Title Minnesota Statutes, Minnesota Statutes

62K.05 FEDERAL ACT; COMPLIANCE REQUIRED. A health carrier shall comply with all provisions of the Affordable Care Act to the extent that it imposes a requirement that applies in this state. Compliance with any provision of the Affordable Care Act is required as of the effective d…

62K.06 METAL LEVEL MANDATORY OFFERINGS. § Subdivision 1.Identification. A health carrier that offers individual or small group health plans in Minnesota must provide documentation to the commissioner of commerce to justify actuarial value levels as specified in section 1302(d) of…

62K.07 INFORMATION DISCLOSURES. § Subdivision 1.Generally. (a) A health carrier offering individual or small group health plans must submit the following information in a format determined by the commissioner of commerce: (1) claims payment policies and practices; (2) periodic fi…

62K.075 PROVIDER NETWORK NOTIFICATIONS. (a) A health carrier must provide on the carrier's website the provider network for each product offered by the carrier, and must update the carrier's website at least once a month with any changes to the carrier's provider network, includi…

62K.08 MARKETING STANDARDS. § Subdivision 1.Marketing. (a) A health carrier offering individual or small group health plans must comply with all applicable provisions of the Affordable Care Act, including, but not limited to, the following: (1) compliance with all state laws pert…

62K.09 ACCREDITATION STANDARDS. § Subdivision 1.Accreditation; general. (a) A health carrier that offers any individual or small group health plans in Minnesota outside of MNsure must be accredited in accordance with this subdivision. A health carrier must obtain accreditation th…

62K.10 GEOGRAPHIC ACCESSIBILITY; PROVIDER NETWORK ADEQUACY. § Subdivision 1.Applicability. (a) This section applies to all health carriers that either require an enrollee to use or that create incentives, including financial incentives, for an enrollee to use, health care provide…

62K.105 NETWORK ADEQUACY COMPLAINTS. The commissioner of health shall establish a clear, easily accessible process for accepting complaints from enrollees regarding health carrier compliance with section 62K.10, subdivision 2, 3, or 4. Using this process, an enrollee may file a c…

62K.11 BALANCE BILLING PROHIBITED. (a) A network provider is prohibited from billing an enrollee for any amount in excess of the allowable amount the health carrier has contracted for with the provider as total payment for the health care service. A network provider is permitted …

62K.12 QUALITY ASSURANCE AND IMPROVEMENT. § Subdivision 1.General. (a) All health carriers offering an individual health plan or small group health plan must have a written internal quality assurance and improvement program that, at a minimum: (1) provides for ongoing evaluation …

62K.13 SERVICE AREA REQUIREMENTS. (a) Any health carrier that offers an individual or small group health plan, must offer the health plan in a service area that is at least the entire geographic area of a county unless serving a smaller geographic area is necessary, nondiscrimina…

62K.14 LIMITED-SCOPE PEDIATRIC DENTAL PLANS. (a) Limited-scope pediatric dental plans must be offered to the extent permitted under the Affordable Care Act: (1) on a guaranteed issue and guaranteed renewable basis; (2) with premiums rated on allowable rating factors used for heal…

62K.15 ANNUAL OPEN ENROLLMENT PERIODS; SPECIAL ENROLLMENT PERIODS. (a) Health carriers offering individual health plans must limit annual enrollment in the individual market to the annual open enrollment periods for MNsure. Nothing in this section limits the application of specia…