Missouri Revised Statutes

Chapter 376
Life, Health and Accident Insurance

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Rsmo Number Section Description
Chapter Cross Reference
All license, permit and certificate applications shall contain the Social Security number of the applicant, 324.024
Annual statement convention blank to be filed by insurers with the N.A.I.C., failure to comply, effect, 375.041
Group service or indemnity contracts to cover newborn child, 376.406
Health coverage provider subject to jurisdiction and examination of department of insurance, 374.194
Incorporation of insurance companies other than life, may issue life policy, 379.010
Injured employees, insurance, payment of fees and integration of systems of insurers and entities administering claims, department rules not applicable, when, 375.427
Insurer, defined, 375.932
Penalty for unauthorized person or corporation transacting insurance business, 375.310
Reduction of capital stock where not fully subscribed, 375.231
Second mortgages, insurance coverage authorized as additional charge, 408.233
Unfair practices and frauds, 375.930 to 375.948
Withdrawal of securities, 375.480
   
GENERAL PROVISIONS
376.005. Definitions.
376.010. Who may form company--purposes.
376.015. Involuntary unemployment insurance may be issued in connection with extension of credit or certain group life insurance, requirements.
376.020. Various companies defined.
376.050. Declaration of corporators.
376.060. Stock companies--content of charter.
376.070. To be submitted to attorney general.
376.080. Director to examine, when.
376.090. To furnish certificate of deposit, when.
376.100. Mutual companies--contents of charter.
376.110. To be submitted to attorney general.
376.120. Director to examine and certify, when.
376.130. To furnish certificate of deposit, when.
376.142. Stock company may become mutual--procedure--policyholders' meeting--acquisition of stock.
376.143. Stock company may acquire its own shares to be held in trust for mutual--appointment, powers and duties of trustees.
376.144. Acquisition of shares of dissenting stockholders, procedure--abandonment of mutualization.
376.145. Officers of stock company to continue as officers of mutual.
376.146. Board of directors or trustees of mutual, membership qualifications, term of office.
376.147. Meetings of board of mutual, notice--executive committee of board, powers.
376.148. Policyholders are members of mutual--voting rights--directors may alter articles--additional assessments prohibited.
376.150. Stock and mutual companies--content of charter.
376.160. Formation of stock and mutual companies.
376.170. Special deposits for registered policies and annuity bonds.
376.180. Certificates as to registration and reserves on policy--policies exempt, exceptions.
376.190. Additional deposits required.
376.200. Definition of net value.
376.210. Excess deposits.
376.220. May use realty to secure notes and bonds.
376.230. Changing of securities on deposit.
376.240. Deposits to be held in trust by director.
376.250. Deposits to be kept separate.
376.260. Fees collected by director of revenue.
376.270. Director may proceed against depositary companies.
376.280. Capital necessary to do business--how invested.
376.290. Deposit and transfer of securities.
376.291. Applicability and inapplicability.
376.292. Definitions.
376.293. Permissible investments--written plan for investments required.
376.294. Prohibited acts.
376.295. Additional prohibited acts--authorized actions.
376.296. Value of investments, how calculated.
376.297. Investment subsidiaries not permitted, when.
376.298. Acquisition of rate credit instruments, when.
376.300. Equity interests permitted, when.
376.301. Tangible personal property interests permitted, when.
376.302. Mortgage interests, may be acquired, when--other real estate interests.
376.303. Lending and repurchase, permitted when.
376.304. Acquisition of foreign investments, when.
376.305. Rulemaking authority.
376.306. Cash surrender value, life insurer may lend to policyholder, when.
376.307. Limits on acquisition of certain investments.
376.308. Secondary mortgage market act, not to preempt health insurer, when.
376.309. Separate account defined--establishment of account and special voting or control rights authorized--approved investments--approval of director required.
376.310. Investment of surplus and reserve funds by foreign companies.
376.311. Investment of capital reserve and surplus of life insurance companies in investment pools--definitions--qualifications--requirements.
376.325. Any willing provider provision--definitions.
376.330. Securities may be changed.
376.350. Reports to director.
376.360. Distribution of surplus funds to participating policyholders--method.
376.365. Standard valuation law--definitions.
376.370. Director to value reserves, methods.
376.379. Medication synchronization services, offer of coverage required.
376.380. Legal minimum standards for valuation--interest rates--valuation manual, operative date, effect of--reserves required.
376.381. Health insurance products, department duties.
376.383. Health care claims for reimbursement, how paid, when--definitions--clean claims, procedure--unpaid claims, procedure--fraudulent claims, notification to the department, procedure--requests for additional information, contents.
376.384. Reimbursement of claims, duties of health carriers--claims submitted in electronic format, when--compliance monitored by department--complaint procedures developed--standard medical code sets required, when--rulemaking authority.
376.385. Diabetes--insurance coverage for equipment, supplies and self-management training.
376.386. Prescription drugs, one co-payment for dosage prescribed.
376.388. Maximum allowable costs--definitions--contract requirements--reimbursement--appeals process required.
376.390. Reserve liability for group insurance--how computed.
376.391. Co-payments for chiropractic services, cap.
376.392. Prescription drug formularies, enrollees to be notified of changes to, when.
