PURPOSE: This regulation describes the conversion privilege to be accorded to family memberships on either a group or direct-pay basis. This regulation applies to health service corporations offering nongroup health care plans in Missouri. This regulation is adopted pursuant to section 354.120, RSMo 1986 and to implement section 354.085, RSMo 1986.

1. (1) Offer of Conversion.

   1. (A) Whenever a family membership, either through a group or on a direct-pay basis, is terminated because of the death of the subscribing member, any one (1) or more of the surviving dependents of the member who were beneficiaries under the decedent’s membership contract at the time of death shall have the option to become subscribing members of the health service corporation for not less than thirty (30) days after the death of that subscribing member. The conversion program shall consist of an option for these dependents to choose among all those nongroup membership plans then being offered by that health service corporation.
   2. (B) The conversion program shall be continuous with the terminated program with no intervening periods of contestability or waiting periods other than the unexpired portion of such provisions in the direct pay or group membership contract from which the conversion is being made.
   3. (C) This option shall be explained in each certificate of coverage, description of benefits or other explanation of benefits afforded issued after April 30, 1976.

AUTHORITY: sections 354.085 and 354.120, RSMo 1986.* This rule was previously filed as 4 CSR 190-15.070. Original rule filed Dec. 30, 1975, effective Jan. 15, 1976.

*Original authority: 354.085, RSMo 1973 and 354.120, RSMo 1973.