The Missouri Department of Insurance licenses and monitors HMOs and investigates consumer complaints. It also regulates the plan's grievance process, by which enrollees can appeal a plan's decision on whether or not certain medical care is needed or on the amount of reimbursement. The Department does not, however, review quality of care.
The Missouri Health Insurance Pool (MHIP) was established by and operates according to legislation enacted by the Missouri General Assembly in 1991. Although the MHIP is not an insurance company, it is supervised by the Missouri Department of Insurance. The MHIP is funded by premiums paid by its enrollees and assessments paid by health insurers and HMOs that issue coverage to Missouri residents. There is no limit on the number of individuals who may be enrolled in the MHIP. The MHIP offers individual coverage through four major medical plans which differ only in the amount of the annual deductible and out-of-pocket maximums. Deductibles range from $500 to $5,000; out-of-pocket maximums range from $2,500 to $5,000. The maximum benefit payable on behalf of any individual during his or her lifetime under any plan or combination of plans the MHIP offers is $1,000,000 for all injuries and illnesses combined. At the end of 2004, 2,800 persons were enrolled in the pool.