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Section: 379.0952 Carriers to market plan coverage--agent or broker, prohibited activities, exception--variance in compensation prohibited, exceptions--carriers, prohibited activities--denial of application, requirements--penalty--applicability to th...


Published: 2015

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Missouri Revised Statutes













Chapter 379

Insurance Other Than Life

←379.950

Section 379.952.1

379.975→

August 28, 2015

Carriers to market plan coverage--agent or broker, prohibited activities, exception--variance in compensation prohibited, exceptions--carriers, prohibited activities--denial of application, requirements--penalty--applicability to third party administrators.

379.952. 1. Each small employer carrier shall actively market all health

benefit plans sold by the carrier in the small group market to eligible

employers in the state, except for plans developed for health benefit trust

funds.



2. (1) Except as provided in subdivision (2) of this subsection, no

small employer carrier or agent or broker shall, directly or indirectly,

engage in the following activities:



(a) Encouraging or directing small employers to refrain from filing an

application for coverage with the small employer carrier because of the

health status, claims experience, industry, occupation or geographic location

of the small employer;



(b) Encouraging or directing small employers to seek coverage from

another carrier because of the health status, claims experience, industry,

occupation or geographic location of the small employer.



(2) The provisions of subdivision (1) of this subsection shall not apply

with respect to information provided by a small employer carrier or agent or

broker to a small employer regarding the established geographic service area

or a restricted network provision of a small employer carrier.



3. (1) Except as provided in subdivision (2) of this subsection, no

small employer carrier shall, directly or indirectly, enter into any

contract, agreement or arrangement with an agent or broker that provides for

or results in the compensation paid to an agent or broker for the sale of a

health benefit plan to be varied because of the health status, claims

experience, industry, occupation or geographic location of the small employer.



(2) Subdivision (1) of this subsection shall not apply with respect to a

compensation arrangement that provides compensation to an agent or broker on

the basis of percentage of premium, provided that the percentage shall not

vary because of the health status, claims experience, industry, occupation or

geographic area of the small employer.



4. A small employer carrier shall provide reasonable compensation, as

provided under the plan of operation of the program, to an agent or broker,

if any, for the sale of a basic or standard health benefit plan.



5. No small employer carrier shall terminate, fail to renew or limit its

contract or agreement of representation with an agent or broker for any

reason related to the health status, claims experience, occupation, or

geographic location of the small employers placed by the agent or broker with

the small employer carrier.



6. No small employer carrier or producer shall induce or otherwise

encourage a small employer to separate or otherwise exclude an employee from

health coverage or benefits provided in connection with the employee's

employment; except that, a carrier may offer a policy to a small employer that

charges a reduced premium rate or deductible for employees who do not smoke

or use tobacco products, and such carrier shall not be considered in

violation of sections 379.930 to 379.952 or any unfair trade practice, as

defined in section 379.936, even if only some small employers elect to

purchase such a policy and other small employers do not.



7. Denial by a small employer carrier of an application for coverage from

a small employer shall be in writing and shall state the reason or reasons

for the denial with specificity.



8. The director may promulgate rules setting forth additional standards

to provide for the fair marketing and broad availability of health benefit

plans to small employers in this state.



9. (1) A violation of this section by a small employer carrier or a

producer shall be an unfair trade practice under sections 375.930 to 375.949*.



(2) If a small employer carrier enters into a contract, agreement or

other arrangement with a third-party administrator to provide administrative

marketing or other services related to the offering of health benefit plans to

small employers in this state, the third-party administrator shall be subject

to this section as if it were a small employer carrier.



(L. 1992 S.B. 796 § 12, A.L. 2006 S.B. 567 & 792, A.L. 2007 H.B. 818)



Effective 1-01-08



*Section 375.949 was repealed by S.B. 53, 1991.





2006

1994



2006



379.952. 1. Each small employer carrier shall actively market health

benefit plan coverage, including the basic and standard health benefit

plans, to eligible small employers in the state. If a small employer

carrier denies coverage to a small employer on the basis of the health

status or claims experience of the small employer or its employees or

dependents, the small employer carrier shall offer the small employer the

opportunity to purchase a basic health benefit plan or a standard health

benefit plan.



2. (1) Except as provided in subdivision (2) of this subsection, no

small employer carrier or agent or broker shall, directly or indirectly,

engage in the following activities:



(a) Encouraging or directing small employers to refrain from filing

an application for coverage with the small employer carrier because of the

health status, claims experience, industry, occupation or geographic

location of the small employer;



(b) Encouraging or directing small employers to seek coverage from

another carrier because of the health status, claims experience, industry,

occupation or geographic location of the small employer.



(2) The provisions of subdivision (1) of this subsection shall not

apply with respect to information provided by a small employer carrier or

agent or broker to a small employer regarding the established geographic

service area or a restricted network provision of a small employer carrier.



