Current through Register Vol. 49, No. 6, March 15, 2024
PURPOSE: This rule establishes the requirements for
health carriers seeking an exemption under section 376.421.1(5)(e), (HB 1827,
93rd General Assembly, Second Regular Session (2006)).
(1) Definitions. When used in this
regulation-
(A) "Health benefit plan" shall
have the definition as found in section
376.1350,
RSMo;
(B) "Health carrier" shall
have the definition as found in section
376.1350,
RSMo;
(C) "Producer" shall have the
definition as found in section
375.012, RSMo;
and
(D) "Small employer" shall have
the definition as found in section 379.930.2, RSMo.
(2) Request for Suspension of Rate
Restriction. A health carrier seeking an exemption under section
376.421.1(5)(e), RSMo for a policy issued to an association, a trust or to the
trustees of a fund established, created and maintained for the benefit of
members of one (1) or more associations which is insuring large employers and
small employers shall:
(A) File with the
department completed affidavit forms approved by this rule at the time of
policy inception;
(B) File with the
department completed affidavit forms approved by this rule within the thirty
(30)-day period prior to the annual renewal for any additional year during
which an exemption under section 376.421.1(5)(e), RSMo is sought;
(C) Maintain copies of current affidavits
required by this rule with the health carrier's master policy for the length of
time required by section
374.205,
RSMo and 20 CSR 300-2.200;
(D)
Submit data to the department to track the market impact of this type of
association health benefit plan. The data elements will be identified and
submitted on the Missouri A&H Supplement form or the annual HMO
Supplement data, Supplement 2, as appropriate for the license
type of the carrier submitting the data;
(E) Comply with
20 CSR
400-2.130 except that completion of the forms required
in subsection (2)(A) of this rule shall constitute compliance with
20 CSR
400-2.130(2)(C) for issuance of
policies to an association, a trust or to the trustees of a fund established,
created and maintained for the benefit of members of one (1) or more
associations; and
(F) Comply with
all provisions of the Small Employer Health Insurance Availability Act found in
sections 379.930-379.952, RSMo except for the exempted provision of section
379.936.1(1), RSMo.
(3)
Producer Disclosure. Producers shall disclose the exemption to the association
or trust and to the small employers insured under the association health
benefit plan.
(4) Application
Forms. The following forms have been adopted and approved for filing with the
department:
(A) Association's Request for
Suspension of Index Rate Restriction Affidavit ("Form AHP1"), revised September
2006, or any form which substantially comports with the specified form;
and
(B) Producer's Request for
Suspension of Index Rate Restriction Affidavit ("Form AHP2"), revised September
2006, or any form which substantially comports with the specified form;
and
(C) Health Carrier's Request
for Suspension of Index Rate Restriction Affidavit ("Form AHP3"), revised
September 2006, or any form which substantially comports with the specified
form.
(5) Availability
of Forms. The department on request will supply in printed format the forms
listed in this rule. Accurate reproduction of the forms may be utilized for
filing in lieu of the printed forms. All application forms referenced herein
are available at http://www.insurance.mo.gov.
*Original authority: 374.045, RSMo 1967, amended 1993,
1995; 374.205, RSMo 1992, amended 1997, 1999; 376.421, RSMo 1985, amended 1986,
2006.
