Overview of Senate Bill 79
The Missouri Senate has successfully advanced Senate Bill 79 (SB 79), a legislative proposal aimed at allowing certain eligible organizations to offer alternative health care benefit plans. These plans would be exempt from typical federal and state regulations, provided that specified notification requirements are adhered to.
Criteria for Qualified Organizations
According to a report from AM Best, the bill outlines that qualified organizations include entities like farm bureaus. To qualify, these organizations must have at least 100,000 dues-paying members and possess assets of $500 million. Additionally, these organizations must register with the state and remit a registration fee of $250 every five years. The revenue collected from these fees will be allocated to an insurance-dedicated fund.
Plan Specifications and Requirements
Under the provisions of SB 79, the health care benefit contracts offered by these organizations must explicitly feature notifications indicating that these plans are not traditional health insurance. They provide fewer benefits compared to Affordable Care Act-compliant plans and may exclude coverage for preexisting conditions.
Furthermore, the plans are required to inform policyholders that they are not protected by the state’s guaranty association. Consequently, policyholders will bear responsibility for any medical expenses not covered by the plan. Additionally, the bill prohibits any marketing or advertising that represents these contracts as insurance.
Coverage and Financial Obligations
Despite the exemptions from certain state and federal health insurance laws, SB 79 mandates coverage for essential services such as ambulance services, hospitalizations, emergency services, and laboratory work. The plans must also maintain an annual coverage limit of at least $2 million. To qualify for these plans, applicants must be members of the organization for a minimum of 30 days.
Moreover, the bill imposes an annual fee on plan providers, calculated as 1% of the claims paid in the previous year, due by March 31. These fees are also to be contributed to the insurance-dedicated fund.
Legislative Progress and Future Considerations
While the sponsors of the bill have not offered public comments, attempts to contact the Missouri Insurance Coalition have been unsuccessful. SB 79 is part of broader endeavors to reform healthcare accessibility within Missouri. The Senate adopted a substitute version of the bill on March 25, 2025, which includes provisions to broaden telehealth access.
The bill received its final approval in the Senate on March 27, 2025, and it is currently under review in the Missouri House of Representatives. Should it pass, the law will officially take effect on August 28, 2025.
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