Missouri Senate

House Amendment

RECIPIENTS OF DONATED ORGANS (Section 194.320)

Under this act, no hospital, physician, procurement organization, or other person shall determine the ultimate recipient of an anatomical gift based upon a potential recipient's physical or mental disability or congenital condition, except to the extent that the disability or condition has been found by a physician, following a case-by-case evaluation of the potential recipient, to be medically significant to the provision of the anatomical gift. A person with a disability or congenital condition shall not be required to demonstrate post-operative independent living abilities in order to have access to a transplant if there is evidence that the person will have sufficient, compensatory support and assistance.

A court shall accord priority on its calendar and handle expeditiously any action brought to seek a remedy for purposes of enforcing compliance with this act.

This act shall not be deemed to require referrals or recommendations for or the performance of medically inappropriate organ transplants.

These provisions are similar to SB 712 (2020), and to provisions in SB 466 (2015).

MISSOURI AUTOMOBILE INSURANCE PLAN (Section 303.200)

This act modifies existing law regarding apportionment of substandard insurance risks to create the Missouri Automobile Insurance Plan ("MOAIP"). Under the act, MOAIP is authorized to issue motor vehicle insurance policies to applicants who are unable to procure motor vehicle liability policies through ordinary methods, rather than funding issuance of the policies through other insurers. The act further specifies that the Director of the Department of Commerce and Insurance (the "Director") shall consult with insurance companies "having a certificate of authority to do business in the state and actively writing motor vehicle liability policies" regarding the plan, rather than insurance companies "authorized to issue automobile liability policies". (Section 303.200.1).

MOAIP shall perform its functions under a plan of operation, approved by the Director, and through a board of governors as prescribed in the plan of operation. (Section 303.200.2). The plan of operation shall prescribe the issuance of motor vehicle insurance policies, which may include the administration of the policies by a third party, as specified in the act. (Section 303.200.3).

The act requires MOAIP to obtain approval from the Director before using forms, rates, or manuals. (Section 303.200.4). MOAIP is subject to the applicable insurance laws of this state unless specifically exempted (Section 303.200.5), is required to file annual financial reports and to be subject to examination by the Director, and shall have the authority to make assessments on member insurance companies in proportion to their market share. (Section 303.200.6). Member insurers and members of the governing committee shall be immune from liability for omissions and actions taken in the performance of their powers and duties under the act. (Section 303.200.7)

These provisions are identical to provisions in HB 1648 (2020) and substantially similar to provisions in SB 779 (2020).

CONTINUING EDUCATION CREDITS FOR INSURANCE PRODUCERS (Section 375.029)

This act provides that an insurance producer's active participation as an individual member or employee of a business entity producer member of a professional insurance association may be approved by the Director of the Department of Commerce and Insurance for up to 4 hours of continuing education credit per biennial reporting period. A producer shall not use continuing education credit granted under these provisions to satisfy hours required to be undertaken in a classroom setting, or for ethics education requirements. Credit shall be credited upon timely filing with the Director of a written statement filed by the producer, or by certification filed by the professional association.

These provisions are identical to HCS/HB 1647 (2020).

CREDIT FOR REINSURANCE (Section 375.246)

This act enacts provisions relating to credit for reinsurance as an asset or reduction from liability of an insurer.

The act authorizes the Director of the Department of Commerce and Insurance to promulgate certain rules, as specified in the act, to establish requirements relating to or setting forth the valuation of assets or reserve credits, the amount and forms of security supporting reinsurance agreements described in the act, or the circumstances under which credit will be reduced or eliminated. (Sections 376.246.1 and 376.246.2).

