99-05: Summary of 1999 MO Legis. Impacting Health Plan Benefits

* This bulletin was repealed by 08-05

To:           Health Insurers, Health Services Corporations And Health Maintenance Organizations

From:      Keith A. Wenzel, Director, Missouri Department of Insurance

Re:          Summary Of 1999 Missouri Legislation Impacting Health Plan Benefits

Date:       November 30, 1999

This bulletin is issued to correct information contained in Bulletin 99-04. The corrected information is with respect to the effective date of certain provisions of House Bill 401 as underlined below.

House Bill 191 Enacts Several Requirements for Health Carriers and Their Contracts

This bill creates the Mental Health and Chemical Dependency Insurance Act. Statute sections 376.810 to 376.814, RSMo, which first became law in 1990, require insurers to offer specified benefits for mental illness. House Bill 191 continues to require this benefit offer, but after January 1, 2000, if this offer is rejected, the law will require any policy that provides benefits for mental illness to provide no less than the benefits set forth in 376.825 to 376.835, RSMo.

House Bill 191 also mandates that group and individual contracts issued for delivery, continued or renewed in Missouri on or after August 28, 1999, must cover pelvic exams and pap smears as well as prostate and colorectal exams.

After January 1, 2002, health insurance carriers must use standardized information for the explanation of benefits given to health care providers when a claim is paid or denied.

After January 1, 2002, all health care providers and health carriers shall use standardized information for referrals.

House Bill 401 requires all health carriers to provide coverage for newborn hearing screening, necessary rescreening, audiological assessment and followups, and initial amplification. This mandated coverage applies to contracts issued, continued or renewed after August 28, 1999.

House Bills 316, 660 & 203 require health maintenance organizations and preferred provider organizations to cover services delivered to residents of long-term care facilities licensed pursuant to chapter 198, RSMo. This coverage is to be available under certain conditions whether or not the facility has a contract with the managed care organization.

House Bill 903 adds health maintenance organizations to the entities subject to sections 376.431 to 376.442, RSMo. These sections establish minimum standards for health carriers to provide notices of discontinuance, and to extend benefits for disabled persons in the event of plan amendment or termination.