Missouri Course Update April 2023
> Missouri Life and Health Addendum
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Life and Health
Addendum: for use with Missouri Life and Health online ExamFX courses and study guides version 25685en and 25686en, per exam content outline updates effective 4/26/2023.
The following are content additions to supplement your existing text unless otherwise indicated.
LIFE AND HEALTH:
Introduction
Exam Breakdown – revised exam breakdown
Missouri Life and Health Insurance Examination
155 Total Questions (145 scored; 10 pretest)
|
CHAPTERS |
PERCENTAGE OF EXAM |
|
General Knowledge: |
|
|
Completing the Application, Underwriting, and Delivering the Policy |
8% |
|
Types of Life Policies |
11% |
|
Life Policy Provisions, Riders and Options |
11% |
|
Retirement and Other Insurance Concepts |
6% |
|
Field Underwriting Procedures |
6% |
|
Types of Health Policies |
11% |
|
Health Policy Provisions, Clauses, and Riders |
10% |
|
Social Insurance |
4% |
|
Other Insurance Concepts |
3% |
|
State Law: |
|
|
Missouri Statutes, Rules and Regulations Common to All Lines |
10% |
|
Missouri Statutes, Rules and Regulations Pertinent to Life Insurance Only |
10% |
|
Missouri Statutes, Rules and Regulations Common to Accident and Health Only |
10% |
Missouri Statutes, Rules and Regulations Common to All Lines
A. Director of Commerce and Insurance – changed to Director of Commerce and Insurance
2. Examination of Records — addition to the existing text
It is illegal for any person in any investigation, examination, inquiry, or other proceeding to
- Knowingly make or cause to be made a false statement upon oath or affirmation or in any record that is submitted to the Director or used in any proceeding; or
- Make any false certificate or entry or memorandum upon any of the books or papers of any insurance company, or upon any statement or exhibit offered, filed or offered to be filed in the department, or used in the course of any examination, inquiry, or investigation.
3. Cease and Desist Orders — addition to the existing text
A hearing resulting from a cease and desist order may not be held sooner than 10 days after the notice of hearing is served.
4. Penalties — addition to the existing text
If the violation committed was flagrant and in conscious disregard of the law, the person will be fined up to $25,000 for each violation, not the exceed $250,000 in any 12-month period.
Court Action
The Director may take action through the courts to enjoin any existing or threatened violation of any provision of the Insurance Code, or to enforce any proper order made or action taken by the Director.
The court may
- Issue a permanent or temporary injunction, restraining order, or declaratory judgment;
- Order other appropriate or ancillary relief (such freezing assets or imposing a penalty); or
- Order such other relief as the court considers necessary or appropriate.
Records Expunged
All records of disciplinary actions against an insurance producer that resulted in a monetary penalty of $200 or less and places no other legal duty on the producer will be expunged after 5 years from the date of the execution of the order or settlement agreement by the Director.
B. Licensing Requirements
Temporary License
If necessary, the Director may issue a temporary producer's license without requiring a written examination in any of the following cases for the continuation of a producer's existing business:
- To the surviving spouse or court-appointed personal representative of a producer who is deceased or becomes mentally or physically disabled;
- To a member or employee of a business entity licensed as an insurance producer, upon the death or disability of an individual designated on the business entity application;
- To the designee of a licensed producer who enters active service in the armed forces of the United States;
- In any other circumstance in which the Director deems that public interest will best be served by the issuance of the license.
Producers with a temporary license can perform all of the functions of a regularly licensed producer. Temporary licenses cannot exceed 90 days. The Director may revoke a temporary license if the interests of insureds or the public are endangered. A temporary license may not continue after the owner or the personal representative disposes of the business.
Producer Appointment and Termination of Appointment
An insurance producer cannot act as an agent of an insurer unless the insurance producer is appointed by that insurer. An insurance producer who is not acting as an agent of an insurer is not required to be appointed.
To appoint a producer as its agent, the appointing insurer must enter the name and license number of the producer into the company register within 30 days of authorizing the producer to transact business on its behalf. There
is no charge associated with changing a producer's appointment status on the register. The register must be maintained electronically and be open to inspection by the Director.
An insurer that terminates the appointment, employment, contract, or other insurance business relationship with a producer must notify the Director within 30 days following the effective date of the termination. The insurer must also update the company register within 30 days of appointment termination.