In addition to as currently provided by law, credit for reinsurance shall be allowed when the reinsurance is ceded to an assuming insurer meeting certain conditions. (Section 375.246.1(6)(a)). The assuming insurer shall have its head office or be domiciled in, as applicable, and licensed in a reciprocal jurisdiction, as such term is defined in the act. (Section 375.246.1(6)(a)a). The assuming insurer shall have and maintain minimum capital and surplus, or its equivalent, calculated according to the methodology of its domiciliary jurisdiction in an amount to be set forth by the Director by rule. If the assuming insurer is an association, it shall maintain the same, net of liabilities, and a central fund containing an amount to be set forth by rule. (Section 375.246.1(6)(a)b). The assuming insurer shall have and maintain a minimum solvency or capital ratio, as applicable, which shall be set forth by rule. If the assuming insurer is an association, it shall have and maintain a minimum solvency and capital ratio in the reciprocal jurisdiction where the insurer has its head office or is domiciled, as applicable, and is also licensed. (Section 375.246.1(6)(a)c). The assuming insurer shall agree and provide adequate assurance to the Director that it will provide prompt written notice and explanation to the Director if it falls below minimum capital and surplus requirements outlined in the act, or if any regulatory action is taken against it for serious noncompliance with the law. The assuming insurer shall consent in writing to the jurisdiction of the courts of this state and to the appointment of the Director as agent for service of process. The Director may require that the consent for service of process be provided for and included in each reinsurance agreement. These provisions shall not alter the capacity of the parties to a reinsurance agreement to agree to enforceable alternative dispute resolution mechanisms. The assuming insurer shall consent in writing to pay all final judgments obtained by a ceding insurer or its legal successor, where enforcement is sought, which have been declared enforceable in the jurisdiction where the judgment was obtained. Each reinsurance agreement shall require the assuming insurer to provide security, in an amount equal to 100% of the assuming insurer's liabilities attributable to reinsurance under the agreement, if the assuming insurer resists enforcement of an enforceable final judgment or arbitration award. The assuming insurer shall confirm that it is not presently participating in any solvent scheme of arrangement involving this state's ceding insurers, and shall agree to notify the ceding insurer and the Director and to provide security as specified by rule in an amount equal to 100% of the assuming insurer's liabilities to the ceding insurer should the assuming insurer enter into such a solvent scheme of arrangement. (Section 375.246.1(6)(a)d). The assuming insurer or its legal successor shall provide, if requested by the Director, certain documentation as specified by rule. (Section 375.246.1(6)(a)e). The assuming insurer shall maintain a practice of prompt payment of claims under reinsurance agreements as specified by rule. (Section 375.246.1(6)(a)f). The assuming insurer's supervisory authority shall confirm to the Director on an annual basis that the assuming insurer complies with the minimum capital and surplus or solvency or capital ratio requirements specified in this act. (Section 375.246.1(6)(a)g). Nothing in these provisions precludes an assuming insurer from providing the Director with information on a voluntary basis. (Section 375.246.1(6)(a)h).

This act requires the Director to create and publish a list of reciprocal jurisdictions. (Section 375.246.1(6)(b)). The Director's list shall contain any jurisdiction meeting the definitions provided in the act and shall consider any other reciprocal jurisdiction included on the list published by the National Association of Insurance Commissioners (NAIC). The Director may approve additional jurisdictions under rules promulgated by the Director. (Section 375.246.1(6)(b)a). The Director may remove a jurisdiction from the list upon a determination that the jurisdiction no longer meets the requirements of a reciprocal jurisdiction, except that the Director shall not remove a non-United States jurisdiction that is subject to a covered agreement, as defined in the act, or a United States jurisdiction that meets the requirements for NAIC accreditation. (Section 375.246.1(6)(b)b).

The Director shall create and publish a list of assuming insurers that have satisfied the conditions set forth in this act and to which cessions shall be granted credit as specified in the act. The Director may add an assuming insurer to the list if an NAIC accredited jurisdiction has added the assuming insurer to such a list, or if the eligible assuming insurer submits certain information to the Director, as provided in the act, and complies with any additional requirements the Director may adopt that are not in conflict with an applicable covered agreement. (Section 375.246.1(6)(c)).