3. (1) Except as provided in subdivision (2) of this subsection, no

small employer carrier shall, directly or indirectly, enter into any

contract, agreement or arrangement with an agent or broker that provides

for or results in the compensation paid to an agent or broker for the sale

of a health benefit plan to be varied because of the health status, claims

experience, industry, occupation or geographic location of the small

employer.



(2) Subdivision (1) of this subsection shall not apply with respect

to a compensation arrangement that provides compensation to an agent or

broker on the basis of percentage of premium, provided that the percentage

shall not vary because of the health status, claims experience, industry,

occupation or geographic area of the small employer.



4. A small employer carrier shall provide reasonable compensation, as

provided under the plan of operation of the program, to an agent or broker,

if any, for the sale of a basic or standard health benefit plan.



5. No small employer carrier shall terminate, fail to renew or limit

its contract or agreement of representation with an agent or broker for any

reason related to the health status, claims experience, occupation, or

geographic location of the small employers placed by the agent or broker

with the small employer carrier.



6. No small employer carrier or producer shall induce or otherwise

encourage a small employer to separate or otherwise exclude an employee

from health coverage or benefits provided in connection with the employee's

employment; except that, a carrier may offer a policy to a small employer

that charges a reduced premium rate or deductible for employees who do not

smoke or use tobacco products, and such carrier shall not be considered in

violation of sections 379.930 to 379.952 or any unfair trade practice, as

defined in section 379.936, even if only some small employers elect to

purchase such a policy and other small employers do not.



7. Denial by a small employer carrier of an application for coverage

from a small employer shall be in writing and shall state the reason or

reasons for the denial with specificity.



8. The director may promulgate rules setting forth additional

standards to provide for the fair marketing and broad availability of

health benefit plans to small employers in this state.



9. (1) A violation of this section by a small employer carrier or a

producer shall be an unfair trade practice under sections 375.930 to

375.949, RSMo.



(2) If a small employer carrier enters into a contract, agreement or

other arrangement with a third-party administrator to provide

administrative marketing or other services related to the offering of

health benefit plans to small employers in this state, the third-party

administrator shall be subject to this section as if it were a small

employer carrier.



1994



379.952. 1. Each small employer carrier shall actively

market health benefit plan coverage, including the basic and

standard health benefit plans, to eligible small employers in the

state. If a small employer carrier denies coverage to a small

employer on the basis of the health status or claims experience

of the small employer or its employees or dependents, the small

employer carrier shall offer the small employer the opportunity

to purchase a basic health benefit plan or a standard health

benefit plan.



2. (1) Except as provided in subdivision (2) of this

subsection, no small employer carrier or agent or broker shall,

directly or indirectly, engage in the following activities:



(a) Encouraging or directing small employers to refrain

from filing an application for coverage with the small employer

carrier because of the health status, claims experience,

industry, occupation or geographic location of the small

employer;



(b) Encouraging or directing small employers to seek

coverage from another carrier because of the health status,

claims experience, industry, occupation or geographic location of

the small employer.



(2) The provisions of subdivision (1) of this subsection

shall not apply with respect to information provided by a small

employer carrier or agent or broker to a small employer regarding

the established geographic service area or a restricted network

provision of a small employer carrier.



3. (1) Except as provided in subdivision (2) of this

subsection, no small employer carrier shall, directly or

indirectly, enter into any contract, agreement or arrangement

with an agent or broker that provides for or results in the

compensation paid to an agent or broker for the sale of a health

benefit plan to be varied because of the health status, claims

experience, industry, occupation or geographic location of the

small employer.



(2) Subdivision (1) of this subsection shall not apply with

respect to a compensation arrangement that provides compensation

to an agent or broker on the basis of percentage of premium,

provided that the percentage shall not vary because of the health

status, claims experience, industry, occupation or geographic

area of the small employer.



4. A small employer carrier shall provide reasonable

compensation, as provided under the plan of operation of the

program, to an agent or broker, if any, for the sale of a basic

or standard health benefit plan.



5. No small employer carrier shall terminate, fail to renew

or limit its contract or agreement of representation with an

agent or broker for any reason related to the health status,

claims experience, occupation, or geographic location of the

small employers placed by the agent or broker with the small

employer carrier.



6. No small employer carrier or producer shall induce or

otherwise encourage a small employer to separate or otherwise

exclude an employee from health coverage or benefits provided in

connection with the employee's employment.



7. Denial by a small employer carrier of an application for

coverage from a small employer shall be in writing and shall

state the reason or reasons for the denial with specificity.



8. The director may promulgate rules setting forth

additional standards to provide for the fair marketing and broad

availability of health benefit plans to small employers in this

state.



9. (1) A violation of this section by a small employer

carrier or a producer shall be an unfair trade practice under

sections 375.930 to 375.949, RSMo.



(2) If a small employer carrier enters into a contract,

agreement or other arrangement with a third-party administrator

to provide administrative marketing or other services related to

the offering of health benefit plans to small employers in this

state, the third-party administrator shall be subject to this

section as if it were a small employer carrier.



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