HCS/SS/SB 597 - This act modifies several provisions relating to fees for insurance services, including: (1) MO HealthNet chiropractic services; (2) payments made by insurance companies; and (3) the Missouri Life and Health Insurance Guaranty Association Act.
MO HEALTHNET CHIROPRACTIC SERVICES (Section 208.152)
This act authorizes MO HealthNet reimbursement for up to 20 visits per year for services provided to MO HealthNet participants by licensed chiropractic physicians.
This provision is substantially similar to the truly agreed to and finally passed HB 1516 (2018) and similar to SCS/HB 209 (2017), SB 263 (2017), SB 1092 (2016), and HB 1939 (2016).
PAYMENTS MADE BY INSURANCE COMPANIES (Sections 354.150, 354.495, 374.115, 374.150, and 374.230)
This act creates a unified fee structure for filing fees paid by health services corporations and health maintenance organizations. Additionally, the act specifies that fees paid under the insurance laws of this state shall be collected and deposited into the Insurance Dedicated Fund by the Director of the Department of Insurance, Financial Institutions and Professional Registration rather than by the Director of the Department of Revenue and eliminates a provision specifying that $500,000 from the fund shall be transferred annually to General Revenue.
The act adjusts fees for companies filing insurance documents and enacts fees for filing an own risk and solvency assessment (ORSA) summary report and for insurance holding company filings. The act eliminates fees charged for affixing the seal of the office of the Director of the Department of Insurance, Financial Institutions and Professional Registration and for accepting service of process upon the company.
This act also eliminates the requirement that insurance examiners appointed by the Director be compensated according to the applicable levels established by the National Association of Insurance Commissioners.
These provisions shall become effective on January 1, 2019.
These provisions are identical to provisions in the truly agreed to and finally passed SS/SB 982 (2018) and substantially similar to provisions in SCS/HCS/HB 2337 (2018) and SCS/SB 962 (2018).
MISSOURI LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT (Sections 375.1218 and 376.715 to 376.758)
This act adds guaranty associations' administrative expenses allocable to a receivership to the list of first priority distributions of claims from an insolvent insurer's estate. This provision includes claims for expenses of Missouri's Property and Casualty Insurance Association, Missouri's Life and Health Insurance Guaranty Association, and similar organizations in any other state.
Additionally, the act adds health care providers rendering services covered under health insurance policies or certificates to the list of persons provided coverage by the life and health insurance guaranty association, modifies references to insurers to also include health maintenance organizations, and modifies terminology referring to insurers and insurance consumers.
Currently the Life and Health Insurance Guaranty Association shall not provide coverage for portions of policies or contracts where an external reference is employed in calculating the value of the coverage. The act specifies that this provision shall not apply to any portion of a policy or contract, including to a rider that provides long-term care or any other health insurance benefits. Life and Health Insurance Guaranty Association coverage shall not apply to policies or contracts providing benefits under grants to states for medical assistance programs, including Medicaid and the State Children's Health Insurance Program. Benefits provided by a long-term care rider to a life insurance policy or annuity contract shall be considered the same type of benefit as the basic policy or contract to which it relates.
Currently, the Life and Health Insurance Guaranty Association is required to have between 5 and 9 members. This act raises this range to between 7 and 11 members.
In addition to guaranteeing, assuming, or reinsuring policies and contracts of an impaired or insolvent insurer, the Life and Health Insurance Guaranty Association may reissue the policies and contract. This act also removes the requirement that premiums and benefits provided on behalf of insolvent insurers be identical to the premiums and benefits of payable under the policy of the insolvent insurer. Additionally, this act specifies that substitute coverage offered for individual policies, contracts, and annuities must be offered at actuarially justified rates. If the Life and Health Insurance Guaranty Association reissues terminated coverage, the premium must be actuarially justified, and the issuance shall be subject to prior approval by the Director of Insurance.
The Life and Health Insurance Guaranty Association may, in accordance with the terms and conditions of the policy or contract, file actuarially justified rate or premium increases for any policy or contract for which it provides coverage.
The act modifies provisions relating to Life and Health Insurance Guaranty Association member assessments. It removes a provision specifying that nonpro rata assessments for administrative and legal costs shall not exceed one hundred fifty dollars per member insurer in any one calendar year, and specifies that the amount of other assessments for long-term care insurance written by the impaired or insolvent insurer shall be allocated according to a methodology included in the plan of operation and approved by the director. The methodology shall provide for 50% of the assessment to be allocated to accident and health member insurers, and 50% to life and annuity member insurers.
These provisions shall not apply to any member insurer that is impaired or insolvent prior to the effective date of the act.
These provisions are identical to the truly agreed to and finally passed HCS/HB 1690 (2018) and SCS/SB 908 (2018).
HA#1: CHANGES TITLE TO "RELATING TO INSURANCE SERVICES"
HA#2: ADDS LANGUAGE MODIFYING TELEHEALTH SERVICES, MANAGED CARE ACCREDITATION, PAYMENT FOR UNANTICIPATED OUT-OF-NETWORK COSTS, AND NOTIFICATION OF INSURANCE PLAN CHANGES
HA#3: MAKES THE PROVISION OF MO HEALTHNET CHIROPRACTIC SERVICES SUBJECT TO APPROPRIATION
HA#4: MODIFIES PROVISIONS RELATING TO MO HEALTHNET CLAIMS DUE TO MISSOURI AGAINST A DECEDENT'S ESTATE