Mo. Code Regs. tit. 20 § 400-2.130

Current through Register Vol. 49, No. 21, November 1, 2024.

Section 20 CSR 400-2.130 - Group Health Filings

PURPOSE: This rule effectuates or aids in the interpretation of section 376.421, RSMo. The rule specifies how the Department of Commerce and Insurance will determine whether group health coverage provided, solicited or issued in Missouri complies with the descriptions of groups in section 376.421, RSMo.

(1) As used in this rule, the following terms mean:

(A) Discretionary group, any group not described in section 376.421.1, RSMo;

(B) DCI, the Missouri Department of Commerce and Insurance; and

(C) True group, any group described in section 376.421.1, RSMo.

(2) Group health policies delivered in Missouri are subject to the following:

(A) Any policy must be delivered to a true group or to a discretionary group;

(B) Any policy form issued to a discretionary group must be approved by the MDI under section 376.421.2(1), RSMo. This policy filed with the MDI must be accompanied by an affidavit and necessary exhibits on a form approved by the MDI, as included herein;

(C) Whenever reasonably necessary to determine whether a group policy is being issued by a true group, the MDI may require an affidavit on a form approved by the MDI, as included herein, to determine whether a group is a true group;

(D) Any policy filed with the MDI under this section of this rule is a filing required by law and the filing fee, required by section 374.230(6), RSMo, must be paid; and

(E) If a company violates section 376.421, RSMo or this rule with an unfiled policy, the failure to file will be evidence that the violation was willful.

(3) Group health policies not delivered in Missouri are subject to the following:

(A) Any coverage solicited or sold in this state, whether by direct mail, insurer producer contact, telephone contact or advertisement, must be delivered to a true group or a discretionary group;

(B) Whether a group is a true group will be determined by the descriptions contained in section 376.421.1, RSMo, not by the descriptions or lack of descriptions in another state's law;

(C) Whenever reasonably necessary to determine whether a group policy is being issued to a true group, the MDI may require an affidavit on a form approved by the MDI, as included herein, to determine whether a group is a true group;

(D) The MDI shall require an affidavit with necessary exhibits on a form approved by the MDI, as included herein, for any policy issued to a discretionary group. This affidavit will be unnecessary only if another state having a law substantially similar to section 376.421.2(1), RSMo has approved the policy as a discretionary group policy;

(E) Any policy found by the MDI to be delivered to a true group or to a discretionary group which is approved by another state under subsection (3)(D) is filed for information only. The MDI will not charge a filing fee for a policy filed for information only. Any other policy is a filing required by law for which the filing fee under section 374.230(6), RSMo must be paid; and

(F) If a company violates section 376.421, RSMo or this rule with an unfiled policy, the failure to file will be evidence that the violation was willful.

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20 CSR 400-2.130

AUTHORITY: section 374.045, RSMo 2000.* This rule was previously filed as 4 CSR 190-14.170. Original rule filed Oct. 5, 1989, effective May 1, 1990. Amended: Filed April 23, 1999, effective Nov. 30, 1999. Amended: Filed July 12, 2002, effective Jan. 30, 2003. Non-substantive change filed Sept. 11, 2019, published Oct. 31, 2019.

*Original authority: 374.045, RSMo 1967, amended 1993, 1995.