Mo. Code Regs. tit. 22 § 10-2.030
Current through Register Vol. 49, No. 21, November 1, 2024.
Section 22 CSR 10-2.030 - ContributionsPURPOSE: This amendment revises the Missouri Consolidated Health Care Plan contribution methodology for retiree coverage; removes language related to the Medicare Prescription Drug Only Plan; and renumbers as necessary.
(1) Total premium costs for various levels are based on employment status, retiree status, eligibility for Medicare, and various classifications of dependent participation as established by the plan administrator.(2) The Missouri Consolidated Health Care Plan (MCHCP) contribution toward the premium for active employee coverage shall be determined by the plan administrator.(3) The MCHCP contribution toward the premium for Family Medical Leave Act (FMLA) leave of absence coverage shall be the same as for active employees.(4) The MCHCP shall not make a contribution toward the premium for terminated vested (including terminated non-vested elected state officials and employees), leave of absence (except for FMLA leave of absence), foster parents, or Federal Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage.(5) The MCHCP contribution toward the premium for long-term disability coverage shall be equal to the amount that was contributed toward the comparable rate tier in 2002.(6) The Missouri Consolidated Health Care Plan (MCHCP) contribution toward retiree coverage is based on either of the following: (A) The contribution percentage is calculated by using the number of full creditable years of service at retirement as reported to MCHCP by Missouri State Employees' Retirement System (MOSERS) or Public School Retirement System (PSRS) multiplied by two and one half percent (2.5%). The resulting product shall be capped at sixty-five percent (65%), or in other words the retiree's years of service is capped at twenty-six (26) years. 1. Medicare retirees. A. For Medicare retirees, the contribution percentage is multiplied by the retiree only Medicare Advantage Plan total premium. The resulting product is the MCHCP contribution, which shall be subtracted from the Medicare Advantage total premium. The difference is the amount of the retiree contribution toward the total premium.B. For Medicare retirees covering Medicare-eligible dependents, MCHCP will contribute for the dependent portion of the premium the lesser of the following: the contribution percentage multiplied by the Medicare Advantage premium, or the dollar amount MCHCP contributes for the dependent portion of the PPO 1250 premium for an active employee at the rate tier the retiree has selected.C. For Medicare retirees covering non-Medicare eligible dependents, MCHCP will contribute for the dependent portion of the premium the lesser of the following: the contribution percentage multiplied by the difference in premium of the retiree only Medicare Advantage Plan and the premium of the dependent portion of the PPO 1250 Plan at the rate tier the retiree has selected, or the dollar amount MCHCP contributes for the dependent portion of the PPO 1250 premium for an active employee at the rate tier the retiree has selected.2. Non-Medicare retirees. A. For non-Medicare retirees, the contribution percentage is multiplied by the retiree only PPO 1250 Plan total premium with the tobacco-free incentive and the partnership incentive. The resulting product is the MCHCP contribution, which shall be subtracted from the total premium of the plan chosen by the retiree. The difference is the amount of the retiree contribution toward the total premium.B. For non-Medicare retirees covering Medicare-eligible dependents, MCHCP will contribute for the dependent portion of the premium the lesser of the following: the contribution percentage multiplied by the Medicare Advantage premium, or the dollar amount MCHCP contributes for the dependent portion of the PPO 1250 premium for an active employee at the rate tier the retiree has selected.C. For non-Medicare retirees covering non-Medicare eligible dependents, MCHCP will contribute for the dependent portion of the premium the lesser of the following: contribution percentage multiplied by the difference in premium of the retiree only PPO 1250 Plan total premium with tobacco-free incentive and partnership incentive and the premium of the PPO 1250 Plan at the rate tier the retiree has selected, or the dollar amount MCHCP contributes for the dependent portion of the PPO 1250 premium for an active employee at the rate tier the retiree has selected.(B) For those retiring prior to July 1, 2002, the amount calculated in subsection (6)(A) is compared to the flat dollar amount that was contributed for the same rate tier in 2002. The retiree's subsidy is the greater of the amount calculated in subsection (6)(A) or the flat dollar amount that was contributed in 2002.