Minn. Stat. § 62K.01 TITLE.
62K.01. TITLE.
This chapter may be cited as the "Minnesota Health Plan Market Rules."
2013 c 84 art 2 s 2,17
MINNESOTA HEALTH PLAN MARKET RULES
Minn. Stat. ch. 62K
in effectMinn. Stat. § 62K.02 PURPOSE AND SCOPE.
62K.02. PURPOSE AND SCOPE.
Subdivision 1. Purpose.
The market rules set forth in this chapter serve to clarify and provide guidance on the application of state law and certain requirements of the Affordable Care Act on all health carriers offering health plans in Minnesota, whether or not through MNsure, to ensure fair competition for all health carriers in Minnesota, to minimize adverse selection, and to ensure that health plans are offered in a manner that protects consumers and promotes the provision of high-quality affordable health care, and improved health outcomes. This chapter contains the regulatory requirements as specified in section 62V.05, subdivision 5, paragraph (b), and shall fully satisfy the requirements of section 62V.05, subdivision 5, paragraph (b).
Subd. 2. Scope.
(a) This chapter applies only to health plans offered in the individual market or the small group market.
(b) This chapter applies to health carriers with respect to individual health plans and small group health plans, unless otherwise specified.
(c) If a health carrier issues or renews individual or small group health plans in other states, this chapter applies only to health plans issued or renewed in this state to a Minnesota resident, or to cover a resident of the state, or issued or renewed to a small employer that is actively engaged in business in this state, unless otherwise specified.
(d) This chapter does not apply to short-term coverage as defined in section 62A.65, subdivision 7, or grandfathered plan coverage as defined in section 62A.011, subdivision 1b.
2013 c 84 art 2 s 3; 2013 c 108 art 1 s 67
Minn. Stat. § 62K.03 DEFINITIONS.
62K.03. DEFINITIONS.
Subdivision 1. Applicability.
For purposes of this chapter, the terms defined in this section have the meanings given.
Subd. 2. Affordable Care Act.
"Affordable Care Act" means the federal Patient Protection and Affordable Care Act, Public Law 111-148, as amended, including the federal Health Care and Education Reconciliation Act of 2010, Public Law 111-152, and any amendments, and any federal guidance or regulations issued under these acts.
Subd. 3. Dental plan.
"Dental plan" means a dental plan as defined in section 62Q.76, subdivision 3.
Subd. 4. Enrollee.
"Enrollee" means a natural person covered by a health plan and includes an insured policyholder, subscriber, contract holder, member, covered person, or certificate holder.
Subd. 5. Health carrier.
"Health carrier" means a health carrier as defined in section 62A.011, subdivision 2.
Subd. 6. Health plan.
"Health plan" means a health plan as defined in section 62A.011, subdivision 3.
Subd. 7. Individual health plan.
"Individual health plan" means an individual health plan as defined in section 62A.011, subdivision 4.
Subd. 8. Limited-scope pediatric dental plan.
"Limited-scope pediatric dental plan" means a dental plan meeting the requirements of section 9832(c)(2)(A) of the Internal Revenue Code of 1986, as amended, that provides only pediatric dental benefits meeting the requirements of the Affordable Care Act and is offered by a health carrier. A limited-scope pediatric dental plan includes a dental plan that is offered separately or in conjunction with an individual or small group health plan to individuals who have not attained the age of 19 years as of the beginning of the policy year or to a family.
Subd. 9. MNsure.
"MNsure" means MNsure as defined in section 62V.02.
Subd. 10. Preferred provider organization.
"Preferred provider organization" means a health plan that provides discounts to enrollees or subscribers for services they receive from certain health care providers.
Subd. 11. Qualified health plan.
"Qualified health plan" means a health plan that meets the definition in the Affordable Care Act and has been certified by the board of MNsure in accordance with chapter 62V to be offered through MNsure.
Subd. 12. Small group health plan.
"Small group health plan" means a health plan issued by a health carrier to a small employer as defined in section 62L.02, subdivision 26.
2013 c 84 art 2 s 4; 2013 c 108 art 1 s 67
Minn. Stat. § 62K.04 MARKET RULES; VIOLATION.
