Missouri Small Business
Health Insurance Plans 2022

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MO Small Business Health Insurance Plans

Missouri Small Business Health Insurance Plans

Missouri Small Business Health Insurance Plans 2022. The following is an overview of the rules that govern small group health insurance plans in the State of Missouri.

The information that is discussed below includes the laws that have been mandated by the Affordable Care Act (ACA or "Obamacare"), as well as the laws that are required by Missouri State government.

If you own and operate a MO small business and you already offer small group health insurance or you're thinking about offering small group health insurance - this guide can help you better understand the regulations, requirements and available Missouri small business health insurance plans available.

Learn how to get Missouri small business health insurance plans for 1 to 50 employees. The best small business health insurance providers in MO offer affordable rates, flexible coverage options and access to a large network of medical providers.

Below are some answers to commonly asked MO small business health insurance plan questions:


How Much Does Missouri Small Business Health Insurance Cost?

The average price of a standard Missouri small business health insurance policy ranges from around $583 to over $1706 per employee per month based on; single or family, location, coverages offered, deductibles and more.

What Are The Small Business Health Insurance Regulations In Missouri?

Missouri Small Business Health Insurance Plans

As in all US states, Missouri has specific laws that pertain to small group health insurance. According to state law, health insurance companies are legally required to sell health insurance policies to any qualified Missouri small business that applies.

Additionally, businesses that employ more than 2 but fewer than 50 employees must offer the same types of policies that offer similar coverage options that are sold to all other qualifying small businesses that operate within the state.

If you're a qualifying small business owner, it's important to note that when you apply for small group health insurance, you may be required to meet minimum participation requirements, and according to Missouri law, insurance companies can set those minimum participation requirements.

If the company you apply to purchase health insurance from requires minimum participation and your business fails to, the company can deny the sale of a policy. Moreover, Missouri state law, insurance companies can determine if they would like to require business owners to pay a certain amount of their employees' premiums before the sale of Missouri small business health insurance plans.

While you must be offered the same health insurance policies with similar health benefits, in Missouri, it is legal for companies to set the premiums they charge. The rates the company charges can be based on specific requirements that pertain to the group, such as the group's age and health risk; however, the higher premiums must be within limits.

It is illegal for health insurance companies to terminate existing group policies if a group member falls ill or develops an injury that requires medical care.

According to Cover Missouri, The ACA, which is often called Obamacare, is a law passed in 2010 that made many changes in how Americans get health insurance. It created a website (healthcare.gov), the Health Insurance Marketplace, as a way to buy health insurance.

Does Missouri Participate In The Affordable Care Act?

Affordable Care Act Missouri

In 2010, the Affordable Care Act (ACA or "ObamaCare") was passed by the United States Congress and was signed into law by Obama. Following its passage, provisions of the law have continued to be phased in, and as of January 1, 2014, the majority of American citizens and legal residents of the United States are required, by law, to have qualifying health care coverage.

If they fail to have coverage, they are responsible for paying an annual tax penalty for each month they aren't insured, which is known as the "individual mandate".

The cost of the penalty for failure to have qualifying coverage is $95 per adult and $47.50 per child, or 1% of your total taxable income; whichever amount is higher - as much as $285 per family. In 2017, the penalty increased, and has continued to increase thereafter.

Qualifying Exemptions For The Individual Mandate

Individuals who meet one of the following are exempt from the individual mandate and the associated tax penalties in MO:

  • Illegal aliens
  • Jailed individuals
  • Religious objections
  • The cost of health insurance coverage is higher than 8% of your household income
  • Those who aren't covered for less than three months during the calendar year
  • Those who have hardship waivers
  • Your income level is blow the 100% poverty level

What Are The Affordable Care Act Requirements For Missouri Small Businesses?

Missouri Small Business Health Insurance Plans Claim Form

If you're a small business owner in Missouri, you must provide your employees with insurance. This is a requirement that was put into place by the Affordable Care Act.

Referred to as the Employer Shared Responsibility provision, all employers must offer their employees at least one of the ACA-compliant Missouri small business health insurance plans, otherwise then can face fines of up to $2,000 per employee.

Missouri small business owners can purchase coverage for their employees through the state's Small Health Option Program (SHOP) exchange, or from a private insurance agent or broker.

Affordable Care Act Standardized Essential Health Benefits

As per the ACA, all qualifying health insurance plans must offer 10 standardized essential benefits.

