Establishment and Computation of Reserves

PURPOSE: This regulation describes the method of establishment and computation of reserves for health services corporations. This regulation is adopted pursuant to section 354.120, RSMo and to implement section 354.080, RSMo. (1) Reserves Computed. (A) Any corporation subject to Chapter 354, RSMo which has been in existence more than twelve (12) months must file all financial statements necessary to document its dues income and benefit payments and administrative expenses for the preceding fiscal year with its application for a certificate of authority. (B) Any such corporation with a corporate history of less than twelve (12) months must file this information for the period of its existence with a projection to cover the remainder of a twelve- (12-) month period from its inception. If the corporation has been in existence less than three (3) months, a six- (6-) month projection will be acceptable for these purposes. (C) The information submitted should also describe any factors which would allow proration of the amounts payable under the terms of the health service contracts or any other factors having a bearing upon the reserve computation. (2) Factors to be Considered in Reducing this Reserve Requirement. (A) The primary consideration in any reductions of reserves will be the security for payment of the benefits stated in the membership contract. Any factors which would provide security for payment comparable to the reserve will be considered. (B) The director will consider the fact that a newly formed corporation might increase its membership rapidly for a short initial period tending to over-inflate apparent reserve requirements. A membership increasing steadily could be a factor in support of the reduction or suspension of the reserve requirement. (C) Other factors to be considered include any long-term prepayment of dues or longterm membership contracts; contractual waiver by providers of health services of certain claims against the health services corporation; the size of the membership of such a corporation; and any provisions to increase dues on large group contracts over a period of time. (3) Reduction of Reserves. Any health service corporation subject to Chapter 354, RSMo may petition the director to reduce the section 354.080, RSMo financial reserve requirements pursuant to section 374.055, RSMo. AUTHORITY: sections 354.080 and 354.120, RSMo 2016.* This rule was previously filed as 4 CSR 190-15.010. Original rule filed Sept. 19, 1974, effective Sept. 29, 1974. Amended: Filed Oct. 30, 2018, effective April 30, 2019. *Original authority: 354.080, RSMo 1973 and 354.120, RSMo 1973, amended 1983,1993, 1995.