Chapter 62A — Requirements; Certificates of Coverage Under Policy of Accident and Sickness Insurance

15.001 Application of Laws 2005, Chapter 56, Terminology Changes When Minnesota updates official terminology in state laws, agencies must start using the new terms on new materials but … 62A.001 A cross-reference placeholder connecting related terminology changes to the health insurance chapter. 62A.01 Requirements; Certificates of Coverage Under Policy of Accident and Sickness Insurance Defines what counts as an accident and sickness insurance policy in Minnesota, and requires that people covered under … 62A.011 Definitions Defines key terms used throughout the health insurance chapter, including what counts as a health carrier, health plan, … 62A.02 Policy Forms Health insurance companies must file their policy forms and premium rates with the state for approval before selling … 62A.021 Health Care Policy Rates Health insurance companies must spend a minimum percentage of the premiums they collect on actual health care for … 62A.023 Notice of Rate Change Health insurance companies must give individual policyholders at least 30 days' written notice before changing their … 62A.024 Explanations of Rate Increases; Attribution to Statutory Changes If a health insurance company blames a rate increase on a change in state law, it must tell you exactly how much of the … 62A.025 This statute section has been repealed and is no longer in effect. 62A.03 General Provisions of Policy Individual health insurance policies in Minnesota must meet specific requirements: they must clearly state the premium, … 62A.04 Standard Provisions Sets out the standard provisions that must appear in individual health insurance policies, including grace periods for … 62A.041 Maternity Benefits Health insurance plans cannot treat unmarried women differently from married women when it comes to maternity coverage. … 62A.0411 Maternity Care Health plans must cover at least 48 hours of hospital care after a vaginal delivery and 96 hours after a C-section for … 62A.042 Family Coverage; Coverage of Newborn Infants Requires health insurance plans that cover families to automatically cover newborn babies from the moment of birth, … 62A.043 Dental and Podiatric Coverage If a health plan covers a service that a dentist or podiatrist can legally perform, the plan must pay for that service … 62A.044 Payments to Governmental Institutions Health insurance plans cannot refuse to pay for covered services just because the care was provided at a government-run … 62A.045 Payments on Behalf of Enrollees in Government Health Programs Health insurance companies cannot deny or reduce benefits because a person is also enrolled in Medicaid, MinnesotaCare, … 62A.046 Coordination of Benefits When a person has more than one health plan, the plans must coordinate payments so total coverage does not exceed 100 … 62A.047 Children's Health Supervision Services and Prenatal Care Services Requires health plans to cover well-child checkups, immunizations, and prenatal care services, and prohibits charging … 62A.048 Dependent Coverage Requires health plans that offer dependent coverage to cover children who do not live with the parent on the same terms … 62A.049 Limitation on Preauthorizations; Emergencies Protects you from losing insurance benefits when you need emergency care and cannot get prior authorization first. You … 62A.05 Construction of Provisions If a health insurance policy has language that conflicts with Minnesota's required consumer protections, the state law … 62A.06 Statements in Application An insurer cannot hold you to statements made in your application unless a copy of the application is attached to the … 62A.07 Rights of Insurer, When Not Waived An insurance company does not give up its right to fight a claim just because it acknowledged your notice, sent you … 62A.08 Coverage of Policy, Continuance in Force If an insurer accepts your premium payment past the policy's age limit or end date, your coverage continues until the … 62A.081 Payments to Facilities Operated by State or Local Government Health insurance plans must pay for covered services at state or local government hospitals and medical facilities on … 62A.082 Nondiscrimination in Access to Transplants Health plans that cover organ transplants cannot deny transplant coverage based on a person's disability. Insurers also … 62A.09 Limitation The health insurance rules in sections 62A.01 through 62A.08 do not apply to workers' compensation insurance, casualty … 62A.095 Subrogation Clauses Regulated If your health insurer wants to recover money it paid for your care from a lawsuit settlement or judgment you receive, … 62A.096 Notice to Insurer of Subrogation Claim Required If you file a claim against someone else to recover damages that include medical expenses your health insurer paid, you … 62A.10 Group Insurance Group health insurance can cover employees, members of associations, and their dependents. The policy must give each … 62A.105 Coverages; Transfers to Substantially Similar Products If your health insurer stops selling your type of plan, they must let you switch to a similar plan they still offer … 62A.11 Blanket Accident and Sickness Insurance Blanket accident and sickness insurance covers groups of people like passengers on a bus or train, students at a school, … 62A.12 This statute section has been repealed and is no longer in effect. 