Minnesota Health Information Clearinghouse Frequently Asked Questions and Answers

The Minnesota Health Information Clearinghouse receives a wide variety of calls. Some topics are presented below. If you have a question, call the Clearinghouse at 651-201-5178 or 1-800-657-3793.

Advance Directives
Complaints
Health Care Coverage
Health Care Cost and Quality
Health Care Insurance Fraud
Lists of Clinics and Hospitals
Medical Records
Medicare
Patient Bill of Rights
Portability
Premium Rates
Prescription Drugs
Small Employer Health Insurance
Statistical Information
    Distribution of Health Coverage
    Enrollment and Funding
    Health Care Spending
    Health Plan Market Share
    State Health Rankings
    Uninsured

Advance Directives (health care directives, previously called living wills)

Prepared in advance, this written document tells others what you want done regarding your health care if you get too sick to make decisions yourself.

See Questions and Answers on Health Care Directives, Minnesota Department of Health, Compliance Monitoring, for more detailed information:

  • An explanation of health care directives
  • Why you should consider having this document
  • How to prepare a health care directive
  • What information to include
  • Who to tell you have one
  • Where to keep it, and other useful information.

Call the Minnesota Senior LinkAge Line® at 1-800-333-2433 for more information and to request an advance directives form. The Minnesota Board on Aging has a web version to print and suggestions for completing it. Click on Health Care Directive for the form and explanation.

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Complaints

Complaints about clinics.

  • Call the patient service representative at the clinic to see if a problem can be resolved.
    If the clinic does not have a patient service representative, ask if there is a clinic manager.
  • Ask your health plan whether they take complaints regarding your issue.
  • Is the complaint about a doctor or nurse? Although clinics are not regulated, the doctors and nurses who work at the clinics are licensed. You may be able to file a complaint with their licensing board. See below.

Complaints about practitioners.

Complaints about Health Plans/Health Maintenance Organizations (HMOs).

  • Call the member services or customer services phone number on the back of your health card. You may be able to get answers to your questions or get a problem solved. If not, you can file a written complaint with your health plan.
  • Call the agency that regulates your health plan.
    • For a health maintenance organization (HMO), call the Minnesota Department of Health, Managed Care Systems section at (651) 201-5100 or 1-800-657-3916. Sometimes they can talk with the HMO and resolve your concern. Sometimes you will need to complete a complaint form. The Managed Care Section can send you an HMO Complaint Form or you may print one from the Managed Care Systems website and mail it in.
    • For a health plan other than an HMO, call the Minnesota Department of Commerce, Consumer Response Team at (651) 296-2488 or 1-800-657-3602. Look on the back of your health card to see if these phone numbers are listed there.
      • If you are in a non-government self-insured group, neither the Minnesota Department of Health nor the Minnesota Department of Commerce regulates these plans. In a self-funded or self-insured group, the employer sets up the plan and then pays the health claims for the employees. Often it will say on the back of your health card "this plan is that of the employer." For complaints contact the organization that takes care of employee claims. This number is usually on the back of your health card. You can also contact your employer. If you still need assistance, you can contact the Minnesota Attorney General’s office at (651) 296-3353 or 1-800-657-3787 and the U.S. Department of Labor at 1-866-444-3272 to see if they can assist you with your specific issue.

    Hospital Complaints. To file a complaint about a hospital, call the Minnesota Department of Health, Facility and Provider Compliance complaint intake line at (651) 201-4200. Note: They do not take billing complaints. For billing complaints call the patient service representative at the hospital. To see resolved complaints go to Office of Health Facility Complaints - View Resolved Complaint Findings.

    Home health care complaints. To file a complaint about a home health care agency, call the Facility and Provider Compliance complaint intake line at (651) 201-4200.

    Nursing home complaints. To file a complaint about a nursing home, call the Facility and Provider Compliance complaint intake line at (651) 201-4200.

    View complaints about certain Minnesota health facilities, agencies:

    • hospitals
    • nursing homes
    • board and care homes
    • facilities that offer housing with services
    • home care providers
    • home health agencies
    • hospice facilities and services
    • supervised living facilities

    See the October 11, 2004, Minnesota Department of Health news release Health Facilities Investigation Reports Now Available Online (PDF) summarizing the information you will find there.

    The Joint Commission on Accreditation of Healthcare Organizations accredits health care organizations in order to improve quality and safety of care. The Quality Check section on their website allows users to see the survey results. To find out the number and type of complaints regarding one of their accredited health care organizations call their Office of Quality Monitoring at 1-800-994-6610.  You can file complaints with this organization regarding quality of care. 

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    Health Care Coverage

    What options do I have when I'm looking for health coverage?

    The Health Plan Options booklets are a good place to start to get an overall idea of what coverage might be available to you.

    • The Guide to Purchasing Health Insurance explains available health insurance plans, describes the differences between them, offers tips for shopping for coverage, and provides a checklist for comparing plans.

    • The Guide to Minnesota's Public Health Care Programs provides information about Medical Assistance and MinnesotaCare. It briefly discusses the requirements you must meet in order to qualify for each program. The Minnesota Department of Human Services oversees these programs. They handle the MinnesotaCare program and delegate handling of Medical Assistance to the counties.

    • The Guide to Additional Health Care Resources lists programs or agencies that provide services in certain situations if you are unable to get coverage using the first two guides.

    • Use the Glossary of Commonly Used Health Terms to understand words you may not know.

    My low-income relative/friend does not have health coverage. What would be available?

    • Medical Assistance may be an option. This publicly funded programs is for people who have very little money and assets. Individuals should contact their local county human services agency to see if they qualify.

