SB 1464 - Current law defines a multiple employer self-insured health plan as one that is either offered by a staff or employee leasing company or established or maintained for the purpose of offering or providing health, dental, or short-term disability benefits to employees of two or more employers. This act modifies such definition by providing that a multiple employer self-insured health plan also includes one that is established or maintained for the purpose of offering or providing health, dental, or short-term disability benefits to two or more self-employed individuals and their dependents. (Section 376.1000) Current law also requires a multiple employer self-insured health plan to establish a surplus account with one of three minimum balances, as described in the act. This act provides that such minimum shall either be $600,000, as provided in current law, or an amount equal to two times the authorized control level risk-based capital. (Section 376.1017) This act is similar to a provision in the truly agreed to and finally passed SS/SCS/HCS/HB 2372 (2026), a provision in the truly agreed to and finally passed CCS/SS/HCS/HB 2596 (2026), and a provision in HCS/SB 1019 (2026). TAYLOR MIDDLETON

2026 Regular Session

Allows self-employed individuals to form self-insured health plans and provides flexible surplus account requirements based on risk-based capital levels instead of fixed minimums.

Second Read and Referred S Insurance and Banking Committee

Legislative bill overview

SB 1464 expands Missouri's definition of multiple employer self-insured health plans to include arrangements serving two or more self-employed individuals and their dependents, not just traditional employees. The bill also modifies surplus account requirements, allowing plans to meet either a $600,000 minimum or twice their risk-based capital level, whichever applies.

Why is this important

Self-employed individuals and gig workers often struggle to access affordable health coverage. This change could create new pooling mechanisms for self-employed groups to negotiate better rates and coverage options. It also provides regulatory flexibility for plan solvency requirements, potentially making it easier for smaller plans to comply while maintaining financial safety standards.

Potential points of contention

Market fragmentation risk: Expanding self-insured plans could create numerous small insurance pools with varying stability, potentially increasing regulatory oversight burden and solvency risks

Actuarial adequacy: The alternative surplus calculation (2x risk-based capital) may be insufficient for some plan types, creating underfunding risk that consumers might not immediately recognize

Regulatory clarity gaps: The bill doesn't specify oversight mechanisms for self-employed groups joining these plans or how disputes between self-employed "employers" would be handled