 	defined in paragraph (a). Annually, a health plan company must determine whether any 
24.1 	additional items or services must be covered without cost-sharing requirements or whether 
24.2 	any items or services are no longer required to be covered.
24.3 	(d) Nothing prevents a health plan company from using reasonable medical 
24.4 	management techniques to determine the frequency, method, treatment, or setting for a 
24.5 	preventive item or service to the extent not specified in the recommendation or guideline.
24.6 	(e) This section does not apply to grandfathered plan coverage, as defined in section 
24.7 	62Q.01, subdivision 9. This section does not apply to plans offered by the Minnesota 
24.8 	Comprehensive Health Association.
24.9 		Subd. 2.Coverage for office visits in conjunction with preventive items and 
24.10 	services. (a) A health plan may impose cost-sharing requirements with respect to an office 
24.11 	visit if preventive item or service is billed separately or is tracked as individual encounter 
24.12 	data separately from the office visit.
24.13 	(b) A health plan must not impose cost-sharing requirements with respect to an 
24.14 	office visit if a preventive item or service is not billed separately or is not tracked as an 
24.15 	individual encounter data separately from the office visit and the primary purpose of the 
24.16 	office visit is the delivery of the preventive item or service.
24.17 	(c) A health plan may impose cost-sharing requirements with respect to an office 
24.18 	visit if a preventive item or service is not billed separately or is not tracked as individual 
24.19 	encounter data separately from the office visit and the primary purpose of the office visit is 
24.20 	not the delivery of the preventive item or service.

24.21 	EFFECTIVE DATE. This section is effective the day following final enactment.

24.22 	Sec. 29. Minnesota Statutes 2010, section 62Q.52, is amended to read:
24.23 	62Q.52 DIRECT ACCESS TO OBSTETRIC AND GYNECOLOGIC 
24.24 	SERVICES.
24.25 	(a) Health plan companies shall allow female enrollees direct access to obstetricians 
24.26 	and gynecologistsproviders who specialize in obstetrics and gynecology for the following 
24.27 	services:
24.28 	(1) annual preventive health examinations, which shall include a gynecologic 
24.29 	examination, and any subsequent obstetric or gynecologic visits determined to be 
24.30 	medically necessary by the examining obstetrician or gynecologist, based upon the 
24.31 	findings of the examination evaluation and necessary treatment for obstetric conditions or 
24.32 	emergencies;
24.33 	(2) maternity care; and
25.1 	(3) evaluation and necessary treatment for acute gynecologic conditions or 
25.2 	emergencies, including annual preventive health examinations.
25.3 	(b) For purposes of this section, "direct access" means that a female enrollee may 
25.4 	obtain the obstetric and gynecologic services specified in paragraph (a) from obstetricians 
25.5 	and gynecologists providers who specialize in obstetrics and gynecology in the enrollee's 
25.6 	network without a referral from, or prior approval through, another physician, the health 
25.7 	plan company, or its representatives.
25.8 	(c) Health plan companies shall not require higher co-payments, coinsurance, 
25.9 	deductibles, or other enrollee cost-sharing for direct access.
25.10 	(d) This section applies only to services described in paragraph (a) that are covered 
25.11 	by the enrollee's coverage, but coverage of a preventive health examination for female 
25.12 	enrollees must not exclude coverage of a gynecologic examination.

