Medicare supplement policies guaranteed issue requirements modification

A bill for an act

relating to health insurance; modifying guaranteed issue requirements for Medicare

supplement policies; requiring reinstatement of Medicare supplement policies for

terminations due to cognitive impairment or functional incapacity; amending

Minnesota Statutes 2024, section 62A.31, subdivision 1n, by adding a subdivision;

Minnesota Statutes 2025 Supplement, section 62A.31, subdivisions 1b, 1f, 1h, 1r,

1u.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2025 Supplement, section 62A.31, subdivision 1b, is

amended to read:

Subd. 1b.

Preexisting condition coverage.

(a) The policy must cover preexisting

conditions during the first six months of coverage if the insured was not diagnosed or treated

for the particular condition during the 90 days immediately preceding the effective date of

coverage.

(b) The policy must cover preexisting conditions if the insured meets the
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requirements
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conditions for a premium increase
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under subdivision 1r, paragraph
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(c)
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(d)
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.

Sec. 2.

Minnesota Statutes 2025 Supplement, section 62A.31, subdivision 1f, is amended

to read:

Subd. 1f.

Suspension based on entitlement to medical assistance.

(a) The policy or

certificate must provide that benefits and premiums under the policy or certificate shall be

suspended for any period that may be provided by federal regulation at the request of the

policyholder or certificate holder for the period, not to exceed 24 months, in which the

policyholder or certificate holder has applied for and is determined to be entitled to medical

assistance under title XIX of the Social Security Act, but only if the policyholder or certificate

holder notifies the issuer of the policy or certificate within 90 days after the date the

individual becomes entitled to this assistance.

(b) If suspension occurs and if the policyholder or certificate holder loses entitlement

to this medical assistance, the policy or certificate shall be automatically reinstated, effective

as of the date of termination of this entitlement, if the policyholder or certificate holder

provides notice of loss of the entitlement within 90 days after the date of the loss and pays

the premium attributable to the period, effective as of the date of termination of entitlement.

(c) The policy must provide that upon reinstatement (1) there is no waiting period if the
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enrollee
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policyholder or certificate holder
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meets the
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requirements
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conditions for a premium

increase
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under subdivision 1r, paragraph
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(c)
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(d)
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, with respect to treatment of preexisting

conditions, (2) coverage is provided which is substantially equivalent to coverage in effect

before the date of the suspension. If the suspended policy provided coverage for outpatient

prescription drugs, reinstitution of the policy for Medicare Part D enrollees must be without

coverage for outpatient prescription drugs and must otherwise provide coverage substantially

equivalent to the coverage in effect before the date of suspension, and (3) premiums are

classified on terms that are at least as favorable to the policyholder or certificate holder as

the premium classification terms that would have applied to the policyholder or certificate

holder had coverage not been suspended.

Sec. 3.

Minnesota Statutes 2025 Supplement, section 62A.31, subdivision 1h, is amended

to read:

Subd. 1h.

Limitations on denials, conditions, and pricing of coverage.

(a) No health

carrier issuing Medicare-related coverage in this state may impose preexisting condition

limitations or otherwise deny or condition the issuance or effectiveness of any such coverage

available for sale in this state, nor may it discriminate in the pricing of such coverage,

because of the health status, claims experience, receipt of health care, medical condition,

or age of an applicant where an application for such coverage is submitted:

(1) prior to or during the six-month period beginning with the first day of the month in

which an individual first enrolled for benefits under Medicare Part B; or

(2) during the open enrollment period if the applicant:

(i)
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is age 65 to 70 and the applicant
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is applying for coverage during the open enrollment

period for the first time; and

(ii) meets the
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requirements
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conditions for a premium increase
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under subdivision 1r,

paragraph
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(c)
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(d)
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.

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(b) Notwithstanding paragraph (a), the premium increases permitted under subdivision

1r are allowed.

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(c)
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(b)
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This subdivision applies to each Medicare-related coverage offered by a health

carrier regardless of whether the individual has attained the age of 65 years.