376.395. Definitions for group health conversion policy requirements.
376.397. Converted policy to be offered on termination of group health coverage, when--exceptions--terms and conditions.
376.398. Application to all group policies--effective, when.
376.401. Conversion rights--retirees--dependents of insured.
376.403. Benefit levels--group coverage may be provided in lieu of converted policy--delivery outside state, form.
376.404. Specific requirement requests of policyholder may be met by alteration.
376.405. Group health and accident policies, approval required--exempt, when, director's powers.
376.406. Newborn child to be covered under health policies, extent of coverage--notification of birth, when, effect of--definitions.
376.407. Advance practice nurse, claims for service to be reimbursed, when.
376.410. Insurance companies to maintain reserves--exemptions.
376.421. Group health insurance, authorized categories.
376.422. Direct response solicitation and sponsoring or endorsing entity, defined--certain group or individual insurers paying compensation to policyholder or sponsoring entity to notify policyholders.
376.423. Health insurance, claims for chiropractic services denial, qualified chiropractor to review, qualifications--investigation by department, when.
376.424. Group health insurance policies may be extended to insure family members or dependents.
376.425. Student accident policies, may not limit surgical benefits, when.
376.426. Group health policies, required provisions.
376.427. Assignment of benefits made by insured to provider--payment, how made--exceptions--all claims to be paid, when.
376.428. Federal COBRA provisions to apply to group health insurance policies.
376.429. Coverage for certain clinical trials for prevention, early detection and treatment of cancer, restrictions--definitions--exclusions.
376.431. Employees or members of unions or associations, group or group-type basis coverage, sections 376.431 to 376.442 to apply.
376.432. Group-type basis, defined.
376.433. Self-insurance plans for health care, public entities--subject to Medicaid rights, obligations, and remedies.
376.434. Carrier liable for claims incurred during grace period, when--exceptions.
376.435. Claim information to be reported, when--covered lives defined.
376.436. Discontinuance notice by carrier, contents--notice forms furnished by carrier for distribution to policyholders.
376.438. Group policies, modifying or amending benefits shall provide extension of benefits in event of total disability at date of termination or discontinuance.
376.441. Carrier contract replaced by similar benefit plan of another carrier--liability of prior carrier--succeeding carrier coverage requirements.
376.442. Rules and regulations, procedure.
376.446. Enrollee cost-sharing responsibilities, health carriers to provide timely information--exceptions.
376.450. Citation of law--definitions (Missouri HIPAA).
376.451. Standards prohibiting discrimination.
376.452. Large group market, renewal or continuation of coverage required--nonrenewal or discontinuation permitted, when--conditions for discontinuation.
376.453. Premium--only cafeteria plans required, when.
376.454. Individual market, renewal or continuation at option of individual--nonrenewal or discontinuation permitted, when--discontinuation of a type of coverage, procedure.
376.465. Missouri health insurance rate transparency act--definitions--rate filing requirements, procedure--rulemaking authority.
376.480. Domestic companies may assume risks of foreign companies--duties of director.
376.500. Discriminations, rebates and favors prohibited--contracts to conform to policy.
376.502. Life insurers not to discriminate based on lawful travel destinations--violations, penalty.
376.510. Penalty for violation of section 376.500.
376.531. Life insurance policies, consent of insured required, exceptions--employers have insurable interest in employees, when, effects.
376.540. Policy, to whom payable.
376.562. Charitable, benevolent, educational and religious organizations may be beneficiary or owner of policy, life insurance, when--fraud or coercion, exception.
376.570. Foreign executor or administrator.
376.580. Misrepresentation.
376.590. Misrepresentations, false estimates and circulars prohibited--agents--notes to be held until policy delivered.
376.600. Penalty for violating section 376.590.
376.610. Defense in case of suits.
376.620. Suicide, effect on liability--refund of premiums, when.
376.630. Life insurance policies not to be forfeited or become invalid, when.
376.640. Paid-up policy may be demanded, when.
376.650. Rules of payment on commuted policy.
376.660. Foregoing provisions inapplicable, when.
376.669. Annuity contract requirements--paid-up annuity benefits, how calculated--cash surrender benefits, how calculated--applicable, when.
376.670. Provisions which shall be contained in life insurance policies, exceptions.
376.671. Provisions which shall be contained in annuity contracts--inapplicability date.
376.673. Life insurance policies, regulations relative to.
376.674. Life insurance policies, no cash surrender value, regulations relative to.
376.675. Life insurance policies and annuity contracts to be approved--exemption, when--director's powers--judicial review of disapproval.
376.676. Regulation of the valuation of life insurance policies--may adopt NAIC model regulation.
376.677. Life policies may be issued that have no cash surrender value prior to death--no policy loans so law regulating not applicable--requirements to issue.
376.678. Life insurance policies and annuity contracts, annual statement to holder required--company to furnish policy or contract information to holder upon request.
376.679. Life insurance company may reinsure for risks involving aircraft, limitation.
376.680. Assignment of incidents of ownership, group life policy, effect of.
376.685. Optometrists, health insurance plans not to limit fees charged unless reimbursed by plan--requirements--definitions.
   