If the Director determines an assuming insurer no longer meets one or more requirements for recognition under the act, the Director may revoke or suspend the insurer's eligibility for recognition in accordance with the act. (Section 375.246.1(6)(d)). While an assuming insurer's eligibility is suspended, no reinsurance agreement issued, amended, or renewed after the date of suspension shall qualify for credit, except to the extent that the assuming insurer's obligations are secured as provided by law. (Section 375.246.1(6)(d)a). If an assuming insurer's eligibility is revoked, no credit for reinsurance may be granted after the effective date of revocation with respect to any reinsurance agreement entered into by the insurer, before or after the revocation, except to the extent the insurer's obligations are secured as provided by law. (Section 375.246.1(6)(d)b).

If subject to a legal process of rehabilitation, liquidation, or conservation, as applicable, the ceding insurer or its representative may seek a court order requiring that the assuming insurer post security for all outstanding liabilities. (Section 375.246.1(6)(e)).

Nothing in this act shall limit or in any way alter the capacity of parties to a reinsurance agreement to agree on requirements for security or other terms in that reinsurance agreement, except as expressly prohibited by law. (Section 375.246.1(6)(f)).

Credit may be taken under this act only for reinsurance agreements entered into, amended, or renewed after December 31, 2020, and only with respect to losses incurred and reserves reported after the later of: the date on which the assuming insurer has met applicable eligibility requirements, or the effective date of the new reinsurance agreement, amendment, or renewal. (Section 375.246.1(6)(g)). Nothing in this act shall alter or impair a ceding insurer's right to take credit for reinsurance under the act as long as the reinsurance qualifies for credit under another applicable provision of law. (Section 375.246.1(6)(g)a). Nothing in this act shall limit or in any way alter the capacity of parties to any reinsurance agreement to renegotiate the agreement. (Section 375.246.1(6)(g)b).

The act authorizes the Director to adopt rules and regulations applicable to reinsurance agreements relating to certain life insurance policies, variable annuities with guaranteed benefits, long-term care insurance policies, and such other life and health insurance and annuity products as to which the NAIC adopts model rules with respect to credit for reinsurance. (Section 375.246.4(2)(a)). A rule adopted under these provisions regarding life insurance policies shall apply to any treaty containing policies issued after December 31, 2014, or policies issued prior to January 1, 2015, if risk pertaining to such pre-2015 policies is ceded in connection with a treaty after December 31, 2014. (Section 376.246.4(2)(b)). A rule adopted under these provisions shall require the ceding insurer, in calculating the amounts or forms of security required to be held, to use the NAIC valuation manual to the extent applicable. (Section 375.246.4(2)(c)). Regulations adopted under this authority shall not apply to an assuming insurer that: meets the conditions set forth in this act or, if this state has not fully implemented the provisions of this act, is operating in at least 5 states that have implemented the provisions of this act; is certified in this state; or maintains at least $250,000,000 in capital and surplus as specified in the act and is licensed in at least 26 states, or licensed in at least 10 states and licensed or accredited in at least 35 states. (Section 376.246.4(2)(d)). The authority to adopt regulations under these provisions does not limit the Director's authority to otherwise adopt regulations relating to credit for reinsurance. (Section 375.246.4(2)(e)).

These provisions are identical to HB 1619 (2020), and substantially similar to SB 634 (2020).

INSURANCE COVERAGE FOR BREAST CANCER (Section 376.782)

This act modifies an insurance mandate relating to breast cancer screening and evaluation.

In addition to existing coverage requirements, the act adds "detectors" to the X-ray equipment specifically listed as being covered under the mandate.

The act also specifies that coverage for certain breast cancer screening and evaluation services shall be provided to any woman deemed by her physician to have an above-average risk for breast cancer in accordance with American College of Radiology (ACR) guidelines, rather than specifically to women with a personal or family history of breast cancer.

The act also requires coverage of any additional or supplemental imaging, such as breast MRI or ultrasound, deemed medically necessary by a treating physician for proper screening or evaluation in accordance with applicable ACR guidelines. Furthermore, the act requires coverage of ultrasound or MRI services when determined by a treating physician to be medically necessary for the screening or evaluation of breast cancer for any woman deemed by the treating physician to have an above-average risk of breast cancer in accordance with ACR guidelines for breast cancer screening.