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(d)
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(c)
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If an individual who is enrolled in Medicare Part B due to disability status is

involuntarily disenrolled due to loss of disability status, the individual is eligible for another

six-month enrollment period provided under this subdivision beginning the first day of the

month in which the individual later becomes eligible for and enrolls again in Medicare Part

B and during the open enrollment period. An individual who is or was previously enrolled

in Medicare Part B due to disability status is eligible for another six-month enrollment

period under this subdivision beginning the first day of the month in which the individual

has attained the age of 65 years and either maintains enrollment in, or enrolls again in,

Medicare Part B. If an individual enrolled in Medicare Part B voluntarily disenrolls from

Medicare Part B because the individual becomes enrolled under an employee welfare benefit

plan, the individual is eligible for another six-month enrollment period, as provided in this

subdivision, beginning the first day of the month in which the individual later becomes

eligible for and enrolls again in Medicare Part B.

Sec. 4.

Minnesota Statutes 2024, section 62A.31, subdivision 1n, is amended to read:

Subd. 1n.

Termination of coverage.

(a) Termination by an issuer of a Medicare

supplement policy or certificate shall be without prejudice to any continuous loss that began

while the policy or certificate was in force, but the extension of benefits beyond the period

during which the policy or certificate was in force may be conditioned on the continuous

total disability of the insured, limited to the duration of the policy or certificate benefit

period, if any, or payment of the maximum benefits. The extension of benefits does not

apply when the termination is based on fraud, misrepresentation, or nonpayment of premium.

Receipt of Medicare Part D benefits is not considered in determining a continuous loss.

(b) An issuer may discontinue the availability of a policy form or certificate form if the

issuer provides to the commissioner in writing its decision at least 30 days before

discontinuing the availability of the form of the policy or certificate. An issuer that

discontinues the availability of a policy form or certificate form shall not file for approval

a new policy form or certificate form of the same type for the same Medicare supplement

benefit plan as the discontinued form for five years after the issuer provides notice to the

commissioner of the discontinuance. This period of ineligibility to file a form for approval

may be reduced if the commissioner determines that a shorter period is appropriate. The

sale or other transfer of Medicare supplement business to another issuer shall be considered

a discontinuance for the purposes of this section and section
62A.3099
. A change in the

rating structure or methodology shall be considered a discontinuance under this section and

section
62A.3099
unless the issuer complies with the following requirements:

(1) the issuer provides an actuarial memorandum, in a form and manner prescribed by

the commissioner, describing the manner in which the revised rating methodology and

resulting rates differ from the existing rating methodology and resulting rates; and

(2) the issuer does not subsequently put into effect a change of rates or rating factors

that would cause the percentage differential between the discontinued and subsequent rates

as described in the actuarial memorandum to change. The commissioner may approve a

change to the differential that is in the public interest.

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(c) A health carrier must reinstate a policy or certificate canceled, terminated, or lapsed

due to premium nonpayment if:

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(1) within 90 days after cancellation, termination, or lapse, one of the following

individuals requests reinstatement:

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(i) a policyholder or certificate holder;

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(ii) a person authorized to act on the policyholder's or certificate holder's behalf; or

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(iii) a dependent of the policyholder or certificate holder who is covered under the policy

or certificate; and

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(2) the premium nonpayment was a result of the policyholder's or certificate holder's

cognitive impairment or functional incapacity.

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(d) To determine whether the condition under paragraph (c), clause (2), is satisfied, a

health carrier may require medical evidence substantiating that the policyholder or certificate

holder suffered from cognitive impairment or functional incapacity at the time of cancellation,

termination, or lapse. The health carrier may require that medical evidence required under

this paragraph is provided at the policyholder's or certificate holder's expense.

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(e) A policy or certificate reinstated under paragraph (c) must (1) cover any loss or claim

occurring on or after the date of the termination, cancellation, or lapse, and (2) be issued

without any evidence of insurability.

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(f) Within 15 days after the date a request from a health carrier is received, a policyholder

or certificate holder of a policy or certificate reinstated under paragraph (c) must pay all

unpaid premiums from the date the last premium payment was paid, at the rate that would

have been in effect had the policy or certificate remained in force. If the unpaid premium

is not paid under this paragraph, the health carrier may decline to reinstate the policy or

certificate and the health carrier is not responsible for claims incurred after the initial date

of cancellation, termination, or lapse.

