The national Group Health guide covers group underwriting, COBRA, HIPAA and coordination of benefits. This guide covers Missouri's group health rules in RSMo chapter 376, including state continuation and conversion, and its small employer law in chapter 379.

Group policy provisions

• Grace period: 31 days. The policy stays in force unless the policyholder gave advance written notice of discontinuance (376.426).
• Noncontributory plans must insure all eligible employees except those who refuse in writing (376.421).
• Evidence of insurability may be required from anyone who doesn't apply within 31 days of becoming eligible.
• The insurer issues a master policy to the sponsor. Members get certificates.
• Discretionary groups need DCI approval of the policy form (20 CSR 400-2.130).
• Group health coverage may be solicited only by licensed, appointed producers (20 CSR 400-2.090).
• Changing carriers: expenses applied to the old plan's deductible in the 90 days before the new plan starts must be credited. The old carrier is liable only for accrued claims and extensions of benefits (376.441).

Conversion (376.397)

• Apply in writing and pay the first premium within 31 days after group coverage ends.
• Conversion isn't required if the person wasn't continuously covered for the 3 months before termination, or is or could be covered by Medicare.

State continuation

• Plans not subject to federal continuation: for people whose plans aren't subject to the federal ERISA or PHSA continuation rules, continuation for employees and dependents works the same way as COBRA (376.428).
• Spouses 55 and older (376.892, 376.893):
  • A surviving, divorced or legally separated spouse who is 55 or older when COBRA ends may continue coverage.
  • This applies to employers with 20 or more employees.
  • The spouse gets notice within 14 days and has 60 days to elect.

Small employer health plans (379.930–379.952)

• A small employer has an average of 2 to 50 eligible employees (379.930).
• Plans are renewable at the employer's option, except for listed reasons such as nonpayment, fraud or failing participation rules.
• A carrier ending a plan gives 90 days' notice and offers its other small group plans (379.938).
• A carrier or agent may not encourage a small employer not to apply because of health status, claims, industry, occupation or location (379.952).

Common exam traps

• Group grace period: 31 days. Conversion: 31 days, with 3 months of prior coverage required.
• Credit for the old deductible: expenses in the last 90 days.
• Spouses 55+ may continue after COBRA. Notice 14 days, election 60 days, at employers with 20+ employees.
• Small employer: 2–50 eligible employees.