FRASER AND BOYKINS (Co-sponsors).
Read 1st time February 29, 2000, and 1000 copies ordered printed.
ANNE C. WALKER, Chief Clerk
AN ACT
To repeal sections 376.1209 and 376.1215, RSMo Supp. 1999, relating to health insurance coverage, and to enact in lieu thereof five new sections relating to the same subject.
Section A. Sections 376.1209 and 376.1215, RSMo Supp. 1999, are repealed and five new sections enacted in lieu thereof, to be known as sections 376.1150, 376.1175, 376.1180, 376.1209 and 376.1215, to read as follows:
376.1150. 1. Each policy issued by an entity offering individual and group health insurance which provides coverage on an expense-incurred basis, individual or group health service, or indemnity contracts issued by a nonprofit corporation, individual and group service contracts issued by a health maintenance organization, all self-insured group health arrangements to the extent not preempted by federal law, and all health care plans provided by managed health care delivery entities of any type or description that are delivered, issued for delivery, continued or renewed in this state on or after January 1, 2001, shall provide coverage, without requiring the enrollee to obtain a referral from the enrollee's primary care provider, for an annual gynecological examination from a participating network obstetrician/gynecologist and any medically necessary follow-up care received within ninety days of such examination for any condition which required diagnostic testing or treatment during the annual examination. Any health insurer required to provide coverage pursuant to this section shall, at least once a year, notify every applicable enrollee that such coverage includes coverage for mammograms and PAP smears.
2. The health care service required by this section shall not be subject to any greater deductible or co-payment than other similar health care services provided by the policy, contract or plan.
3. This section shall not apply to a supplemental insurance policy, including a life care contract, accident-only policy, specified disease policy, hospital policy providing a fixed daily benefit only, Medicare supplement policy, long-term care policy, short-term major medical policies of six months or less duration, or any other supplemental policy as determined by the director of the department of insurance.
376.1175. 1. Each policy issued by an entity offering individual and group health insurance which provides coverage on an expense-incurred basis, individual or group health service, or indemnity contracts issued by a nonprofit corporation, individual and group service contracts issued by a health maintenance organization, all self-insured group health arrangements to the extent not preempted by federal law, and all health care plans provided by managed health care delivery entities of any type or description that are delivered, issued for delivery, continued or renewed in this state on or after January 1, 2001, shall provide coverage for hormone replacement therapy when medically necessary.
2. The health care service required by this section shall not be subject to any greater deductible or co-payment than other similar health care services provided by the policy, contract or plan.
3. This section shall not apply to a supplemental insurance policy, including a life care contract, accident-only policy, specified disease policy, hospital policy providing a fixed daily benefit only, Medicare supplement policy, long-term care policy, short-term major medical policies of six months or less duration, or any other supplemental policy as determined by the director of the department of insurance.
376.1180. 1. Each policy issued by an entity offering individual and group health insurance which provides coverage on an expense-incurred basis, individual or group health service, or indemnity contracts issued by a nonprofit corporation, individual and group service contracts issued by a health maintenance organization, all self-insured group health arrangements to the extent not preempted by federal law, and all health care plans provided by managed health care delivery entities of any type or description that are delivered, issued for delivery, continued or renewed in this state on or after January 1, 2001, that provides coverage for outpatient prescription drugs approved by the federal Food and Drug Administration shall not exclude coverage for prescription contraceptive methods approved by the federal Food and Drug Administration.
2. Notwithstanding any other provision of this section to the contrary:
(1) Any health insurer, hospital or health services corporation or health care center may issue to a religious employer an individual or group health insurance policy that excludes coverage for prescription contraceptive methods which are contrary to the religious employer's bona fide religious tenets;
(2) Upon the written request of an individual who states in writing that prescription contraceptive methods are contrary to such individual's religious or moral beliefs, any health insurer, hospital or health services corporation, or health care center may issue to or on behalf of the individual:
(a) An individual health insurance policy that excludes coverage for prescription contraceptive methods; or
(b) A rider to the health insurance policy that excludes coverage for prescription contraceptive methods;
(3) Any health insurer, hospital or health services corporation, or health care center which is owned, operated or substantially controlled by a religious organization which has religious or moral tenets which conflict with the requirements of this section may provide for the coverage of prescription contraceptive methods as required in this section through another such entity offering a limited benefit plan. The cost, terms and availability of such coverage shall not differ from the costs, terms and availability of other prescription coverage offered to the enrollee.
