2006 Minnesota Statutes

62Q.68 DEFINITIONS.
    Subdivision 1. Application. For purposes of sections 62Q.68 to 62Q.72, the terms defined
in this section have the meanings given them. For purposes of sections 62Q.69 and 62Q.70, the
term "health plan company" does not include an insurance company licensed under chapter 60A
to offer, sell, or issue a policy of accident and sickness insurance as defined in section 62A.01
or a nonprofit health service plan corporation regulated under chapter 62C that only provides
dental coverage or vision coverage. For purposes of sections 62Q.69 through 62Q.73, the term
"health plan company" does not include the Comprehensive Health Association created under
chapter 62E.
    Subd. 2. Complaint. "Complaint" means any grievance against a health plan company that
is not the subject of litigation and that has been submitted by a complainant to a health plan
company regarding the provision of health services including, but not limited to, the scope of
coverage for health care services; retrospective denials or limitations of payment for services;
eligibility issues; denials, cancellations, or nonrenewals of coverage; administrative operations;
and the quality, timeliness, and appropriateness of health care services rendered. If the complaint
is from an applicant, the complaint must relate to the application. If the complaint is from a
former enrollee, the complaint must relate to services received during the period of time the
individual was an enrollee. Any grievance requiring a medical determination in its resolution must
have the medical determination aspect of the complaint processed under the appeal procedure
described in section 62M.06.
    Subd. 3. Complainant. "Complainant" means an enrollee, applicant, or former enrollee, or
anyone acting on behalf of an enrollee, applicant, or former enrollee, who submits a complaint.
History: 1999 c 239 s 34; 2002 c 330 s 28