Missouri Healthcare Insurance laws & HR compliance analysis

Missouri Healthcare Insurance: What you need to know

There is no state law requiring employers to offer group healthcare insurance to their employees, but most employers do provide this benefit. However, if any health insurance is offered, Missouri's insurance laws require policies to cover certain benefits (mandated benefits) and give employees the right to continue group coverage or to convert to an individual policy in certain circumstances if the employee leaves the group.
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Missouri law requires that an employer that provides health insurance coverage for which it pays any portion of the premium must also establish a premium-only cafeteria plan as provided by Internal Revenue Code Sec. 125 (MO Rev. Stat. Sec. 376.453).
This requirement does not apply to employers that offer health insurance through any self-insured or self-funded group health benefit plan of any type or description. An employer may still either provide a group health benefit plan or create a premium-only cafeteria plan with defined contributions in which the employee pays the full cost of the policy.
States are not permitted to regulate self-insured benefit plans. Missouri's mandated benefits, continuation, and conversion provisions do not apply to health plans in which the employer pays all benefits without the proceeds of any insurance policy. An employer's health plan is self-insured if the risk of paying claims is on the employer and not on an insurance company. Self-insured plans may contract with third-party administrators (TPAs), including insurance companies, to process benefit claims. The TPA pays the claims and then is reimbursed by the employer. Many self-insured plans also buy “stop-loss” insurance to cover very large claims. The ...

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