    • MinnesotaCare may be another option. There are eligibility requirements including an income and asset limit. You must not have had health coverage in the past four months. You pay a premium based on household income and size. Contact MinnesotaCare for an application: (651) 297-3862 or 1-800-657-3672; TTY 1-800-627-3529.

    For more information on Minnesota Health Care Programs see the Minnesota Department of Human Services website.

    I do not qualify for Medical Assistance or MinnesotaCare. What else is available?

    The following companies are licensed to sell individual and family health plans in Minnesota:

    The websites provide information about the health plans and most show the premium rates.

    You can also contact an insurance agent for assistance.

    What if I apply for coverage and get rejected?

    Call the Minnesota Comprehensive Health Association (MCHA) at 1-866-894-8053. This health coverage was set up by the state legislature as an option when people are rejected by a health plan company. The premium you pay for this coverage is determined by your age and by the deductible plan you choose. We can provide more information on this coverage. We can send you a Summary of Benefits that describes in general what coverage you can expect, a rate chart, and an application.

    I need to see a doctor but I have no health coverage. Where can I go?

    Low cost health clinics are available. The Minnesota Department of Health cannot make recommendations, but provides the following information.

    • Consult the Guide to Additional Health Care Resources which has a section on lower cost health care resources.

    • There is a comprehensive list of Minnesota Essential Community (ECP) Providers available. This list can help you find a provider close to you.  ECPs serve all patients, regardless of their financial limitations.  Patients are charged for services based on a sliding fee schedule.

    • Consult Portico HealthNet at (651) 489-2273 or 1-866-489-4899. (This phone line formerly was answered by the Neighborhood Health Network.) They have a list of clinics that provide care to uninsured and low income individuals. Some charge a sliding fee scale or help you set up a plan to make payments. Some also see people who have certain types of health coverage. A few of these clinics also do dental work.

    • Consult the Children's Defense Fund's Minnesota Low-Cost Health Care Directory which lists low-cost clinics by county. They can be reached by telephone at (651) 227-6121.

    • Consult the 2012 Health Resources Directory for Diverse Cultural Communities if you live in the seven-county metro area or Kandiyohi, Olmsted, Otter Tail, Rice, or Stearns counties. Many of the clinics, hospitals, organizations and services listed here provide service to anyone but see the Eligibility Requirements column of the directory for specifics. Many of those listed do not require that you have a health plan. The list is arranged by county. For a print copy call (651) 201-5414 or 1-877-676-5414.

    Where can I get lower cost dental care? Check these resources:

    • Minnesota Dental Association (612) 767-8400 or 1-800-950-3368. See Resources for Low Cost Dental Care. It lists dental clinics that take Medical Assistance enrollees and also lists some dental clinics which provide care on a sliding fee scale (payment based on person's income).

    • Minneapolis District Dental Society (651) 631-9845

    • St. Paul District Dental Society (651) 697-0831

    • Portico Healthnet (651) 489-2273 or 1-866-489-4899 (phone lines formerly answered by Neighborhood Health Network). Portico Healthnet assists callers in locating lower cost dental clinics.

    • University of Minnesota Dental Clinic (612) 625-2495 Supervised dental work is done by students in their last two years of dental school. For orthodontic work call (612) 625-6444. Supervised orthodontic work is done by residents who have finished their dentistry schooling and are now specializing in orthodontics.

    • Metropolitan State University Dental Clinic (651) 621-8840 Advanced Dental Therapy students provide services under the supervision of licensed dentists.

    For children whose parents cannot afford dental care: Once a year on Give Kids a Smile day volunteer dentists offer free care. It is usually the first weekend in February. The dates for 2013 are Friday, February 1 and Saturday, February 2. The Minnesota Dental Association, Give Kids a Smile website section provides more information about this event including how to make an appointment, who is eligible, and what services will be provided. In the month prior to the event the Minnesota Dental Association's website lists the dentists who will offer the free care and phone numbers to call to make an appointment. The child must have an appointment.

    We are going out of the country and our health plan does not cover us while we are out of the United States.

    Contact the Insurance Federation of Minnesota, Insurance Help Line email to locate companies that provide coverage when you are out of the country.

    I have just graduated from college and no longer will be covered under my parent’s policy. What would be available to me? Note that dependents under the new federal health reform law can stay on their parent's policy until they turn 26 years old.

    • COBRA or continuation coverage, which would be available to you for up to 36 months. Sometimes this coverage can be expensive.

    • Coverage with an insurance company. Taking a higher deductible, if available, will lower your premium. See a list of insurance companies licensed to sell to individuals and families in Minnesota.

    • MinnesotaCare may be an option if you qualify. There are eligibility requirements including an income and asset limit and having to go without health coverage for four months.

    • Short-term or temporary coverage that lasts for up to six months.

    I have lost my job and can not afford COBRA/continuation. What else would be available?

    MinnesotaCare might be an option. Check with your county human service agency to see if you qualify for this public program. You would need to be without health coverage for four months and meet the income and asset guidelines to be eligible. There are some additional requirements.

    Contact the companies below to learn more about the health plans and their premium rates. These companies sell to individuals and families in Minnesota. If needed, consider purchasing a health plan with a higher deductible in order to make your premium less. This would provide coverage in case of a catastrophic health situation.

    Contact an insurance agent for assistance.

    Short-term or temporary coverage may be available to you when you are between jobs and when you do not have a preexisting condition. Contact the companies listed above or contact the Insurance Federation of Minnesota, Insurance Help Line email for more information.

     

    Health Care Cost and Quality

    Minnesota health care cost and quality information at Minnesota Health Information.

