SS#2 SCS HCS HB 818 -- HEALTH INSURANCE

This bill establishes the Missouri Health Insurance Portability
and Accountability Act including provisions to make Missouri
compliant with the federal Health Insurance Portability and
Accountability Act and changes the laws regarding health care
insurance.

MISSOURI CONSOLIDATED HEALTH CARE PLAN

The Missouri Consolidated Health Care Plan must offer all
qualified state employees and retirees the option of receiving
health care coverage through a high-deductible plan combined with
a health savings account beginning with the open enrollment
period in 2009.

MISSOURI HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT

The bill changes the laws regarding health insurance carriers.
Carriers that provide health insurance coverage are allowed to
exclude or limit plan benefits, for no more than 18 months, if a
medical condition received medical consideration within six
months of enrolling into the plan and to reduce pre-existing
condition exclusions by the amount of creditable coverage a
participant has accrued, subject to specified restrictions.  A
carrier can provide an affiliation period for coverage if no
pre-existing condition exclusions are imposed, the period is
applied uniformly and does not exceed two months or three months
for a late enrollee, or the period starts on the enrollment date
and runs concurrently with waiting periods.  A carrier can also
discontinue or not renew a type of coverage or all health
insurance coverage offered in the market, subject to specified
exceptions.  Small employer carriers are not required to offer
coverage to an employer or employee if the employer or employee
is not physically located in the carrier's established geographic
service area or there is no capability to deliver adequate
services.  Carriers offering coverage in the individual market
can modify coverage at the time of renewal only if the change is
applied uniformly among all individual policies.

Health insurance carriers are prohibited from applying
pre-existing conditions relating to a pregnancy or to a child who
is adopted or placed for adoption before reaching 18 years of age
when creditable coverage applies and from discontinuing a type of
coverage or all health insurance coverage offered in the market
subject to some specified exceptions.  The carriers are allowed
to make modifications to the coverage.  Carriers are also
prohibited from denying coverage renewal to an employer unless
they deny coverage renewal to all employers in the association;
and employer associations cannot deny coverage renewal to an
individual unless the association doesn't renew coverage to all
employees.

Health insurance carriers are required to provide a certification
of creditable coverage to the insured and special enrollment
periods in certain specified circumstances.  Carriers must follow
standards prohibiting the discrimination of eligible individuals
based on physical or mental health, claims experience, medical
history, genetics, insurability, or disability and premiums based
on health status; however, there will be no restrictions on the
amount of employer contributions or from offering discounts or
rebates for individuals who participate in health promotion and
disease prevention programs if that premium discount or rebate
will not be included when computing a small group rate band under
the Small Employer Health Insurance Availability Act.  If a
carrier elects to discontinue offering all coverage in a defined
market, notice to discontinue or not renew all health insurance
coverage in the market must be provided, and the issuer cannot
re-enter the market for five years.

Employers that sponsor health plans through a carrier can opt to
renew or continue coverage, subject to specified restrictions;
and if the employer contributes to a health plan for an employee,
the employer must provide a premium-only cafeteria plan.
Employers who are self-insured are not required to offer
cafeteria plans.  Employers can also pursue a
defined-contribution model without a group plan operated through
a carrier.  Small employer health plans must comply with the
requirements used by small employer carriers when determining
whether to provide coverage to an employer, and if an eligible
employee chooses to retain his or her individually underwritten
health benefit plan when he or she gains employment with a small
employer that offers small group coverage, the individually
underwritten plan is not subject to the small group provisions.
A carrier is prohibited from requiring minimum participation by
greater than 100% of groups of three or fewer eligible employees
or greater than 75% of groups of more than three employees.
Small employer carriers must actively market all plans sold in
the small group market to eligible small employers.  Small
employer carriers will not be required to actively market plans
developed for health benefit trust funds to all eligible
employers in the state.

MISSOURI HEALTH INSURANCE POOL

The Missouri Health Insurance Pool Board of Directors is allowed
to administer a separate account for federally eligible
individuals from other pool eligible individuals, and its
administrator and its employees are exempt from legal action
regarding their participation in the required duties of the pool.
Additional reasons for removing members from the board are
specified including neglect of duty, misfeasance, malfeasance, or
nonfeasance in office.  Five ex officio members are added to the
board including two members of the House of Representatives, two
Senators, and one member from a Missouri hospital.  Their term of
office will expire December 31, 2009.   The board must conduct a
study regarding the financing of the pool and submit a report of
its findings and recommendations to the General Assembly by
January 1, 2008.

