Missouri Code of State Regulations Title 22 - Missouri Consolidated Health Care Plan
Here’s an overview of Title 22 – Missouri Consolidated Health Care Plan from the Missouri Code of State Regulations:
📘 General Overview – Division 10
Chapter 1 — General Organization (22 CSR 10‑1.010)
MCHCP established on January 1, 1994, under an Act of the General Assembly.
It provides health coverage for state employees, retirees, and eligible public entities.
Governed by a Board of Trustees and administered via an executive director (law.cornell.edu, mchcp.org).
Chapter 2 — State Membership (22 CSR 10‑2.x)
Definitions (22 CSR 10‑2.010): Includes key terms like "active employee," "benefits," "coinsurance," and "plan administrator" (sos.mo.gov).
Membership rules (10‑2.020): Covers enrollment, eligibility, and member obligations (e.g., accuracy of submissions) (sos.mo.gov).
Higher‑education eligibility (10‑2.025): Details entry, coverage, and exit rules for Participating Higher Education Entities (PHEEs) (sos.mo.gov).
Premium Contributions (10‑2.030): Explains how contributions are determined: active employees, retirees (based on service years, capped at 65 %), COBRA, FMLA, etc. (sos.mo.gov).
Utilization Review & Plan Provisions (10‑2.045 to 10‑2.061): Defines deductible structures (PPO 750, PPO 1250, HSA), coverage limits, pre‑certification rules for certain services (sos.mo.gov).
Coordination of Benefits (10‑2.070): Describes how MCHCP coordinates with other insurers—the plan may pay primary or secondary depending on typical COB rules (regulations.justia.com).
Appeals Process (10‑2.075): Outlines submission, internal review, and Board of Trustees appeal timelines and procedures (sos.mo.gov).
Medicare Advantage (10‑2.088): Non‑active Medicare‑primary members must enroll in MCHCP’s Medicare Advantage PPO; opt‑out results in plan disenrollment (regulations.justia.com).
Pharmacy EGWP (10‑2.089): Pharmacy coverage for Medicare-primary members through an Employer Group Waiver Plan (sos.mo.gov).
Other benefits (10‑2.090 to 10‑2.095): Covers voluntary dental, vision, TRICARE supplement plans, and tobacco‑free premium incentives (sos.mo.gov).
Chapter 3 — Public Entity Membership (22 CSR 10‑3.x)
Specific rules for public entities that opt into MCHCP.
Benefit Provisions (e.g., 22 CSR 10‑3.057): Rules around transition of care when providers leave the network, including coverage for eyeglasses/contact lenses (mchcp.org, mchcp.org).
PPO 750 Provisions (22 CSR 10‑3.058): Network deductible per individual/network $750, family/network $1,500; and non-network higher deductibles (law.cornell.edu).
🔗 How to Access the Regulations
The monthly up-to-date version is online via the Missouri Secretary of State’s CSR database under Title 22 → Division 10 (sos.mo.gov).
Official downloadable PDFs by chapter, e.g., Chapter 2 definitions at “22c10‑2.pdf,” and Chapter 3 updates for public entities (sos.mo.gov).
You can also check resources like Justia or Cornell LII, which provide searchable versions (though official source is recommended) .
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