25.13 	Sec. 30. Minnesota Statutes 2010, section 62Q.55, is amended to read:
25.14 	62Q.55 EMERGENCY SERVICES.
25.15 	(a) Enrollees have the right to available and accessible emergency services, 24 hours 
25.16 	a day and seven days a week. The health plan company shall inform its enrollees how 
25.17 	to obtain emergency care and, if prior authorization for emergency services is required, 
25.18 	shall make available a toll-free number, which is answered 24 hours a day, to answer 
25.19 	questions about emergency services and to receive reports and provide authorizations, 
25.20 	where appropriate, for treatment of emergency medical conditions. Emergency services 
25.21 	shall be covered whether provided by participating or nonparticipating providers and 
25.22 	whether provided within or outside the health plan company's service area. In reviewing 
25.23 	a denial for coverage of emergency services, the health plan company shall take the 
25.24 	following factors into consideration:
25.25 	(1) a reasonable layperson's belief that the circumstances required immediate medical 
25.26 	care that could not wait until the next working day or next available clinic appointment;
25.27 	(2) the time of day and day of the week the care was provided;
25.28 	(3) the presenting symptoms, including, but not limited to, severe pain, to ensure 
25.29 	that the decision to reimburse the emergency care is not made solely on the basis of the 
25.30 	actual diagnosis;
25.31 	(4) the enrollee's efforts to follow the health plan company's established procedures 
25.32 	for obtaining emergency care; and
25.33 	(5) any circumstances that precluded use of the health plan company's established 
25.34 	procedures for obtaining emergency care.
26.1 	(b) The health plan company may require enrollees to notify the health plan 
26.2 	company of nonreferred emergency care as soon as possible, but not later than 48 hours, 
26.3 	after the emergency care is initially provided. However, emergency care which would 
26.4 	have been covered under the contract had notice been provided within the set time frame 
26.5 	must be covered.
26.6 	(c) Notwithstanding paragraphs (a) and (b), a health plan company, health insurer, or 
26.7 	health coverage plan that is in compliance with the rules regarding accessibility of services 
26.8 	adopted under section 62D.20 is in compliance with this section. 

26.9 	Sec. 31. [62Q.57] DESIGNATION OF PRIMARY CARE PROVIDER.
26.10 	A health plan that requires or provides for the designation of a participating primary 
26.11 	care provider must allow a child enrolled in the health plan to designate a physician who 
26.12 	specializes in pediatrics as the child's primary care provider, if such provider participates 
26.13 	in the network of the health plan.

26.14 	Sec. 32. Minnesota Statutes 2010, section 62Q.68, subdivision 1, is amended to read:
26.15 		Subdivision 1.Application. For purposes of sections 62Q.68 to 62Q.72, the terms 
26.16 	defined in this section have the meanings given them. For purposes of sections 62Q.69
26.17 	and 62Q.70, the term "health plan company" does not include an insurance company 
26.18 	licensed under chapter 60A to offer, sell, or issue a policy of accident and sickness 
26.19 	insurance as defined in section 62A.01 or a nonprofit health service plan corporation 
26.20 	regulated under chapter 62C that only provides dental coverage or vision coverage. For 
26.21 	purposes of sections 62Q.69 through 62Q.73, the term "health plan company" does 
26.22 	not include the Comprehensive Health Association created under chapter 62E. Section 
26.23 	62Q.70 does not apply to individual coverage. However, a health plan company offering 
26.24 	individual coverage that is grandfathered plan coverage as defined in section 62Q.01, 
26.25 	subdivision 9, may, pursuant to section 62Q.69, subdivision 3, paragraph (c), follow the 
26.26 	process outlined in section 62Q.70.

26.27 	Sec. 33. Minnesota Statutes 2010, section 62Q.69, subdivision 3, is amended to read:
26.28 		Subd. 3.Notification of complaint decisions. (a) The health plan company must 
26.29 	notify the complainant in writing of its decision and the reasons for it as soon as practical 
26.30 	but in no case later than 30 days after receipt of a written complaint. If the health plan 
26.31 	company cannot make a decision within 30 days due to circumstances outside the control 
26.32 	of the health plan company, the health plan company may take up to 14 additional days to 
26.33 	notify the complainant of its decision. If the health plan company takes any additional 
27.1 	days beyond the initial 30-day period to make its decision, it must inform the complainant, 
27.2 	in advance, of the extension and the reasons for the extension.
27.3 	(b) For group coverage, if the decision is partially or wholly adverse to the 
27.4 	complainant, the notification must inform the complainant of the right to appeal the 
27.5 	decision to the health plan company's internal appeal process described in section 62Q.70
27.6 	and the procedure for initiating an appeal. 
27.7 	(c) For individual coverage, if the decision is partially or wholly adverse to the 
27.8 	complainant, the notification must inform the complainant of the right to submit the 
27.9 	complaint decision to the external review process described in section 62Q.73 and the 
27.10 	procedure for initiating the external process. Notwithstanding the provisions in this 
27.11 	subdivision, a health plan company offering individual coverage that is grandfathered plan 
27.12 	coverage as defined in section 62Q.01, subdivision 9, may instead follow the process for 
27.13 	group coverage outlined in paragraph (b).
27.14 	(c)(d) The notification must also inform the complainant of the right to submit the 
27.15 	complaint at any time to either the commissioner of health or commerce for investigation 
27.16 	and the toll-free telephone number of the appropriate commissioner.

