COBRA Law Summaries
26-4200 Missouri, COBRA Law Summaries Missouri's health care continuation law is codified in the Missouri Revised Statutes at Chapter 376, Sections 376.397, 376.428 and 376.893.
DEFINITIONS
"Insured" means any person entitled to benefits under a contract of accident and sickness insurance, or medical-payment insurance issued as a supplement to liability insurance but not including any other coverage contained in a liability or a workers' compensation policy, issued by an insurer (Sec. 376.427).
"Insurer" means any person, reciprocal exchange, interinsurer, fraternal benefit society, health services corporation, self-insured group arrangement to the extent not prohibited by federal law, or any other legal entity engaged in the business of insurance (Sec. 376.427).
COVERAGE
Missouri's health care continuation law covers all employers maintaining group health policies issued for delivery in Missouri (Sec. 376.428).
EXCEPTIONS
Missouri's health care continuation laws do not apply to persons who are subject to the federal COBRA law (Sec. 376.428).
PROCEDURES
An employer must offer continuation coverage to employees and dependents who have been continuously insured under a group policy for the entire three-month period prior to termination of group coverage. Surviving and divorced spouses are also eligible. Further, continuation coverage must be offered to legally separated, divorced or surviving spouses who are 55 years of age at the time federal COBRA ends, if the employer has 20 or more employees (Sec. 376.428 and Sec. 376.893, as amended by H. 1217, L. 1996, effective August 28, 1996).
Continuation coverage is triggered by loss of coverage resulting from termination of employment, the death of a covered employee, or because of the divorce or legal separation of a covered employee from a spouse. Persons eligible for Medicare or other group coverage are not eligible (Sec. 376.428 and Sec. 376.893, as amended by H. 1217, L. 1996, effective August 28, 1996).
Employers must provide a written notice to their employees of the duties of such employees under the law no later than the date on which coverage would otherwise terminate (Sec. 376.428).
A legally separated or divorced spouse eligible for continued coverage must give the plan administrator written notice of the event within 60 days of legal separation or the entry of a decree of dissolution of marriage or prior to the expiration of a 36-month federal COBRA continuation period covering a legally separated or divorced spouse, if such spouse has elected and maintained such COBRA coverage. After an employee's death the group policyholder must give the plan administrator written notice of the death and the mailing address of the surviving spouse. The plan administrator, within 14 days of receipt of the above notices, must then give notice to the legally separated, divorced or surviving spouse that the policy may be continued (Sec. 376.893, as amended by H. 1217, L. 1996, effective August 28, 1996).
The employee must request continuation coverage in writing within 31 days of the date coverage would otherwise terminate. A divorced, legally separated or surviving spouse must elect continuation coverage by mailing an election form provided by the plan administrator within 60 days after the date the plan administrator mailed the notice of the right to continuation coverage (Sec. 376.428 and Sec. 376.893, as amended by H. 1217, L. 1996, effective August 28, 1996).
WHAT THE EMPLOYER MUST DO
Missouri's health care continuation law requires an employer to offer continuation coverage to employees, surviving spouses and dependents. Further, continuation coverage must be offered to legally separated, divorced or surviving spouses who are 55 years of age at the time federal COBRA ends, if the employer has 20 or more employees (Sec. 376.428 and Sec. 376.893, as amended by H. 1217, L. 1996, effective August 28, 1996).
Eligibility requirements. --Employees and dependents who have been continuously insured under a group policy for the entire three-month period prior to termination of group coverage because of termination of employment are eligible. Surviving and divorced spouses are also eligible when coverage is lost due to the death of a covered employee or because of the divorce or legal separation of a covered employee from a spouse. Persons eligible for Medicare or for other group coverage are not eligible (Sec. 376.428 and 376.892).