Depending on the state, additional benefits may also be required. The 10 ACA standardized essential benefits are as follows:

  1. Ambulatory patient services (medical care that is offered without being admitted to a hospital)
  2. Emergency services
  3. Hospitalizations, such as overnight stays and surgical procedures
  4. Lab services
  5. Mental health and substance abuse disorder services, including behavioral health treatments, such as psychotherapy and counseling
  6. Pediatric health care services, including vision and oral care; however, adult vision and dental coverage aren't essential health benefits under ACA
  7. Pregnancy, maternity, and newborn care, including before and after birth
  8. Prescription pharmaceuticals
  9. Preventative and wellness services, as well as management for chronic diseases
  10. Rehabilitative and habilitative services and devices, including services and devices for injuries, disabilities, and chronic health conditions

Additional Health Benefits Mandated In Missouri

Not only do small business owners have to offer Missouri small business health insurance plans that include the 10 standardized essential health benefits that are required by the ACA, but they must also offer additional benefits that have been mandated by MO state government. These additional benefits include the following:

  • Bone marrow testing
  • Breast reconstruction and prosthetic devices following mastectomy
  • Clinical trials that include routine patient care costs that are associated with Phase II, III, or IV trials for cancer treatment

Standardized Missouri Small Business Health Insurance Plans
ACA Metal Levels

In order to make it easier to compare costs and benefits, the Affordable Care Act has designated all qualifying Missouri small business health insurance plans to be one of four metal colors, including Bronze, Silver, Gold, and Platinum.

Each of these designations is based on the average amount of health care costs that the plan will cover, which is illustrates at percentages of how much the insurance company will cover for health care, as well as the amount the insured will have to pay out-of-pocket.

All insurance companies that are participating in the federal or state health care exchange program must offer at least the Silver and Gold Missouri small business health insurance plans.

All four of the metal plans have a shared maximum out-of-pocked amount that the insured can be charged during any calendar year. The following table illustrates this information:

Metal Plan Insurer Pays / Insured Pays
Bronze60% / 40%
Silver70% / 30%
Gold80% / 20%
Platinum90% / 10%


Guaranteed Issue

As per the ACA, individuals cannot be denied coverage or charged higher premiums because of their past health history, or their gender.

Additionally, look-back and waiting periods cannot be imposed. Additionally, policies are effective when they are issued and all coverage is renewable if the individual chooses to renew the policy.

However, plans can be canceled if the individual fails to pay their premiums or commits fraud.

How Are MO Health Insurance Premiums Determined?

A premium is the amount the insured must pay out-of-pocket in order to maintain their health insurance policy. The premiums that are charged for any of the qualifying metal plans can be based on the following:

  • Age of the individual
  • Whether or not the individual uses tobacco
  • Where the individual lives, based on a rating area
  • The number of family members who will be enrolling

What Types Of Health Insurance Plans Are Available For Missouri Small Businesses?

Health Insurance Plan Types

While there are several types of health insurance plans to choose from, the following plans are the most popular among MO small business owners:

Health Maintenance Organization - Simply known as an "HMO", this type of plan offers a variety of health-related services via a network of health care providers and hospitals that exclusively contract with the HMO, or who agree to offer their services to members of the HMO. Employees who participate in this type of plan usually have to choose a primary care physician (PCP), and receive most of their care from this physician. If a specialist is needed, the PCP will recommend one that is affiliated with the HMO.

Preferred Provider Organization - More commonly referred to simply as "PPO", this type of health insurance plan is the most common among Missouri small business owners. The insurance company provides a preferred list of health care providers, and employees must receive their medical care from the doctors and hospitals on that list for their claims to be paid at the highest level possible - but they also have the flexibility to see any other provider anywhere in or out of state.

Point-of-Service Plan - Known as a (POS), this type of health insurance plan provides access to health care services at a lower overall cost, but with fewer choices. Members can access care from in-network or out-of-network providers and facilities, but coverage is better when you stay in-network. POS plans may vary, but generally, plans are considered a blend of HMO and PPO plans - offering more flexibility than HMOs, but less than PPOs.

Health Savings Account - A health savings account (HSA) is a special type of bank account that allows participants in the insurance plan to save money that can be used specifically for the medical care they require in the future. HSA-qualified health insurance plans are usually PPO plans that are specifically designed to be used with an HSA.

Indemnity Health Insurance - This type of health insurance plan allows members to control their own health care and to visit any doctor or hospital they choose. The insurance company would then pay a pre-determined percentage of the total charges for the services that were rendered. Employees may have to pay for some types of services up-front and then they can submit a request for reimbursement with the insurance company.

