Effective August 28, 2021, employers with 20 or more employees within the state must provide unpaid leave to employees who are victims of domestic or sexual violence or have a family/household member who is a victim. The specific reasons for leave include: obtaining victim services from an organization, counseling, seeking legal assistance or remedies and recovering from or seeking medical attention for injuries.

Employers have many responsibilities under the new law. If they have 20 to 49 employees, they must provide eligible employees with one-week unpaid leave per year; those with 50 or more employees must provide two weeks. An employee on such leave is entitled to benefit continuation at the normal cost and restoration to the same or equivalent job. Importantly, an employer must also provide reasonable safety accommodations for the employee. Examples include a change in worksite, reassignment, transfer, modified schedule, lock installation and implementation of a safety procedure.

If an employer has not yet notified existing employees of the new leave entitlement, they should distribute the notice below as soon as possible. Going forward, the notice should be provided to all new employees. The notice may be distributed electronically.

Missouri Victims Economic Safety and Security Act »

Recently, Gov. Parson issued Executive Order 21-10 in response to the federal vaccine mandates. The order provides that no state agency, board, commission or other entity of the executive branch shall compel any individual to obtain the COVID-19 vaccine pursuant to the federal vaccine mandate when the individual refuses due to a sincerely held religious belief or for medical reasons. Further, no such state agency is permitted to impose a penalty to any individual or business for failure to comply with any federally imposed COVID-19 vaccine mandate when failure to comply is due to a sincerely held religious belief or for medical reasons.

Employers should be aware of these developments. For more information on the federal vaccine mandates, see our original article on the federal mandate in the November 9, 2021, edition of Compliance Corner.

Executive Order 21-10 »

A new bill (H.B. 1682) signed into law on July 13, 2020, expands coverage for mammography and related breast imaging services. Effective August 28, 2020, health plans are required to cover annual mammograms for patients deemed by a treating physician to have an above-average risk for breast cancer, as well as additional or supplemental imaging (e.g., ultrasound or magnetic resonance imaging services) which a treating physician determines to be medically necessary for breast cancer screening.

As background, Missouri law requires health insurance issuers to include coverage for certain benefits and services in health plans that employers can purchase from issuers. These Missouri health benefit mandates apply to group health insurance plans delivered, issued for delivery or renewed in Missouri. Further, Missouri health benefit mandates do not apply to self-insured group health plans.

Employers who sponsor fully insured group health plans issued in Missouri should be aware of this new mandate and confirm that their policies are in compliance effective August 28, 2020.

H.B. 1682 »

On May 15, 2020, the Missouri Department of Commerce and Insurance issued Insurance Bulletin 20-15, which extends the applicability of prior Bulletin 20-07 through June 15, 2020. As mentioned in our prior Compliance Corner March 31, 2020, article “COVID-19 and Health Insurance Coverage: Executive Orders and Insurance Bulletins,” Bulletin 20-07 strongly encourages Missouri residents to access health care services via telehealth for all services provided through telehealth, including mental health services (not just testing for COVID-19). Further, the department reminds health insurers of the requirement to cover telehealth services in the same manner as they would provide coverage for in-person services. Originally expiring May 15, 2020, Bulletin 20-07 is now extended through June 15, 2020, in light of the continued COVID-19 public health crisis.

Employers should be aware of these developments.

Insurance Bulletin 20-15 »

On May, 7, 2020, the Department of Commerce and Insurance issued Insurance Bulletin 20-10, extending the application of Bulletin 20-05 until June 15, 2020.

As background, Bulletin 20-05 strongly encourages health carriers to extend a grace period of at least 60 days from coverage in effect on March 13, 2020, if premiums are unpaid (as mentioned in the March 31, 2020, Compliance Corner article “COVID-19 and Health Insurance Coverage: Executive Orders and Insurance Bulletins”), and is effective until May 15, 2020. Bulletin 20-10 extends the effective date until June 15, 2020, in light of the continued public health emergency. As such, all insurers are strongly encouraged to extend grace periods until June 15, 2020.