GROUP LIFE INSURANCE
376.691. Group life policies, eligible groups authorized for issue--premiums, how paid.
376.693. Special group life policies, requirements--director's approval.
376.694. Group life, definitions of direct response solicitation and sponsoring or endorsing entity--certain insurers required to give notice of compensation to policyholder or endorsing entity.
376.695. Extension of policy to insure for loss due to death of spouse or dependent children, requirements, limitations.
376.696. Political subdivisions purchasing any insurance policies to submit to competitive bidding, when--renewal between bidding periods deemed extension.
376.697. Required provisions for group life policies.
376.699. Person insured by group policy entitled to individual life policy, notice requirements.
   
BUYER'S GUIDE
376.700. Purpose--use of additional material.
376.702. Application of law--exceptions.
376.704. Definitions.
376.706. Delivery of guide and summary required, when.
376.708. Required presentations and statements--company to maintain file.
376.710. Effect of omission.
376.712. Effective date.
376.714. Contents and form of buyer's guide.
   
GUARANTY ASSOCIATION--LIFE AND HEALTH INSURANCE
Cross Reference

Effective date of certain amendments, 376.758 ***

376.715. Citation of law, purpose.
376.717. Coverages provided, persons covered--coverage not provided, when--maximum benefits allowable.
376.718. Definitions.
376.720. Association, created--accounts--director to supervise.
376.722. Board of directors, established, members, how selected--expense reimbursement.
376.724. Impaired insurers, association's options, duties--insolvent insurers, association's options, duties--alternative policies, requirements.
376.725. Terminated coverage, reissuance of, premium set, how--obligation to cease, date--interest rate, guaranteed minimum.
376.726. Nonpayment of premiums, effect of.
376.728. Law not applicable, when.
376.730. Liens, association may impose, when.
376.732. Director to have association's powers and duties, when--association may appear in court, when.
376.733. Assignment of rights to association by persons receiving benefits, when--subrogation rights.
376.734. Additional powers of association.
376.735. Assessments against members, when due, classes--amounts, how determined.
376.737. Deferment of assessment, how, when--maximum assessment--refund of, when--members may increase premiums to cover assessments.
376.738. Certificate of contribution, when issued.
376.740. Plan of operation, required, approval of director--provisions of plan.
376.742. Director, powers and duties.
376.743. Board of directors, powers.
376.745. Assessments, offset against tax liability, when, how.
376.746. Records of association meetings to be kept--association deemed creditor of insolvent or impaired insured.
376.747. Distribution of member insurer assets upon liquidation, priority of association.
376.748. Liquidation, recovery of distributions, when, exceptions, limitations.
376.750. Financial report, submitted to director, when--tax exempt status--immunity from liability.
376.752. Member insurer's deposit with director, exemption from, amount.
376.754. Stay of proceedings, insolvent insurer, when.
376.755. Advertising, use of guaranty association prohibited.
376.756. Summary document, association to prepare, when, contents--policy not covered by guaranty association to contain notice, form determined by director.
376.758. Law inapplicable to insolvent insurers on effective date of law.
   
INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE
376.770. Title of law.
376.773. Definitions.
376.775. Matters required in policies.
376.776. Hospital and medical expense provisions extended for certain handicapped and dependent children past normal coverage age.