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(g) If a health carrier denies a request for reinstatement under paragraph (c), the health

carrier must notify the policyholder or certificate holder and requesting individual under

paragraph (c), clause (1), that the policyholder or certificate holder and requesting individual

may request a hearing before the commissioner.

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Sec. 5.

Minnesota Statutes 2025 Supplement, section 62A.31, subdivision 1r, is amended

to read:

Subd. 1r.

Community rate.

(a) Each health maintenance organization, health service

plan corporation, insurer, or fraternal benefit society that sells Medicare-related coverage

shall establish a separate community rate for that coverage. No Medicare-related coverage

may be offered, issued, sold, or renewed to a Minnesota resident, except at the community

rate required by this subdivision. The same community rate must apply to newly issued

coverage and to renewal coverage.

(b) For coverage that supplements Medicare and for the Part A rate calculation for plans

governed by section 1833 of the federal Social Security Act, United States Code, title 42,

section 1395, et seq., the community rate may take into account only the following factors:

(1) actuarially valid differences in benefit designs or provider networks;

(2) geographic variations in rates if preapproved by the commissioner of commerce;
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and
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(3) premium reductions in recognition of healthy lifestyle behaviors, including but not

limited to, refraining from the use of tobacco. Premium reductions must be actuarially valid

and must relate only to those healthy lifestyle behaviors that have a proven positive impact

on health. Factors used by the health carrier making this premium reduction must be filed

with and approved by the commissioner of commerce
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; and
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.
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(4)
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(c) Notwithstanding subdivision 1h, paragraph (a),
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for coverage that supplements

Medicare,
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a health carrier may impose a onetime
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premium
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increases
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increase
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on an individual

who enrolls in a Medicare supplement policy outside of the individual's initial enrollment

period in Medicare Part B. This paragraph does not apply to individuals who enroll in a

Medicare supplement policy pursuant to subdivision 1u, paragraph (b), clauses (1) to (8).

The
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increases
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increase
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described in paragraph
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(c) apply each year
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(d) may be imposed only

on the first plan year in which
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an individual is enrolled in
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a
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the
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Medicare supplement policy

and
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are
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is
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in addition to any standard increases in community rate.

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(c)
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(d)
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The premium
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increases
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increase
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permitted under paragraph
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(b), clause (4):
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(c)
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(1) apply to
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may be imposed only on
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an individual
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age 65 to 70;
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(2) apply to an individual
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who enrolls in a Medicare supplement policy pursuant to

subdivision 1h, paragraph (a), clause (2)
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;
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. The premium increase under paragraph (c) must

not exceed ten percent.
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(3) apply only the first time the individual enrolls;

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(4) apply for the duration of time the policy is in force; and

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(5) must equal:

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(i) for an individual who enrolls during the 2026 open enrollment period, 15 percent;

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(ii) for an individual who enrolls during the 2027 open enrollment period, 20 percent;

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(iii) for an individual who enrolls during the 2028 open enrollment period, 25 percent;

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(iv) for an individual who enrolls during the 2029 open enrollment period, 30 percent;

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(v) for an individual who enrolls during the 2030 open enrollment period, 35 percent;

and

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(vi) for an individual who enrolls during an open enrollment period after 2029, 35 percent.

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If an individual age 65 to 70 enrolls in a subsequent Medicare supplement policy that is not

a replacement or renewal, the individual is not subject to the premium increases as described

in paragraph (b), clause (4).

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Sec. 6.

Minnesota Statutes 2025 Supplement, section 62A.31, subdivision 1u, is amended

to read:

Subd. 1u.

Guaranteed issue for eligible persons.

(a)(1) Eligible persons are those

individuals described in paragraph (b) who seek to enroll under the policy during the period

specified in paragraph (c) and who submit evidence of the date of termination or

disenrollment described in paragraph (b), or of the date of Medicare Part D enrollment, with

the application for a Medicare supplement policy.

