Mississippi Health Insurance Policy Requirements

Mississippi has health insurance regulations that work alongside federal requirements. Understanding these state-specific rules is essential for the licensing exam.

Regulatory Structure

Mississippi health coverage is regulated by the Mississippi Insurance Department (MID):

Health Insurance Marketplace

Mississippi uses the federal HealthCare.gov marketplace:

• One of the states using the federally facilitated marketplace
• Provides access to qualified health plans (QHPs)
• Premium tax credits available for eligible residents
• Open enrollment and special enrollment periods apply

Metal Tier Plans

Plans available through the marketplace are categorized by metal tiers:

Pre-Existing Condition Protections

Mississippi prohibits pre-existing condition exclusions in ACA-compliant plans:

Guaranteed Issue and Renewal

Mississippi requires:

Guaranteed Issue

• Insurers must accept all applicants for ACA-compliant plans
• Cannot deny coverage based on health status
• Applies to individual and small group markets

Guaranteed Renewal

• Insurers cannot cancel coverage except for:
  • Non-payment of premium
  • Fraud or misrepresentation
  • Plan discontinuation (with proper notice)

Mental Health Parity

Mississippi has mental health parity requirements:

State Parity Law Requirements

Mississippi law requires:

• Large employer fully-insured plans must cover behavioral health conditions
• Individual and small employer plans must offer optional behavioral health coverage
• At least 30 days of inpatient care must be covered
• At least 60 days of partial hospitalization must be covered
• At least 52 outpatient visits must be covered

Financial Parity Requirements

Federal MHPAEA Compliance

Mississippi requires insurers to comply with the federal Mental Health Parity and Addiction Equity Act (MHPAEA):

• Financial requirements must be comparable
• Treatment limitations must be comparable
• Prior authorization requirements must be comparable
• Out-of-pocket costs must be comparable

Exam Tip: Mississippi requires behavioral health coverage with parity protections, meaning mental health benefits cannot be more restrictive than medical/surgical benefits.

Essential Health Benefits

All individual and small group plans must cover:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorders
6. Prescription drugs
7. Rehabilitative services
8. Laboratory services
9. Preventive and wellness services
10. Pediatric services (including dental and vision)

Claims Handling Requirements

Mississippi has specific claims handling timeframes:

Insurers must:

• Furnish claim forms within 15 days of notice
• Pay clean claims within specified timeframes
• Notify claimants of additional documentation needed