Insurance Law

CCS/HCS/SS#2/SCS/SB 1 – Affirmatively states that occupational diseases are exclusively covered under workers’ compensation laws. Employers shall not have subrogation rights in toxic exposure cases when a third person is liable to the employee. Also modifies provisions relating to workers’ compensation insurers. 

Workers’ compensation insurers may develop an individual risk premium modification rating plan which prospectively modifies premiums based upon individual risk characteristics which are predictive of future loss. The plan shall be filed 30 days prior to use and may be subject to disapproval by the director. The rating plan shall establish objective standards for measuring variations in individual risks for hazards or expense and be actuarially justified. They shall not result in premiums which are excessive, inadequate, or unfairly discriminatory. 

The act shall become effective January 1, 2014. (See also Workers Compensation Law) (Signed 7/10/13) 

CCS/HCS/SS/SB 34 – Requires the Division of Workers’ Compensation to develop and maintain a workers’ compensation claims database that is accessible to potential employers during a pre–hire period and searchable by an employee’s name and social security number. 

Prohibits the experience rating plan used by workers’ compensation insurers from making an adjustment to the experience modification of an employer if the total medical cost does not exceed 20% of the current split point of primary and excess losses under the uniform experience rating plan. 

Also includes provisions relating to the formula to equalize premium rates for employers within the construction group of code classifications. (Vetoed 7/2/13) 

SB 59 – Revises the definition of "Covered Claim" for purposes of The Missouri Property and Casualty Insurance Guaranty Association Act. 

Provides that no member insurer of the Missouri Property and Casualty Insurance Guaranty Association may be assessed in any year on any account an amount greater than 2%of that member insurer’s net direct written premiums for the preceding calendar year on the kinds of insurance in the account. 

Modifies the membership of the board of directors of the Missouri Property and Casualty Insurance Association. 

Modifies the law regarding insurance coverage under the Missouri Life and Health Insurance Guaranty Association Act. (Signed 5/17/13) 

SB 60 – Changes the laws regarding the accreditation requirements for reinsurance companies in order to comply with the federal Nonadmitted and Reinsurance Reform Act of 2010. 

The provisions of this act become effective on January 1, 2014. (Vetoed 5/17/13) 

HCS/SB 148 – Modifies various provisions relating to the regulation of salvage motor vehicles that affect insurers. (See also Motor Vehicles & Transportation Law

SS/SCS/SB 159 – Prohibits health carriers from imposing greater copayments or coinsurance percentages to insureds for certain prescribed covered services. (See Health and Hospital Law

CCS/HCS/SB 161 – Under this act, the Oversight Division of the Joint Committee on Legislative Research must conduct an actuarial analysis of the cost impact to consumers, health insurers, and other private and public payers if a state mandate was enacted to provide health benefit plan coverages for: 

Certain orally administered anticancer medications charged at the same out–of–pocket cost as intravenously administered or injected cancer medications; and diagnosis and treatment of certain eating disorders that include residential treatment and access to psychiatric and medical treatments. (Signed 7/8/13) 

CCS/HCS/SS/SB 262 – Modifies various provisions relating to health insurance. Provisions included affect: 

HMOS and deductible plans 

Exclusive in–network plans 

Individual and group policy form approval process 

The Missouri Health Insurance Pool – transition to federal health insurance exchange 

An actuarial analysis of certain health insurance mandates – is required to be conducted by the Oversight Division of the Joint Committee on Legislative Research. 

Utilization review procedure – Missouri’s current utilization review procedure is updated so that health carriers may notify health care providers of certain insurance determinations in an electronic manner. Current law only allows health carriers to notify providers by telephone. 

Credentialing of health care practitioners – Requirements are outlined for a health carrier to credential a health care practitioner within 60 business days of receiving a completed application and to pay the practitioner for treatment services pending approval. Certain conditions apply. 

The Department of Insurance, Financial Institutions and Professional Registration shall establish a mechanism for reporting alleged violations of this act to the department. 

