SCS/SB 467 - This act is a compliance bill for the federal Health Insurance Portability and Accountability Act of 1996. It requires availability and renewability of health insurance policies for all groups and specified individuals in the state.

GROUPS - The general group insurance statutes of Chapter 376, RSMo, are revised to assure minimum compliance with the federal law.

INDIVIDUALS - All individual health plans must comply with federal law. This applies to all eligible individuals under the federal law and all other individuals with creditable coverage of at least 12 months. Insurers with group policies for trusts and associations shall be considered part of the individual market. Insurers in the individual market shall make the two most popular health benefit plans available to such individuals.

SMALL GROUPS - The small group statutes of Chapter 379, RSMo, are rewritten in particular to comply with the federal law. Small employers must have between 2 and 50 employees. No health status-related factors may be used in establishing classes or issuing or renewing coverage.

Policies need not be renewed if the insurer decides to discontinue a particular type of plan and follows the notification procedures. Currently law generally requires these policies to be renewed with several exceptions. An insurer that elects not to offer any small group plans shall be prevented from reentering that market for 5 years.

All health benefit plans actively marketed by the insurer shall be made available to small employers, with a minimum of at least two plans. Current law requires two plans to be offered. All health benefit plans used by the insurer shall be filed with the Director of Insurance; the director may disapprove them if they violate the law. The availability requirement is not applied to bona fide associations and purchasing alliances. Small group plans may be modified, as long as the same changes are made for all those covered by the plan.

Preexisting condition limits must be reduced by the period of creditable coverage if such coverage was continuous to within 63 days of the enrollment date of new coverage. Affiliation periods and waiting periods are limited. Preexisting conditions may not be imposed for pregnancy or adoption. Special provisions are made for network plans.

REINSURANCE - The current sections on reinsurance for small group employer plans are repealed.

COMMUNITY RATING PILOT PROJECTS - Health insurers may apply to the Director of Insurance to set up pilot projects using modified community rating and equalized mental health coverage. Up to two projects may be approved, with boundaries set by the Governor, the Department of Insurance and the affected residents and insurers. At least two insurers must be willing to sell policies in a project area. Premiums may only vary according to age, geographic location and family composition. Mental health services shall have the same coverage limitations as other medical services.

EMERGENCY CLAUSE - The act goes into effect on July 1, 1997 or when approved by the Governor, whichever comes later.

MIKE HOEFERKAMP