HCS/SS/SB 498 - This act modifies provisions relating to health insurance. HEALTHCARE EXCHANGE NAVIGATORS This act adds requests for criminal background checks for navigators to requests requiring a fourteen dollar fee. This act also requires that an applicant for a navigator license must take an exam administered by the Department of Insurance or an independent testing service with which the Department has contracted and requires applicants for individual licenses to provide two sets of fingerprints for the purpose of doing Missouri and national criminal record reviews. SCHIP This act changes section references within the SCHIP to remove any reference relating to the uninsured women's health program. This act also removes the requirement that parents annually prove their total net worth is below $250,000 and changes the ineligibility period for children whose parents have failed to meet copayment or premium obligations from six months to ninety days. SHOW-ME HEALTHY BABIES This act establishes the Show-Me Healthy Babies Program within the Department of Social Services as a separate children's health insurance program for any low-income unborn child. For an unborn child to be eligible for enrollment in the program, the mother of the child must not be eligible for coverage under certain programs or affordable employer-subsidized health care and meet family income eligibility requirements. Coverage for an unborn child enrolled in the program must not have a waiting period and must include all prenatal care from conception to birth and pregnancy-related services that benefit the health of the unborn child and promote healthy labor, delivery, and birth, but does not need to include services that are solely for the benefit of the pregnant mother. Coverage for the child shall continue for specified periods after birth for each the mother and the child. The act also specifies how the department may provide coverage for an unborn child enrolled in the program and provide information about and enrolling unborn children in the program. Within 60 days after the effective date of these provisions, the department must submit a state plan amendment or seek any necessary waivers from the federal Department of Health and Human Services requesting approval for the program. At least annually, the Department of Social Services must prepare and submit a report to the Governor, the Speaker of the House of Representatives, and the President Pro Tem of the Senate analyzing and projecting the cost savings and benefits, if any, to specified entities by enrolling unborn children in the program. The program is not to be deemed an entitlement program, but instead is subject to a federal allotment or other federal appropriations and matching state appropriations. The state is not obligated to continue the program if the allotment or payments from the federal government end or are not sufficient for the program to operate or if the General Assembly does not appropriate funds for the program. These provisions must not be construed as expanding MO HealthNet or fulfilling a mandate imposed by the federal government on the state. INSURANCE MANDATES This act exempts health benefit plans categorized as "excepted benefit plans" from requirements of any health insurance mandate, but requires that such excepted benefit plans shall provide a disclaimer conspicuously indicating that the plan is not minimum essential coverage on policies, certificates, application and enrollment forms, advertising materials, and plan identification cards. OPTOMETRIC AND OPHTHALMIC INSURANCE COVERAGE This act prohibits contracts between insurers and providers of optometric and ophthalmic services from limiting fees for noncovered services or materials provided to insureds by optometrists subject to the contracts and prohibits providers from charging more than the usual and customary rates for noncovered services or materials. This act also requires that the contracted fees not be less than what the insurers would pay unless reduced by contractual limitations of enrollees' deductibles, co-pays, or coinsurance and that those contracted fees are reasonable and not de minimus reimbursement to avoid the prohibition on fee limits for noncovered services. MICHELA BIRK