    Listed below are some suggested resources to check for information on cost and/or quality:

    For Clinics/Medical Groups:

    The "Minnesota Community Measurement 2012 Health Care Quality Report" rates Minnesota medical groups/clinics based on how well they follow treatment guidelines for certain categories of care. At present for medical groups some of these categories include: asthma, breast cancer screening, cancer screenings, cervical cancer screenings, childhood immunizations (combo 3), chlamydia screening, treatment for children's upper respiratory infections, colorectal cancer screening, diabetes, high blood pressure, and children's health. Also included, some hospital data and patient experience of their clinic care. View information on cost of 105 health care services received in a physician's office at Minnesota HealthScores.

    For Prescription Drugs:

    • Consumer Reports Best Buy Drugs is a website that locates information about the quality of a prescription drug, specifically the effectiveness of the drug and its side effects. The website was produced by the Minnesota Senior Federation (now disbanded), the Minnesota Medical Association, Consumers Union, and other groups.

    For Hospitals:

    To view the Adverse Health Events annual reports on hospitals and surgical centers, see the Patient Safety section of the Minnesota Department of Health (MDH) website. Click on Patient Safety Publications. There are 28 types of incidents that are now tracked and reported to MDH. See Search Facilities' Adverse Events Reporting to search for Minnesota hospitals by name for events.

    To compare hospitals, go to the federal government website Medicare.gov - Hospital Compare. The information compares certain types of medical treatment provided at hospitals. You put in the name of the hospitals or the geographic location of the hospitals you want to compare and choose the type of medical treatment you want to compare. The information is listed in the form of bar charts and tables with an explanation of the type of medical treatment compared. It also shows how that compares with the average for all reporting hospitals in Minnesota and in the U.S.

    The Minnesota Hospital Quality Partnership, formed by the Minnesota Hospital Association and Stratis Health, the Quality Improvement Organization for Minnesota, provides some information on patient safety and patient care in hospitals.

    The website Minnesota Hospital Price Check provides information to compare certain hospital procedure costs between hospitals. The site lists "Minnesota hospital prices for the 50 most common inpatient hospitalizations and the 25 most common same-day procedures." The price is for hospital services and does not include charges such as physician or surgeon services. You select the county, the hospital, the category of service, the specific service, and whether it's inpatient hospital stay or outpatient same day procedure. You get information on the average charge, average charge per day, and median charge for your selected hospital as well as for all hospitals in the region and similar-sized hospitals. Be sure to read the three explanations below the table: Notes About This Table, Understanding Facility Charge Information, and Why Charges May Differ Between Facilities. The Minnesota Hospital Association manages the website.

    For Nursing Homes:

    The Minnesota Department of Health and Minnesota Department of Human Services have compiled a Nursing Home Report Card which uses seven quality measures to compare nursing homes. Also see the Nursing Home Report Card Fact Sheet mentioned there for more information and answers to questions you may have about the report card.

    The Medicare website has a section called Nursing Home Compare. Click on Resource Locator and then on Nursing Home Compare which compares results of inspections. On that page also see Guide to Choosing a Nursing Home and Nursing Home Checklist. Also see Medicare's Nursing Home Compare brochure. Two other publications of interest: Medicare: Skilled Nursing Facility Care and Medicare and Skilled Nursing Facility Benefits: Getting Started.

    The Minnesota Board on Aging website links to publications to aid in choosing a nursing home. Click on Ombudsman for Long Term Care.

    For Health Care Organizations:

    The Joint Commission on Accreditation of Healthcare Organizations accredits health care organizations in order to improve quality and safety of care. The Quality Check section on their website allows users to see the survey results. To find out the number and type of complaints regarding one of their accredited health care organizations call their Office of Quality Monitoring at 1-800-994-6610. You can file complaints with this organization regarding quality of care. 

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    Health Care Insurance Fraud

    The Minnesota Department of Commerce website provides information about insurance fraud. Always check with the Minnesota Department of Commerce to be sure a health plan is licensed or certified to sell in Minnesota (651-296-2488 or 1-800-657-3602).

    • Buyer Beware: Discount Health Care Plans alerts consumers to be cautious of health discount plans, of unlicensed insurance agents selling false policies, and of health insurance scams targeted at small businesses. Lists potential signs of insurance fraud.
    • "Consumer Alert: Beware of Health Care Reform Scams" alerts consumers about fraudulent sales of health policies that are occurring in other parts of the country where consumers are told the policies are part of the new health reform law and some scams saying there's a limited enrollment period.

    The Minnesota Attorney Generals Office provides information warning consumers to"Beware of Unlicensed Health Plans".

    Quick Facts about Medicare Plans and Protecting Your Personal Information provides information to help seniors understand and avoid scams involving sales of Medicare health plans. It is published by the federal government Centers for Medicare and Medicaid Services.

    The Coalition Against Insurance Fraud website has tips to avoid health coverage scams.

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    Lists of Clinics and Hospitals

    Clinic List

    Do you have a list of clinics in the state? No. The Minnesota Medical Directory produced by Jola Publications at (612) 529-5001 may provide the information you are looking for. You could also check with a library to see if they have that publication.

    Hospital List

    Do you have a list of hospitals in the state? See the Licensed Health Care Directory. You can list hospitals by county and by city. A printed Directory is available for purchase through Minnesota's Bookstore (651) 297-3000 or 1-800-657-3757. The Directory is published by the Facility and Provider Compliance Division of the Minnesota Department of Health. Also at that website locate and produce lists of other Minnesota licensed, registered or certified health care providers which include:

    •Boarding care homes

    • Community mental health clinics (Medicare)

    • Comprehensive outpatient rehab facilities (Medicare)

    • End stage renal dialysis (Medicare)

    • Home care and home health agencies

    • Hospices

    • Nursing homes

    • Outpatient surgical centers

    • Psychiatric hospitals

    • Rehabilitation (Medicare)

    • Rural health clinics (Medicare)

    • Supervised living facilities

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    Medical Records

    What can providers charge for copying a patient’s medical records?

