Missouri Code of State Regulations
Title 22 - MISSOURI CONSOLIDATED HEALTH CARE PLAN
Division 10 - Health Care Plan
Chapter 2 - State Membership
Section 22 CSR 10-2.030 - Contributions
Universal Citation: 22 MO Code of State Regs 10-2.030
Current through Register Vol. 49, No. 18, September 16, 2024
PURPOSE: This amendment revises the Missouri Consolidated Health Care Plan contribution methodology for retiree coverage; removes language related to the Medicare Prescription Drug Only Plan; and renumbers as necessary.
(1) Total premium costs for various levels are based on employment status, retiree status, eligibility for Medicare, and various classifications of dependent participation as established by the plan administrator.
(2) The Missouri Consolidated Health Care Plan (MCHCP) contribution toward the premium for active employee coverage shall be determined by the plan administrator.
(3) The MCHCP contribution toward the premium for Family Medical Leave Act (FMLA) leave of absence coverage shall be the same as for active employees.
(4) The MCHCP shall not make a contribution toward the premium for terminated vested (including terminated non-vested elected state officials and employees), leave of absence (except for FMLA leave of absence), foster parents, or Federal Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage.
(5) The MCHCP contribution toward the premium for long-term disability coverage shall be equal to the amount that was contributed toward the comparable rate tier in 2002.
(6) The Missouri Consolidated Health Care Plan (MCHCP) contribution toward retiree coverage is based on either of the following:
(A) The contribution percentage is
calculated by using the number of full creditable years of service at
retirement as reported to MCHCP by Missouri State Employees' Retirement System
(MOSERS) or Public School Retirement System (PSRS) multiplied by two and one
half percent (2.5%). The resulting product shall be capped at sixty-five
percent (65%), or in other words the retiree's years of service is capped at
twenty-six (26) years.
1. Medicare retirees.
A. For Medicare retirees, the contribution
percentage is multiplied by the retiree only Medicare Advantage Plan total
premium. The resulting product is the MCHCP contribution, which shall be
subtracted from the Medicare Advantage total premium. The difference is the
amount of the retiree contribution toward the total premium.
B. For Medicare retirees covering
Medicare-eligible dependents, MCHCP will contribute for the dependent portion
of the premium the lesser of the following: the contribution percentage
multiplied by the Medicare Advantage premium, or the dollar amount MCHCP
contributes for the dependent portion of the PPO 1250 premium for an active
employee at the rate tier the retiree has selected.
C. For Medicare retirees covering
non-Medicare eligible dependents, MCHCP will contribute for the dependent
portion of the premium the lesser of the following: the contribution percentage
multiplied by the difference in premium of the retiree only Medicare Advantage
Plan and the premium of the dependent portion of the PPO 1250 Plan at the rate
tier the retiree has selected, or the dollar amount MCHCP contributes for the
dependent portion of the PPO 1250 premium for an active employee at the rate
tier the retiree has selected.
2. Non-Medicare retirees.
A. For non-Medicare retirees, the
contribution percentage is multiplied by the retiree only PPO 1250 Plan total
premium with the tobacco-free incentive and the partnership incentive. The
resulting product is the MCHCP contribution, which shall be subtracted from the
total premium of the plan chosen by the retiree. The difference is the amount
of the retiree contribution toward the total premium.
B. For non-Medicare retirees covering
Medicare-eligible dependents, MCHCP will contribute for the dependent portion
of the premium the lesser of the following: the contribution percentage
multiplied by the Medicare Advantage premium, or the dollar amount MCHCP
contributes for the dependent portion of the PPO 1250 premium for an active
employee at the rate tier the retiree has selected.
C. For non-Medicare retirees covering
non-Medicare eligible dependents, MCHCP will contribute for the dependent
portion of the premium the lesser of the following: contribution percentage
multiplied by the difference in premium of the retiree only PPO 1250 Plan total
premium with tobacco-free incentive and partnership incentive and the premium
of the PPO 1250 Plan at the rate tier the retiree has selected, or the dollar
amount MCHCP contributes for the dependent portion of the PPO 1250 premium for
an active employee at the rate tier the retiree has selected.
(B) For those retiring
prior to July 1, 2002, the amount calculated in subsection (6)(A) is compared
to the flat dollar amount that was contributed for the same rate tier in 2002.
The retiree's subsidy is the greater of the amount calculated in subsection
(6)(A) or the flat dollar amount that was contributed in 2002.
(7) Premium. Payroll deductions, Automated Clearing House (ACH) transactions, debit cards, credit cards, and/or direct bills are processed by MCHCP.
(A)
Active Employee Whose Payroll Information is Housed in the SAM II Human
Resource System.
1. Monthly medical premium
payroll deductions are divided in half and taken by MCHCP at the end of the
prior month and the fifteenth of the current month for the current month's
coverage (example: September 30 and October 15 payroll deductions are taken for
October medical premiums).
2.
Monthly dental and vision premium payroll deductions are divided in half and
taken by MCHCP on the fifteenth of the current month and the end of the current
month for the current month's dental and vision coverage (example: October 15
and October 31 payroll deductions are taken for October dental and vision
premiums).
