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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