Carriers to market plan coverage--agent or broker, prohibitedactivities, exception--variance in compensation prohibited,exceptions--carriers, prohibited activities--denial ofapplication, requirements--penalty--applicability to third partyadministrators.
379.952. 1. Each small employer carrier shall actively market allhealth benefit plans sold by the carrier in the small group market toeligible employers in the state, except for plans developed for healthbenefit trust funds.
2. (1) Except as provided in subdivision (2) of this subsection, nosmall employer carrier or agent or broker shall, directly or indirectly,engage in the following activities:
(a) Encouraging or directing small employers to refrain from filingan application for coverage with the small employer carrier because of thehealth status, claims experience, industry, occupation or geographiclocation of the small employer;
(b) Encouraging or directing small employers to seek coverage fromanother carrier because of the health status, claims experience, industry,occupation or geographic location of the small employer.
(2) The provisions of subdivision (1) of this subsection shall notapply with respect to information provided by a small employer carrier oragent or broker to a small employer regarding the established geographicservice area or a restricted network provision of a small employer carrier.
3. (1) Except as provided in subdivision (2) of this subsection, nosmall employer carrier shall, directly or indirectly, enter into anycontract, agreement or arrangement with an agent or broker that providesfor or results in the compensation paid to an agent or broker for the saleof a health benefit plan to be varied because of the health status, claimsexperience, industry, occupation or geographic location of the smallemployer.
(2) Subdivision (1) of this subsection shall not apply with respectto a compensation arrangement that provides compensation to an agent orbroker on the basis of percentage of premium, provided that the percentageshall not vary because of the health status, claims experience, industry,occupation or geographic area of the small employer.
4. A small employer carrier shall provide reasonable compensation, asprovided under the plan of operation of the program, to an agent or broker,if any, for the sale of a basic or standard health benefit plan.
5. No small employer carrier shall terminate, fail to renew or limitits contract or agreement of representation with an agent or broker for anyreason related to the health status, claims experience, occupation, orgeographic location of the small employers placed by the agent or brokerwith the small employer carrier.
6. No small employer carrier or producer shall induce or otherwiseencourage a small employer to separate or otherwise exclude an employeefrom health coverage or benefits provided in connection with the employee'semployment; except that, a carrier may offer a policy to a small employerthat charges a reduced premium rate or deductible for employees who do notsmoke or use tobacco products, and such carrier shall not be considered inviolation of sections 379.930 to 379.952 or any unfair trade practice, asdefined in section 379.936, even if only some small employers elect topurchase such a policy and other small employers do not.
7. Denial by a small employer carrier of an application for coveragefrom a small employer shall be in writing and shall state the reason orreasons for the denial with specificity.
8. The director may promulgate rules setting forth additionalstandards to provide for the fair marketing and broad availability ofhealth benefit plans to small employers in this state.
9. (1) A violation of this section by a small employer carrier or aproducer shall be an unfair trade practice under sections 375.930 to375.949*, RSMo.
(2) If a small employer carrier enters into a contract, agreement orother arrangement with a third-party administrator to provideadministrative marketing or other services related to the offering ofhealth benefit plans to small employers in this state, the third-partyadministrator shall be subject to this section as if it were a smallemployer carrier.
Carriers to market plan coverage--agent or broker, prohibitedactivities, exception--variance in compensation prohibited,exceptions--carriers, prohibited activities--denial ofapplication, requirements--penalty--applicability to third partyadministrators.
379.952. 1. Each small employer carrier shall actively market allhealth benefit plans sold by the carrier in the small group market toeligible employers in the state, except for plans developed for healthbenefit trust funds.
2. (1) Except as provided in subdivision (2) of this subsection, nosmall employer carrier or agent or broker shall, directly or indirectly,engage in the following activities:
(a) Encouraging or directing small employers to refrain from filingan application for coverage with the small employer carrier because of thehealth status, claims experience, industry, occupation or geographiclocation of the small employer;
(b) Encouraging or directing small employers to seek coverage fromanother carrier because of the health status, claims experience, industry,occupation or geographic location of the small employer.
(2) The provisions of subdivision (1) of this subsection shall notapply with respect to information provided by a small employer carrier oragent or broker to a small employer regarding the established geographicservice area or a restricted network provision of a small employer carrier.
3. (1) Except as provided in subdivision (2) of this subsection, nosmall employer carrier shall, directly or indirectly, enter into anycontract, agreement or arrangement with an agent or broker that providesfor or results in the compensation paid to an agent or broker for the saleof a health benefit plan to be varied because of the health status, claimsexperience, industry, occupation or geographic location of the smallemployer.
(2) Subdivision (1) of this subsection shall not apply with respectto a compensation arrangement that provides compensation to an agent orbroker on the basis of percentage of premium, provided that the percentageshall not vary because of the health status, claims experience, industry,occupation or geographic area of the small employer.
