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S.F. No. 1963 - Changes to the Health Coverage Requirements
 
Author: Senator Michelle R. Benson
 
Prepared By: Katie Cavanor, Senate Counsel (651/296-3801)
 
Date: March 20, 2017



 

Section 1 (62A.04, subd. 1) specifies that certain required standard policy provisions when referenced in other sections do not apply to accident and sickness or accident and health insurance that are health plans.

Section 2 (62A.21, subd. 2a) specifies that continuation of coverage only applies to a former spouse who was covered on the insured’s health plan on the day before entry of a valid divorce decree.

Section 3 (62A.65, subd. 2) clarifies that a health carrier may refuse to renew an individual health plan for the intentional misrepresentation of a material fact.  This section also states that a health carrier may elect to discontinue health plan coverage of an individual in the individual market, but only under one of these situations:

  1. the health carrier is ceasing to offer individual health plan coverage in the individual market;
  2. the individual no longer resides, lives, or works in the service area of the health carrier, or the area for which the health carrier is authorized to do business, but only if coverage is terminated uniformly without regard to any health status-related factors of covered individuals; or
  3. a decision by a health carrier to discontinue offering a particular type of individual health plan if the carrier provides notice in writing to each individual at least 90 days before the date coverage is to be discontinued;  provides notice to the Commissioner of Commerce at least 30 business days before the health carrier gives notice to the individuals; offers each covered individual the option to purchase another individual health plan currently being offered by the health carrier or related health carrier for individuals in that market; and acts uniformly without regard to any health status-related factor of covered individuals or dependents who may become eligible for coverage.

Section 4 (62A.65, subd. 2a) Paragraph (a) permits a health carrier to modify a health plan for a product as defined under the ACA offered to an individual in the individual market at the time of coverage renewal of the modification is effectively uniform for all individuals with that product.

Paragraph (b) specifies that modifications made uniformly and solely pursuant to applicable federal or state requirements are considered a uniform modification of coverage if the modification is made within a reasonable time period and is directly related to the imposition or modification of the requirement.

Paragraph (c) specifies that other modifications may also be made if the product is offered by the same health carrier; the product is offered as the same product network type; the product continues to cover at least a majority of the same service area; within each product the plan has the same cost-sharing structure as before the modification, except for any variation solely related to changes in cost and utilization of medical care or to maintain the same metal level; and the provider provides the same covered benefits, except for any changes in benefits that cumulatively impact the plan adjusted index rate.

Section 5 (62A.65, subd. 5) states that beginning January 1, 2017, a health carrier no longer is required to offer an individual health plan to an individual who was previously covered under a group health plan issued by that health carrier.

Section 6 (62D.105, subd. 1) specifies that an health maintenance organization (HMO) only has to provide coverage to an enrollee’s dependent children and former spouse who was covered on the day before the entry of a valid divorce decree.

Section 7 (62D.105, subd. 2) clarifies the definition of dependent children.

Section 8 (62E.04, subd. 11) clarifies that any policy of accident and health insurance subject to the requirements of the ACA, the requirements of this section do not apply.

Section 9 (62E.05, subd. 1) clarifies that any policy of accident and health insurance subject to the requirements of the ACA do not have to certify whether the plan is a #1, #2, or #3 coverage plan.

Section 10 (62E.06, subd. 5) clarifies that the requirements for qualified plans do not apply to any policy of accident and health insurance subject to the requirements of the ACA.

Section 11 (62Q.18, subd. 7) states that beginning January 1, 2017, a health plan company is no longer required to offer continuous coverage to an individual who maintains continuous coverage and who qualifies under the group’s eligibility requirements.

Section 12 (62Q.575, subd. 1) requires a health plan company to contract with a primary care provider as an in- network provider if the provider is certified as a health care home or is in the process of becoming certified as a health care home.

Subd. 2 prohibits a health plan company from imposing a co-payment or fee or other cost-sharing requirement for selecting or designating a primary care provider of the enrollee’s choosing, unless the health plan company imposes the same cost-sharing requirements or fees upon an enrollee’s selection or designation on any of the health plan company’s primary care providers.

Subd. 3 requires the provider contract to include a care coordination payment in addition to the payment rate for the covered services provided by the primary care provider, and prohibits the health care company from imposing a co-payment, fee, or other cost-sharing requirement on care coordination services.

Subd. 4 requires the health plan company to provide notice to enrollees of the provisions of this section.

Subd. 5 defines primary care provider.

Subd. 6 specifies that this section only applies to individual health plans and does not apply to the public health care programs.

Subd. 7 specifies that the Commissioner of Health enforces this section.

Section 12 (62V.052) requires MNsure to confirm that an individual has provided sufficient information to determine the individual's eligibility as of the date of application for enrollment in a qualified health plan.

Section 13 clarifies that the unauthorized provider services section passed in SF1 does not apply to the public health care programs.

Section 14 modifies the effective date for the unauthorized provider services section passed in SF1 to January 1, 2019.

 

 

 
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