HB 1570 -- Health Insurance

Sponsor:  Ervin

This bill changes the laws regarding health insurance to comply
with the federal Health Insurance Portability and Accountability
Act (HIPAA).

HEALTH MAINTENANCE ORGANIZATIONS (HMOs) (Section 354.536, RSMo)

Proof that a dependent child is incapable of maintaining
employment due to a mental or physical handicap and is dependent
upon the policy holder for support and maintenance must be
submitted to the insured's HMO within 31 days, instead of the
current at least 31 days, after the child has attained the age
when the child's coverage is to be terminated.

GROUP HEALTH INSURANCE POLICIES (Sections 376.397, 376.401,
376.421, 376.424, and 376.426)

Currently, an insurer can refuse to renew a converted group
policy health benefit plan if the covered individual qualifies
for services covered by any state or federal law.  The bill
removes this provision making it unlawful for a health insurer to
refuse to renew a converted policy for these individuals.

Currently, when an employee retires prior to being eligible for
Medicare benefits, the retiree's converted employer group health
benefit plan can be reduced or terminated by the insurer when the
retiree becomes eligible for Medicare.  The bill removes this
provision.

The provision is repealed which allows health insurers the
ability to exclude or limit coverage on group health benefit
policies issued to certain groups with less than 10 members in
the group including employers and employees, creditors and
debtors, and labor unions and members.  The bill also removes the
provision which allows health insurers to exclude or limit
coverage for group health benefit plan recipients when the
recipient cannot prove satisfactory insurability to the insurer.
Health insurers will be required to comply with HIPAA regulations
regarding reduced-rate premiums or deductibles on policies for
employees who do not smoke or use tobacco products.

The bill removes the provision which allows insurers to exclude
or limit coverage for health benefit plans issued to family
members of employees for employers with less than 10 employees
and removes other provisions that restrict coverage for employers
with more than 10 employees.

Currently, group health insurance policies must specify any
exclusions and limitations to the policy regarding a disease or
physical condition that an individual was treated for during the
12 months prior to the effective date of the coverage.  The bill
limits the exclusions and limitations to the prior six months
before the enrollment date of the coverage.  Exclusions and
limitations cannot apply to a loss or disability that occurred 12
months after the enrollment date or, in the case of a late
enrollee, 18 months from the enrollment date.  Proof that a
dependent child is incapable of maintaining employment due to a
mental or physical handicap and is dependent upon the policy
holder for support and maintenance must be submitted to the
health insurer within 31 days, instead of the current at least 31
days, after the dependent child has attained the age when
coverage is to be terminated.

MISSOURI HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
(Sections 376.450.1 and 376.450.6)

The State Children's Health Insurance Program (SCHIP) is added to
the list of credible coverages for individuals under the Missouri
Health Insurance Portability and Accountability Act, and the
definition for "waiting period" as it relates to the act is
revised to be the time period that must pass before coverage for
an employee or dependent who is otherwise eligible to enroll in a
group health plan can become effective.  Any time period before
late or special enrollment is not considered a waiting period for
late or special enrollees.  A waiting period begins on the date
an individual submits a substantially complete application for
coverage and ends on the date coverage begins or when the
application is denied or lapses.

Health insurance issuers offering group coverage will be required
to provide a special enrollment period for a dependent in the
case of a placement for adoption for an employee or an employee's
dependent who loses health insurance coverage previously provided
by Medicaid or SCHIP and requests coverage within 60 days of
becoming eligible for the group plan.

INDIVIDUAL HEALTH INSURANCE POLICIES (Section 376.776)

Proof that a dependent child is incapable of maintaining
employment due to a mental or physical handicap and is dependent
upon the policy holder for support and maintenance must be
submitted to the health insurer within 31 days, instead of the
current at least 31 days, after the dependent child has attained
the age when coverage is to be terminated.

MISSOURI HEALTH INSURANCE POOL (MHIP) (Sections 376.960 and
376.966)

The bill adds recipients of coverage under the State Children's
Health Insurance Program (SCHIP) to the list of individuals with
credible coverage under the MHIP and changes the definition of
"dependent" to be an unmarried child that is medically certified
as disabled and dependent upon the parent or a state resident
younger than 19 years of age who is not eligible for any other
group or individual coverage or entitled to state or federal
health benefits.

Eligibility limits for MHIP coverage are revised to include
persons whose health insurance premiums have risen above the
limit set by the MHIP Board.  The board cannot set the
eligibility limit in excess of 200% of the rates established by
the board.  Federally eligible individuals are also eligible for
coverage.

LIMITED MANDATE HEALTH INSURANCE ACT (Section 376.995)

The provision is repealed which requires insurers that provide
limited mandate health insurance plans to restrict their
marketing to individuals who do not have health insurance
coverage or to individuals or employers who certify in writing to
the insurer that they are terminating coverage because of the
cost.

EMPLOYER REQUIREMENTS FOR HEALTH REIMBURSEMENT ARRANGEMENT ONLY
PLANS (Section 376.1600)

The Director of the Department of Insurance, Financial
Institutions and Professional Registration is authorized to allow
employees to use funds from one or more employer health
reimbursement arrangement (HRA) only plans to help pay for
individual health insurance coverage.  HRAs are employer-provided
employee benefit plans that establish an account or trust which
is funded solely by the employer and not through a salary
reduction or under a cafeteria plan to reimburse the employee for
qualified medical expenses incurred by the employee and his or
her spouse and dependents.  The HRAs establish a maximum defined
coverage amount for a defined coverage period and carry forward
any unused funds at the end of the coverage period to subsequent
coverage periods.

SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT (Sections
379.930, 379.940, and 379.952)

Children eligible for the State Children's Health Insurance
Program (SCHIP) are added to the list of individuals considered
to have credible coverage under the Small Employer Health
Insurance Availability Act.  The definition of "dependent" is
revised as it relates to insurance coverage to be a person that
is a spouse, an unmarried child who resides in Missouri and is
younger than 19 years of age and is not covered by any group or
individual health benefit plan or entitled to federal Social
Security assistance benefits, or an unmarried child of any age
who is disabled and dependent upon his or her parent.

A small employer carrier that establishes more than one class of
business must maintain and issue all health benefit plans it
actively markets to eligible small employers in the state.

The bill requires a small employer insurance carrier to
reasonably compensate an agent or broker for the sale of any
small employer health benefit plan.  Currently, a small employer
insurance carrier will not be in violation of any unfair trade
practice if the small employer charges a reduced premium or
deductible for employees who do not smoke or use tobacco
products.  The bill revises the definition of "unfair trade
practice" by using the provisions that apply to all insurance
carriers in Missouri instead of only health and accident
insurance companies.  The bill requires health insurers to comply
with the nondiscrimination provisions of the HIPAA regulations
regarding reduced premium rates or deductibles for employees who
do not smoke or use tobacco products.

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