Missouri Health Insurance Guide
Missouri Health Insurance Information, Health Organizations and Resources and access to online health insurance quotes
As a resident of Missouri you can choose from a variety of private health insurance plans including individuals and group plans provided by an employer. Depending on your income or employment status, you may also be eligible for Missouri State-funded affordable health insurance for individuals and families, and federal programs such as Medicaid and COBRA.
Missouri is not a guarantee issue state. That means private insurance companies are not required to sell you an individual health insurance policy if do not meet their underwriting criteria. You can be turned down for any number of reasons including your past or current health. If you are accepted, there is no limit on the exclusionary or look-back periods for pre-existing conditions. These can be exercised at anytime that your policy is in effect. If a condition is deemed to be pre-existing, benefits can be denied. Missouri also allows elimination riders, which can temporarily or permanently result in denial of benefits for a specific medical condition. Insurers issuing individual health policies in Missouri do not have to give credit for prior creditable coverage, unless you have 18 months of prior creditable coverage. Missouri law does not set caps on what an insurer can charge for individual health care policies. Your individual Missouri health insurance quote can be based on your age, sex, where you live, the plan you choose and your health.
Missouri is a guarantee issue state for group health plans issued to small businesses. If your Missouri health insurance is provided through your employer, your coverage cannot be denied because of your past or current health. However, a maximum 12-month exclusionary period and 6-month look-back period for pre-existing conditions can be applied if you don’t have proof of prior creditable coverage. Before imposing an exclusionary period, the insurer must inform you in writing. Missouri allows group health insurance issuers to medically underwrite policies to determine the premium they will charge the entire group, although the highest premium cannot be more than 25% of the standard rate. Rates can be adjusted based on the nature of a business, its location and the size of the group.
Missouri is a guaranteed renewal state. Regardless of your health, your insurer must renew your individual health insurance policy as long as you’ve paid your premiums on time and haven’t defrauded the company, or in the case of some HMOs, as long as you haven’t moved out of the service area. However, your premiums can be increased to reflect your current health status.
Missouri Mandated Health Benefits
Missouri laws require private health insurance policies to cover several state-mandated benefits. These currently include:
- Alcoholism and Drug Abuse Treatment
- Ambulatory Surgery
- Blood Lead Poisoning
- Bone Marrow Transplants
- Bone Mass Measurement
- Breast Reconstruction
- Cervical Cancer and HPV Screening
- Clinical Trials
- Colorectal Cancer Screening
- Contraceptives
- Dental Anesthesia
- Diabetic Supplies
- Emergency Services
- Hair Prostheses
- Mammography
- Mastectomy and Mastectomy Stays
- Maternity and Maternity Stays
- General and Parity Mental Health
- Newborn Hearing Screening
- Off-Label Drug Use
- PKU/Formula
- Prostate Cancer Screening
- Second Surgical Opinion
- Well-Child Care
- Coverage for newborns under parent's policy
- Coverage for continuation/dependents under their parents’ policies
- Coverage for continuation/employees
- Coverage for conversion to non-group
Plans Available in Missouri
The following major medical health insurance plans are generally available in Missouri. Major medical plans cover illness and injury, hospitalization, prescription drugs and office visits, as well as the mandated services stated above.
Indemnity plans - Typically the most flexible and therefore highest priced choice, an indemnity plan lets you select your health providers and facilities. Depending on your plan, you will have to pay a deductible or co-insurance.
Preferred provider organization plans (PPOs) - You select from a network of preferred health care providers and facilities, and receive services at an agreed-upon discounted rate. You also have the option of going outside the network, but typically at a higher cost. You do not need a referral from a primary care physician to see a specialist. Premiums may be less than an indemnity plan but more than an HMO. You will have to pay a deductible or co-insurance.
Health maintenance organizations (HMOs) - HMOs plans require you to select a primary care physician from a prescribed network of providers, who must issue a referral before you can see a specialist. Services and covered costs are typically more comprehensive than those provided by a PPO. HMOs offer the advantage of affordable premiums and low out-of-pocket costs, with an emphasis on preventive care. Non-emergency services out of network are usually not reimbursed.
Point of Service plans (POS) - Similar to a PPO in that you will receive reimbursement for out-of-network care, but with an HMO’s requirement for a primary care physician who must provide referrals to specialists. Premiums, co-pays and co-insurance are typically higher than what you’d pay with an HMO.
Alternative Health Programs in Missouri
Missouri Health Insurance Pool
MHIP provides health coverage to Missouri residents who are unable to obtain private health insurance. You are eligible if your health insurance has been involuntarily terminated or if you are being charged in excess of 150% of the standard coverage premium. Other eligibility requirements may also apply. You can choose from one of four different PPO plans with deductibles ranging from $500 to $5,000. All options require you to pay a 20% coinsurance for in-network services and 50% or out-of-network care. Maximum out-of-pocket costs vary per plan. All plans also have separate deductibles for prescription drugs. Enrollment is open. Premiums are based on similar plans at the standard risk rate, but cannot be less than 125% or greater than 200% of that standard rate. Pre-existing conditions will involve a 6-month waiting period before benefits are payable, but waivers are available. Lifetime maximum benefits on all MHIP plans is $1million.
Missouri HealthNet for Kids
MO HealthNet for Kids provides comprehensive health coverage to resident uninsured children up to age 19, whose family household income meets the plan requirements. Some waiting periods may apply.
Monthly premiums vary by family income but cannot exceed 5% of annual income. If out-of-pocket expenses in a plan year exceed the annual premium, premium payments are waived for the remainder of the year. Co-pays may be required for some services. Enrollment is open and continuous unless family size or income changes.
Regulating Agency
The Missouri Department of Insurance, Financial Institutions and Professional Registration is responsible for regulating Missouri’s health insurance industry.
Get access to Missouri health insurance quotes from einsurance.com.
Department of Insurance, Financial Institutions & Professional Registration
PO Box 690
Jefferson City, MO 65102-0690
(573) 751-4126
http://insurance.mo.gov
Missouri Health Insurance Pool
Managed health care coverage for Missourians who are unable to obtain standard health coverage because of high-risk health conditions.
Penntower Building
3100 Broadway, Suite 210
Kansas City, MO 64111-2533
(800) 821-2231
(800) THE-MHIP ((800) 842-6447
http://www.mhip.org
MO HealthNet for Kids
Missouri Department of Social Services
221 West High Street
PO Box 1527
Jefferson City, MO 65102-1527
http://www.dss.mo.gov/mhk/index.htm
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
http://www.naic.org/
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org/