Purpose

This bill changes how Minnesota regulate's coverage choices in the individual health insurance market. It focuses on when health carriers can discontinue or modify plans, adds procedures for notifying state officials and consumers, and introduces a formal concept of uniform modifications to coverage.

Main Provisions

• Guaranteed renewal

  • Requires that any individual health plan offered in Minnesota be guaranteed renewable. The renewal premium must not be set based on a person’s claims experience or health status after the plan was issued.
  • The premium at renewal must still meet all other requirements in the statute.
  • Carriers cannot refuse to renew a plan for these reasons, except if the enrollee did one of the following: failed to pay premiums on time, committed fraud or misrepresented material facts, or no longer lives in the carrier’s approved service area.

• Discontinuing an individual health plan (changing or ending a plan)

  • A carrier that wants to discontinue a particular type of plan must:
  • Notify the commissioner in writing about the plan forms and filings for the intended discontinuation, by a deadline set by the commissioner.
  • Notify every individual policyholder enrolled in the plan at least 90 days before coverage ends.
  • Offer affected individuals the option to purchase other current, guaranteed-issue plans from the same carrier.
  • The commissioner can disapprove the discontinuation within 60 days if it isn’t in Minnesota policyholders’ best interests. The commissioner may consider enrollment size, availability of comparable options, and other relevant factors.
  • Discontinuation decisions can be appealed under contested case procedures, with a 30-day window to appeal.
  • A health carrier may discontinue an individual health plan without commissioner approval only if:
  • The plan is not a catastrophic or platinum-level plan (as defined by federal rules),
  • The plan has fewer than 25 enrollees, or
  • The plan is grandfathered under existing rules.

• Uniform modification of coverage (modifying coverage in a consistent way)

  • Health carriers may modify a product’s coverage for the individual market if the modification is applied uniformly for all individuals with that product.
  • Modifications may occur at the time of renewal.
  • Modifications made uniformly in response to federal or state requirements are considered uniform modifications of coverage if:
  • They occur within a reasonable time after the requirement is imposed or changed, and
  • They are directly related to that requirement.
  • Other uniform modifications are allowed if, for the product in the individual market:
  • The same carrier or a linked related company (controlled group) offers the product,
  • The product maintains the same network type (e.g., HMO, PPO, etc.),
  • The product covers at least the same service area,
  • The cost-sharing structure is the same, except for changes due to cost/utilization or to maintain the same metal level,
  • The product provides the same covered benefits, except for changes that would change the plan’s rate index by no more than plus or minus 2 percentage points, excluding changes required by law or regulation.

Significant Changes to Existing Law

• Introduces a formal process for discontinuing individual health plans, including notice to the commissioner and advance notice to policyholders, plus an opportunity to switch to other guaranteed-issue plans.
• Establishes a potential for commissioner oversight by disallowing discontinuation if it’s not in policyholder best interests.
• Adds a new framework for uniform modification of coverage, allowing changes to be made consistently across all enrollees of a product, with specific criteria and protections to keep benefits, networks, and cost-sharing aligned with the product’s structure.

Practical Effects (What this means for consumers and carriers)

• Carriers face clearer procedures and timelines if they intend to discontinue a type of plan, including a potential commissioner review.
• Consumers in Minnesota may receive advance notice and an offer to switch to another guaranteed-issue plan if their plan is being discontinued.
• Carriers can modify plans more uniformly, but only in ways that apply evenly to all enrollees of the same product and within defined limits.
• Some small or grandfathered plans could be discontinued without commissioner approval, if they meet the specified size or grandfathering criteria.

Note on Key Terms

• Guaranteed renewal, guaranteed issue, health carrier, individual health plan, discontinuing, uniform modification of coverage, product, service area, network type (HMO/PPO/etc.), cost-sharing, plan-adjusted index rate, catastrophic plan, platinum-level plan, grandfathered plan, May 1 deadline, 90-day notice, 60-day commissioner review, 30-day appeal.

Relevant Terms guaranteed renewal; premium rate; claims experience; health status; health carrier; individual health plan; discontinuing; guaranteed issue; notice; commissioner; May 1; 90 days; 60 days; uniform modification of coverage; product; network type; service area; cost-sharing; plan-adjusted index rate; catastrophic; platinum-level; grandfathered.