376.777. Specifically required provisions--exemptions, when--director's powers--inapplicability of certain provisions to individual health insurance coverage.
376.778. Payment direct to public hospitals or clinics with or without assignment, when--provisions required in contracts.
376.779. Health insurance policies to offer coverage for treatment of alcoholism--exclusions.
376.780. Limits on provisions, effect of conflict of policy with law.
376.781. Speech and hearing disorders, companies to offer coverage, when--rules, procedure.
376.782. Mammography--low-dose screening, defined--health care policies to provide required coverage.
376.783. Insured bound only if copy of application attached to policy.
376.785. What does not constitute waiver of defenses.
376.787. Effect of age limit provision.
376.789. Definition of actual charge and actual fee.
376.790. Limits on applicability of law.
376.791. Portion of section 376.777 not applicable to individual health insurance coverage.
376.800. Misrepresentation made in obtaining individual accident and health policy no defense, exception.
376.801. Coverage for child health supervision services required--definitions--permitted limitations on benefits.
376.805. Elective abortion to be by optional rider and requires additional premium--elective abortion defined--health insurance exchanges not to offer coverage for elective abortions.
376.806. Refund of health insurance unearned premium on notice of death of insured--refunded to whom--definitions--exception--failure to notify within one year.
376.807. Policies not to reduce or deny benefits to persons eligible for medical assistance--deemed primary contract.
376.810. Definitions for policy requirements for chemical dependency.
376.811. Coverage required for chemical dependency by all insurance and health service corporations--minimum standards--offer of coverage may be accepted or rejected by policyholders, companies may offer as standard coverage--mental health benefits provided, when--exclusions.
376.814. Rules and regulations authorized, department of mental health to advise department--procedure.
376.816. Adopted children to be provided health care coverage on the same basis as other dependents--effective from date of birth or on placement--placement defined.
376.818. Eligibility for Medicaid may not be considered by insurers.
376.819. MO HealthNet division to have right to payment for health care services provided.
376.820. Insurers may not deny coverage of child because of marital status of parents, residence or income tax dependency claim.
376.821. Insurers may not cancel health or dental insurance solely because the insured is incarcerated--insurer, defined.
376.823. Prohibition on kickbacks not applicable for rebates for certain chronic illnesses.
   
EATING DISORDERS
376.845. Definitions--eating disorders, coverage for diagnosis and treatment of--limitations on coverage.
   
MEDICARE SUPPLEMENT INSURANCE
376.850. Law, how cited.
376.854. Definitions.
376.859. Medicare supplement law applicable to what policies--policies not included.
376.864. Policies not to duplicate benefits provided by Medicare--preexisting conditions, limitations on--director to issue rules establishing standards.
376.869. Standards for policies, minimum, director to adopt.
376.874. Requirements of policy, return to policyholders.
376.879. Outline of coverage for fair disclosure--furnished to each applicant--format and content--rules and standards.
376.881. Policy certificate front page to contain notice of right to return and receive premium refund.
376.882. Cancellation of policy, refund required--notification.
376.884. Advertisement to be reviewed by director.
376.886. Regulations, requirements--rules, procedure.
376.889. Violations, penalty.
376.890. Invalidity of any section regulating Medicare supplement not to affect others.
   
