Minnesota Administrative Code

2740.1600 TERMINATION OF COVERAGE; CONVERSION PRIVILEGES. Subpart 1. [Repealed, L 1998 c 407 art 8 s 14] Subp. 2. Duty to offer conversion policy or contract. Duty to offer conversion policy or contracts: A. For the purposes of Minnesota Statutes, section 62E.16, an insurer, heal…

2740.1700 REVISION OF ACTUARIAL EQUIVALENCE TABLES. The commissioner shall periodically, no less frequently than biennially, review the actuarial equivalence tables set forth in parts 2740.9909 to 2740.9993, and shall require that the relative point values set forth therein be ac…

2740.2100 DEFINITIONS. Subpart 1. Accident and health insurance business. "Accident and health insurance business" means the issuance or renewal of any accident and health insurance policy as defined in Minnesota Statutes, section 62E.02, subdivision 11. A. An insurer is engaged …

2740.2200 MANDATORY MEMBERSHIP. As a condition of doing accident and health insurance business, self-insurance business, or health maintenance organization business in Minnesota, all insurers, self-insurers, fraternals, and health maintenance organizations licensed or authorized …

2740.2400 ASSESSMENTS. Contributing members will be assessed for their proportionate share of the operating and administrative expenses of the association, incurred or estimated to be incurred, together with losses, if any, incurred by the association as a result of operation of …

2740.2500 LEVY OF ASSESSMENTS. Subpart 1. Annual. The association shall make an annual determination of each contributing member's liability, if any, and may levy assessments following each fiscal year end. The fiscal year ends on December 31 unless the association establishes a …

2740.2600 FAILURE TO PAY ASSESSMENTS. Any contributing members that fail to pay annual or interim assessments when such assessments become payable will be reported by the association to the commissioner for appropriate action within the discretion of the commissioner. Statutory A…

2740.2700 ORGANIZATION AND APPROVAL. Subpart 1. Powers. The association shall operate pursuant to the provisions of Minnesota Statutes, chapter 62E, with all the powers of a corporation formed under Minnesota Statutes, chapter 317A, except that if the provisions of the two chapte…

2740.2800 BOARD OF DIRECTORS. Subpart 1. Composition. The management of the association shall be vested in a board of seven directors who shall be representative of the membership of the association, and be officers, employees, or agents of members of the association during their…

2740.2900 DETERMINATION OF MEMBER'S VOTING RIGHTS. Subpart 1. Meetings. Every member is entitled to vote at the annual meeting and at any special meeting of the members. Subp. 2. Weighted vote. A member's vote shall be a weighted vote based on the member's total cost of self-insu…

2740.3000 MEETINGS OF ASSOCIATION. Subpart 1. Annual meeting. An annual meeting of the members shall be held for the purpose of electing directors as provided in part 2740.2800, subpart 2 and for the purpose of transacting any other appropriate business of the membership of the a…

2740.3100 MINIMUM BENEFITS OF COMPREHENSIVE HEALTH INSURANCE PLANS. Subpart 1. Duty to offer. The association shall offer a number 1 and number 2 qualified plan and a qualified Medicare supplement plan to eligible persons. The association shall offer health maintenance plans in a…

2740.3200 APPROVAL OF STATE PLAN. Subpart 1. Submission of proposed state plan. Members of the association may submit to the association policies or contracts that have been approved by the commissioner for selection by the association as the state plan. Subp. 2. Approval of poli…

2740.3600 ENROLLMENT. Subpart 1. Open enrollment. The state plan shall be open for enrollment by eligible persons at all times. Subp. 2. Eligible person. "Eligible person," as used in subpart 1, means a resident of Minnesota who submits or on whose behalf is submitted a complete …

2740.3700 ASSOCIATION'S RESPONSE. Subpart 1. Time limitation. Within 30 days of receipt of a complete certificate of eligibility and enrollment form pursuant to part 2740.3600, subpart 2, items A, B, and C, the association or the writing carrier shall accept the certificate of el…

2740.3800 APPEAL TO COMMISSIONER. Any applicant or covered person who is determined by the association to be ineligible for coverage under the state plan may appeal such determination to the commissioner within a reasonable period of time. Upon receipt of an appeal from a determi…

2740.3900 DISSEMINATION OF INFORMATION CONCERNING STATE PLAN. Subpart 1. Plan. The association shall develop a plan for use by the association, upon approval by the commissioner, to publicize the existence of the state plan and the eligibility requirements and procedures for enro…

