62E.02 DEFINITIONS.

§

Subdivision 1.Application.

For the purposes of sections 62E.01 to 62E.19, the terms and phrases defined in this section have the meanings given them. §

Subd. 2.Employer.

“Employer” means any person, partnership, association, trust, estate or corporation, including the state of Minnesota or any agency, instrumentality or governmental subdivision thereof, which employs ten or more individuals who are residents of this state. §

Subd. 2a.Essential health benefits.

“Essential health benefits” has the meaning given under section 62Q.81, subdivision 4. §

Subd. 3.Health maintenance organization.

“Health maintenance organization” means a corporation licensed and operated as provided in chapter 62D. §

Subd. 4.Qualified plan.

“Qualified plan” means those health benefit plans which have been certified by the commissioner as providing the minimum benefits required by section 62E.06 or the actuarial equivalent of those benefits. §

Subd. 5.Qualified Medicare supplement plan.

“Qualified Medicare supplement plan” means those health benefit plans which have been certified by the commissioner as providing the minimum benefits required by section 62E.07. §

Subd. 6.Commissioner.

“Commissioner” means the commissioner of commerce. §

Subd. 7.

[Repealed, 2013 c 84 art 1 s 94] §

Subd. 8.Employee.

“Employee” means any Minnesota resident who has entered into the employment of or works under contract or service or apprenticeship with any employer. “Employee” does not include a person who has been employed for less than 30 days by that person’s present employer, nor one who is employed less than 30 hours per week by that person’s present employer, nor an independent contractor. §

Subd. 9.Plan of health coverage.

“Plan of health coverage” means any plan or combination of plans of coverage, including combinations of self insurance, individual accident and health insurance policies, group accident and health insurance policies, coverage under a nonprofit health service plan, or coverage under a health maintenance organization subscriber contract. §

Subd. 10.Insurer.

“Insurer” means those companies operating pursuant to chapter 62A or 62C and offering, selling, issuing, or renewing policies or contracts of accident and health insurance. “Insurer” does not include health maintenance organizations or community integrated service networks. §

Subd. 11.Accident and health insurance policy or policy.

“Accident and health insurance policy” or “policy” means insurance or nonprofit health service plan contracts providing benefits for hospital, surgical and medical care. “Policy” does not include coverage which is (1) limited to disability or income protection coverage, (2) automobile medical payment coverage, (3) supplemental to liability insurance, (4) designed solely to provide payments on a per diem, fixed indemnity or nonexpense incurred basis, (5) credit accident and health insurance issued pursuant to chapter 62B, (6) designed solely to provide dental or vision care, (7) blanket accident and sickness insurance as defined in section 62A.11, or (8) accident only coverage issued by licensed and tested insurance agents or solicitors which provides reasonable benefits in relation to the cost of covered services. The provisions of clause (4) shall not apply to hospital indemnity coverage which is sold by an insurer to an applicant who is not then currently covered by a qualified plan. §

Subd. 12.Health benefits.

“Health benefits” means benefits offered to employees on an indemnity or prepaid basis which pay the costs of or provide medical, surgical or hospital care. §

Subd. 13.Eligible person.

(a) “Eligible person” means an individual who:

(1) is currently and has been a resident of Minnesota for the six months immediately preceding the date of receipt by the association or its writing carrier of a completed certificate of eligibility;

(2) meets the enrollment requirements of section 62E.14; and

(3) is not otherwise ineligible under this subdivision.

For purposes of eligibility under section 62E.14, subdivision 4c, paragraph (b), this definition is modified as provided in that paragraph.

(b) No individual is eligible for coverage under a qualified or a Medicare supplement plan issued by the association for whom a premium is paid or reimbursed by the medical assistance program as of the first day of any term for which a premium amount is paid or reimbursed. §

Subd. 14.Minnesota Comprehensive Health Association or association.

“Minnesota Comprehensive Health Association” or “association” means the association created by section 62E.10. §

Subd. 15.Medicare.

“Medicare” means the Health Insurance for the Aged Act, title XVIII of the Social Security Amendments of 1965, United States Code, title 42, sections 1395 to 1395hhh, as amended, or title I, part I, of Public Law 89-97, as amended. §

Subd. 16.Medicare supplement plan.