SPOUSAL COVERAGE CONTINUATION
376.891. Definitions.
376.892. Surviving spouse may continue coverage, when--divorced or separated spouse may continue coverage, when--services offered.
376.893. Divorced or separated spouse, continuation of coverage, notice--contents of notice--failure to elect, effect--application.
376.894. Amount of premium, date of payment--termination of right of continuation of coverage, grounds.
   
LIFE CARE CONTRACTS
376.900. Definitions.
376.905. Administration by department, powers, duties--fees.
376.910. Certificate of authority required.
376.915. Application for certificate, content--renewal, content, filed when--extensions, fee.
376.920. Annual statement, form, contents.
376.925. Seven-day rescission period, all money or property to be refunded.
376.930. Insured to be furnished application for certificate and annual statement, when.
376.935. Certificates issued for one year--nontransferable--not endorsement by department.
376.940. Escrow account for entrance fees required, released when.
376.945. Escrow account, amount required--principal, how released, investment.
376.950. Board of directors, one member to be resident of facility.
   
LONG-TERM CARE
376.951. (Transferred 2002; now 376.1100)
376.952. (Transferred 2002; now 376.1103)
376.953. (Transferred 2002; now 376.1106)
376.955. (Transferred 2002; now 376.1109)
376.956. (Transferred 2002; now 376.1112)
376.957. (Transferred 2002; now 376.1115)
376.958. (Transferred 2002; now 376.1118)
   
HEALTH INSURANCE POOL
376.960. Definitions.
376.961. Missouri health insurance pool created--members to be all health insurers in state--board of directors, members, terms, qualifications--transitioning resources.
376.962. Plan of operation to be submitted by board--effective when--failure to submit, director's duty to develop rules--plan content--amendments, procedure.
376.964. Board, powers and duties--including providing for issuing policies and reinsuring risks--staff appointment--rulemaking authority.
376.965. Board members not civilly liable for performance of duties, exception.
376.966. No employee to lose coverage by enrolling in pool--eligibility for pool coverage, ineligibility--medical underwriting considerations, notification required, when--expiration date.
376.968. Administration of pool by insurer or insurers by competitive bids--insurer's qualifications--board to establish criteria for bid content.
376.970. Administering insurer to serve for three years subject to removal for cause--duties--reports--bidding process.
376.973. Administering insurer at close of fiscal year to make accounting and assessment--how calculated--excess to be held at interest for future losses or to reduce premiums--future losses, defined--assessments, continuation of.
376.975. Member's proportion of participation in pool to be determined annually--deficits to be recouped by proportioned assessment--amount of assessment to be offset against certain taxes.
376.978. Director of revenue to determine reduced amount in county foreign insurance tax fund, state treasurer to reimburse fund by reducing amount to general revenue.
376.980. Pool member exempt from taxation of financial institution, may be allowed to offset against sales or use tax, when--excess of assessment over sales or use tax payable in any one year a credit succeeding years until excess is exhausted.
376.982. Rulemaking procedure.
376.984. Abatement or deferring all or part of assessment of member, when--amount abated or deferred may be assessed against other members--deficiency liability.
376.986. Pool to offer medical coverage--premiums, how established--standard risk rate, how calculated--director to approve rates--exclusions--benefits reduced by other insurance or workers' compensation--medical expense to include prayer for spiritual healing.
376.987. High deductible health plans and establishment of health savings plans to be offered as options--definitions--rulemaking authority.
376.989. No liability, criminal or civil, for participation in pool by members.
   
LIMITED MANDATE HEALTH INSURANCE
376.995. Limited mandate health insurance policies defined--certain sections not to apply to limited mandate health insurance policies, exceptions--requirements to sell or issue--certain law to apply.
   