3. Any health insurance policy issued pursuant to subsection 2 of this section shall provide written notice to each enrollee or prospective enrollee that prescription contraceptive methods are excluded from coverage pursuant to this section. Such notice shall appear in not less than ten point type in the policy, application and sales brochure for such policy.
4. Nothing in this section shall be construed as authorizing an individual or group health insurance policy to exclude coverage for prescription drugs ordered by a health care provider with prescriptive authority for reasons other than contraceptive purposes.
5. As used in this section, "religious employer" means an employer that is a "qualified church-controlled organization" as defined in 26 U.S.C. Section 3121 or a church-affiliated organization.
6. This section shall not apply to a supplemental insurance policy, including a life care contract, accident-only policy, specified disease policy, hospital policy providing a fixed daily benefit only, Medicare supplement policy, long-term care policy, short-term major medical policies of six months or less duration, or any other supplemental policy as determined by the director of the department of insurance.
376.1209. 1. Each entity offering individual and group health insurance policies providing coverage on an expense-incurred basis, individual and group service or indemnity type contracts issued by a nonprofit corporation, individual and group service contracts issued by a health maintenance organization, all self-insured group arrangements to the extent not preempted by federal law, and all managed health care delivery entities of any type or description, that provide coverage for the surgical procedure known as a mastectomy, and which are delivered, issued for delivery, continued or renewed in this state on or after January 1, 1998, shall provide coverage for prosthetic devices or reconstructive surgery necessary to restore symmetry as recommended by the [oncologist or primary] attending care physician for the patient incident to the mastectomy. Coverage for prosthetic devices and reconstructive surgery shall be subject to the same deductible and coinsurance conditions applied to the mastectomy and all other terms and conditions applicable to other benefits.
2. As used in this section, the term "mastectomy" means the removal of all or part of the breast for medically necessary reasons, as determined by a physician licensed pursuant to chapter 334, RSMo.
3. The provisions of this section shall not apply to a supplemental insurance policy, including a life care contract, accident only policy, specified disease policy, hospital policy providing a fixed daily benefit only, Medicare supplement policy or long-term care policy.
4. No insurer, as defined in section 376.960, shall require as a condition of coverage that procedures performed pursuant to this section be performed on an outpatient basis.
376.1215. 1. All individual and group health insurance policies providing coverage on an expense-incurred basis, individual and group service or indemnity type contracts issued by a health services corporation, individual and group service contracts issued by a health maintenance organization and all self-insured group arrangements to the extent not preempted by federal law and all managed health care delivery entities of any type or description shall provide coverage for immunizations of a child from birth to five years of age as provided by department of health regulations and shall notify enrollees who add a dependent through birth or adoption of the schedule of mandatory immunizations.
2. Such coverage shall not be subject to any deductible or co-payment limits.
3. The contract issued by a health maintenance organization may provide that the benefits required pursuant to this section shall be covered benefits only if the services are rendered by a provider who is designated by and affiliated with the health maintenance organization, except that the health maintenance organization shall, as a condition of participation, comply with the immunization requirements of state or federally funded health programs.
4. This section shall not apply to supplemental insurance policies, including life care contracts, accident-only policies, specified disease policies, hospital policies providing a fixed daily benefit only, Medicare supplement policies, long-term care policies, coverage issued as a supplement to liability insurance, short-term major medical policies of six months or less duration and other supplemental policies as determined by the department of insurance.
5. The department of health shall promulgate rules and regulations to determine which immunizations shall be covered by policies, plans or contracts described in this section. No rule or portion of a rule promulgated under the authority of this section shall become effective unless it has been promulgated pursuant to the provisions of section 536.024, RSMo.
6. No health care provider shall charge more than one hundred percent of the reasonable and customary charges for
providing any immunization.
Missouri House of Representatives