Missouri Revised Statutes
Chapter 103 - Health Plan for State Employees
Section 103.003 - Definitions.

Effective - 28 Aug 2016, 2 histories
103.003. Definitions. — As used in sections 103.003 to 103.175, the following terms mean:
(1) "Actuarial reserves", the necessary funding required to pay all the medical expenses for services provided to members of the plan but for which the claims have not yet been received by the claims administrator;
(2) "Actuary", a member of the American Academy of Actuaries or who is an enrolled actuary under the Employee Retirement Income Security Act of 1974;
(3) "Agency", a state-sponsored institution of higher learning, political subdivision or governmental entity or instrumentality;
(4) "Alternative delivery health care program", a plan of covered benefits that pays medical expenses through an alternate mechanism rather than on a fee-for-service basis. This includes, but is not limited to, health maintenance organizations and preferred provider organizations, all of which shall include chiropractic physicians licensed under chapter 331, in the provider networks or organizations;
(5) "Board", the board of trustees of the Missouri consolidated health care plan;
(6) "Claims administrator", an agency contracted to process medical claims submitted from providers or members of the plan and their dependents;
(7) "Coordination of benefits", to work with another group-sponsored health care plan which also covers a member of the plan to ensure that both plans pay their appropriate amount of the health care expenses incurred by the member;
(8) "Covered benefits", a schedule of covered services, including chiropractic services, which are payable under the plan;
(9) "Employee", any person employed full time by the state or a participating member agency, or a person eligible for coverage by a state-sponsored retirement system or a retirement system sponsored by a participating member agency of the plan;
(10) "Evidence of good health", medical information supplied by a potential member of the plan that is reviewed to determine the financial risk the person represents to the plan and the corresponding determination of whether or not he or she should be accepted into the plan;
(11) "Health care plan", any group medical benefit plan providing coverage on an expense-incurred basis, any HMO, any group service or indemnity contract issued by a health plan of any type or description;
(12) "Medical benefits coverages" shall include services provided by chiropractic physicians as well as physicians licensed under chapter 334;
(13) "Medical expenses", costs for services performed by a provider and covered under the plan;
(14) "Missouri consolidated health care plan benefit fund account", the benefit trust fund account containing all payroll deductions, payments, and income from all sources for the plan;
(15) "Officer", an elected official of the state of Missouri;
(16) "Participating higher education entity", a state-sponsored institution of higher learning;
(17) "Participating member agency", a political subdivision or governmental entity that has elected to join the plan and has been accepted by the board;
(18) "Plan year", a twelve-month period designated by the board which is used to calculate the annual rate categories and the appropriate coverage;
(19) "Provider", a physician, hospital, pharmacist, psychologist, chiropractic physician or other licensed practitioner who or which provides health care services within the respective scope of practice of such practitioner pursuant to state law and regulation;
(20) "Retiree", a person who is not an employee and is receiving or is entitled to receive an annuity benefit from a state-sponsored retirement system or a retirement system of a participating member agency of the plan or becomes eligible for retirement benefits because of service with a participating member agency.
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(L. 1992 H.B. 1574 § 1 subsec. 1, A.L. 1995 S.B. 410, A.L. 1996 H.B. 1400, A.L. 2000 S.B. 885, A.L. 2016 S.B. 997)

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Structure Missouri Revised Statutes

Missouri Revised Statutes

Title VIII - Public Officers and Employees, Bonds and Records

Chapter 103 - Health Plan for State Employees

Section 103.003 - Definitions.

Section 103.005 - Missouri consolidated health care plan established, purpose — powers to carry out plan.

Section 103.008 - Administration to be by board of trustees — members, qualifications, appointment, terms — vacancies.

Section 103.010 - MOSERS medical staff will serve jointly on both boards — rates and services, decisions prior to January 1, 1994, to be made by MOSERS board.

Section 103.012 - Board chairman and vice chairman elected annually by secret ballot — powers and duties.

Section 103.014 - Executive director appointed by board, not to be board member — powers and duties.

Section 103.016 - Executive director and staff to be state employees — board members not to be employed by plan for four years after leaving board, exception.

Section 103.019 - Staff salaries to be set by board.

Section 103.020 - Summons and writs to be served on executive director.

Section 103.023 - Actuary or actuarial firm to give technical advice.

Section 103.025 - Annual audit of records and accounts by CPA.

Section 103.027 - Records to be open to public — annual report on financial condition of plan, content.