All documents, records, and statements provided to the Director are deemed confidential and absolutely privileged. The Director must provide all obtained written material associated with the appointment or termination of appointment to the producer.
LIFE:
Introduction
Exam Breakdown – revised exam breakdown
Missouri Life Insurance Examination
100 Total Questions (90 scored; 10 pretest)
|
CHAPTERS |
PERCENTAGE OF EXAM |
|
General Knowledge: |
|
|
Completing the Application, Underwriting, and Delivering the Policy |
13% |
|
Types of Life Policies |
17% |
|
Life Policy Provisions, Riders and Options |
17% |
|
Retirement and Other Insurance Concepts |
9% |
|
State Law: |
|
|
Missouri Statutes, Rules and Regulations Common to All Lines |
22% |
|
Missouri Statutes, Rules and Regulations Pertinent to Life Insurance Only |
22% |
Completing the Application, Underwriting, and Delivering the Policy
Gramm-Leach-Bliley Act (GLBA) Privacy
The Gramm-Leach-Bliley Act stipulates that in general, an insurance company may not disclose nonpublic personal information to a nonaffiliated third party except for the following reasons:
- The insurance company clearly and conspicuously discloses to the consumer in writing that information may be disclosed to a third party;
- The consumer is given the opportunity, before the time that information is initially disclosed, to direct that information not be disclosed to the third party; or
- The consumer is given an explanation of how the consumer can exercise a nondisclosure option.
The Gramm-Leach-Bliley Act requires 2 disclosures to a customer (a consumer who has an ongoing financial relationship with a financial institution):
- When the customer relationship is established (a policy is purchased); and
- Before disclosing protected information.
The customer must also receive an annual privacy disclosure, and have the right to opt out, or choose not to have their private information shared with other parties.
Life Policy Provisions, Riders and Options
A. Policy Provisions
Beneficiary Designations
Designation by Class
A class of beneficiary is using a designation such as "my children." This term can be vague if the insured has been married more than once, has adopted children, or has children out of wedlock.
An example of a class that is less vague is "children of the union of Jane Smith and James Smith." Many insurers encourage the insured to name each child specifically and to state the percentage of benefit they are to receive.
When naming beneficiaries, it is most prudent to be specific by naming each individual and by designating the exact amount to be given for that individual. Two class designations are available for use when an insured chooses to "group" the beneficiaries: per capita and per stirpes. Per capita, meaning by the head, evenly distributes benefits among the living named beneficiaries.
Per stirpes, meaning by the bloodline, distributes the benefits of a beneficiary who died before the insured to that beneficiary's heirs.
B. Policy Riders – additional riders
Disability Income
With the disability income rider, in the event of disability the insurer will waive the policy premiums and pay a monthly income to the insured. The amount paid is normally based on a percentage of the face amount of the policy to which it is attached.
Cost of Living
The cost of living rider addresses the inflation factor by automatically increasing the amount of insurance without evidence of insurability from the insured. The face value of the policy may be increased by a cost of living factor tied to an inflation index such as the Consumer Price Index (CPI).
Taxation, Retirement, and Other Insurance Concepts – chapter renamed as “Retirement and Other Insurance Concepts”
Viatical Settlements – topic deleted from the General Knowledge outline
Missouri Statutes, Rules and Regulations Pertinent to Life Only
E. Variable Products
1. Company Qualifications – addition to content
Every individual annuity contract must have the following provisions in place once premium payments are stopped:
- The insurer must grant a paid-up annuity benefit;
- If a contract provides for a lump-sum settlement at maturity, the company will pay a cash surrender benefit instead of any paid-up annuity benefit upon surrender or prior to commencement of annuity payments;
- A statement of the mortality table and interest rates used in calculating any minimum paid-up annuity, cash surrender, or death benefits that are guaranteed; and
- A statement that any paid-up annuity, cash surrender, or death benefits that may be available are not less than the minimum benefits required.
