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Public Entity Members

Enrollment

Eligible Members

 Employees

Employees

MCHCP plans are available for individuals who meet their employer's eligibility criteria. A waiting period may be required by the employer.

View information for New Employees

 Retirees and Survivors

Retirees and Survivors

MCHCP plans are available to retired subscribers and survivors as long as the public entity employer continues with MCHCP.

View information for Retirement
View information for Medicare

 Dependents

Dependents

MCHCP plans are available to eligible dependents of enrolled subscribers. Dependents include:

  • Spouse
    Marriage must be recognized by Missouri law.
    • Exceptions
      • Spouses who are both employed by different MCHCP-covered public entities must elect coverage through only one employer, not both.
      • Spouses who are both employed by the same MCHCP-covered public entity may elect coverage individually or under the spouse (if allowed by the employer). Members cannot be covered both individually and under their spouse's coverage.
      • MCHCP-covered public entity members who are married to an MCHCP-covered state employee may elect individual coverage under their employer or coverage under their state spouse. They may not have coverage in both places.
  • Children
    Dependent children are eligible for coverage through the end of the month in which they turn 26. Eligible children include:
    • Natural children
    • Adopted children from the date legal obligation begins for total or partial support of the child
    • Stepchildren
    • Foster children
    • Children for whom the subscriber or spouse is the court-appointed legal guardian
    • Newborn of a covered dependent, as long as the dependent continues to be covered by the subscriber
    • Children for whom the subscriber or spouse is required to provide coverage under a Qualified Medical Child Support Order (QMCSO)
    • Exceptions
      • Children age 26 or older may continue coverage if they became permanently disabled prior to age 26. New employees may add eligible disabled dependents as long as the disability occurred prior to age 26.
      • Children under 26 who are state employees may continue coverage under a parent's plan.
      • Children may have dual coverage if the parents are divorced or have never married, and both have coverage through MCHCP. MCHCP will only pay for a service once. If a child has coverage under both parents, the child will have a separate deductible and coinsurance under each policy.

Enrollment Periods

 New Employees

New Employees

New employee enrollment period is a 31-day period beginning on the eligibility date. The eligibility date is determined by the employer and MCHCP coverage cannot begin before that date.

View more information for New Employees

 Open Enrollment

Open Enrollment

During the annual Open Enrollment period, active employees may elect coverage and/or change coverage levels for themselves and eligible dependents, effective the following Jan. 1.

Retiree or survivor subscribers may change plans during Open Enrollment, but cannot add dependents nor enroll in new coverage.

View information for Retirement

 Other Enrollment Periods

Other Enrollment Periods

Outside of Open Enrollment, active employees may enroll themselves and/or their dependents, and retirees and survivors may enroll new dependents, when one of the following occurs:

View Change or Cancel Coverage for information on how to handle specific enrollment and change events.

Termination of Coverage

Unless stated otherwise, coverage will terminate on the last day of the month in which one of the following events happen:

  • Subscriber employment ends, regardless of whether subscriber quits or is fired
  • Divorce or legal separation from the subscriber
  • Child reaches age 26
  • Failure to pay required premiums (see Premium Payments section below). In some cases coverage termination may be retroactive.
  • An act of fraud as prohibited by the terms of the plan or coverage. In some cases coverage termination may be retroactive. For more information, refer to Code of State Regulations
  • Threatening or committing violent acts against MCHCP or an employee of MCHCP

Coverage cannot be terminated on the basis of health status or the exercise of rights under MCHCP's appeal procedures.

Premium Payments

Active employee premiums are paid through payroll deduction. Subscribers whose premiums are not deducted from payroll are direct billed. Most direct billed premium payments are due on the 15th of each month. If the subscriber fails to make the necessary premium payments, coverage may terminate on the last day of the month for which full premium payment was received. The subscriber is responsible for claims submitted after the termination date.

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