Health carrier discontinuation of individual health plans requirements elimination provision and health carrier's uniform modification of coverage under an individual market health plan state exemption establishment provision

A bill for an act

relating to insurance; eliminating requirements necessary for a health carrier to

discontinue individual health plans; establishing a state exception for a health

carrier's uniform modification of coverage under an individual market health plan;

amending Minnesota Statutes 2024, section 62A.65, by adding a subdivision;

Minnesota Statutes 2025 Supplement, section 62A.65, subdivisions 2, 2a.

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

Section 1.

Minnesota Statutes 2025 Supplement, section 62A.65, subdivision 2, is amended

to read:

Subd. 2.

Guaranteed renewal.

No individual health plan may be offered, sold, issued,

or renewed to a Minnesota resident unless the health plan provides that the plan is guaranteed

renewable at a premium rate that does not take into account the claims experience or any

change in the health status of any covered person that occurred after the initial issuance of

the health plan to the person. The premium rate upon renewal must also otherwise comply

with this section. A health carrier is prohibited from refusing to renew a Minnesota resident's

individual health plan unless:

(1) the enrollee has failed to pay premiums in accordance with the health plan's terms,

including any timeliness requirements;

(2) the enrollee has performed an act or practice that constitutes fraud or made an

intentional misrepresentation of material fact under the health plan's terms;

(3) the enrollee no longer lives in the area where the
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issuer
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health carrier
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is authorized

to operate;

(4) a health carrier discontinues an individual health plan under subdivision 2a; or

(5) a health carrier discontinues issuing new individual health plans and refuses to renew

all of the health carrier's existing individual health plans issued in Minnesota as provided

under subdivision 8.

Sec. 2.

Minnesota Statutes 2025 Supplement, section 62A.65, subdivision 2a, is amended

to read:

Subd. 2a.

Discontinuing individual health plan.

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(a)
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In order to discontinue a particular

type of individual health plan in Minnesota for purposes of subdivision 2, clause (4), a health

carrier must:

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(1) provide written notice to the commissioner that approves the individual health plan's

policy forms and filings, in a form and manner approved by the commissioner, regarding

the health carrier's intent to discontinue a particular type of individual health plan in

Minnesota. The notice must be provided no later than May 1 of the year before the date the

individual health plan intends to discontinue the particular type of individual health plan;

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(2)
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(1)
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provide written notice to each
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individual
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policyholder
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enrolled in the individual

health plan no later than 90 days before the date the coverage is discontinued;

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(3)
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(2)
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offer to each individual covered by the individual health plan that the health

carrier intends to discontinue the option to purchase on a guaranteed issue basis any other

individual health plan currently offered by the health carrier for individuals in the individual

market; and

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(4)
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(3)
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act uniformly without regard to any health status factor of a covered individual

or a dependent of a covered individual who may become eligible for coverage.

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(b) Subject to paragraph (d), the commissioner may disapprove a health carrier

discontinuing a particular type of individual health plan within 60 days after receiving notice

under paragraph (a) if the commissioner determines discontinuing the plan is not in Minnesota

policyholders' best interest. When making the determination under this paragraph, the

commissioner may consider the plan's enrollment size, the availability of comparable

individual health plan options offered by the health carrier in Minnesota, or any other factor

the commissioner deems relevant.

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(c) A health carrier may appeal the commissioner's determination made under paragraph

(b) to disapprove the health carrier's plan to discontinue a particular type of individual health

plan in Minnesota. An appeal under this paragraph is subject to the contested case procedures

under chapter 14 and must be made within 30 days of the date the commissioner makes a

written determination under paragraph (b).

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(d) A health carrier may discontinue an individual health plan without commissioner

approval if the individual health plan is not a catastrophic or platinum-level health plan, as

defined in United States Code, title 42, section 18022, and the plan:

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(1) has fewer than 25 enrollees; or

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(2) is a grandfathered plan, as defined in section
62A.011, subdivision 1b
.

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Sec. 3.

Minnesota Statutes 2024, section 62A.65, is amended by adding a subdivision to

read:

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Subd. 2b.

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Exception for uniform modification of coverage.

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(a) A health carrier may

modify the health plan for a product, as defined under Code of Federal Regulations, title

45, section 144.103, offered to an individual in the individual market if the modification is

effective uniformly for all individuals with that product. A health carrier may modify the

health plan for a product under this paragraph only at the time coverage is renewed.

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(b) For purposes of paragraph (a), modifications made uniformly and solely pursuant to

applicable federal or state requirements are considered a uniform modification of coverage

if the modification is:

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(1) made within a reasonable time period after the federal or state requirement is imposed

or modified; and

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(2) directly related to the federal or state requirement that is imposed or modified.

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(c) Other types of modifications made uniformly are considered a uniform modification

of coverage if the health plan for the product in the individual market meets all of the

following criteria:

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(1) the product is offered by the same health carrier or, if the health carrier is a member

of a controlled group, as described in Code of Federal Regulations, title 45, section 147.106,

paragraph (d)(4), another health carrier that is a member of the controlled group;

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(2) the product is offered as the same product network type, which includes but is not

limited to a health maintenance organization, preferred provider organization, exclusive

provider organization, point of service, or indemnity;

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(3) the product continues to cover at least a majority of the same service area;

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(4) within the product, each health plan has the same cost-sharing structure as before

the modification, except for any variation in cost-sharing solely related to changes in cost

and utilization of medical care or to maintain the same metal level, as defined under section

62K.06, subdivision 4; and

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(5) the product provides the same covered benefits, except for any changes in benefits

that cumulatively impact the plan-adjusted index rate, as described in Code of Federal

Regulations, title 45, section 156.80, paragraph (d)(2), for any health plan within the product

within an allowable variation of plus or minus two percentage points, not including changes

pursuant to applicable federal or state requirements.

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