Minnesota Administrative Rules
Agency 120 - Commerce Department
Chapter 2740 - COMPREHENSIVE HEALTH INSURANCE
SOLICITATION, APPLICATION, AND ENROLLMENT
Part 2740.3600 - ENROLLMENT
Universal Citation: MN Rules 2740.3600
Current through Register Vol. 49, No. 27, December 30, 2024
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 certificate of eligibility and enrollment form to the association or its writing carrier and who is not already covered by another state plan policy or contract.
A. A complete certificate of eligibility and
enrollment form may provide:
(1) name,
address, age, and length of time as a resident of Minnesota;
(2) name, address, and age of eligible
dependents, if any, if they are to be insured. "Eligible dependent" means the
insured person's spouse who has not reached age 65 or unmarried child,
excluding:
(a) a legally separated
spouse;
(b) a child who is 19 years
old or older unless that child is a student or disabled child;
(c) a spouse or child who has applied for an
individual state plan policy or contract pursuant to any conversion privilege
granted to such eligible dependent under the insured person's state plan policy
or contract; and
(d) a spouse or
child on active duty in any military, naval or air force of any
country;
(3) evidence of
rejection, or a requirement of a restrictive rider, rate-up, or preexisting
conditions limitation on a qualified plan or qualified Medicare supplement
plan, the effect of which is to substantially reduce coverage from that
received by a person who is considered a standard risk, by one association
member, or by an authorized representative, including an insurance agent,
acting on behalf of an association member, within six months of the date of
application. "Substantially reduce coverage from that received by a person who
is considered a standard risk" includes any restriction on coverage as a result
of an illness, condition, or risk which the association deems substantial, any
increase in rates for an applicant based on an illness, condition, or risk,
which the association deems substantial, and any preexisting conditions
limitation which the association deems substantial.
B. In lieu of evidence of rejection, or a
requirement of a restrictive rider, rate-up, or preexisting conditions
limitation on a qualified plan or qualified Medicare supplement plan, as
required by item A, subitem (3), a complete certificate of eligibility and
enrollment form may provide evidence which meets the requirements of an
operating rule adopted by the association of a proposed covered person having
been treated within three years of the date of the certificate of eligibility
and enrollment form for one or more conditions listed in the operating
rule.
C. Before a person is
determined to be an eligible person, the board may require that any items
listed in items A and B or, if acting pursuant to provisions of the
association's operating rules, other necessary information be submitted to the
association or its writing carrier and may also investigate the authenticity of
information submitted as a part of the certificate of eligibility.
D. If a covered person, under a qualified
plan of the state plan, upon reaching age 65, or becoming enrolled in Medicare,
wishes to purchase a state plan qualified Medicare supplement plan, the
requirement that the person obtain one rejection, restrictive rider, rate-up,
or preexisting conditions limitation on a qualified Medicare supplement plan,
the effect of which is to substantially reduce coverage from that received by a
person who is considered a standard risk, from one member of the association,
or from an authorized representative, including an insurance agent acting on
behalf of an association member, within the preceding six months may be waived
by the board if acting pursuant to provisions of the association's operating
rules.
E. A person who is age 65 or
older shall be eligible for coverage only under the state plan's qualified
Medicare supplement plan and when an insured person under a qualified plan
reaches age 65, the board may, if acting pursuant to provisions of the
association's operating rules, terminate or refuse to renew coverage under the
qualified plan. A person under age 65 who is otherwise eligible for coverage
under the state plan and is enrolled in Medicare shall be permitted to purchase
a qualified plan 1 or 2 or the qualified Medicare supplement plan of the state
plan.
F. An applicant or any person
proposed to be covered under a qualified plan of the state plan who has
previously been covered under one or more qualified plans of the state plan and
who has exhausted the $250,000 maximum lifetime benefit shall not be an
eligible person for coverage under a qualified plan of the state plan; an
applicant or any person proposed to be covered under a qualified Medicare
supplement plan of the state plan who has previously been covered under one or
more qualified Medicare supplement plans of the state plan and who has
exhausted the $100,000 maximum lifetime benefit shall not be an eligible person
for coverage under a qualified Medicare supplement plan of the state
plan.
G. When a covered person
under the state plan no longer meets one or more of the requirements for
eligibility for coverage under the state plan, the board may, if acting
pursuant to the association's operating rules, terminate or refuse to renew
coverage under the state plan.
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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