§ 379.938 — Renewability, exceptions — carrier not renewing prohibited from writing new business in market, when — application of section in certain geographic areas.

Missouri § 379.938

• Jurisdiction: Missouri
• Title XXIV: BUSINESS AND FINANCIAL INSTITUTIONS
• Ch. 379: Insurance Other Than Life

Text

1.  A health benefit plan subject to sections 379.930 to 379.952 shall be renewable with respect to all eligible employees and dependents, at the option of the small employer, except in any of the following cases:

(1)  The plan sponsor fails to pay a premium or contribution in accordance with the terms of a health benefit plan or the health carrier has not received a timely premium payment;

(2)  The plan sponsor performs an act or practice that constitutes fraud, or makes an intentional misrepresentation of material fact under the terms of the coverage;

(3)  Noncompliance with the carrier's minimum participation requirements;

(4)  Noncompliance with the carrier's employer contribution requirements;

(5)  In the case of a small employer carrier that offers coverage through a network plan, there is no longer any enrollee under the health benefit plan who lives, resides or works in the service area of the health insurance issuer and the small employer carrier would deny enrollment with respect to such plan under subsection 4 of this section;

(6)  The small employer carrier elects to discontinue offering a product, as defined in 45 CFR 144.103 , in the state's small group market.  A type of product may be discontinued by a small employer carrier in such market only if such carrier:

(a)  Issues a notice to each plan sponsor provided coverage of such type in the small group market (and participants and beneficiaries covered under such coverage) of the discontinuation at least ninety days prior to the date of discontinuation of the coverage;

(b)  Offers to each plan sponsor provided coverage of such type the option to purchase all other health benefit plans currently being offered by the small employer carrier in the state's small group market; and

(c)  Acts uniformly without regard to the claims experience of those plan sponsors or any health status-related factor relating to any participants or beneficiaries covered or new participants or beneficiaries who may become eligible for such coverage;

(7)  A small employer carrier elects to discontinue offering all health insurance coverage in the small group market in this state.  A small employer carrier shall not discontinue offering all health insurance coverage in the small employer market unless:

(a)  The carrier provides notice of discontinuation to the director and to each plan sponsor (and participants and beneficiaries covered under such coverage) at least one hundred eighty days prior to the date of the discontinuation of coverage; and

(b)  All health insurance issued or delivered for issuance in Missouri in the small employer market is discontinued and coverage under such health insurance is not renewed;

(8)  In the case of health insurance coverage that is made available in the small group market only through one or more bona fide associations, the membership of an employer in the association (on the basis of which the coverage is provided) ceases but only if such coverage is terminated under this subdivision uniformly without regard to any health status-related factor relating to any covered individual;

(9)  The director finds that the continuation of the coverage would:

(a)  Not be in the best interests of the policyholders or certificate holders; or

(b)  Impair the carrier's ability to meet its contractual obligations.

2.  A small employer carrier that elects not to renew a health benefit plan under subdivision (7) of subsection 1 of this section shall be prohibited from writing new business in the small employer market in this state for a period of five years from the date of notice to the director.

3.  In the case of a small employer carrier doing business in one established geographic service area of the state, the provisions of this section shall apply only to the carrier's operations in such service area.

4.  At the time of coverage renewal, a health insurance issuer may modify the health insurance coverage for a product offered to a group health plan in the small group market if, for coverage that is available in such market other than only through one or more bona fide associations, such modification is consistent with state law and effective on a uniform basis among group health plans with that product.  For purposes of this subsection, renewal shall be deemed to occur not more often than annually on the anniversary of the effective date of the group health plan's health insurance coverage unless a longer term is specified in the policy or contract.

5.  In the case of health insurance coverage that is made available by a small employer carrier only through one or more bona fide associations, references to plan sponsor in this section is deemed, with respect to coverage provided to a small employer member of the association, to include a reference to such employer.

Legislative History

(L. 1992 S.B. 796 § 5, A.L. 2007 H.B. 818, A.L. 2016 S.B. 865 & 866)