Employers should be aware of these developments.

Insurance Bulletin 20-10 »
Insurance Bulletin 20-05 »

On March 18, 2020, Gov. Parson issued Executive Order 20-04 which provides guidance in light of the public health emergency — including guidance on telemedicine services. Among other topics, the executive order temporarily eliminates the requirement that patients have established relationships with a provider that requires a physical exam prior to using telemedicine services (so that telemedicine is more accessible with less risk of exposure to both health care providers and patients).

In addition, the Department of Commerce and Insurance (DCI) issued Insurance Bulletins 20-05 and 20-07 (on March 21, 2020, and March 26, 2020, respectively), which:

• Strongly encourage health carriers to extend a grace period of at least 60 days from coverage in effect on March 13, 2020, if premiums are unpaid.
• Strongly encourage Missouri residents to access health care services via telehealth for all services provided through telehealth, including mental health services (not just testing for COVID-19). Further, the DCI reminds health insurers of the requirement to cover telehealth services in the same manner as they would provide coverage for in-person services.

Employers should be aware of these developments.

Executive Order 20-04 »
Insurance Bulletin 20-05  »
FAQs Regarding Bulletin 20-05 »
Insurance Bulletin 20-07 »

On March 3, 2020, the Department of Commerce and Insurance issued Insurance Bulletin 20-03 addressing information related to the coronavirus (COVID-19). The Department issued the Bulletin in response to insurance related services needed during the ongoing public health crisis.

As explained further in the Bulletin, highlights of what the Department is asking of health insurance carriers include:

• Informing insureds of available benefits and quickly responding to insured inquiries.
• Waiving any cost sharing for COVID-19 testing. In addition, carriers are asked to waive cost sharing for an in-network provider office (and urgent care) visit when testing for COVID-19.
• Ensuring robust telehealth programs that are able to meet increased demand.
• Specifying that carriers should not use preauthorization requirements as a barrier to any necessary treatments for COVID-19.
• Covering any immunizations at no cost sharing for all covered individuals in the event an immunization becomes available.

Employers with employees in Missouri should confirm with their carriers, as applicable, when addressing questions regarding health insurance coverage and COVID-19.

Insurance Bulletin 20-23 »

On Nov. 21, 2018, Insurance Director Lindley-Myers issued Bulletin 18-04. The bulletin discusses the state and federal regulation of AHPs after the DOL’s final rules on AHPs were issued this summer. As background, AHPs are MEWAs and can fall under the jurisdiction of both federal and state law. This bulletin addresses fully insured and self-insured group health plans and how Missouri law applies to them.

The bulletin essentially confirms that insurers in Missouri may issue group health insurance to associations that either satisfy the requirements under state law or the DOL’s final rule. Additionally, Missouri laws regarding the filing and review of group health coverage apply to policies issued to associations that meet the DOL’s requirements.

Finally, the Missouri Department of Insurance recommends that any insurer or entity wishing to organize or insure an AHP should submit proposed form and rate filings to the Department. A submitted filing will enable the Department to review the individual facts and circumstances and address any specific organizational questions or concerns that interested parties may have.

Bulletin 18-04 »

On July 9, 2018, Gov. Parson signed SB 826 into law. This bill amends Section 376.1237 of the state’s insurance code to repeal the expiration date applicable to coverage for prescription eye drops. Specifically, the new law prohibits plans from applying greater deductibles or copayments to early prescription eye drop refills than deductibles or copayments that apply to other, similar health-care services covered by plans. Additionally, due to the passage of this law the coverage requirement for early refills of prescription eye drops no longer expires on Jan. 1, 2020 (which was the sunset date previously included in the law). The new law takes effect on Aug. 28, 2018.

SB 826 »

On July 9, 2018, Gov. Parson signed SB 718 into law. This bill makes various changes to the insurance code including requiring plans to provide coverage for medication-assisted treatment of substance use disorders (Section 376.811) and removing language excluding chemical dependency from the definition of “mental health conditions” (Section 376.1550). The law takes effect on Aug. 28, 2018.

SB 718 »