Lastly, language relating to out-of-pocket expenditures is modified to apply to the additional modalities required to be covered under the act.

These provisions are identical to SB 841 (2020) and HB 2468 (2020).

INSURANCE FOR LIVING ORGAN DONORS (Section 376.1590)

This act specifies that a person's status as a living organ donor shall not be the sole factor in the offering, issuance, cancellation, price, or conditions of an insurance policy, nor in the amount of coverage provided.

The Department of Commerce and Insurance shall provide information to the public on the access of a living organ donor to insurance as specified in the act.

If the Department of Commerce and Insurance or the Department of Health and Senior Services receives materials related to live organ donation from a recognized live organ donation organization, the materials may be made available to the public. These departments may seek or accept gifts, grants, or donations from public or private sources for purposes of this act.

These provisions are identical to HCS/HB 1709 (2020).

INDUCEMENTS TO INSURANCE (Sections 379.402 and 379.404)

This act specifies that insurers and insurance producers may provide products or services in conjunction with a policy of property and casualty insurance for free, at a discount, or at market value, if the products or services are intended to prevent or mitigate loss, provide loss control, reduce rates or claims, educate about risk of loss, monitor or assess risk, identify sources of risk, develop strategies for the elimination or reduction of risk, or provide post-loss services. (Section 379.402.1)

Insurers or producers of insurance may offer gifts, goods, or merchandise that contain advertising or promotion of the insurer or producer to policyholders, prospective policyholders, and members of the public. (Section 379.402.2)

Products or services provided as specified in this act shall not be considered an inducement to insurance, a rebate, nor any other impermissible consideration prohibited by law. The products or services described in this act shall not be required to be included in the contract or policy form filings. (Section 379.402.3)

The Director of the Department of Commerce and Insurance may promulgate rules to exempt, but not restrict, additional categories of products or services with regard to the prohibitions against inducements to insurance. (Section 379.402.4)

The act also exempts commercial property and casualty insurers from the prohibitions against inducements to insurance, except with regard to any producer commission reduction not included in the insurer's rate filings. (Section 376.404)

These provisions are identical to SB 900 (2020) and to provisions in HCS/HB 1634 (2020).

MISSOURI BASIC PROPERTY INSURANCE INSPECTION AND PLACEMENT PROGRAM (Section 379.860)

This act also modifies the Missouri Basic Property Insurance Inspection and Placement Program. Under the act, ten of the members of the program's governing committee shall be elected as specified in the program's plan of operation, rather than prescribing entities from which the members shall be elected. (Section 379.860.2). Member insurers and members of the governing committee shall be immune from liability for omissions and actions taken in the performance of their powers and duties under the act. (Section 379.860.4)

These provisions are identical to provisions in HB 1648 (2020) and substantially similar to provisions in SB 779 (2020).

GROUP PERSONAL LINES PROPERTY AND CASUALTY INSURANCE (Sections 379.1800 to 379.1816)

This act enacts provisions relating to group personal lines property and casualty insurance.

The act specifies that no policy of group personal lines property and casualty insurance shall be issued or delivered in the state unless it conforms to one of the categories described in the act. (Section 379.1800.1)

