Renewability, exceptions--carrier not renewing prohibited from writingnew business in market, when--application of section in certaingeographic areas.
379.938. 1. A health benefit plan subject to sections 379.930 to379.952 shall be renewable with respect to all eligible employees anddependents, at the option of the small employer, except in any of thefollowing cases:
(1) The plan sponsor fails to pay a premium or contribution inaccordance with the terms of a health benefit plan or the health carrierhas not received a timely premium payment;
(2) The plan sponsor performs an act or practice that constitutesfraud, or makes an intentional misrepresentation of material fact under theterms of the coverage;
(3) Noncompliance with the carrier's minimum participationrequirements;
(4) Noncompliance with the carrier's employer contributionrequirements;
(5) In the case of a small employer carrier that offers coveragethrough a network plan, there is no longer any enrollee under the healthbenefit plan who lives, resides or works in the service area of the healthinsurance issuer and the small employer carrier would deny enrollment withrespect to such plan under subsection 4 of this section;
(6) The small employer carrier elects to discontinue offering aparticular type of health benefit plan in the state's small group market.A type of health benefit plan may be discontinued by a small employercarrier in such market only if such carrier:
(a) Issues a notice to each plan sponsor provided coverage of suchtype in the small group market (and participants and beneficiaries coveredunder such coverage) of the discontinuation at least ninety days prior tothe date of discontinuation of the coverage;
(b) Offers to each plan sponsor provided coverage of such type theoption to purchase all other health benefit plans currently being offeredby the small employer carrier in the state's small group market; and
(c) Acts uniformly without regard to the claims experience of thoseplan sponsors or any health status-related factor relating to anyparticipants or beneficiaries covered or new participants or beneficiarieswho may become eligible for such coverage;
(7) A small employer carrier elects to discontinue offering allhealth insurance coverage in the small group market in this state. A smallemployer carrier shall not discontinue offering all health insurancecoverage in the small employer market unless:
(a) The carrier provides notice of discontinuation to the directorand to each plan sponsor (and participants and beneficiaries covered undersuch coverage) at least one hundred eighty days prior to the date of thediscontinuation of coverage; and
(b) All health insurance issued or delivered for issuance in Missouriin the small employer market is discontinued and coverage under such healthinsurance is not renewed;
(8) In the case of health insurance coverage that is made availablein 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 thecoverage is provided) ceases but only if such coverage is terminated underthis subdivision uniformly without regard to any health status-relatedfactor 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 certificateholders; or
(b) Impair the carrier's ability to meet its contractual obligations.
In such instance the director shall assist affected small employers infinding replacement coverage.
2. A small employer carrier that elects not to renew a health benefitplan under subdivision (7) of subsection 1 of this section shall beprohibited from writing new business in the small employer market in thisstate 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 oneestablished geographic service area of the state, the provisions of thissection shall apply only to the carrier's operations in such service area.
4. At the time of coverage renewal, a health insurance issuer maymodify the health insurance coverage for a product offered to a grouphealth plan in the small group market if, for coverage that is available insuch market other than only through one or more bona fide associations,such modification is consistent with state law and effective on a uniformbasis among group health plans with that product. For purposes of thissubsection, renewal shall be deemed to occur not more often than annuallyon the anniversary of the effective date of the group health plan's healthinsurance coverage unless a longer term is specified in the policy orcontract.
5. In the case of health insurance coverage that is made available bya small employer carrier only through one or more bona fide associations,references to plan sponsor in this section is deemed, with respect tocoverage provided to a small employer member of the association, to includea reference to such employer.
Renewability, exceptions--carrier not renewing prohibited from writingnew business in market, when--application of section in certaingeographic areas.
379.938. 1. A health benefit plan subject to sections 379.930 to379.952 shall be renewable with respect to all eligible employees anddependents, at the option of the small employer, except in any of thefollowing cases:
(1) The plan sponsor fails to pay a premium or contribution inaccordance with the terms of a health benefit plan or the health carrierhas not received a timely premium payment;
(2) The plan sponsor performs an act or practice that constitutesfraud, or makes an intentional misrepresentation of material fact under theterms of the coverage;
(3) Noncompliance with the carrier's minimum participationrequirements;
(4) Noncompliance with the carrier's employer contributionrequirements;
(5) In the case of a small employer carrier that offers coveragethrough a network plan, there is no longer any enrollee under the healthbenefit plan who lives, resides or works in the service area of the healthinsurance issuer and the small employer carrier would deny enrollment withrespect to such plan under subsection 4 of this section;
(6) The small employer carrier elects to discontinue offering aparticular type of health benefit plan in the state's small group market.A type of health benefit plan may be discontinued by a small employercarrier in such market only if such carrier:
(a) Issues a notice to each plan sponsor provided coverage of suchtype in the small group market (and participants and beneficiaries coveredunder such coverage) of the discontinuation at least ninety days prior tothe date of discontinuation of the coverage;
(b) Offers to each plan sponsor provided coverage of such type theoption to purchase all other health benefit plans currently being offeredby the small employer carrier in the state's small group market; and
(c) Acts uniformly without regard to the claims experience of thoseplan sponsors or any health status-related factor relating to anyparticipants or beneficiaries covered or new participants or beneficiarieswho may become eligible for such coverage;
(7) A small employer carrier elects to discontinue offering allhealth insurance coverage in the small group market in this state. A smallemployer carrier shall not discontinue offering all health insurancecoverage in the small employer market unless:
(a) The carrier provides notice of discontinuation to the directorand to each plan sponsor (and participants and beneficiaries covered undersuch coverage) at least one hundred eighty days prior to the date of thediscontinuation of coverage; and
(b) All health insurance issued or delivered for issuance in Missouriin the small employer market is discontinued and coverage under such healthinsurance is not renewed;
(8) In the case of health insurance coverage that is made availablein 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 thecoverage is provided) ceases but only if such coverage is terminated underthis subdivision uniformly without regard to any health status-relatedfactor 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 certificateholders; or
(b) Impair the carrier's ability to meet its contractual obligations.
