HB 748 -- Missouri High Risk Health Insurance Pool

Sponsor:  Ervin

This bill changes the laws regarding the Missouri High Risk
Health Insurance Pool (MHIP).

A Missouri resident who has exhausted his or her maximum benefits
from his or her health insurer or can only obtain health
insurance from a carrier at a rate that is more expensive than
the pool's eligibility rates will be eligible for coverage under
the pool.  Currently, after December 31, 2009, a person who has
health insurance coverage through an insurer and has experienced
a premium rate increase of 300% or more of the individual
standard rates established by the MHIP Board is eligible to
obtain coverage through the pool.  The bill removes this
provision.

An individual who has had prior creditable coverage with a group,
governmental, or church plan and is not eligible for certain
Social Security or Title XIX benefits; does not have other health
insurance coverage; and has exhausted continuation of coverage
through COBRA will be eligible for coverage under the pool.

All health insurers must notify an insured when he or she has
exhausted 85% of his or her total lifetime health insurance
benefits and of the person's eligibility for and the methods of
applying for coverage under the pool.  Notification must be
repeated when an insured has exhausted 100% of his or her total
lifetime health insurance benefits, and the insurer must also
notify the pool with the name and address of the affected person.

The board is required to offer health benefit plans that are in
the best interest of the individuals covered under the pool
including, but not limited to, coverage for dental, vision, and
limited mandate plans or other flexible benefit plans and can
establish a premium rate load to allow enrollees to buy down
creditable coverage.  An individual's premium rate for the pool
must be based on the individual's family size.  The bill removes
the lower limit requirement for pool coverage for applicants.
Pool coverage rates cannot exceed 125% of those applicable to
individual standard risks for individuals who have had prior
creditable coverage with a group, governmental, or church plan;
are not eligible for certain Social Security or Title XIX
benefits; do not have other health insurance coverage; and have
exhausted continuation of coverage through COBRA.  Pool coverage
rates cannot exceed 125% of rates applicable to individual
standard risks for all others covered in the pool.

The pool must establish a premium assistance program, subject to
appropriations, for individuals with incomes less than the pool's
eligibility limit or who jointly contribute to their premium with
their employer.  The premium assistance will be based on a
sliding income scale established by the pool along with any cost-
sharing requirements, such as deductibles, co-payments, and co-
insurance.

When implementing the provisions regarding the coverage for pool
enrollees and provider payments, the board is required to make
sure that the special needs of Missouri's Tier I Safety Net
providers are not disproportionately impacted by its rules.

Insurance agents and brokers selling or renewing pool policies
will receive a 5% commission.

Missouri House of Representatives
95th General Assembly, 1st Regular Session
Last Updated November 17, 2009 at 9:25 am