EXCEPTED BENEFIT PLANS
376.998. Health insurance mandate exemption for excepted benefit plans--definitions--procedure to exempt.
   
MULTIPLE EMPLOYER SELF-INSURED HEALTH PLANS
376.1000. Multiple employer self-insured health plan, defined.
376.1002. Certificate of authority required--penalty for noncompliance--law inapplicable, when--exempt organizations.
376.1005. Application for certificate of authority, form--fee--policy or other evidence of coverage provided to employees, form.
376.1007. Plan to file copy of bylaws, coverage and agreements with director.
376.1010. Excess stop-loss coverage maintained by plan.
376.1012. Funds collected from employers held in trust--requirements--board of trustees, elected, duties--annual report, filed when.
376.1015. Department not to grant approval, when.
376.1017. Plan to establish loss reserves--plan to establish surplus account, amount.
376.1020. Plan to maintain principal place of business in Missouri, exception.
376.1022. Dissolution of plan, application, procedure, granted when--distribution of assets, procedures.
376.1025. Director may adopt rules.
376.1027. Plan in unsound condition, powers of director.
376.1030. Agreement of employer to pay benefits, requirements, form--copy filed with director--no excuse from liability.
376.1032. Plan considered insurer, when.
376.1035. Chapter 376 applicable to plan.
376.1037. Plan subject to premium taxes.
376.1040. Plan not to be offered to general public--marketing restrictions.
376.1042. Marketing by agent, agency or broker violation of law.
376.1045. Injunctive relief, director may seek, when--procedures.
   
DENTAL SERVICES
376.1060. Access to dental services not to be sold, assigned, or granted access without express authorization--definitions--requirements.
   
ADMINISTRATORS, CERTAIN INSURANCE POLICIES
376.1075. Definitions.
376.1077. Administrator to have agreement with insurer, form, contents--termination, how.
376.1080. Payments of premiums and claims deemed paid, when.
376.1082. Records maintained by administrator for insurer--director may examine records--records owned by insurer, transfer allowed, when.
376.1083. Advertising restrictions for administrator.
376.1084. Insurer responsible for benefits and underwriting practices--insurer to conduct review of administrator, when.
376.1085. Premiums held in fiduciary capacity, duties--financial records, duties--withdrawals from fiduciary account by agreement only, contents--payment of claims.
376.1087. Commissions not to be contingent on savings in payment of claims--may be based on premiums collected.
376.1088. Notice to policyholder of administrator, contents, required--disclosure of receipts to insurer.
376.1090. Materials delivered to administrator for insured to be promptly delivered.
376.1092. Certificate of authority, required, application, contents, fee--refusal to issue, when--renewal--bond, required when.
376.1093. Annual report filed with director, when--contents--filing fee, amount.
376.1094. Certificate of authority, suspension or revocation, grounds--civil action, when.
376.1095. Rules and regulations, promulgation.
   
LONG-TERM CARE
376.1100. Law, how cited--definitions.
376.1103. Laws applicable, Medicare supplement laws not applicable--purpose--policies or riders must be in compliance.
376.1106. Policies issued in other states may be issued to residents of Missouri if in compliance with Missouri regulations.
376.1109. Policies, content requirements, provisions prohibited--rules authorized--cancellation, refund required.
376.1112. Director to provide buyer's guide--content--advertising of long-term care policies to contain notice of availability of guide.
376.1115. Coverage outline to be delivered to applicants, when, content.
376.1118. Benefits funded by a life insurance death benefit acceleration, reports to policyholder required, content.
376.1121. Denial of claim, long-term care insurance, duties of issuer.
376.1124. Rescinding of a long-term care policy, permitted when--grounds for contesting--no field issuance, when.
376.1127. Nonforfeiture benefit option required for long-term care insurance policies, requirements of offer--rulemaking authority.
376.1130. Rulemaking authority.
   
HEALTH BENEFIT EXCHANGES
376.1186. State-based health benefit exchanges prohibited without statutory authority--executive order to establish prohibited--state agency restrictions--taxpayer standing--definitions.
   