    An updated fact sheet "Maximum Charges for Patient Records," February 2013, (PDF: 37.89KB/1 page) shows the latest charges and provides general information on the state and federal laws and regulations that impact these charges. When providers are allowed to charge for copies, the maximum copying charge per page for 2013 is $1.30. When a retrieval charge is allowed, the maximum charge for 2013 is $17.21. Providers can charge less. The new charges are published each year in February or March by the Minnesota Department of Health.

    The copying charges for worker's compensation medical records are different. Please contact the Minnesota Department of Labor at 651 284-5032 for that information.

    How long does the provider have to make these copies?

    Minnesota Statute 144.292, Subdivision 5 does not state a specific length of time. It says "shall promptly furnish." The federal government HIPAA Privacy Rule says within 30 days. (Code of Federal Regulations, Title 45, Part 164.524(b)(2) Security and Privacy, Implementation specifications: requests for access and timely action. Timely action by the covered entity).

    Where can I get the poster Access to Health Records Notice of Rights (PDF: 58KB/1 page)?

    The Clearinghouse sends these out upon request to clinics and hospitals. Providers must post the document in a visible place (Minnesota Statute 144.292, Subdivision 4). Individuals may also request a copy. The most recent English revision is dated April 14, 2009. The poster is also available in Hmong, Russian, Somali, Spanish, and Vietnamese at Notices Related to Health Records.

    Where can I find my immunization records?

    • If you had immunizations at a public health department, call them to see if they have your records. If you had immunizations at a public health department in St. Paul, call the St. Paul-Ramsey County Public Health Department at (651) 266-1323 (located at 555 Cedar Street, St. Paul, Minnesota 55101). If you had immunizations at a public health department in Minneapolis call (612) 348-2741 and press 2.
    • Call the schools you previously attended to see if they still have this information.
    • If you were ever in a hospital, the hospital may have this information.
    • If your clinic has closed or you can't locate your doctor, see below.
    • Call the Minnesota Immunization Information Connection (MIIC) registry at the Minnesota Department of Health. MIIC is an immunization registry for all ages but at this time more likely to contain more data on children. Call (651) 201-5503 or 1-800-657-3970. You can also email your request to health.miichelp@state.mn.us.

    I am looking for my medical records. My clinic closed and I cannot locate my doctor.

    • Call the Board of Medical Practice at (612) 617-2130 or 1-800-657-3709. Ask if they have any information on your doctor's current location. See the Board of Medical Practice website and click on Health Professional Finder.

    • Were there other doctors at the clinic whose names you can remember? You may be able to locate one of them to ask where the clinic records went.

    • If you were ever in a hospital, there may be some information in those records. A hospital's records must always be kept.

    My hospital closed and I am looking for those medical records.

    • Link to Locating Hospital Medical Records on the Minnesota Department of Health's website. You can locate closed, renamed, and current hospitals.

    • The Minnesota Health Information Clearinghouse can look up information on closed hospitals and tell you where the medical records were sent. Call (651) 201-5178 or 1-800-657-3793.

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    Medicare

    What options are there to help with costs Medicare doesn't cover?

    If you are low income, contact your county human services agency or contact the Minnesota Senior LinkAge Line at 1-800-333-2433 to determine if you are eligible for the following programs. This assistance is sometimes referred to as the Medicare Savings Programs and it helps some low income seniors and disabled pay for certain Medicare costs.

    • Medical Assistance for Qualified Individuals (QI-1) helps pay Medicare Part B premiums.
    • Medical Assistance for Qualified Medicare Beneficiaries (QMB) helps pay Medicare Part A and Part B premiums and Medicare deductibles, co-insurance and co-pays.
    • Medical Assistance for Service Limited Medicare Beneficiaries (SLMB) helps pay Medicare Part B premiums.

    For more detailed information regarding these programs, see the Minnesota Department of Human Services website. Also see their Minnesota Health Care Programs publications Medical Assistance for Qualified Individuals, Medical Assistance for Qualified Medicare Beneficiaries, and Medical Assistance for Service Limited Medicare Beneficiaries.

    For private insurance to supplement Medicare, the Minnesota Department of Commerce website lists some companies and health maintenance organizations that are approved to sell additional Medicare coverage in Minnesota and lists their annual premiums:

    The publication Health Care Choices for Minnesotans on Medicare 2012 edition (PDF:4.2MB/199 pages) provides detailed information on health care plans in Minnesota that provide additional coverage to Medicare enrollees. Charts help you compare benefits offered by each plan. There also is information on assistance programs and other helpful information for seniors. Free copies are available from the Minnesota Senior LinkAge Line 1-800-333-2433. It is published by the Minnesota Board on Aging. The Minnesota Senior Federation, which previously published this booklet, closed operations in June 2009. You can also link to the booklet from the MinnesotaHelp.info website.

    Seniors can receive health insurance counseling from the Senior LinkAge Line® at 1-800-333-2433.

    Where can I get more information about the Medicare Prescription Drug Benefit, Medicare Part D?