62K.04. MARKET RULES; VIOLATION.
Subdivision 1. Compliance.
(a) A health carrier issuing an individual health plan to a Minnesota resident or a small group health plan to provide coverage to a small employer that is actively engaged in business in Minnesota shall meet all of the requirements set forth in this chapter. The failure to meet any of the requirements under this chapter constitutes a violation of section 72A.20.
(b) The requirements of this chapter do not apply to short-term coverage as defined in section 62A.65, subdivision 7, or grandfathered plan coverage as defined in section 62A.011, subdivision 1c.
Subd. 2. Penalties.
In addition to any other penalties provided by the laws of this state or by federal law, a health carrier or any other person found to have violated any requirement of this chapter may be subject to the administrative procedures, enforcement actions, and penalties provided under section 45.027 and chapters 62D and 72A.
2013 c 84 art 2 s 5
Minn. Stat. § 62K.05 FEDERAL ACT; COMPLIANCE REQUIRED.
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 date established for that provision in the federal act, except as otherwise specifically stated earlier in state law.
2013 c 84 art 2 s 6
Minn. Stat. § 62K.06 METAL LEVEL MANDATORY OFFERINGS.
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 the Affordable Care Act for all individual and small group health plans offered inside and outside of MNsure.
Subd. 2. Minimum levels.
(a) A health carrier that offers a catastrophic plan or a bronze level health plan within a service area in either the individual or small group market must also offer a silver level and a gold level health plan in that market and within that service area.
(b) A health carrier with less than five percent market share in the respective individual or small group market in Minnesota is exempt from paragraph (a), until January 1, 2017, unless the health carrier offers a qualified health plan through MNsure. If the health carrier offers a qualified health plan through MNsure, the health carrier must comply with paragraph (a).
Subd. 3. MNsure restriction.
MNsure may not, by contract or otherwise, mandate the types of health plans to be offered by a health carrier to individuals or small employers purchasing health plans outside of MNsure. Solely for purposes of this subdivision, "health plan" includes coverage that is excluded under section 62A.011, subdivision 3, clause (6).
Subd. 4. Metal level defined.
For purposes of this section, the metal levels and catastrophic plans are defined in section 1302(d) and (e) of the Affordable Care Act.
Subd. 5. Enforcement.
The commissioner of commerce shall enforce this section.
2013 c 84 art 2 s 7,17; 2013 c 108 art 1 s 67
Minn. Stat. § 62K.07 INFORMATION DISCLOSURES.
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 financial disclosures;
(3) data on enrollment;
(4) data on disenrollment;
(5) data on the number of claims that are denied;
(6) data on rating practices;
(7) information on cost-sharing and payments with respect to out-of-network coverage; and
(8) other information required by the secretary of the United States Department of Health and Human Services under the Affordable Care Act.
(b) A health carrier offering an individual or small group health plan must comply with all information disclosure requirements of all applicable state and federal law, including the Affordable Care Act.
(c) Except for qualified health plans sold on MNsure, information reported under paragraph (a), clauses (3) and (4), is nonpublic data as defined under section 13.02, subdivision 9. Information reported under paragraph (a), clauses (1) through (8), must be reported by MNsure for qualified health plans sold through MNsure.
Subd. 2. Prescription drug costs.
(a) Each health carrier that offers a prescription drug benefit in its individual health plans or small group health plans shall include in the applicable rate filing required under section 62A.02 the following information about covered prescription drugs:
(1) the 25 most frequently prescribed drugs in the previous plan year;
(2) the 25 most costly prescription drugs as a portion of the individual health plan's or small group health plan's total annual expenditures in the previous plan year;
(3) the 25 prescription drugs that have caused the greatest increase in total individual health plan or small group health plan spending in the previous plan year;
(4) the projected impact of the cost of prescription drugs on premium rates;
(5) if any health plan offered by the health carrier requires enrollees to pay cost-sharing on any covered prescription drugs including deductibles, co-payments, or coinsurance in an amount that is greater than the amount the enrollee's health plan would pay for the drug absent the applicable enrollee cost-sharing and after accounting for any rebate amount; and
(6) if the health carrier prohibits third-party payments including manufacturer drug discounts or coupons that cover all or a portion of an enrollee's cost-sharing requirements including deductibles, co-payments, or coinsurance from applying toward the enrollee's cost-sharing obligations under the enrollee's health plan.
