354.551. Health maintenance organizations may offer point of service (POS) riders, when. - Missouri Statutes

Health maintenance organizations may offer point of service (POS)riders, when.

354.551. 1. Missouri licensed health maintenance organizations shall bepermitted to offer point of service riders (POS) to their approved health planproducts, without being required to obtain a separate license as a healthinsurer pursuant to chapter 376, RSMo, so long as medical and hospitalexpenses incurred under the POS rider do* not exceed ten percent of totalmedical and hospital expenses incurred for all health plan products sold.

2. Health maintenance organizations which have been licensed for atleast one calendar year, who choose to insure the POS rider, shall maintain anet worth of the greater of:

(1) One million two hundred thousand dollars; or

(2) Two percent of total premium revenue for the immediately precedingtwelve months plus fifty percent of uncovered liabilities as reported in theimmediately preceding calendar quarter.

3. Health maintenance organizations which have been licensed for lessthan one calendar year, who choose to insure the POS rider, shall maintain anet worth of the greater of:

(1) One million two hundred thousand dollars; or

(2) Ten percent of the yearly average of the three-year annual premiumplus fifty percent of its average annual uncovered liabilities as projected inits application for a certificate of authority.

4. The department of insurance, financial institutions and professionalregistration may modify the net worth requirements for a health maintenanceorganization which has been licensed for less than one calendar year if itsactual results deviate materially from its projections. In addition to anyother deposit required of a licensed health maintenance organization pursuantto section 354.410, any health maintenance organization which chooses to issuea POS rider shall deposit an additional six hundred thousand dollars** withthe director of the department of insurance, financial institutions andprofessional registration. Any health maintenance organization which issues aPOS rider whose medical and hospital expenses incurred under the POS riderexceed*** ten percent of total medical and hospital expenses incurred for allhealth plan products sold shall either cease insuring new POS riders until itcomes into compliance with the ten percent limitation of this section or meetthe minimum net worth requirements and all other statutory and regulatoryrequirements of a Missouri domestic life insurance company.

(L. 1997 H.B. 335 § 11)

*Word "does" appears in original rolls.

**Word "dollars" does not appear in original rolls.

***Word "exceeds" appears in original rolls.