HB 1495 -- Health Insurance Contracts and Plans

Sponsor:  Schaaf

This bill changes the laws regarding health insurance contracts
and plans.

CO-PAYMENTS FOR PRESCRIPTION DRUGS (Sections 354.535 and 376.387,
RSMo)

When the usual and customary retail price of a prescription drug
is less than the co-payment applied by a health maintenance
organization or health insurer, the enrollee will only be
required to pay the usual and customary retail price of the
prescription drug and there will be no further charge to the
enrollee or plan sponsor for the prescription.  If the price is
more than the co-payment, the enrollee will only be required to
pay the usual and customary retail price of the prescription drug
and there will be no further charge to the enrollee or plan
sponsor for the prescription.

STANDARDIZED INSURANCE APPLICATIONS (Section 374.184)

The Director of the Department of Insurance, Financial
Institutions and Professional Registration after consultation
with health insurers and a public hearing must establish by rule
uniform insurance application forms to be used by all insurers
for group health insurance policies, except for group health
plans for small employers.

WILLING PROVIDERS OF HEALTH CARE (Section 376.393)

Health insurers, the MO HealthNet Program, and the federal
Medicare Program are prohibited from discriminating against any
Missouri health care provider, licensed pharmacy, or licensed
home health care agency located within the geographic coverage
area of a health benefit plan who is willing to meet the terms
and conditions for participation in the plan.

HEALTH INSURANCE CONTRACTS (Section 376.444)

The bill prohibits any agreement between a health insurance
carrier and a participating licensed health care provider from
containing a provision which:

(1)  Prohibits a provider from contracting with another carrier
to accept a lower reimbursement than the payment specified in the
agreement;

(2)  Requires the provider to accept a lower reimbursement from
the carrier if the provider agrees with another carrier to accept
a lower payment for services;

(3)  Terminates or renegotiates the agreement if the provider
agrees to accept a lower payment from a different carrier for
services; or

(4)  Requires the provider to disclose his or her contracted
reimbursement rates with other contracted providers.

A violation of any of these provisions will make an agreement
void and unenforceable.

Missouri House of Representatives
95th General Assembly, 2nd Regular Session
Last Updated September 14, 2010 at 3:11 pm