Telehealth Health Insurance Coverage – Under this act, health carriers issuing or renewing health benefit plans on or after January 1, 2014, shall not deny coverage for a health care service on the basis that the service was provided through telehealth if the same service would be covered when delivered in person. 

Under the act, a health care service provided through telehealth services shall not be subject to any greater deductible, copayment, or coinsurance amount than would be applicable if the same health care service was provided through face–to–face diagnosis, consultation, or treatment. 

Allows a health carrier or health benefit plan to limit coverage for health care services that are provided through telehealth to health care providers that are in a network approved by the plan or the health carrier. 

The provisions of the act do not apply to certain types of supplemental insurance policies such as accident–only policies or Medicare supplement policies. 

The telehealth mandate portion of the act has an effective date of January 1, 2014. 

Establishes the Missouri Oral Chemotherapy Parity Interim Committee. 

Provides that no individual or entity shall perform, offer to perform, or advertise any service as a navigator in Missouri or receive navigator funding from Missouri or a health insurance exchange unless licensed as a navigator by the Department of Insurance, Financial Institutions and Professional Registration. 

Unless properly licensed as a health insurance producer in this state, a navigator shall not: 

 (1) Sell, solicit, or negotiate health insurance; 

 (2) Engage in any activity that would require an insurance producer license; 

 (3) Provide advice concerning the benefits, terms, and features of a particular health plan or offer advice about which exchange health plan is better or worse for a particular individual or employer; 

 (4) Recommend or endorse a particular health plan or advise consumers about which health plan to choose; or 

 (5) Provide any information or services related to health benefit plans or other products not offered in the exchange. 

The act specifically exempts certain entities from the licensure requirements. Specifically, health insurance producers, law firms, licensed attorneys, and certain health care providers are exempt from licensure. 

The act delineates the process for obtaining a navigator license, including the qualifications for obtaining such a license, the payment of licensing fees, and other ancillary matters. 

Under the act, any navigator who has contact with a person who acknowledges having existing health insurance coverage obtained through an insurance producer must advise the person to consult with a licensed insurance producer regarding coverage in the private market. The act establishes a procedure for suspending, revoking, or refusing to issue or renew a navigator license. 

Allows the director to issue administrative orders and maintain civil actions against persons who are violating the navigator licensure provisions. 

Under the terms of the act, each licensed navigator shall report to the director within 30 calendar days of the final disposition of the matter of any administrative action taken against him or her in another jurisdiction or by another governmental agency in this state. The act further requires, within 30 days of the initial pretrial hearing date, a navigator to report any criminal prosecution of the navigator in any jurisdiction. 

The provisions pertaining to navigator licensing are severable. 

Authorizes the director to promulgate rules and regulations to implement the licensing provisions. 

Provides that the Department of Insurance shall exercise its authority and responsibility over health insurance product form filings, consumer complaints, and investigations into compliance with state law, regardless as to how a health insurance product may be sold or marketed in this state or to residents of this state. 

The navigator provisions are subject to an emergency clause. 

Requires health carriers to accept any willing licensed physician into its closed or exclusive network established under the act who agrees to accept a fee schedule, payment or reimbursement rate that is 15% less than the health carrier’s standard prevailing or market fee schedule, payment or reimbursement rate for such network in the specific geography of the licensed physician’s practice. The provisions of this portion of the act shall not apply to any licensed physician who does not meet the health carrier’s selection standards and credentialing criteria or who has not entered into the health carrier’s standard participating provider agreement. (Signed 7/12/13) 

SCS/SB 287 – Modifies Missouri’s current captive insurance law to allow for the formation of sponsored captive insurance companies. 