62A.13 Commercial Traveler Insurance Companies Special rules allow certain membership associations for commercial travelers and professionals to issue health and … 62A.135 Fixed Indemnity Policies; Minimum Loss Ratios Fixed indemnity insurance policies (which pay a set dollar amount per service rather than covering actual costs) must … 62A.136 Hearing, Dental, and Vision Plan Coverage Standalone hearing, dental, and vision plans are exempt from many of the health insurance mandates that apply to … 62A.14 Disabled Children Health insurance coverage for a dependent child cannot be cut off at the age limit if the child has a disability that … 62A.141 Coverage for Disabled Dependents Requires group health plans that include dependent coverage to cover disabled dependents who cannot support themselves … 62A.145 Survivor; Definition Defines who counts as a 'survivor' for health insurance continuation purposes — specifically a spouse, child, or other … 62A.146 Continuation of Benefits to Survivors When a person with health insurance dies, the surviving spouse and dependent children can continue their coverage under … 62A.147 Disabled Employees' Benefits; Definitions Defines key terms related to continuation of group health insurance for totally disabled employees, including what … 62A.148 Group Insurance; Provision of Benefits for Disabled Employees An employer cannot cancel a totally disabled employee's group health insurance just because the employee is unable to … 62A.149 Benefits for Alcoholics and Drug Dependents Requires group health insurance policies in Minnesota to provide coverage for the treatment of alcoholism, chemical … 62A.15 Coverage of Certain Licensed Health Professional Services Group health plans must cover services provided by chiropractors, optometrists, advanced practice registered nurses, … 62A.151 Health Insurance Benefits for Emotionally Disabled Children Group health insurance plans that cover inpatient hospital care must also cover treatment for emotionally disabled … 62A.152 Benefits for Ambulatory Mental Health Services Requires group health insurance plans that cover hospital treatment for mental health conditions to also cover … 62A.153 Outpatient Medical and Surgical Services Health insurance plans that cover hospital services must also cover the same treatments and surgeries when performed on … 62A.154 Benefits for Des Related Conditions Health insurance companies cannot deny coverage, charge higher premiums, or impose special limitations solely because a … 62A.155 Coverage for Services Provided to Ventilator-dependent Persons Health plans that cover home care for ventilator-dependent people must also cover up to 120 hours of their home care … 62A.16 Scope of Certain Continuation and Conversion Requirements Minnesota's health insurance continuation and conversion rights apply to all group health plans covering Minnesota … 62A.17 Termination of or Layoff From Employment; Continuation and Conversion Rights Gives employees who are fired or laid off the right to keep their group health insurance for up to 18 months by paying … 62A.18 Prohibition Against Disability Offsets Health insurance policies cannot reduce your disability benefits just because your Social Security, workers' … 62A.19 Prohibition Against Nondiagnostic X-rays Dental insurance companies cannot require X-rays that are not needed for patient care, and dentists can refuse to take … 62A.20 Continuation Coverage of Current Spouse and Children When the primary insured person becomes eligible for Medicare, the spouse and dependent children can continue their … 62A.21 Continuation and Conversion Privileges for Insured Former Spouses and Children Protects former spouses and children after a divorce by requiring health insurance plans to continue covering them. … 62A.22 Refusal to Provide Coverage Because of Option Under Workers' Compensation Health insurers cannot refuse to sell or renew your health insurance just because you have the option to elect workers' … 62A.23 Group Disability Income Coverage; Termination Without Prejudice; Definitions Defines the terms 'employer' and 'insurer' as used in the rules about group disability income insurance and continuation … 62A.24 Continuation of Benefits If a group disability income insurance policy is terminated, the insurer must still honor claims for disabilities that … 62A.25 Reconstructive Surgery Health plans must cover reconstructive surgery when it follows surgery for injury or disease, or for children born with … 62A.26 Coverage for Phenylketonuria Treatment Health plans must cover special dietary treatment for phenylketonuria (PKU) when prescribed by a doctor. 