Missouri Life and Health Insurance FAQ

Life Insurance Questions: What is term life insurance?
What is whole life insurance?
What is an annuity?

Group Health: Can my employer change our health insurance carrier and level of benefits during the year?
What happens when my group health coverage ends?

COBRA Benefits: What happens to my group health coverage if leave my employer?; What options do I have if my employer isn't large enough to be affected by COBRA?

Individual Health: Can my health insurance carrier continue to raise my premium rates?
Can health insurance companies deny my application for individual insurance due to a health condition?
What is a preexisting condition?
If I change from one individual health policy to another, can the company impose preexisting condition exclusion on the new policy?

HMOs - Medicare Part C: What is an HMO?
Can my doctor bill me for the services I received when I am covered under an HMO?
What happens if the HMO denies my claim for payment of services?

Long-Term Care Insurance: What is long-term care insurance?
What is the difference between a qualified and a non-qualified plan?
Who pays for long term care?

Medicare Supplements: When should I apply for a Medicare supplement policy?
I am not satisfied with the company I currently have my Medicare supplement with. How often can I switch companies?

Life Insurance Questions

What is term life insurance?: Term insurance provides protection for a specified period of time; a term of 1, 5, 10 or 20 years or up to age 65 is available. This type of policy only pays a benefit if you die during the policy term. Term insurance does not build cash value. If you stop paying your premium, the insurance expires. This insurance generally is less expensive than other types of life insurance.
What is whole life insurance?: Whole life insurance is meant to be kept in force throughout your entire life. An important feature of whole life insurance is the accumulation of cash value. The cash value is the cash available to borrow against the policy, or the value of the policy paid to the policyowner when the contract is surrendered before maturity. Any withdrawal of cash value is treated as a policy loan and interest accumulates based on the loan amount. If you do not pay back the loan, the death benefit is reduced by the outstanding loan amount.
What is an annuity?: An annuity pays a monthly (or quarterly, semi-annual, or annual) income benefit for the life of a person or for a specified period of time. The annuitant (insured) can never outlive the income from the annuity. While the basic purpose of life insurance is to provide an income for a beneficiary at the death of the insured, the annuity is intended to provide an income for the life of the annuitant.
There are two basic types of annuities, fixed annuities, which pay a fixed income backed by fixed dollar investment such as secure bonds and mortgages, and variable annuities, which vary in payment according to the value of stock and bond investments.

Group Health

Can my employer change our health insurance carrier and level of benefits during the year?: Yes. It is completely up to the employer whether or not they will offer health insurance to employees at all and they can change carriers and level of benefits at any time.
What happens when my group health coverage ends?: You can apply for individual health coverage under the federal law Health Insurance Portability and Accountability Act (HIPAA). This type of policy is issued on a guaranteed issue basis if you meet the qualifying criteria. However, there is no limit on the maximum premium the company can charge. Preexisting conditions are waived.

COBRA Benefits

What happens to my group health coverage if leave my employer?: If your employer has more than 20 employees, it is subject to the federal Consolidated Omnibus Budget Reconciliation Act (COBRA) law and entitled to a minimum of 18 months of continuation coverage. Under each of these options, you will have to pay the full premium yourself even if your employer paid part of your premium while you were employed. You can find out more about COBRA continuation of group health benefits from the Federal Department of Labor Office of Pension and Welfare Benefits Administraton website or by calling 816-426-5131.
What options do I have if my employer isn't large enough to be affected by COBRA?: If your employer has less than 20 employees, you are entitled to 9 months of continued group health coverage with your employers group plan under Missouri law (376.428 RSMo).

Individual Health

Can my health insurance carrier continue to raise my premium rates?: Yes. Missouri is an open competition state and, as such, we do not have the authority to regulate premiums on most types of health insurance. Our state relies on competition among companies to determine the premium rates. Medicare supplement insurance premiums are subject to some regulatory oversight.
Can health insurance companies deny my application for individual insurance due to a health condition?: Yes, the company has the right to deny coverage for almost any reason on a new application. However, once you are accepted for coverage, your policy can only be terminated for one of two reasons. The company can cancel your policy for failure to pay your premiums in a timely manner. If you misrepresent information on the application or fail to disclose known information, the company may rescind the policy for material misrepresentation.
What is a preexisting condition?: This is normally a physical or mental condition for which medical advice, diagnosis, care or treatment is recommended or received before the effective date of the policy. The definition can vary from policy to policy.
If I change from one individual health policy to another, can the company impose preexisting condition exclusion on the new policy?: Yes.

HMOs

What is an HMO?: HMO stands for Health Maintenance Organization, a managed care plan where you have the ability to choose your primary care physician (PCP) from a list of network providers. Your PCP is responsible for management of all aspects relating to your health care. If you require care from any network provider other than your PCP, you may need a referral from your PCP to see that provider. Check with your plan to see if your PCP is also the "gatekeeper" for access to other network providers. You must obtain care from a network provider in order to have your claim paid through the HMO. Treatment received outside the network is generally not covered, or covered at a reduced level.
Can my doctor bill me for the services I received when I am covered under an HMO?: No. Under Missouri law, a network contracting provider cannot bill you even if the insurance company is slow in paying; and they cannot bill you for the difference between the amount charged and the amount they are paid by the insurance company. You are only responsible for your copayments, deductible or coinsurance.
What happens if the HMO denies my claim for payment of services?: The company must have an appeal process for you to follow. There is a first and second level appeal process in which you and your physician can present documentation showing your reasons for requesting the proposed treatment. Your appeal must be in writing and the insurance company has up to 30 days to complete an investigation on each level of grievance. You also have the right to contact the Missouri Department of Insurance, Financial Institutions & Professional Registration anytime during this process. The toll free number for the Missouri Department of Insurance, Financial Institutions & Professional Registration is 1-800-726-7390.

Long-Term Care Insurance

What is long-term care insurance?: These are individual insurance policies that may help you when you are unable to take care of yourself due to prolonged illness or disability. However, policies may or may not cover home health care, adult care or other alternative services.
What is the difference between a qualified and a non-qualified plan?: Benefits paid by a qualified long-term care plan generally are not taxable as income. Benefits from a non-qualified long-term care plan may be taxable as income. Check with your tax advisor about the possibility of deducting a portion of the premiums paid in addition to the individual tax consequences involved.
Who pays for long term care?: You do. Medicare only pays for short-term stays. Medicaid may pay if you are qualified for government assistance after spending down most of your assets.

Medicare Supplements

When should I apply for a Medicare supplement policy?: When you elect coverage under Medicare Part B either due to age or disability, you have a 6-month open enrollment for a Medicare supplement policy, which guarantees you coverage with a plan and company of your choice. You may choose from the 10 standardized plans (A-J). If you do not purchase a plan within your 6-month open enrollment, any company you apply with can deny coverage based on your health conditions. There are some limited additional open enrollment periods available to some persons disenrolling from a Medicare HMO. Please contact us about these.
I am not satisfied with the company I currently have my Medicare supplement with. How often can I switch companies?: Each year on your Medicare supplement annual anniversary date you have the ability to switch companies as long as you apply for the same plan (A-J) that you currently are enrolled in and you apply for the policy within 30 days before or after your annual anniversary date.