INCOME TAX DEDUCTIONS - The act repeals the statutory tax deduction currently given for a self-employed individual's health insurance costs (Section 143.111 and 143.113).

HMO PROVIDER LISTINGS - This act allows HMOs to provide health care provider listings electronically provided an enrollee can still obtain a paper copy upon request (section 354. 442).

DEPENDENT COVERAGE - Under current law, proof that a dependent child is incapable of maintaining employment due to a mental or physical handicap and is dependent upon the insured for support and maintenance must be furnished to the health insurer at least 31 days after the dependent child has attained the age when coverage would normally be terminated in order to continue receiving the extended coverage provided by the statutes. This act requires the proof of incapacity and dependency to be furnished within 31 days after the child's attainment of the limiting age. This modification applies to group policies, individual polices and health maintenance organization polices (Sections 354.536, 376.426, and 376.776). These provisions are contained in SB 415 (2009).

The definition of "dependent" is changed in the Small Employer Health Insurance Availability Act to mirror the definition of dependent contained in the HMO, individual and group policy statutes. The definition of "dependent" is revised to be a person that is a spouse, an unmarried child who resides in Missouri and is younger than 25 years of age and is not covered by any group or individual health benefit plan or entitled to federal Social Security assistance benefits, or an unmarried child of any age who is disabled and dependent upon his or her parent (Section 379.930.2). This provision is contained in SB 415 (2009).

GROUP HEALTH INSURANCE POLICIES - Under current law, group health insurance policies must contain a provision that specifies any exclusions and limitations to the policy in regard to a disease or physical condition that an individual was treated for during the 12 months prior to the enrollment date of an individual's policy. Under the act, the exclusion or limitation may only apply to diseases or conditions for which treatment or medical advice was recommended or received by the person during the 6 month period prior to the enrollment date of coverage. Under the terms of the act, exclusions and limitations cannot apply to a loss or disability that occurred after the end of the 12 month period following the enrollment date or during the 18-month period thereafter (reduced from 2 years) in the case of late enrollees (Section 376.426).

CREDITABLE COVERAGE AND WAITING PERIOD DEFINITIONS - The act adds the SCHIP program to the categories of insurance that qualify as "creditable coverage" for purposes of health insurance portability. The act also modifies the definition for the term "waiting period" to include late enrollees and individuals seeking coverage in the individual health insurance market. The definition for "waiting period" as it relates to the Missouri Health Insurance Portability and Accountability Act is revised to be a time period that must pass before coverage for an employee or dependent who is otherwise eligible to enroll in a group health plan becomes effective. Any time period before late or special enrollment is not considered a waiting period for late or special enrollees. A waiting period begins on the date an individual submits an application for coverage and ends when the application for coverage is approved, denied, or lapses (Section 376.450).

HEALTH REIMBURSEMENT ARRANGEMENT - The act also provides that if an employer provides health insurance to an employee and the employee pays any portion of the cost of the premium, the employer must also provide a premium-only cafeteria plan or a health reimbursement arrangement (Section 376.453). Current law only requires the provision of a premium-only cafeteria plan. This provision is contained in SB 415 (2009).

Under this act, employees are allowed to use funds from one or more employer health reimbursement arrangement only plans to help pay for individual health insurance coverage. HRAs are employee benefit plans provided by an employer which establish an account funded solely by the employer to reimburse the employee for qualified medical expenses incurred by the employee or his or her family. HRAs allow the employee to carry forward any unused funds at the end of the coverage period to subsequent coverage periods (Section 376.1600). A similar provision is contained in SB 415 (2009)(Section 376.1600).

STUDY TO IDENTIFY ADMINISTRATIVE AND REGULATORY BARRIERS FOR NEW INSURANCE PRODUCTS - By January 1, 2010, the Director of the Department of Insurance, Financial Institutions and Professional Registration must provide recommendations to the General Assembly of changes to remove any unnecessary barriers that limit the entry of new health insurance products into the Missouri insurance market. The director must also examine proposals adopted in other states that streamline the regulatory processes to allow insurance companies to market new and existing products more easily (Section 376.1618). This section is contained in SB 415 (2009).

PLACEMENT FOR ADOPTION - Health insurance issuers offering group coverage will be required to provide a special enrollment period for a dependent in the case of a placement for adoption (Section 376.450.6).

SMALL EMPLOYER HEALTH REIMBURSEMENT ARRANGEMENTS - If an eligible employee of a small employer retains his or her individually underwritten health insurance, a small employer may provide a defined contribution through the establishment of health reimbursement arrangement (Section 379.940).

HMO ENROLLEE INFORMATION - Under the terms of this act, a health maintenance organization may provide its enrollees a list of its participating providers in an electronic format unless a paper copy is requested by the enrollee (Section 354.442).

CONVERSION POLICIES - Under this act, an insurer may not refuse to renew a conversion policy because the insured person is eligible for Medicare or other similar state or federal assistance (Section 376.397). This act repeals a provision of law which allows conversion policies to reduce or terminate conversion policy coverage when the insured becomes eligible for coverage under Medicare or other similar program (Section 376.401).

GROUP HEALTH INSURANCE EXCLUSION RULES - This act repeals a provision of law which currently allows a group health insurer to exclude coverage on persons under policies insuring fewer than 10 employees as to whom there is evidence of unsatisfactory individual insurability. The act also repeals a similar rule for group health policies insuring greater than 10 employees where applications are made past 31 days after eligibility, the person voluntarily terminates coverage, or where the person fails to enroll during a period of open enrollment (Sections 376.421 and section 376.424)).

REDUCED PREMIUMS FOR NONSMOKERS - Under this act, when an insurer charges a reduced premium rate for employees who do not smoke or use tobacco, the insurer must comply with the nondiscrimination provisions of HIPAA (Section 376.421 and Section 379.952).

HIGH RISK POOL - This act adds health insurance coverage provided under the SCHIP program to the list of insurance that qualifies a creditable coverage for purposes of the high risk pool. The act also modifies the definition of "dependent" to mean a resident of Missouri who is under the age of 25 and who is not provided health insurance coverage under a group or individual policy or Medicare. The act also modifies the definition of the term "significant break in coverage" (Section 376.960). Under current law, a person who has health insurance coverage but who premiums have increased to 150% to 200% of the rates is eligible for coverage under the high risk pool. This act repeals the 150% floor so that a person with health insurance coverage whose premiums have increased beyond the eligibility limits set by the board may still qualify for pool coverage (section 376.966). The act replaces the term "gap" in Section 376.986 with the term "break."

LIMITED MANDATE HEALTH INSURANCE POLICIES - This act repeals the current marketing restriction placed upon the sale of limited mandate health insurance policies which limits the sale of such policies to individuals that do not have health insurance or employers who certify that they will terminate their current coverage because of current cost (Section 376.995).

STEPHEN WITTE