1.1.................... moves to amend H.F. No. 222 as follows:
1.2Delete everything after the enacting clause and insert:
1.3 "Section 1. Minnesota Statutes 2010, section 62A.65, subdivision 2, is amended to read:
1.4 Subd. 2.
Guaranteed issue and renewal. No individual health plan may be offered,
1.5sold
, or issued
, or renewed to a Minnesota resident unless
the health plan provides that the
1.6plan is on a guaranteed issue basis. The health plan must be guaranteed renewable at a
1.7premium rate that does not take into account the claims experience or any change in the
1.8health status of any covered person that occurred after the initial issuance of the health
1.9plan to the person. The premium rate upon renewal must also otherwise comply with this
1.10section. A health carrier must not refuse to renew an individual health plan, except for
1.11nonpayment of premiums, fraud, or misrepresentation.
1.12EFFECTIVE DATE.This section is effective January 1, 2012, and applies to
1.13coverage issued on or after that date.
1.14 Sec. 2. Minnesota Statutes 2010, section 62A.65, is amended by adding a subdivision
1.15to read:
1.16 Subd. 2a. Ceding risk to MCHA. (a) A health carrier may cede risk to the
1.17Minnesota Comprehensive Health Association under section 62E.10, subdivision 7, with
1.18respect to any individual health plan issued by the carrier.
1.19(b) The risk must be ceded only at the time of issuance of the health plan. The
1.20health carrier may charge a premium rate up to 25 percent higher than the otherwise
1.21applicable premium rate that would apply to the individual in the absence of the ceded
1.22risk for a preexisting condition.
1.23(c) Risk ceded under paragraph (a) is subject to any preexisting condition limitation
1.24to which the individual is subject under subdivision 5, except to the extent the individual
1.25qualifies for a waiver of the preexisting condition under section 62E.14, subdivision 3.
2.1(d) A health carrier must not compensate a licensed insurance producer differently
2.2depending upon whether the health carrier cedes a risk under this subdivision and must
2.3not take adverse action against a sales representative for enrolling an individual who is
2.4high-risk or subject to a preexisting condition.
2.5EFFECTIVE DATE.This section is effective January 1, 2012, and applies to
2.6coverage issued on or after that date.
2.7 Sec. 3. Minnesota Statutes 2010, section 62A.65, subdivision 5, is amended to read:
2.8 Subd. 5.
Portability and conversion of coverage. (a) No individual health plan
2.9may be offered, sold, issued, or with respect to children age 18 or under renewed, to a
2.10Minnesota resident that contains a preexisting condition limitation, preexisting condition
2.11exclusion, or exclusionary rider, unless the limitation or exclusion is permitted under this
2.12subdivision and under chapter 62L, provided that, except for children age 18 or under,
2.13underwriting restrictions may be retained on individual contracts that are issued without
2.14evidence of insurability as a replacement for prior individual coverage that was sold
2.15before May 17, 1993. The individual may be subjected to an 18-month preexisting
2.16condition limitation, unless the individual has maintained continuous coverage as defined
2.17in section
62L.02. The individual must not be subjected to an exclusionary rider. An
2.18individual who has maintained continuous coverage may be subjected to a onetime
2.19preexisting condition limitation of up to 12 months, with credit for time covered under
2.20qualifying coverage as defined in section
62L.02, at the time that the individual first is
2.21covered under an individual health plan by any health carrier. Credit must be given for
2.22all qualifying coverage with respect to all preexisting conditions, regardless of whether
2.23the conditions were preexisting with respect to any previous qualifying coverage. The
2.24individual must not be subjected to an exclusionary rider. Thereafter, the individual must
2.25not be subject to any preexisting condition limitation, preexisting condition exclusion,
2.26or exclusionary rider under an individual health plan by any health carrier, except an
2.27unexpired portion of a limitation under prior coverage, so long as the individual maintains
2.28continuous coverage as defined in section
62L.02.
