PURPOSE: This rule requires a conversion privilege from group health insurance policies. Family health insurance coverage should not terminate abruptly upon the death of one family member, leaving the surviving family members without health insurance coverage by effect of group contract terms. These contracts are not “reasonably adequate to meet needed requirements for the protection of those insured,” section 376.405, RSMo and will not be approved for use in this state. This rule was adopted pursuant to section 374.045, RSMo 1986 and implements sections 376.405 and 376.777, RSMo.

1. (1) Group Conversion Privilege Required.

   1. (A) Any insurer authorized to write accident and sickness insurance in this state must offer a conversion privilege as part of each group policy to apply following the death of FINANCIAL INSTITUTONS AND PROFESSIONAL REGISTRATION

any certificate holder or other person upon whose employment, membership or other status eligibility for the coverage is predicated.

1. (B) Each conversion privilege must—

   1. 1. Consist of an offer by the insurer to

issue to the surviving spouse or other dependents without evidence of insurability a conversion policy upon written application by the surviving spouse or dependents;

1. 2. Be effective from the termination of

coverage under the group plan with no intervening periods of contestability, time limit on certain defenses or preexisting conditions any greater than the unexpired portion of those provisions in the group contract from which the conversion is being made;

1. 3. Extend the option to convert if the

surviving spouse has not been notified by either the insurer or the group policyholder within fifteen (15) days prior to expiration of the thirty (30)-day conversion period, an additional thirty (30) days after the expiration of the thirty (30)-day conversion period; and

1. 4. Be explained in each certificate,

booklet certificate or other evidence of coverage under the group policy.

1. (2) Extent of Coverage. Any conversion policy issued pursuant to the requirements of sections 376.395–376.404, RSMo must include coverage for maternity expense if the group policy provided this coverage. The requirements of this section shall apply only to certificates of insurance delivered or issued for delivery to Missouri residents.

AUTHORITY: sections 374.045, 376.405 and 376.777, RSMo 1986.* This rule was previously filed as 4 CSR 190-14.100. Original rule filed Dec. 23, 1975, effective Feb. 1, 1976. Amended: Filed Feb. 14, 1984, effective June 18, 1984.

*Original authority: 374.045, RSMo 1967; 376.405, RSMo 1939, amended 1967; and 376.777, RSMo 1959, amended 1984.