Minnesota Administrative Code

2720.0600 ADEQUACY OF SURPLUS. The factors set forth under Minnesota Statutes, section 60D.20, subdivision 4, are not intended to be an exhaustive list. In determining the adequacy and reasonableness of an insurer's surplus no single factor shall be controlling. The commissioner,…

2720.1100 FORMS. The forms described in parts 2720.9910 to 2720.9940 are intended to be guides in the preparation of the statements required by Minnesota Statutes, chapter 60D, and are not intended to be blank forms to be filled in. The statements filed shall contain the numbers …

2720.1200 INCORPORATIONS BY REFERENCE, SUMMARIES, AND OMISSIONS. Information required by any item of the forms described in parts 2720.9910 to 2720.9940 may be incorporated by reference in answer or partial answer to any other item. Information contained in any financial statemen…

2720.1300 INFORMATION UNKNOWN OR UNAVAILABLE. Subpart 1. Conditions for omission. Information required need be given only insofar as it is known or reasonably available to the person filing the statement. If any required information is unknown and not reasonably available to the …

2720.1400 ADDITIONAL INFORMATION AND EXHIBITS. In addition to the information expressly required to be included in the statements under parts 2720.9910 to 2720.9940, further material information shall be added as may be necessary to clarify and eliminate any misleading informatio…

2720.1500 AMENDMENTS. Any amendment to the forms or statements required under parts 2720.9910 to 2720.9940 must include on the top of the cover page the phrase: "Amendment No. ____ to" and must indicate the date of the amendment and not the date of the original filing. Statutory …

2720.1600 ACQUISITION FILING STATEMENT. Subpart 1. Statement required. A person required to file a statement under Minnesota Statutes, section 60D.17, must furnish the information required by these rules, specifically including the information on form A, part 2720.9910. Subp. 2. …

2720.1700 ANNUAL REGISTRATION OF INSURERS; STATEMENT; FILING. Subpart 1. Statement required. An insurer required to file an annual registration statement pursuant to Minnesota Statutes, section 60D.19, and this chapter shall furnish the required information on form B, part 2720.9…

2720.1800 EXEMPTIONS FROM FILING. The provisions of the act, section 3, shall not apply in those situations described therein and in this part. A. The registration and amendments required in the act, section 3, shall not be required for any insurance company domiciled in the stat…

2720.1900 DISCLAIMERS AND TERMINATION OF REGISTRATION. Subpart 1. Information required. A disclaimer of affiliation or a request for termination of registration, claiming that a person does not or will not, upon the taking of some proposed action, control another person (hereinaf…

2720.2000 TRANSACTIONS SUBJECT TO PRIOR NOTICE. An insurer required to give notice of a proposed transaction pursuant to Minnesota Statutes, section 60D.20, shall furnish the required information on form D, part 2720.9940. Statutory Authority: MS s 45.023; 60D.23 History: 17 SR 1…

2720.9910 FORM A; ACQUISITION FILING STATEMENT. FORM A STATEMENT REGARDING THE ACQUISITION OF CONTROL OF A DOMESTIC INSURER _ Name of Domestic Insurer BY _ Name of Acquiring Person (Applicant) Filed with the Minnesota Department of Commerce Dated: _ , ____ Name, title, address an…

2720.9920 FORM B; ANNUAL REGISTRATION STATEMENT. FORM B INSURANCE HOLDING COMPANY SYSTEM ANNUAL REGISTRATION STATEMENT Filed with the Insurance Department of the State of _ BY _ Name of Registrant On behalf of the Following Insurance Companies Name Address _ _ _ _ _ Date: _ , _ N…

2720.9930 FORM C; REGISTRATION SUMMARY STATEMENT. FORM C SUMMARY OF REGISTRATION STATEMENT Filed with the Insurance Department of the State of _ BY _ Name of Registrant On behalf of the Following Insurance Companies Name Address _ _ _ _ _ Date: _ , _ Name, Title, Address, and Tel…

2720.9940 FORM D; TRANSACTION NOTICE. FORM D PRIOR NOTICE OF A TRANSACTION Filed with the Insurance Department of the State of _ By _ Name of Registrant On behalf of the Following Insurance Companies Name Address _ _ _ _ _ Date: _ , ____ Name, Title, Address, and Telephone Number…