2.29(b) A health carrier must offer an individual health plan to any individual previously
2.30covered under a group health plan issued by that health carrier, regardless of the size of
2.31the group, so long as the individual maintained continuous coverage as defined in section
2.3262L.02
. If the individual has available any continuation coverage provided under sections
2.3362A.146
;
62A.148;
62A.17, subdivisions 1 and 2;
62A.20;
62A.21;
62C.142;
62D.101; or
2.3462D.105
, or continuation coverage provided under federal law, the health carrier need not
2.35offer coverage under this paragraph until the individual has exhausted the continuation
3.1coverage. The offer must not be subject to underwriting, except as permitted under this
3.2paragraph. A health plan issued under this paragraph must be a qualified plan as defined
3.3in section
62E.02 and must not contain any preexisting condition limitation, preexisting
3.4condition exclusion, or exclusionary rider, except for any unexpired limitation or
3.5exclusion under the previous coverage. The individual health plan must cover pregnancy
3.6on the same basis as any other covered illness under the individual health plan. The offer
3.7of coverage by the health carrier must inform the individual that the coverage, including
3.8what is covered and the health care providers from whom covered care may be obtained,
3.9may not be the same as the individual's coverage under the group health plan. The offer
3.10of coverage by the health carrier must also inform the individual that the individual, if
3.11a Minnesota resident, may be eligible to obtain coverage from (i) other private sources
3.12of health coverage, or (ii) the Minnesota Comprehensive Health Association, without a
3.13preexisting condition limitation, and must provide the telephone number used by that
3.14association for enrollment purposes. The initial premium rate for the individual health
3.15plan must comply with subdivision 3. The premium rate upon renewal must comply with
3.16subdivision 2. In no event shall the premium rate exceed 100 percent of the premium
3.17charged for comparable individual coverage by the Minnesota Comprehensive Health
3.18Association, and the premium rate must be less than that amount if necessary to otherwise
3.19comply with this section. An individual health plan offered under this paragraph to a
3.20person satisfies the health carrier's obligation to offer conversion coverage under section
3.2162E.16
, with respect to that person. Coverage issued under this paragraph must provide
3.22that it cannot be canceled or nonrenewed as a result of the health carrier's subsequent
3.23decision to leave the individual, small employer, or other group market. Section
72A.20,
3.24subdivision 28
, applies to this paragraph.
3.25(c) An individual who was enrolled in the Minnesota Comprehensive Health
3.26Insurance Association as of December 31, 2011, applies for other private sector coverage
3.27after that date, and whose risk is ceded to the Minnesota Comprehensive Health Insurance
3.28Association by a private sector carrier, shall be given credit for continuous coverage, as
3.29defined in section 62L.02, subdivision 9, provided previously by the association against
3.30any new preexisting condition limitation imposed as a result of the ceding of risk to the
3.31association.
3.32(d) Prior continuous health coverage under a public program that does not limit
3.33coverage for preexisting conditions is creditable coverage for purposes of this subdivision.
3.34EFFECTIVE DATE.This section is effective January 1, 2012, and applies to
3.35coverage issued on or after that date.
4.1 Sec. 4. Minnesota Statutes 2010, section 62E.10, subdivision 7, is amended to read:
4.2 Subd. 7.
General powers. The association may:
4.3(a) Exercise the powers granted to insurers under the laws of this state;
4.4(b) Sue or be sued;
4.5(c) Enter into contracts with insurers, similar associations in other states or with
4.6other persons for the performance of administrative functions including the functions
4.7provided for in clauses (e) and (f);
4.8(d) Establish administrative and accounting procedures for the operation of the
4.9association;
and
4.10(e) Provide for the reinsuring of risks incurred as a result of
its members issuing
4.11the individual coverages
that its members are required by
sections
62E.04 and
62E.16
4.12by members of the association law to issue.
Each member which elects to reinsure
4.13its required risks shall determine the categories of coverage it elects to reinsure in the
4.14association. The categories of coverage are:
4.15(1) individual qualified plans, excluding group conversions;
4.16(2) group conversions;
4.17(3) group qualified plans with fewer than 50 employees or members; and
4.18(4) major medical coverage.
4.19A separate election may be made for each category of coverage. If a member elects
4.20to reinsure the risks of a category of coverage, it must reinsure the risk of the coverage
4.21of every life covered under every policy issued in that category. A member electing to
4.22reinsure risks of
a category of coverage health coverage issued shall enter into a contract
4.23with the association establishing a reinsurance plan for the risks. This contract may include
4.24provision for
the rules for ceding of risk, reinsurance thresholds, reinsurance premiums,
4.25disclosure of underwriting information, and pooling of members' risks reinsured through
4.26the association
and. It may provide for assessment of each member reinsuring risks for
4.27losses and operating and administrative expenses incurred, or estimated to be incurred
4.28in the operation of the reinsurance plan.
The reinsurance plan must provide appropriate
4.29restrictions or prohibitions on a member's right to cede risk to the association after the
4.30member has issued coverage to an insured or after the member has granted an insured's
4.31request to change the insured's coverage provided by the member. This reinsurance plan
4.32shall be approved by the commissioner before it is effective. Members
electing to shall
4.33administer the risks which are reinsured in the association
by providing the same network
4.34access, disease management, customer service, and similar services that the member
4.35offers to its other insureds, and shall comply with the benefit determination guidelines
,
4.36claim processing standards, premium collection, and accounting procedures established
5.1by the association. The fee charged by the association for the reinsurance of risks shall
5.2not be less than 110 percent of the total anticipated expenses incurred by the association
5.3for the reinsurance
; and.
