Minnesota Health Insurance Guide
Minnesota Health Insurance Information, Health Organizations and Resources and access to online health insurance quotes
If you live in Minnesota you can choose from a variety of private health insurance plans including individuals and group plans provided by an employer. Depending on your income or employment status, you may also be eligible for Minnesota State-funded affordable health insurance for individuals and families, and federal programs such as Medicaid and COBRA.
Minnesota is not a guarantee issue state. That means private insurance companies are not required to sell you an individual health insurance policy if do not meet their underwriting criteria. You can be turned down for any number of reasons including your past or current health, age and the size of your family if you’re applying for their coverage, too. If you are accepted, the insurer has the right to impose an exclusionary period up to 12 months for any pre-existing conditions and a 6-month look-back period. However, if you have proof of prior creditable coverage, exclusionary and look-back periods are not allowed. Minnesota law prohibits health insurance companies from adding elimination riders to your policy and pregnancy cannot be deemed a pre-existing condition. There are no restrictions on what you can be charged and rates can be based on your health, age, occupation and location, but you cannot be quoted a higher premium because of your sex. Standardized plans are not required by law.
Minnesota is a guarantee issue state for group health plans issued to small businesses. If your Minnesota health insurance is provided through your employer, your coverage cannot be denied because of your past or current health. However, a 12-month exclusionary period and 6-month look-back period for pre-existing conditions can be applied if you don’t have proof of prior creditable coverage. Minnesota allows group health insurance issuers to medically underwrite policies to determine the premium they will charge the entire group, although the highest premium cannot be more than 25% of the standard rate.
Minnesota is a guaranteed renewal state. Regardless of your health, your insurer must renew your individual health insurance policy as long as you’ve paid your premiums on time and haven’t defrauded the company, or in the case of some HMOs, as long as you haven’t moved out of the service area. However, your premiums can be increased to reflect your current health status.
Minnesota Mandated Health Benefits
Minnesota laws require private health insurance policies to cover several state-mandated benefits. These currently include:
- Alcoholism and Drug Abuse Treatment
- Ambulatory Surgery
- Anti-Psychotic Drugs
- Bone Marrow Transplants
- Breast Reconstruction
- Cervical Cancer and HPV Screening
- Chemotherapy
- Cleft Palate
- Clinical Trials
- Contraceptives
- Dental Anesthesia
- Diabetes Supplies and Self Management
- Emergency Services
- Hair Prostheses
- Hearing Aids
- HPV Vaccine
- Lyme Disease
- Mammography
- Mastectomy
- Maternity and Maternity Stays
- General and Parity Mental Health
- Off-Label Drug Use
- PKU/Formula
- Portwine Stain Elimination
- Prostate Cancer Screening
- TMJ Disorder
- Well-Child Care
- Coverage for newborns under parent's policy
- Coverage for adopted children under parent's policy
- Coverage for handicapped and continuation/dependents
- Coverage for dependent students under their parent's policy.
- Coverage for non-custodial children under their parent’s policy
- Coverage for continuation/employees
- Coverage for conversion to non-groups and grandchildren
Types Health Insurance Plans Available in Minnesota
The following major medical health insurance plans are generally available in Minnesota. Major medical plans cover illness and injury, hospitalization, prescription drugs and office visits, as well as the mandated services stated above.
Indemnity plans - Typically the most flexible and therefore highest priced choice, an indemnity plan lets you select your health providers and facilities. Depending on your plan, you will have to pay a deductible or co-insurance.
Preferred provider organization plans (PPOs) - You select from a network of preferred health care providers and facilities, and receive services at an agreed-upon discounted rate. You also have the option of going outside the network, but typically at a higher cost. You do not need a referral from a primary care physician to see a specialist. Premiums may be less than an indemnity plan but more than an HMO. You will have to pay a deductible or co-insurance.
Health maintenance organizations (HMOs) - HMOs plans require you to select a primary care physician from a prescribed network of providers, who must issue a referral before you can see a specialist. Services and covered costs are typically more comprehensive than those provided by a PPO. HMOs offer the advantage of affordable premiums and low out-of-pocket costs, with an emphasis on preventive care. Non-emergency services out of network are usually not reimbursed.
Point of Service plans (POS) - Similar to a PPO in that you will receive reimbursement for out-of-network care, but with an HMO’s requirement for a primary care physician who must provide referrals to specialists. Premiums, co-pays and co-insurance are typically higher than what you’d pay with an HMO.
Alternative Health Programs in Minnesota
Minnesota Comprehensive Health Association
MCHA provides health coverage to Minnesota residents who have lived in the state at least six months prior to applying. You are eligible if you cannot obtain health insurance in the private market because of pre-existing medical conditions, do not have access to employer-provided health insurance, have exhausted your COBRA benefit, have exceeded lifetime maximum limits or lost access to employer-provided health care because the company you worked for went bankrupt. Other eligibility requirements may also apply. You can choose from seven different plans: five PPOs with various deductibles, two high deductible health plans and one basic Medicare Supplement plan. Once your deductible is satisfied, you will pay a 20% coinsurance for in-network providers. Annual coinsurance limit varies by plan. Enrollment is open. Premiums are based on age, sex, plan selection and tobacco use. Some pre-existing conditions will involve a waiting period before benefits are payable, but waivers are available.
Regulating Agency
The Insurance Division of Minnesota Department of Commerce is responsible for regulating Minnesota’s health insurance industry.
Get access to Minnesota health insurance quotes from http://www.einsurance.com/health-insurance.
Minnesota Department of Commerce
85 7th Place East, Suite 500
St Paul, MN 55101
(651) 296-2488
(800) 657-3602 (MN only-beyond metro)
http://www.state.mn.us/portal/mn/jsp/home.do?agency=Insurance
Minnesota Comprehensive Health Association
401 Carlson Parkway
Minnetonka, MN 55305-5387
(866) 894-8053
http://www.mchamn.com
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
http://www.naic.org/
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org/