Rule for Participating Higher Education Entity Entry into the Missouri Consolidated Health Care Plan

PURPOSE: This rule establishes the policy of the board of trustees in regard to the procedures for Participating Higher Education Entities joining the Missouri Consolidated Health Care Plan. (1) Terms and Conditions for Joining. Participating Higher Education Entities (PHEE) shall be a state-sponsored institution of higher learning. The PHEE shall provide a letter to the board stating their intent to join the Missouri Consolidated Health Care Plan (MCHCP) no later than June 1, for coverage beginning January 1 of the following year. (2) Eligibility Requirements. Notwithstanding any provision of rule to the contrary, eligibility of PHEE employees and retirees shall be solely determined by the PHEE. The PHEE shall be responsible for complying with all laws pertaining to employee benefits as to eligibility. (A) The PHEE shall provide to MCHCP appropriate documen tation of initial and ongoing eligibility of PHEE employees. Once provided by the PHEE, the employees of the PHEE submit ted shall be included in the term state employee used through out this chapter. (B) If the PHEE chooses to cover retirees, they shall provide to MCHCP appropriate documentation of initial and ongoing eligibility. Once provided by the PHEE, the retirees of the PHEE submitted shall be included in the term retiree used throughout this chapter. (3) Enrollment. (A) Initial enrollment of PHEE eligible employees and/or re tirees shall take place during the plan’s next open enrollment period. (B) Ongoing enrollment shall be handled in the same man ner as new employees to the state. (4) Coverage. The MCHCP Board of Trustees shall set all benefits, plan design, rates, incentives, and contribution levels. The board shall not set different benefits, plan designs, rates, incentives, or contribution levels for a PHEE than what they choose to set for state employees. (5) Payment. The PHEE shall be responsible for submitting payment of full premiums of their employees according to their payroll cycles and in accordance with 22 CSR 10-2.030. If at any time the PHEE falls behind in the amount of two (2) months of premiums, coverage on all PHEE employees shall be terminated due to non-payment, effective the last day of the month a full premium was received. (6) At the end of the first year of coverage, MCHCP shall have an actuary evaluate the population being brought into the plan and compare to the current population in the state plan to determine if the population is substantial and materially different than the current population. If the population is determined to have been substantially and materially different to the plan’s detriment, the actuary will determine the amount that should be charged the PHEE pursuant to section 103.079.2, RSMo. (7) Withdrawal from Plan. (A) Once participating, the PHEE shall remain in the state plan for a period of five (5) years. (B) After maintaining coverage for a period of five (5) years, the PHEE may withdraw from the plan by providing official notice that the PHEE’s governing board has approved the with drawal from the MCHCP. Such notice shall be received with a minimum six- (6-) month notice prior to the end of a current plan year. (C) All withdrawals of PHEE shall be effective January 1. No withdrawals may take place during a plan year. (D) If a PHEE does not stay in the plan for a period of five (5) years from first entering the plan, they shall be prohibited from rejoining the plan under section 103.079.2, RSMo, without a vote from the board of trustees allowing for the PHEE to reenter the plan. AUTHORITY: section 103.059, RSMo 2016.* Original rule filed Oct. 28, 2016, effective May 30, 2017. Emergency amendment filed Oct. 25, 2024, effective Jan. 1, 2025, expired June 29, 2025. Amended: Filed Oct. 25, 2024, effective May 30, 2025. *Original authority: 103.059, RSMo 1992.