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Rights – Laws

Minnesota was one of the better places for health insurance regulations even before federal reform, as they tended to be more lenient than other states on the key provisions affecting consumers. The Affordable Care Act subtly began making changes to the system from 2010 to 2014, and Minnesota followed up accordingly, creating a state-run insurance marketplace, and implementing other changes without putting up a fight, unlike many other states. Minnesota’s state laws regarding insurance now are mostly impacted by the federal health law.

While the health plans in this state receive great customer feedback, all health insurers get their complaints. It is one of your rights as a policyholder to be able to dispute a claim if you feel a service should have been covered when it was not, or inform the carrier of a disappointment with customer service or another experience. More individual protections include state laws enacted to give broader access to medical care by making certain benefits mandatory, which also correlates with health reform.

The following laws are key in individual insurance, and this is how they are regarded in Minnesota.


Guaranteed Renewal

Minnesota health plans are backed by the guaranteed renewability provision, which gives policyholders a bit of reprieve when it comes to keeping their plans. This law protects individuals with health plans by preventing their carrier from terminating their benefits for any reason other than fraud, nonpayment of premiums, or giving false information on your application. If you pay your premiums on time and aren’t committing any crimes, your plan cannot get canceled even if you get sick. Your insurer must also offer to renew your plan for another year under this law. By enforcing this law, you have a better opportunity to maintain a flawless record of creditable coverage with no gaps.


Guaranteed Issue

Minnesota residents are able to apply for coverage with any insurer because they must guarantee issue of coverage, regardless of occupation, gender or condition. Initially, the Affordable Care Act prohibited insurers from declining children with conditions, and now adults with major illnesses can obtain coverage anywhere they like. Whether you apply for a group plan, individual coverage, or Medicaid, your health will not stand in the way of getting insured.


Community Rating

Under the ACA, people with conditions cannot have their rates increased based on how sick they are. Additionally, women can no longer be considered more expensive to insure than men: premiums are the same regardless of gender. The health law makes it such that insurers can only adjust premiums based on age and tobacco use.


Mandatory Benefits

Minnesota approved many benefits the ACA considers essential health benefits even before the law was in full effect, making it mandatory for certain plans to cover a particular group of services. Qualified health plans include each of the ACA’s essential health benefits, and other comprehensive health plans are required to cover additional specifics, as listed below. Based on the plan you choose and your medical needs, the following benefits may be included as they are required by law.

  • Ambulatory surgery
  • Birth control
  • Bone marrow transplants
  • Breast reconstruction
  • Chemotherapy and radiation
  • Cleft palate and lip surgery
  • Clinical trials
  • Coverage for newborns and adopted children under parent’s plan
  • Coverage for non-custodial children under parent’s plan
  • Dental anesthesia
  • Diabetes management and supplies
  • Emergency care
  • Hair prosthesis
  • Hearing aids
  • HPV and cervical cancer screening
  • Lymes disease treatment
  • Mammograms
  • Mastectomy
  • Maternity (including inpatient stays)
  • Medical foods
  • Mental health and substance abuse
  • Off-label prescriptions
  • Port-wine stain removal
  • Preventive care
  • Prostate cancer screening
  • TMJ disorder treatment


 ACA Essential Health Benefits

These types of care are covered by each qualified health plan on and off the exchange in the individual and small group markets. Group plans are not required to include EHBs in their plans.

  • Ambulatory patient care
  • Emergency services
  • Hospitalization
  • Rehabilitative and habilitative services and devices
  • Mental health and substance abuse disorder care
  • Maternity and newborn care
  • Prescription drugs
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric care, including vision and dental