HCS HB 818 -- MISSOURI HEALTH INSURANCE PORTABILITY AND
ACCOUNTABILITY ACT (Ervin)

COMMITTEE OF ORIGIN:  Special Committee on Health Insurance

This substitute establishes the Missouri Health Insurance
Portability and Accountability Act and changes the laws regarding
the Missouri Health Insurance Pool, small employer insurance
availability, prescription drug formularies, and health carrier
claims information.

MISSOURI HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT

The substitute:

(1)  Establishes the Missouri Health Insurance Portability and
Accountability Act with provisions that will apply to small,
large, and individual group health insurance markets which:

(a)  Bring the Missouri Health Insurance Pool into compliance
with the federal Health Insurance Portability and Accountability
Act (HIPPA);

(b)  Define the terms needed to carry out the provisions of the
substitute;

(c)  Allow an entity providing a group health plan to exclude or
limit plan benefits, for no more than 18 months, if a medical
condition received medical consideration within six months of
enrolling into the plan;

(d)  Allow an entity providing a group health plan to reduce
pre-existing condition exclusions by the amount of creditable
coverage a participant has accrued, subject to specified
restrictions;

(e)  Prohibit an entity providing group health insurance coverage
from applying pre-existing conditions when creditable coverage
applies;

(f)  Require carriers to provide a certification of creditable
coverage;

(g)  Require a health insurance issuer to provide special
enrollment periods when a health insurance issuer allows an
employee or a dependent who is eligible but not enrolled for
coverage, subject to specified restrictions; and

(h)  Allow a health management organization to provide an
affiliation period for coverage if no pre-existing condition
exclusions are imposed, the period is applied uniformly and does
not exceed three months, or the period starts on the enrollment
date and runs concurrently with waiting periods;

(2)  Requires an entity offering group health insurance coverage
to follow standards prohibiting discrimination of eligible
individuals based on physical or mental health, claims
experience, medical history, genetics, insurability, or
disability and premiums based on health status; however, there
will be no restrictions on the amount of employer contributions
or from offering discounts or rebates for adherence to health
programs;

(3)  Requires the health insurance issuer to renew or continue
coverage if opted by a health plan sponsor or individual, subject
to specified restrictions;

(4)  Prohibits an issuer from discontinuing a type of coverage or
all health insurance coverage offered in the market subject to
some specified exceptions, but allows modifications to the
coverage;

(5)  Prohibits a renewal from being denied to the employer unless
it is denied to all employers in the association;

(6)  Requires a premium-only cafeteria plan to be provided by a
carrier when employers contribute to a health plan for an
employee.  Currently, there are premium only, child care, and
reimbursed medical expenses sections of a cafeteria plan;

(7)  Allows an employer to pursue a define-contribution model
without a group plan;

(8)  Allows an issuer to discontinue or not renew a type of
coverage or all health insurance coverage offered in the market,
subject to specified exceptions;

(9)  Requires a health insurance issuer electing to discontinue
offering all coverage in a defined market to provide notice and
discontinue or not renew all health insurance coverage in the
market.  The issuer cannot re-enter the market for five years;

(10)  Allows a health insurance issuer offering coverage in the
individual market to modify coverage at the time of renewal only
if the change is applied uniformly among all individual policies;

(11)  Prohibits an association from denying coverage renewal to
an individual unless the association doesn't renew all coverage;

(12)  Requires an insurer to provide a certification of coverage
to the insured;

(13)  Requires small employer health plans to comply with the
requirements used by small employer carriers when determining
whether to provide coverage to an employer.  A carrier is
prohibited from requiring minimum participation by greater than
100% of groups of three or less eligible employees or greater
than 75% of groups of three or more employees;

(14)  Allows a small employer carrier to not offer coverage to an
employer or employee if the employer or employee is not
physically located in the carrier's established geographic
service area or there is no capability to deliver services
adequately; and

(15)  Requires each small employer carrier to actively market all
plans sold in the small group market to eligible small employers.

MISSOURI HEALTH INSURANCE POOL

The substitute:

(1)  Provides additional reasons for removing board members from
the Missouri Health Insurance Pool Board;

(2)  Establishes criteria for determining the eligibility of an
individual for the high-risk pool and for determining when
notifications need to be provided to pool members regarding
underwriting, eligibility, premiums, and changes in coverage;

(3)  Requires rates charged to pool members to be between 125%
and 135% of the standard rate charge;

(4)  Requires pool coverage to exclude expenses for pre-existing
conditions;

(5)  Excludes individuals without significant gaps in coverage
from pre-existing condition exclusions; and

(6)  Exempts the pool board administrator or employees from legal
action pertaining to participation in the required duties of the
pool.

PRESCRIPTION DRUG FORMULARIES

Any health carrier or health benefit plan that provides
prescription drug coverage is required to notify enrollees in
writing of all additions or deletions in its prescription drug
formularies at least 30 days prior to the immediately preceding
plan year and for each calendar quarter.

HEALTH CARRIER CLAIMS INFORMATION

Health carriers are required to provide a report of the total
number and dollar amount of claims paid in the previous three
years within 30 days of an employer's request.  When an employer
has multiple plans, the total dollar amounts must be combined
into one report.  The information will be furnished in a manner
that does not individually identify any employee or other person
covered by the health benefit plan and will comply with all
applicable federal and state privacy laws regarding the
disclosure of health records.

FISCAL NOTE:  Estimated Cost on General Revenue Fund of Unknown
less than $18,099,228 in FY 2008, Unknown less than $27,132,342
in FY 2009, and Unknown less than $31,615,917 in FY 2010.
Estimated Cost on Other State Funds of Unknown less than $10,833
in FY 2008, Unknown less than $13,000 in FY 2009, and Unknown
less than $13,000 in FY 2010.

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