HEALTH CARE MANDATE REVIEW
376.1190. Health care mandates--review by oversight division--actuarial analysis.
376.1192. Mandated health insurance coverage--actuarial analysis by oversight division--cost--expiration date.
   
WOMEN'S HEALTH
376.1199. Coverage for certain obstetrical/gynecological services--exclusion of contraceptive coverage permitted, when--rulemaking authority.
   
BREAST CANCER, OFFER OF COVERAGE
376.1200. Certain policies to offer coverage for treatment of breast cancer--limitation on deductible, lifetime maximum benefit--administration of benefits--application, effect.
376.1209. Mastectomy--mandatory insurance coverage for prosthetic devices and reconstructive surgery--no time limit to be imposed.
   
MATERNITY BENEFITS, MANDATED HOSPITAL CARE
376.1210. Maternity benefits, minimum hospital stays, exceptions--notice of benefits, contents--attending physician defined--rulemaking.
   
IMMUNIZATIONS, MANDATED COVERAGE
376.1215. Immunizations, mandated coverage, exceptions, rulemaking.
   
PART C OF IDEA (FIRST STEPS PROGRAM) COVERAGE
376.1218. Insurance coverage for children enrolled in the Part C early intervention system (First Steps).
   
PKU FORMULA, MANDATED COVERAGE
376.1219. PKU formula and low protein modified food products covered by insurance, when--exceptions.
   
NEWBORN HEARING SCREENINGS, MANDATED COVERAGE
376.1220. Insurance coverage for newborn hearing screenings mandated.
   
SCALP HAIR PROSTHESES
376.1222. Prostheses and scalp prostheses to be provided for children under eighteen by Medicaid, children's health insurance and the consolidated plan--no additional insurance cost--amount allowable.
   
AUTISM SPECTRUM DISORDER
376.1224. Definitions--insurance coverage required--limitations on coverage--maximum benefit amount, adjustments--reimbursements, how made--applicability to plans--waiver, when--report.
   
DENTAL CARE, ANESTHESIA AND HOSPITALIZATION, MANDATED COVERAGE
376.1225. Mandated coverage for general anesthesia and hospital charges for dental care, when--prior authorization required, when--exceptions.
376.1226. Fee schedule for services not covered under health benefit plans--definitions.
   
CHIROPRACTIC CARE
376.1230. Chiropractic care coverage, rates, terms, conditions, limits, and exclusions.
   
PROSTHETICS, OFFER OF COVERAGE
376.1232. Insurers to offer coverage for prosthetics.
   
PHYSICAL THERAPY SERVICES
376.1235. No co-payments or coinsurance for physical or occupational therapy services, when--actuarial analysis of cost, when.
   
PRESCRIPTION EYE DROPS
376.1237. Refills for prescription eye drops, required, when--definitions--termination date.
   
CANCER COVERAGE
376.1250. Cancer screening, health insurance coverage required, when, types.
376.1253. Second opinion, right of newly diagnosed cancer patients, attending physician to inform--insurance coverage for such second opinions required, when.
376.1257. Orally administered anticancer medications, plan to provide coverage no less favorable than IV or injected medications--definitions--requirements--effective date.
   
BONE MARROW TRANSPLANTS
376.1275. Coverage for human leukocyte antigen testing for bone marrow transplantation required, when--exceptions.
   
LEAD TESTING
376.1290. Coverage for lead testing.
   
REORGANIZATION OF DOMESTIC MUTUAL LIFE INSURANCE COMPANY
376.1300. Reorganization of a domestic mutual life insurance company, authority.
376.1305. Formation of holding company, application--shareholder approval.
376.1307. Issuance of shares.
376.1309. Member's interest--nontransference of membership--immunity from liability--assessments, not imposed--security, membership interest.
376.1312. Nonapplicability of certain provisions of insurance holding companies law.
376.1315. Incorporation of mutual holding company, authority, approval.
376.1318. Powers of mutual holding company, engaging in business of insurance, no authority, affiliation and merger agreements.
376.1322. Mutual holding company subject to supervision of director, dissolution or liquidation--demutualization.
   