2740.4300 SELECTION AND APPROVAL OF WRITING CARRIERS. Subpart 1. Selection. The association may select a writing carrier or writing carriers on the basis of criteria for selection which shall include but not be limited to: A. the member's proven ability to handle large group acci…

2740.4400 OPERATIONS OF WRITING CARRIER. Subpart 1. Administrative and claims payment functions. The writing carrier shall perform all administrative and claims payment functions relating to the state plan. A. The writing carrier shall establish a premium billing procedure for co…

2740.4500 APPEAL TO COMMISSIONER. Any covered person whose claim for benefits under the state plan is denied, in whole or in part, may appeal such determination to the commissioner within a reasonable period of time. Upon receipt of an appeal from a claim denial, the commissioner…

2740.5100 AUTHORITY TO MAKE AVAILABLE REINSURANCE. The association may provide for reinsurance of risks incurred by insurer or fraternal members resulting from such members' issuance of all or any of the following categories of coverage as provided in the act. A member may make a…

2740.5200 REINSURANCE PLAN. Subpart 1. Pool agreement. The association may enter into reinsurance pooling agreements with insurer and fraternal members to establish a reinsurance plan for risks of categories of coverage described in part 2740.5100. The reinsurance plan may provid…

2740.5300 POOLING PAYMENTS. The association may require pooling payments from all participating members, to provide for reimbursement to participating members for claims paid under reinsured policies and contracts and for payment of administrative expenses of the pool incurred or…

2740.5400 ASSESSMENT OF PARTICIPATING MEMBERS. Subpart 1. Annual. At the end of each calendar year (or other fiscal year end established by the association) the board may assess participating members on the basis of the formula established in or as a part of the reinsurance pooli…

2740.5500 EXCESS RECEIPTS. If pooling payments, reinsurance assessments and other receipts by the association or its reinsurance administrator as a result of the reinsurance plan exceed actual reinsurance losses and administrative expenses of the pool, such excess shall be held a…

2740.9904 PURPOSE. Minnesota Statutes, section 62E.02, defines "qualified plans" as health benefit plans that provide the benefits required in Minnesota Statutes, section 62E.06 or "the actuarial equivalent of those benefits." Minnesota Statutes, section 62E.06 describes three qu…

2740.9909 COMPOSITE POINT VALUES FOR QUALIFIED PLAN NUMBER THREE. The composite point values for a qualified plan number three for 1984 are as shown herein. Composite Point Values for Minnesota Qualified Plan Number 3 Points Benefit 363 Hospital room and board, unlimited days, se…

2740.9914 DETERMINATION OF AVERAGE SEMIPRIVATE HOSPITAL ROOM AND BOARD LEVEL OF SURGICAL CHARGES. Subpart 1. When values determined. In December of each year, the commissioner will publish the following values: A. the average semiprivate hospital room and board (ASP value); B. th…

2740.9919 TABLE OF SURGICAL FACTORS TO DEVELOP SURG VALUE. CPT4 Code Surgical Factor Description SKIN 10060 .7710 Abscess, incision, and drainage, simple 11400 2.0161 Benign lesion removal of (up to 0.5 cm.) 11750 .4368 Nail, permanent removal of 12011 1.9732 Simple wound, simple…

2740.9924 HOW TO USE THE LIST. Subpart 1. Basic and comprehensive major medical plans. The list is used in the following manner: A. Determine the ASP value, SURG value, ASP factor, SURG factor, and COMP factor for the calendar year. This is published annually by the commissioner.…

2740.9929 BENEFIT VARIATIONS NOT COVERED BY TABLES. Only those plan variations that are most common are recognized. For instance, comprehensive plan coinsurance was assumed normally not to exceed 20 percent. Therefore, no points are shown for 25 percent. However, points for such …

2740.9934 USE OF TABLES. Subpart 1. Certification of plans. Any insurer, self-insurer, or policyholder may use the test for actuarial equivalence as a guide. To obtain certification of any plan of health benefits as qualified, it must be submitted to the commissioner. Subp. 2. Fi…

2740.9939 UPDATE OF TABLES. Periodically, the tables may be revised as health care costs change. Also, as health care costs change, a plan may automatically lose or change its qualification. Annual revaluation of plans is required. When a plan is revalued and its qualification st…