(2) With respect to eligible persons, an issuer shall not: deny or condition the issuance

or effectiveness of a Medicare supplement policy described in paragraph (c) that is offered

and is available for issuance to new enrollees by the issuer; discriminate in the pricing of

such a Medicare supplement policy because of health status, claims experience, receipt of

health care, medical condition, or age; or impose an exclusion of benefits based upon a

preexisting condition under such a Medicare supplement policy.

(b) An eligible person is an individual described in any of the following:

(1) the individual is enrolled under an employee welfare benefit plan that provides health

benefits that supplement the benefits under Medicare; and the plan terminates, or the plan

ceases to provide all such supplemental health benefits to the individual;

(2) the individual is enrolled with a Medicare Advantage organization under a Medicare

Advantage plan under Medicare Part C, and any of the following circumstances apply, or

the individual is 65 years of age or older and is enrolled with a Program of All-Inclusive

Care for the Elderly (PACE) provider under section 1894 of the federal Social Security Act,

and there are circumstances similar to those described in this clause that would permit

discontinuance of the individual's enrollment with the provider if the individual were enrolled

in a Medicare Advantage plan:

(i) the organization's or plan's certification under Medicare Part C has been terminated

or the organization has terminated or otherwise discontinued providing the plan in the area

in which the individual resides;

(ii) the individual is no longer eligible to elect the plan because of a change in the

individual's place of residence or other change in circumstances specified by the secretary,

but not including termination of the individual's enrollment on the basis described in section

1851(g)(3)(B) of the federal Social Security Act, United States Code, title 42, section

1395w-21(g)(3)(b) (where the individual has not paid premiums on a timely basis or has

engaged in disruptive behavior as specified in standards under section 1856 of the federal

Social Security Act, United States Code, title 42, section 1395w-26), or the plan is terminated

for all individuals within a residence area;

(iii) the individual demonstrates, in accordance with guidelines established by the

Secretary, that:

(A) the organization offering the plan substantially violated a material provision of the

organization's contract in relation to the individual, including the failure to provide an

enrollee on a timely basis medically necessary care for which benefits are available under

the plan or the failure to provide such covered care in accordance with applicable quality

standards; or

(B) the organization, or agent or other entity acting on the organization's behalf, materially

misrepresented the plan's provisions in marketing the plan to the individual; or

(iv) the individual meets such other exceptional conditions as the secretary may provide;

(3)(i) the individual is enrolled with:

(A) an eligible organization under a contract under section 1876 of the federal Social

Security Act, United States Code, title 42, section 1395mm (Medicare cost);

(B) a similar organization operating under demonstration project authority, effective for

periods before April 1, 1999;

(C) an organization under an agreement under section 1833(a)(1)(A) of the federal Social

Security Act, United States Code, title 42, section 1395l(a)(1)(A) (health care prepayment

plan); or

(D) an organization under a Medicare Select policy under section
62A.318
or the similar

law of another state; and

(ii) the enrollment ceases under the same circumstances that would permit discontinuance

of an individual's election of coverage under clause (2);

(4) the individual is enrolled under a Medicare supplement policy, and the enrollment

ceases because:

(i)(A) of the insolvency of the issuer or bankruptcy of the nonissuer organization; or

(B) of other involuntary termination of coverage or enrollment under the policy;

(ii) the issuer of the policy substantially violated a material provision of the policy; or

(iii) the issuer, or an agent or other entity acting on the issuer's behalf, materially

misrepresented the policy's provisions in marketing the policy to the individual;

(5)(i) the individual was enrolled under a Medicare supplement policy and terminates

that enrollment and subsequently enrolls, for the first time, with any Medicare Advantage

organization under a Medicare Advantage plan under Medicare Part C; any eligible

organization under a contract under section 1876 of the federal Social Security Act, United

States Code, title 42, section 1395mm (Medicare cost); any similar organization operating

under demonstration project authority; any PACE provider under section 1894 of the federal

