The Missouri Accident and Health Producer License
Missouri's health line of authority is "Accident and health or sickness" - defined by RSMo 375.018 as "insurance coverage for sickness, bodily injury or accidental death." On Pearson VUE's fee table it is the Accident and Health Insurance Producer exam, code 51.
The standalone exam is 100 items in 2 hours for $32; the combined Life, Accident and Health paper (code 54) is 105 items in 3 hours for $40. Since adding Life later as its own exam costs another $32, the combo is $24 cheaper if life cases are anywhere in your plan.
Getting licensed is a three-item list from the DCI: be 18, pass the exam, apply and pay $100. No pre-licensing course - the department says "Missouri does not require pre-licensing courses" - and no fingerprints.
If long-term care is in your plan, budget for the separate LTC training on top of your continuing education. It hangs off this line rather than the life line.
Accident and Health Alone, or the Combined Paper
Both are offered. Accident and Health Insurance Producer (code 51): 100 items in 2 hours, $32. Life, Accident and Health Insurance Producer (code 54): 105 items in 3 hours, $40.
Each exam is built as two scored sections plus embedded pretest items. On the standalone paper that is 50 general and 40 Missouri scored items, plus 10 pretest - so 90 of the 100 count toward your score. On the combined paper the Missouri section grows to 45. The handbook says pretest items "are mixed in with the scored questions and are not identified."
Passing is a scaled 70. The handbook states that the reported score "is neither the number of questions you answered correctly nor the percentage of questions you answered correctly." Missouri publishes multiple forms of each exam and equates between them so that a harder form does not disadvantage the candidate who drew it. The Personal Lines guide covers the equating mechanics and what your score report will and will not tell you.
Retakes: "Candidates must wait one (1) day before scheduling a reexamination," and reservations cannot be made at the test centre. Each attempt is a fresh $32.
Your score is good for a year. 20 CSR 700-1.010(3)(C) gives you "one (1) year from the date of the examination in which to submit an application for licensure."
Most Tested Topics on the Missouri Accident and Health Exam
Missouri's health regulation has more structural oddities than most states, and the exam leans on them. Three of the clusters below - the unit of time in the prompt-pay statute, the annual compliance percentage, and the two-tiered external review - have no clean national analogue. From the TESTivity Missouri regulations curriculum, statute-verified:
| Concept | The Missouri rule |
|---|---|
| The unit prompt pay is measured in | Processing days, and the statute defines the term itself: the days "the health carrier or any of its agents, subsidiaries, contractors, subcontractors, or third-party contractors has the claim in its possession", excluding days spent awaiting a claimant response. The clock stops while the ball is in the claimant's court (RSMo 376.383.1(7)) - and it governs every day-count in the payment cascade |
| Clean claim, defined | "A claim that has no defect, impropriety, lack of any required substantiating documentation, or particular circumstance requiring special treatment that prevents timely payment" (RSMo 376.383.1(2)) |
| The prompt-pay clocks | 48 hours to send an electronic acknowledgment of receipt (376.383.2); 30 processing days to send a status notice telling the claimant either that the claim is a clean claim or that additional information is required (376.383.3); 10 processing days after additional information arrives; 5 processing days after a final request |
| The two clocks that are NOT processing days | The 48-hour acknowledgment at RSMo 376.383.2, and the acknowledgment of requested additional information "within five calendar days" at RSMo 376.383.10. Everything in the payment cascade - 30, 10, 5 and 45 - is a processing day; these two are not |
| Interest and penalty for late payment | Two separate charges, not one: 1% interest per month and a penalty of 1% of the claim per day, once a claim is unpaid after 45 processing days, computed on the unpaid balance as of the forty-fifth day (RSMo 376.383.6) |
| Claims over $35,000 | The 1%-per-day penalty runs "for a maximum of one hundred days," after which the carrier pays 2% interest per month instead (RSMo 376.383.6) |
| What counts as compliance | A portfolio test, not a per-claim promise: "properly processing and paying ninety-five percent of all claims received in a given calendar year" (RSMo 376.384) |
| Paper claims | Excluded from prompt pay altogether. A claim submitted by a health care provider after January 1, 2003 "in a nonelectronic format shall not be subject to the provisions of section 376.383" (RSMo 376.384) |
| Filing windows for providers | One year from date of service for a nonparticipating provider; six months for a participating provider. A carrier's refund or offset request is capped at 12 months after payment, except for fraud (RSMo 376.384) |