27.17 	Sec. 34. Minnesota Statutes 2010, section 62Q.70, subdivision 1, is amended to read:
27.18 		Subdivision 1.Establishment. (a) Each health plan company shall establish an 
27.19 	internal appeal process for reviewing a health plan company's decision regarding a 
27.20 	complaint filed in accordance with section 62Q.69. The appeal process must meet the 
27.21 	requirements of this section. This section applies only to group coverage. However, a 
27.22 	health plan company offering individual coverage that is grandfathered plan coverage as 
27.23 	defined in section 62Q.01, subdivision 9, may, pursuant to section 62Q.69, subdivision 3, 
27.24 	paragraph (c), follow the process outlined in this section.
27.25 	(b) The person or persons with authority to resolve or recommend the resolution of 
27.26 	the internal appeal must not be solely the same person or persons who made the complaint 
27.27 	decision under section 62Q.69. 
27.28 	(c) The internal appeal process must permit the receipt of testimony, correspondence, 
27.29 	explanations, or other information from the complainant, staff persons, administrators, 
27.30 	providers, or other persons as deemed necessary by the person or persons investigating or 
27.31 	presiding over the appeal.

27.32 	Sec. 35. Minnesota Statutes 2010, section 62Q.71, is amended to read:
27.33 	62Q.71 NOTICE TO ENROLLEES.
28.1 	Each health plan company shall provide to enrollees a clear and concise description 
28.2 	of its complaint resolution procedure, if applicable under section 62Q.68, subdivision 1, 
28.3 	and the procedure used for utilization review as defined under chapter 62M as part of 
28.4 	the member handbook, subscriber contract, or certificate of coverage. If the health plan 
28.5 	company does not issue a member handbook, the health plan company may provide 
28.6 	the description in another written document. The description must specifically inform 
28.7 	enrollees: 
28.8 	(1) how to submit a complaint to the health plan company;
28.9 	(2) if the health plan includes utilization review requirements, how to notify the 
28.10 	utilization review organization in a timely manner and how to obtain certification for 
28.11 	health care services;
28.12 	(3) how to request an appeal either through the procedures described in sections 
28.13 	62Q.69 and section62Q.70, if applicable, or through the procedures described in chapter 
28.14 	62M; 
28.15 	(4) of the right to file a complaint with either the commissioner of health or 
28.16 	commerce at any time during the complaint and appeal process;
28.17 	(5) of the toll-free telephone number of the appropriate commissioner; and
28.18 	(6) of the right, for individual and group coverage, to obtain an external review 
28.19 	under section 62Q.73 and a description of when and how that right may be exercised., 
28.20 	including that under most circumstances an enrollee must exhaust the internal complaint 
28.21 	or appeal process prior to external review. However, an enrollee may proceed to external 
28.22 	review without exhausting the internal complaint or appeal process under the following 
28.23 	circumstances:
28.24 	(i) the health plan company waives the exhaustion requirement;
28.25 	(ii) the health plan company is considered to have waived the exhaustion requirement 
28.26 	by failing to substantially comply with any requirements including, but not limited to, 
28.27 	time limits for internal complaints or appeals; or
28.28 	(iii) the enrollee has applied for an expedited external review at the same time the 
28.29 	enrollee qualifies for and has applied for an expedited internal review under chapter 62M.

