HB 2413 -- Missouri Health Insurance Pool and Insure Missouri
Program

Sponsor:  Ervin

This bill changes the laws regarding the Missouri Health
Insurance Pool and establishes the Insure Missouri Program to
provide health insurance to certain low-income adults.

MISSOURI HEALTH INSURANCE POOL

The bill:

(1)  Increases the lifetime benefit cap for an individual covered
under the Missouri Health Insurance Pool (MHIP) from $1 million
to $2 million;

(2)  Reduces the pre-existing condition waiting period from 12
months to six months;

(3)  Requires the pool to offer stop-loss coverage for any
insurer in the private individual health insurance market to
cover claim liability for an insured person who becomes
uninsurable or an uninsurable dependent and to establish a
two-year pilot program that offers small group stop-loss coverage
to stabilize small group premiums when risks associated with
specific individuals under a small group policy would result in
increased premiums for the entire group.  The MHIP board is
required to submit a report to the General Assembly by January 1,
2011, regarding the pilot program and any recommendations to
expand the program statewide;

(4)  Allows the MHIP board to establish a premium subsidy program
for low-income individuals;

(5)  Requires the pool, beginning July 1, 2008, to offer at least
one plan that meets the criteria of the federal Centers for
Medicare and Medicaid for uninsurable individuals eligible under
the Insure Missouri Program;

(6)  Establishes premium rates for health insurance coverage
through the pool.  For individuals with incomes of less than 300%
of the federal poverty level, the premium will be equal to the
standard risk rate.  For individuals with incomes of 300% or more
of the federal poverty level, the premium will be a sliding scale
rate based on his or her income of between 100% and 125% of the
standard risk rate;

(7)  Specifies that any licensed insurance agent or broker who
sells a health insurance policy offered under the pool to an
eligible individual will receive a commission for the sale equal
to 1% of the premium; and

(8)  Eliminates insurer assessments under the pool and
distributes premium taxes currently collected from insurers
offering health-related insurance products to the pool beginning
January 1, 2009.

INSURE MISSOURI PROGRAM

The bill:

(1)  Establishes the Insure Missouri Program within the
Department of Social Services to provide health care coverage to
low-income working Missourians;

(2)  Requires the department to apply to the United States
Department of Health and Human Services for a waiver and/or a
Medicaid state plan amendment to develop and implement the
program and to submit the proposed application to the Joint
Committee on MO HealthNet for its review and recommendations;

(3)  Specifies that the program is not an entitlement program for
noncustodial parents, custodial parents, or other participants
with incomes over 85% of the federal poverty level.  The maximum
enrollment of program participants is dependent on the moneys
appropriated by the General Assembly, and eligibility for the
program can be phased in incrementally based on appropriations;

(4)  Requires the department to establish certain specified
standards for consumer protection;

(5)  Requires the program to pay 100% of the premium costs for
participants, except for transitional program participants;

(6)  Specifies eligibility requirements for program participants
and requires them to be subject to approval by the United States
Department of Health and Human Services;

(7)  Specifies covered, medically necessary services and that the
program can include incentives designed to promote and encourage
healthy lifestyles;

(8)  Establishes a health care account for each eligible
individual into which payments for his or her participation can
be made by the individual, an employer, the state, or any
philanthropic or charitable contributor.  The account will be
used to pay the individual's deductible under the program;

(9)  Specifies that an individual's participation in the program
does not begin until the participant makes an initial payment of
at least one-twelfth of the annual required payment;

(10)  Specifies that a participant's annual required payment is
the lesser of $1,000 less any payments under the Mo HealthNet
Program, the Children's Health Insurance Program, and the federal
Medicare Program or a certain percentage of his or her household
income;

(11)  Requires the state to contribute the difference to the
participant's account if his or her annual required payment is
less than $1,000;

(12)  Specifies that a participant can be terminated from
participation in the plan if his or her required payment is not
made within 60 days after the required date.  Written notice must
be given before a participant can be terminated from the plan;

(13)  Specifies that approved participants are eligible for a
12-month period but must file a renewal application to remain in
the program;

(14)  Specifies that an eligible individual who participates in
the program without a break in service and has an income
exceeding 225% of the federal poverty level at the time of
renewal will be eligible for transitional participation in the
program.  Transitional participants will be eligible for coverage
under the premium rates established for the program, but will be
responsible for payment of the entire premium;

(15)  Requires any moneys remaining in the health care account to
be used to reduce the participant's payments for the subsequent
program period if the individual renews his or her participation.
The division must refund any amount remaining in the health care
account less any healthy lifestyles incentive moneys to a
participant who is no longer eligible, has not renewed
participation, is terminated from the program, or is a
transitional participant;

(16)  Specifies how health insurance coverage will be obtained
for approved program participants;

(17)  Prohibits the deductible for any qualified plan under the
program from exceeding $2,500;

(18)  Specifies that any licensed insurance agent or broker who
sells a health insurance policy offered under the Missouri Health
Insurance Pool (MHIP) to an individual eligible for the program
will receive a commission equal to 1% of the premium; and

(19)  Requires the department, in consultation and coordination
with the Department of Insurance, Financial Institutions, and
Professional Registration and the MHIP board of directors, to
ensure that eligible participants are able to obtain health
insurance coverage through licensed insurance agents and brokers.

Certain provisions regarding the MHIP become effective January 1,
2009.

The bill contains an emergency clause.

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