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HMO Regulation Provisions

Sidebar to the main story on HMO regulation.

JEFFERSON CITY -If you're an HMO enrollee, you may need a scalpel to dissect the measures flooding the House and Senate committees. Here are some of the major requirements the various bills would impose on HMOs:

• Establishment of "community rates," which would mean premiums for coverage would be based only on age, family size and geographic area.
• Disclosure of plan information to enrollees, including doctor lists, costs and a detailed plan coverage.
• Coverage of pre-existing conditions.
• Coverage of minimum hospital stays of both mother and newborn - 48 hours for vaginal delivery and 96 hours for C-section delivery.
• Notification of 90 days to doctors before dropping them from the plan.
• Notification of why a doctor was dropped from a plan.
• Regulation and certification of measures by Missouri Insurance Department.