HCS/SCS/SBs 567 & 792 -This act modifies laws on health insurance coverage.
HEALTH INSURANCE BENEFITS
Currently, an employer may provide or contract for health insurance at a reduced premium rate for employees who do not smoke or use tobacco products. This act allows the employer to also provide or contract for health insurance at a reduced deductible level for employees who do not smoke or use tobacco products. Insurers or small-employer carriers offering these policies will not be in violation of any unfair trade practice.
These provisions are similar to HB 1101 (2006).
CLINICAL TRIALS HEALTH INSURANCE COVERAGE
This act requires health insurance companies to provide coverage for routine patient care costs incurred as the result of phase II clinical trials undertaken to treat cancer. Currently, Section 376.429, RSMo, requires coverage for phases III or IV only. In addition, health benefit plans may limit coverage for the routine patient care costs of patients in phase II of a clinical trial to those treating facilities within the health benefit plans' provider network; except that, this provision shall not be construed as relieving a health benefit plan of the sufficiency of network requirements under state statute.
Routine patient care costs coverage for phase II clinical trials shall apply if the trial is sanctioned by the National Institutes of Health (NIH) or National Cancer Institute (NCI) and conducted at an academic or National Cancer Institute Center; and the person covered under this section is enrolled in the clinical trial and not merely following the protocol of phase II clinical trials. In addition, the provisions of this act regarding phase II of a clinical trial shall not apply automatically to an individually underwritten health benefit plan, but shall be an option to any such plan.
HEALTH INSURANCE CO-PAYMENTS FOR PRESCRIPTION DRUGS
This act provides that health insurers will be required to charge only one co-payment on a prescription if the required single dosage is not available and a combination of dosage amounts must be dispensed to fill the prescription. This provision does not apply to prescriptions in excess of a one-month supply. If technology does not permit adjudication, the health carrier or health benefit plan will provide reimbursement forms for the patients.
These provisions are similar to HB 1904 (2006).