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Missouri State Continuation Coverage Mandate FAQs
Mercy Health Plans (MHP) offers the following information regarding Missouri House Bill 231, Missouri State Continuation Coverage, effective June 26, 2009. The bill requires fully-insured group policies not covered by federal COBRA to provide the state continuation coverage to a terminated employee in the same manner as by COBRA.
This information is subject to modification in the event formal guidance from the Missouri Department of Insurance (DOI) is promulgated.
What groups are affected? The law extends the Missouri state continuation coverage for fully-insured employer small groups (2 to 20 employees), to 18/29/36 months (depending on the type of qualifying event). The same terms and conditions for qualifications and termination of coverage under COBRA will apply to Missouri state continuation coverage.
Who is eligible for state continuation?
The law applies to qualified beneficiaries: an employee, spouse, or dependent child who has had at least one day of coverage on the employer’s group health plan, but loses group coverage due to a qualifying event. A qualifying event includes voluntary and involuntary termination (for reasons other than gross misconduct), reduction in hours, death of employee, divorce or legal separation, employee entitlement to Medicare, dependent child ceasing to qualify as a dependent, and the bankruptcy of the employer.
Who is responsible for notifications?
As under COBRA, employers are required to provide all related notices to employees. The employer is required to mail the terminated employee a general notice and election for continuation within 14 days of a qualifying event. Additionally, notices are required whenever a covered employee or dependents cease to qualify for continuation coverage, or coverage terminates. The Missouri Department of Insurance will not mandate or promulgate use of a state-specific notice for state continuation. Therefore, employers may use the COBRA model notices found on the Department of Labor website at
www.dol.gov, or they may create their own.
When does coverage begin? The qualified beneficiary must notify the employer group within 60 days
after qualifying events that the employer may not be aware of, such as divorce or legal separation or a child's ceasing to be covered as a dependent under the policy.
State continuation coverage must be elected within 60 days after the qualifying event, or
within 60 days after receipt of the date the notice, whichever is later. In no event will an application for Missouri State continuation coverage be accepted, if filed after this election period.
When does coverage end? State continuation
coverage can be terminated when the beneficiary:
- Reaches the last day of maximum coverage;
- Fails to make timely premium payments;
- Becomes entitled to Medicare after state continuation was
elected;
- Obtains coverage with another employer group health plan
and have satisfied any waiting periods for preexisting conditions
under the new plan; or,
- The employer ceases to maintain a group health plan.
For questions or more information about Missouri
State Continuation visit:
Or call, Missouri Department of Insurance toll-free number: 1-800-726-7390.
For more information relative to your coverage plan, Mercy Health Plans encourages you to contact your account manager.
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