Subdivision 1. Findings and purpose. The purpose of this section is to establish a standard for the determination of whether an insurance policy or other evidence or coverage should be treated as a policy of accident and sickness insurance or a stop loss policy for the purpose of the regulation of the business of insurance. The laws regulating the business of insurance in Minnesota impose distinctly different requirements upon accident and sickness insurance policies and stop loss policies. In particular, the regulation of accident and sickness insurance in Minnesota includes measures designed to reform the health insurance market, to minimize or prohibit selective rating or rejection of employee groups or individual group members based upon health conditions, and to provide access to affordable health insurance coverage regardless of preexisting health conditions. The health care reform provisions enacted in Minnesota will only be effective if they are applied to all insurers and health carriers who in substance, regardless of purported form, engage in the business of issuing health insurance coverage to employees of an employee group. This section applies to insurance companies and health carriers and the policies or other evidence of coverage that they issue. This section does not apply to employers or the benefit plans they establish for their employees.
Subd. 2. Definitions. For purposes of this section, the terms defined in this subdivision have the meanings given.
(a) "Attachment point" means the claims amount incurred by an insured group beyond which the insurance company or health carrier incurs a liability for payment.
(b) "Direct coverage" means coverage under which an insurance company or health carrier assumes a direct obligation to an individual, under the policy or evidence of coverage, with respect to health care expenses incurred by the individual or a member of the individual's family.
(c) "Expected claims" means the amount of claims that, in the absence of a stop loss policy or other insurance or evidence of coverage, are projected to be incurred by an employer-sponsored plan covering health care expenses.
(d) "Expected plan claims" means the expected claims less the projected claims in excess of the specific attachment point, adjusted to be consistent with the employer's aggregate contract period.
(e) "Health plan" means a health plan as defined in section 62A.011 and includes group coverage regardless of the size of the group.
(f) "Health carrier" means a health carrier as defined in section 62A.011.
Subd. 3. Health plan policies issued as stop loss coverage. (a) An insurance company or health carrier issuing or renewing an insurance policy or other evidence of coverage, that provides coverage to an employer for health care expenses incurred under an employer-sponsored plan provided to the employer's employees, retired employees, or their dependents, shall issue the policy or evidence of coverage as a health plan if the policy or evidence of coverage:
(1) has a specific attachment point for claims incurred per individual that is lower than $20,000; or
(2) has an aggregate attachment point that is lower than 110 percent of expected claims.
(b) An insurer shall determine the number of persons in a group, for the purposes of this section, on a consistent basis, at least annually. Where the insurance policy or evidence of coverage applies to a contract period of more than one year, the dollar amounts set forth in paragraph (a), clause (1), must be multiplied by the length of the contract period expressed in years.
(c) A policy or evidence of coverage issued by an insurance company or health carrier that provides direct coverage of health care expenses of an individual including a policy or evidence of coverage administered on a group basis is a health plan regardless of whether the policy or evidence of coverage is denominated as stop loss coverage.
Subd. 3a. Actuarial certification. An insurer shall file with the commissioner annually on or before March 15, an actuarial certification certifying that the insurer is in compliance with this section and section 60A.236. The certification shall be in a form and manner, and shall contain information, specified by the commissioner. A copy of the certification shall be retained by the insurer at its principal place of business.
Subd. 4. Compliance. (a) An insurance company or health carrier that is required to issue a policy or evidence of coverage as a health plan under this section shall, even if the policy or evidence of coverage is denominated as stop loss coverage, comply with all the laws of this state that apply to the health plan, including, but not limited to, chapters 62A, 62C, 62D, 62E, 62L, and 62Q.
(b) With respect to an employer who had been issued a policy or evidence of coverage denominated as stop loss coverage before August 1, 2009, compliance with this section is required as of the first renewal date occurring on or after August 1, 2009, and applies to policies issued or renewed on or after that date.
1995 c 258 s 6; 2009 c 178 art 1 s 16; 2017 c 2 art 2 s 2
Structure Minnesota Statutes
Chapters 59A - 79A — Insurance
Chapter 60A — General Insurance Powers
Section 60A.03 — Commissioner Of Commerce.
Section 60A.031 — Examinations.
Section 60A.032 — Commissioner's Orders, Report.
Section 60A.033 — Scheduling Conference And Order.
Section 60A.035 — Government Controlled Or Owned Company Prohibited From Transacting Business.
Section 60A.052 — Certificates Of Authority; Enforcement Actions.
Section 60A.06 — Kinds Of Insurance Permitted.
Section 60A.07 — Authorization And Requirements.
Section 60A.078 — Short Title.
Section 60A.0782 — Definitions.
