Subdivision 1. Applicability. The provisions of this section shall be applicable to nonprofit prepaid health care plans regulated under chapter 317A, and health maintenance organizations regulated pursuant to sections 62D.01 to 62D.30, both of which for purposes of this section shall be known as "health plans."
Subd. 2. [Repealed, 1984 c 464 s 46]
Subd. 3. Open enrollment. A health plan providing health maintenance services or reimbursement for health care costs to a specified group or groups may limit the open enrollment in each group plan to members of such group or groups, but after it has been in operation 24 months shall have an annual open enrollment period of at least 14 days during which it shall accept all otherwise eligible individuals in the order in which they apply for enrollment in a manner which does not discriminate on the basis of age, sex, race, health, or economic status. The health maintenance organization shall notify potential enrollees of any limitations on the number of new enrollees to be accepted. "Specified groups" may include, but shall not be limited to:
(1) employees of one or more specified employers;
(2) members of one or more specified labor unions;
(3) members of one or more specified associations;
(4) patients of physicians providing services through a health care plan who had previously provided services outside the health care plan; and
(5) members of an existing group insurance policy.
Subd. 4. Waivers. A health plan may apply to the commissioner of health for a waiver of the requirements of this section or for authorization to impose such underwriting restrictions upon open enrollment as are necessary (1) to preserve its financial stability, (2) to prevent excessive adverse selection by prospective enrollees, or (3) to avoid unreasonably high or unmarketable charges for enrollee coverage for health care services. The commissioner of health upon a showing of good cause, shall approve or upon failure to show good cause shall deny such application within 30 days of the receipt thereof from the health plan. The commissioner of health may, in accordance with chapter 14, promulgate rules to implement this section.
Subd. 5. Application fee. Any fee charged by a health maintenance organization for the process of determining an applicant's eligibility, and any other application fee charged, shall be refunded with interest to the applicant if the applicant is not accepted for enrollment in the health maintenance organization, or credited with interest to the applicant's premiums due if the applicant is accepted for enrollment in the organization.
Subd. 6. Statement of risk sharing. Health maintenance organization contracts under section 62D.04, subdivision 1, shall include a clear statement of the risk sharing arrangement.
1973 c 670 s 10; 1974 c 284 s 3,4; 1977 c 305 s 45; 1977 c 409 s 3; 1982 c 424 s 130; 1984 c 464 s 25,26; 1987 c 130 s 3; 1987 c 384 art 2 s 1; 1989 c 304 s 137
Structure Minnesota Statutes
Chapters 59A - 79A — Insurance
Chapter 62D — Health Maintenance Organizations
Section 62D.01 — Citation And Purpose.
Section 62D.03 — Establishment Of Health Maintenance Organizations.
Section 62D.04 — Issuance Of Certificate Authority.
Section 62D.041 — Protection In The Event Of Insolvency.
Section 62D.042 — Initial Net Worth Requirement.
Section 62D.044 — Admitted Assets.
Section 62D.045 — Investment Restrictions.
Section 62D.05 — Powers Of Health Maintenance Organizations.
Section 62D.06 — Governing Body.
Section 62D.07 — Evidence Of Coverage; Required Terms.
Section 62D.08 — Annual Report.
Section 62D.09 — Information To Enrollees.
Section 62D.095 — Enrollee Cost Sharing.
Section 62D.10 — Provisions Applicable To All Health Plans.
Section 62D.101 — Continuation And Conversion Privileges For Former Spouses And Children.
Section 62D.102 — Family Therapy.
Section 62D.103 — Second Opinion Related To Substance Use Disorder And Mental Health.
Section 62D.104 — Required Out-of-area Conversion.
Section 62D.105 — Coverage Of Current Spouse, Former Spouse, And Children.
Section 62D.107 — Equal Access To Acupuncture Services.
Section 62D.109 — Services Associated With Clinical Trials.
Section 62D.11 — Complaint System.
Section 62D.115 — Quality Of Care Complaints.
Section 62D.12 — Prohibited Practices.
Section 62D.121 — Required Replacement Coverage.
Section 62D.123 — Provider Contracts.
Section 62D.124 — Geographic Accessibility.
Section 62D.13 — Powers Of Insurers And Nonprofit Health Service Plans.
Section 62D.14 — Examinations.
Section 62D.145 — Disclosure Of Information Held By Health Maintenance Organizations.
Section 62D.15 — Suspension Or Revocation Of Certificate Of Authority.
Section 62D.16 — Denial, Suspension, And Revocation; Administrative Procedures.
Section 62D.17 — Penalties And Enforcement.
Section 62D.18 — Rehabilitation Or Liquidation Of Health Maintenance Organization.
Section 62D.181 — Insolvency; Mcha Alternative Coverage.
Section 62D.182 — Liabilities.
Section 62D.19 — Unreasonable Expenses.
Section 62D.211 — Renewal Fee.
Section 62D.22 — Statutory Construction And Relationship To Other Laws.
Section 62D.23 — Filings And Reports As Public Documents.
Section 62D.24 — Commissioner Of Health's Authority To Contract.