HEALTH:
Introduction
Exam Breakdown – revised breakdown
Missouri Accident and Health Insurance Examination
100 Total Questions (90 scored; 10 pretest)
|
CHAPTERS |
PERCENTAGE OF EXAM |
|
General Knowledge: |
|
|
Field Underwriting Procedures |
9% |
|
Types of Health Policies |
18% |
|
Health Policy Provisions, Clauses, and Riders |
17% |
|
Social Insurance |
7% |
|
Other Insurance Concepts |
5% |
|
State Law: |
|
|
Missouri Statutes, Rules and Regulations Common to All Lines |
22% |
|
Missouri Statutes, Rules and Regulations Pertinent to Health Only |
22% |
Types of Health Insurance Policies
A. Medical Expense Insurance
Health Reimbursement Accounts (HRAs)
Health Reimbursement Accounts (HRAs) consist of funds set aside by employers to reimburse employees for qualified medical expenses, such as deductibles or coinsurance amounts. Employers qualify for preferential tax treatment of funds placed in an HRA in the same way that they qualify for tax advantages by funding an insurance plan. Employers can deduct the cost of a health reimbursement account as a business expense.
The following are key characteristics of HRAs:
- They are contribution healthcare plans, not defined benefit plans;
- Not a taxable employee benefit;
- Employers' contributions are tax deductible;
- Employees can roll over unused balances at the end of the year;
- Employers do not need to advance claims payments to employees or healthcare providers during the early months of the plan year;
- Provided with employer dollars, not employee salary reductions;
- Permit the employer to reduce health plan costs by coupling the HRA with a high-deductible (and usually lower-cost) health plan; and
- Balance the group purchasing power of larger employers and smaller employers.
HRAs are open to employees of companies of all sizes; however, the employer determines eligibility and contribution limits.
An HRA has no statutory limit. Limits may be set by employer, and rollover at the end of the year based on employer discretion. Former employees, including retirees, can have continued access to unused HRAs, but this is done at the employer's discretion. HRAs remain with the originating employer and do not follow an employee to new employment.
Long-Term Care — Eligibility for Benefits
Normally to be eligible for benefits from a long-term care policy, the insured must be unable to perform some of the activities of daily living (ADLs). Activities of daily living include bathing, dressing, toileting, transferring positions (also called mobility), continence, and eating.
Other Health Insurance Concepts
Cost Containment
With the dramatic rise in the cost of medical care over the past few decades, the concept of managed care has become a necessity for insurance companies. Managed care plans, such as HMOs and PPOs, are designed to control costs by controlling the behavior of the plan participants.
Cost-Saving Services
Cost-saving services or case-management provisions provide plans with controlled access of providers, large claim management, preventive care, hospitalization alternatives, second surgical opinions, preadmission testing, catastrophic case management, risk sharing, and providing high quality of care. Insurance companies use the services of case managers for large, ongoing claims through a process of utilization management. The case manager evaluates the appropriateness, necessity, and quality of health care, and may include prospective and concurrent review.
Preventive Care
Managed care plans encourage preventive care and living a healthier lifestyle. Annual physical exams, mammograms, and other procedures used to detect medical problems before symptoms appear can result in a considerable cost savings if a problem is detected early and treated quickly.
Hospital Outpatient Benefit
Because hospital confinement has become so costly, many plans require the patient to take advantage of outpatient services when possible.
Alternatives to Hospital Services
Alternatives to hospital care might include home health care where the patient stays at home and is visited periodically by a health professional. A home health aide that could work in conjunction with a family member may meet daily needs. Terminally ill patients may elect hospice care rather than a hospital stay. Hospice attends to the patient’s daily needs and provides pain relief but attempts no curative procedures. Within cost containment, painkillers and special hospital beds are paid for, but operations or antibiotics are not.
Utilization Management
Utilization management is a system for reviewing the appropriateness and efficient allocation of health care services and resources that are being given or are proposed to be given to an insured. It also covers the review of claims for services that may be covered by a health care provider. There are different types of utilization management reviews: prospective, retrospective, or concurrent review.
Prospective Review
Under the prospective review or precertification process, the physician can submit claim information prior to providing treatment to know in advance if the procedure is covered under the insured’s plan and at what rate it will be paid.
Concurrent Review
Under the concurrent review process, the insurance company will monitor the insured’s hospital stay to make sure that everything is proceeding according to schedule and that the insured will be released from the hospital as planned.
