FIRSTREGULARSESSION
HOUSEBILLNO.626
103RDGENERALASSEMBLY
INTRODUCEDBYREPRESENTATIVEKELLEY.
1811H.01I DANARADEMANMILLER,ChiefClerk
ANACT
Torepealsection376.446,RSMo,andtoenactinlieuthereofonenewsectionrelatingto
healthinsurancereimbursement.
BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
SectionA.Section376.446,RSMo,isrepealedandonenewsectionenactedinlieu
2thereof,tobeknownassection376.446,toreadasfollows:
376.446.1.Immediatelyuponthewrittenororalrequestofanenrollee,ahealth
2[carriers] carriershallpermit[individuals] anenrolleetolearn:
3 (1)Theamountofcost-sharing,includingdeductibles,copayments,andcoinsurance,
4underthe[individual's] enrollee'shealthbenefitplanorcoveragethatthe[individual]
5enrolleewouldberesponsibleforpayingwithrespecttothefurnishingofaspecificitemor
6servicebyaparticipatingprovider[inatimelymannerupontherequestoftheindividual];
7and
8 (2)Iftheenrolleeprovidesaspecificbillingcodeforahealthcareservice:
9 (a)Thereimbursementamount,expressedindollarsandnotasapercentage,
10thatthehealthcarrierwillpayaparticipatingproviderforthehealthcareservice;and
11 (b)Thereimbursementamount,expressedindollarsandnotasapercentage,
12thatthehealthcarrierwillpaytheenrolleeforthehealthcareserviceifthehealthcare
13serviceisnotdeliveredbyaparticipatingprovider.
14 2.Ataminimum,[such] theinformationdescribedinsubsection1ofthissection
15shallbemadeavailableto[suchindividual] theenrolleethroughaninternetwebsiteandsuch
16othermeansfor[individuals] enrolleeswithoutaccesstotheinternet.
EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 17 3.Asusedinthissection,theterms"enrollee","healthcarrier"[and],"healthbenefit
18[plans"] plan","healthcareservice",and"participatingprovider"shallhavethesame
19meaningsassignedtotheminsection376.1350.
20 [2.]4.Thissectionshallnotapplytoasupplementalinsurancepolicy,includingalife
21carecontract,accident-onlypolicy,specifieddiseasepolicy,hospitalpolicyprovidingafixed
22dailybenefitonly,Medicaresupplementpolicy,long-termcarepolicy,hospitalization-
23surgicalcarepolicy,short-termmajormedicalpolicyofsixmonthsorlessduration,orany
24othersupplementalpolicy.
25 [3.Theprovisionsofsubsections1and2shallbecomeeffectiveonJanuary1,2014.]
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