62A.265 Coverage for Lyme Disease All health plans in Minnesota must cover treatment for diagnosed Lyme disease and cannot impose any special deductibles, … 62A.27 Coverage of Adopted Children Health plans must cover adopted children on the same terms as biological children, starting from the date the child is … 62A.28 Coverage for Scalp Hair Prostheses Health plans must cover scalp hair prostheses (wigs) up to $1,000 per year when prescribed by a doctor for hair loss … 62A.285 Prohibited Underwriting; Breast Implants Health insurers cannot deny, limit, or charge higher premiums for coverage just because a person has breast implants. 62A.29 Surety Bond or Security for Certain Health Benefit Plans Employers who self-insure their employee health plans and buy stop-loss insurance must file a surety bond or other … 62A.30 Coverage for Diagnostic Procedures for Cancer Health plans must cover cancer screening tests including mammograms, Pap smears, colorectal screenings, and ovarian … 62A.301 This statute section has been repealed and is no longer in effect. 62A.302 Coverage of Dependents Requires health plans that offer dependent coverage to cover children up to age 26, regardless of whether the child … 62A.3021 Coverage of Dependents by Plans Other Than Health Plans Defines who counts as a dependent for non-health insurance plans (such as dental, vision, accident-only, and Medicare … 62A.303 Prohibition; Severing of Groups Health insurers cannot break up an employer's group into smaller pieces to charge higher rates — the rules against group … 62A.304 Coverage for Port-wine Stain Elimination Health plans must cover treatment to remove or reduce port-wine stain birthmarks, and insurers cannot raise rates … 62A.305 Fibrocystic Condition; Termination or Reduction of Coverage Health plans cannot cancel your coverage, raise your rates, or limit your benefits just because you have been diagnosed … 62A.306 Use of Gender Prohibited Health insurance companies in Minnesota cannot set premiums or make coverage decisions based on a person's gender or … 62A.307 Prescription Drugs; Equal Treatment of Prescribers Health plans that cover prescription drugs must cover a prescription regardless of what type of provider wrote it, as … 62A.3075 Cancer Chemotherapy Treatment Coverage Health plans cannot charge higher co-pays or deductibles for oral chemotherapy pills than for IV chemotherapy drugs used … 62A.308 Hospitalization and Anesthesia for Dental Procedures Health plans must cover hospital and anesthesia charges for dental procedures when the patient is a child under five, is … 62A.309 This statute section has been repealed and is no longer in effect. 62A.3091 Nondiscriminate Coverage of Tests Health plans must cover lab tests, diagnostic tests, and X-rays ordered by nurse practitioners and physician assistants … 62A.3092 Equal Treatment of Surgical First Assisting Services Health plans that cover surgical first-assisting services must also cover those services when performed by a registered … 62A.3093 Coverage for Diabetes Requires health plans to cover diabetes equipment, supplies, and outpatient self-management education and training, … 62A.3094 Coverage for Autism Spectrum Disorders Requires large employer health plans to cover diagnosis, evaluation, and treatment for children under 18 with autism … 62A.3095 Prescription Eye Drops Coverage Health plans that cover prescription eye drops cannot deny an early refill if the doctor authorized additional … 62A.3097 Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (pandas) and Pediatric Acute-onset Neuropsychiatric Syndrome (pans) Treatment; Coverage Health plans must cover treatment for PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with … 62A.3098 Rapid Whole Genome Sequencing; Coverage Health plans must cover rapid whole genome sequencing (rWGS) testing for critically ill children age 21 and under who … 62A.3099 Definitions Defines key terms used throughout the Medicare supplement insurance rules, including what counts as a Medicare … 62A.31 Medicare Supplement Benefits; Minimum Standards Sets minimum standards for all Medicare supplement policies sold in Minnesota, including required policy provisions, … 62A.315 Extended Basic Medicare Supplement Plan; Coverage The extended basic