SHORT TERM MAJOR MEDICAL INSURANCE

This act specifies that all short-term major medical policies delivered or issued for delivery in the state shall include on applications and fact pages a conspicuous and clearly labeled paragraph stating that the policy may not cover preexisting conditions or essential health benefits, and a recommendation to discuss the policy with the individual's insurance broker. (Section 376.008.1)

No short-term major medical policy shall be delivered or issued for delivery in this state until the prospective insured has confirmed receipt of a benefit summary statement, as defined in the act. (Section 376.008.2)

The act specifies that for short-term major medical policies with durations of less than one year, health carriers shall permit individuals to learn the amount of cost-sharing he or she would have to pay for a particular item or service from a participating provider. (Section 376.446)

This act exempts short-term major medical policies with durations of less than one year from the requirement to offer policy renewals. (Section 376.452 and 376.454)

The act requires the actuarial analysis undertaken by the Joint Committee on Legislative Research between September 1, 2013, and December 31, 2013, to assume that certain coverages do not apply short-term major medical policies with durations less than one year. (Section 376.1192)

This act also specifies that certain health insurance mandates shall not apply to short-term major medical policies with durations of less than one year. The act exempts the policies from mandates regarding:

• Human immunodeficiency virus infection (section 191.671);

• Diabetes (section 376.385);

• Clinical trial coverage (section 376.429);

• Alcoholism treatment (section 376.779);

• Speech and hearing disorders (section 376.781);

• Mammography screenings (section 376.782);

• Chemical dependency (section 376.811);

• Eating disorders (section 376.845);

• Obstetrical/gynocological services (section 376.1199);

• Breast cancer (section 376.1200);

• Mastectomy reconstruction and prosthetics (section 376.1209);

• Maternity (section 376.1210);

• Childhood immunizations (section 376.1215);

• First Steps for children eligible for Part C early intervention (section 376.1218);

• Phenylketonuria (PKU) testing and formula (section 376.1219);

• Newborn infant hearing screening (section 376.1220);

• Autism spectrum disorders (section 376.1224);

• Hospital dental procedures (section 376.1225);

• Chiropractic care (section 376.1230);

• Prosthetics (section 376.1232);

• Physical and occupational therapy (section 376.1235);

• Refills for prescription eyedrops (section 376.1237);

• Cancer screenings (section 376.1250);

• Second opinion for cancer diagnosis (section 376.1253);

• Oral chemotherapy (section 376.1257);

• Antigen testing for bone marrow transplants (section 376.1275);

• Lead testing (section 376.1290);

• Explanations of benefits (section 376.1400);

• Mental health parity (section 376.1550); and

• Telehealth services (section 376.1900).

These provisions are identical to provisions in HCS/SB 103 (2019), and similar to SCS/SB 48 (2019), HB 582 (2019), HB 1020 (2019), the House perfected HCS/HB 1685 (2018), and provisions in SS/SCS/SB 860 (2018), HB 708 (2017), and HCB 10 (2017).

UNANTICIPATED OUT-OF-NETWORK HEALTH CARE SERVICES

This act specifies that health care professionals shall, rather than may, utilize the process outlined in statute for claims for unanticipated out-of-network care. (Section 376.690)

This provision is identical to a provision in HCS/SB 103 (2019), provisions in the truly agreed to and finally passed SB 514 (2019), provisions in SS/SCS/HCS/HB 399 (2019), provisions in SS#2/HB 219 (2019), the perfected HB 756 (2019), provisions in HCS/HB 1235 (2019), provisions in HCS/SS/SCS/SBs 70 & 128 (2019), provisions in HCS/SB 275 (2019).

ERIC VANDER WEERD