To repeal section 379.930, RSMo 1994, relating to small employer health insurance eligibility, and to enact one new section relating to the same subject.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF MISSOURI, AS FOLLOWS:

     Section A. Section 379.930, RSMo 1994, is repealed and one new section enacted in lieu thereof, to be known as section 379.930, to read as follows:

     379.930. 1. Sections 379.930 to 379.952 shall be known and may be cited as the "Small Employer Health Insurance Availability Act".

     2. For the purposes of sections 379.930 to 379.952:

     (1) "Actuarial certification" means a written statement by a member of the American Academy of Actuaries or other individual acceptable to the director that a small employer carrier is in compliance with the provisions of section 379.936, based upon the person's examination, including a review of the appropriate records and of the actuarial assumptions and methods used by the small employer carrier in establishing premium rates for applicable health benefit plans;

     (2) "Affiliate" or "affiliated" means any entity or person who directly or indirectly through one or more intermediaries, controls or is controlled by, or is under common control with, a specified entity or person;

     (3) "Agent" means "insurance agent" as that term is defined in section 375.012, RSMo;

     (4) "Base premium rate" means, for each class of business as to a rating period, the lowest premium rate charged or that could have been charged under the rating system for that class of business, by the small employer carrier to small employers with similar case characteristics for health benefit plans with the same or similar coverage;

     (5) "Basic health benefit plan" means a lower cost health benefit plan developed pursuant to section 379.944;

     (6) "Board" means the board of directors of the program established pursuant to sections 379.942 and 379.943;

     (7) "Broker" means "broker" as that term is defined in section 375.012, RSMo;

     (8) "Carrier" means any entity that provides health insurance or health benefits in this state. For the purposes of sections 379.930 to 379.952, carrier includes an insurance company, health services corporation, fraternal benefit society, health maintenance organization, multiple employer welfare arrangement specifically authorized to operate in the state of Missouri, or any other entity providing a plan of health insurance or health benefits subject to state insurance regulation;

     (9) "Case characteristics" means demographic or other objective characteristics of a small employer that are considered by the small employer carrier in the determination of premium rates for the small employer, provided that claim experience, health status and duration of coverage since issue shall not be case characteristics for the purposes of sections 379.930 to 379.952;

     (10) "Class of business" means all or a separate grouping of small employers established pursuant to section 379.934;

     (11) "Committee" means the health benefit plan committee created pursuant to section 379.944;

     (12) "Control" shall be defined in manner consistent with chapter 382, RSMo;

     (13) "Dependent" means a spouse or an unmarried child under the age of nineteen years; an unmarried child who is a full-time student under the age of twenty-three years and who is financially dependent upon the parent; or an unmarried child of any age who is medically certified as disabled and dependent upon the parent;

     (14) "Director" means the director of the department of insurance of this state;

     (15) "Eligible employee" means an employee who works on a full-time basis and has a normal work week of thirty or more hours. The term includes a sole proprietor, a partner of a partnership, and an independent contractor, if the sole proprietor, partner or independent contractor is included as an employee under a health benefit plan of a small employer, but does not include an employee who works on a part-time, temporary or substitute basis. For purposes of sections 379.930 to 379.952, a person[, his spouse] and his minor children shall constitute only one eligible employee when they are employed by the same small employer;

     (16) "Established geographic service area" means a geographical area, as approved by the director and based on the carrier's certificate of authority to transact insurance in this state, within which the carrier is authorized to provide coverage;

     (17) "Health benefit plan" means any hospital or medical policy or certificate, health services corporation contract, or health maintenance organization subscriber contract. Health benefit plan does not include a policy of individual accident and sickness insurance or hospital supplemental policies having a fixed daily benefit, or accident-only, specified disease-only, credit, dental, vision, medicare supplement, long-term care, or disability income insurance, or coverage issued as a supplement to liability insurance, worker's compensation or similar insurance, or automobile medical payment insurance;

     (18) "Index rate" means, for each class of business as to a rating period for small employers with similar case characteristics, the arithmetic mean of the applicable base premium rate and the corresponding highest premium rate;

     (19) "Late enrollee" means an eligible employee or dependent who requests enrollment in a health benefit plan of a small employer following the initial enrollment period for which such individual is entitled to enroll under the terms of the health benefit plan, provided that such initial enrollment period is a period of at least thirty days. However, an eligible employee or dependent shall not be considered a late enrollee if:

     (a) The individual meets each of the following:

     a. The individual was covered under qualifying previous coverage at the time of the initial enrollment;

     b. The individual lost coverage under qualifying previous coverage as a result of termination of employment or eligibility, the involuntary termination of the qualifying previous coverage, death of a spouse or divorce;

     c. The individual requests enrollment within thirty days after termination of the qualifying previous coverage;

     (b) The individual is employed by an employer that offers multiple health benefit plans and the individual elects a different plan during an open enrollment period; or

     (c) A court has ordered coverage be provided for a spouse or minor or dependent child under a covered employee's health benefit plan and request for enrollment is made within thirty days after issuance of the court order;

     (20) "New business premium rate" means, for each class of business as to a rating period, the lowest premium rate charged or offered, or which could have been charged or offered, by the small employer carrier to small employers with similar case characteristics for newly issued health benefit plans with the same or similar coverage;

     (21) "Plan of operation" means the plan of operation of the program established pursuant to sections 379.942 and 379.943;

     (22) "Premium" means all moneys paid by a small employer and eligible employees as a condition of receiving coverage from a small employer carrier, including any fees or other contributions associated with the health benefit plan;

     (23) "Producer" includes an insurance agent or broker;

     (24) "Program" means the Missouri small employer health reinsurance program created pursuant to sections 379.942 and 379.943;

     (25) "Qualifying previous coverage" and "qualifying existing coverage" mean benefits or coverage provided under:

     (a) Medicare or medicaid;

     (b) An employer-based health insurance or health benefit arrangement that provides benefits similar to or exceeding benefits provided under the basic health benefit plan; or

     (c) An individual health insurance policy (including coverage issued by a health maintenance organization, health services corporation or a fraternal benefit society) that provides benefits similar to or exceeding the benefits provided under the basic health benefit plan, provided that such policy has been in effect for a period of at least one year;

     (26) "Rating period" means the calendar period for which premium rates established by a small employer carrier are assumed to be in effect;

     (27) "Restricted network provision" means any provision of a health benefit plan that conditions the payment of benefits, in whole or in part, on the use of health care providers that have entered into a contractual arrangement with the carrier pursuant to section 354.400, RSMo, et seq. to provide health care services to covered individuals;

     (28) "Small employer" means any person, firm, corporation, partnership or association that is actively engaged in business that, on at least fifty percent of its working days during the preceding calendar quarter, employed not less than three nor more than twenty-five eligible employees, the majority of whom were employed within this state. In determining the number of eligible employees, companies that are affiliated companies, or that are eligible to file a combined tax return for purposes of state taxation, shall be considered one employer;

     (29) "Small employer carrier" means a carrier that offers health benefit plans covering eligible employees of one or more small employers in this state;

     (30) "Standard health benefit plan" means a health benefit plan developed pursuant to section 379.944.