In such instance the director shall assist affected small employers infinding replacement coverage.
2. A small employer carrier that elects not to renew a health benefitplan under subdivision (7) of subsection 1 of this section shall beprohibited from writing new business in the small employer market in thisstate 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 oneestablished geographic service area of the state, the provisions of thissection shall apply only to the carrier's operations in such service area.
4. At the time of coverage renewal, a health insurance issuer maymodify the health insurance coverage for a product offered to a grouphealth plan in the small group market if, for coverage that is available insuch market other than only through one or more bona fide associations,such modification is consistent with state law and effective on a uniformbasis among group health plans with that product. For purposes of thissubsection, renewal shall be deemed to occur not more often than annuallyon the anniversary of the effective date of the group health plan's healthinsurance coverage unless a longer term is specified in the policy orcontract.
5. In the case of health insurance coverage that is made available bya small employer carrier only through one or more bona fide associations,references to plan sponsor in this section is deemed, with respect tocoverage provided to a small employer member of the association, to includea reference to such employer.
Renewability, exceptions--carrier not renewing prohibited from writingnew business in market, when--application of section in certaingeographic areas.
379.938. 1. A health benefit plan subject to sections 379.930 to379.952 shall be renewable with respect to all eligible employees anddependents, at the option of the small employer, except in any of thefollowing cases:
(1) The plan sponsor fails to pay a premium or contribution inaccordance with the terms of a health benefit plan or the health carrierhas not received a timely premium payment;
(2) The plan sponsor performs an act or practice that constitutesfraud, or makes an intentional misrepresentation of material fact under theterms of the coverage;
(3) Noncompliance with the carrier's minimum participationrequirements;
(4) Noncompliance with the carrier's employer contributionrequirements;
(5) In the case of a small employer carrier that offers coveragethrough a network plan, there is no longer any enrollee under the healthbenefit plan who lives, resides or works in the service area of the healthinsurance issuer and the small employer carrier would deny enrollment withrespect to such plan under subsection 4 of this section;
(6) The small employer carrier elects to discontinue offering aparticular type of health benefit plan in the state's small group market.A type of health benefit plan may be discontinued by a small employercarrier in such market only if such carrier:
(a) Issues a notice to each plan sponsor provided coverage of suchtype in the small group market (and participants and beneficiaries coveredunder such coverage) of the discontinuation at least ninety days prior tothe date of discontinuation of the coverage;
(b) Offers to each plan sponsor provided coverage of such type theoption to purchase all other health benefit plans currently being offeredby the small employer carrier in the state's small group market; and
(c) Acts uniformly without regard to the claims experience of thoseplan sponsors or any health status-related factor relating to anyparticipants or beneficiaries covered or new participants or beneficiarieswho may become eligible for such coverage;
(7) A small employer carrier elects to discontinue offering allhealth insurance coverage in the small group market in this state. A smallemployer carrier shall not discontinue offering all health insurancecoverage in the small employer market unless:
(a) The carrier provides notice of discontinuation to the directorand to each plan sponsor (and participants and beneficiaries covered undersuch coverage) at least one hundred eighty days prior to the date of thediscontinuation of coverage; and
(b) All health insurance issued or delivered for issuance in Missouriin the small employer market is discontinued and coverage under such healthinsurance is not renewed;
(8) In the case of health insurance coverage that is made availablein 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 thecoverage is provided) ceases but only if such coverage is terminated underthis subdivision uniformly without regard to any health status-relatedfactor 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 certificateholders; or
(b) Impair the carrier's ability to meet its contractual obligations.
In such instance the director shall assist affected small employers infinding replacement coverage.
2. A small employer carrier that elects not to renew a health benefitplan under subdivision (7) of subsection 1 of this section shall beprohibited from writing new business in the small employer market in thisstate 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 oneestablished geographic service area of the state, the provisions of thissection shall apply only to the carrier's operations in such service area.
4. At the time of coverage renewal, a health insurance issuer maymodify the health insurance coverage for a product offered to a grouphealth plan in the small group market if, for coverage that is available insuch market other than only through one or more bona fide associations,such modification is consistent with state law and effective on a uniformbasis among group health plans with that product. For purposes of thissubsection, renewal shall be deemed to occur not more often than annuallyon the anniversary of the effective date of the group health plan's healthinsurance coverage unless a longer term is specified in the policy orcontract.
5. In the case of health insurance coverage that is made available bya small employer carrier only through one or more bona fide associations,references to plan sponsor in this section is deemed, with respect tocoverage provided to a small employer member of the association, to includea reference to such employer.
