MO HB1968

Expands risk-based capital (RBC) requirements to apply to health organizations (health services corporations, HMOs, limited health service organizations, dental/vision plans, hospitals, and managed care organizations) in addition to existing insurer requirements.

Changes HMO examination frequency from every three years to every five years, with examination costs paid by the examined organization as provided in section 374.160.

Adds definitions for "domestic health organization" and "foreign health organization" and creates new RBC calculation formulas for health organizations accounting for asset risk, credit risk, underwriting risk, and other business risks.

Establishes company action level, regulatory action level, authorized control level, and mandatory control level events for health organizations with corresponding director actions including RBC plan requirements and corrective orders.

Allows the director to exempt domestic health organizations from RBC requirements if they write direct business only in Missouri with annual premiums of $2 million or less and assume no reinsurance exceeding 5 percent of direct premiums written, or if they are limited health service organizations covering fewer than 2,000 lives.