Section 103.029 - Attorney at law may be employed for legal advice and representation.

Section 103.032 - Investment counselors may be employed for investment advice, qualifications, duties.

Section 103.036 - Benefit trust fund account to be established by board, purpose — powers of board to carry out duties.

Section 103.039 - Deposit of funds — commingling of funds prohibited — executive director to be responsible, bond required.

Section 103.042 - Board to serve without compensation — expenses authorized — board members performing duties not to suffer loss of their regular compensation.

Section 103.045 - Meetings of board, held where and how set — notice to board members.

Section 103.047 - Board members to have one vote — six members to be quorum — majority vote of trustees present for official actions — meeting not required, procedure to determine will of board.

Section 103.050 - Principal office for plan to be in Jefferson City, seal — courts to take judicial notice.

Section 103.055 - Errors in members or providers receiving more or less than entitled to — board's power to correct or recover overpayments.

Section 103.057 - False statement or falsifying record of plan, penalty.

Section 103.059 - Rules authorized, duties of board.

Section 103.061 - Inspection by board of accounts and records of participants in plan or requesting participants.

Section 103.064 - Subpoena of witnesses or production of records, powers of board.

Section 103.067 - Trustees and employees not to profit from plan transactions — acceptance of gratuity or compensation to influence investment, penalties.

Section 103.070 - Tax exemptions for plan's assets.

Section 103.075 - Plan to become effective on January 1, 1994 — prior to effective date employees' retirement medical care plan to remain in effect.

Section 103.078 - Foster parents permitted to purchase, when.

Section 103.079 - Health care programs sponsored by other state agencies may become part of consolidated plan, procedure — departments may review plan and withdraw, when — higher education entities may become part of consolidated plan, procedure.

Section 103.080 - High deductible plans and health savings accounts to be offered — definitions — premiums — consumer-driven health care plans — rulemaking authority.

Section 103.083 - Medical benefit coverage, board's authority to contract for — comparable benefits for employees relying on spiritual healing.

Section 103.084 - Recommendation to change to an October first plan year for health care provider contracts.

Section 103.085 - Termination of coverage, when, exceptions, certain persons may choose to continue coverage, requirements.

Section 103.089 - Medicare benefits participants, effect.

Section 103.095 - General assembly members, elected officials and employees who cease to hold office may continue coverage — time limitation to elect coverage.

Section 103.098 - Thirty-day enrollment period for state employees, retirees and dependents — preexisting condition not covered for twelve months.

Section 103.100 - Cost of medical benefit program, estimated amount, how computed — notification of authorized medical benefit options — recommendation of portion to be paid by employees — appropriations requested.

Section 103.105 - Participating member agencies to pay executive director monthly — payment deposited in health fund.

Section 103.110 - Certification of costs of providing recommended options — premium amounts, payment — deposit in fund.

Section 103.115 - Consultants, former employees from certain state agencies, judges or teachers to be compensated for advice which will be paid toward medical benefits, amount.

Section 103.130 - Agencies joining plan to be by majority vote of governing body, procedure — coverage to be effective, when — must be offered to all eligible employees, retirees and dependents of agency.

Section 103.133 - Withdrawal from plan — participating agencies and political subdivisions, procedure — termination of plan effective, when.

Section 103.136 - Agencies and political subdivisions, coverage by plan after termination, two-year period, exception, board action.

Section 103.138 - Plan not responsible for liabilities prior to effective date — for participating agencies and political subdivisions.

Section 103.141 - Participating agencies and political subdivisions, persons eligible for plan.

Section 103.145 - Enrollment period of thirty days for employees, retirees and dependents of participating member agency.

Section 103.150 - Coverage to terminate when person no longer employee of participating member agency — exceptions.

Section 103.155 - Reimbursement by participating member agency of start-up costs incurred solely for member agency.

Section 103.158 - Premiums to be paid by participating agencies — deposit into fund.

Section 103.163 - Delinquent participating member agency, effect — first lien on member agency's fund — writ of mandamus for payment.

Section 103.165 - Termination of agency's participation in plan for failure to pay — no payment of claims during period of nonpayment.

Section 103.170 - Deficiency in year participating member agencies withdraw to be prorated by the actuary.

Section 103.175 - Feasibility of agencies and school district retirees not having joined plan to join — board to study and report.

Section 103.178 - Alternative system of benefits for treatment of chemical dependency, pilot project — design of project, report.