|SB 0338||Modifies existing law with respect to small employer, self- employed and individual health insurance policies|
|LR Number:||L1604.06C||Fiscal Note:||1604-06|
|Committee:||Insurance and Housing|
|Last Action:||05/14/99 - In Conference||Journal page:|
|Title:||HCS SS SCS SB 338|
|Effective Date:||August 28, 1999|
HS/HCS/SS/SCS/SB 338 - This act makes several changes to existing mental health and health insurance law. Many of these provisions are contained in HS/HCS/HB 718 et al.
MENTAL HEALTH COVERAGE NOTIFICATION ACT: Requires health insurers to notify the purchaser that the policy does not provide coverage for certain enumerated mental illnesses.
MENTAL HEALTH COMMISSION: The Mental Health Commission may employ no more than three additional persons to serve at its pleasure.
HEALTH INSURANCE TAX DEDUCTION - The act also allows an individual income tax deduction for insurance premiums and out-of-pocket medical costs paid by a taxpayer up to $2,000 per tax year for a married couple and $1,000 for a single person and head of household. The deductible amount is available only to the extent that the costs are included in a taxpayer's federal adjusted gross income. Out-of-pocket medical costs are those deductions allowed for health costs as a federal itemized deduction. This deduction is available to those who elect to itemize or those who elect to take the standardized deduction. This deduction will expire on December 31, 2004.
ADVISORY COMMISSION ON HEALTH INSURANCE MANDATES - Establishes the Advisory Commission on Health Insurance Mandates. The commission is charged with studying the costs and benefits of each health insurance benefit or offer mandated by Missouri law. The commission must report by January 1, 2000, the results of its study to the Governor, the Speaker of the House of Representatives, and the President Pro Tem of the Senate.
MISSOURI HEALTH INSURANCE POOL - Allows individuals to be eligible for coverage through the Missouri Health Insurance Pool (also referred to as the "high risk pool") if they have been refused coverage, offered coverage at a rate exceeding 135% of the standard rate, or had coverage for not less than 12 months. The rate for coverage under the pool is 135% of the standard rate for individuals who had continuous coverage through a date not less than 63 days prior to the effective date of pool coverage or who enroll during the open enrollment period. The rate for other eligible individuals is 200% of the standard rate.
SMALL EMPLOYER HEALTH INSURANCE - Modifies the Small Employer Health Insurance Availability Act so that it complies with the federal Health Insurance Portability and Accountability Act of 1996. Under this act, a small employer employs 2 to 50 employees. Current law defines a small employer as any association which employs 3 to 25 employees. This act also removes from the act language that requires a husband and wife working for the same small employer to be considered one eligible employee.
A small employer health benefit plan is renewable except when: 1) the plan sponsor fails to pay a premium or contribution in accordance with the terms of the plan; 2) the plan sponsor commits an act of fraud; 3) the small employer carrier decides to discontinue offering a particular type of group health benefit plan in the small employer market; or 4) when the small employer's membership in a professional association, in which the employer obtains the insurance, ends. A small employer carrier offering coverage through a network plan is not required to offer coverage to persons or small employers who no longer reside, live or work in the service area for which the carrier is authorized to do business.
Small employer plans are allowed to apply preexisting condition exclusions during the first 12 months of coverage but are required to waive the exclusions for the period of time that an individual has coverage continuous to a date not less than 63 days prior to obtaining the new coverage. The exclusion must also be waived if the individual's prior coverage is for a period of 12 of the most recent 18 months. Insurers may discontinue offering a plan under certain conditions. No preexisting condition exclusions are allowed relating to pregnancy or a condition for which medical advice was received during a period when the person had qualifying coverage.
LIFE INSURANCE AND HEALTH INSURANCE - This act prohibits insurance companies from requiring the purchase of life insurance policies or annuities as a condition of purchasing health insurance.
MISSOURI INDIVIDUAL HEALTH BENEFIT REINSURANCE ASSOCIATION - This act establishes an individual health benefit reinsurance association and requires all entities providing health insurance or health benefits subject to state insurance regulation to be members of the association. Those entities that provide plans only for Medicaid recipients are exempted from membership in the association. The association's board is responsible for developing a plan to provide for the sharing of losses related to individuals enrolled in health plans without medical underwriting. Board members are immune from civil liability for performing duties.
INDIVIDUAL HEALTH INSURANCE POLICIES - This act establishes rating restrictions for individual health insurance policies. An insurer may refuse to issue an individual policy of accident and health insurance based upon the insurer's underwriting standards. An insurer, however, shall not refuse to issue the individual policy if the applicant had prior creditable coverage which was terminated within 63 days prior to the application, the period of creditable coverage is not less than 12 months, and the individual has exhausted any COBRA coverage. An insurer is not required to issue individual health benefit coverage without medical underwriting when such plans constitute 2% or more of that insurer's earned premium on an annual basis from individual health plans.
An individual policy of accident and sickness insurance shall be renewable except for the following reasons: 1) nonpayment of premiums; 2) fraud or misrepresentation; 3) attainment of eligibility for Medicare due to age; 4) the insurer decides not to renew all policies within the state; and 5) the director of insurance finds that continuance of the policy would not be in the best interests of other enrollees or would impair the carrier's ability to meet its contractual obligations. The act also includes several rating restrictions for individual health insurance policies.
This act allows insurance companies issuing individual health insurance policies to apply preexisting condition exclusions during the first 12 months of coverage but are required to waive the exclusions for the period of time that an individual has coverage continuous to a date not less than 63 days prior to obtaining new coverage. Genetic information cannot be treated as a condition for which a preexisting exclusion may be imposed in the absence of a diagnosis of the condition related to the information.
HEALTH INSURANCE PURCHASING COOPERATIVE - This act requires the Department of Insurance to administer a grant program to assist in the establishment of health insurance purchasing cooperatives. Each individual grant is limited to $25,000. Funds for the grants must be appropriated from general revenue and the total amount of grants may not exceed $400,000. This act also establishes the Advisory Joint Committee on Health Insurance Purchasing Cooperatives.
CLOSING A BLOCK OF BUSINESS - This act requires health insurers to follow certain procedures if they close a block of insurance business pertaining to individual health insurance policies. The insurer cannot close a block of business unless the insurer allows the existing contract holders to purchase a policy from a similar block of business which provides similar benefits and the insurer pools the experience of the closed block of business with other similar blocks of business to determine the new premium rate. If the insurer cannot offer a comparable block of insurance business, then the insurer must provide notice to the director of revenue that it is deciding to close a block of business.
This act is similar to SS#2/SCS/HB 191.
HA 1 - MAKES VARIOUS TECHNICAL CHANGES AND AMENDS THE SECTION DEALING WITH COMMUNITY RATING.
HA 2 - MAKES TECHNICAL CHANGES TO TITLE AND ENACTING CLAUSE.
HA 3 - THIS AMENDMENT ALLOWS SELF-EMPLOYED TAXPAYERS TO DEDUCT THE AMOUNT PAID FOR HEALTH INSURANCE FOR THE TAXPAYER, HIS OR HER SPOUSE, AND DEPENDENTS TO THE EXTENT THAT THE COSTS ARE INCLUDED IN TEH TAXPAYER'S FEDERAL ADJUSTED GROSS INCOME.
HA 4 - REMOVES THE MAJORITY OF SECTION 630.003.