376.452. Large group market, renewal or continuation of coverage required--nonrenewal or discontinuation permitted, when--conditions for discontinuation.
Large group market, renewal or continuation of coveragerequired--nonrenewal or discontinuation permitted,when--conditions for discontinuation.
376.452. 1. Except as provided in this section, if a healthinsurance issuer offers health insurance coverage in the large group marketin connection with a group health plan, the health insurance issuer shallrenew or continue the coverage in force at the option of the plan sponsor.
2. A health insurance issuer may nonrenew or discontinue healthinsurance coverage offered in connection with a group health plan in thelarge group market if:
(1) The plan sponsor has failed to pay premiums or contributions inaccordance with the terms of the health insurance coverage or if the healthinsurance issuer has not received timely premium payments;
(2) The plan sponsor has performed an act or practice thatconstitutes fraud or has made an intentional misrepresentation of materialfact under the terms of the coverage;
(3) The plan sponsor has failed to comply with the health insuranceissuer's minimum participation requirements;
(4) The plan sponsor has failed to comply with the health insuranceissuer's employer contribution requirements;
(5) The health insurance issuer is ceasing to offer coverage in thelarge group market in accordance with subsection 3 of this section;
(6) In the case of a health insurance issuer that offers healthinsurance coverage in the large group market through a network plan, thereis no longer any enrollee under the group health plan who lives, resides,or works in the service area of the health insurance issuer or in the areafor which the issuer is authorized to do business;
(7) In the case of health insurance coverage that is made availablein the large group market only through one or more bona fide associations,the membership of an employer in the bona fide association ceases, but onlyif coverage is terminated under this subdivision uniformly without regardto any health status-related factor of any covered individual.
3. A health insurance issuer shall not discontinue offering aparticular type of group health insurance coverage offered in the largegroup market unless:
(1) The issuer provides notice to each plan sponsor, participant andbeneficiary provided coverage of this type in the large group market of thediscontinuation at least ninety days prior to the date of thediscontinuation of the coverage;
(2) The issuer offers to each plan sponsor being provided coverage ofthis type in the large group market the option to purchase any other healthinsurance coverage currently being offered by the health insurance issuerto a group health plan in the large group market; and
(3) The issuer acts uniformly without regard to the claims experienceof those plan sponsors or any health status-related factor of anyparticipant or beneficiary covered or new participant or beneficiary whomay become eligible for such coverage.
4. (1) A health insurance issuer shall not discontinue offering allhealth insurance coverage in the large group market unless:
(a) The issuer provides notice of discontinuation to the director andto each plan sponsor, participant and beneficiary covered at least onehundred eighty days prior to the date of the discontinuation of coverage;and
(b) All health insurance issued or delivered for issuance in Missouriin the large group market is discontinued and coverage under such healthinsurance is not renewed.
(2) In the case of a discontinuation under this subsection, thehealth insurance issuer shall not provide for the issuance of any healthinsurance coverage in the large group market for a period of five yearsbeginning on the date of the discontinuation of the last health insurancecoverage not renewed.
5. At the time of coverage renewal, a health insurance issuer maymodify the health insurance coverage for a product offered to a grouphealth plan in the large group market. For purposes of this subsection,renewal shall be deemed to occur not more often than annually on theanniversary of the effective date of the group health plan's healthinsurance coverage unless a longer term is specified in the policy orcontract.
6. In the case of health insurance coverage that is made available bya health insurance issuer only through one or more bona fide associations,a reference to plan sponsor in this section is deemed, with respect tocoverage provided to an employer member of the association, to include areference to such employer.
(L. 2007 H.B. 818)Effective 1-01-08