2730.0200 AUTHORITY AND PURPOSE. Parts 2730.0200 to 2730.0700 are promulgated pursuant to the authority granted by Minnesota Statutes, sections 14.05 to 14.28, 62D.10, subdivision 4, and 62D.19 for the purpose of setting forth rules and procedural standards that the commissioner …

2730.0300 EXAMINATION OF AGENTS, SOLICITORS, AND BROKERS. Pursuant to Minnesota Statutes, section 62D.22, subdivision 8, and in accordance with Minnesota Statutes, chapter 60K, and agents' license rules of the Department of Commerce, part 2795.2000, the commissioner shall conduct…

2730.0400 SPECIAL EXAMINATIONS. Upon application in writing, affirmatively showing the reason or reasons therefor, the commissioner of commerce may conduct special examinations for purposes of authorizing solicitation or advertising limited in scope or duration or for particular …

2730.0500 DETERMINATION OF UNREASONABLE EXPENSES. Not less frequently than once every three years, the commissioner of health or the commissioner of commerce shall determine whether any expense a health maintenance organization incurs or pays is unreasonably high in relation to t…

2730.0600 COMMISSIONER'S ENFORCEMENT AUTHORITY. Upon a finding by the commissioner of health or the commissioner of commerce that a health maintenance organization is incurring or paying for any expense that is unreasonably high in relation to the value of the service or goods pr…

2730.0700 INTERAGENCY AGREEMENT. The commissioner of commerce may by agreement with the commissioner of health provide procedures for the implementation and coordinated enforcement of part 2730.0500. Statutory Authority: MS s 62D.10; 62D.19 History: 9 SR 1187 Published Electronic…

2735.0100 DEFINITIONS. Subpart 1. Scope. For the purposes of parts 2735.0100 to 2735.0500, the terms defined in this part have the meanings given them. Subp. 2. Contracts. "Contracts" means any insurance policy, plan, group contract certificate, or binder, including any rider or …

2735.0200 PURPOSE. The purpose of parts 2735.0100 to 2735.0500 is to eliminate the act of denying benefits or coverage on the basis of sex or marital status in the terms and conditions of insurance contracts and in the underwriting criteria of insurance carriers. Statutory Author…

2735.0300 AUTHORITY. Parts 2735.0100 to 2735.0500 are adopted pursuant to Minnesota Statutes, sections 45.023; 72A.19, subdivision 2; and 72A.20, subdivision 16. Statutory Authority: MS s 72A.19 History: 10 SR 1266 Published Electronically: September 14, 2007

2735.0400 APPLICABILITY AND SCOPE. Parts 2735.0100 to 2735.0500 apply to all contracts delivered or issued for delivery in this state by an insurer on or after December 9, 1985, to all existing group contracts which are amended on or after these parts, and to all group insurance …

2735.0500 AVAILABILITY REQUIREMENTS. Availability of any insurance contract shall not be denied to an insured or prospective insured on the basis of sex or marital status of the insured or prospective insured. The amount of benefits payable, or any term, condition, or type of cov…

2737.0100 DEFINITIONS. Subpart 1. Scope. For the purposes of this chapter, the terms defined in Minnesota Statutes, chapter 62W, have the meanings given them. For purposes of this chapter, the terms defined in this part have the meanings given them. Subp. 2. Aggregate. "Aggregate…

2737.0200 AUTHORITY, SCOPE, AND PURPOSE. This chapter is promulgated pursuant to Minnesota Statutes, chapter 62W, and Laws 2019, chapter 39, section 20. This chapter applies to all pharmacy benefit managers that are licensed or authorized to do business in or otherwise doing busi…

2737.0300 GOVERNMENT PROGRAMS. Subpart 1. Governmental agencies providing pharmacy management services. Where an agency of the state of Minnesota directly provides pharmacy management services, the agency is extended the exemption granted to the Department of Human Services under…

2737.0400 BUSINESS LICENSE REQUIREMENTS; INITIAL APPLICATION. Subpart 1. Application. A pharmacy benefit manager doing business in Minnesota on or after January 1, 2020, must apply to the commissioner in the manner and form prescribed by the commissioner in order to perform, act,…

2737.0500 BUSINESS LICENSE REQUIREMENTS; RENEWAL APPLICATION. Subpart 1. Renewal application. In order to obtain a renewal of a license, a pharmacy benefit manager must annually meet the requirements needed to obtain an initial pharmacy benefit management license under part 2737.…