Medicare supplement plan covers Medicare Part A hospital deductibles and coinsurance, skilled nursing … 62A.316 Basic Medicare Supplement Plan; Coverage The basic Medicare supplement plan covers Medicare Part A hospital coinsurance (after the deductible), Part B … 62A.3161 Medicare Supplement Plan With 50 Percent Coverage Describes a Medicare supplement plan option that covers 50 percent of certain costs not paid by Medicare, including … 62A.3162 Medicare Supplement Plan With 75 Percent Coverage Describes a Medicare supplement plan option that covers 75 percent of certain costs not paid by Medicare, including … 62A.3163 Medicare Supplement Plan With 50 Percent Part a Deductible Coverage Describes a Medicare supplement plan option that covers 50 percent of the Medicare Part A deductible along with other … 62A.3164 Medicare Supplement Plan With $20 and $50 Co-payment Medicare Part B Coverage Describes a Medicare supplement plan option that uses fixed co-payments ($20 for office visits, $50 for emergency room … 62A.3165 Medicare Supplement Plan With High Deductible Coverage Describes a high-deductible Medicare supplement plan that provides 100 percent coverage after you pay a set annual … 62A.317 Standards for Claims Payment Medicare supplement insurers must accept Medicare notices as claims, process claims within 30 days, and pay interest on … 62A.318 Medicare Select Policies and Certificates Medicare Select policies offer lower premiums in exchange for using a network of preferred providers. If you go outside … 62A.319 This statute section has been repealed and is no longer in effect. 62A.32 This statute section has been repealed and is no longer in effect. 62A.33 This statute section has been repealed and is no longer in effect. 62A.34 This statute section has been repealed and is no longer in effect. 62A.35 This statute section has been repealed and is no longer in effect. 62A.36 Loss Ratio Standards Medicare supplement insurers must return a minimum percentage of premiums as benefits. If they fall short, they must … 62A.37 Government Certifications, Approvals, and Endorsements Medicare supplement insurers cannot use government seals, emblems, or names in a way that implies government approval or … 62A.38 Notice of Free Examination Medicare supplement policies must include a notice giving buyers 30 days to return the policy for a full refund if they … 62A.39 Disclosure Insurers must give Medicare supplement plan buyers a clear outline of coverage describing benefits, exclusions, … 62A.40 Replacement Regulated Insurance agents cannot replace your Medicare supplement plan with another one of the same type unless the new one is … 62A.41 Penalties Insurers and agents who violate Medicare supplement insurance rules face penalties including fines up to $25,000 per … 62A.42 Rulemaking Authority The commissioner of commerce has authority to adopt rules for Medicare supplement insurance, including standards, … 62A.421 Demonstration Projects The commissioner of commerce can authorize experimental Medicare supplement demonstration projects to test innovative … 62A.43 Limitations on Sales Sets limits on selling Medicare supplement insurance, including prohibitions on selling duplicate coverage or policies … 62A.436 Commissions Regulates commissions paid to agents selling Medicare supplement plans, ensuring that commission structures do not … 62A.44 Applications Medicare supplement insurance applications must include questions to help determine if the applicant already has similar … 62A.45 This statute section has been repealed and is no longer in effect. 62A.451 Definitions Defines key terms used in the long-term care insurance sections, including what counts as long-term care insurance, … 62A.4511 Certificate of Authority Required Prepaid limited health service organizations (like discount dental or vision plans) must get a certificate of authority … 62A.4512 Application for Certificate of Authority Sets out the application requirements for prepaid limited health service organizations seeking a certificate of … 62A.4513 Issuance of Certificate of Authority; Denial Establishes the process and criteria for the commissioner to issue or deny a certificate of authority to a prepaid … 62A.4514 Filing Requirements for Authorized Entities Authorized prepaid limited health service organizations must file updates with the commissioner, including any changes … 62A.4515 Material Modifications Prepaid limited health service organizations must report material changes to the commissioner before making them, and … 62A.4516 Evidence of Coverage Prepaid limited health service organizations must provide each enrollee with written evidence of coverage describing the … 62A.4517 Construction With Other Laws Explains how the prepaid limited health service organization