Social Security Act, or a Medicare Select policy under section
62A.318
or the similar law

of another state; and

(ii) the subsequent enrollment under item (i) is terminated by the enrollee during any

period within the first 12 months of the subsequent enrollment during which the enrollee

is permitted to terminate the subsequent enrollment under section 1851(e) of the federal

Social Security Act;

(6) the individual, upon first enrolling for benefits under Medicare Part B, enrolls in a

Medicare Advantage plan under Medicare Part C, or with a PACE provider under section

1894 of the federal Social Security Act, and disenrolls from the plan by not later than 12

months after the effective date of enrollment;

(7) the individual enrolls in a Medicare Part D plan during the initial Part D enrollment

period, as defined under United States Code, title 42, section 1395ss(v)(6)(D), and, at the

time of enrollment in Part D, was enrolled under a Medicare supplement policy that covers

outpatient prescription drugs and the individual terminates enrollment in the Medicare

supplement policy and submits evidence of enrollment in Medicare Part D along with the

application for a policy described in paragraph (e), clause (4);

(8) the individual was enrolled in a state public program and is losing coverage due to

the unwinding of the Medicaid continuous enrollment conditions, as provided by Code of

Federal Regulations, title 45, section 155.420 (d)(9) and (d)(1), and Public Law 117-328,

section 5131 (2022); or

(9) the individual meets the requirements under subdivision 1r, paragraph
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(c)
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(d)
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, and

enrolls during the open enrollment period.

(c)(1) In the case of an individual described in paragraph (b), clause (1), the guaranteed

issue period begins on the later of: (i) the date the individual receives a notice of termination

or cessation of all supplemental health benefits or, if a notice is not received, notice that a

claim has been denied because of a termination or cessation; or (ii) the date that the applicable

coverage terminates or ceases; and ends 63 days after the later of those two dates.

(2) In the case of an individual described in paragraph (b), clause (2), (3), (5), or (6),

whose enrollment is terminated involuntarily, the guaranteed issue period begins on the

date that the individual receives a notice of termination and ends 63 days after the date the

applicable coverage is terminated.

(3) In the case of an individual described in paragraph (b), clause (4), item (i), the

guaranteed issue period begins on the earlier of: (i) the date that the individual receives a

notice of termination, a notice of the issuer's bankruptcy or insolvency, or other such similar

notice if any; and (ii) the date that the applicable coverage is terminated, and ends on the

date that is 63 days after the date the coverage is terminated.

(4) In the case of an individual described in paragraph (b), clause (2), (4), (5), or (6),

who disenrolls voluntarily, the guaranteed issue period begins on the date that is 60 days

before the effective date of the disenrollment and ends on the date that is 63 days after the

effective date.

(5) In the case of an individual described in paragraph (b), clause (7), the guaranteed

issue period begins on the date the individual receives notice pursuant to section

1882(v)(2)(B) of the Social Security Act from the Medicare supplement issuer during the

60-day period immediately preceding the initial Part D enrollment period and ends on the

date that is 63 days after the effective date of the individual's coverage under Medicare Part

D.

(6) In the case of an individual described in paragraph (b) but not described in this

paragraph, the guaranteed issue period begins on the effective date of disenrollment and

ends on the date that is 63 days after the effective date.

(7) For an individual described in paragraph (b), clause (9), the guarantee issue period

is the open enrollment period.

(d)(1) In the case of an individual described in paragraph (b), clause (5), or deemed to

be so described, pursuant to this paragraph, whose enrollment with an organization or

provider described in paragraph (b), clause (5), item (i), is involuntarily terminated within

the first 12 months of enrollment, and who, without an intervening enrollment, enrolls with

another such organization or provider, the subsequent enrollment is deemed to be an initial

enrollment described in paragraph (b), clause (5).

(2) In the case of an individual described in paragraph (b), clause (6), or deemed to be

so described, pursuant to this paragraph, whose enrollment with a plan or in a program

described in paragraph (b), clause (6), is involuntarily terminated within the first 12 months

of enrollment, and who, without an intervening enrollment, enrolls in another such plan or

program, the subsequent enrollment is deemed to be an initial enrollment described in

paragraph (b), clause (6).

