MO SB505

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

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

Health carriers must report annually to the insurance director their total revenues, premiums, health expenditures, and calculated care share percentages; the director must publish these metrics and require them in all marketing materials.

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

Violations constitute level four violations under Missouri law; the director may audit 10% of carriers annually and assess fees to cover monitoring and compliance costs.