Section 376.1850

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS

Chapter 376

Effective - 28 Aug 2025, see footnote   

  376.1850.  Exemption from insurance coverage for certain organization contracts — registration requirements — contract requirements — fee, amount — coverage. — 1.  As used in this section, the following terms mean:

  (1)  "Contract for health care benefits", a self-funded contractual arrangement made in accordance with this section between a qualified membership organization and its members to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services;

  (2)  "Farm bureau", a nonprofit agricultural membership organization first incorporated in this state at least one hundred years ago, or an affiliate designated by the nonprofit agricultural membership organization;

  (3)  "Health care service", the same meaning as is ascribed to such term in section 376.1350;

  (4)  "Member of a qualified membership organization", a natural person who pays periodic dues or fees, other than payments for a contract for health care benefits, for membership in a qualified membership organization, and the natural person's spouse or dependent children under the age of twenty-six;

  (5)  "Qualified membership organization", a farm bureau, or an entity with at least one hundred thousand dues-paying members, that is governed by a council of its members, that has at least five hundred million dollars in assets, and that exists to serve its members beyond solely offering health coverage.

  2.  The provisions of this chapter relating to health insurance, health maintenance organizations, health benefit plans, group health services, and health carriers shall not apply to contracts for health care benefits provided by a qualified membership organization.  A qualified membership organization providing contracts for health care benefits shall not be considered to be engaging in the business of insurance for purposes of any provision of chapters 361 to 385.

  3.  It is unlawful to provide a contract for health care benefits under this section unless the qualified membership organization providing the contract is registered with the department of commerce and insurance as provided in this subsection.  To register as a qualified membership organization, an applicant shall file information with the director demonstrating it meets the requirements of this section and pay an application fee of two hundred ^* fifty dollars.  A registration is valid for five years and may be renewed for additional five-year terms if the qualified membership organization continues to meet the requirements of this section and pays a renewal fee of two hundred ^* fifty dollars.  All amounts collected as registration or renewal fees shall be deposited into the insurance dedicated fund established under section 374.150.

  4.  Contracts for health care benefits provided under this section shall be offered only to members of a qualified membership organization who have been members of the organization for at least thirty days; and shall be sold, solicited, or negotiated only by insurance producers licensed under chapter 375 to produce accident and health or sickness coverage.

  5.  Notwithstanding any provision of law to the contrary, a qualified membership organization providing a contract for health care benefits under this section shall use the services of an administrator permitted to provide services in accordance with sections 376.1075 to 376.1095, and shall agree in the contract with such administrator to utilize processes for benefit determinations and claims payment procedures in accordance with the requirements applicable to health carriers and health benefit plans under sections 376.383, 376.690, and 376.1367.  A contract for health care benefits provided under this section shall not be subject to the laws of this state relating to insurance or insurance companies except as specified in this section.

  6.  The risk under contracts provided in accordance with this section may be reinsured in accordance with section 375.246.

  7.  (1)  Contracts for health care benefits under this section shall include the following written disclaimer on the front of the contract and all related applications and renewal forms in a bold font no smaller than sixteen point:

"NOTICE

This contract is not health insurance and is not subject to federal or state laws relating to health insurance.  This contract offers fewer benefits than an ACA-compliant health plan and may exclude coverage for preexisting conditions.  You may qualify for income-based subsidies through the ACA Health Insurance Marketplace.  This contract is not covered by the Missouri Insurance Guaranty Association.  You may be financially responsible for costs of medical treatment that may not be covered under this contract.".

  (2)  The written disclaimers required by subdivision (1) of this subsection on applications and renewal forms shall be signed by the member entering into or renewing the contract, specifically acknowledging that the coverage is not considered insurance and is not subject to regulation by the department of commerce and insurance.

  (3)  The qualified membership organization providing the contract shall retain a copy of written acknowledgements required under subdivision (2) of this subsection for the duration for which claims may be submitted under the contract, and shall provide a copy of the acknowledgement to the member upon the member's request.

  8.  Contracts provided under this section shall not be subject to individual post-claim medical underwriting while coverage remains in effect, and no member covered under a contract provided under this section shall be subject to cancellation, nonrenewal, modification, or increase in premium for reason of a medical event.

  9.  Notwithstanding subsection 2 of this section, the department of commerce and insurance shall receive and review complaints and inquiries from members of a qualified membership organization, pursuant to section 374.085, subject to section 374.071.

  10.  By March thirty-first of each year, each qualified membership organization providing a contract for health care benefits under this section, or its administrator, shall pay to the director a fee equal to one percent of the Missouri claims paid under this section during the immediately preceding year.  Funds collected by the director shall be deposited in the insurance dedicated fund established under section 374.150.

  11.  No qualified membership organization, or other entity on behalf of a qualified membership organization, shall refer to a contract for health care benefits under this section as insurance or health insurance in any marketing, advertising, or other communication with the public or members of the qualified membership organization.  Violation of this subsection shall be an unlawful practice under section 407.020.

  12.  Contracts for health care benefits provided under this section:

  (1)  Shall include coverage for:

  (a)  Ambulatory patient services;

  (b)  Hospitalization;

  (c)  Emergency services, as defined in section 376.1350; and

  (d)  Laboratory services; and

  (2)  Shall not be subject to an annual limit of less than two million dollars per year.

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(L. 2025 S.B. 79)

*Word "and" appears here in original rolls.