Minnesota Administrative Rules
Agency 120 - Commerce Department
Chapter 2740 - COMPREHENSIVE HEALTH INSURANCE
ACTUARIAL EQUIVALENCE OF QUALIFIED PLANS AND QUALIFIED MEDICARE SUPPLEMENT PLANS
Part 2740.9924 - HOW TO USE THE LIST
Universal Citation: MN Rules 2740.9924
Current through Register Vol. 49, No. 13, September 23, 2024
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.
B.
List the plan benefits, ignoring deductibles, coinsurance, well baby care,
emergency accident, supplemental accident, and student dependents. Include the
plan maximum in the plan benefits.
C. For each benefit, find the appropriate
table of equivalent points for basic and major medical plans.
D. Extract the appropriate point value for
the benefit from the table, interpolating as necessary or indicated, and place
it opposite the listed benefit. Ignore benefits for which no table
exists.
E. Total the points for
these benefits.
F. List deductible
and coinsurance if the plan is a comprehensive major medical plan.
G. Determine the appropriate point values for
deductible, interpolating as necessary, and place the value in the list of
points. Calculate the coinsurance points and place the values in the list of
points.
H. Determine the total
points after the deduction for deductible and coinsurance.
I. Determine the deduction for coordination
and nonduplication of benefits.
J.
Determine the number of points for the limit on "out-of-pocket" expenses, well
baby care, emergency accident, supplemental accident, and student
dependents.
K. Calculate the grand
total.
L. To determine
qualification, utilize the grand total in the test for actuarial equivalence in
part
2740.9949.
Subp. 2. Superimposed major medical plans.
The following govern superimposed major medical plans:
A. Follow steps outlined in subpart
1, items A to D for basic
health plan benefits.
B. Total the
points for the basic plan.
C.
Utilize part
2740.9964, subparts 23, 24, and 25
to determine the point value of a Minnesota qualified plan superimposed over
the basic plan with the deductible and benefit period of the plan at hand,
interpolating as necessary. Put the points in the point column.
D. Compare the benefits in the superimposed
major medical plan with the benefit structure of a Minnesota qualified plan:
(1) $250,000 lifetime maximum.
(2) 80/20 coinsurance.
(3) $3,000 annual per person out-of-pocket
maximum.
(4) Eligible expenses are
usual and customary expenses for:
(a) hospital
services;
(b) physician
care;
(c) prescription
drugs;
(d) nursing home care of up
to 120 days in one year, commencing within 14 days of hospitalization of at
least three days;
(e) home health
care;
(f) radium and radioactive
therapy;
(g) oxygen;
(h) anesthetics;
(i) prostheses;
(j) rental or purchase of durable medical
equipment;
(k) diagnostic X-rays
and laboratory tests;
(l) oral
surgery on impacted teeth, on tooth roots, or on gums and tissues of the mouth
when not performed in connection with tooth extraction;
(m) physical therapy;
(n) maternity same as any illness;
(o) Minnesota statutorily mandated benefits;
and
(p) coordination of
benefits.
E.
Consult the tables for point adjustments (usually negative for Minnesota
qualified plan benefits not in the superimposed major medical plan being
tested). Put the adjustments in the point column.
F. Calculate the total by adding the points
for the basic plan (item B), the superimposed major medical plan (item C), and
the adjustments (item E).
G. To
determine qualification, utilize the grand total in the test for actuarial
equivalence in part
2740.9949.
Statutory Authority: MS s 62E.09
Disclaimer: These regulations may not be the most recent version. Minnesota may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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