HB 1469 -- Health Insurance

Sponsor:  Jolly

This bill creates the Missouri Health Insurance Portability and
Accountability Act and revises the laws regarding health
insurance.

MISSOURI HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT

The bill:

(1)  Requires health insurance coverage offered in the individual
market, small group market, and large group market to comply with
the act, and if applicable, the Small Employer Health Insurance
Availability Act;

(2)  Creates numerous definitions including "affiliation period,"
"bona fide association," "excepted benefits," and "pre-existing
condition exclusion";

(3)  Allows health insurers who offer group health insurance to
impose or not impose a pre-existing condition exclusion in
certain instances;

(4)  Requires health insurers who offer group health insurance to
provide a certification of creditable coverage and special
enrollment periods;

(5)  Allows health maintenance organizations who offer group
health insurance coverage to provide an affiliation period;

(6)  Requires health insurers who offer group health insurance to
comply with standards prohibiting discrimination when determining
a client's eligibility;

(7)  Requires health insurers who offer group health insurance in
a large group market to renew or to continue the coverage in
force under specified conditions;

(8)  Specifies conditions when a health insurer can discontinue
the offer of a particular type of group health insurance
coverage;

(9)  Specifies conditions of renewal for group health insurance
plans offered in large group markets;

(10)  Requires health insurers who provide individual insurance
coverage to renew or continue the coverage in force at the
request of an individual;

(11)  Specifies conditions when health insurers can discontinue
health insurance coverage in individual markets; and

(12)  Specifies conditions of renewal for individual health
insurance policies offered in individual markets.

GROUP HEALTH CONVERSION POLICIES

The bill prohibits premium rates for group health conversion
policies from exceeding the premium rates charged by the Missouri
Health Insurance Pool for similar coverage.

MISSOURI HEALTH INSURANCE POOL

The bill:

(1)  Creates numerous definitions including "church plan,"
"creditable coverage," "federally defined eligible individual,"
and "trade act eligible individual";

(2)  Increases the size of the board of trustees for the pool to
eight members;

(3)  Makes changes in the eligibility requirements for
participation in the pool;

(4)  Requires health insurers who take certain actions based on
underwriting considerations to notify all affected persons about
the availability of the pool;

(5)  Revises provisions regarding the computation of assessments
for participation in the pool and pool assessment offsets;

(6)  Requires the pool to establish the premium rates for
coverage provided by the pool; and

(7)  Establishes conditions prohibiting the application of pre-
existing condition exclusions for federally defined eligible
persons.

MISSOURI SMALL EMPLOYER HEALTH INSURANCE AVAILABILITY ACT

The bill:

(1)  Creates numerous definitions including "bona fide
association," "church plan," "creditable coverage," and "excepted
benefits";

(2)  Contains provisions concerning the renewal and non-renewal
of health insurance coverage;

(3)  Requires health benefit plans covering small employers to
comply with sections contained in the Missouri Health Insurance
Portability and Accountability Act;

(4)  Requires small employer carriers to offer all health benefit
plans that are offered to small employers in Missouri;

(5)  Prohibits the Missouri Small Employer Health Reinsurance
Program from accepting new risks or renewing existing risks on or
after October 1, 2004.  Program assets or moneys exceeding a
certain amount or moneys that remain after a certain date will be
transferred to the Missouri Health Insurance Pool; and

(6)  Repeals the Missouri Small Employer Health Reinsurance
Program effective December 31, 2005.

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