(7) Premium. Payroll deductions, Automated Clearing House (ACH) transactions, debit cards, credit cards, and/or direct bills are processed by MCHCP. (A) Active Employee Whose Payroll Information is Housed in the SAM II Human Resource System. 1. Monthly medical premium payroll deductions are divided in half and taken by MCHCP at the end of the prior month and the fifteenth of the current month for the current month's coverage (example: September 30 and October 15 payroll deductions are taken for October medical premiums).2. Monthly dental and vision premium payroll deductions are divided in half and taken by MCHCP on the fifteenth of the current month and the end of the current month for the current month's dental and vision coverage (example: October 15 and October 31 payroll deductions are taken for October dental and vision premiums).3. If a subscriber owes premiums outside the current month, payroll deductions for all other premiums owed will be divided equally and taken from the subscriber's future payrolls as follows: A. Fifty dollars ($50) or less, deduction will be taken from one (1) payroll;B. Fifty-one dollars ($51) to one hundred dollars ($100) will be deducted from two (2) payrolls;C. One hundred one dollars ($101) to two hundred dollars ($200) will be deducted from three (3) payrolls;D. Two hundred one dollars ($201) to three hundred dollars ($300) will be deducted from four (4) payrolls;E. Three hundred one dollars ($301) to four hundred dollars ($400) will be deducted from five (5) payrolls;F. Four hundred one dollars ($401) to five hundred dollars ($500) will be deducted from six (6) payrolls;G. Five hundred one dollars ($501) to six hundred dollars ($600) will be deducted from seven (7) payrolls;H. Six hundred one dollars ($601) to seven hundred dollars ($700) will be deducted from eight (8) payrolls;I. Seven hundred one dollars ($701) to eight hundred dollars ($800) will be deducted from nine (9) payrolls;J. Eight hundred one dollars ($801) to nine hundred dollars ($900) will be deducted from ten (10) payrolls;K. Nine hundred one dollars ($901) to one thousand dollars ($1,000) will be deducted from eleven (11) payrolls; andL. One thousand one dollars ($1,001) and over will be deducted from twelve (12) payrolls.4. If the active employee's check is not sufficient to cover his/her premium, the active employee will receive a monthly bill for the premium.(B) Active Employee Whose Payroll Information is not Housed in the SAM II Human Resource System. 1. Premium payroll deductions are submitted to MCHCP monthly from the agency based on the deductions taken from the employee's payroll.A. Medical premium payroll deduction received at the end of the month is applied to the employee's next month's coverage (example: September 30 payroll deduction is taken for the October medical premium).B. Dental and vision premium payroll deductions received at the end of the month are applied to the current month's dental and vision coverage (example: September 30 payroll deductions are taken for September dental and vision premiums).C. If a subscriber owes past-due premiums, payroll deductions for current premiums along with the payroll deductions for past-due premiums may be taken at the discretion of the employer.2. If the active employee's check is not sufficient to cover his/her premium, the active employee will receive a monthly bill for the premium.(C) Retirees and Survivors Premiums From Benefit Check.1. Deduction amounts are received monthly from MOSERS based on the deductions taken from the benefit checks. Medical, dental, and vision deductions received at the end of the month pay for the next month's coverage (example: September 30 benefit check deduction is taken for October medical, dental, and vision premiums).2. If a retiree or survivor is currently having deductions taken from his/her benefit check and owes past-due premiums due to a change in his/her deductions, MCHCP will contact MOSERS to determine if the benefit check is large enough to cover the past-due premiums. If the benefit check is large enough to cover the past-due premiums, deductions will be divided and taken from the retiree or survivor's next three (3) benefit checks and coverage will be continuous. If the retiree or survivor's benefit check is not large enough to cover the deductions, and the retiree or survivor has failed to make the necessary premium payments, coverage will be terminated due to nonpayment, effective the last day of the month a full premium was received.