28.30 	Sec. 36. Minnesota Statutes 2010, section 62Q.73, is amended to read:
28.31 	62Q.73 EXTERNAL REVIEW OF ADVERSE DETERMINATIONS.
28.32 		Subdivision 1.Definition. For purposes of this section, "adverse determination" 
28.33 	means:
28.34 	(1) for individual coverage, a complaint decision relating to a health care service or 
28.35 	claim that is partially or wholly adverse to the complainant; 
29.1 	(2) individual coverage offered by a health plan that is grandfathered plan coverage 
29.2 	as defined in section 62Q.01, subdivision 9, may instead apply the definition of "adverse 
29.3 	determination" for group coverage in clause (3);
29.4 	(1)(3) for group coverage, a complaint decision relating to a health care service or 
29.5 	claim that has been appealed in accordance with section 62Q.70 and the appeal decision is 
29.6 	partially or wholly adverse to the complainant; 
29.7 	(2)(4) any initial determination not to certify that has been appealed in accordance 
29.8 	with section 62M.06 and the appeal did not reverse the initial determination not to certify; 
29.9 	or
29.10 	(3)(5) a decision relating to a health care service made by a health plan company 
29.11 	licensed under chapter 60A that denies the service on the basis that the service was not 
29.12 	medically necessary.; or
29.13 	(6) the enrollee has met the requirements of subdivision 6, paragraph (e).
29.14 	An adverse determination does not include complaints relating to fraudulent marketing 
29.15 	practices or agent misrepresentation.
29.16 		Subd. 2.Exception. (a) This section does not apply to governmental programs 
29.17 	except as permitted under paragraph (b). For purposes of this subdivision, "governmental 
29.18 	programs" means the prepaid medical assistance program, the MinnesotaCare program, 
29.19 	the prepaid general assistance medical care program, the demonstration project for people 
29.20 	with disabilities, and the federal Medicare program.
29.21 	(b) In the course of a recipient's appeal of a medical determination to the 
29.22 	commissioner of human services under section 256.045, the recipient may request an 
29.23 	expert medical opinion be arranged by the external review entity under contract to provide 
29.24 	independent external reviews under this section. If such a request is made, the cost of 
29.25 	the review shall be paid by the commissioner of human services. Any medical opinion 
29.26 	obtained under this paragraph shall only be used by a state human services referee as 
29.27 	evidence in the recipient's appeal to the commissioner of human services under section 
29.28 	256.045. 
29.29 	(c) Nothing in this subdivision shall be construed to limit or restrict the appeal rights 
29.30 	provided in section 256.045 for governmental program recipients. 
29.31 		Subd. 3.Right to external review. (a) Any enrollee or anyone acting on behalf 
29.32 	of an enrollee who has received an adverse determination may submit a written request 
29.33 	for an external review of the adverse determination, if applicable under section 62Q.68, 
29.34 	subdivision 1, or 62M.06, to the commissioner of health if the request involves a health 
29.35 	plan company regulated by that commissioner or to the commissioner of commerce if the 
29.36 	request involves a health plan company regulated by that commissioner. Notification of 
30.1 	the enrollee's right to external review must accompany the denial issued by the insurer. 
30.2 	The written request must be accompanied by a filing fee of $25. The fee may be waived 
30.3 	by the commissioner of health or commerce in cases of financial hardship and must be 
30.4 	refunded if the adverse determination is completely reversed. No enrollee may be subject 
30.5 	to filing fees totaling more than $75 during a plan year for group coverage or policy year 
30.6 	for individual coverage. 
30.7 	(b) Nothing in this section requires the commissioner of health or commerce to 
30.8 	independently investigate an adverse determination referred for independent external 
30.9 	review.
30.10 	(c) If an enrollee requests an external review, the health plan company must 
30.11 	participate in the external review. The cost of the external review in excess of the filing 
30.12 	fee described in paragraph (a) shall be borne by the health plan company.
30.13 	(d) The enrollee must request external review within six months from the date of 
30.14 	the adverse determination.
30.15 		Subd. 4.Contract. Pursuant to a request for proposal, the commissioner of 
30.16 	administration, in consultation with the commissioners of health and commerce, shall 
30.17 	contract with an organizationat least three organizations or business entityentities to 
30.18 	provide independent external reviews of all adverse determinations submitted for external 
30.19 	review. The contract shall ensure that the fees for services rendered in connection with the 
30.20 	reviews beare reasonable.
30.21 		Subd. 5.Criteria. (a) The request for proposal must require that the entity 
30.22 	demonstrate:
30.23 	(1) no conflicts of interest in that it is not owned, a subsidiary of, or affiliated 
30.24 	with a health plan company or, utilization review organization, or a trade organization 
30.25 	of health care providers;
30.26 	(2) an expertise in dispute resolution;
30.27 	(3) an expertise in health-related law;
30.28 	(4) an ability to conduct reviews using a variety of alternative dispute resolution 
30.29 	procedures depending upon the nature of the dispute;
30.30 	(5) an ability to maintain written records, for at least three years, regarding reviews 
30.31 	conducted and provide data to the commissioners of health and commerce upon request on 
30.32 	reviews conducted; and
30.33 	(6) an ability to ensure confidentiality of medical records and other enrollee 
30.34 	information.;
30.35 	(7) accreditation by a nationally recognized private accrediting organization; and
30.36 	(8) the ability to provide an expedited external review process.
31.1 	(b) The commissioner of administration shall take into consideration, in awarding 
31.2 	the contract according to subdivision 4, any national accreditation standards that pertain to 
31.3 	an external review entity.
31.4 		Subd. 6.Process. (a) Upon receiving a request for an external review, the 
31.5 	commissioner shall assign an external review entity on a random basis. The assigned 
31.6 	external review entity must provide immediate notice of the review to the enrollee and to 
31.7 	the health plan company. Within ten business days of receiving notice of the review, the 
31.8 	health plan company and the enrollee must provide the assigned external review entity 
31.9 	with any information that they wish to be considered. Each party shall be provided an 
31.10 	opportunity to present its version of the facts and arguments. The assigned external review 
31.11 	entity must furnish to the health plan company any additional information submitted by 
31.12 	the enrollee within one business day of receipt. An enrollee may be assisted or represented 
31.13 	by a person of the enrollee's choice.
31.14 	(b) As part of the external review process, any aspect of an external review involving 
31.15 	a medical determination must be performed by a health care professional with expertise in 
31.16 	the medical issue being reviewed.
31.17 	(c) An external review shall be made as soon as practical but in no case later than 40 
31.18 	days after receiving the request for an external review and must promptly send written 
31.19 	notice of the decision and the reasons for it to the enrollee, the health plan company, and 
31.20 	the commissioner who is responsible for regulating the health plan company.
31.21 	(d) The external review entity and the clinical reviewer assigned must not have a 
31.22 	material professional, familial, or financial conflict of interest with:
31.23 	(1) the health plan company that is the subject of the external review;
31.24 	(2) the enrollee, or any parties related to the enrollee, whose treatment is the subject 
31.25 	of the external review;
31.26 	(3) any officer, director, or management employee of the health plan company;
31.27 	(4) a plan administrator, plan fiduciaries, or plan employees;
31.28 	(5) the health care provider, the health care provider's group, or practice association 
31.29 	recommending treatment that is the subject of the external review;
31.30 	(6) the facility at which the recommended treatment would be provided; or
31.31 	(7) the developer or manufacturer of the principal drug, device, procedure, or other 
31.32 	therapy being recommended.
31.33 	(e)(1) An expedited external review must be provided if the enrollee requests it 
31.34 	after receiving:
31.35 	(i) an adverse determination that involves a medical condition for which the time 
31.36 	frame for completion of an expedited internal appeal would seriously jeopardize the life 
32.1 	or health of the enrollee or would jeopardize the enrollee's ability to regain maximum 
32.2 	function and the enrollee has simultaneously requested an expedited internal appeal;
32.3 	(ii) an adverse determination that concerns an admission, availability of care, 
32.4 	continued stay, or health care service for which the enrollee received emergency services 
32.5 	but has not been discharged from a facility; or
32.6 	(iii) an adverse determination that involves a medical condition for which the 
32.7 	standard external review time would seriously jeopardize the life or health of the enrollee 
32.8 	or jeopardize the enrollee's ability to regain maximum function.
32.9 	(2) The external review entity must make its expedited determination to uphold or 
32.10 	reverse the adverse determination as expeditiously as possible but within no more than 72 
32.11 	hours after the receipt of the request for expedited review and notify the enrollee and the 
32.12 	health plan company of the determination.
32.13 	(3) If the external review entity's notification is not in writing, the external review 
32.14 	entity must provide written confirmation of the determination within 48 hours of the 
32.15 	notification.
32.16 		Subd. 7.Standards of review. (a) For an external review of any issue in an adverse 
32.17 	determination that does not require a medical necessity determination, the external review 
32.18 	must be based on whether the adverse determination was in compliance with the enrollee's 
32.19 	health benefit plan.
32.20 	(b) For an external review of any issue in an adverse determination by a health plan 
32.21 	company licensed under chapter 62D that requires a medical necessity determination, the 
32.22 	external review must determine whether the adverse determination was consistent with the 
32.23 	definition of medically necessary care in Minnesota Rules, part 4685.0100, subpart 9b.
32.24 	(c) For an external review of any issue in an adverse determination by a health plan 
32.25 	company, other than a health plan company licensed under chapter 62D, that requires a 
32.26 	medical necessity determination, the external review must determine whether the adverse 
32.27 	determination was consistent with the definition of medically necessary care in section 
32.28 	62Q.53, subdivision 2. 
32.29 	(d) For an external review of an adverse determination involving experimental 
32.30 	or investigational treatment, the external review entity must base its decision on all 
32.31 	documents submitted by the health plan company and enrollee, including medical 
32.32 	records the attending physician or health care professional's recommendation, consulting 
32.33 	reports from health care professionals, the terms of coverage, federal Food and Drug 
32.34 	Administration approval, and medical or scientific evidence or evidence-based standards.
32.35 		Subd. 8.Effects of external review. A decision rendered under this section shall 
32.36 	be nonbinding on the enrollee and binding on the health plan company. The health plan 
33.1 	company may seek judicial review of the decision on the grounds that the decision was 
33.2 	arbitrary and capricious or involved an abuse of discretion.
33.3 		Subd. 9.Immunity from civil liability. A person who participates in an external 
33.4 	review by investigating, reviewing materials, providing technical expertise, or rendering a 
33.5 	decision shall not be civilly liable for any action that is taken in good faith, that is within 
33.6 	the scope of the person's duties, and that does not constitute willful or reckless misconduct.
33.7 		Subd. 10.Data reporting. The commissioners shall make available to the public, 
33.8 	upon request, summary data on the decisions rendered under this section, including the 
33.9 	number of reviews heard and decided and the final outcomes. Any data released to the 
33.10 	public must not individually identify the enrollee initiating the request for external review.