The act describes policies issued to an employer or trustees of a fund established by an employer (Section 379.1800.1(1)), policies issued to a labor union or similar employee organization (Section 379.1800.1(2)), policies issued to a trust, or trustees of a fund, established by two or more employers or by one or more labor unions or similar employee organizations or by a combination thereof (Section 379.1800.1(3)), and policies issued to an association or to a trust, or trustees of a fund, established for the benefit of members of one or more associations. (Section 379.1800.1(4)) For each, the act specifies persons' eligibility for coverage under the policies, and the sources of funds from which the policy premiums may be paid. For policies issued for the benefit of an association or associations, the act further requires that the association or associations have at the outset at least 100 members, have been organized and maintained in good faith for purposes other than obtaining insurance, and have been in active existence for at least 1 year. (Section 379.1800.1(4)) The association or associations' constitution and bylaws shall require that the association shall meet at least annually to further the purposes of the members, shall collect dues or solicit member contributions, and shall provide members with voting privileges and representation on the governing board and committees. (Section 379.1800.1(4)) Lastly, if compensation of any kind will be paid to the policyholder in connection with a group policy issued for the benefit of an association or associations, the insurer shall notify prospective insureds as required in the act. (Section 379.1800.1(4)(c))

Group personal lines property and casualty insurance issued to a group other than one described above shall meet additional requirements. (Section 379.1800.2) No such policy shall be issued or delivered in this state unless the Director of the Department of Commerce and Insurance finds that the issuance of the group policy is not contrary to the best interest of the public, would result in economies of acquisition or administration, and that the benefits are reasonable in relation to the premiums charged. (Section 379.1800.2(1)) No policy issued or delivered in another state shall offer coverage in this state unless the Director, or another state with comparable requirements, determines these additional requirements have been met. (Section 379.1800.2(2)) Premiums for these plans shall be paid from funds that are contributed by the policyholder, by covered persons, or by both. (Section 379.1800.2(3)) If compensation is to be paid to the policyholder in connection with the group policy, the insurer shall notify prospective insureds as specified in the act. (Section 379.1800.2(4))

For all group personal lines property and casualty insurance, master policies shall be issued to the policyholders, and eligible employees or members insured under a master policy shall be issued certificates of coverage setting forth a statement as to the insurance protection to which they are entitled. (Section 379.1802.1) No master policy or certificate of insurance, nor any subsequent amendments to the policy forms, shall be issued or delivered in this state unless the forms and any amendments thereto have met the applicable filing requirements of this state. (Section 379.1802.2) The master policy shall set forth coverages, exclusions, and conditions of the insurance provided, together with the terms and conditions of the agreement between the policyholder and insurer, as provided in the act. (Section 379.1802.3) If the master policy provides for remittance of premiums by the policyholder, failure by the policyholder to remit premiums timely paid by an employee or member shall not be considered nonpayment of premium by the employee or member. (Section 379.1802.4)

The master policy shall provide a basic package of coverages and limits that are available to all eligible employees or members, including at least the minimum coverages and limits required in the employee's or member's state of residence or in the state where the subject property is located, and may offer additional coverages or limits to qualified employees or members for an increased premium. (Section 379.1804.1) The master policy shall provide coverage for all eligible employees or members who elect coverage during their initial period of eligibility, which may be up to 31 days. Employees or members who do not elect coverage during the initial period and later request coverage shall be subject to the insurer's underwriting standards. (Section 379.1804.2) Coverage under a master policy may be reduced only as to all members of a class, and may never be reduced to a level below the limits required by applicable law. (Section 379.1804.3) Coverage under the master policy may be terminated as to an employee or member only for reasons specified in the act. (Section 379.1804.4) If optional coverages or limits are required by law to be available, the policyholder's acceptance or rejection of them on behalf of the group shall be binding on the employees or members. If the policyholder rejects any coverages or limits that are required by law to be provided unless rejected by the named insured, notice of the rejection shall be given to the employees or members upon or before delivery of their certificates of coverage. (Section 379.1804.5) The act prohibits the stacking of coverages or limits under a master policy, except that state law shall apply with regard to the stacking of coverages for separate certificates of coverage issued to relatives living in the same household. (Section 379.1804.6)

