Minnesota Health Insurance Policy Requirements

Minnesota has comprehensive health insurance regulations with strong consumer protections. The Minnesota Department of Commerce regulates health coverage in the state.

Regulatory Structure

Minnesota health coverage is regulated by a single agency:

HMO Regulation in Minnesota

Minnesota regulates Health Maintenance Organizations (HMOs):

• HMOs must be licensed by Department of Commerce
• Must meet net worth requirements
• Required to have quality assurance programs
• Must have grievance and appeals processes
• Must maintain adequate provider networks

MNsure Marketplace

MNsure is Minnesota's state-based health insurance marketplace:

• Minnesota operates its own state-based exchange (not Healthcare.gov)
• Offers qualified health plans (QHPs)
• Open enrollment and special enrollment periods
• Premium subsidies available based on income
• Website: mnsure.org

Exam Tip: Minnesota operates its own state-based exchange called MNsure - it does NOT use Healthcare.gov.

MinnesotaCare

Minnesota offers MinnesotaCare for low-income residents:

• Subsidized health coverage for those who don't qualify for Medicaid
• Income-based premiums
• Administered through MNsure
• Covers essential health benefits

Free Look Period

Minnesota provides free look periods for health insurance:

• Individual health insurance policies typically have a 10-day free look
• Policyholder can return for full premium refund
• Begins when policy is delivered
• No penalty for exercising this right

Required Coverage

Minnesota mandates coverage for numerous benefits in accordance with ACA requirements:

Essential Health Benefits

All individual and small group ACA-compliant plans must cover:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorders
6. Prescription drugs
7. Rehabilitative services
8. Laboratory services
9. Preventive and wellness services
10. Pediatric services (including dental and vision)

Mental Health Parity

Minnesota requires mental health parity in health insurance:

• Mental health benefits must be equal to medical benefits
• Same copays, deductibles, and limits apply
• Covers mental illness and substance use disorders
• Applies to group and individual plans

Covered Conditions

Mental health parity applies to conditions including:

• Major depression
• Bipolar disorder
• Schizophrenia
• Anxiety disorders
• Substance use disorders
• Eating disorders

Pre-Existing Condition Protections

Minnesota prohibits pre-existing condition exclusions in ACA-compliant plans:

Guaranteed Issue and Renewal

Minnesota requires for ACA-compliant plans:

Guaranteed Issue

• Insurers must accept all applicants during open enrollment
• Cannot deny coverage based on health status
• Applies to individual and small group markets

Guaranteed Renewal

• Insurers cannot cancel coverage except for:
  • Non-payment of premium
  • Fraud or misrepresentation
  • Plan discontinuation (with notice)