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SECOND REGULAR SESSION
[TRUL Y AGREED T O AND FINALL Y P ASSED]
CONFERENCE COMMITTEE SUBSTITUTE FOR
SENA TE SUBSTITUTE FOR
HOUSE COMMITTEE SUBSTITUTE FOR
HOUSE BILL NO. 2596
103RD GENERAL ASSEMBL Y
5996H.04T 2026
AN ACT
T o repeal sections 376.1000, 376.1012, 376.1017, and 376.1240, RSMo, and to enact in lieu
thereof five new sections relating to health benefit plans.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Sections 376.1000, 376.1012, 376.1017, and 376.1240, RSMo, are
2 repealed and five new sections enacted in lieu thereof, to be known as sections 376.1000,
3 376.1012, 376.1017, 376.1240, and 1, to read as follows:
376.1000. 1. As used in sections 376.1000 to 376.1045, a "multiple employer self-
2 insured health plan" is any plan or arrangement which is not fully insured and which is either:
3 (1) Offer ed by a staff or employee leasing company; or
4 (2) Established or maintained for the purpose of of fering or providing health, dental
5 or short-term disability benefits to employees of two or more employers and to two or mor e
6 self-employed individuals, each with at least one common-law employee, and their
7 dependents .
8 2. A plan or arrangement is considered fully insured only if an insurer licensed to
9 transact business in this state retains the ultimate responsibility for all benefits payable by a
10 contract or policy of insurance.
376.1012. Funds collected from the participating employers under multiple employer
2 self-insured health plans shall be held in trust subject to the following requirements:
EXPLANA TION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is
intended to be omitted from the law . Matter in bold-face type in the above bill is proposed language.
3 (1) A board of trustees elected by participating employers shall serve as fund
4 managers on behalf of participants. T rustees shall be plan participants. No participating
5 employer may be represented by more than one trustee. No trustee may represent more than
6 one employer . A minimum of three and a maximum of seven trustees may be elected.
7 T rustees may not receive remuneration but they may be reimbursed for actual and reasonable
8 expenses incurred in connection with duties as trustee. A trustee may not be an agent, or
9 broker for or an owner , of ficer or employee of any third-party administrator , insurance agency
10 or insurer utilized by the plan. The trustees shall have the authority to approve applications of
11 association members for participation in the arrangement and to contract with a licensed
12 third-party administrator to administer the day-to-day af fairs of the plan;
13 (2) Each trustee shall be bonded in an amount of not less than one hundred fifty
14 thousand dollars by a licensed insurer;
15 (3) Investment of plan funds is subject to the same restrictions which are applicable to
16 insurers pursuant to sections 376.291 to 376.307; provided, however , that no foreign plan
17 shall be exempt under section 376.310 from the investment laws of this state unless such plan
18 is subject to laws in its state of domicile which are substantially similar to sections 376.1032
19 to 376.1045. All investments shall be managed by a bank or other investment entity licensed
20 to operate in Missouri;
21 (4) T rustees, on behalf of the plan, shall file an annual report with the director of the
22 department of commerce and insurance by March first [ showing the condition and af fairs of
23 the plan as of the preceding thirty-first day of December . The report shall be made on forms
24 prescribed by the director . The report shall summarize the financial condition of the fund,
25 itemize collections from participating employers, detail all fund expenditures and provide any
26 additional information which the director requires ] in compliance with section 375.041 .
27 More frequent reports may be required at the discretion of the director . The plan shall also
28 pr epar e and file a report with the dir ector in compliance with section 375.1252 as it
29 applies to health organizations, and the pr ovisions of section 375.1267 shall apply to
30 such re ports.
376.1017. 1. A plan shall establish loss reserves for all incurred losses, both reported
2 and unreported, and for unearned premiums.
3 2. A plan also shall establish a surplus account equal to the greater of the following:
4 (1) [Three times the average paid monthly premium during the plan's most recent
5 fund year;
6 (2) For plans which do not yet have one fund year's experience, three times estimated
7 monthly premium; or
8 (3) ] Six hundred thousand dollars ; or
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9 (2) An amount equal to two times the authorized contr ol level risk-based capital,
10 as that term is defined in section 375.1250 .
376.1240. 1. For purposes of this section, terms shall have the same meanings as
2 ascribed to them in section 376.1350, and the term "self-administered hormonal
3 contraceptive" shall mean a drug that is composed of one or more hormones and that is
4 approved by the Food and Drug Administration to prevent pregnancy , excluding emer gency
5 contraception. Nothing in this section shall be construed to apply to medications approved by
6 the Food and Drug Administration to terminate an existing pregnancy .
7 2. (1) Any health benefit plan delivered, issued for delivery , continued, or renewed in
8 this state on or after January 1, 2026, that provides coverage for self-administered hormonal
9 contraceptives shall provide coverage to reimburse a health care provider or dispensing entity
10 for the dispensing of a supply of self-administered hormonal contraceptives intended to last
11 up to ninety days, or intended to last up to one hundred eighty days for generic self-
12 administered hormonal contraceptives. The pr ovisions of this subdivision shall no longer
13 be in effect after December 31, 2026.
14 (2) Any health benefit plan deliver ed, issued for delivery , continued, or renew ed
15 in this state on or after January 1, 2027, that pr ovides coverage for self-administer ed
16 hormonal contraceptives shall prov ide coverage to rei mburse a health care pr ovider or
17 dispensing entity for the dispensing of a supply of self-administere d hormonal
18 contraceptives, including generic and brand-name contraceptives, intended to last up
19 to one year .
20 3. The coverage required under this section shall not be subject to any greater
21 deductible or co-payment than other similar health care services provided by the health
22 benefit plan.
Section 1. If any pr ovision of sections 376.1000, 376.1012, 376.1017, and 376.1240
2 or the application ther eof to any person or cir cumstance is held invalid, such
3 determination shall not affect the pr ovisions or applications of sections 376.1000,
4 376.1012, 376.1017, and 376.1240 which may be given effect without the invalid
5 pr ovision or application, and to that end the prov isions of sections 376.1000, 376.1012,
6 376.1017, and 376.1240 ar e severable.
✔
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