Read 1st time January 11, 2000, and 1000 copies ordered printed.
ANNE C. WALKER, Chief Clerk
AN ACT
To repeal section 376.986, RSMo 1994, relating to health insurance for the working poor, and to enact in lieu thereof two new sections relating to the same subject.
Section A. Section 376.986, RSMo 1994, is repealed and two new sections enacted in lieu thereof, to be known as sections 135.920 and 376.986, to read as follows:
135.920. 1. As used in this section, the following terms mean:
(1) "Eligible employee", an employee who works on a full-time basis and has a normal work week of thirty or more hours. The term includes a sole proprietor, a partner of a partnership, and an independent contractor, if the sole proprietor, partner or independent contractor is included as an employee under a health benefit plan of a small employer, but does not include an employee who works on a part-time, temporary or substitute basis. For purposes of this section, a person, such person's spouse and such person's minor children shall constitute only one eligible employee when they are employed by the same small employer; except that, in the case of a person who is a farmer, such person may constitute an eligible employee and such person's spouse, if hired by such person, may constitute a second eligible employee;
(2) "Eligible small employer", any person, firm, corporation, partnership or association that is actively engaged in business that, on at least fifty percent of its working days during the preceding calendar quarter, employed not less than two nor more than fifty eligible employees, the majority of whom were employed within this state. In determining the number of eligible employees, companies that are affiliated companies, or that are eligible to file a combined tax return for purposes of state taxation, shall be considered one employer;
(3) "Farmer", any person who derives at least two-thirds of such person's income from using or cultivating land for the production of agricultural crops, livestock or livestock products, poultry or poultry products, milk or dairy products, or fruit or other horticultural products; provided that, the term shall not include a person who processes farm products or distributes farming supplies by contracting to provide spraying, harvesting or other farming services; and
(4) "Private health insurance purchasing cooperative", a private cooperative association formed for the purpose of purchasing and providing health care insurance for its members' employees, the members of which consist of any combination of private persons, firms, corporations, partnerships, associations or other entities at least fifty percent of which are eligible small employers.
2. For tax years beginning on or after January 1, 2001, an eligible small employer which joins a private health insurance purchasing cooperative, which does not, as of January 1, 2001, pay its employees' health insurance premiums and which first begins to pay health insurance premiums on behalf of such employer's eligible employees during such tax year or thereafter shall be allowed to claim a credit against the tax otherwise due pursuant to chapter 143, RSMo, excluding sections 143.191 to 143.265, RSMo, and related provisions, for health insurance premiums paid on behalf of such employer's eligible employees in an amount as follows:
(1) For the first two years the eligible small employer pays health insurance premiums on behalf of such employer's eligible employees fifty dollars per month per employee;
(2) For the third and fourth years the eligible small employer pays health insurance premiums on behalf of such employer's eligible employees, thirty-five dollars per month per employee; and
(3) For each year subsequent to the fourth year the eligible small employer pays health insurance premiums on behalf of such employer's eligible employees, twenty-five dollars per month per employee.
3. For tax years beginning on or after January 1, 2001, an eligible small employer which does not qualify for a tax credit pursuant to subsection 2 of this section because such employer, as of January 1, 2001, was already paying its employees' health insurance premiums, shall be allowed to claim a credit against the tax otherwise due pursuant to chapter 143, RSMo, excluding sections 143.191 to 143.265, RSMo, and related provisions, in an amount equal to twenty-five dollars per month per eligible employee for whom such small employer pays health insurance premiums.
4. The department of revenue is authorized to promulgate any rules necessary to administer the tax credit allowed by this section. No rule or portion of a rule promulgated pursuant to the authority of this section shall become effective unless it is promulgated pursuant to the provisions of chapter 536, RSMo.
5. The tax credit allowed by this section is subject to appropriation from moneys received by the state pursuant to the master settlement agreement entered into on November 23, 1998, by the state and leading United States tobacco product manufacturers, and deposited by the state treasurer to the credit of the tobacco settlement trust fund.
376.986. 1. The pool shall offer major medical expense coverage to every person eligible for coverage [under] pursuant to section 376.966. The coverage to be issued by the pool and its schedule of benefits, exclusions and other limitations, shall be established by the board with the advice and recommendations of the pool members, and such plan of pool coverage shall be submitted to the director for approval. The pool shall also offer coverage for drugs and supplies requiring a medical prescription and coverage for patient education services, to be provided at the direction of a physician, encompassing the provision of information, therapy, programs, or other services on an inpatient or outpatient basis, designed to restrict, control, or otherwise cause remission of the covered condition, illness or defect.
2. In establishing the pool coverage the board shall take into consideration the levels of health insurance provided in this state and medical economic factors as may be deemed appropriate, and shall promulgate benefit levels, deductibles, coinsurance factors, exclusions and limitations determined to be generally reflective of and commensurate with health insurance provided through a representative number of insurers in this state.
3. Premiums charged for pool coverage may not be unreasonable in relation to the benefits provided, the risk experience and the reasonable expenses of providing the coverage. Separate schedules of premium rates based on age, sex and geographical location may apply for individual risks.
4. The pool shall determine the standard risk rate by calculating the average individual standard rate charged by the five insurers with the largest number of individual contracts in force. In the event five insurers do not offer comparable coverage, the standard risk rate shall be established using reasonable actuarial techniques and shall reflect anticipated experience and expenses for such coverage. Initial rates for pool coverage shall not be less than one hundred fifty percent of rates established as applicable for individual standard risks. Subsequent rates shall be established to provide fully for the expected costs of claims including recovery of prior losses, expenses of operation, investment income of claim reserves, and any other cost factors subject to the limitations described herein. In no event shall pool rates exceed [two] one hundred thirty-five percent of rates applicable to individual standard risks. All rates and rate schedules shall be submitted to the director for approval.
5. Pool coverage established pursuant to this section shall provide an appropriate high and low deductible to be selected by the pool applicant. The deductibles and coinsurance factors may be adjusted annually in accordance with the medical component of the consumer price index.
6. Pool coverage shall exclude charges or expenses incurred during the first [twelve] six months following the effective date of coverage as to any condition which, during the six-month period immediately preceding the effective date of coverage, had manifested itself in such a manner as would cause an ordinarily prudent person to seek diagnosis, care or treatment or for which medical advice, care or treatment was recommended or received as to such condition. Such preexisting condition exclusions shall be waived to the extent to which similar exclusions, if any, have been satisfied under any prior health insurance coverage which was involuntarily terminated, if that application for pool coverage is made not later than sixty days following such involuntary termination and, in such case, coverage in the pool shall be effective from the date on which such prior coverage was terminated.
7. Benefits otherwise payable under pool coverage shall be reduced by all amounts paid or payable through any other health insurance, or insurance arrangement, and by all hospital and medical expense benefits paid or payable under any workers' compensation coverage, automobile medical payment or liability insurance whether provided on the basis of fault or nonfault, and by any hospital or medical benefits paid or payable under or provided pursuant to any state or federal law or program except medicaid. The insurer or the pool shall have a cause of action against an eligible person for the recovery of the amount of benefits paid which are not for covered expenses. Benefits due from the pool may be reduced or refused as a setoff against any amount recoverable [under] pursuant to this subsection.
8. Medical expenses shall include expenses for comparable benefits for those who rely solely on spiritual means through
prayer for healing.
Missouri
House of Representatives