Disability of dependent child. --If a group health plan specifies that a dependent child's coverage must terminate upon that child's attainment of a specified age, the attainment of that age will not operate to terminate the coverage of the child while the child is incapable of self-sustaining employment by reason of mental or physical disability and chiefly dependent upon the employee for support and maintenance. Proof of disability and dependency must be furnished by the employee within 31 days of the child's attainment of the specified age and thereafter, as required by the insurer, but not more frequently than annually after the two-year period following the child's attainment of the specified age (Sec.376.426).
Conversion to individual policy. --Employees and dependents who have been continuously covered under a group policy for the entire three-month period prior to termination of coverage are eligible for conversion coverage. Surviving and divorced spouses are also eligible. An employee is not eligible for conversion coverage if the employee is eligible for Medicare or for other group coverage, or if the group coverage is terminated for failure to make a timely premium payment (Sec. 376.397.1 and 376.401.2).
Notice. --Notice of the conversion privilege shall be included in each certificate of coverage (Sec. 376.397.3).
Deadlines. --Written application and the first premium payment for the converted policy must be made to the insurer not later than 31 days after group coverage terminates (Sec. 376.397.1).
Premiums. --The premium shall be determined in accordance with the insurer's table of premium rates applicable to the age and class of risk of each person to be covered under the policy and to the type and amount of insurance provided (Sec. 376.397.1).
Termination of coverage. --Coverage will terminate if:
(1) fraud or material misrepresentation occurs in the application for benefits;
(2) the employee becomes eligible for Medicare; or
(3) the employee becomes eligible for other group insurance that, taken together with the converted coverage, would result in overinsurance
(Sec. 376.397.1).
Duration of coverage. --Continuation coverage generally lasts nine months after the date group coverage terminates (Sec. 376.428).
Premiums: Continuation coverage. --The premium charged for continuation coverage must not be more than the group rate of the insurance being continued on the due date of each payment (Sec. 376.428).
Premiums: Conversion coverage. --The premium for a converted policy shall be determined in accordance with the insurer's table of premium rates applicable to the age and class of risk of each person to be covered under the policy and to the type and amount of insurance provided (Sec. 376.397.1).
Termination of coverage: Continuation coverage. --Continuation coverage will terminate if:
(1) the employee becomes eligible for Medicare or for other group coverage;
(2) the employee fails to make a timely premium payment; or
(3) the employer terminate participation in the group policy
(Sec. 376.428).
Termination of coverage: Conversion coverage. --Coverage will terminate if:
(1) fraud or material misrepresentation occurs in the application for benefits;
(2) the employee becomes eligible for Medicare; or
(3) the employee becomes eligible for other group insurance that, taken together with the converted coverage, would result in overinsurance
(Sec. 376.397.1).
NOTICE
Continuation coverage. --Employers must provide a written notice to their employees of the duties of such employees under the law no later than the date on which coverage would otherwise terminate (Sec. 376.428).
A legally separated or divorced spouse eligible for continued coverage must give the plan administrator written notice of the event within 60 days of legal separation or the entry of a decree of dissolution of marriage or prior to the expiration of a 36-month federal COBRA continuation period covering a legally separated or divorced spouse, if such spouse has elected and maintained such COBRA coverage. After an employee's death, the group policyholder must give the plan administrator written notice of the death and the mailing address of the surviving spouse. The plan administrator must then, within 14 days of receipt of the above notices, give notice to the legally separated, divorced or surviving spouse that the policy may be continued (Sec. 376.893, as amended by H. 1217, L. 1996, effective August 28, 1996).
Conversion coverage. --Notice of the conversion privilege must be included in each certificate of coverage (Sec. 376.397.3).
DEADLINES
Continuation coverage. --The employee must request continuation coverage in writing within 31 days of the date coverage would otherwise terminate. A divorced, legally separated or surviving spouse must elect continuation coverage by mailing an election form provided by the plan administrator within 60 days after the date the plan administrator mailed the notice of the right to continuation coverage (Sec. 376.428 and Sec. 376.893, as amended by H. 1217, L. 1996, effective August 28, 1996).
Conversion coverage. --Written application and the first premium payment for the converted policy must be made to the insurer not later than 31 days after group coverage terminates (Sec. 376.397.1).