| Who decides an external review | The director first. A grievance is resolved by the director, and "if the grievance is unresolved by the director then it shall be resolved by referral of such grievance to an independent review organization" (RSMo 376.1387.1) |
| Is the external decision binding? | Yes - "a final agency decision within the director's discretion, binding upon the enrollee and health carrier," with 30 days to seek judicial review (RSMo 376.1387.1) |
| Continuation after group coverage ends | Missouri does have a mini-COBRA. RSMo 376.428.1 requires group policies to allow continuation "in the same manner as continuation of coverage is required under" federal COBRA - the state statute incorporates the federal rules by reference rather than writing its own month counts |
| Two further continuation rights | A spouse may continue on dissolution of marriage or death of the employee (RSMo 376.428.2), and conversion rights apply after continued coverage ends (RSMo 376.428.3) |
| Individual accident and health grace period | 7 days on a weekly premium policy, 10 days on a monthly, 31 days on all others - three different numbers in one provision (RSMo 376.777.1(3)) |
| Misstatement of age, accident and health | Adjusted to what the premium would have purchased at the correct age - age only, unlike the life rule, which also reaches sex (RSMo 376.777.2(2)) |
The processing-day definition is the highest-value item on this page, because it changes every other number in the statute. Thirty processing days is not thirty calendar days. If a carrier requests additional information on day 12 and the provider takes three weeks to answer, those three weeks do not count. A candidate who converts these figures to calendar days will get every timing item wrong, and the statute defines the term precisely so that they cannot.
The compliance percentage is the second. Missouri's prompt-pay duty operates at two levels that are easy to fuse. At the level of the individual claim, RSMo 376.383.6 gives that claimant interest and a daily penalty. At the level of the carrier's regulatory standing, RSMo 376.384 asks only whether it properly processed and paid 95% of all claims received in a given calendar year. So a carrier can owe a particular provider money and still be fully compliant - and the unit there is a calendar year, not a month.
The paper-claim carve-out is the third, and it is the one most likely to catch a producer out. Where a reader would expect one standard to apply to electronic and paper claims alike, Missouri writes provider paper claims out of the prompt-pay statute entirely for anything submitted after 1 January 2003. There is no slower clock for paper; there is no clock.
On external review, hold the two-step shape. Missouri is not a refer-straight-to-an-IRO state: the director resolves the grievance, and the IRO is what happens if the director cannot. And note what the statute does not contain - it sets no deadline to request a review and none to decide one. The 20-day, 45-day and 72-hour figures in circulation come from the DCI's own description of how it runs its IRO contract, not from RSMo 376.1387.
What Missouri Asks, and Why It Matters More Here
Most states run two screens on a new producer: the questions on the application, and a fingerprint-based criminal history check. Missouri runs only the first. There is no MACHS appointment, no service code and no fingerprint fee on a producer application - the DCI reserves fingerprinting for Bail Bond Agent, General Bail Bond Agent and Surety Recovery Agent applicants.
That makes the disclosure questions the whole of the screen, and it makes answering them carefully more consequential than in a state where the record is going to surface anyway.
What the statute conditions licensure on. RSMo 375.015(1) requires that the applicant "has not committed any act that is a ground for denial, suspension or revocation set forth in section 375.141", and provides that approval may be withheld where the application indicates "a conviction for a felony or a crime involving moral turpitude." RSMo 375.015(3) then lets the director "require any documents reasonably necessary to verify the information contained in an application" - so a disclosure generates follow-up rather than an automatic refusal.
The fourteen grounds in RSMo 375.141 are what the questions are testing for. They run from the predictable - providing materially incorrect information in the application, obtaining a licence by misrepresentation or fraud, conviction of a felony or a crime of moral turpitude, misappropriating moneys or properties - to several that are specific enough to be worth naming: signing another person's name without authorisation (ground 10), improperly using reference materials during an examination (ground 11), acting as an unlicensed producer or accepting business from an unlicensed person (ground 12), and failing to comply with child support or tax payment orders (grounds 13 and 14).
Ground 1 is the one that catches people, and it is independent of everything you disclose. Providing materially incorrect information in the application is itself a ground for denial, suspension or revocation. A conviction disclosed honestly is a fact the director weighs; the same conviction concealed is a second, freestanding problem that does not go away when the first is forgiven.