HEALTH CARE UTILIZATION REVIEW
376.1350. Definitions.
376.1353. Utilization review activities monitored.
376.1356. Utilization review organization monitored, when.
376.1359. Written utilization program implemented, filed with the director.
376.1361. Documented clinical review criteria used in a utilization program--medical director qualifications--compensation of utilization review services.
376.1363. Utilization review decisions, procedures.
376.1365. Reconsideration of an adverse determination, when.
376.1367. Emergency services benefit determination, coverage required, when.
376.1369. Certification of compliance, when.
376.1372. Certification and member handbook to include utilization review procedures.
376.1375. Registry of grievances maintained, procedures--definitions.
376.1378. Grievances and certificate of compliance filed with the director, when.
376.1382. First- and second-level grievance review for managed care plans, first-level procedures.
376.1385. Second-level review procedures.
376.1387. Appeals of grievances determined by the director.
376.1389. Expedited grievance review procedure.
   
RULEMAKING AUTHORITY
376.1399. Rules, effective, when--rules invalid and void, when.
   
STANDARDIZATION OF INFORMATION
376.1400. Explanation of benefits, standardized information used, contents, when.
376.1403. Referrals, standardized information used, content, when.
   
DOCUMENTS AND MATERIALS
376.1450. Enrollee's right to receive documents and materials in printed or electronic form, when.
   
DISCOUNT MEDICAL PLANS
376.1500. Definitions.
376.1502. Requirements for transaction of business.
376.1504. Registration requirements--term of registration--renewal.
376.1506. Violations, penalty.
376.1508. Processing fee--cancellation of membership, effect of.
376.1510. Prohibited acts.
376.1512. Required disclosures.
376.1514. Written agreement required, contents.
376.1516. Written membership materials, required contents--forms to be filed with director, fee.
376.1516. Written membership materials, required contents--forms to be submitted to director.
376.1518. Net worth to be maintained, amount.
376.1520. Notice of changes.
376.1522. List of providers to be maintained on website.
376.1524. Advertising and marketing materials, approval in writing required.
376.1528. Rulemaking authority.
376.1530. Denial and refusal to issue registrations, when.
376.1532. Violations, penalties.
   
MENTAL HEALTH COVERAGE
376.1550. Mental health coverage, requirements--definitions--exclusions.
   
CREDENTIALING OF PRACTITIONERS
376.1575. Definitions
376.1578. Credentialing procedure, health carrier duties--violations, mechanism for reporting.
   
HEALTH CARE SHARING MINISTRY
376.1750. Health care sharing ministry, provisions not to apply to--ministry not engaging in the business of insurance, when--health care sharing ministry defined.
   
SERVICES RELATED TO PREGNANCY
376.1753. Services related to pregnancy, persons holding ministerial or tocological certification may provide.
   
MEDICAL RETAINER AGREEMENTS
376.1800. Definitions--medical retainer agreements not insurance--agreement requirements--use of health savings accounts for fees.
   
TELEHEALTH
376.1900. Definitions--reimbursement for telehealth services, when.
   
HEALTH INSURANCE MARKETPLACE INNOVATION ACT
376.2000. Citation of law--definitions.
376.2002. Navigators, license required--permitted acts--prohibited acts--exemptions.
376.2004. Application procedure.
376.2006. Term of licensure--renewal--continuing education.
376.2008. Consultation with licensed insurance producer, navigator to advise, when.
376.2010. Sanction of license, when--restitution required, when--examination and investigation of records.
376.2011. Violations, administrative orders, civil actions--penalty.
376.2012. Navigators duty to report, when.
376.2014. Applicability--severability--rulemaking authority.
   
DISCLOSURE OF COSTS
376.2020. Contracts prohibiting disclosure of certain payments and costs are unenforceable.
   
STEP THERAPY
376.2030. Definitions.
376.2034. Restriction on step therapy protocol, patient to have access to override exception determination--procedure.
376.2036. Enforcement--applicability to health insurance plans, when.
   
UNCLAIMED LIFE INSURANCE BENEFITS ACT
376.2050. Citation of act.
376.2051. Definitions.
376.2052. Comparison of in-force policies to death master file--violation deemed an unfair trade practice.
376.2053. Exemption from requirements, when.

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