MO SB44

Health carriers with 50,000 or more insured persons in Missouri must spend at least 90 percent of Missouri-associated revenue on health care services, with non-health expenditures capped at 10 percent annually.

Health carriers with 25,000 to 50,000 insured persons in Missouri must spend at least 85 percent of Missouri-associated revenue on health care services, with non-health expenditures capped at 15 percent annually.

Health carriers must report annually to the director of insurance on total revenues, Missouri-associated revenue, health expenditures, and care share percentages, which the director shall publish and include in marketing materials.

Health carriers failing to meet required care share percentages must refund the difference to insured persons by April 30 of the following year, or reduce premiums by the shortfall amount upon written notice to the director.

The director shall audit a random sample of 10 percent of health carriers with more than 25,000 insured persons annually and assess fees to cover audit costs, with violations constituting level four violations under existing law.