(b) The commissioner of commerce, in consultation with the commissioner of health, shall release a summary of the information reported in paragraph (a) at the same time as the information required under section 62A.02, subdivision 2, paragraph (c).
Subd. 3. Enforcement.
The commissioner of commerce shall enforce this section.
2013 c 84 art 2 s 8,17; 2013 c 108 art 1 s 67; 1Sp2019 c 9 art 8 s 8
Minn. Stat. § 62K.08 MARKETING STANDARDS.
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 pertaining to the marketing of individual or small group health plans; and
(2) establishing marketing practices and benefit designs that will not have the effect of discouraging the enrollment of individuals with significant health needs in the health plan.
(b) No marketing materials may lead consumers to believe that all health care needs will be covered.
Subd. 2. Enforcement.
The commissioner of commerce shall enforce this section.
2013 c 84 art 2 s 9
Minn. Stat. § 62K.09 ACCREDITATION STANDARDS.
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 through URAC, the National Committee for Quality Assurance (NCQA), or any entity recognized by the United States Department of Health and Human Services for accreditation of health insurance issuers or health plans by January 1, 2018. Proof of accreditation must be submitted to the commissioner of health in a form prescribed by the commissioner of health.
(b) A health carrier that rents a provider network is exempt from this subdivision, unless it is part of a holding company as defined in section 60D.15 that in aggregate exceeds ten percent market share in either the individual or small group market in Minnesota.
Subd. 2. Accreditation; MNsure.
(a) MNsure shall require all health carriers offering a qualified health plan through MNsure to obtain the appropriate level of accreditation no later than the third year after the first year the health carrier offers a qualified health plan through MNsure. A health carrier must take the first step of the accreditation process during the first year in which it offers a qualified health plan. A health carrier that offers a qualified health plan on January 1, 2014, must obtain accreditation by the end of the 2016 plan year.
(b) To the extent a health carrier cannot obtain accreditation due to low volume of enrollees, an exception to this accreditation criterion may be granted by MNsure until such time as the health carrier has a sufficient volume of enrollees.
Subd. 3. Oversight.
A health carrier shall comply with a request from the commissioner of health to confirm accreditation or progress toward accreditation.
Subd. 4. Enforcement.
The commissioner of health shall enforce this section.
2013 c 84 art 2 s 10,17; 2013 c 108 art 1 s 67
Minn. Stat. § 62K.10 GEOGRAPHIC ACCESSIBILITY; PROVIDER NETWORK ADEQUACY.
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 providers that are managed, owned, under contract with, or employed by the health carrier. A health carrier that does not manage, own, or contract directly with providers in Minnesota is exempt from this section, unless it is part of a holding company as defined in section 60D.15 that in aggregate exceeds ten percent in either the individual or small group market in Minnesota.
(b) Health carriers renting provider networks from other entities must submit the rental agreement or contract to the commissioner of health for approval. In reviewing the agreements or contracts, the commissioner shall review the agreement or contract to ensure that the entity contracting with health care providers accepts responsibility to meet the requirements in this section.
Subd. 1a. Health care provider system access.
For those counties in which a health carrier actively markets an individual health plan, the health carrier must offer, in those same counties, at least one individual health plan with a provider network that includes in-network access to more than a single health care provider system. This subdivision is applicable only for the year in which the health carrier actively markets an individual health plan.
Subd. 2. Time and distance standards.
Health carriers must meet the time and distance standards under Code of Federal Regulations, title 45, section 155.1050.
Subd. 3.
MS 2024 [Repealed, 1Sp2025 c 3 art 2 s 36]
Subd. 4. Network adequacy.
