Current through Register Vol. 49, No. 13, September 23, 2024
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 areas of the state where a
health maintenance organization has agreed to make the coverage available and
has been selected as a writing carrier in accordance with part
2740.4300. The association may
provide for coverage for eligible dependents.
Subp. 2.
Benefits of number 1 and
number 2 qualified plan.
Benefits shall meet or exceed the requirements of Minnesota
Statutes, section
62E.06
or the actuarial equivalence thereof as determined pursuant to the actuarial
equivalence tables in parts
2740.9909 to
2740.9993, except where
substitution of an actuarially equivalent benefit is not permissible under the
act.
A. The minimum benefits shall be
equal to at least 80 percent of the charges for covered expenses in excess of
the annual deductible, which shall not exceed $500 for a number 2 qualified
plan, or $1,000 for a number 1 qualified plan.
B. Coverage shall include an annual (calendar
year) limitation of not more than $3,000 per covered person on total
out-of-pocket expenses, which out-of-pocket expenses shall include the
deductible under the state plan policy or contract, and which out-of-pocket
expense limitation is not subject to substitution of an actuarially equivalent
benefit.
C. Coverage shall be
subject to a maximum lifetime benefit of not less than $250,000 per covered
person, less any amount paid to or on behalf of the covered person under any
other qualified plan of the state plan. This benefit is not subject to
substitution of an actuarially equivalent benefit.
Subp. 3.
Benefits of qualified Medicare
supplement plan.
Benefits of a qualified Medicare supplement plan shall meet
or exceed the following minimum standards.
A. The plan shall provide benefits to covered
persons by supplementing Medicare through provision of:
(1) coverage of part A Medicare eligible
expenses for hospitalization to the extent not covered by Medicare to at least
50 percent of the deductible and copayment required under Medicare for the
first 60 days of any Medicare benefit period;
(2) coverage of part A Medicare eligible
expenses for hospitalization to the extent not covered by Medicare from the
61st day through the 90th day in any Medicare benefit period;
(3) coverage of part A Medicare eligible
expenses incurred as daily hospital charges during use of Medicare's lifetime
hospital inpatient reserve days to the extent not covered by
Medicare;
(4) upon exhaustion of
all Medicare hospital inpatient coverage including the lifetime reserve days,
coverage of 90 percent of all Medicare part A eligible expenses for
hospitalization not covered by Medicare subject to a lifetime maximum benefit
of an additional 365 days;
(5)
coverage of 20 percent of the amount of Medicare eligible expenses under part B
regardless of hospital confinement and coverage of at least 100 percent of the
Medicare calendar year part B deductible.
B. The plan shall provide 80 percent of the
covered charges for expenses as provided in Minnesota Statutes, section
62E.06,
which charges are not paid or payable under Medicare or would not have been
paid or payable had the covered person who is or was entitled or eligible to
enroll in Medicare been so enrolled or which charges are not paid or payable
under item A.
C. Coverage shall
include an annual limitation of $1,000 total out-of-pocket expenses per covered
person for covered charges, provided that an annual deductible of not more than
$200 is permissible for those covered charges not paid or payable under
Medicare or otherwise included in item A or B.
D. Coverage shall be subject to a maximum
lifetime benefit of not less than $100,000 per covered person, less any amount
paid to or on behalf of the covered person under any other qualified Medicare
supplement plan of the state plan.
E. The minimum coverage of a qualified
Medicare supplement plan required by this subpart is not subject to
substitution of actuarially equivalent benefits.
Subp. 4.
Benefits of health maintenance
plan.
Benefits of a health maintenance plan shall include those
comprehensive health maintenance services required by Minnesota Statutes,
chapter 62D and rules promulgated thereunder.
Subp. 5.
Preexisting conditions.
No person who obtains coverage under a policy or contract of
the state plan shall be covered for any preexisting condition during the first
six months of coverage under the state plan if such covered person was
diagnosed or treated for that condition during the 90 days immediately
preceding the filing of a completed certificate of eligibility.
Statutory Authority: MS s
62E.09
