HB 646 -- Health Insurance

Sponsor:  Luetkenhaus

This bill makes changes to statutes relating to group health
insurance, the health insurance pool, and the Small Employer
Health Insurance Availability Act.  In its main provisions, the
bill:

(1)  Defines related terms including, pre-existing condition
exclusions and waiting period;

(2)  Prohibits group health insurance issuers from establishing
enrollment eligibility requirements based on health status--
related factors, including medical history and genetic
information;

(3)  Prohibits health insurance issuers offering group health
insurance coverage from requiring any individual, as a condition
of enrollment, to pay a premium or other contribution that is
greater than that made by other similarly situated individuals
enrolled in the plan on the basis of health status-related
factors;

(4)  Requires health insurance issuers offering large group
health plan coverage to renew or continue coverage in force at
the option of the plan sponsor;

(5)  Outlines conditions under which health insurance issuers
can nonrenew or discontinue group health plan coverage,
particular types of large group health insurance coverage, and
all large group health insurance coverage;

(6)  Permits health insurance issuers to modify coverage for a
large group health plan at the time of coverage renewal;

(7)  Changes the definition of the term "placement" as it
pertains to coverage of adopted children.  In current law,
"placement" means that the child is in the physical custody of
the adoptive parent.  The bill changes it to mean the assumption
and retention by the insured of a legal obligation for total or
partial support of a child in anticipation of adoption;

(8)  Adds to the defined terms relating to the health insurance
pool the terms "church plan" and "federal defined eligible
individual";

(9)  Designates as eligible for pool coverage individuals who
are residents of Missouri and who provide evidence of (a)
refusal by one insurer to issue substantially similar insurance
for health reasons or (b)  refusal by an insurer to issue
insurance except at a rate exceeding 150% of the standard risk
rate;

(10)  Makes eligible for pool coverage persons who terminated
coverage in the pool less than 12 months prior and persons on
whose behalf the pool has paid out $1 million in benefits.
Under current law, these persons are ineligible for pool
coverage;

(11)  Allows persons who do not maintain residency in Missouri
to be terminated at the end of the policy period;

(12)  Changes the percentage limit on pool rates from 200% of
rates applicable to individual standard risks to 135% for
federally defined eligible individuals and 150% for all other
individuals covered under the pool;

(13)  Changes the time within which a person has to apply for
pool coverage in order to have a waiver of preexisting condition
exclusions to the extent to which similar exclusions have been
satisfied under prior terminated health insurance coverage from
60 days to 63 days;

(14)  Adds to definitions for the Small Employer Health
Insurance Availability Act the terms "church plan," "creditable
coverage," "excepted benefits," "government plan," "group health
plan," "health status-related factor," "medical care," "network
plan," "plan sponsor," "professional association," and
"professional association plan";

(15)  Modifies the definition of the term "small employer" as it
pertains to a group health plan to include political
subdivisions.  A small employer employed an average of 2 to 50
eligible employees on business days during the preceding
calendar year and employs at least 2 employees on the first day
of the plan year.  Provisions for employers not in existence
throughout the preceding calendar year are included;

(16)  Modifies conditions under which small employer health
benefit plans are not renewable.  Current law allows nonrenewal
based on nonpayment of the required premiums, fraud or
misrepresentation of the small employer or the insureds, and
repeated misuse of a provider network provision.  The bill
repeals these conditions and allows nonrenewal when the plan
sponsor fails to pay a premium according to the terms of the
plan or the health carrier has not received a timely premium
payment, when the plan sponsor performs an act or practice
constituting fraud or intentionally misrepresents material facts
under the terms of coverage, and when no enrollee in the network
plan lives or works in the service area of the health insurance
issuer;

(17)  Lists conditions under which small employer carriers can
discontinue a particular type of small group health benefit plan
and discontinue all small employer health insurance coverage;

(18)  Repeals the requirement for small employer carriers
electing to nonrenew all of its small employer health plans in
the state to provide certain types of notice;

(19)  Allows small employer carriers offering coverage through a
network plan not to offer coverage to an eligible person who no
longer lives or works in the service area or to a small employer
who no longer has an enrollee in the plan who lives or works in
the service area;

(20)  Requires small employer carriers to offer all health
benefit plans they actively market to small employers in the
state.  Current law requires small employer carriers to offer at
least 2 health benefit plans:  a basic and a standard health
benefit plan;

(21)  Changes the way small employer health benefit plans can
define pre-existing conditions.  The bill specifies that a
pregnancy existing on the effective date of coverage is not
considered a pre-existing condition;

(22)  Changes the requirement that creditable coverage be
continuous to a date not less than 63 days prior to application
for new coverage.  Current law is 30 days prior to the effective
date of new coverage; and

(23)  Establishes cases where small employer carriers are
prohibited from imposing any pre-existing condition exclusion.

Missouri House of Representatives
Last Updated September 13, 2001 at 2:03 pm