Provisions affected include definitions to capital and surplus requirements, cancellation of hearings, merging or consolidating a licensed captive insurance company, and a premium tax. (Signed 5/16/13) 

SCS/SB 324 – Regulates the offer and dissemination of travel insurance and establishes a limited lines travel insurance producer licensure system. The Director of Insurance is authorized to promulgate rules to administer the provisions of the act. (Signed 5/16/13) 

– Governs the responsibility of vendors for selling portable electronics insurance. Deletes the requirement that the vendors provide actual policies or certificates of coverage to prospective customers. This act contains an emergency clause. (Signed 6/25/13) 

HB 133 – Changes the laws regarding the accreditation requirements for reinsurance companies in order to comply with the federal Nonadmitted and Reinsurance Reform Act of 2010. The act changes the requirements for a reinsurance company to do business in Missouri and specifies when an insurance company can take credit or reduce liability on its financial statement due to reinsurance. The act is based upon the NAIC Credit for Reinsurance Model Law. The provisions of this act become effective on January 1, 2014. (Signed 6/12/13) 

SCS/HB 322 – Allows proof of financial responsibility and other insurance–related documents to be provided or presented through electronic means. 

Allows a motorist to provide proof of financial responsibility for vehicle registration purposes by displaying an image of an insurance identification card on a mobile electronic device. 

Allows the insurance identification card that contains proof of insurance information for a motor vehicle to be produced in a paper or an electronic format. Acceptable electronic forms include the display of electronic images on a cellular phone or any other type of portable electronic device. Under the act, an image of a motor vehicle liability insurance policy displayed on a mobile electronic device shall serve as satisfactory evidence of insurance in lieu of an insurance identification card. 

The display of an image of an insurance card on a mobile electronic device shall not serve as consent for a law enforcement officer to access other contents of the device in any manner other than to verify the image of the insurance card. 

Under the act, a person presenting his or her mobile electronic device to a law enforcement officer shall assume all liability for any damage to the mobile electronic device except for damage willfully or maliciously caused by a law enforcement officer. 

It will be a Class B misdemeanor to knowingly or intentionally produce or distribute fraudulent identification card images on a mobile electronic device. 

Missouri Auto Insurance Plan – Amends Missouri’s automobile insurance residual market mechanism law. 

Delivery, Storage and Presentation of Insurance Documents – Under the terms of this act, any notice to a party or any other document required under applicable law in an insurance transaction or that is to serve as evidence of insurance coverage may be delivered, stored, and presented by electronic means so long as it meets the requirements of the Uniform Electronic Transactions Act. Conditions apply, however, nothing in the act shall prevent insurers from offering discounts to insureds who elect to receive notices and other documents in an electronic format. 

Provision of Policy Forms and Endorsements Electronically – Provides that certain property insurance policy forms and endorsements, which do not contain personally identifiable information, may be made available electronically on the insurer’s website in lieu of mailing or delivering a paper copy of policy forms and endorsements to an insured. The insurer shall also notify the insured of their right to obtain a paper copy of the policy forms and endorsements at no cost and provide either a toll–free telephone number or the telephone number of the insured’s producer by which the insured can make this request. Certain conditions apply. (Signed 7/9/13) 

HB 339 – Under the terms of this act, uninsured motorists forfeit their ability to collect noneconomic damages from insured motorists due to motor vehicle accidents in which the insured motorists are alleged to be at fault. The statutory “no pay, no play” waiver or forfeiture shall not apply if the accident is caused by tortfeasor who operated a motor vehicle under the influence of alcohol or drugs, or is caused by a person convicted of second degree manslaughter or second degree assault. The act shall not apply to uninsured motorists whose immediately previous insurance policy was terminated or nonrenewed for failure to pay the premium unless notice of termination or nonrenweal for failure to pay such premium was provided by the insurer at least 6 months prior to the accident. Under the act, the jury shall not be informed that the uninsured tort victim is forfeiting noneconomic damages. The terms of the act shall not apply to the passengers in an uninsured motor vehicle. (Vetoed 7/1/13) 

– Includes provisions relating to Telehealth Health Insurance Coverage. (See Health & Hospital Law)