Missouri Individual Health Insurance Regulations: What You Need to Know

The state of Missouri requires all individual health insurance policies to go through the medical underwriting process. This allows health insurance providers to know a consumer's health history and current medical issues in order to determine whether or not they will choose to offer them coverage. Missouri regulations regarding medical insurance states that the insurer has a few options when given an application for health insurance. The insurer may approve an application and offer health plan coverage as the original plan states. The insurer may approve the application with adjustments, such as limitations for coverage and exclusions of treatment for pre-existing conditions. Or the insurer may deny coverage to the applicant.

According to Missouri state law, insurance providers can issue a two year exclusion period for a pre-existing condition. Additionally, Missouri allows insurance carriers to utilize Elimination Riders-adjustments to the policy that allow the carrier to exclude coverage of benefits for a condition. Only consumers who have been covered for 18 months by federal HIPAA qualify for credit for previous health coverage.

Missouri Small Group Medical Insurance Regulations

A Missouri employer who has from three to 25 employees is labeled a "small group" for insurance purposes. Under Missouri law, small group health insurance is a guarantee issue and cannot be declined by an insurer, even if the overall health of the group is poor or an individual employee has a high number of claims.

Small group employers still have the right to impose a waiting period for new hires; however, once the waiting period is over, coverage must be fulfilled. Missouri gives insurance providers the ability to review 6 months prior to the application to identify any pre-existing conditions. If conditions are identified, insurers can legally impose a maximum one year exclusionary period, but only after the carrier notifies the applicant in writing of its plans to utilize the exclusionary period in their case. Applicants who have prior healthcare coverage will receive credit with the new insurer.

In Missouri, premium rates for small groups go through the medical underwriting process; rates may vary within 25% of the standard rate.

Understanding Missouri COBRA and Continuation Coverage Issues

Missouri mini-COBRA laws state that all companies eligible for small business health insurance will offer terminated employees continuation coverage for up to 9 months. Eligibility for Missouri mini-COBRA is based on the following:

• Employee must have received coverage under the group health insurance plan for a minimum of three months before the termination date.
• If the employee chooses the continuation coverage, he or she must put the request in writing within 31 days from the date of the previous coverage's termination.

Once the continuation benefits are used up (following the 9 months), conversion policies are available to terminated employees. If an individual has used all of the available COBRA coverage and cannot obtain coverage through a private insurance plan, he or she may receive guarantee issued coverage from any insurer providing Missouri individual health insurance, but the premium rates will likely be high, and the benefits may be limited.