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State of Minnesota
S.F. No. 1 - Individual Market Premium Assistance and Market Reforms, As Introduced
Author: Senator Michelle R. Benson
Prepared By: Christopher B. Stang, Senate Counsel (651/296-0539)
Date: January 9, 2017


Article 1 - Premium Assistance

Section 1 requires the Commissioner of Minnesota Management and Budget, in consultation with the Commissioners of Commerce and Revenue, to establish and administer a premium assistance program for eligible persons in the individual market for 2017.

Section 2 provides definitions for purposes of the premium assistance program.

Section 3, subdivision 1, allows an eligible individual to apply for premium assistance no later than January 31, 2018, in a manner and form prescribed by the Commissioner of Minnesota Management and Budget. The commissioner must notify applicants of their eligibility status and their premium assistance amount.

Subdivision 2 requires health plan companies to provide specified information to the commissioner with respect to each individual for whom it provides qualified health coverage.

Subdivision 3 establishes income eligibility rules for the program. Individuals earning more than 300 percent but less than 800 percent of the federal poverty line are eligible.

Subdivision 4 requires the commissioner to determine premium assistance amounts such that the appropriation for the program is not exceeded. Until March 31, eligible individuals qualify for assistance of 25 percent of premium, and after that until December 31, eligible individuals qualify for assistance on a sliding scale depending on income (20 to 30 percent of premium) with the assistance for the top income group dependent on availability of funding.

Subdivision 5 requires the commissioner to provide the assistance amount to the individual on a monthly basis. The individual may be required to provide documentation of payment of the premium.

Subdivision 6 allows the commissioner to contract with a third-party administrator to determine eligibility for assistance.

Subdivision 7 requires the commissioner to verify that applicants are residents of Minnesota.

Section 4 requires the legislative auditor to audit implementation of the program. A report is due to the Legislature by June 1, 2018. The Commissioner of Revenue must ensure that only eligible individuals receive premium assistance.

Section 5 transfers $300,500,000 from the budget reserve to the general fund.

Section 6 appropriates $285,000,000 from the general fund to Commissioner of Minnesota Management and Budget for the premium assistance program on a one-time basis. Also appropriates $500,000 to the legislative auditor for the audit.

This article is effective the day following final enactment.

Article 2 - Insurance Market Reforms

Section 1 requires the Commissioner of Commerce to provide public access to rate filings for individual and small market plans within ten days of receiving the filing together with specified compiled data.

Section 2 reduces the allowed attachment point for claims per individual for a stop loss policy from $20,000 to $10,000. Aggregate attachment point for all groups is set at no less than 110% of expected claims.

Section 3 requires claim settlement periods under a stop loss policy to be no less favorable than claims incurred during the contract period and paid by the plan during the contract period or within one month after expiration of the contract period.

Sections 4 -9 allows for profit HMOs to operate in the state.

Section 10 allows a health carrier to issue an individual plan to an employee of a small employer if the small employer is in compliance with the federal 21st Century Cures Act.

Section 11 requires an enrollee to have the same cost-sharing requirements for defined unauthorized provider services as those applicable to services received from a participating provider.

Section 12 prohibits balance billing an enrollee for amounts in excess of what the health plan company has contracted with the provider for.

Section 13 entitles an enrollee suffering from specified conditions who was involuntarily terminated in the individual market to receive services otherwise covered under the terms of a 2017 health plan from a provider who provided in-network care to the enrollee during 2016 but who is out of network for 2017. The Commissioner of Minnesota Management and Budget is required to reimburse the new health plan company for the costs of services authorized under this section. This only applies if the enrollee’s health care provider agrees to specified terms. The health plan company may require medical records and other supporting information be provided with a request for authorization.

Section 14 requires an agency incurring administrative costs under the act to perform its duties within existing appropriations unless otherwise provided.

Section 15 requires the Commissioner of Commerce to report by February 15, 2017, on specified issues related to residency verification and use of certain sections of Minnesota Statutes related to health care access.

Section 16 appropriates $15,000,000 from the general fund to the Commissioner of Minnesota Management and Budget for the purposes of section 13 (transition of care coverage).

Section 17 repeals several provisions as a conforming change to other elements of the bill.

Sections 1-3 and 11 of this article are effective 30 days following final enactment.  Sections 4-10 and 15-17 are effective the day following final enactment. Section 12 is effective July 1, 2017. Section 13 is effective for health plans issued after December 31, 2016 and before March 2, 2017 and in effect for all or a portion of calendar year 2017.


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