    • See Medicare.gov or call Medicare at 1-800-633-4227 (TTY: 1-877-486-2048) for information and questions about Medicare Part D.
    • See Health Care Choices for Minnesotans on Medicare 2012 edition (PDF:4.2MB/199 pages) or call the Minnesota Senior LinkAge Line® at 1-800-333-2433 if you have questions or you need help comparing plans. You can request a free copy of the booklet.
    • See if you are eligible to apply for the Low Income Subsidy (LIS) assistance to help pay for the prescription drug benefit. Call Social Security at 1-800-772-1213 or the Minnesota Senior LinkAge Line® at 1-800-333-2433 for assistance.
      • Depending on your income and assets you may be eligible for full or partial assistance.
      • Often referred to as "extra help," LIS helps certain enrollees pay for Medicare Part D prescription drug premiums, co-pays, co-insurance and deductibles.
      • There is no "doughnut hole" or "coverage gap" when you receive "extra help" but you may have to pay a co-pay or co-insurance.
      • Some individuals are automatically provided this assistance and would not need to apply for it.

    Medicare started offering a drug benefit January 1, 2006. Each year there is an open enrollment period during which enrollees can make changes to their prescription drug coverage. The dates in 2011 are from October 15 through December 7 with changes and coverage starting the following January 1. There are certain situations where you may have the opportunity to change plans other than during this time period.

    When there are problems processing my Medicare claims, where can I call?

    • For problems regarding processing of Part A claims, call 1-800-MEDICARE (1-800-633-4227) to be connected to Noridian Administrative Services. This company processes Part A claims (for example, hospital bills, skilled nursing care and Part B claims for outpatient hospital services).

    • For problems regarding processing of Part B claims, call 1-800-MEDICARE (1-800-633-4227) to be connected to Wisconsin Physician Services. This company processes Part B claims, for example, your doctors' bills.

    • For problems regarding processing of claims for durable medical equipment and supplies, call 1-800-MEDICARE (1-800-633-4227) to be connected to AdminaStar Federal which processes these claims.

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    Portability

    In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA). In 1997 the Legislature amended Minnesota law to conform to the new federal law. These changes affected how employers and health carriers deal with individuals who have a preexisting condition when they change jobs or apply for new health insurance. Minnesota law applies to fully insured health plans. Self-insured health plans are subject to federal law.

    With the passage of the federal Affordable Care Act in 2010, and changes in state law in 2013 to conform to new requirements, portability has changed significantly. This publication is intended to provide guidance as to our understanding of state and federal laws governing portability of health insurance. It is not intended to provide legal advice and should not be construed as such.

    Please note that many of these changes are effective for health plans issued, offered, sold or renewed on or after January 1, 2014. Please also take note that some changes do not apply to grandfathered health plans. We have tried to identify these for your convenience. For a more comprehensive look at changes, see Laws of Minnesota 2013, chapter 84, articles 1 and 2.

    Q. What is "portability"?

    A. This is the right of someone who obtains new qualifying health coverage within 63 days of losing previous qualifying coverage, to be given credit for the previous coverage toward any preexisting condition exclusion.

    Q. What is a "pre-existing condition"?

    A. This is a medical condition for which medical advice, diagnosis, care or treatment was recommended or received during the six months immediately preceding the enrollment date.

    Q. What is a "pre-existing condition exclusion"?

    A.  This means that the new health insurance excludes coverage for any services related to the preexisting condition to the extent the 12 months (18 months for late entrants) has not been satisfied by the previous coverage.

    Q. Who is a "late entrant"?

    A. A late entrant is someone who seeks to enroll in a health plan at a time other than:

    • the initial enrollment period
    • an open enrollment period
    • a special enrollment period

    A late entrant either did not have or voluntarily dropped qualifying coverage.

    Q. What is an "initial enrollment period"?

    A. Initial enrollment means the first time a new employee and dependents are eligible to enroll in the group health plan.

    Q. What is "open enrollment"?

    A. Open enrollment means the time each year when employees and dependents can enroll in the group plan.

    Q. What is "special enrollment"?

    A. Special enrollment means a time other than initial or open enrollment when an employee or a dependent can enroll in the group plan based on certain qualifying events such as marriage, birth or adoption of a child, divorce, exhaustion of COBRA coverage, termination of employment.

    Q. What is "grandfathered" plan?

    A. This is a health plan that was in existence on March 23, 2010.

    Q. What does "guaranteed issue" mean?

    A. Guaranteed issue means a health carrier cannot use health history, current health status, or underwriting standards to turn down an application for health insurance.

    Q. What are the portability requirements as of January 1, 2014?

    A.  Credit must be given for previous qualifying coverage as long as the gap between the previous and new coverage is no more than 63 days.

    A preexisting condition exclusion may not be applied to properly enrolled newborns or adopted children.

    For plan years beginning on or after January 1, 2014, no individual health plan may be offered, sold, issued, or renewed to a Minnesota resident that contains a preexisting condition limitation, preexisting condition exclusion, or exclusionary rider.

    An individual age 19 or older may be subjected to an 18 month preexisting condition limitation during plan years beginning prior to January 1, 2014 unless he or she has maintained continuous coverage. He or she cannot be subjected to an exclusionary rider (refusal by a health plan to ever cover certain conditions or diagnoses).

    During plan years beginning prior to January 1, 2014 an individual age 19 or older and who has maintained continuous coverage may be subjected to a onetime preexisting condition limitation of up to 12 months, with credit for time covered under previous qualifying coverage.

    Thereafter, an individual who is age 19 or older and who has maintained continuous coverage may be subjected to a onetime preexisting condition limitation of up to 12 months with credit for time covered under qualifying coverage with respect to all preexisting conditions, regardless of whether the conditions were preexisting with respect to any previous qualifying coverage.

    Once the preexisting condition limitation has been satisfied, the individual must not be subjected to any preexisting condition limitation or exclusion or rider under an individual health plan by any carrier so long as he or she maintains continuous coverage.

    The prohibition on preexisting condition limitations for children age 18 or under does not apply to individual health plans that are grandfathered plans.