(3) For purposes of paragraph (b), clauses (5) and (6), no enrollment of an individual

with an organization or provider described in paragraph (b), clause (5), item (i), or with a

plan or in a program described in paragraph (b), clause (6), may be deemed to be an initial

enrollment under this paragraph after the two-year period beginning on the date on which

the individual first enrolled with the organization, provider, plan, or program.

(e) The Medicare supplement policy to which eligible persons are entitled under:

(1) paragraph (b), clauses (1) to (4), is any Medicare supplement policy that has a benefit

package consisting of the basic Medicare supplement plan described in section
62A.316,

paragraph (a)
, plus any combination of the three optional riders described in section
62A.316,

paragraph (b)
, clauses (1) to (3), offered by any issuer;

(2) paragraph (b), clause (5), is the same Medicare supplement policy in which the

individual was most recently previously enrolled, if available from the same issuer, or, if

not so available, any policy described in clause (1) offered by any issuer, except that after

December 31, 2005, if the individual was most recently enrolled in a Medicare supplement

policy with an outpatient prescription drug benefit, a Medicare supplement policy to which

the individual is entitled under paragraph (b), clause (5), is:

(i) the policy available from the same issuer but modified to remove outpatient

prescription drug coverage; or

(ii) at the election of the policyholder, a policy described in clause (4), except that the

policy may be one that is offered and available for issuance to new enrollees that is offered

by any issuer;

(3) paragraph (b), clause (6), is any Medicare supplement policy offered by any issuer;

(4) paragraph (b), clause (7), is a Medicare supplement policy that has a benefit package

classified as a basic plan under section
62A.316
if the enrollee's existing Medicare

supplement policy is a basic plan or, if the enrollee's existing Medicare supplement policy

is an extended basic plan under section
62A.315
, a basic or extended basic plan at the option

of the enrollee, provided that the policy is offered and is available for issuance to new

enrollees by the same issuer that issued the individual's Medicare supplement policy with

outpatient prescription drug coverage. The issuer must permit the enrollee to retain all

optional benefits contained in the enrollee's existing coverage, other than outpatient

prescription drugs, subject to the provision that the coverage be offered and available for

issuance to new enrollees by the same issuer.

(f)(1) At the time of an event described in paragraph (b), because of which an individual

loses coverage or benefits due to the termination of a contract or agreement, policy, or plan,

the organization that terminates the contract or agreement, the issuer terminating the policy,

or the administrator of the plan being terminated, respectively, shall notify the individual

of the individual's rights under this subdivision, and of the obligations of issuers of Medicare

supplement policies under paragraph (a). The notice must be communicated

contemporaneously with the notification of termination.

(2) At the time of an event described in paragraph (b), because of which an individual

ceases enrollment under a contract or agreement, policy, or plan, the organization that offers

the contract or agreement, regardless of the basis for the cessation of enrollment, the issuer

offering the policy, or the administrator of the plan, respectively, shall notify the individual

of the individual's rights under this subdivision, and of the obligations of issuers of Medicare

supplement policies under paragraph (a). The notice must be communicated within ten

working days of the issuer receiving notification of disenrollment.

(g) Reference in this subdivision to a situation in which, or to a basis upon which, an

individual's coverage has been terminated does not provide authority under the laws of this

state for the termination in that situation or upon that basis.

(h) An individual's rights under this subdivision are in addition to, and do not modify

or limit, the individual's rights under subdivision 1h.

Sec. 7.

Minnesota Statutes 2024, section 62A.31, is amended by adding a subdivision to

read:

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Subd. 1x.

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Guaranteed issue of other policies.

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(a) A health carrier that issues a Medicare

supplement policy or certificate must permit policyholders and certificate holders to purchase,

during the open enrollment period, any Medicare supplement policy offered in Minnesota

by the health carrier that includes the same or lesser benefits.

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(b) A health carrier that issues a Medicare supplement policy or certificate is not required

to allow a policyholder or certificate holder to make a purchase under paragraph (a) if the

policyholder or certificate holder does not pay a premium or makes a material

misrepresentation with respect to the policy or certificate.

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