(a) Each designated provider network must include a sufficient number and type of providers, including providers that specialize in mental health and substance use disorder services, to ensure that covered services are available to all enrollees without unreasonable delay. In determining network adequacy, the commissioner of health shall consider availability of services, including the following:
(1) primary care physician services are available and accessible 24 hours per day, seven days per week, within the network area;
(2) a sufficient number of primary care physicians have hospital admitting privileges at one or more participating hospitals within the network area so that necessary admissions are made on a timely basis consistent with generally accepted practice parameters;
(3) specialty physician service is available through the network or contract arrangement;
(4) mental health and substance use disorder treatment providers, including but not limited to psychiatric residential treatment facilities, are available and accessible through the network or contract arrangement;
(5) to the extent that primary care services are provided through primary care providers other than physicians, and to the extent permitted under applicable scope of practice in state law for a given provider, these services shall be available and accessible; and
(6) the network has available, either directly or through arrangements, appropriate and sufficient personnel, physical resources, and equipment to meet the projected needs of enrollees for covered health care services.
(b) The commissioner may establish sufficiency by referencing any reasonable criteria, which include but are not limited to:
(1) ratios of providers to enrollees by specialty;
(2) ratios of primary care professionals to enrollees;
(3) geographic accessibility of providers;
(4) waiting times for an appointment with participating providers;
(5) hours of operation;
(6) the ability of the network to meet the needs of enrollees that are:
(i) low-income persons;
(ii) children and adults with serious, chronic, or complex health conditions, physical disabilities, or mental illness; or
(iii) persons with limited English proficiency and persons from underserved communities;
(7) other health care service delivery system options, including telemedicine or telehealth, mobile clinics, centers of excellence, and other ways of delivering care; and
(8) the volume of technological and specialty care services available to serve the needs of enrollees that need technologically advanced or specialty care services.
Subd. 5. Waiver.
(a) A health carrier may apply to the commissioner of health for a waiver of the requirements in subdivision 2 if it is unable to meet the statutory requirements. A waiver application must be submitted on a form provided by the commissioner, must be accompanied by an application fee of $500 for each application to waive the requirements in subdivision 2 for one or more provider types per county, and must:
(1) demonstrate with specific data that the requirement of subdivision 2 is not feasible in a particular service area or part of a service area; and
(2) include specific information as to the steps that were and will be taken to address the network inadequacy, and, for steps that will be taken prospectively to address network inadequacy, the time frame within which those steps will be taken.
(b) The commissioner shall establish guidelines for evaluating waiver applications, standards governing approval or denial of a waiver application, and standards for steps that health carriers must take to address the network inadequacy and allow the health carrier to meet network adequacy requirements within a reasonable time period. The commissioner shall review each waiver application using these guidelines and standards and shall approve a waiver application only if:
(1) the standards for approval established by the commissioner are satisfied; and
(2) the steps that were and will be taken to address the network inadequacy and the time frame for taking these steps satisfy the standards established by the commissioner.
(c) If, in its waiver application, a health carrier demonstrates to the commissioner that there are no providers of a specific type or specialty in a county, the commissioner may approve a waiver in which the health carrier is allowed to address network inadequacy in that county by providing for patient access to providers of that type or specialty via telehealth, as defined in section 62A.673, subdivision 2.
(d) The waiver shall automatically expire after one year. Upon or prior to expiration of a waiver, a health carrier unable to meet the requirements in subdivision 2 must submit a new waiver application under paragraph (a) and must also submit evidence of steps the carrier took to address the network inadequacy. When the commissioner reviews a waiver application for a network adequacy requirement which has been waived for the carrier for the most recent one-year period, the commissioner shall also examine the steps the carrier took during that one-year period to address network inadequacy, and shall only approve a subsequent waiver application that satisfies the requirements in paragraph (b), demonstrates that the carrier took the steps it proposed to address network inadequacy, and explains why the carrier continues to be unable to satisfy the requirements in subdivision 2.
(e) Application fees collected under this subdivision shall be deposited in the state government special revenue fund in the state treasury.
Subd. 5a.
MS 2017 Supp [Expired, 2017 c 2 art 2 s 11]
Subd. 6. Referral centers.
Subdivision 2 shall not apply if an enrollee is referred to a referral center for health care services. A referral center is a medical facility that provides highly specialized medical care, including but not limited to organ transplants. A health carrier or preferred provider organization may consider the volume of services provided annually, case mix, and severity adjusted mortality and morbidity rates in designating a referral center.