4. A small employer carrier shall provide reasonable compensation, asprovided under the plan of operation of the program, to an agent or broker,if any, for the sale of a basic or standard health benefit plan.
5. No small employer carrier shall terminate, fail to renew or limitits contract or agreement of representation with an agent or broker for anyreason related to the health status, claims experience, occupation, orgeographic location of the small employers placed by the agent or brokerwith the small employer carrier.
6. No small employer carrier or producer shall induce or otherwiseencourage a small employer to separate or otherwise exclude an employeefrom health coverage or benefits provided in connection with the employee'semployment; except that, a carrier may offer a policy to a small employerthat charges a reduced premium rate or deductible for employees who do notsmoke or use tobacco products, and such carrier shall not be considered inviolation of sections 379.930 to 379.952 or any unfair trade practice, asdefined in section 379.936, even if only some small employers elect topurchase such a policy and other small employers do not.
7. Denial by a small employer carrier of an application for coveragefrom a small employer shall be in writing and shall state the reason orreasons for the denial with specificity.
8. The director may promulgate rules setting forth additionalstandards to provide for the fair marketing and broad availability ofhealth benefit plans to small employers in this state.
9. (1) A violation of this section by a small employer carrier or aproducer shall be an unfair trade practice under sections 375.930 to375.949*, RSMo.
(2) If a small employer carrier enters into a contract, agreement orother arrangement with a third-party administrator to provideadministrative marketing or other services related to the offering ofhealth benefit plans to small employers in this state, the third-partyadministrator shall be subject to this section as if it were a smallemployer carrier.
Carriers to market plan coverage--agent or broker, prohibitedactivities, exception--variance in compensation prohibited,exceptions--carriers, prohibited activities--denial ofapplication, requirements--penalty--applicability to third partyadministrators.
379.952. 1. Each small employer carrier shall actively market allhealth benefit plans sold by the carrier in the small group market toeligible employers in the state, except for plans developed for healthbenefit trust funds.
2. (1) Except as provided in subdivision (2) of this subsection, nosmall employer carrier or agent or broker shall, directly or indirectly,engage in the following activities:
(a) Encouraging or directing small employers to refrain from filingan application for coverage with the small employer carrier because of thehealth status, claims experience, industry, occupation or geographiclocation of the small employer;
(b) Encouraging or directing small employers to seek coverage fromanother carrier because of the health status, claims experience, industry,occupation or geographic location of the small employer.
(2) The provisions of subdivision (1) of this subsection shall notapply with respect to information provided by a small employer carrier oragent or broker to a small employer regarding the established geographicservice area or a restricted network provision of a small employer carrier.
3. (1) Except as provided in subdivision (2) of this subsection, nosmall employer carrier shall, directly or indirectly, enter into anycontract, agreement or arrangement with an agent or broker that providesfor or results in the compensation paid to an agent or broker for the saleof a health benefit plan to be varied because of the health status, claimsexperience, industry, occupation or geographic location of the smallemployer.
(2) Subdivision (1) of this subsection shall not apply with respectto a compensation arrangement that provides compensation to an agent orbroker on the basis of percentage of premium, provided that the percentageshall not vary because of the health status, claims experience, industry,occupation or geographic area of the small employer.
4. A small employer carrier shall provide reasonable compensation, asprovided under the plan of operation of the program, to an agent or broker,if any, for the sale of a basic or standard health benefit plan.
5. No small employer carrier shall terminate, fail to renew or limitits contract or agreement of representation with an agent or broker for anyreason related to the health status, claims experience, occupation, orgeographic location of the small employers placed by the agent or brokerwith the small employer carrier.
6. No small employer carrier or producer shall induce or otherwiseencourage a small employer to separate or otherwise exclude an employeefrom health coverage or benefits provided in connection with the employee'semployment; except that, a carrier may offer a policy to a small employerthat charges a reduced premium rate or deductible for employees who do notsmoke or use tobacco products, and such carrier shall not be considered inviolation of sections 379.930 to 379.952 or any unfair trade practice, asdefined in section 379.936, even if only some small employers elect topurchase such a policy and other small employers do not.
7. Denial by a small employer carrier of an application for coveragefrom a small employer shall be in writing and shall state the reason orreasons for the denial with specificity.
8. The director may promulgate rules setting forth additionalstandards to provide for the fair marketing and broad availability ofhealth benefit plans to small employers in this state.
9. (1) A violation of this section by a small employer carrier or aproducer shall be an unfair trade practice under sections 375.930 to375.949*, RSMo.
(2) If a small employer carrier enters into a contract, agreement orother arrangement with a third-party administrator to provideadministrative marketing or other services related to the offering ofhealth benefit plans to small employers in this state, the third-partyadministrator shall be subject to this section as if it were a smallemployer carrier.
