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 400-2.130 - Group Health Filings
Universal Citation: 20 MO Code of State Regs 400-2.130
Current through Register Vol. 49, No. 6, March 15, 2024
PURPOSE: This rule effectuates or aids in the interpretation of section 376.421, RSMo. The rule specifies how the Department of Commerce and Insurance will determine whether group health coverage provided, solicited or issued in Missouri complies with the descriptions of groups in section 376.421, RSMo.
(1) As used in this rule, the following terms mean:
(A)
Discretionary group, any group not described in section 376.421.1,
RSMo;
(B) DCI, the Missouri
Department of Commerce and Insurance; and
(C) True group, any group described in
section 376.421.1, RSMo.
(2) Group health policies delivered in Missouri are subject to the following:
(A)
Any policy must be delivered to a true group or to a discretionary
group;
(B) Any policy form issued
to a discretionary group must be approved by the MDI under section
376.421.2(1), RSMo. This policy filed with the MDI must be accompanied by an
affidavit and necessary exhibits on a form approved by the MDI, as included
herein;
(C) Whenever reasonably
necessary to determine whether a group policy is being issued by a true group,
the MDI may require an affidavit on a form approved by the MDI, as included
herein, to determine whether a group is a true group;
(D) Any policy filed with the MDI under this
section of this rule is a filing required by law and the filing fee, required
by section
374.230(6),
RSMo, must be paid; and
(E) If a company violates section
376.421,
RSMo or this rule with an unfiled policy, the failure to file will be evidence
that the violation was willful.
(3) Group health policies not delivered in Missouri are subject to the following:
(A)
Any coverage solicited or sold in this state, whether by direct mail, insurer
producer contact, telephone contact or advertisement, must be delivered to a
true group or a discretionary group;
(B) Whether a group is a true group will be
determined by the descriptions contained in section 376.421.1, RSMo, not by the
descriptions or lack of descriptions in another state's law;
(C) Whenever reasonably necessary to
determine whether a group policy is being issued to a true group, the MDI may
require an affidavit on a form approved by the MDI, as included herein, to
determine whether a group is a true group;
(D) The MDI shall require an affidavit with
necessary exhibits on a form approved by the MDI, as included herein, for any
policy issued to a discretionary group. This affidavit will be unnecessary only
if another state having a law substantially similar to section 376.421.2(1),
RSMo has approved the policy as a discretionary group policy;
(E) Any policy found by the MDI to be
delivered to a true group or to a discretionary group which is approved by
another state under subsection (3)(D) is filed for information only. The MDI
will not charge a filing fee for a policy filed for information only. Any other
policy is a filing required by law for which the filing fee under section
374.230(6),
RSMo must be paid; and
(F) If a
company violates section
376.421,
RSMo or this rule with an unfiled policy, the failure to file will be evidence
that the violation was willful.
*Original authority: 374.045, RSMo 1967, amended 1993, 1995.
Disclaimer: These regulations may not be the most recent version. Missouri may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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