3. If a subscriber owes
premiums outside the current month, payroll deductions for all other premiums
owed will be divided equally and taken from the subscriber's future payrolls as
follows:
A. Fifty dollars ($50) or less,
deduction will be taken from one (1) payroll;
B. Fifty-one dollars ($51) to one hundred
dollars ($100) will be deducted from two (2) payrolls;
C. One hundred one dollars ($101) to two
hundred dollars ($200) will be deducted from three (3) payrolls;
D. Two hundred one dollars ($201) to three
hundred dollars ($300) will be deducted from four (4) payrolls;
E. Three hundred one dollars ($301) to four
hundred dollars ($400) will be deducted from five (5) payrolls;
F. Four hundred one dollars ($401) to five
hundred dollars ($500) will be deducted from six (6) payrolls;
G. Five hundred one dollars ($501) to six
hundred dollars ($600) will be deducted from seven (7) payrolls;
H. Six hundred one dollars ($601) to seven
hundred dollars ($700) will be deducted from eight (8) payrolls;
I. Seven hundred one dollars ($701) to eight
hundred dollars ($800) will be deducted from nine (9) payrolls;
J. Eight hundred one dollars ($801) to nine
hundred dollars ($900) will be deducted from ten (10) payrolls;
K. Nine hundred one dollars ($901) to one
thousand dollars ($1,000) will be deducted from eleven (11) payrolls;
and
L. One thousand one dollars
($1,001) and over will be deducted from twelve (12) payrolls.
4. If the active employee's check
is not sufficient to cover his/her premium, the active employee will receive a
monthly bill for the premium.
(B) Active Employee Whose Payroll Information
is not Housed in the SAM II Human Resource System.
1. Premium payroll deductions are submitted
to MCHCP monthly from the agency based on the deductions taken from the
employee's payroll.
A. Medical premium payroll
deduction received at the end of the month is applied to the employee's next
month's coverage (example: September 30 payroll deduction is taken for the
October medical premium).
B. Dental
and vision premium payroll deductions received at the end of the month are
applied to the current month's dental and vision coverage (example: September
30 payroll deductions are taken for September dental and vision
premiums).
C. If a subscriber owes
past-due premiums, payroll deductions for current premiums along with the
payroll deductions for past-due premiums may be taken at the discretion of the
employer.
2. If the
active employee's check is not sufficient to cover his/her premium, the active
employee will receive a monthly bill for the premium.
(C) Retirees and Survivors Premiums From
Benefit Check.
1. Deduction amounts are
received monthly from MOSERS based on the deductions taken from the benefit
checks. Medical, dental, and vision deductions received at the end of the month
pay for the next month's coverage (example: September 30 benefit check
deduction is taken for October medical, dental, and vision premiums).
2. If a retiree or survivor is currently
having deductions taken from his/her benefit check and owes past-due premiums
due to a change in his/her deductions, MCHCP will contact MOSERS to determine
if the benefit check is large enough to cover the past-due premiums. If the
benefit check is large enough to cover the past-due premiums, deductions will
be divided and taken from the retiree or survivor's next three (3) benefit
checks and coverage will be continuous. If the retiree or survivor's benefit
check is not large enough to cover the deductions, and the retiree or survivor
has failed to make the necessary premium payments, coverage will be terminated
due to nonpayment, effective the last day of the month a full premium was
received.
(D) Direct Bill
of Premium Owed By Subscribers Whose Premium is not Deducted from Payroll or
Benefit Check.
1. Premiums are billed on the
last working day of the month for the next month's coverage. Premiums are due
fifteen (15) days from the last day of the month in which they are billed
(example: bill mailed September 30 for October medical, dental, and vision
premiums, premium due October 15).
2. A subscriber may elect to pay premiums by
ACH electronic payment. In that case, the subscriber agrees that he/she will
not receive a monthly bill.
A. Premiums are
deducted from a subscriber's bank account on the fifth of the month to pay for
the current month's coverage (example: October 5 deduction taken for October
medical, dental, and vision premiums).
B. If there are insufficient funds, MCHCP
will bill the subscriber for the premium owed. The due date of the premium owed
shall not change due to insufficient funds.
(8) Premium Payments.
(A) By enrolling in coverage under MCHCP, an
active employee agrees that MCHCP may deduct the member's contribution toward
the total premium from the subscriber's paycheck. Payment for the first month's
premium is made by payroll deduction. Subsequent premium payments are deducted
from the active employee's paycheck. If the active employee's check is not
sufficient to cover his/her premium, the active employee agrees to pay MCHCP by
check, money order, ACH or cash, or by any other monetary transaction supported
by MCHCP.
(B) By enrolling in
coverage under MCHCP, the retiree or survivor agrees that MCHCP will
automatically deduct the premium from the retiree or survivor's benefit check.
The retiree or survivor may choose to receive a monthly bill in lieu of an
automatic deduction. If the retiree or survivor's deduction is not sufficient
to cover his/her premium or the retiree or subscriber chooses to receive a
monthly bill, the retiree or survivor agrees to pay MCHCP by check, money
order, ACH or cash, or by any other monetary transaction supported by
MCHCP.
(C) If the subscriber fails
to make the necessary premium payments, coverage terminates on the last day of
the month for which full premium payment was received. The subscriber is
responsible for claims submitted after the termination date.
1. If a non-Medicare subscriber fails to pay
premiums by the required due date, MCHCP allows a thirty-one- (31-) day grace
period from the due date. In the event that MCHCP has not received payment of
premium at the end of the thirty-one- (31-) day grace period, coverage will be
retroactively terminated on the last day of the month for which full premium
payment was received. The subscriber will be responsible for the value of the
services rendered after the retroactive termination date, including, but not
limited to, the grace period.
2. If
a Medicare primary subscriber fails to pay premiums by the required due date,
MCHCP allows a sixty- (60-) day grace period from the due date. In the event
that MCHCP has not received payment of premium at the end of the sixty- (60-)
day grace period, coverage will be terminated effective the end of month in
which the sixty- (60-) day grace period ends.
(9) Refunds of overpayments are limited to the amount overpaid during the twelve- (12-) month period ending at the end of the month preceding the month during which notice of overpayment is received by MCHCP.
*Original authority: 103.059, RSMo 1992.
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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