    The prohibition on preexisting condition limitations for adults age 19 and over beginning for plan years on or after January 1, 2014 does not apply to individual health plans that are grandfathered plans.

    Guaranteed issue is required for all health plans, except grandfathered plans, beginning January 1, 2014.

    A health carrier must offer an individual health plan to any individual previously covered under a group health plan issued by that carrier, so long as he or she maintained continuous qualifying coverage. The plan offered must not contain any preexisting condition limitation, exclusion or exclusionary rider, except for any unexpired limitation or exclusion under the previous coverage.

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    Patient Bill of Rights

    Where can I get copies of the Patient Bill of Rights?

    These are available in English on the Minnesota Department of Health, Facility and Provider Compliance division website. Some are available in Hmong, Laotian, Russian, Somali, and Spanish. Call (651) 201-4101 for a printed copy if you are unable to print it from the web. These publications are also available in Braille. The available publications include:

    • Minnesota Patient Bill of Rights (for hospitals)
    • Resident Bill of Rights (for nursing homes)
    • Minnesota Home Care Bill of Rights
    • Minnesota Home Care Bill of Rights for Assisted Living Clients
    • Combined Bill of Rights for Home Care
    • Combined Bill of Rights for Home Care for Assisted Living Clients
    • Minnesota Hospice Bill of Rights, and Minnesota Outpatient Surgical Center Patients Bill of Rights.

    The Minnesota Patient Bill of Rights for hospitals is available as a poster or brochure in English from the Minnesota Hospital Association at (651) 641-1121 or 1-800-462-5393. There is a charge for their posters and brochures.

    Where can I get a copy of a Patient’s Bill of Rights poster posted at my clinic? We are not aware of any generic patient bill of rights that applies to clinics. If you have seen such a poster at your clinic, check with the clinic as it may be something specific to that clinic. Our department has not produced such a poster.

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    Premium Rates

    Why are premium rates going up? See Health Insurance Premiums and Cost Drivers in Minnesota, 2009, Issue Brief March 2011 (PDF: 158KB/7 pages) published by the Minnesota Department of Health, Health Economics Program.

    To inquire about rate reviews for small employer groups and HMOs (both individual and small group policies): Contact a Health Financial Analyst at the Minnesota Department of Commerce, Insurance Division at (651) 282-5605.

    To inquire about individual and conversion rate reviews and Medicare supplement and long-term care rate reviews: Contact the Minnesota Department of Commerce at (651) 296-2488 or 1-800-657-3602.

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    Prescription Drugs

    I can't afford my prescriptions.

    The Senior LinkAge Line® provides a free service to help consumers find the prescription drugs they need. You do not need to be a senior to use this service. Using a database they locate programs that provide free or discounted prescription drugs. Usually there are eligibility requirements. Applications are available for each program. Call 1-800-333-2433.

    There are Internet sites to use to see whether your prescription drugs are available at a lower cost and whether you are eligible. Two of these are Rx Assist and NeedyMeds On the NeedyMeds website, click on Generic Name Drugs or Brand Name Drugs to see if your drug is listed and which programs may be available to you. When you click on Company List it lists companies that have (and do not have) prescription assistance programs. Most of the prescription assistance programs have eligibility requirements. Also see the Partnership for Prescription Assistance website and its Directory of PhRMA Member Company Patient Assistance Programs (PDF)

    For a list of these and other prescription drug resources see "Low Cost Options for Prescription Drugs," April 2012 (PDF: 28.45KB/5 pages), Managed Care Systems Section, Minnesota Department of Health. Call the Minnesota Health Information Clearinghouse, 651-201-5178 or 1-800-657-3793, for a print copy.

    websites to compare cost and quality of prescription drugs:

    CRBestBuyDrugs.com locates information about the quality of a prescription drug, specifically the effectiveness of the drug and its side effects. The website was produced by the Minnesota Senior Federation, the Minnesota Medical Association, Consumers Union, and other groups.

    Where can I get more information about the Medicare Prescription Drug Benefit, Medicare Part D?

    See www.medicare.gov for detailed information and a list of plans in your area.

    Call Medicare at 1-800-633-4227 (TTY: 1-877-486-2048) for questions about Medicare Part D. Certain enrollees will be eligible for a partial or full subsidy to help pay for this drug benefit.

    Call the Minnesota Senior LinkAge Line® at 1-800-333-2433 if you have questions or you need help comparing plans. They are the health insurance counselors for seniors in Minnesota. They provide a free publication called "Health Care Choices for Minnesota Seniors on Medicare 2012 edition" (PDF: 4.2MB/199 pages) which provides information about Medicare Part D and lists the plans available to Minnesotans. It is published each year.

    Look at "6 Ways to Lower Your Costs in the Drug Coverage Gap" for resources to help lower prescription costs while in the "doughnut hole"/coverage gap. This article is on the U.S. Government's Medicare website. Scroll down to it.

    To Keep Track of Your Medications

    Download a free copy of "My Medicine List" or call the Minnesota Hospital Association at 651 641-1121 or toll free 1-800-462-5393. There are columns to list the name of the medication, the dose, directions for taking it, why you are taking it, and starting and stopping dates. There are places to list allergies and immunizations. By compiling this information, it is all in one place for easy reference. The Minnesota Alliance for Patient Safety (MAPS) developed the form. They suggest carrying a copy of My Medicine List with you in your wallet so it is available to show any doctor, hospital, or pharmacy to prevent harmful prescription interactions. See also "Tips for Medicine Safety." The publications are available in six languages: English, Spanish, Hmong, Vietnamese, Somali, and Russian.