Section 60A.0783 — Insurable Interest Required.
Section 60A.0784 — Prohibited Practices.
Section 60A.0785 — Prohibition; Entry Into Settlement Contracts.
Section 60A.0786 — Presumption Of Stoli Practices.
Section 60A.0787 — Processing Change Of Ownership Or Beneficiary Requests.
Section 60A.0788 — Fraudulent Acts.
Section 60A.08 — Contracts Of Insurance.
Section 60A.081 — Aircraft Insurance.
Section 60A.0811 — Breach Of Insurance Policy; Recovery Of Interest.
Section 60A.082 — Group Insurance; Benefits Continued If Insurer Changed.
Section 60A.084 — Notification On Group Policies.
Section 60A.085 — Cancellation Of Group Coverage; Notification To Covered Persons.
Section 60A.086 — Retroactive Termination Of Coverage Under Group Policies Prohibited.
Section 60A.09 — Limits Of Risk; Reinsurance.
Section 60A.091 — Definition; Qualified United States Financial Institution.
Section 60A.092 — Reinsurance Credit Allowed A Domestic Ceding Insurer.
Section 60A.0921 — Credit For Reinsurance; Certified Reinsurers.
Section 60A.095 — Reinsurance Agreements Affected.
Section 60A.096 — Qualifying Letter Of Credit.
Section 60A.097 — Qualifying Trust Agreements.
Section 60A.10 — Deposits For Protection Of Policyholders.
Section 60A.11 — Investments Permitted For Domestic Companies.
Section 60A.112 — Investment Policy Required.
Section 60A.12 — Assets And Liabilities.
Section 60A.121 — Valuations; Definitions.
Section 60A.122 — Required Written Procedures For Valuations.
Section 60A.123 — Valuation Procedure.
Section 60A.124 — Independent Audit.
Section 60A.125 — Appraisal By Independent Appraiser.
Section 60A.126 — Reports To Board; Valuations.
Section 60A.127 — Independent Appraisals Of Certain Properties.
Section 60A.1285 — Other Impairments.
Section 60A.1291 — Annual Audit.
Section 60A.1295 — Actuarial Opinion Of Reserves And Supporting Documentation.
Section 60A.1296 — Confidentiality.
Section 60A.13 — Annual Statement, Inquiries, Renewal Licenses.
Section 60A.131 — Other Business And Insurance Interests, Disclosure.
Section 60A.135 — Report; Certain Transactions.
Section 60A.136 — Acquisitions And Dispositions Of Assets.
Section 60A.137 — Nonrenewals, Cancellations, Or Revisions Of Ceded Reinsurance Agreements.
Section 60A.139 — Electronic Notices And Documents.
Section 60A.1391 — Corporate Governance Annual Disclosure.
Section 60A.16 — Mergers And Consolidations.
Section 60A.161 — Insurer Domestication And Conversion.
Section 60A.172 — Insurance Agency Contracts; Cancellation.
Section 60A.173 — Effective Date.
Section 60A.174 — Severability.
Section 60A.175 — Agent Commissions.
Section 60A.1755 — Agent Errors And Omissions Insurance; Choice Of Source.
Section 60A.176 — Definitions.
Section 60A.177 — Involuntary Termination Of An Agent By The Insurer.
Section 60A.178 — Life Or Health Insurance Sales Quotas.
Section 60A.179 — Life Or Health Insurance Sales Quotas For Exclusive Agents.
Section 60A.19 — Foreign Companies.
Section 60A.196 — Definitions.
Section 60A.197 — Rates And Forms.
Section 60A.198 — Transaction Of Nonadmitted Insurance.
Section 60A.199 — Examinations.
Section 60A.201 — Placement Of Insurance By Broker.
Section 60A.202 — Evidence Of Placement Of Insurance By Broker.
Section 60A.203 — Retention Of Records.
Section 60A.204 — Fees And Commissions.
Section 60A.205 — Compensation.
Section 60A.206 — Qualification As Eligible Surplus Lines Insurer.
Section 60A.207 — Policies To Include Notice.
Section 60A.208 — Broker Association.
Section 60A.2085 — Surplus Lines Association Of Minnesota.
Section 60A.2086 — Licensee's Duty To Submit Documents; Penalty.
Section 60A.209 — Insurance Procured From Ineligible Insurers.
Section 60A.2095 — Construction.
Section 60A.21 — Unauthorized Insurers Process Act.
Section 60A.23 — Miscellaneous.
Section 60A.236 — Stop Loss Regulation; Small Employer Coverage.
Section 60A.24 — Exemptions From Insurance Laws Of This State.
Section 60A.25 — Insolvent Companies.
