HB 1278 -- Insurance

Sponsor:  Luetkemeyer

This bill makes changes to the laws regarding insurance.

DEPARTMENT OF INSURANCE FEES

The bill changes the way fees are assessed to pay for expenses
incurred by the Department of Insurance.  The bill:

(1)  Limits the expenses that insurance companies must pay for
examinations by the department.  Current law allows the director
to assess fees on each insurer for the examination of that
insurer.  The bill limits this assessment to the direct expenses
incurred by the examiners.  The department must provide an
itemized report of expenses which includes the rate of pay for
each examiner and the amount of time spent by each examiner.  The
itemized reports must be verified by the insurance company before
the department can issue the assessment;

(2)  Changes the additional assessment for examiner support staff
from 15% to 5% of the total expenses assessed; and

(3)  Limits the reimbursement of department employees to either
80% of the federal per diem rate or the actual travel expenses
incurred in conducting the examinations, whichever is less.

MANDATED HEALTH BENEFIT REVIEW COMMISSION

The bill creates the Mandated Health Benefit Review Commission.
The commission will review all health insurance coverage mandates
currently required by law and any mandates offered by legislators
in the future.  The commission must file a report with the
General Assembly by January 2006 detailing any proposed changes
to those mandates currently in law.  Any bill containing a health
insurance coverage mandate must be evaluated by the commission
before the law can be enacted.  The bill sets an extensive list
of issues that the commission must address when it reviews any
proposed mandate.  The commission will be composed of the
directors of the departments of Insurance and Health and Senior
Services, two members of the House of Representatives, and two
members of the Senate, all of whom serve as ex-officio members.
The Governor will appoint six voting members to the commission
who will include two individuals representing employers, two
employees who pay for a portion of their health insurance, and
two individuals who purchase their own health insurance.  The
bill also removes all of the mandated coverages from the Limited
Mandate Health Insurance Law.  Under current law, health insurers
may sell a less expensive health insurance policy that does not
include many of the coverages that are mandated by law.  This
limited mandate policy contains nine mandated coverage areas.
The bill removes those nine mandated coverages, which include
maternity stays in the hospital, mammograms, immunizations, PKU
coverage, and coverage for adopted children.  The bill also
removes language that restricts the marketing of limited coverage
to people who do not have health insurance.

PROPERTY AND CASUALTY INSURANCE

The bill amends the laws governing the Property and Casualty
Insurance Guaranty Association Act.  The bill:

(1)  Expands the guaranty association's obligations for claims
arising from bodily injury, sickness, or disease to include
damages for pain and suffering;

(2)  Adds provisions establishing the guaranty association's
obligations for insurance products that have been created during
the past several years; and

(3)  Clarifies provisions regarding the administration of the
guaranty fund to comply with the recommendations of the National
Conference on Insurance Guaranty Funds.

GROUP HEALTH INSURANCE

The bill amends the law regarding group health insurance.  The
bill:

(1)  Defines the terms "pre-existing condition exclusions" and
"waiting period";

(2)  Prohibits group health insurance issuers from establishing
enrollment eligibility requirements based on health status-
related factors, which include medical history and genetic
information;

(3)  Prohibits health insurance issuers that offer group health
insurance coverage from requiring any individual, as a condition
of enrollment, to pay a premium or other contribution that is
greater than that made by other similarly situated individuals
enrolled in the plan on the basis of health status-related
factors;

(4)  Requires health insurance issuers offering large group
health plan coverage to renew or continue coverage in force at
the option of the plan sponsor;

(5)  Outlines conditions under which health insurance issuers can
non-renew or discontinue group health plan coverage, particular
types of large group health insurance coverage, and all large
group health insurance coverage;

(6)  Permits health insurance issuers to modify coverage for a
large group health plan at the time of coverage renewal; and

(7)  Changes the definition of the term "placement" as it
pertains to coverage of adopted children.  In current law,
placement means that the child is in the physical custody of the
adoptive parent.  The bill changes it to mean the assumption and
retention by the insured of a legal obligation for total or
partial support of a child in anticipation of adoption.

