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Rights – Laws

When purchasing a health insurance plan, it is important to know your rights, what is permitted by the state for insurers, and what you can do if certain laws do not work in your favor. Missouri health insurers have many freedoms of their own, which are about to change at the hand of the Affordable Care Act. These regulations currently permit them to be selective as to who they choose to write plans for, and how they do so. Such laws have been a very important part of underwriting, and the way health insurance operates in Missouri. There are also laws that protect the consumer, and more on the way, which prevent insurance companies from canceling coverage, and also make sure policyholder get the health care they need.

Anyone who has a health plan may also exercise the right, when appropriate, to make a complaint against their insurer if they feel one of their company policies has been violated. Another commonly used consumer right of health insurance is the claims appeal. Filing an appeal for a denied claim is quite common, as mistakes are often made with coding, or individuals are unaware of their coverage. Regardless of the issue, a health insurance plan is an important investment, and you have the right to know how it works.


Guaranteed Renewal

As in most states, Missouri health insurance companies are unable to terminate your benefits if you have coverage and become sick during your term. This provision also is key in maintaining continuous coverage, as your insurer is required to offer to renew your plan for another year before your coverage year is over. Unless you have committed fraud or misrepresentation on your health insurance application, or have not been responsible with paying premiums on time, all policyholders have the benefit of guaranteed renewal. This law is designed to keep people with health insurance protected and insured.


Pre-Existing Conditions

After the health care reform law took effect, several aspects of national health insurance changed for people with conditions. Adults are still subject to decline for having a condition (which is defined by the insurer) at any point chosen by the health plan. Missouri insurance companies have no limit on their look-back period. If accepted for coverage with a condition, an insurance company has the right to issue an exclusion period for any amount of time they decide, as there is no maximum exclusion period. Elimination riders are also allowed in Missouri, which would give an applicant the complete inability to have coverage for their condition under that health plan.

However, if a dependent child under age 19 has a pre-existing condition, they will not be declined completely, only rated up based on their health and risk. Those who are 19 or older and have been declined coverage have access to insurance PCIP, another part of the health care law. In many cases, adults with pre-existing conditions will experience a rate increase paired with an exclusion period, which can also deem you eligible for the Missouri Health Insurance Pool or PCIP.


Mandatory Benefits

Health insurance companies in Missouri are required by law to offer preventive care for no cost in each of their plans, which includes immunizations, well-child visits, routine exams, and other federally mandated preventive benefits according to the HHS. Missouri also has its own set of benefits to be covered by every private health plan in the state, though they may not be included in every single plan. The following are Missouri’s required health care services:


  • Autism coverage
  • Birth control
  • Blood lead poisoning
  • Bone marrow transplants
  • Bone density measurement
  • Cervical cancer and HPV screenings
  • Dental anesthesia
  • Diabetes management and supplies
  • Disabled dependent coverage
  • Emergency care
  • Hair prosthesis
  • Mammograms
  • Mastectomy including inpatient stays
  • Maternity care including hospital stays
  • Medical foods
  • Mental health care
  • Newborn dependent coverage
  • Newborn hearing exam
  • Outpatient surgery
  • Prostate cancer screening
  • Second opinion for surgery
  • Substance abuse treatment