The national Medical Plans guide covers major medical design, HMOs, PPOs, HSAs and the ACA. This guide covers Minnesota's own rules: the health plan entity types, newborn and dependent mandates, mental health parity, the right to cancel and MNsure.

Who offers health coverage in Minnesota

• Insurers sell accident and health policies under chapter 62A, regulated by the Commissioner of Commerce.
• Nonprofit health service plan corporations contract for health services in exchange for subscriber prepayments (62C.02).
• HMOs need a certificate of authority from the Commissioner of Health (62D.03).
  • An HMO provides comprehensive services for a fixed prepaid sum, regardless of how often services are used (62D.02).
  • At a minimum, it covers emergency, ambulance, inpatient hospital and physician, outpatient and preventive services.
• MNsure is Minnesota's health insurance marketplace for individuals and small employers (62V.03).

Dependents and newborns

• Newborns under a family policy or HMO contract are covered from the moment of birth for illness, injury, congenital malformation and premature birth (62A.042).
  • Notice can't be required as a condition of coverage, though any added premium may be collected.
  • Coverage includes grandchildren who are financially dependent on, and have lived with, a covered grandparent since birth.
  • Cleft lip and palate treatment is covered, including orthodontics and oral surgery.
• Disabled dependents: reaching the limiting age doesn't end coverage for a child who can't support himself or herself because of a disability and depends mainly on the policyholder. Proof is due within 31 days of reaching that age. After two years, the insurer may ask for proof no more than once a year (62A.14).
• Children with emotional disabilities in a licensed residential treatment facility are covered on the same basis as other benefits (62A.151).

Mental health parity (62Q.47)

• Cost sharing and limits for outpatient mental health and chemical dependency services can't be more restrictive than those for outpatient medical services.
• Therapy and medication-management visits are treated as primary care visits for cost sharing.

Plan design limits (72A.20)

• No financial incentives to providers based solely on denying services or not authorizing referrals. Capitation is still allowed (subd. 33).
• No network design, access policy or marketing meant to discourage enrollment by people seen as costly (subd. 32).
• No action based solely on taking part in an HIV vaccine clinical trial (subd. 29a).
• No fees beyond premium for conversion policies (subd. 28).

Right to cancel (72A.51)

• The buyer of an individual sickness policy, nonprofit health service plan contract or HMO contract may cancel until midnight of the 10th day after purchase. The purchase date is the day the buyer receives the policy.
• The refund is due within 10 days, and the policy is void from the start. This right can't be waived.
• Medicare-related coverage and long-term care have their own 30-day periods. See the Minnesota Senior guide.

Guaranty protection

The Minnesota Life and Health Insurance Guaranty Association covers up to $500,000 in health benefits (61B.19).

Common exam traps

• HMOs are licensed by the Commissioner of Health. Insurers are licensed by the Commissioner of Commerce.
• Newborns are covered at birth, with no notice required. Grandchildren living with the grandparent can qualify.
• Disabled dependent proof is due within 31 days of reaching the limiting age.
• Mental health cost sharing can't exceed medical cost sharing.
• Individual health free look: 10 days, and it can't be waived.