SCS/SBs 415 & 547 - This act modifies several provisions of law relating to laws governing health insurance. TAX CREDIT FOR SMALL EMPLOYEES ENROLLED IN QUALIFIED HSA PLANS - Under this act, small employers who employ less than 50 persons are allowed a tax credit in the amount of $250 for each employee enrolled in a qualified health insurance plan. Under the act, a qualified health insurance plan is a health savings account eligible health plan (high deductible plan) that is combined with a health savings account in a manner provided by federal law. Under the act, the tax credit may be carried forward to the next 4 succeeding years (Section 135.349). EXEMPTION FROM STATE AND LOCAL PREMIUM TAXES FOR QUALIFIED HSA HEALTH INSURANCE PLANS - This act provide an exemption from state and local insurance premium taxes for premiums paid on health savings account eligible plans (high deductible plans) that are sold in Missouri (Section 148.372). STUDY TO IDENTIFY ADMINISTRATIVE AND REGULATORY BARRIERS FOR NEW INSURANCE PRODUCTS - By January 1, 2010, the Director of the Department of Insurance, Financial Institutions and Professional Registration must provide recommendations to the General Assembly of changes to remove any unnecessary barriers that limit the entry of new health insurance products into the Missouri insurance market. The director must also examine proposals adopted in other states that streamline the regulatory processes to allow insurance companies to market new and existing products more easily (Section 376.1618). This section is contained in HB 229 (2009). HRA ONLY PLANS - Under this act, employees are allowed to use funds from one or more employer health reimbursement arrangement (HRA) only plans to help pay for individual health insurance coverage. HRAs are employee benefit plans provided by an employer which establish an account funded solely by the employer to reimburse the employee for qualified medical expenses incurred by the employee or his or her family. HRAs allow the employee to carry forward any unused funds at the end of the coverage period to subsequent coverage periods (Section 376.1600). A similar provision is contained in HB 229 (2009). COINSURANCE AMOUNTS FOR NON-NETWORK SERVICES UNDER A HSA PLAN - Under this act, a health carrier may offer HSA qualified health plans with coinsurance percentage thresholds of 50% or greater for non-network services (Section 376.1606). PROMOTION AND APPROVAL OF HSA HEALTH PLANS - Under the act, the Director of the Department of Insurance is expressly authorized to adopt policies to promote, approve, and encourage health savings account eligible high deductible plans in Missouri. The act directs the director to conduct a national study of health savings account eligible high deductible health plans available in other states and determine if and how these plans serve the uninsured. The act also directs the Director to develop a fast track approval process for health savings account eligible high deductible plans (Section 376.1603). HEALTH MANAGEMENT AND DISEASE MANAGEMENT PROGRAMS IN QUALIFIED HSA PLANS - This act expressly allows health carriers to include wellness and health promotion programs, condition or disease management programs, health risk appraisal programs, and similar provisions in high deductible plans that comport with federal law. The programs must be approved by the department. Health carriers that include such programs in high deductible plan shall not be considered to be in engaging in unfair trade practices (Section 376.1609). MISSOURI MINI-COBRA LAW TO MIRROR FEDERAL COBRA LAW - This act requires group health insurance policies issued by health carriers to employers not covered by the federal COBRA law (employers with 2 to 19 employees) to provide terminated employees with group insurance coverage continuation rights in the same manner as provided by the federal COBRA law (Section 376.428). This provision is contained in HB 231 (2009). CONTINUATION OF HEALTH INSURANCE COVERAGE FROM AGE 55 - Under this act, every group health insurance policy issued or renewed on or after January 1, 2010, must contain a provision that allows an employee or group member, whose continuation coverage under the federal COBRA law or state’s continuation law has expired, to continue coverage under that group policy provided the employee or group member was 55 years or older when coverage under COBRA or the state continuation law expired. The extended continuation coverage provided by this act will terminate upon the earliest of the following: (1) The date the employee or group member fails to pay premiums; (2) The date the group policy is terminated as to all group members; (3) The date on which the employee or group member becomes insured under another group policy; (4) The date on which the employee or group member becomes eligible for coverage under the federal Medicare program; or (5) The date on which the employee or group member turns 65 (Section 376.437). RATING OF MISSOURI CONTINUATION COVERAGE POLICIES - This act requires health insurance policies that are issued to individuals eligible for continuation coverage under state law to be pooled across all fully insured group business in Missouri. The experience of all persons covered by a continuation of coverage provision shall be pooled and spread over all fully insured premiums in Missouri on an equal percentage basis (Section 376.439). CONTINUATION OF COVERAGE RIGHTS THROUGH A HSA ELIGIBLE HIGH DEDUCTIBLE HEALTH PLAN - This act requires health carriers who provide group insurance policies to persons who are exercising their continuation of coverage rights under COBRA or the state continuation of coverage law (Section 376.428) to offer such persons the option of continuation of coverage through a HSA eligible high deductible plan rather than the underlying group policy. The premiums for the HSA eligible high deductible plans shall be consistent with the underlying group plans rated relative to the standard or manual rates for the benefits provided (Section 376.443). DEPENDENT COVERAGE - Under current law, proof that a dependent child is incapable of maintaining employment due to a mental or physical handicap and is dependent upon the insured for support and maintenance must be furnished to the health insurer at least 31 days after the dependent child has attained the age when coverage would normally be terminated in order to continue receiving the extended coverage provided by the statutes. This act requires the proof of incapacity and dependency to be furnished within 31 days after the child’s attainment of the limiting age. This modification applies to group policies, individual polices and health maintenance organization polices (sections 354.536, 376.426, and 376.776). These provisions are contained in HB 229 (2009). The definition of "dependent" is changed in the Small Employer Health Insurance Availability Act to mirror the definition of dependent contained in the HMO, individual and group policy statutes. The definition of "dependent" is revised to be a person that is a spouse, an unmarried child who is financially dependent upon the parent, resides in Missouri, is younger than 25 years of age, and is not covered by any group or individual health benefit plan or entitled to federal Social Security assistance benefits, or an unmarried child of any age who is disabled and dependent upon his or her parent (Section 379.930.2). HIGH RISK POOL LEGISLATIVE STUDY COMMITTEE - This act creates a legislative study committee to research new plan designs and options for the state high risk pool to include rewards and incentives, use of biometrics, wellness, prevention, early intervention, and condition management. The committee shall be comprised of the director of the Department of Insurance, Financial Institutions and Professional Registration, the high risk pool board members, 2 Missouri Senators and 2 Missouri House of Representatives members. The committee must submit a report to the General Assembly by March 1, 2010 (Section 376.991). HIGH RISK POOL ELIGIBILITY (WAIVER OF COBRA EXHAUSTION) - Under this act, a person's eligibility for COBRA or continuation rights under state law shall not render the person ineligible for coverage under the high risk pool (Section 376.966). GUARANTEED ISSUE HSA ELIGIBLE PLANS - This act requires the high risk pool to offer high-deductible health plans, offered in conjunction with health savings accounts, to be offered on a guaranteed-issue basis (Section 376.987) STEPHEN WITTE