HCS HB 2282 -- HEALTH INSURANCE

SPONSOR:  Wilson, 130 (Ervin)

COMMITTEE ACTION:  Voted "do pass" by the Special Committee on
Health Insurance by a vote of 8 to 0.

This substitute changes the laws regarding health insurance.

INCOME TAX DEDUCTIONS, CREDITS, AND REFUNDS

A self-employed, Missouri resident's individual health insurance
premiums will be excluded from being deducted from his or her
adjusted gross income when computing his or her Missouri taxable
income.

The definition of "debt" is revised to exclude unpaid health care
expenses due to a hospital or health care provider that is being
enforced by the Department of Health and Senior Services.

Hospitals and health care providers that have an unpaid claim of
more than 90 days delinquent for services provided to persons who
are not eligible for state medical health care benefits can
submit a claim to the Department of Revenue instead of the
Department of Health and Senior Services.  The Department of
Revenue must develop the unpaid claim form for hospitals and
health care providers to use to certify that the services were
provided to a person who is not eligible for state medical health
care benefits and that the person has not paid for the services
in the 180 days since they were provided and that reasonable
attempts have been made to contact the person to arrange payment
for the services.  When certifying an unpaid claim, the hospital
or health care provider is responsible for providing the
information to identify the debtor.  If the debtor is determined
to be entitled to a refund by the department, the department must
notify the hospital or health care provider that a refund has
been set-off on behalf of the hospital or provider and settle the
debt.  The department must offset child support obligations
enforced by the Family Support Division within the Department of
Social Services with any remaining refund dollars prior to
reimbursing a state agency.  The departments of Revenue and
Social Services must establish rules to administer the provisions
regarding unpaid claims for health care providers, instead of the
departments of Revenue and Health and Human Services.

STATE LOTTERY FUND

Currently, the Department of Revenue can enter into agreements
with the Missouri Lottery Commission to satisfy outstanding state
agency debts from a person's lottery winnings.  The department
will no longer be required to work with the Department of Health
and Senior Services to enter into an agreement to pay a claim to
a health care provider.

HEALTH MAINTENANCE ORGANIZATIONS (HMOs)

The substitute requires proof that a dependent child is incapable
of maintaining employment due to a mental or physical handicap to
be submitted to the insured's HMO within 31 days after the child
has attained the age when the child's coverage is to be
terminated instead of the current at least 31 days.

GROUP HEALTH INSURANCE POLICIES

Currently, group health insurance policies must contain a
provision that specifies any exclusions and limitations to the
policy in regard to a disease or physical condition that an
individual was treated for during the 12 months prior to the
enrollment date of an individual's policy.  The substitute limits
the exclusions and limitations to the prior six months before an
individual becomes covered under the policy.  Exclusions and
limitations cannot apply to a loss or disability that occurred
after the enrollment date or during the 18-month period
thereafter in the case of a late enrollee.

The substitute requires proof that a dependent child is incapable
of maintaining employment due to a mental or physical handicap
and is dependent upon the policy holder for support and
maintenance to be submitted to the health insurer within 31 days
after the dependent child has attained the age when coverage is
to be terminated in order to sustain coverage instead of the
current at least 31 days.

MISSOURI HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT

The State Children's Health Insurance Program coverage is added
to the list of credible coverages for individuals.

The definition for "waiting period" as it relates to the Missouri
Health Insurance Portability and Accountability Act is revised to
be a time period that must pass before coverage for an employee
or dependent who is otherwise eligible to enroll in a group
health plan becomes effective.  Any time period before late or
special enrollment is not considered a waiting period for late or
special enrollees.  A waiting period begins on the date an
individual submits an application for coverage and ends when the
application for coverage is approved, denied, or lapses.

Health insurance issuers offering group coverage will be required
to provide a special enrollment period for a dependent in the
case of a placement for adoption.

INDIVIDUAL HEALTH INSURANCE POLICIES

The substitute requires proof that a dependent child is incapable
of maintaining employment due to a mental or physical handicap
and is dependent upon the policy holder for support and
maintenance to be submitted to the health insurer within 31 days
after the dependent child has attained the age when coverage is
to be terminated in order to sustain coverage instead of the
current at least 31 days.

MISSOURI HEALTH INSURANCE POOL

Currently, if an individual pays more than 150% of the standard
insurance premium rates, he or she is eligible for insurance
coverage through the Missouri Health Insurance Pool (MHIP).  The
MHIP board is required to establish the eligibility limits, but
the substitute specifies that the limit cannot be in excess of
200% of the standard rates for individual health insurance
coverage.  Federally defined eligible individuals are not
disqualified from being eligible for the pool.

SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT

The definition of "dependent" is revised as it relates to
insurance coverage to be a person that is a spouse, an unmarried
child who resides in Missouri and is younger than 25 years of age
and is not covered by an individual health benefit plan or
entitled to federal Social Security assistance benefits, or a
disabled person who is dependent upon his or her parent.

A small employer can make a defined contribution to its employees
with individual health insurance plans by establishing a
cafeteria plan according to the laws regulating the Missouri
Health Insurance Portability and Accountability Act.

A small employer insurance carrier must reasonably compensate an
agent or broker for the sale of any small employer health benefit
plan, and a small employer carrier must maintain and issue all
health benefit plans it actively markets to small employers in
the state.

Currently, a small employer insurance carrier will not be in
violation of any unfair trade practice if the small employer
charges a lesser premium or deductible for employees who do not
use tobacco products.  The substitute revises the definition of
"unfair trade practice" by using the provisions that apply to all
insurance carriers in Missouri instead of only health and
accident insurance companies.

FISCAL NOTE:  Estimated Cost on General Revenue Fund of
$1,094,695 in FY 2009, $1,205,502 in FY 2010, and Unknown less
than $4,271,871 in FY 2011.  No impact on Other State Funds in FY
2009, FY 2010, and FY 2011.

PROPONENTS:  Supporters say that the provisions of the bill are a
result of House Bill 818 from 2007, are needed to clarify the
laws regarding health insurance, and contain necessary technical
changes.

Testifying for the bill was Representative Ervin.

OPPONENTS:  There was no opposition voiced to the committee.

Missouri House of Representatives
94th General Assembly, 2nd Regular Session
Last Updated October 15, 2008 at 3:12 pm