     

    Small Employer Health Insurance

    Introduction

    Minnesota enacted the Minnesota Small Employer Health Benefit Act in 1992 to address concerns that underwriting and rating practices in the market created hardships and unfairness, created unnecessary administrative costs, and adversely affected the health of Minnesota residents. This new law included guaranteed renewal of small employer plans as well as guaranteed issue of health plans under certain circumstances. Effective January 1, 2014, guaranteed issue and other reforms will be in place for all small employer health plans. Changes in the small employer market are based on the federal Affordable Care Act (ACA) and market rules enacted by the Minnesota Legislature in 2013.

    Frequently Asked Questions & Answers

    Q. Who qualifies as a small employer?

    A. Any person, firm, corporation, partnership, association or other entity actively engaged in business (including political subdivisions of the state) is considered a small business if employs fewer than 50 full-time employees. Sole proprietors do not qualify as small employers; they can get insurance as individuals through MNsure, the new online marketplace.

    Q. Are small employers required to provide health insurance to their employees?

    A. No, but there are some incentives to do so via MNsure. Employees would be able to choose from among several carriers and qualified health plans rather than the employer choosing one plan for everyone. Tax credits may be available to the small employer via MNsure.

    Q. Do all of the insurance companies and health maintenance organizations (HMOs) operating in Minnesota participate in the small employer market?

    A. No. Coverage is marketed, offered, sold, issued, or renewed only by those health carriers that have decided to participate in the small employer health plan market. A list of participating insurance companies and HMOs which have approved policies and rates as of October 2013 is available at Small Employer Health Plan Market - Plan Listings.

    A number of carriers offer small employer health coverage on the MNsure health marketplace. Go to MNsure to see the various qualified health plans (QHPs) being offered in the Small Employer Health Options Program market.

    Q. Do carriers participating in the small employer market have to guarantee small employers coverage and renewal if they request it?

    A. Yes.

    Q. Can dependents be covered under the small employer group health plan?

    A. Yes. Dependents, including spouses and children, can be covered at the option of the employer.

    Q. Can the health carrier limit coverage for individuals with pre-existing conditions?

    A. No. Effective January 1, 2014 carriers are not permitted to impose preexisting condition limitations in the small employer market.

    Q. Will premium rates be the same for all small employers?

    A. No. Premium rates may vary based on ages of the eligible employees and dependents; geographic rating areas; use of tobacco.

    Q. Will the premium rates for my company's health benefit plan increase at renewal?

    A. They may.

    Q. Will the gender of the employees be considered in the setting of the premium rates?

    A. No.

    Q. What kinds of health plans are available to small employers?

    A. Effective January 1, 2014 all health plans offered to small employers, both on and off MNsure must include the essential health benefits package required under the ACA and conforming state law. See Minnesota Statutes 62Q.81 for the list of essential health benefits.

    Q. What is the tax credit and how does the tax credit work for small employers?

    A. Federal tax credits are available now for qualifying taxable and tax-exempt organizations to help reduce the cost of coverage for employees. Small employers with fewer than 25 employees who provide health insurance, and use MNsure to purchase health insurance, may qualify for a federal tax credit federal tax credit of up to 50%. The tax credit is taken on the annual tax return.

    Go to IRS: Small business health care tax credit for small employers for more information and consult your tax advisor.

    Rates

    For premium rate estimates for your small employer group, you should contact your insurance agent or broker. If you do not have an agent or broker, contact these health carriers. To shop online or to compare various QHPs being offered in your area, go to MNsure.

    Additional references

    The Minnesota Department of Health certifies and regulates HMOs. Contact the Managed Care Systems section at 651-201-5100 or 1-800-657-3916 for further information about Minnesota HMOs.

    The Minnesota Department of Commerce licenses other health carriers including Blue Cross and Blue Shield of Minnesota. Please contact the Minnesota Department of Commerce at (651) 539-1500 or 1-800-657-3602 for further information on these health carriers.

    List of participating carriers participating in the small employer market: Small Employer Health Plan Market - Plan Listings

    For information about insurance companies or non-profit health service plans:

    Minnesota Department of Commerce
    85 East Seventh Place
    St. Paul, MN 55101
    (651) 539-1500 or 1-800-657-3602
    www.commerce.state.mn.us

    For information about tax implications related to the provision of health care coverage for employees:

    Internal Revenue Service
    Room 385 Federal Building
    316 North Robert Street
    St. Paul, MN 55101
    1-800-829-4933
    www.irs.gov

    For more information, contact the Managed Care Systems Section:

    By U.S. Mail:
    Minnesota Department of Health
    Managed Care Systems Section
    85 East Seventh Place, P.O. Box 64882
    St. Paul, Minnesota 55164-0882

    By Telephone: 651-201-5100 or 1-800-657-3916
    Fax: (651) 201-5186
    www.health.state.mn.us/hmo

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    Statistical Information

    The Minnesota Department of Health's Health Economics Program does research and analysis. We use many of their publications to answer questions. Check their site for additional information. Their "Minnesota Health Care Markets Chartbook" compiles statistical data about Minnesota's health care market. The "Chartbook" is divided into eight sections: Minnesota Health Care Spending and Cost Drivers, Trends and Variation in Health Insurance Coverage, Employment-Based Health Insurance, Small Group and Individual Health Insurance Markets, Public Health Insurance Programs, Uninsurance and the Safety Net, Health Plans, and Health Care Providers and Service Availability. Information in each section is updated as new information becomes available.

    Distribution of Health Coverage

    What's the current estimate of the distribution of health coverage among Minnesotans? The latest figures we have are for 2008. In 2008, 26.4% had private fully insured plans, 40.2% had private self-insured plans, .5% had MCHA (Minnesota Comprehensive Health Association), 14.4% had Medicare, 11.2% were on Medical Assistance, General Assistance Medical Care, MinnesotaCare, and 7.3% were uninsured. (Source: "Distribution of Health Insurance Coverage in Minnesota, 2008, Issue Brief, November 2010" (PDF: 81KB/5 pages), Minnesota Department of Health, Health Economics Program) Note: 2011 uninsured information below now available. See Uninsured heading below.