If a disclosure applies to you, look at the 1033 waiver before you file. Federal law bars a person convicted of a felony involving dishonesty or breach of trust from working in insurance without written consent, and the DCI publishes a Missouri 1033 waiver application. Both the resident and nonresident producer pages link to it.
Three ongoing reporting duties start the day you are licensed, and all three run on the same clock. Under RSMo 375.141 you must report an address change within 30 days, an administrative action in another jurisdiction within 30 days, and a criminal prosecution within 30 days of the initial pretrial hearing. That last one is unusual - the duty attaches at the pretrial hearing, not at conviction, so it can arise long before there is anything to be guilty of.
What happens if the director acts. RSMo 375.141 requires written notice with reasons for a denial or non-renewal, and appeals go to the Administrative Hearing Commission under chapter 621 - a separate tribunal, not an internal departmental review. Note also that RSMo 375.141 contains no dollar figures at all; the penalty ladder lives two sections away in RSMo 374.049, and the Property & Casualty guide walks it.
What It Costs
Two payments and nothing else - no course fee, no fingerprint fee. Missouri is among the least expensive states in the country to enter.
Eligibility Requirements
At least 18, exam passed for each line applied for, $100 paid, and no act committed that is a ground under RSMo 375.141 (RSMo 375.015(1)). No course, no prints, no sponsorship.
One duty worth internalising before you handle a single premium: RSMo 375.051 holds a producer "responsible in a trust or fiduciary capacity" for money collected - to the company under subsection 1 where you act for the insurer, and to the applicant or insured under subsection 2 where you act for them. Missouri adds a practical twist at subsection 3: you need not maintain separate bank accounts per payor, provided the funds are "reasonably ascertainable from the books of account and records of the insurance producer." That is a lighter mechanical rule than most states impose, and it puts the weight on your recordkeeping instead.
Keeping the License
Important CE details: 16 credit hours per two-year cycle, 3 of which must cover ethics, Missouri law and producer duties to the department as one combined block (RSMo 375.020.1; 20 CSR 700-3.200(2)). Missouri allows carryover of excess hours to the immediately following period, which is unusual (RSMo 375.020.4). Selling Qualified Long-term Care Partnership policies carries its own training: 8 hours of initial basic training before selling, then at least 4 hours each two-year renewal period. Whether those hours also count toward the 16 is not stated on the DCI page.
16 credit hours every two years, 3 of them a single combined block. The 16 is statutory - RSMo 375.020.1 requires "a minimum of sixteen hours of instruction" per two-year period, and mandates "business ethics, including sales suitability" as content without setting an hours figure. The 3 is regulatory, and it is not three hours of ethics alone: 20 CSR 700-3.200(2) requires "three (3) hours of instruction covering ethics, Missouri law, and producer duties and obligations to the department during any two-(2-)year licensure period." The rule sits in 20 CSR 700-3 “Education Requirements”; 700-1 has no CE rule at all. Note too that the 16 does not grow with lines held: the DCI lists Life/Health 16, Property/Casualty 16, and "Life/Health + Property/Casualty: 16 hours any combination." Title producers do 8.
Excess hours carry forward. RSMo 375.020.4 permits hours accumulated in one two-year period to be "carried forward to the two-year period immediately following." Carryover is worth knowing about because it changes how you plan a cycle. The limit is in the words: forward to the immediately following period only. Against that, the DCI page requires courses to be "completed during the biennium to which they are to be applied" and says "Courses may not be duplicated during a renewal period" - so what carries is surplus hours, not permission to re-sit a course.
Long-term care Partnership training is a separate gate, and note how narrowly the DCI scopes it: 8 hours of initial basic training specific to Partnership policies before selling such policies, then "at least four (4) hours of continuing education regarding such policies during each two-year renewal period thereafter." The requirement is written around Qualified Long-term Care Partnership policies rather than long-term care generally, and the DCI page does not say which line of authority it attaches to or whether the hours count toward the 16 - so this guide does not claim either. Classes must be pre-approved by the DCI. The authority is RSMo 208.690 to 208.698 and 20 CSR 400-4.120.
Waivers and extensions are available under RSMo 375.020.5 for serious illness, military service, residence overseas, or reaching age 70. And some licensees are exempt from CE entirely: RSMo 375.020.7 covers licences "for which an examination is not required" plus limited and restricted lines, and RSMo 375.020.8 covers life producers limited by written agreement to funeral or burial policies of $20,000 or less.
Renewal mechanics - the two-year term, the fee and the reinstatement window - are in the Property & Casualty guide.
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