5.4(f) Provide for the administration by the association of policies which are reinsured
5.5pursuant to clause (e). Each member electing to reinsure one or more categories of
5.6coverage in the association may elect to have the association administer the categories of
5.7coverage on the member's behalf. If a member elects to have the association administer
5.8the categories of coverage, it must do so for every life covered under every policy issued
5.9in that category. The fee for the administration shall not be less than 110 percent of the
5.10total anticipated expenses incurred by the association for the administration.
5.11EFFECTIVE DATE.This section is effective January 1, 2012, and applies to
5.12coverage issued on or after that date.
5.13 Sec. 5. Minnesota Statutes 2010, section 62E.11, subdivision 1, is amended to read:
5.14 Subdivision 1.
Enrollment. Upon certification as an eligible person in the manner
5.15provided by section
62E.14, an eligible person may enroll in the comprehensive health
5.16insurance plan by payment of the state plan premium to the writing carrier.
Effective
5.17January 1, 2012, no further enrollment may be accepted into the comprehensive health
5.18insurance plan. Coverage provided by the association to persons enrolled in the
5.19comprehensive health insurance plan prior to January 1, 2012, may continue.
5.20EFFECTIVE DATE.This section is effective January 1, 2012, and applies to
5.21coverage issued on or after that date.
5.22 Sec. 6. Minnesota Statutes 2010, section 62E.14, subdivision 1, is amended to read:
5.23 Subdivision 1.
Application, contents. Subject to section 62E.11, subdivision 1, the
5.24comprehensive health insurance plan shall be open for enrollment by eligible persons.
5.25An eligible person shall enroll by submission of an application to the writing carrier. The
5.26application must provide the following:
5.27(a) name, address, age, list of residences for the immediately preceding six months
5.28and length of time at current residence of the applicant;
5.29(b) name, address, and age of spouse and children if any, if they are to be insured;
5.30(c) evidence of rejection, a requirement of restrictive riders, a rate up, or a
5.31preexisting conditions limitation on a qualified plan, the effect of which is to substantially
5.32reduce coverage from that received by a person considered a standard risk, by at least one
5.33association member within six months of the date of the application, or other eligibility
6.1requirements adopted by rule by the commissioner which are not inconsistent with this
6.2chapter and which evidence that a person is unable to obtain coverage substantially similar
6.3to that which may be obtained by a person who is considered a standard risk;
6.4(d) if the applicant has been terminated from individual health coverage which
6.5does not provide replacement coverage, evidence that no replacement coverage that
6.6meets the requirements of section
62D.121 was offered, and evidence of termination of
6.7individual health coverage by an insurer, nonprofit health service plan corporation, or
6.8health maintenance organization, provided that the contract or policy has been terminated
6.9for reasons other than (1) failure to pay the charge for health care coverage; (2) failure to
6.10make co-payments required by the health care plan; (3) enrollee moving out of the area
6.11served; or (4) a materially false statement or misrepresentation by the enrollee in the
6.12application for the terminated contract or policy; and
6.13(e) a designation of the coverage desired.
6.14An eligible person may not purchase more than one policy from the state plan. Upon
6.15ceasing to be a resident of Minnesota a person is no longer eligible to purchase or renew
6.16coverage under the state plan, except as required by state or federal law with respect to
6.17renewal of Medicare supplement coverage.
6.18EFFECTIVE DATE.This section is effective January 1, 2012, and applies to
6.19coverage issued on or after that date.
6.20 Sec. 7. Minnesota Statutes 2010, section 62E.14, subdivision 3, is amended to read:
6.21 Subd. 3.
Preexisting conditions. No person who obtains coverage pursuant to
6.22this section shall be covered for any preexisting condition during the first six months of
6.23coverage under the state plan if the person was diagnosed or treated for that condition
6.24during the 90 days immediately preceding the date the application was received by the
6.25writing carrier, except as provided under subdivisions
3a, 4, 4a, 4b, 4c, 4d,
4e, 5, 6, and 7
6.26and section
62E.18.
6.27EFFECTIVE DATE.This section is effective January 1, 2012, and applies to
6.28coverage issued on or after that date.
6.29 Sec. 8.
REPEALER.
6.30Minnesota Statutes 2010, section 62A.65, subdivision 6, is repealed.
6.31EFFECTIVE DATE.This section is effective January 1, 2012, and applies to
6.32coverage issued on or after that date."
6.33Amend the title accordingly