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

369 words·~2 min read·/mo/chapter-379/379-932

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379.932. Applicability of act, conditions — treatment as single carrier or separate carrier — ceding agreements prohibited, when. — 1. Sections 379.930 to 379.952 shall apply to any health benefit plan that provides coverage to the employees of a small employer in this state if any of the following conditions are met:

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

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

(3)The health benefit plan is treated by the employer or any of the eligible employees or dependents as part of a plan or program for the purposes of section 162, section 125 or section 106 of the federal Internal Revenue Code.

(1)Except as provided in subdivision

(2)of this subsection, for the purposes of sections 379.930 to 379.952 , carriers that are affiliated companies or that are eligible to file a consolidated tax return shall be treated as one carrier and any restrictions or limitations imposed by this act * shall apply as if all health benefit plans delivered to small employers in this state by such affiliated carriers were issued by one carrier.

(2)An affiliated carrier that is a health maintenance organization having a certificate of authority under section 354.400 , et seq., may be considered to be a separate carrier for the purposes of sections 379.930 to 379.952 .

(3)Unless otherwise authorized by the director, a small employer carrier shall not enter into one or more ceding arrangements with respect to health benefit plans delivered or issued for delivery to small employers in this state if such arrangements would result in less than fifty percent of the insurance obligation or risk for such health benefit plans being retained by the ceding carrier.

3. Sections 379.930 to 379.952 shall not apply to any plan or program when the employees pay the total cost of the health benefit plan.

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(L. 1992 S.B. 796 § 2)

Effective 7-01-93

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