Missouri Statutes, Rules and Regulations Pertinent to Health Only
A. Required Provisions and Benefits
5. Coverage for Mental Health Services – addition to the existing text
Health care plans must also ensure timely access to care with the following guidelines:
- Routine care, without symptoms — within 30 days from the time the enrollee contacts the provider;
- Routine care, with symptoms — within 5 business days from the time the insured contacts the provider;
- Urgent care (for situations that require immediate care, but are not emergencies) — within 24 hours from the time the insured contacts the provider;
- Emergency care — an appropriate mental health provider or emergency care facility must be available 24 hours per day, 7 days per week; and
- Telephone access — a licensed mental health care professional must be available 24 hours per day, 7 days per week.
Systems for delivery of treatment for mental health conditions must have enough mental health care providers to meet timely access to care requirements. If the network does not, coverage of mental health treatment outside of the network must be the same as if the treatment had been inside the network.
10. Grievance Procedures
First- and Second-Level Grievance Review
A health carrier that offers managed care plans must establish a first-level and second-level grievance review process for its managed care plans. A grievance may be submitted by an enrollee, an enrollee's representative or a provider acting on behalf of an enrollee.
Upon receipt of a request for first-level grievance review, a health carrier must
- Acknowledge receipt of the grievance in writing within 10 working days;
- Conduct a complete investigation of the grievance within 20 working days after receiving it;
- If the investigation cannot be completed within 20 working days, the enrollee must be notified in writing on or before the 20th working day. The investigation must then be completed within the next 30 working days. The notice must include the specific reasons additional time is needed;
- Within 5 working days of the completion of the investigation, have someone not involved in the grievance or its investigation decide the appropriate resolution of the grievance and notify the enrollee in writing of the health carrier's decision regarding the grievance and of the right to file an appeal for a second-level review; and
- Within 15 working days after the investigation is completed, notify the person who submitted the grievance of the carrier's resolution of the grievance.
Upon receipt of a request for second-level review, a health carrier must submit the grievance to a grievance advisory panel consisting of
- Other enrollees; and
- Representatives of the health carrier that were not involved in the circumstances giving rise to the grievance or in any subsequent investigation or determination of the grievance.
If the grievance advisory panel decides to uphold an adverse determination, the health carrier must submit the grievance for review to two independent clinical peers in the same or similar specialty. If both independent reviews concur with the decision, the panel's decision will stand. If both independent reviewers disagree with the decision, the initial adverse determination will be overturned. If one of the two independent reviewers disagrees with the decision, the panel must reconvene and make a final decision.
Independent Review
If an insured's health coverage is denied, reduced, modified or terminated by their carrier, and, after having exhausted the carrier's grievance processes, the insured may request their case to be reviewed by a certified independent review organization. The review organizations must be established and placed in a rotating schedule by the Commissioner.
The review agency may request the following information from the carrier:
- Any medical records of the insured that are relevant to the review;
- Any documents used by the carrier in making the determination to be reviewed by the certified independent review organization;
- Any documentation and written information submitted to the carrier in support of the appeal; and
- A list of each physician or health care provider that has provided care to the insured, and that may have medical records relevant to the appeal.
Health information or other confidential or proprietary information in the custody of a carrier may be provided to an independent review organization, subject to rules adopted by the commissioner.
All documents requested by the reviewing organization must be received from the carrier within 3 business days of notification. Once a request for an independent review determination has been made, the independent review organization must proceed to a final determination, unless requested otherwise by both the carrier and the insured or the insured's representative. Carriers must implement the certified independent review organization's determination in a timely fashion and must also pay the certified independent review organization's charges. If the reviewing organization finds a pattern of substandard or egregious conduct by a carrier, they should report their findings to the Office of the Insurance Commissioner.
Expedited Review
An enrollee or enrollee’s representative or health carrier may request an expedited external review if the adverse determination
- Concerns an admission, availability of care, continued stay, or health care service for which the enrollee received emergency services, but has not been discharged from a facility; or
- Involves a medical condition for which the delay occasioned by the standard external review time frame would jeopardize the life or health of the enrollee or jeopardize the enrollee’s prognosis or ability to regain maximum function.
For cases like that, a health carrier must establish written procedures for the expedited review of a grievance involving a situation where the standard time frame of the grievance process would seriously jeopardize the life or health of an enrollee or would jeopardize the enrollee's ability to regain maximum function. A request for an expedited review may be submitted orally or in writing. However, the request will not be considered a grievance unless submitted in writing.