33.11 	Sec. 37. Minnesota Statutes 2010, section 62Q.80, subdivision 2, is amended to read:
33.12 		Subd. 2.Definitions.  For purposes of this section, the following definitions apply:
33.13 	(a) "Community-based" means located in or primarily relating to the community, 
33.14 	as determined by the board of a community-based health initiative that is served by the 
33.15 	community-based health care coverage program.
33.16 	(b) "Community-based health care coverage program" or "program" means a 
33.17 	program administered by a community-based health initiative that provides health care 
33.18 	services through provider members of a community-based health network or combination 
33.19 	of networks to eligible individuals and their dependents who are enrolled in the program.
33.20 	(c) "Community-based health initiative" or "initiative" means a nonprofit corporation 
33.21 	that is governed by a board that has at least 80 percent of its members residing in the 
33.22 	community and includes representatives of the participating network providers and 
33.23 	employers, or a county-based purchasing organization as defined in section 256B.692.
33.24 	(d) "Community-based health network" means a contract-based network of health 
33.25 	care providers organized by the community-based health initiative to provide or support 
33.26 	the delivery of health care services to enrollees of the community-based health care 
33.27 	coverage program on a risk-sharing or nonrisk-sharing basis.
33.28 	(e) "Dependent" means an eligible employee's spouse or unmarried child who 
33.29 	is under the age of 1926 years.