Section 60A.26 — Suspension Of Insurers; Notifications And Reports.
Section 60A.27 — Discipline Of Insurer By Another State; Notice To Commissioner.
Section 60A.28 — Documents Filed With Commissioner, Verification.
Section 60A.29 — Nonprofit Risk Indemnification Trust Act.
Section 60A.315 — Expedited Form And Rate Filing.
Section 60A.32 — Rate Filing For Crop Hail Insurance.
Section 60A.351 — Renewal Of Insurance Policy With Altered Rates.
Section 60A.352 — Workers' Compensation Insurance.
Section 60A.36 — Midterm Cancellation.
Section 60A.38 — Interpretation And Penalties.
Section 60A.39 — Certificates Of Insurance.
Section 60A.41 — Subrogation Against Insureds Prohibited.
Section 60A.42 — Disability Income Coverage; Prohibited Provision.
Section 60A.52 — Company Action Level Event.
Section 60A.53 — Regulatory Action Level Event.
Section 60A.54 — Authorized Control Level Event.
Section 60A.55 — Mandatory Control Level Event.
Section 60A.57 — Access To And Use Of Rbc Information.
Section 60A.58 — Supplemental Provisions.
Section 60A.59 — Foreign Health Organizations.
Section 60A.61 — Risk-based Capital Reports.
Section 60A.62 — Company Action Level Event.
Section 60A.63 — Regulatory Action Level Event.
Section 60A.64 — Authorized Control Level Event.
Section 60A.65 — Mandatory Control Level Event.
Section 60A.67 — Confidentiality.
Section 60A.68 — Supplemental Provisions; Rules; Exemption.
Section 60A.69 — Foreign Insurers.
Section 60A.705 — Definitions.
Section 60A.715 — Required Contract Provisions; Reinsurance Intermediary-brokers.
Section 60A.72 — Books And Records; Reinsurance Intermediary-brokers.
Section 60A.725 — Duties Of Insurers Utilizing The Services Of A Reinsurance Intermediary-broker.
Section 60A.73 — Required Contract Provisions; Reinsurance Intermediary-managers.
Section 60A.735 — Prohibited Acts.
Section 60A.74 — Duties Of Reinsurer Utilizing The Services Of A Reinsurance Intermediary-manager.
Section 60A.745 — Examination Authority; Reinsurance Intermediary - Broker.
Section 60A.76 — Purpose And Scope.
Section 60A.761 — Glossary Of Technical Terms Used.
Section 60A.762 — Categories Of Reserves.
Section 60A.763 — Claim Reserves.
Section 60A.764 — Premium Reserves.
Section 60A.765 — Contract Reserves Required.
Section 60A.766 — Minimum Standards For Contract Reserves.
Section 60A.767 — Reinsurance.
Section 60A.768 — Specific Standards For Morbidity, Interest, And Mortality.
Section 60A.803 — Life And Health Reinsurance Agreements.
Section 60A.91 — Filing Requirements.
Section 60A.93 — Confidentiality.
Section 60A.94 — Revocation Of Certificate Of Authority.
Section 60A.951 — Definitions.
Section 60A.952 — Disclosure Of Information.
Section 60A.953 — Enforcement; Refusal To Cooperate With An Investigation.
Section 60A.954 — Insurance Antifraud Plan.
Section 60A.955 — Claim Forms To Contain Fraud Warning.
Section 60A.956 — Other Law Enforcement Authority.
Section 60A.957 — Definitions.
Section 60A.9572 — License And Bond Requirements.
Section 60A.9573 — License Revocation And Denial.
Section 60A.9574 — Approval Of Viatical Settlement Contracts And Disclosure Statements.
Section 60A.9575 — Reporting Requirements And Privacy.
Section 60A.9577 — Disclosure To Viator.
Section 60A.9579 — General Rules.
Section 60A.9581 — Prohibited Practices And Conflicts Of Interest.
Section 60A.9583 — Fraud Prevention And Control.
Section 60A.9585 — Unfair Trade Practice.
Section 60A.975 — Definitions.
Section 60A.976 — Annuity Issuers Financial Requirements.
Section 60A.985 — Definitions.
Section 60A.9851 — Information Security Program.
Section 60A.9852 — Investigation Of A Cybersecurity Event.
Section 60A.9853 — Notification Of A Cybersecurity Event.
Section 60A.9854 — Power Of Commissioner.
Section 60A.9855 — Confidentiality.
Section 60A.9856 — Exceptions.
Section 60A.9858 — Exclusivity.
Section 60A.99 — Interstate Insurance Product Regulation Compact.
Section 60A.991 — Interstate Insurance Product Regulation Compact Opt Out Administration.