A health carrier must notify an enrollee orally within 72 hours of receiving a request for an expedited review, and must provide written confirmation of its decision covering an expedited review within 3 working days of providing notification of the determination.
11. Chiropractic Services – addition to the existing text
Copayments for chiropractic services may not exceed 50% of the total cost of providing a single chiropractic service.
B. Required Offers
1. Speech and Hearing – addition to the existing text
Necessary care and treatment includes services to identify, assess, diagnose and consult about any treatment needed for the loss or impairment of speech or hearing.
These services include evaluation of hearing; determining range, nature and degree of hearing function; testing, adjusting and evaluating auditory prosthetic devices; and evaluating and treating children with delayed or impaired speech or language disorders.
C. Medicare Supplement
4. Commissions – change to content; commissions must be provided for no fewer than 5 renewal years
E. Group Policies
5. Association and Discretionary Group Coverage – addition to the existing text
Any sales materials, policy and other plan documents issued to the group, and certificates or other evidence of coverage delivered to covered members must clearly disclose
- Whether there are mechanisms established to effect different premium rates for an individual unit covered by the group policy and, if so, how often a unit may be reclassified for a different rate and the formula or amount by which these rate level classifications differ;
- Whether renewal rates will be calculated on the basis of experience for the group or for individual units, or a combination of both;
- To what extent individual units within the group can be cancelled or nonrenewed solely on the basis of deterioration of health of one or more covered members within the unit; and
- The period of time in advance of the premium due date within which notification is provided as to any premium rate change applicable to the policyholder or any individual unit to which the change applies.
Property and Casualty
Addendum: for use with the Missouri Property and Casualty online ExamFX courses and study guide version 25687en/25688en, per exam content outline updates effective 04/26/2023.
The following are content additions to supplement your existing text unless otherwise indicated.
Introduction
Exam Breakdowns – revised exam breakdowns
Missouri Property Insurance Examination
100 Total Questions (90 scored, 10 pretest)
Time Limit: 2 hours
Passing Score: 70%
|
CHAPTERS |
PERCENTAGE OF EXAM |
|
General Knowledge: |
|
|
Property Insurance Terms and Related Concepts |
17% |
|
Property Policy Provisions and Contract Law |
14% |
|
Types of Property Policies |
24% |
|
State Law: |
|
|
Missouri Statutes, Rules and Regulations Common to All Lines |
28% |
|
Missouri Statutes, Rules and Regulations Pertinent to Property Insurance Only |
17% |
Missouri Casualty Insurance
100 Total Questions (90 scored, 10 pretest)
Time Limit: 2 hours
Passing Score: 70%
|
CHAPTERS |
PERCENTAGE OF EXAM |
|
General Knowledge: |
|
|
Casualty Insurance Terms and Related Concepts |
17% |
|
Casualty Policy Provisions |
13% |
|
Types of Policies, Bonds, and Related Terms |
25% |
|
State Law: |
|
|
Missouri Statutes, Rules and Regulations Common to All Lines |
28% |
|
Missouri Statutes, Rules and Regulations Pertinent to Casualty Insurance Only |
17% |
Missouri Property and Casualty Insurance Examination
150 Total Questions (140 scored, 10 pretest)
Time Limit: 3 hours
Passing Score: 70%
|
CHAPTERS |
PERCENTAGE OF EXAM |
|
General Knowledge: |
|
|
Insurance Terms and Related Concepts |
21% |
|
Policy Provisions and Contract Law |
18% |
|
Types of Property Policies |
16% |
|
Types of Casualty Policies, Bonds, and Related Terms |
17% |
|
State Law: |
|
|
Missouri Statutes, Rules and Regulations Common to All Lines |
14% |
|
Missouri Statutes, Rules and Regulations Pertinent to Property Insurance Only |
7% |
|
Missouri Statutes, Rules and Regulations Pertinent to Casualty Insurance Only |
7% |
Types of Property Policies
B. Commercial Lines
Cyber First-Party Coverage
With an ever-growing reliance on technology, it is no surprise that cyberattacks and data breaches are more common than ever. Businesses that obtain and store personal, financial, or otherwise sensitive data are prone to extortion and fraud. To protect businesses and consumers, cyber insurance is made available to businesses, designed to lessen the financial impact resulting from cyberattacks and data breaches.
