Missouri Code of State Regulations
Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE
Division 400 - Life, Annuities and Health
Chapter 2 - Accident and Health Insurance in General
Section 20 CSR 400-2.090 - Group Health Classification
Current through Register Vol. 49, No. 6, March 15, 2024
PURPOSE: This rule implements the provisions of sections 375.786 (unauthorized insurers), 375.791.2 (foreign insurers), 375.014 (agent licensing), 375.071 (broker licensing), 376.405 (group insurance form filing and approval) and 376.421, RSMo (authorized group insurance), defines certain underwriting and rating practices as prohibited pursuant to section 375.936, RSMo (unfair trade practices) and ensures that group health insurance coverages solicited and sold in the state conform to applicable Missouri requirements.
(1) No health insurance of any kind may be solicited or sold, or both, to an employer, union or similar organizational unit located in Missouri unless the insurer for which it is being solicited or sold, or both, has a valid certificate of authority in accordance with the requirements of sections 375.786 and 375.791.2, RSMo.
(2) No health insurance of any kind may be solicited or sold, or both, to an employer, union or similar organizational unit located in Missouri unless the person or entity making these solicitations or sales, or both, is a duly licensed insurance producer in accordance with the requirements of sections 375.014 and 375.071, RSMo and holds a current and valid appointment with the insurer for which these solicitations or sales, or both, are made.
(3) Section 376.421.1, RSMo defines those entities eligible for group health insurance issued in Missouri. Section 376.421.2, RSMo applies to group coverages offered or provided in Missouri other than specifically authorized in section 376.421.1, RSMo. Individual evidence of insurability may be required as to both section 376.421.1 and 376.421.2, RSMo groups and these groups may exclude or limit coverage as to any individual as to whom evidence of insurability is unsatisfactory.
(4) Group policies issued to a multiple employer or union trust in Missouri or any other state as described in section 376.421.1(4), RSMo under which coverages are solicited and sold to employer, union or other organizational units located in Missouri shall be subject to the following requirements of this section:
(5) This rule supersedes the previous version of 20 CSR 400-2.090 which was effective January 1, 1989. Sections (1)-(3) and subsection (4)(A) of this new rule shall take effect on September 15, 1989. Subsections (4)(B) and (C) of this rule shall take effect and apply to all solicitations or sales, or both, commencing on and after December 14, 1989.
*Original authority: 374.045, RSMo 1967, amended 1993, 1995.