Effective 28 Aug 1997
354.551. Health maintenance organizations may offer point of service (POS) riders, when. — 1. Missouri licensed health maintenance organizations shall be permitted to offer point of service riders (POS) to their approved health plan products, without being required to obtain a separate license as a health insurer pursuant to chapter 376, so long as medical and hospital expenses incurred under the POS rider do* not exceed ten percent of total medical and hospital expenses incurred for all health plan products sold.
2. Health maintenance organizations which have been licensed for at least one calendar year, who choose to insure the POS rider, shall maintain a net worth of the greater of:
(1) One million two hundred thousand dollars; or
(2) Two percent of total premium revenue for the immediately preceding twelve months plus fifty percent of uncovered liabilities as reported in the immediately preceding calendar quarter.
3. Health maintenance organizations which have been licensed for less than one calendar year, who choose to insure the POS rider, shall maintain a net worth of the greater of:
(1) One million two hundred thousand dollars; or
(2) Ten percent of the yearly average of the three-year annual premium plus fifty percent of its average annual uncovered liabilities as projected in its application for a certificate of authority.
4. The department of commerce and insurance may modify the net worth requirements for a health maintenance organization which has been licensed for less than one calendar year if its actual results deviate materially from its projections. In addition to any other deposit required of a licensed health maintenance organization pursuant to section 354.410, any health maintenance organization which chooses to issue a POS rider shall deposit an additional six hundred thousand dollars** with the director of the department of commerce and insurance. Any health maintenance organization which issues a POS rider whose medical and hospital expenses incurred under the POS rider exceed*** ten percent of total medical and hospital expenses incurred for all health plan products sold shall either cease insuring new POS riders until it comes into compliance with the ten percent limitation of this section or meet the minimum net worth requirements and all other statutory and regulatory requirements of a Missouri domestic life insurance company.
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(L. 1997 H.B. 335 § 11)
*Word "does" appears in original rolls.
**Word "dollars" does not appear in original rolls.
***Word "exceeds" appears in original rolls.
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