Cyber security insurance is broken into the following coverage types:
- First-party cyber insurance — Protects businesses from damages resulting from cyber losses to the business' own network or system; and
- Third-party cyber insurance — Covers legal expenses for lawsuits resulting from a business's inability to properly secure consumer data.
Examples of losses covered by a first-party cyber policy include:
- Business interruption and lost revenue;
- Customer notifications;
- Credit monitoring services for affected customers;
- Ransom payments to extortionists holding data hostage; and
- Costs associated with public relation campaigns.
Types of Casualty Policies, Bonds, and Related Terms
B. Automotive: Personal Auto and Business Auto
8. Business Auto Coverage Forms
Mobile Equipment Endorsement
Under the business auto coverage form, mobile equipment is covered for liability insurance when being carried or towed by a covered auto. If a land vehicle that fits the definition of mobile equipment, but because of where or how it is being used becomes subject to compulsory insurance as if it were an auto, an insured could potentially have a coverage problem. For example, a bulldozer is required to have compulsory insurance because to get from one part of a job site to another, it must drive on a public road. If the insured has a Symbol 7 (Specified Auto) listed on the Declarations, that bulldozer would need to be included on the insured's vehicle schedule to be covered for liability. If it is not listed, a solution would be to use this endorsement. The bulldozer would be specifically described in the endorsement and granted coverage.
Covered autos liability coverage does not apply to bodily injury, property damage, or covered pollution cost or expense resulting from the operation of any machinery or equipment that is on, attached to, or part of any of the covered autos.
F. Professional Liability
Liquor Liability
Liquor liability (also known as dram shop liability) refers to the exposure that bars, restaurants, and other similar establishments face due to the selling, distributing, manufacturing, or serving of alcoholic beverages. Liquor liability provides protection in the event of action brought against the insured for selling liquor to a customer who is later involved in an accident and suffers bodily injury or property damage.
Businesses of manufacturing, distributing, selling, serving, or furnishing alcoholic beverages all may have liability exposure to actions under state or local statutes that establish responsibilities for those injuries arising from the distribution or use of alcoholic beverages and causing injuries to the user or caused to others by the user.
Businessowners Policy (BOP) – please refer to the online course for complete text (“Types of Policies, Bonds, and Related Terms” chapter)
Missouri Statutes, Rules and Regulations Common to All Lines
2. Examination of Records — addition to the existing text
It is illegal for any person in any investigation, examination, inquiry, or other proceeding to
- Knowingly make or cause to be made a false statement upon oath or affirmation or in any record that is submitted to the Director or used in any proceeding; or
- Make any false certificate or entry or memorandum upon any of the books or papers of any insurance company, or upon any statement or exhibit offered, filed or offered to be filed in the department, or used in the course of any examination, inquiry, or investigation.
3. Cease and Desist Orders — addition to the existing text
A hearing resulting from a cease and desist order may not be held sooner than 10 days after the notice of hearing is served.
4. Penalties — addition to the existing text
If the violation committed was flagrant and in conscious disregard of the law, the person will be fined up to $25,000 for each violation, not the exceed $250,000 in any 12-month period.
Court Action
The Director may take action through the courts to enjoin any existing or threatened violation of any provision of the Insurance Code, or to enforce any proper order made or action taken by the Director.
The court may
- Issue a permanent or temporary injunction, restraining order, or declaratory judgment;
- Order other appropriate or ancillary relief (such freezing assets or imposing a penalty); or
- Order such other relief as the court considers necessary or appropriate.
Records Expunged
All records of disciplinary actions against an insurance producer that resulted in a monetary penalty of $200 or less and places no other legal duty on the producer will be expunged after 5 years from the date of the execution of the order or settlement agreement by the Director.
B. Licensing Requirements
Temporary License
If necessary, the Director may issue a temporary producer's license without requiring a written examination in any of the following cases for the continuation of a producer's existing business:
- To the surviving spouse or court-appointed personal representative of a producer who is deceased or becomes mentally or physically disabled;
- To a member or employee of a business entity licensed as an insurance producer, upon the death or disability of an individual designated on the business entity application;
- To the designee of a licensed producer who enters active service in the armed forces of the United States;
- In any other circumstance in which the Director deems that public interest will best be served by the issuance of the license.