MISSOURI HEALTH INSURANCE POOL

The bill makes several changes to the laws regarding the Missouri
Health Insurance Pool, known as the high-risk pool.  The bill:

(1)  Adds the term "federal defined eligible individual" as it
relates to the health insurance pool;

(2)  Adds two members to the board of directors;

(3)  Designates as eligible for pool coverage individuals who are
residents of Missouri and who provide evidence of:  (a)  refusal
by one insurer to issue substantially similar insurance for
health reasons; or (b)  refusal by an insurer to issue insurance
except at a rate exceeding 150% of the standard risk rate;

(4)  Creates a qualified plan that will comply with the federal
Trade Adjustment Assistance Reform Act of 2002;

(5)  Requires insurers to inform a person of the existence of the
high-risk pool and how to apply for coverage when the person is
affected by a change in the insurer's underwriting, such as the
insurer putting new limitations on coverage or increasing
premiums;

(6)  Defers, for three years, the deductions from premium taxes
that may be taken for high-risk pool participation assessments,
starting in the 2005 tax year;

(7)  Makes eligible for pool coverage persons who terminated
coverage in the pool less than 12 months prior, persons on whose
behalf the pool has paid out $1 million in benefits, and persons
receiving treatment for drug or alcohol abuse.  Under current
law, these persons are ineligible for pool coverage;

(8)  Allows persons who do not maintain residency in Missouri to
be terminated at the end of the policy period;

(9)  Changes the percentage limit on pool rates from 200% to 150%
of the rates applicable to individual standard risks; and

(10)  Changes the time within which a person has to apply for
pool coverage from 60 days to 63 days in order to have a waiver
of pre-existing condition exclusions.

SMALL EMPLOYER HEALTH INSURANCE

The bill amends the laws regarding the Small Employer Health
Insurance Availability Act.  The bill:

(1)  Adds the terms "creditable coverage," "excepted benefits,"
"health status-related factor," and "medical care" as they relate
to the Small Employer Health Insurance Availability Act;

(2)  Modifies the definition of "small employer" as it pertains
to a group health plan to include political subdivisions.  A
small employer is one who employs two to 50 eligible employees.
Under current law, a small employer has three to 25 employees;

(3)  Modifies conditions under which small employer health
benefit plans are not renewable;

(4)  Lists conditions under which small employer carriers can
discontinue a particular type of small group health benefit plan
and discontinue all small employer health insurance coverage;

(5)  Repeals the requirement for small employer carriers electing
to non-renew all of its small employer health plans in the state
to provide certain types of notice;

(6)  Allows small employer carriers offering coverage through a
network plan not to offer coverage to an eligible person who no
longer lives or works in the service area or to a small employer
who no longer has an enrollee in the plan who lives or works in
the service area;

(7)  Requires small employer carriers to offer all health benefit
plans they actively market to small employers in the state.
Current law requires small employer carriers to offer at least
two health benefit plans:  a basic and a standard health benefit
plan;

(8)  Changes the way small employer health benefit plans can
define pre-existing conditions.  The bill specifies that a
pregnancy existing on the effective date of coverage is not
considered a pre-existing condition;

(9)  Changes the requirement that creditable coverage be
continuous from 30 days prior to the effective date of new
coverage to a date not less than 63 days prior to application for
new coverage;

(10)  Establishes cases where small employer carriers are
prohibited from imposing any pre-existing condition exclusion;
and

(11)  Abolishes the Missouri Small Employer Reinsurance Program
on December 31, 2005.  The program will not take on any risk
after October 1, 2004.

OTHER PROVISIONS

In other provisions regarding insurance, the bill:

(1)  Repeals the sunset clause on a section of law governing the
liquidation of insurance companies.  This provision is currently
set to expire on December 31, 2005.  The provision allows an
estimation of contingent liabilities to be used to fix creditors'
claims during the liquidation process.  It also requires a
reinsurer's payment to be made directly to the liquidator, except
where the contract specifically provides for another payee or
where another insurer assumes the ceding insurer's policy
obligations;

(2)  Changes the definition of "renewal" as it applies to
automobile insurance.  Any automobile insurance policy with a
term of less than six months or with no fixed expiration date
will be considered a six-month policy.  Under current law, the
default term is 12 months;

(3)  Repeals the bond requirement for acquiring a license to sell
surplus lines of insurance; and

(4)  Amends the formula used to determine extraordinary dividends
for shareholders in insurance holding companies.

Missouri House of Representatives
92nd General Assembly, 2nd Regular Session
Last Updated September 23, 2004 at 11:15 am