Subd. 7. Essential community providers.
Each health carrier must comply with section 62Q.19.
Subd. 8. Enforcement.
The commissioner of health shall enforce this section.
2013 c 84 art 2 s 11,17; 2017 c 2 art 2 s 11; 2017 c 13 art 2 s 1; 1Sp2019 c 9 art 8 s 10; 1Sp2021 c 7 art 6 s 28; 2023 c 57 art 2 s 39; 2023 c 70 art 2 s 22; 2024 c 85 s 115; 1Sp2025 c 3 art 2 s 15-17
Minn. Stat. § 62K.11 BALANCE BILLING PROHIBITED.
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 to bill an enrollee the approved co-payment, deductible, or coinsurance.
(b) A network provider is permitted to bill an enrollee for services not covered by the enrollee's health plan as long as the enrollee agrees in writing in advance before the service is performed to pay for the noncovered service.
2013 c 84 art 2 s 12
Minn. Stat. § 62K.12 QUALITY ASSURANCE AND IMPROVEMENT.
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 of the quality of health care provided to its enrollees;
(2) periodically reports the evaluation of the quality of health care to the health carrier's governing body;
(3) follows policies and procedures for the selection and credentialing of network providers that is consistent with community standards;
(4) conducts focused studies directed at problems, potential problems, or areas with potential for improvements in care;
(5) conducts enrollee satisfaction surveys and monitors oral and written complaints submitted by enrollees or members; and
(6) collects and reports Health Effectiveness Data and Information Set (HEDIS) measures and conducts other quality assessment and improvement activities as directed by the commissioner of health.
(b) The commissioner of health shall submit a report to the chairs and ranking minority members of senate and house of representatives committees with primary jurisdiction over commerce and health policy by February 15, 2015, with recommendations for specific quality assurance and improvement standards for all Minnesota health carriers. The recommended standards must not require duplicative data gathering, analysis, or reporting by health carriers.
Subd. 2. Exemption.
A health carrier that rents a provider network is exempt from this section, unless it is part of a holding company as defined in section 60D.15 that in aggregate exceeds ten percent market share in either the individual or small group market in Minnesota.
Subd. 3. Waiver.
A health carrier that has obtained accreditation through the URAC for network management; quality improvement; credentialing; member protection; and utilization management, or has achieved an excellent or commendable level ranking from the National Committee for Quality Assurance (NCQA), shall be deemed to meet the requirements of subdivision 1. Proof of accreditation must be submitted to the commissioner of health in a form prescribed by the commissioner. The commissioner may adopt rules to recognize similar accreditation standards from any entity recognized by the United States Department of Health and Human Services for accreditation of health insurance issuers or health plans.
Subd. 4. Enforcement.
The commissioner of health shall enforce this section.
2013 c 84 art 2 s 13,17
Minn. Stat. § 62K.13 SERVICE AREA REQUIREMENTS.
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, nondiscriminatory, and in the best interest of enrollees. The service area for any individual or small group health plan must be established without regard to racial, ethnic, language, concentrated poverty, or health status-related factors, or other factors that exclude specific high-utilizing, high-cost, or medically underserved populations.
(b) If a health carrier that offers an individual or small group health plan requests to serve less than the entire county, the request must be made to the commissioner of health on a form and manner determined by the commissioner and must provide specific data demonstrating that the service area is not discriminatory, is necessary, and is in the best interest of enrollees.
(c) The commissioner of health shall enforce this section.
2013 c 84 art 2 s 14,17
Minn. Stat. § 62K.14 LIMITED-SCOPE PEDIATRIC DENTAL PLANS.
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 health plans; and (3) without any exclusions or limitations based on preexisting conditions.
(b) Notwithstanding paragraph (a), a health carrier may discontinue a limited scope pediatric dental plan at the end of a plan year if the health carrier provides written notice to enrollees before coverage is to be discontinued that the particular plan is being discontinued and the health carrier offers enrollees other dental plan options that are the same or substantially similar to the dental plan being discontinued in terms of premiums, benefits, cost-sharing requirements, and network adequacy. The written notice to enrollees must be provided at least 105 days before the end of the plan year.