33.30 	Sec. 38. [72A.328] RESCISSION.
33.31 		Subdivision 1.Prohibition on retroactively terminating coverage. (a) A health 
33.32 	carrier, as defined in section 62A.011, may not retroactively terminate coverage under 
33.33 	a health plan with respect to an individual, including a group to which the individual 
34.1 	belongs or family coverage in which the individual is included, after the individual is 
34.2 	covered under the health plan, unless:
34.3 	(1) the individual or a person seeking coverage on behalf of the individual, performs 
34.4 	an act, practice, or omission that constitutes fraud;
34.5 	(2) the individual makes an intentional misrepresentation or omission of material 
34.6 	fact, as prohibited by the terms of the health plan;
34.7 	(3) the individual has failed to timely pay required premiums or contributions 
34.8 	toward the cost of coverage; or
34.9 	(4) the individual has coverage under an employer health plan, and the employee 
34.10 	pays no premiums for coverage after termination of eligibility, and the cancellation 
34.11 	or discontinuance of coverage is effective retroactively to the date of termination of 
34.12 	eligibility due to a delay in administrative record keeping.
34.13 	(b) Retroactive termination is otherwise permitted by law.
34.14 	(c) This section does not apply to any benefits classified as excepted benefits under 
34.15 	United States Code, title 42, section 300gg-91(c), or regulations enacted there under 
34.16 	from time to time.
34.17 		Subd. 2.Notice required. A health carrier shall provide at least 30 days advance 
34.18 	written notice to each individual who would be affected by the proposed rescission of 
34.19 	coverage before coverage under the plan may be terminated retroactively.