laws interact with other insurance and health care laws in … 62A.4518 Nonduplication of Coverage Prepaid limited health service organizations cannot provide coverage that duplicates coverage already required to be … 62A.4519 Complaint System Prepaid limited health service organizations must maintain a complaint system and respond to member complaints in a … 62A.4520 Examination of Organization The commissioner of commerce can examine the books, records, and operations of prepaid limited health service … 62A.4521 Investments Sets investment standards for prepaid limited health service organizations to ensure they have adequate funds to pay … 62A.4522 Agents Agents selling prepaid limited health service plans must be licensed and follow the same rules as other insurance … 62A.4523 Protection Against Insolvency; Deposit Prepaid limited health service organizations must maintain a financial deposit with the state to protect enrollees if … 62A.4524 Officer's and Employee's Fidelity Bond Officers and employees of prepaid limited health service organizations who handle funds must be covered by a fidelity … 62A.4525 Reports Prepaid limited health service organizations must file annual financial reports with the commissioner of commerce. 62A.4526 Suspension or Revocation of Certificate of Authority The commissioner can suspend or revoke the certificate of authority of a prepaid limited health service organization for … 62A.4527 Penalties Violations of the prepaid limited health service organization laws can result in penalties including fines and … 62A.4528 Rehabilitation, Conservation, or Liquidation If a prepaid limited health service organization becomes financially troubled, the commissioner can take steps to … 62A.46 Definitions Provides additional definitions for long-term care insurance regulation, including terms related to benefit triggers, … 62A.48 Long-term Care Policies Sets requirements for long-term care insurance policies sold in Minnesota, including rules about benefit levels, … 62A.49 Home Care Services Coverage Long-term care policies that cover nursing home care must also provide coverage for home care services, including home … 62A.50 Disclosures and Representations Long-term care insurers must clearly disclose what their policies cover and do not cover, and cannot misrepresent their … 62A.52 Review of Plan of Care Long-term care insurers must review the insured person's plan of care when coverage is initially approved and at … 62A.54 Prohibited Practices Prohibits unfair practices in the sale or administration of long-term care insurance, including twisting (replacing an … 62A.56 Rulemaking The commissioner of commerce has authority to adopt rules to carry out the long-term care insurance regulations. 62A.59 Coverage of Service; Prior Authorization Health plans must honor prior authorization approvals for the duration stated in the approval and cannot retroactively … 62A.60 Retroactive Denial of Expenses Prevents insurance companies from denying payment for covered health services after the fact if the insurer failed to do … 62A.61 Disclosure of Methods Used by Health Carriers to Determine Usual and Customary Fees Health insurers must disclose, upon request, the method they use to determine usual and customary fee amounts for … 62A.615 This statute section has been repealed and is no longer in effect. 62A.616 Coverage for Nursing Home Care for Terminally Ill and Other Services Health plans that cover nursing home care must also cover nursing home stays for terminally ill patients, even if the … 62A.62 Demonstration Project The commissioner of commerce may authorize demonstration projects to test cost-effective health coverage alternatives. 62A.63 Definitions Defines key terms used in the employee health insurance conversion and continuation rules, including what counts as a … 62A.64 Health Insurance; Prohibited Agreements Health insurers cannot include contract terms that prohibit health care providers from discussing treatment options with … 62A.65 Individual Market Regulation Sets the rules for individual health insurance sold in Minnesota, including guaranteed renewal rights, limits on premium … 62A.651 This statute section has been repealed and is no longer in effect. 62A.66 This statute section has been repealed and is no longer in effect. 62A.661 This statute section has been repealed and is no longer in effect. 62A.67 This statute section has been repealed and is no longer in effect. 62A.671 This statute section has been repealed and is no longer in effect. 62A.672 This statute section has been repealed and is no longer in effect. 62A.673 Coverage of Services Provided Through Telehealth Requires health plans in Minnesota to cover telehealth services the same way they cover in-person services, including …