Missouri Health Insurance (MO)

Missouri (MO)
Individual Health Insurance Regulations

Learn more about Missouri Individual Health Insurance

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 do any one of the following: 1) approve your application and offer full and complete coverage under the requested health insurance plan 2) 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 3) reject the application and deny coverage. Missouri law also provides the health insurance carrier a 24 month exclusionary period with regard to 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 too 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 medical insurance under federal HIPAA regulations.

Missouri (MO)
Small Group Health Insurance Regulations

Missouri defines a small group employer as a company who employs 3–25 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

Under Missouri state mini-COBRA laws, all companies that classify for small business health insurance coverage 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.

Missouri mini-COBRA laws (revised August 05) requires employers with less than 20 employees to offer COBRA for 9 months as long as they were insured under the group plan for at least 3 months.

Additional Missouri Resources

• Missouri Health Insurance Pool (MHIP)
  Offered through the State of Missouri and administered by Blue Cross Blue Shield of Missouri, the Missouri Health Insurance Pool is designed for individuals unable to obtain individual health insurance coverage due to their high risk health status.
• Missouri MC+ for Kids
  A state sponsored and federally funded health insurance program for eligible uninsured children, ages birth to 19 years of age.
• Missouri Department of Social Services
  The Missouri Department of Social Services, Division of Medical Services administers the Medicaid Program in the State of Missouri. The goal of this department is to provide and monitor the health care needs of the disabled and low income residents of the state.

MO Medical Insurance Statistics

Total Population: 5,710,000
With Health Insurance: 5,019,000 / 87.9%
Without Health Insurance: 691,000 / 12.1%
*According to 2005 CPS Reports / U.S. Census Bureau

Note: The percentage of Missouri residents without health insurance has increase by .5% since 2004.

Missouri Department of Insurance Financial Institutions & Professional Registration
Phone: 573-751-4126
The DIFP regulates the insurance industry in Missouri, offering consumer information and many helpful consumer links.

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