Life and Health Section
Insurance must approve any life or health insurance policy form that an insurer wants to sell in the state. This prior-approval requirement extends to all group or individual insurance policies or annuity contracts issued in Missouri by any insurer, health service corporation, fraternal benefit society, prepaid dental plan or HMO.
Missouri does not require filing or prior approval of rates charged for most life and health insurance policies, except Medicare supplement (Medigap) policies. The 10 standardized Medicare supplement policy forms require substantial disclosure to consumers about the coverage available. Federal and state law require Medicare supplement policies to return benefits equal to at least 65 percent of the premium collected of the lifetime of the policy. The Life and Health Section approves these policies, related forms, rates and advertising.
Under Missouri’s long-term care insurance law, the Life and Health Section reviews these policies to verify that rates are established to meet a 60 percent minimum loss standard as well as provide the legally required benefits.
Credit insurance rates are regulated only if the insurers propose rates that exceed those in law or use rating methods different from the legal standard. The Life and Health Section monitors these deviations to maintain compliance with legal loss standards.
The Life and Health Section also assures that insurers offering health coverage to Missouri’s small businesses comply with the Small Employer Health Insurance Availability Act. Missouri has 54 companies registered as carriers for employer groups of three to 25 employees. This law, together with the federal Health Insurance Portability and Accountability Act (HIPAA) of 1996, provides protection to smaller employers. Although federal agencies enforce the HIPAA law in Missouri, Insurance monitors compliance, fields complaints from consumers and advises federal regulators on problems. Missourians consequently benefit from whichever provisions of state or federal laws are more favorable to them.
The Life and Health Section approves registration applications of utilization review agents which evaluate the appropriateness and necessity of services that health benefit plans may cover. The section also processes renewal applications for the 137 active utilization review agents in Missouri.