2737.0600 REVIEW BY COMMISSIONER. Subpart 1. Additional information. The commissioner may request additional information within 30 days of receiving completed initial or renewal application data. The 30-day initial review period does not begin until complete application data has …

2737.0700 ENFORCEMENT BY COMMISSIONER. Subpart 1. Acting without a license. If a pharmacy benefit manager acts without a license, the pharmacy benefit manager may be subject to a fine of up to $5,000 per day for the period the pharmacy benefit manager is found to be in violation.…

2737.0800 ADEQUATE NETWORK. Subpart 1. Pharmacy type. A network is adequate if it contains at least one of each of the following types of pharmacies: A. retail; B. specialty; C. home infusion; D. mail order; E. long-term care; and F. Indian health service, Tribal organizations, a…

2737.0900 TRANSPARENCY REPORTS TO PLAN SPONSORS. Subpart 1. Publication of template. The commissioner must post on the Department of Commerce's website a template that a plan sponsor may use to submit a transparency request of the data provided under Minnesota Statutes, section 6…

2737.1000 TRANSPARENCY REPORTS TO COMMISSIONER. Subpart 1. Publication of submission form. Annually no later than 60 days before the transparency reporting deadline date, the commissioner must post to the department's website the transparency report submission process, including …

2737.1100 PHARMACY OWNERSHIP INTEREST. Subpart 1. Networks with only owned pharmacies. A pharmacy benefit manager requires an enrollee to use a pharmacy if the pharmacy benefit manager establishes a network of pharmacies that includes only pharmacies directly or indirectly owned …

2737.1200 SECTION 340B PARTICIPANTS. Subpart 1. Prohibition on 340B participants. A pharmacy benefit manager is prohibited from adopting a rule, requirement, or condition that provides that, in order to be included in the pharmacy benefit manager's pharmacy network, a pharmacy, m…

2737.1300 OUT-OF-POCKET COST COMPARISONS. Subpart 1. Request format. A pharmacy benefit manager may create specific forms, rules, or guidelines for an enrollee to request out-of-pocket cost information. Any forms, rules, or guidelines a pharmacy benefit manager creates must not b…

2737.1400 MAXIMUM ALLOWABLE COST PRICING. Subpart 1. Maximum allowable cost price list. A pharmacy benefit manager subject to Minnesota Statutes, section 62W.08, must make available to all pharmacies the pharmacy benefit manager has a contract with a version of the pharmacy benef…

2737.1500 PHARMACY AUDITS. Subpart 1. Publication of pharmacy audit standards. A. A pharmacy benefit manager must make available to a pharmacy or pharmacist the standards and parameters under which the pharmacy or pharmacist is audited. B. The entity conducting the audit must pro…

2737.1600 ALLOWABLE CLAIM AMOUNT. The allowable claim amount is equivalent to the amount the health carrier or pharmacy benefit manager has agreed to pay the pharmacy for the prescription medication. Statutory Authority: L 2019 c 39 s 20 History: 46 SR 809 Published Electronicall…

2737.1700 RETROACTIVE ADJUSTMENTS. Subpart 1. Contracts. Minnesota Statutes, section 62W.13, must not be waived or modified by contract. Subp. 2. Billing errors. A claim for a billing error must be documented and the information supporting the claim, if any, must be provided to t…

2740.0100 DEFINITIONS. Subpart 1. Scope. All terms used herein that are defined in Minnesota Statutes, chapter 62E shall have the meanings attributed to them therein. For the purpose of Minnesota Statutes, chapter 62E and these rules, the terms defined herein shall have the meani…

2740.0200 AUTHORITY, SCOPE, AND PURPOSE. These rules are promulgated pursuant to Minnesota Statutes, section 62E.09, clause (i) relating to qualified comprehensive health insurance plans and the operations of the Minnesota Comprehensive Health Association. These rules and all fut…

2740.1100 DUTIES OF EMPLOYERS. Subpart 1. Duty to make available a qualified plan. An employer shall be deemed to have made available a qualified plan to its employees as required in Minnesota Statutes, section 62E.03, subdivision 1 when participation under a number 2 or number 3…

2740.1200 DUTIES OF INSURERS AND FRATERNALS. Subpart 1. Exception to definition of accident and health insurance policy. The exception provided by Minnesota Statutes, section 62E.02, subdivision 11, clause (4) shall apply with respect to hospital indemnity coverage sold by an ins…