379.932. Applicability of act, conditions--treatment as single carrier or separate carrier--ceding agreements prohibited, when. - Missouri Statutes

Applicability of act, conditions--treatment as single carrier orseparate carrier--ceding agreements prohibited, when.

379.932. 1. Sections 379.930 to 379.952 shall apply to anyhealth benefit plan that provides coverage to the employees of asmall employer in this state if any of the following conditionsare met:

(1) Any portion of the premium or benefits is paid by or onbehalf of the small employer;

(2) An eligible employee or dependent is reimbursed,whether through wage adjustments or otherwise, by or on behalf ofthe small employer for any portion of the premium; or

(3) The health benefit plan is treated by the employer orany of the eligible employees or dependents as part of a plan orprogram for the purposes of section 162, section 125 or section106 of the federal Internal Revenue Code.

2. (1) Except as provided in subdivision (2) of thissubsection, for the purposes of sections 379.930 to 379.952,carriers that are affiliated companies or that are eligible tofile a consolidated tax return shall be treated as one carrierand any restrictions or limitations imposed by this act* shallapply as if all health benefit plans delivered to small employersin this state by such affiliated carriers were issued by onecarrier.

(2) An affiliated carrier that is a health maintenanceorganization having a certificate of authority under section354.400, et seq., RSMo, may be considered to be a separatecarrier for the purposes of sections 379.930 to 379.952.

(3) Unless otherwise authorized by the director, a smallemployer carrier shall not enter into one or more cedingarrangements with respect to health benefit plans delivered orissued for delivery to small employers in this state if sucharrangements would result in less than fifty percent of theinsurance obligation or risk for such health benefit plans beingretained by the ceding carrier.

3. Sections 379.930 to 379.952 shall not apply to any planor program when the employees pay the total cost of the healthbenefit plan.

(L. 1992 S.B. 796 § 2)

Effective 7-1-93

*"This act" (S.B. 796, 1992) contains numerous sections. Consult Disposition of Sections table for definitive listing.