376.995. Limited mandate health insurance policies defined--certain sections not to apply to limited mandate health insurance policies, exceptions--requirements to sell or issue--certain law to apply.
Limited mandate health insurance policies defined--certain sectionsnot to apply to limited mandate health insurance policies,exceptions--requirements to sell or issue--certain law to apply.
376.995. 1. This section shall be known as the "Limited MandateHealth Insurance Act".
2. Limited mandate health insurance policies and contracts shall meanthose policies and contracts of health insurance as defined in section376.960 and which cover individuals and their families (but not includingany Medicare supplement policy or contract) and groups sponsored by anemployer who employs fifty or fewer persons.
3. No law requiring the coverage of a particular health care serviceor benefit, or requiring the reimbursement, utilization or inclusion of aspecific category of licensed health care practitioner, shall apply tolimited mandate health insurance policies and contracts, except thefollowing provisions:
(1) Subsection 1 of section 354.095, RSMo, to the extent that itregulates maternity benefits;
(2) Section 375.995, RSMo;
(3) Section 376.406;
(4) Section 376.428;
(5) Section 376.782;
(6) Section 376.816;
(7) Section 376.1210;
(8) Section 376.1215; and
(9) Section 376.1219.
4. In order for an insurer as defined in section 376.960 to beeligible to market, sell or issue limited mandate health insurance, theinsurer shall:
(1) Restrict its marketing and sales efforts to only those persons orgroups as defined in subsection 2 of this section which currently do nothave health insurance coverage or to those persons or employers whichcertify in writing to the insurer that they will terminate the coveragethey currently have at the time they would otherwise renew coverage becauseof cost;
(2) Fully and clearly disclose to the person or group to whom thelimited mandate health insurance policy or contract is to be issued thatthe reason coverage for this product is less expensive than other coverageis because the policy or contract does not contain coverages or healthprofessional payment mechanisms that are required by subsection 3 of thissection;
(3) Clearly disclose in all sales, promotional and advertisingmaterial related thereto that the product is a limited mandate healthinsurance policy or contract.
5. The provisions of section 376.441 shall not apply to any groupwhich replaces its current coverage with a limited mandate health insurancepolicy or contract if the benefit to be extended is one for services whichare not covered by the replacing policy or contract.
6. Notwithstanding any other provision of this section to thecontrary, the provisions of paragraph (b) of subdivision (11) of section375.936, RSMo, shall apply to limited mandate health insurance policieswith respect to physician services covered under such policies, which canbe provided by persons licensed pursuant to section 332.181, RSMo.
(L. 1990 H.B. 998 § 15, A.L. 1992 S.B. 796, A.L. 1996 H.B. 904, et al. merged with H.B. 1069, A.L. 1997 H.B. 600 & 388)