62D.01 CITATION AND PURPOSE. Subdivision 1. Title. Sections 62D.01 to 62D.24 may be cited as the “Health Maintenance Act of 1973.” Subd. 2. Legislative findings and intent; policy. (a) Faced with the continuation of mounting costs of health care coupled with its inaccessibility to large segments of the population, the legislature has determined that there […]
62D.02 DEFINITIONS. Subdivision 1. Applicability. For the purposes of sections 62D.01 to 62D.30, unless the context clearly indicates otherwise, the terms defined in this section shall have the meaning here given them. Subd. 2. [Repealed, 1990 c 538 s 32] Subd. 3. Commissioner of health or commissioner. “Commissioner of health” or “commissioner” means the state […]
62D.03 ESTABLISHMENT OF HEALTH MAINTENANCE ORGANIZATIONS. Subdivision 1. Certificate of authority required. Notwithstanding any law of this state to the contrary, any foreign or domestic corporation organized to do so or a local governmental unit may apply to the commissioner of health for a certificate of authority to establish and operate a health maintenance organization […]
62D.04 ISSUANCE OF CERTIFICATE AUTHORITY. Subdivision 1. Application review. Upon receipt of an application for a certificate of authority, the commissioner of health shall determine whether the applicant for a certificate of authority has: (a) demonstrated the willingness and potential ability to assure that health care services will be provided in such a manner as […]
62D.041 PROTECTION IN THE EVENT OF INSOLVENCY. Subdivision 1. Definition. (a) For the purposes of this section, the term “uncovered expenditures” means the costs of health care services that are covered by a health maintenance organization for which an enrollee would also be liable in the event of the organization’s insolvency, and that are not […]
62D.042 INITIAL NET WORTH REQUIREMENT. Subdivision 1. Definition. For purposes of this section, if a health maintenance organization offers supplemental benefits as described in section 62D.05, subdivision 6, “expenses” does not include any expenses attributable to the supplemental benefit. Subd. 2. Initial net worth requirement. Beginning organizations shall maintain net worth of at least 8-1/3 […]
62D.044 ADMITTED ASSETS. “Admitted assets” includes the following: (1) petty cash and other cash funds in the organization’s principal or official branch office that are under the organization’s control; (2) immediately withdrawable funds on deposit in demand accounts, in a bank or trust company organized and regularly examined under the laws of the United States […]
62D.045 INVESTMENT RESTRICTIONS. Subdivision 1. Restrictions. Funds of a health maintenance organization shall be invested only in securities and property designated by law for investment by domestic life insurance companies, except that money may be used to purchase real estate, including leasehold estates and leasehold improvements, for the convenient accommodation of the organization’s business operations, […]
62D.05 POWERS OF HEALTH MAINTENANCE ORGANIZATIONS. Subdivision 1. Authority granted. Any corporation or local governmental unit may, upon obtaining a certificate of authority as required in sections 62D.01 to 62D.30, operate as a health maintenance organization. Subd. 2. Contracts; generally. A health maintenance organization may enter into health maintenance contracts in this state and engage […]
62D.06 GOVERNING BODY. Subdivision 1. Governing body composition; enrollee advisory body. The governing body of any health maintenance organization which is a corporation may include enrollees, providers, or other individuals; provided, however, that after a health maintenance organization which is a corporation has been authorized under sections 62D.01 to 62D.30 for one year, at least […]
62D.07 EVIDENCE OF COVERAGE; REQUIRED TERMS. Subdivision 1. Requirement. Every health maintenance organization enrollee residing in this state is entitled to evidence of coverage or contract. The health maintenance organization or its designated representative shall issue the evidence of coverage or contract. Subd. 2. Filing with commissioner. No evidence of coverage or contract, or amendment […]
62D.08 ANNUAL REPORT. Subdivision 1. Notice of changes. A health maintenance organization shall, unless otherwise provided for by rules adopted by the commissioner of health, file notice with the commissioner of health prior to any modification of the operations or documents described in the information submitted under clauses (a), (b), (e), (f), (g), (i), (j), […]
62D.09 INFORMATION TO ENROLLEES. Subdivision 1. Marketing requirements. (a) Any written marketing materials which may be directed toward potential enrollees and which include a detailed description of benefits provided by the health maintenance organization shall include a statement of enrollee information and rights as described in section 62D.07, subdivision 3, clauses (2) and (3). Prior […]
62D.095 ENROLLEE COST SHARING. Subdivision 1. General application. A health maintenance contract may contain enrollee cost-sharing provisions as specified in this section. Co-payment and deductible provisions in a group contract must not discriminate on the basis of age, sex, race, disability, economic status, or length of enrollment in the health plan. During an open enrollment […]
62D.10 PROVISIONS APPLICABLE TO ALL HEALTH PLANS. 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. […]
62D.101 CONTINUATION AND CONVERSION PRIVILEGES FOR FORMER SPOUSES AND CHILDREN. Subdivision 1. Termination of coverage. No health maintenance contract which, in addition to covering an enrollee, also covers the enrollee’s spouse shall contain a provision for termination of coverage for a spouse covered under the health maintenance contract solely as a result of a break […]
62D.102 FAMILY THERAPY. Covered treatment for a minor includes treatment for the family if family therapy is recommended by a health maintenance organization provider. For purposes of determining benefits under this section, “hours of treatment” means treatment rendered on an individual or single-family basis. If treatment is rendered on a group basis, the hours of […]
62D.103 SECOND OPINION RELATED TO SUBSTANCE USE DISORDER AND MENTAL HEALTH. A health maintenance organization shall promptly evaluate the treatment needs of any enrollee who is seeking treatment for a problem related to substance use disorder or mental health conditions. In the event that the health maintenance organization or a participating provider determines that no […]
62D.104 REQUIRED OUT-OF-AREA CONVERSION. Enrollees who have individual health maintenance organization contracts and who have become nonresidents of the health maintenance organization’s service area but remain residents of the state of Minnesota shall be given the option, to be arranged by the health maintenance organization if an agreement with an insurer can reasonably be made, […]
62D.105 COVERAGE OF CURRENT SPOUSE, FORMER SPOUSE, AND CHILDREN. Subdivision 1. Requirement. Every health maintenance contract, which in addition to covering the enrollee also provides coverage to the spouse, dependent children, which is defined as required by section 62A.302, and former spouse who was covered on the day before the entry of a valid decree […]