(c) Limited-scope pediatric dental plans must ensure primary care dental services are available within 60 miles or 60 minutes' travel time.
(d) If a stand-alone dental plan as defined under the Affordable Care Act or a limited-scope pediatric dental plan is offered, either separately or in conjunction with a health plan offered to individuals or small employers, the health plan shall not be considered in noncompliance with the requirements of the essential benefit package in the Affordable Care Act because the health plan does not offer coverage of pediatric dental benefits if these benefits are covered through the stand-alone or limited-scope pediatric dental plan, to the extent permitted under the Affordable Care Act.
(e) Health carriers offering limited-scope pediatric dental plans must comply with this section and sections 62K.07, 62K.08, 62K.13, and 62K.15.
(f) The commissioner of commerce shall enforce paragraphs (a) and (b). Any limited-scope pediatric dental plan that is to be offered to replace a discontinued dental plan under paragraph (b) must be approved by the commissioner of commerce in terms of cost and benefit similarity, and the commissioner of health in terms of network adequacy similarity. The commissioner of health shall enforce paragraph (c).
2013 c 84 art 2 s 15,17
Minn. Stat. § 62K.15 ANNUAL OPEN ENROLLMENT PERIODS; SPECIAL ENROLLMENT PERIODS.
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 special or limited open enrollment periods as defined under the Affordable Care Act.
(b) Health carriers offering individual health plans must inform all applicants at the time of application and enrollees at least annually of the open and special enrollment periods as defined under the Affordable Care Act.
(c) Health carriers offering individual health plans must provide a special enrollment period for enrollment in the individual market by employees of a small employer that offers a qualified small employer health reimbursement arrangement in accordance with United States Code, title 26, section 9831(d). The special enrollment period must be available only to employees newly hired by a small employer offering a qualified small employer health reimbursement arrangement, and to employees employed by the small employer at the time the small employer initially offers a qualified small employer health reimbursement arrangement. For employees newly hired by the small employer, the special enrollment period shall last for 30 days after the employee's first day of employment. For employees employed by the small employer at the time the small employer initially offers a qualified small employer health reimbursement arrangement, the special enrollment period shall last for 30 days after the date the arrangement is initially offered to employees.
(d) The commissioner of commerce shall enforce this section.
(e) Health carriers offering individual health plans through MNsure must provide a special enrollment period as required under the easy enrollment health insurance outreach program under section 62V.13.
2013 c 84 art 2 s 16,17; 2013 c 108 art 1 s 67; 1Sp2017 c 6 art 13 s 1; 2023 c 70 art 16 s 6
Minn. Stat. § 62K.075 PROVIDER NETWORK NOTIFICATIONS.
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, including provider changes from in-network status to out-of-network status. A health carrier must also provide on the carrier's website, for each product offered by the carrier, a list of the current waivers of the requirements in section 62K.10, subdivision 2 or 3, in a format that is easily accessed and searchable by enrollees and prospective enrollees.
(b) Upon notification from an enrollee, a health carrier must reprocess any claim for services provided by a provider whose status has changed from in-network to out-of-network as an in-network claim if the service was provided after the network change went into effect but before the change was posted as required under paragraph (a) unless the health carrier notified the enrollee of the network change prior to the service being provided. This paragraph does not apply if the health carrier is able to verify that the health carrier's website displayed the correct provider network status on the health carrier's website at the time the service was provided.
(c) The limitations of section 62Q.56, subdivision 2a, shall apply to payments required by paragraph (b).
2016 c 179 s 1; 1Sp2019 c 9 art 8 s 9
Minn. Stat. § 62K.105 NETWORK ADEQUACY COMPLAINTS.
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 complaint with the commissioner that a health carrier is not in compliance with the requirements of section 62K.10, subdivision 2, 3, or 4. The commissioner of health shall investigate all complaints received under this section.
1Sp2019 c 9 art 8 s 11
Source: Minnesota Office of the Revisor of Statutes (revisor.mn.gov)URL: https://www.revisor.mn.gov/statutes/cite/62KFetched: 10/19/2026