62Q.51 POINT-OF-SERVICE OPTION.

207 words·~1 min read·/mn/chapter-62/62q-51

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

Subdivision 1. Definition.

For purposes for this section, "point-of-service option" means a health plan under which the health plan company will reimburse an appropriately licensed or registered provider for providing covered services to an enrollee, without regard to whether the provider belongs to a particular network and without regard to whether the enrollee was referred to the provider by another provider.

Subd. 2. Required point-of-service option.

Each health plan company operating in the small group or large group market shall offer at least one point-of-service option in each such market in which it operates.

Subd. 3. Rate approval.

The premium rates and cost sharing requirements for each option must be submitted to the commissioner of health or the commissioner of commerce as required by law. A health plan that includes lower enrollee cost sharing for services provided by network providers than for services provided by out-of-network providers, or lower enrollee cost sharing for services provided with prior authorization or second opinion than for services provided without prior authorization or second opinion, qualifies as a point-of-service option.

Subd. 4. Exemption.

This section does not apply to a health plan company with fewer than 50,000 enrollees in its commercial health plan products.