Missouri Small Business Health Insurance Plans - The Bottom Line

We strongly advise business owners to speak with a CPA and a MO health insurance broker before jumping in and getting any type of the Missouri small business health insurance plans available.

Make sure that you know exactly what each option can do for your company and the potential drawbacks associated with it.

Missouri Economic Data And Business Insurance Regulations

Made In Missouri

Are you a business-minded individual who is considering setting up shop in the state of Missouri? If so, before you take the leap and start putting plans into action, it's important that you do your due diligence to determine whether or not the state offers favorable conditions that will allow your business to succeed. It's also a good idea to find out the rules and regulations that are in place within the state regarding commercial insurance.

Below, we provide an overview of key information that relates to business development in The Show-Me State so you can determine whether or not it will be a suitable location for your business operations.

Economic Trends For Missouri Businesses

The latest reports from the Bureau of Labor Statistics reveal that the unemployment rate in the state of Missouri was 3.3 percent in May of 2022; 0.3 percent below the national average. The unemployment rate is a good indicator of whether or not a state offers favorable conditions for businesses, as it directly reflects the labor market; a low unemployment rate suggests that the climate is healthy, as there are enough jobs to sustain the overall population.

More jobs are a sign that more businesses are flourishing in the area, which directly reflects whether or not the economic climate is healthy for entrepreneurs. It's predicted that the unemployment rate in Missouri will remain within the recently reported range through upcoming years.

St. Louis is an ideal spot for business owners who are looking to set up shop in the Show Me State. It's estimated that for every 1,000 residents in the city, a new business is opened, which is rather impressive. Areas outside of St. Louis also prove to be promising for those interested in starting a business, including:

  • Brentwood
  • Bridgeton
  • Clayton
  • Creve Coeur
  • Des Peres
  • Ellisville
  • Maryland Heights
  • Sunset Hills
  • Town and Country

While businesses in many areas flourish in the state, the following industries are seeing the most growth in MO:

  • Advanced manufacturing
  • Agriculture and bioscience
  • Financial and professional services
  • Health care and social assistance
  • Manufacturing
  • Retail trade
Commercial Insurance Regulations For Businesses In Missouri

The Missouri Department of Insurance regulates insurance in Missouri. Of all the things business owners can invest in, commercial insurance is the most important. In the event that something goes wrong, commercial insurance provides financial protection for the owners and operators of establishments, as well as the customers and vendors they work with and the employees that they rely on.

Certain types of commercial insurance are required in the state of Missouri. Business owners must invest in the following policies, regardless of what industry they are in. Workers' compensation insurance, a policy that covers employee-related accidents and illnesses that occur on the job. Other types of insurance coverage business owners need to carry depend on the nature of the business, as well as the size of the organization.

Request a free Missouri small business health insurance plans quote in these other MO cities: Affton, Arnold, Ballwin, Bellefontaine Neighbors, Belton, Berkeley, Blue Springs, Bolivar, Boonville, Branson, Bridgeton, Cameron, Cape Girardeau, Carthage, Chesterfield, Chillicothe, Clayton, Clinton, Columbia, Concord, Crestwood, Creve Coeur, Dardenne Prairie, Des Peres, Ellisville, Eureka, Excelsior Springs, Farmington, Ferguson, Festus, Florissant, Fort Leonard Wood, Fulton, Gladstone, Grain Valley, Grandview, Hannibal, Harrisonville, Hazelwood, Independence, Jackson, Jefferson City, Jennings, Joplin, Kansas City, Kearney, Kennett, Kirksville, Kirkwood, Ladue, Lake St. Louis, Lebanon, Lee's Summit, Lemay, Liberty, Manchester, Marshall, Maryland Heights, Maryville, Mehlville, Mexico, Moberly, Monett, Neosho, Nixa, O'Fallon, Oakville, Old Jamestown, Overland, Ozark, Park Hills, Perryville, Poplar Bluff, Raymore, Raytown, Republic, Richmond Heights, Rolla, Sedalia, Sikeston, Smithville, Spanish Lake, Springfield, St. Ann, St. Charles, St. Joseph, St. Louis, St. Peters, Sunset Hills, Town and Country, Troy, Union, University City, Warrensburg, Washington, Webb City, Webster Groves, Wentzville, West Plains, Wildwood and all other MO cities & Missouri counties near me in The Show-Me State.

Also find MO local small businesses by General Liability Class Code and learn about Missouri small business insurance requirements for general liability, business property, commercial auto & workers compensation including MO business insurance costs. Call us (314) 499-6799.

Small Business Health Insurance Plans By State

You can find more state specific small business health insurance information including requirments and coverage by clicking on the state below:


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