(D) Direct Bill of Premium Owed By Subscribers Whose Premium is not Deducted from Payroll or Benefit Check.1. Premiums are billed on the last working day of the month for the next month's coverage. Premiums are due fifteen (15) days from the last day of the month in which they are billed (example: bill mailed September 30 for October medical, dental, and vision premiums, premium due October 15).2. A subscriber may elect to pay premiums by ACH electronic payment. In that case, the subscriber agrees that he/she will not receive a monthly bill.A. Premiums are deducted from a subscriber's bank account on the fifth of the month to pay for the current month's coverage (example: October 5 deduction taken for October medical, dental, and vision premiums).B. If there are insufficient funds, MCHCP will bill the subscriber for the premium owed. The due date of the premium owed shall not change due to insufficient funds.(8) Premium Payments. (A) By enrolling in coverage under MCHCP, an active employee agrees that MCHCP may deduct the member's contribution toward the total premium from the subscriber's paycheck. Payment for the first month's premium is made by payroll deduction. Subsequent premium payments are deducted from the active employee's paycheck. If the active employee's check is not sufficient to cover his/her premium, the active employee agrees to pay MCHCP by check, money order, ACH or cash, or by any other monetary transaction supported by MCHCP.(B) By enrolling in coverage under MCHCP, the retiree or survivor agrees that MCHCP will automatically deduct the premium from the retiree or survivor's benefit check. The retiree or survivor may choose to receive a monthly bill in lieu of an automatic deduction. If the retiree or survivor's deduction is not sufficient to cover his/her premium or the retiree or subscriber chooses to receive a monthly bill, the retiree or survivor agrees to pay MCHCP by check, money order, ACH or cash, or by any other monetary transaction supported by MCHCP.(C) If the subscriber fails to make the necessary premium payments, coverage terminates on the last day of the month for which full premium payment was received. The subscriber is responsible for claims submitted after the termination date. 1. If a non-Medicare subscriber fails to pay premiums by the required due date, MCHCP allows a thirty-one- (31-) day grace period from the due date. In the event that MCHCP has not received payment of premium at the end of the thirty-one- (31-) day grace period, coverage will be retroactively terminated on the last day of the month for which full premium payment was received. The subscriber will be responsible for the value of the services rendered after the retroactive termination date, including, but not limited to, the grace period.2. If a Medicare primary subscriber fails to pay premiums by the required due date, MCHCP allows a sixty- (60-) day grace period from the due date. In the event that MCHCP has not received payment of premium at the end of the sixty- (60-) day grace period, coverage will be terminated effective the end of month in which the sixty- (60-) day grace period ends.(9) Refunds of overpayments are limited to the amount overpaid during the twelve- (12-) month period ending at the end of the month preceding the month during which notice of overpayment is received by MCHCP. AUTHORITY: section 103.059, RSMo 2000.* Emergency rule filed Dec. 16, 1993, effective Jan. 1, 1994, expired April 30, 1994. Emergency rule filed April 4, 1994, effective April 14, 1994, expired Aug. 11, 1994. Original rule filed Dec. 16, 1993, effective July 10, 1994. Emergency rescission and rule filed Dec. 21, 1994, effective Jan. 1, 1995, expired April 30, 1995. Emergency rule filed April 13, 1995, effective May 1, 1995, expired Aug. 28, 1995. Rescinded and readopted: Filed Dec. 21, 1994, effective June 30, 1995. Emergency rescission and rule filed Dec. 20, 2004, effective Jan. 1, 2005, expired June 29, 2005. Rescinded and readopted: Filed Dec. 20, 2004, effective June 30, 2005. Emergency amendment filed Nov. 1, 2011, effective Jan. 1, 2012, expired June 28, 2012. Amended: Filed Nov. 1, 2011, effective May 30, 2012. Amended: Filed Oct. 30, 2012, effective May 30, 2013. Emergency amendment filed Oct. 30, 2013, effective Jan. 1, 2014, expired June 29, 2014. Amended: Filed Oct. 30, 2013, effective June 30, 2014. Amended by Missouri Register April 1, 2015/Volume 40, Number 07, effective 5/31/2015Amended by Missouri Register April 1, 2016/Volume 41, Number 07, effective 5/31/2016Amended by Missouri Register April 17, 2017/Volume 42, Number 08, effective 5/31/2017Amended by Missouri Register April 2, 2018/Volume 43, Number 7, effective 5/31/2018Amended by Missouri Register April 1, 2019/Volume 44, Number 7, effective 5/31/2019*Original authority: 103.059, RSMo 1992.