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    Enrollment and Funding

    What is the current HMO enrollment? This enrollment information is available on the Managed Care Systems section website. The Minnesota Health Information Clearinghouse can also email you the latest enrollment information by health plan.

    What is Minnesota's Medicare enrollment?
    The U.S. Centers for Medicare and Medicaid provide Medicare enrollment information by state and by county. See also Minnesota Department of Health, Health Economics Program, "Chartbook, Section 5: Public Health Insurance Programs, Medicare."

    How are Medical Assistance and MinnesotaCare funded?
    Medical Assistance is funded through federal, state, and county tax dollars. MinnesotaCare is funded by federal matching payments for pregnant women, eligible parents, and children enrollees and through the Health Care Access Fund. The Health Care Access Fund's primary sources of revenue are the premiums paid by MinnesotaCare enrollees and a 2% tax on all health care providers.(Source: "Health Care Coverage and Financing in Minnesota: Public Sector Programs, January 2003" (PDF: 199.4KB/40 pages).)

    What is the enrollment in these publicly-funded programs?
    The latest enrollment figures for Medical Assistance and MinnesotaCare are available on the Minnesota Department of Human Services website. Also see the Minnesota Department of Health, Health Economics Program "Chartbook, Section 5: Public Health Insurance Programs," for some information on enrollment and spending history for Medical Assistance and MinnesotaCare.

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    Health Care Spending

    How much does Minnesota spend on health care and on what is this money spent? A recent Health Economics Program publication states Minnesota health care spending reached $37.7 billion in 2010. The publication discusses health care spending in 2010 including sources of funds and spending by type of services. Includes the following tables and charts: Minnesota Health Care Spending and Growth Rate Trends, Minnesota and U.S. Total Health Care Expenditure Growth, Minnesota and U.S. Per Capita Health Care Spending and Share of Economy, Minnesota and U.S. Shares of Health Care Spending by Payer, Minnesota Health Care Spending in 2010: Where It Went, Minnesota Health Care Spending by Type of Expense, Health Care Spending in Minnesota Without the Impact of Reform, 2000 to 2020. The publication includes a section on Health Care Spending Projections. See "Minnesota Health Care Spending and Projections, 2010 (PDF: 344KB/26pages) July 2012.

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    Health Plan Market Share

    Who are the largest insurers in the state by market share?

    For 2009 in Minnesota's commercial health insurance market, they were Blue Cross Blue Shield Minnesota (32.9%), HealthPartners (28.7%), and Medica (23.8%). Note: This includes affiliated companies under common ownership (i.e., Blue Cross Blue Shield of Minnesota includes both Blue Cross Blue Shield of Minnesota and Blue Plus). (Source: Minnesota Health Care Markets Chartbook, Section 7: Health Plans)

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    State Health Rankings

    One source for state health rankings is the annual report by United Health Foundation. For 2011 Minnesota ranked sixth in overall state ranking. The report shows each state's information for 2011 and compares it with the state that ranks first in that measure. For 2011 in the overall state rankings, Vermont ranks first as the healthiest state, New Hampshire was second, Connecticut was third, Hawaii was fourth, and Massachusetts was fifth. The 2011 report looks at four determinants of health: Personal Behaviors (smoking, binge drinking, obesity, high school graduation), Community Environment (violent crime, occupational fatalities, infectious disease, children in poverty, and air pollution), Public and Health Policies (lack of health insurance, per capita public health spending, immunization coverage), Clinical Care (prenatal care, primary care physicians, preventable hospitalizations). The report also looks at eight Health Outcomes measures: diabetes, poor mental health days, poor physical health days, infant mortality, cardiovascular deaths, cancer deaths, premature deaths, and geographic disparity. View, download or order a free print copy of the complete 2011 report published by United Health Foundation at United Health's website. The website allows you to compare Minnesota with other states both overall and individually, including comparing each of the health determinants listed above.

     

    Uninsured

    What percent of Minnesotans are uninsured? In 2011 about 9.1 percent were uninsured statewide (in 2009 it was 9.0%, in 2008 it was 7.3 percent, in 2007 it was 7.2 percent).

    How many people are uninsured in the state? In 2011 about 490,000 people.

    For additional information and the source of these 2011 figures see: "Fact Sheet, March 2012, Health Insurance Coverage in Minnesota, Early Results from the 2011 Minnesota Health Access Survey" (PDF: 165KB/8 pages).

    How much would it cost to cover the uninsured in Minnesota?

    At the request of the Governor's Health Cabinet, the Minnesota Department of Health's Health Economics Program prepared a background paper providing potential estimates of the cost of providing health coverage to Minnesota's uninsured, July 2006. "How much would it cost to cover the uninsured in Minnesota? Preliminary Estimates" (PDF: 116KB/10 pages) discusses who the uninsured are, a public coverage option and a private coverage option, the pros and cons of mandating individual health coverage, costs to the state vs. overall health care cost, and includes a table showing the characteristics of uninsured Minnesotans compared to the general population.

    More uninsured information

    See Section 6, Minnesota Health Care Markets Chartbook, Uninsurance and a Safety Net (uncompensated care) for more detailed statistics on Minnesota's uninsured. Includes demographic and employment characteristics. Users can compile their own tables or Excel spreadsheets from the Minnesota Health Access Survey.

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Updated Thursday, February 06, 2014 at 04:56PM