Producers with a temporary license can perform all of the functions of a regularly licensed producer. Temporary licenses cannot exceed 90 days. The Director may revoke a temporary license if the interests of insureds or the public are endangered. A temporary license may not continue after the owner or the personal representative disposes of the business.
Producer Appointment and Termination of Appointment
An insurance producer cannot act as an agent of an insurer unless the insurance producer is appointed by that insurer. An insurance producer who is not acting as an agent of an insurer is not required to be appointed.
To appoint a producer as its agent, the appointing insurer must enter the name and license number of the producer into the company register within 30 days of authorizing the producer to transact business on its behalf. There is no charge associated with changing a producer's appointment status on the register. The register must be maintained electronically and be open to inspection by the Director.
An insurer that terminates the appointment, employment, contract, or other insurance business relationship with a producer must notify the Director within 30 days following the effective date of the termination. The insurer must also update the company register within 30 days of appointment termination.
All documents, records, and statements provided to the Director are deemed confidential and absolutely privileged. The Director must provide all obtained written material associated with the appointment or termination of appointment to the producer.
E. Marketing Practices
3. Rebating — addition to the existing text
Producers who sell or solicit property and casualty insurance products may offer to provide products or services for free, at a discount, or at market value if such products are intended to:
- Prevent or mitigate loss to property;
- Provide loss control;
- Reduce rates or claims;
- Educate about risk or loss to property;
- Monitor or assess risk;
- Identify sources of risk;
- Develop strategies for eliminating or reducing risk; or
- Provide post-loss services.
Products or services, including gifts, goods, or merchandise containing advertisements or promotions are not required to be present in the contract or policy form filings.
The Director may maintain additional product or service exceptions; however, the Director cannot restrict the exceptions. Rebate regulations do not apply to commission reductions not included in insurance company filings.
Missouri Statutes, Rules and Regulations Pertinent to Casualty Insurance Only
C. Claim Settlement Practices
Definitions
The following definitions apply to claim settlement practices:
- Claimant — Any person or entity submitting a claim on behalf of an insured, including a legally designated representative or immediate family member designated by a claimant;
- First-party claimant — Any individual, corporation, association, partnership, or other legal entity requesting payment arising from a loss covered under an insurance policy;
- Notification of claim — Notification by a claimant to an insurer, either in writing or by other means, which provides facts pertinent to a claim; and
- Third-party claimant — Any individual, corporation, association, partnership, or other legal entity requesting payment for a claim against an insured under an insurance policy.
D. Workers Compensation
Employment Covered
For the purposes of workers compensation regulations, the term employer refers to:
- Every person, partnership, association, corporation, limited liability company, trustee, receiver, legal representative of a deceased employer, or anyone using the service of another for pay; and/or
- State, county, or municipal corporations, school districts, political subdivisions, or cities under special charter, or under the commission form of government.
To be considered an employer, a person or entity must employ at least 5 employees. Construction industry employers who biuld, demolish, alter, or repair improvements only need to employ a minimum of one employee.
2. Exempt Occupations, Employers — addition to the existing text
Partners and sole proprietors may elect coverage on themselves. If coverage is purchased on themselves, it must also be extended to include the partner or sole proprietor's employees, if any.
5. Waiting Period — addition to the existing text
If benefit payments, which are not contested between the employer or the insurer, are made 30 days after becoming due, benefits must include a 10% interest. If benefits are contested by the employer or insurer, payable interest is only required upon an administrative judge's ruling.
6. Permanent Total Disability — addition to the existing text
For occupational diseases due to toxic exposure (excluding mesothelioma) which results in permanent total disability or death, benefits must be equal to 200% of the state's average weekly wage.
E. Medical Malpractice Insurance
Employment Covered — addition to the existing text
An association may begin doing business no sooner than 7 days from the Director's approval. A license authorizing the association to transact medical malpractice insurance is valid for 1 year. The association may not be required to pay any premium taxes in connection with the conduct of its business. The association must pay an annual renewal fee of $100 within 30 days of license expiration.
The Director may conduct an examination of an association's financial condition, affairs, and management at any time, at the expense of the association.