“Medicare supplement plan” means any plan of insurance protection which provides benefits for the costs of medical, surgical or hospital care and which is marketed as providing benefits which complement or supplement the benefits provided by Medicare. §

Subd. 17.State plan premium.

“State plan premium” means the premium determined pursuant to section 62E.08. §

Subd. 18.Writing carrier.

“Writing carrier” means the insurer or insurers, health maintenance organization or organizations, community integrated service network or networks, or other entity selected by the association and approved by the commissioner to administer the comprehensive health insurance plan. §

Subd. 19.Fraternal benefit society or fraternal.

“Fraternal benefit society” or “fraternal” means a corporation, society, order, or voluntary association without capital stock which sells health and accident insurance in accordance with chapter 64B. §

Subd. 20.Comprehensive health insurance plan or state plan.

“Comprehensive health insurance plan” or “state plan” means policies of insurance and contracts of health maintenance organization or community integrated service network coverage offered by the association through the writing carrier. §

Subd. 21.Self-insurer.

“Self-insurer” means an employer or an employee welfare benefit fund or plan which directly or indirectly provides a plan of health coverage to its employees and administers the plan of health coverage itself or through an insurer, trust or agent except to the extent of accident and health insurance premium, subscriber contract charges or health maintenance organization contract charges. “Self-insurer” does not include an employer engaged in the business of providing health care services to the public which provides health care services directly to its employees at no charge to them. §

Subd. 22.Self-insurance.

“Self-insurance” means a plan of health coverage offered by a self-insurer. §

Subd. 23.Contributing member.

“Contributing member” means those companies regulated under chapter 62A and offering, selling, issuing, or renewing policies or contracts of accident and health insurance; health maintenance organizations regulated under chapter 62D; nonprofit health service plan corporations regulated under chapter 62C; community integrated service networks regulated under chapter 62N; fraternal benefit societies regulated under chapter 64B; the Minnesota employees insurance program established in section 43A.317, effective July 1, 1993; and joint self-insurance plans regulated under chapter 62H. For the purposes of determining liability of contributing members pursuant to section 62E.11 payments received from or on behalf of Minnesota residents for coverage by a health maintenance organization or community integrated service network shall be considered to be accident and health insurance premiums.

History:

1976 c 296 art 1 s 2; 1977 c 409 s 4-7; 1979 c 272 s 1,2; 1981 c 318 s 13; 1983 c 289 s 114 subd 1; 1984 c 655 art 1 s 92; 1985 c 49 s 41; 1986 c 444; 1987 c 268 art 2 s 17; 1987 c 384 art 2 s 1; art 3 s 47; 1988 c 612 s 27; 1992 c 549 art 3 s 13; 1992 c 564 art 1 s 34,54; 1994 c 625 art 8 s 7-10; art 10 s 50; 1995 c 258 s 40; 1997 c 175 art 1 s 1; 1997 c 225 art 2 s 62; art 6 s 1,2; 1999 c 177 s 44; 1999 c 245 art 10 s 10; 2007 c 147 art 12 s 2; 2010 c 384 s 21; 2013 c 84 art 1 s 37; 2016 c 158 art 2 s 12; 2017 c 2 art 2 s 9

History: History: 1976 c 296 art 1 s 2; 1977 c 409 s 4-7; 1979 c 272 s 1,2; 1981 c 318 s 13; 1983 c 289 s 114 subd 1; 1984 c 655 art 1 s 92; 1985 c 49 s 41; 1986 c 444; 1987 c 268 art 2 s 17; 1987 c 384 art 2 s 1; art 3 s 47; 1988 c 612 s 27; 1992 c 549 art 3 s 13; 1992 c 564 art 1 s 34,54; 1994 c 625 art 8 s 7-10; art 10 s 50; 1995 c 258 s 40; 1997 c 175 art 1 s 1; 1997 c 225 art 2 s 62; art 6 s 1,2; 1999 c 177 s 44; 1999 c 245 art 10 s 10; 2007 c 147 art 12 s 2; 2010 c 384 s 21; 2013 c 84 art 1 s 37; 2016 c 158 art 2 s 12; 2017 c 2 art 2 s 9