Health Benefit Plans Issued to Associations with Small and Large Employers

PURPOSE: This rule establishes the requirements for health carriers seeking an exemption under section 376.421.1(5)(e), (HB 1827, 93rd General Assembly, Second Regular Session (2006)). (1) Definitions. When used in this regulation— (A) “Health benefit plan” shall have the definition as found in section 376.1350, RSMo; (B) “Health carrier” shall have the definition as found in section 376.1350, RSMo; (C) “Producer” shall have the definition as found in section 375.012, RSMo; and (D) “Small employer” shall have the definition as found in section 379.930.2, RSMo. (2) Request for Suspension of Rate Restriction. A health carrier seeking an exemption under section 376.421.1(5)(e), RSMo for a policy issued to an association, a trust or to the trustees of a fund established, created and maintained for the benefit of members of one (1) or more associations which is insuring large employers and small employers shall: (A) File with the department completed affidavit forms approved by this rule at the time of policy inception; (B) File with the department completed affidavit forms approved by this rule within the thirty (30)-day period prior to the annual renewal for any additional year during which an exemption under section 376.421.1(5)(e), RSMo is sought; (C) Maintain copies of current affidavits required by this rule with the health carrier’s master policy for the length of time required by section 374.205, RSMo and 20 CSR 300-2.200; (D) Submit data to the department to track the market impact of this type of association health benefit plan. The data elements will be identified and submitted on the Missouri A&H Supplement form or the annual HMO Supplement data, Supplement 2, as appropriate for the license type of the carrier submitting the data; (E) Comply with 20 CSR 400-2.130 except that completion of the forms required in subsection (2)(A) of this rule shall constitute compliance with 20 CSR 400-2.130(2)(C) for issuance of policies to an association, a trust or to the trustees of a fund established, created and maintained for the benefit of members of one (1) or more associations; and (F) Comply with all provisions of the Small Employer Health Insurance Availability Act found in sections 379.930-379.952, RSMo except for the exempted provision of section 379.936.1(1), RSMo. (3) Producer Disclosure. Producers shall disclose the exemption to the association or trust and to the small employers insured under the association health benefit plan. (4) Application Forms. The following forms have been adopted and approved for filing with the department: (A) Association’s Request for Suspension of Index Rate Restriction Affidavit (“Form AHP1”), revised September 2006, or any form which substantially comports with the specified form; and (B) Producer’s Request for Suspension of Index Rate Restriction Affidavit (“Form AHP2”), revised September 2006, or any form which substantially comports with the specified form; and (C) Health Carrier’s Request for Suspension of Index Rate Restriction Affidavit (“Form AHP3”), revised September 2006, or any form which substantially comports with the specified form. (5) Availability of Forms. The department on request will apply in printed format the forms listed in this rule. Accurate reproduction of the forms may be utilized for filing in lieu of the printed forms. All application forms referenced herein are available at http://www.insurance.mo.gov. AUTHORITY: sections 374.045 and 374.205, RSMo 2000, and 376.421, RSMo (HB 1827, 93rd General Assembly, Second Regular Session 2006).* Original rule filed Sept. 1, 2006, effective Feb. 28, 2007. *Original authority: 374.045, RSMo 1967, amended 1993, 1995; 374.205, RSMo 1992, amended 1997, 1999; 376.421, RSMo 1985, amended 1986, 2006.