2740.9944 MISUSE OF TABLES. The tables of equivalent points are not intended for any other use, especially not for premium calculations. They represent a composite of data and were adjusted to be usable for testing actuarial equivalence. No other use is contemplated. Statutory Au…

2740.9949 TEST FOR ACTUARIAL EQUIVALENCE FOR PLANS OTHER THAN MEDICARE SUPPLEMENT PLANS. Subpart 1. Table for 1984. If the Grand Total of any Plan is: Then that Plan is the Actuarial Equivalent of Minnesota Qualified Plan No. 1192 + points 3 911 + points 2 767 + points 1 Less tha…

2740.9954 WORKSHEET FOR OTHER THAN MEDICARE SUPPLEMENT PLANS. Comprehensive Health Insurance Test for Actuarial Equivalence Other than Medicare Supplement Plans Major Medical Subparts of part 2740.9964 Benefit Basic Superimposed Comprehensive 1. Hospital room and board 2. Hospita…

2740.9959 LOCATION OF TABLES OF EQUIVALENT POINTS FOR BASIC AND MAJOR MEDICAL HEALTH PLANS. Subparts of part 2740.9964 Other than Medicare Supplement Plans Name 1. Hospital room and board 2. Hospital extras 3. Surgery 4. Home and office physician care 5. In-hospital physician car…

2740.9964 EQUIVALENT POINTS FOR BASIC AND MAJOR MEDICAL HEALTH PLANS; NOT TO BE USED FOR MEDICARE SUPPLEMENT PLANS. Subpart 1. Hospital room and board. Maximum Days Room & Board 31 327 70 347 120 351 365 359 Unlimited 363 A. Room and board is defined to include a semiprivate room…

2740.9979 BASIC BACKGROUND FOR EXAMPLES. Subpart 1. Inflation assumptions for 1985. The examples which follow assume that the actuarial equivalence of a series of plans is being calculated for calendar year 1985. Inflation was assumed to be 15.5 percent and 8.0 percent for hospit…

2740.9991 EXAMPLE I. Subpart 1. Use of actuarial equivalence test. A. Question: Is the following plan actuarially equivalent to any Minnesota qualified plan? Surgery Includes Assistant Surgeon and Administration of Anesthesia Deductible: $100 Coinsurance: 80/20 Maximum: $250,000 …

2740.9992 EXAMPLE II. Subpart 1. Use of actuarial equivalence test. A. Question: Is the following plan actuarially equivalent to any Minnesota qualified plan? Hospital: $170 per day, 365 days; 80 percent of miscellaneous extras, the cost of anesthesia is included. The policy does…

2740.9993 EXAMPLE III. Subpart 1. Use of actuarial equivalence test. A. Question: Is the following plan actuarially equivalent to any Minnesota qualified plan? Hospital: $80 per day, 120 days, $2,000 extras. Surgery: $1,500 maximum surgical schedule, add ten percent for administr…

2742.0100 PURPOSE AND SCOPE. Subpart 1. Generally. Parts 2742.0100 to 2742.0400 are intended to establish uniformity in the permissive use of overinsurance provisions and to avoid claim delays and misunderstandings that could otherwise result from the use of inconsistent or incom…

2742.0200 DEFINITIONS. Subpart 1. Scope. For the purposes of parts 2742.0100 to 2742.0400, the terms in this part have the meanings given them. Subp. 2. Plan. "Plan" is a form of coverage with which coordination is allowed. The definition of plan in the group contract must state …

2742.0300 MODEL COORDINATION OF BENEFITS CONTRACT PROVISION. Subpart 1. General. Subpart 4 contains a model coordination of benefits provision for use in group contracts. That use is subject to parts 2742.0200, subpart 2, items B and C and 2742.0400. Subp. 2. Flexibility. A group…

2742.0400 RULES FOR COORDINATION OF BENEFITS. Subpart 1. General. The primary plan must pay or provide its benefits as if the secondary plan or plans did not exist. A secondary plan may take the benefits of another plan into account only when, under this part, it is secondary to …

2742.0500 EFFECTIVE DATE. Parts 2742.0100 to 2742.0400 are effective July 5, 1986. Parts 2742.0100 to 2742.0400 apply to every group contract which provides health care benefits and is issued on or after that date. A group contract which provides health care benefits and was issu…