EXPENSES OF INSURANCE GUARANTY ASSOCIATIONS (Section 375.1218)

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.

This provision is identical to provisions in HCS/SS/SB 597 (2018), and in SCS/SB 908 (2018).

THE MISSOURI LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT (Sections 376.715 to 376.758)

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.

This act also modifies references to insurers to also include health maintenance organizations, and modifies terminology referring to insurers and insurance consumers.

Currently the life and health 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 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.

For purposes of the life and health insurance guaranty association, 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 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 guaranty association may reissue the policies and contract. The 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.

The act specifies that substitute coverage offered for individual policies, contracts, and annuities must be offered at actuarially justified rates.

If the life and health guaranty association reissues terminated coverage, the premium must be actuarially justified, and specifies that the issuance is subject to prior approval by the Director of Insurance and not by a court.

The life and health 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 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.

The provisions of this act 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 provisions in SB 597 (2018) and SCS/SB 908 (2018).

ERIC VANDER WEERD