HB 1485 -- Health Insurance

Co-Sponsors:  Abel, Ward, Kreider

This bill modifies several provisions of law relating to health
insurance.  In its provisions relating to the Missouri Health
Insurance Pool (also referred to as the "high risk" pool), the
bill:

(1)  Prohibits assessments of members in excess of the amount
paid in premium tax for the previous year.  Any deficits
incurred by the pool and not recouped through assessments of
members must be paid from the General Revenue Fund or another
source designated for this purpose;

(2)  Requires information on the pool to be available on an
Internet web site;

(3)  Allows individuals to apply for coverage through the pool
when their premiums have increased to an amount greater than the
premium charged for the pool's least expensive plan.  Currently,
individuals may participate in the pool if their premiums have
increased to 300% or more of the rates established for standard
risks;

(4)  Requires the pool administrator to pay insurance agents a
fee of $50 to $75 for referring participants to the pool;

(5)  Requires the pool to offer plans that are similar to plans
offered in the regular health insurance market;

(6)  Prohibits establishing initial rates for coverage through
the pool at less than 125% of the standard rates.  In addition,
pool rates may not exceed 175% of the standard rates.
Currently, initial rates may not be less than 150% of the
standard rates and pool rates may not exceed 200% of the
standard rates.  Premium rates above 125% of the standard rates
may be adjusted based on the applicant's income, but no
discounts may apply to individuals with incomes above 250% of
the poverty level; and

(7)  Limits health coverage offered by the pool to 3,500
participants.

In provisions relating to the market for individual health
benefit plans, the bill:

(1)  Prohibits health carriers from establishing a rate for one
block of business that exceeds by more than 20% the rate for
another block of business, after making adjustments for
variations in benefits and rating characteristics.  This
requirement may be suspended when it is reasonable due to the
financial condition of the carrier.  Also, the rate for one
block of business may not exceed by more than 30% the rate for
another block of business due to rating characteristics;

(2)  Requires a carrier to disclose to individuals at the time
of offering a health benefit plan the extent to which premium
rates are adjusted based on rating characteristics, the
carrier's right to increase rates, policy provisions relating to
renewal, preexisting condition provisions, and descriptions of
all the plans offered by the carrier;

(3)  Requires a carrier to maintain in its principal place of
business a description of its rating practices; and

(4)  Requires health benefit plans to be renewable at the
individual's option except for nonpayment of premiums, fraud, or
a decision by the carrier to discontinue offering a particular
plan or all of its individual plans in the state's health
insurance market.  Carriers may modify the individual's health
insurance coverage at the time of renewal and refuse to renew
coverage to an individual who is no longer employed or residing
in the carrier's service area.

In provisions relating to the Small Employer Health Insurance
Availability Act, the bill:

(1)  Allows part-time employees who regularly work 20 or more
hours a week to be considered eligible employees under the Act,
except for purposes of meeting a carrier's minimum participation
requirements;

(2)  Requires carriers to disclose the reasons for not issuing
coverage to a group; and

(3)  Allows a small employer that has been denied coverage or
offered coverage at a rate exceeding 125% of its standard rate
to apply for coverage again after one or more employees have
applied for coverage through the Missouri Health Insurance
Pool.  If an employee obtains coverage through the pool, the
employer is required to pay a portion of the employee's pool
premiums so that the employee's contribution for premiums is no
greater than it would have been through the small employer's
carrier.