No master policy or certificate of insurance shall be issued or delivered in this state unless the rating plan and amendments thereto have met applicable filing requirements of this state. (Section 379.1806.1) Group insurance premium rates shall not be unfairly discriminatory if adjusted to reflect past and prospective loss experience or group expense factors, or if averaged broadly among persons covered under the master policy. The rates likewise shall not be deemed unfairly discriminatory if they do not reflect individual rating factors including surcharges and discounts required for individual personal lines property and casualty policies. (Section 379.1806.2) Experience refunds or dividends may be paid to the policyholder of a group personal lines property and casualty policy if justified by the insurer's experience under that policy. However, if an experience refund or dividend is paid, it shall be applied for the sole benefit of the insured employees or members to the extent it exceeds the policyholder's contribution to premiums for the applicable period. (Section 379.1806.3)

An insurer issuing or delivering group personal lines property and casualty insurance shall maintain separate statistics as to the loss and expense experience pertinent thereto. (Section 379.1808.1) No insurer shall issue or deliver a policy if purchasing insurance is a condition of employment or membership in the group, or if any employee or member shall be penalized for nonparticipation. (Section 379.1808.2) The act prohibits insurers from issuing or delivering a policy if the purchase is contingent on purchase of other insurance, product, or services, or on the purchase of additional coverage under the policy, except as specified in the act. (Section 379.1808.3). The insurer's experience from the policies shall be included in the determination of its participation in residual market plans. (Section 379.1808.4). For purposes of premium taxes, the insurer shall allocate premiums in accordance with the rules for individual personal lines policies, except that the allocation may be based on an annual survey of the insureds. Premiums shall be apportioned among states without differentiation between the source of payment. (Section 379.1808.5)

The act requires persons acting as an insurance agent or broker in connection with the policies to be licensed in this state as an insurance agent or broker, except as otherwise specified in the act (Section 379.1810.1), and provides that the signature of a licensed agent or broker residing in this state shall not be required for issuance or delivery of a policy. (Section 379.1810.2)

Regarding termination of coverage, the act requires insurers to give 30 days written notice, as specified in the act, to persons whose coverage is being terminated for reasons other than by their own request or a failure to pay premiums. (Section 379.1812.1) The employee or member whose coverage is terminated shall be entitled to be issued a comparable individual policy if he or she applies and pays the first premium within 30 days of receiving the notice. (Section 379.1812.2) These notice and replacement policy provisions shall not apply if the master policy is replaced within 30 days. (Section 379.1812.3)

The act further requires insurers to be duly licensed or an eligible nonadmitted insurer as provided by law, specifies that the act is not applicable to mass marketing of individual policies, excludes certain credit insurance, specifies that it does not apply or modify motor vehicle insurance, and provides that it shall not modify the authority of the Director with respect to consumer complaints or disputes. (Section 379.1814)

These provisions shall take effect on January 1, 2021. A master policy or certificate of insurance that is lawfully in effect at that time shall comply with these provisions within 12 months of such date. (Section 379.1816)

These provisions are identical to provisions in HCS/HBs 1634 & 2085 (2020), and similar to SB 843 (2020).

MEDICAL MALPRACTICE JOINT UNDERWRITING ASSOCIATION (Sections 383.155, 383.160, and 383.175)

The act modifies the authority to create a medical malpractice insurance joint underwriting association by specifying that the composition of the association's board of directors shall be established by its plan of operation (Section 383.155.6), and provides that member insurers and members of the governing committee shall be immune from liability for omissions and actions taken in the performance of their powers and duties under the act. (Section 383.155.9). Under the act, all policies of insurance written by the association shall be written to "provide medical malpractice insurance coverage as provided in the plan of operation", rather than to "apply to injury which results from acts or omissions occurring during the policy period. (Section 383.160.1). Lastly, the act specifies that the association's board of directors shall be established by its plan of operation, rather than prescribing entities from which the members shall be elected. (Section 383.175)

These provisions are identical to provisions in HCS/HBs 1634 & 2085 (2020), and similar to SB 843 (2020).

ERIC VANDER WEERD

HA 1 - MODIFIES PROVISIONS RELATING TO A RELIGIOUS EXEMPTION FROM THE MOTOR VEHICLE FINANCIAL RESPONSIBILITY LAW.

HA 2 - MAKES A TECHNICAL CORRECTION.