34.20 	Sec. 39. Minnesota Statutes 2010, section 471.61, subdivision 1a, is amended to read:
34.21 		Subd. 1a.Dependents. Notwithstanding the provisions of Minnesota Statutes 1969, 
34.22 	section 471.61, as amended by Laws 1971, chapter 451, section 1, the word "dependents" 
34.23 	as used therein shall mean spouse and minor unmarried children under the age of 18 26
34.24 	years and dependent students under the age of 25 years actually dependent upon the 
34.25 	employee. 

34.26 	Sec. 40.  REPEALER.
 34.27 	Minnesota Statutes 2010, section 62E.02, subdivision 7, is repealed effective the 
34.28 	day following final enactment.

34.29 	Sec. 41. SUNSET.
 34.30 	If any provisions of the federal act relating to any provisions of this act are repealed, 
34.31 	rendered invalid by final judicial decree, or in the event the state is granted a federal 
34.32 	waiver from implementing provisions of the federal act, then the related provisions in 
34.33 	this act must sunset unless legislation is signed into law that specifically extends the 
35.1 	related provisions of this act. The commissioner of commerce must act within 30 days 
35.2 	of the repeal, invalidation, or waiver to ensure uniform implementation of this sunset 
35.3 	provision, taking into account the timing of health plan contract changes that may need 
35.4 	to be made as groups or policies renew. This action may take the form of a bulletin or 
35.5 	a notice in the Minnesota State Register.