HB 818 -- Health Insurance Portability and Accessibility Act

Sponsor:  Ervin

This bill changes the laws regarding the Missouri Health
Insurance Pool and establishes the Missouri Health Insurance
Portability and Accessibility Act.

MISSOURI HEALTH INSURANCE POOL

In its main provisions, the bill:

(1)  Requires, effective January 1, 2009, or the date established
by the board of the pool, all insurers and insurance arrangements
who provide health plans to be members of the pool;

(2)  Gives pool members voting rights;

(3)  Allows pool members to decide which individuals or groups
may be ceded into the pool;

(4)  Requires pool members ceding a risk to the pool to retain at
least 20% of the risk and to pay a premium as determined by the
rules governing the pool.  The premium must be at least the amount
charged to the insured.  Risks may be ceded to the pool for as
long as the insured is covered;

(5)  Does not require pool members to provide coverage to any
person or group; and

(6)  Allows pool members to request verification of employment or
residence for eligibility determination.

HEALTH INSURANCE PORTABILITY AND ACCESSIBILITY ACT

In its main provisions, the bill:

(1)  Allows the Governor to establish the Missouri Health
Insurance Exchange, a private, nonprofit corporation to implement
the provisions of the act by providing individuals with greater
access, choice, and portability of health insurance products;

(2)  Establishes a board of directors of the exchange to be
composed of nine members including the Director of the Department
of Insurance, Financial Institutions, and Professional
Registration; the Director of the Department of Social Services;
the administrator of the Missouri High Risk Pool; the Director of
the Missouri Consolidated Health Care Plan; a member of the
Senate; a member of the House of Representatives; and three
private sector individuals appointed by the Governor;

(3)  Authorizes the exchange to enter into contracts for the
operation of the exchange;

(4)  Requires the exchange to establish and administer procedures
to enroll, elect, and manage coverages;

(5)  Requires the exchange to hold open enrollment for eligible
individuals in November of each year.  Eligible individuals cannot
be denied coverage during open enrollment with some exceptions;

(6)  Requires certified health carriers offering insurance through
the exchange to be licensed in Missouri;

(7)  Requires carriers offering plans at standard rates based on
age, geography, lifestyle, and family composition to be
actuarially sound.  Rates may be adjusted because of experience
and modifications to plan benefits;

(8)  Establishes rules governing pre-existing conditions for
current and new plan participants as follows:

(a)  Participants who choose a different plan or option for the
next year are not subject to the pre-existing condition
provisions;

(b)  New participants with 18 or more months of credible coverage
are not subject to the pre-existing condition provisions;

(c)  New participants with partial credible coverage of two to 17
months may enroll subject to the pre-existing condition provisions
for up to 12 months or be charged a premium of up to 125% of the
standard rate for up to three years;

(d)  New participants with less than two months of credible
coverage will be subject to the pre-existing condition provisions
for up to 12 months or be charged a premium of up to 150% of the
standard rate for up to three years;

(e)  New eligible dependents are not subject to the pre-existing
condition provisions unless previously specified in the insured's
plan; and

(f)  Carriers may elect to waive the pre-existing condition
provisions and instead extend the rate surcharge for one
additional year;

(9)  Establishes rules for eligible individuals to retain coverage
and procedures for resolving disputes about the operations of the
exchange;

(10)  Allows employers to contract with the exchange to provide
health insurance benefits to plan enrollees if:

(a)  The sponsoring employer plan is administered by the exchange
director;

(b)  The participating employer plan is restricted to the coverage
and benefits offered by the participating insurance plan;

(c)  Any individual who is eligible for coverage under the
employer's participating plan can elect coverage under any
participating insurance plan;

(d)  The employer offers supplemental benefits to those offered
through the exchange;

(e)  The employer agrees not to offer individuals eligible to
participate in the exchange because of their eligibility under the
employer's participating employer plan any separate or competing
health plan offering similar benefits as those provided by other
insurance plans in the exchange;

(f)  The employer reserves the right to determine the terms and
contribution amount for participating employer plans; and

(g)  Participating employer plans do not provide additional or
different services or benefits not provided or offered to all
other participating employer plans;

(11)  Allows Missouri-licensed producers to enroll eligible
individuals in the exchange for a commission; and

(12)  Prohibits a carrier from issuing or renewing an individual
health plan benefit or a group health plan to employers with less
than 51 employees after the first day of the plan year following
open enrollment.

Missouri House of Representatives
94th General Assembly, 1st Regular Session
Last Updated July 25, 2007 at 11:20 am