376.451. Standards prohibiting discrimination.
Standards prohibiting discrimination.
376.451. 1. A health insurance issuer offering group healthinsurance coverage shall comply with the following standards prohibitingdiscrimination as to eligibility based upon health status:
(1) A health insurance issuer offering group health insurancecoverage shall not establish rules for eligibility, including continuedeligibility, of any individual to enroll under the terms of the grouphealth plan based on any of the following health status-related factors ofthe individual or a dependent of the individual:
(a) Health status;
(b) Medical condition, including both physical and mental illness;
(c) Claims experience;
(d) Receipt of health care;
(e) Medical history;
(f) Genetic information;
(g) Evidence of insurability, including conditions arising out ofacts of domestic violence; or
(h) Disability;
(2) This subsection does not require a health insurance issueroffering group health insurance coverage to provide particular benefitsother than those provided under the terms of the group health insurancecoverage, or prevent the issuer from establishing limitations orrestrictions on the amount, level, extent, or nature of the benefits orcoverage for similarly situated individuals enrolled in the group healthinsurance coverage;
(3) For purposes of subdivision (1) of this subsection, rules foreligibility to enroll include rules defining any applicable waiting oraffiliation period for such enrollment, and rules relating to late andspecial enrollments.
2. A health insurance issuer offering group health insurance coverageshall comply with the following standards prohibiting discrimination as topremium contributions based upon health status:
(1) A health insurance issuer offering health insurance coverage inconnection with a group health plan shall not require any individual, as acondition of enrollment or continued enrollment under the plan, to pay apremium or contribution that is greater than the premium or contributionfor a similarly situated individual enrolled in the group health plan onthe basis of any health status-related factor in relation to the individualor to an individual enrolled under the plan as a dependent of theindividual;
(2) Nothing in subdivision (1) of this subsection shall be construedto:
(a) Restrict the amount that any employer may be charged for coverageunder a group health plan, other than as provided in sections 379.930 to379.952, RSMo, for health insurance coverage provided in the small groupmarket; or
(b) Prevent a health insurance issuer offering group health insurancecoverage from establishing premium discounts or rebates or modifyingotherwise applicable co-payments or deductibles in return for adherence toprograms of health promotion and disease prevention. Premium discount orrebates established under this subsection shall not be included whencomputing a small group rate band under section 379.936, RSMo.
(L. 2007 H.B. 818)Effective 1-01-08