97-08: Licensing of Health Maintenance Organization Enrollment

* This bulletin was repealed by 08-05

To:           All Health Maintenance Organizations

From:      Jay Angoff, Director

Re:          Licensing of Health Maintenance Organization Enrollment Representatives

Date:       December 3, 1997

The Missouri Departement of Insurance has received many inquiries from representatives of health maintenance organizations (HMOs) regarding the changes, if any, to the requirements for professional licensing of marketing agents, representatives, and employees of HMOs, in light of the passage of HB 335 during the last legislative session.   The purpose of this Bulletin is to inform the industry of the licensing requirements for HMO representatives, and agents engaged in marketing and/or enrollment activities.

Prior to the passage of HB 335, the requirements for the licensing and appointment of insurance agents and brokers, contained in sections 375.012-375.158, RSMo, did not apply to representatives, employees, or agents of HMOs, because sections of 354.400-354.550 did not make the insurance laws, including Chapter 375, specifically applicable to HMOs.   With the enactment of HB 335, however, the licensing and appointment requirements contained in sections 375.012-375.158 are now applicable to HMOs, due to the fact that section 375.012(5) specifically defines "insurance company" or "insurer" to include "any other legal entity engaged in the business of insurance, including...health maintenance organizations."

In light of the fact that the provisions of Chapter 375 are made specifically applicable to HMOs, any person who is engaged in activities which involve soliciting, negotiating, or procuring coverage on behalf of an HMO, and who is not paid, either partly or entirely on commission, does not need to be licensed.

For additional information regarding the licensing and appointment of those individuals who solicit, negotiate, or procure coverage on behalf of HMOs, please contact the Department's Licensing Section at (573) 751-3518.