Mo. Code Regs. tit. 22 § 10-3.030

Current through Register Vol. 49, No. 21, November 1, 2024.

Section 22 CSR 10-3.030 - Public Entity Membership Agreement and Participation Period

PURPOSE: This amendment revises participation and contribution requirements for dental coverage.

(1) The participation agreement, these rules, and applicable provisions of law constitute the membership agreement between a public entity and the Missouri Consolidated Health Care Plan (MCHCP).

(A) By applying for coverage under MCHCP, a public entity agrees that-

1. A public entity must make health care coverage available to all eligible employees, their dependents, former employees entitled to a future retirement benefit, and retirees;

2. MCHCP will be the only health care offering made to its eligible members;

3. The public entity shall contribute at least fifty percent (50%) of the lowest-cost employee-only premium per month toward each active employee's premium for the plan(s) offered through MCHCP. There is no contribution requirement for dependents or retirees;

4. There are no participation or contribution requirements for dental coverage;

5. There are no participation or contribution requirements for vision coverage;

6. The Employee Assistance Program is paid by the employer and requires one hundred percent (100%) participation of employees eligible for medical coverage and can be expanded to additional classifications;

7. For public entities with fewer than twenty-five (25) employees, the public entity shall only offer one (1) MCHCP medical plan choice to its employees. For public entities with twenty-five (25) or more employees, the public entity may offer two (2) MCHCP medical plan choices;

8. For public entities with more than a total of three (3) employees, at least seventy-five percent (75%) of all eligible employees must enroll in MCHCP. If an employee declines coverage, s/he must submit a form stating coverage is waived. If the employee is waiving coverage because s/he is covered under another group health plan, Medicare or Medicaid, the employee must submit proof of other coverage. An employee with other group coverage, Medicare, or Medicaid is exempt from the seventy-five percent (75%) enrollment participation requirement. A participation audit will be conducted annually to ensure the participation requirement is met;

9. Any individual eligible as an employee may be covered as either an employee or dependent, but not both. Employees enrolled as dependents will not be considered as eligible employees;

10. A public entity may apply a probationary period, not to exceed applicable federal guidelines, before benefits become effective; and

11. A public entity must notify MCHCP of a member's termination within thirty (30) days of the termination.

(B) In order to provide retiree coverage, any participating member agency joining MCHCP must have one (1) of the criteria listed below.

1. An established retirement plan with contributions shared by both the employee and the employer (or made by the employer only) with an established minimum vesting period. The employer must offer coverage to retirees who have met this minimum vesting period requirement.

2. An employer-sponsored (but no contribution made by employer) retirement plan in which the employee is currently participating or from which the employee is eligible to receive a benefit. In this case, in order to be considered an eligible retiree, the prospective member must have met a vesting criterion equal to Missouri State Employees' Retirement System (MOSERS). If this criterion was not met, the employer may not offer coverage to that person as a retiree.

(2) Eligibility Changes.

(A) The following changes can be made prior to open enrollment or fiscal year end:

1. Change the classifications of employees that are offered benefits; or

2. Change the waiting or probationary period that determines when employees are eligible for benefits.

(B) A public entity may change its eligibility requirements during any of the following:

1. Prior to the annual open enrollment period, the public entity must submit the Selection of Offerings form selecting the new requirements. The requirements will go into effect January 1 of the following year;

2. Thirty (30) days prior to the end of its fiscal year. The public entity's top administrator must write a letter requesting the change. The effective date of the change will be the first day of the new fiscal year; or

3. A new employee classification is added to the public entity. The determination of the employee classification for eligibility is at the discretion of the public entity, effective the first day of the month coinciding with or following notification.

(3) Total premium costs for coverage levels of employee participation, based on employment status, eligibility for Medicare, and for various classifications of dependent participation, are established by the plan administrator.

(4) Premiums. Premiums are billed the fifteenth day of the current month for the next month's coverage. Premiums are due the fifteenth day of the next month or the next business day if the fifteenth falls on a weekend or holiday. Except for Consolidated Omnibus Budget Reconciliation Act (COBRA) and retiree members, the public entity will be billed and responsible for collecting any premium due directly from the subscriber. COBRA and retiree members are billed directly by MCHCP.

(A) If a retiree or COBRA member is delinquent for two (2) months of premiums and payment is not received by the fifteenth of the month following the delinquency, coverage will be terminated for nonpayment retroactive to the last day of the month for which full premium was received (example: Bill sent September 15 for October premiums and no payment was received; bill mailed October 15 for October and November premiums, due on November 15. If payment is not received, coverage will be terminated due to nonpayment effective September 30). The member will be responsible for the repayment of the services rendered after the retroactive termination date.

(B) If a public entity is delinquent for one (1) month of premiums and the delinquent payment is not received at the end of the month for the month of coverage, coverage for members is terminated for nonpayment on the last day of the month for which full premium was received (example: Bill sent September 15 for October premiums and no payment was received; bill mailed October 15 for November premiums due November 15 and October delinquent premiums due on October 31. If the October premium is not received by October 31, coverage will be terminated due to nonpayment effective September 30). The public entity will be responsible for repayment of the services rendered after the retroactive termination date. A termination of coverage resulting from nonpayment will not relieve the public entity of obligations assumed by the public entity in the Amended and Restated Participation Agreement and under state law. Moneys are due to MCHCP upon or following termination pursuant to Chapter 103, RSMo.

(5) If a subscriber is on a leave of absence, the public entity will be billed the active rate and is responsible for collecting any premium due directly from the subscriber.

(6) Termination Policy.

(A) MCHCP may terminate a public entity for any of the following reasons:

1. Failure to pay premiums;

2. Failure to abide by the terms and conditions of the participation agreement;

3. Failure to maintain participation requirements;

4. Failure to abide by the applicable provisions of Chapter 103, RSMo, or rules and regulations promulgated by MCHCP; or

5. MCHCP ceases to operate.

(B) A public entity may terminate voluntarily with ninety (90) days written notice prior to the end of the plan year, effective January 1 of the following year.

(7) Refunds of overpayments are limited to the amount overpaid during the twelve- (12-) month period preceding the month during which notice of overpayment is received.

22 CSR 10-3.030

AUTHORITY: section 103.059, RSMo 2000.* Emergency rule filed Dec. 20, 2004, effective Jan. 1, 2005, expired June 29, 2005. Original rule filed Dec. 20, 2004, effective June 30, 2005. Emergency amendment filed Dec. 22, 2008, effective Jan. 1, 2009, expired June 29, 2009. Amended: Filed Dec. 22, 2008, effective June 30, 2009. Emergency amendment filed Dec. 22, 2009, effective Jan. 1, 2010, expired June 29, 2010. Amended: Filed Jan. 4, 2010, effective June 30, 2010. Amended: Filed Nov. 1, 2011, effective May 30, 2012. Amended: Filed Oct. 30, 2012, effective May 30, 2013.

Amended by Missouri Register December 1, 2020/Volume 45, Number 23, effective 1/1/2021

Amended by Missouri Register April 15, 2021/Volume 46, Number 08, effective 5/31/2021

*Original authority: 103.059, RSMo 1992.