Missouri (MO)
Individual Health Insurance Regulations

Learn more about Missouri Individual Health Insurance

Health insurance is necessary in safeguarding your future against financially-crippling situations like sickness and injury. As the main earning member of your family, it becomes your duty to secure your family’s health care needs through an appropriate health insurance. Before opting for a health policy, it is wise to access your budget and family’s basic medical needs. If you live in Missouri, you can choose from various options of health insurance. The Missouri Department of Insurance, Financial Institutions & Professional Registration supervises the regulations under which the Missouri health insurers can sell private health insurance to individuals and families.

In Missouri, individual health insurance policies are medically underwritten. This process allows for the health insurance carrier to obtain information regarding your past and present health conditions and utilize that information in determining whether or not to offer you health insurance coverage. Under Missouri law, the insurance carrier may opt to approve your application and offer full and complete coverage under the requested health insurance plan; or approve your application, offering modified coverage under the terms of the requested health insurance plan by placing specific limitations and exclusions for treatment of pre-existing conditions; or reject the application and deny coverage. There is no limit on the look-back period and exclusionary period with regard to pre-existing conditions. Thus, your health insurer can look back in your history for any length of period and decide to impose an exclusion period for any length of time for pre-existing conditions. Missouri also permits the use of Elimination Riders. An Elimination Rider is an amendment to the health insurance policy which allows the insurance carrier to temporarily or permanently exclude coverage of a specific condition, body part or body system. Under Missouri state law, Credit for prior coverage is not required to be given unless a new enrollee has had 18 months of prior, qualifying for medical insurance under federal HIPAA regulations.

Missouri (MO)
Small Group Health Insurance Regulations

Missouri defines a small group employer as a company who employs 2-50 employees. Small group health insurance, under Missouri law, is guarantee issue. Guarantee issue coverage provides that an application for small group health insurance coverage may not be denied or declined by a health insurance carrier based on the overall health of the group or an individual employee. Eligible employees may have a waiting period imposed upon them by their employer, but must be offered coverage once the waiting period has been satisfied. Missouri allows group health insurance carriers a 6 month look back with a maximum 12 month exclusionary period with regard to pre-existing conditions. Prior to imposing any exclusionary period, the health insurance carrier must notify the applicant of their intent to exercise a pre-existing medical condition waiting period in writing. Credit for prior coverage must be given to applicants with prior creditable coverage. Small group rates are medically underwritten and, based on the health of the group, may fluctuate by plus or minus 25 percent of the indexed rated.

Missouri COBRA and Continuation Coverage

Employers with 20 or more employees fall under federal COBRA regulations. Under the federal COBRA laws, the employer is obligated to provide the option to a departing employee to remain on the group health plan for a minimum of 18 months. In special cases, some persons may be entitled to 36 months of continued COBRA coverage under federal law. The COBRA recipient is responsible for paying the insurance premiums that the employer was paying for the coverage along with 2% administrative costs.

Under Missouri state mini-COBRA laws enacted through Missouri mini-COBRA laws, all companies with less than 20 employees must offer their employees an additional nine months of continuation coverage. To be eligible for Missouri mini-COBRA, an employee must have been insured under the group health plan for a minimum of 3 months prior to the date of termination. Provided the employee has suffered a qualifying event and meets state eligibility requirements, the employee may continue, at his/her sole expense, to receive health insurance benefits under the group plan. Election of continuation coverage benefits must be made in writing and within thirty-one days of the date coverage would have terminated. Conversion policies are available once continuation benefits have been exhausted. For persons that have exhausted their COBRA coverage and are not eligible for standard issue individual health insurance, they may obtain guaranteed issue coverage from any insurance company that offers individual health plans in Missouri.