Criteria are established for determining the eligibility of an
individual for the high-risk pool.  Persons who have or obtain
coverage similar to a pool plan are ineligible for coverage.
This exclusion will not apply to a person who has the coverage if
the premiums have increased to 150% to 200% of the rates
established by the board.  After December 31, 2009, the exclusion
will not apply to a person who has the coverage if the premiums
have increased to 300% of the rates established by the board.  A
person may maintain eligibility by keeping other insurance
coverage in order to satisfy a pre-existing condition waiting
period.  Similarly, a person may maintain plan coverage to
satisfy a pre-existing condition waiting period under another
health insurance policy intended to replace the pool policy.  A
health insurance carrier must notify individuals of the existence
of the pool and its eligibility requirements if the carrier takes
certain actions such as the rejection or cancellation of coverage
or the limitation of coverage which are likely to make the
individual eligible for pool coverage.  The high-risk pool must
offer all eligible persons for pool coverage the option of
receiving health insurance coverage through a high-deductible
plan with a health savings account.  The high-risk pool must
establish premium rates for pool coverage.  Premium rates and
schedules must be submitted to the department director for
approval prior to their use.  The standard risk rate will be
determined by considering the premium rates charged by other
health insurers offering individual coverage.  The initial rates
for pool coverage will not be less than 125% of the rates
established as applicable for individual standard risks.  Pool
rates cannot exceed 150% of the standard rate charge for
federally eligible individuals.  Coverage provided in the pool
will exclude expenses for 12 months for pre-existing conditions,
and certain individuals will be excluded including federally
eligible individuals without significant gaps in coverage from
pre-existing condition exclusions.

SMALL EMPLOYER HEALTH INSURANCE ACT

Small employer health insurance premium rates can vary from the
federal Consumer Price Index by 35% rather than the current 25%.
Health benefit plans must be renewable to eligible employees and
dependents at the option of the employer unless the employer
fails to pay premiums, commits fraud, or discontinues coverage in
the small group market; there are no eligible individuals
residing in the service area; the health insurance carrier
discontinues coverage; or the employer discontinues membership in
his or her association through which the coverage is provided.
Employers can modify health plan coverage in the small group
market if changes are uniform across the state and with other
health plans.

HEALTH CARE SHARING MINISTRY

"Health care sharing ministry," defined in Section 376.1750,
RSMo, as a faith-based, nonprofit organization that acts as a
source of information between members who have financial,
physical, or medical needs and members who can assist those with
these needs, will not be subject to Missouri's health insurance
laws.  Beginning January 1, 2007, the bill authorizes an income
tax deduction for the amount a taxpayer has paid as a member of a
health care sharing ministry.  The deduction is only allowed to
the extent that the amount is not deducted on the taxpayer's
federal income tax return.

HEALTH INSURANCE TAX CREDITS AND INCOME TAX DEDUCTIONS

A self-employed taxpayer, who is otherwise ineligible for the
federal income tax health insurance deduction under federal law,
will be allowed to receive a tax credit for the amount of federal
taxes paid for health insurance.

The bill authorizes 100% of the amount paid for qualified health
insurance premiums to be deducted from a taxpayer's Missouri
taxable income to the extent the amount is not already included
in the taxpayer's itemized deductions.

DELINQUENT MEDICAL BILLS

Currently, state agencies are allowed to submit an agency debt to
the Department of Revenue in order to set off the debt by the
person's tax refund.  The bill establishes a process for
hospitals and other health care providers to intercept a person's
tax refund or lottery winnings.

DOWN SYNDROME PRENATAL INFORMATION

A health care provider is required to give certain information to
a patient who receives a positive result from a prenatal test for
Down Syndrome or other condition, including current information
about the tested conditions, accuracy of the tests, resources for
obtaining support services, and referrals to support service
providers, including the Missouri Alternatives to Abortion
Services Program.

DEPENDENT HEALTH INSURANCE COVERAGE

If a health maintenance organization, a group health insurance,
or an accident or sickness insurance plan provides coverage for
an enrollee's eligible dependent and the coverage ends upon the
dependent child reaching a limiting age, the enrollee may elect
to continue the coverage until the dependent's twenty-fifth
birthday.  To be eligible, the enrollee must elect to continue
coverage within 31 days of the child reaching the limiting age
and the dependent must be unmarried, a state resident, and not be
covered under a health benefit plan or government program.
"Dependent" is defined, as it relates to the Missouri Health
Insurance Pool, as a resident spouse or unmarried child younger
than 19 years of age, a child who is a student younger than 25
years of age and who is dependent upon the parent, or a child of
any age who is disabled and dependent upon the parent.

PRESCRIPTION DRUG COVERAGE

Any health carrier or health benefit plan that provides
prescription drug coverage must notify enrollees in writing or
electronically of all deletions in its prescription drug
formularies at least 30 days prior to the deletion.

DISCOUNT MEDICAL PLAN ORGANIZATIONS

The bill establishes regulations for discount medical plan
organizations and specifies that a discount medical plan cannot
allow discounts or prices to be sold, rented, or otherwise
provided to another carrier, a self-insured or self-funded
employer-sponsored plan, or a Taft-Hartley trust.

TOCOLOGISTS

The bill specifies that any person who holds a current
certification for a minister of religion or in tocology, the
science of childbirth, midwifery, or obstetrics, by an
organization accredited by the National Organization for
Competency Assurance may provide services related to pregnancy,
including prenatal, delivery, and postpartum services.

The provisions regarding the Missouri Health Insurance
Portability and Accountability Act, delinquent medical bills,
prescription drug coverage, dependent health insurance coverage,
and certain sections regarding the Missouri Health Insurance Pool
become effective January 1, 2008.

Missouri House of Representatives
94th General Assembly, 1st Regular Session
Last Updated July 25, 2007 at 11:20 am