Missouri Revised Statutes

Chapter 354
Health Services Corporations--Health Maintenance Organizations--Prepaid Dental Plans

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Rsmo Number Section Description
Chapter Cross Reference
Adopted children coverage on placement required, placement defined, 376.816
Adopted children, health coverage to be same as other children, 376.816
Advance practice nurse, coverage required, when, 376.1230
Annual statement convention blank to be filed by insurers with the N.A.I.C., failure to comply, effect, 375.041
Chiropractic services, claim denial, qualified chiropractor to view claim, chiropractor's qualifications to review, 376.423
Dental coverage required, general anesthesia and hospital stay, when, 376.1225
Documents and materials, enrollee's right to receive waived, when, 376.1450
Elective abortions, by optional rider only, additional premium required, 376.805
Health care assistance payments fraud and abuse, 191.900 to 191.910
Health coverage provider subject to jurisdiction and examination of department of insurance, 374.194
Hearing disorders, companies to provide coverage, when, 376.781
Insurers may not cancel health or dental coverage solely because the insured is incarcerated, 376.821
Mammography, low dose screening, health insurance and plans to provide coverage, 376.782
Patient satisfaction and quality of health care, report of department of insurance, 374.426
Payment direct to public hospitals or clinics with or without assignment, when, provisions required in contracts, 376.778
Refund of unearned premiums on death of insured, 376.806
Reimbursement of claims, how paid, when, 376.383
Secondary mortgage market act not to preempt, 376.308
Speech, loss or impairment, companies to offer coverage, when, 376.781
Utilization review agents certification requirements, violations, penalties, 374.500 to 374.515
   
HEALTH SERVICES CORPORATIONS
Cross Reference

Physical therapy, referral by physician employed by HMO and also providing therapy exempt from referral prohibition, 334.253 *** Termination, coverage to continue for period after termination, 376.428 ***

354.010. Definitions.
354.015. Health services corporations, laws applicable to--exceptions.
354.020. Preexisting health services corporation to amend articles, effect of.
354.025. Corporate purposes and authority.
354.027. Discrimination in coverage or reimbursement for covered service by licensed persons, prohibited.
354.030. For-profit corporations excluded from act.
354.035. Procedure for organization of corporation.
354.040. Articles of incorporation, required information and contents.
354.045. Issuance of certificate, effect of.
354.050. General powers of corporation.
354.055. Certificate of authority required--expiration of, extended how.
354.060. Director to issue certificate, when.
354.065. Articles of incorporation, how amended--copy to director, when.
354.070. Certificate of authority automatically extended, when.
354.075. Capital required to do business.
354.080. Reserves required, how computed.
354.085. Membership contract forms, approval by director, when--time for filing--time for disapproval.
354.090. Health services corporation contracts, purposes, parties to.
354.095. Limitation of membership and benefits--certain benefits to be provided, when.
354.105. Annual report required, contents of.
354.115. Member's grievance, how and where filed--director may investigate, court action not barred.
354.120. Rules and regulations by director authorized--procedure, review.
354.125. Corporation not liable for injuries resulting from medical services rendered members.
354.130. Exemption from certain taxes, exceptions.
354.140. Dissolution, liquidation or rehabilitation of corporation, procedure for.
354.145. Appeal from director's actions or decisions, how taken.
354.150. Fees.
354.152. Premiums, dues or fees subject to restrictions--violation, hearing--order prohibiting.
354.155. Disclaimer as to nonhealth services corporations.
354.165. Certain organizations exempt.
354.175. Wage continuation plans by employer exempt.
354.180. Administrative order, director to issue, when.
354.190. Examinations, procedures.
354.195. Records of examination, duty to keep.
354.200. Examinations, false testimony, penalty.
354.205. Examinations--costs, how paid.
354.207. Second medical opinion to be allowed by health services corporations, procedure, costs.
354.210. Director may seek relief, when.
354.215. Examiner's sick leave to apply to health services corporations.
354.220. Director may bring suit to recover fees or sums.
354.225. Enrollment representative, defined--annual report to furnish information--solicitors of members to be insurance agent or broker, exception.
354.230. License required for enrollment representative.
354.235. Enrollment representative--license issued when, qualifications.
354.240. Nonresident may be licensed--examination waived, when.
354.265. Nonrenewable temporary license issued, when.
354.275. Violations by enrollment representatives, penalties.
354.280. Officers of corporation found to be of known bad character or incompetent--authority to transact business, effect.
354.285. Management agreements to control corporation, notice to department, when--examination requirements--violations.
354.290. Examiner's duties--examination contents--hearing on reports allowed--publication of report, when.
354.295. Certificate of authority not to be issued if controlling management involved in improper actions.
354.300. Certificate of authority suspended or revoked, when.
354.305. Corporation advertising assets also to show liabilities--penalties.
354.315. Data processing system authorized, cost, amount allowed--amortization not to exceed ten years.
354.320. Corporate funds and securities use for private gain by officers and employees prohibited, penalty.
354.325. Investigation by director of investments--records to be kept by division--criminal action, when.
354.330. Public official failing to perform duties as to investment violations, penalty.
354.335. Damages allowed if corporation without reasonable cause refuses to pay.
354.340. Unsatisfied judgments against corporation--suspension or revocation of certificate of authority until judgment satisfied.
354.345. Court decree of specific performance--membership contract, failure of corporation to comply, procedure, effect.
354.350. Fraudulent or bad faith conduct--investigation by division--hearing, procedure.
354.355. Injunctions, permanent or temporary, grounds, procedure--dissolution of corporation or rehabilitation, procedure.
354.357. Receivership, grounds, procedure.
354.362. Newborn child coverage required--notice of birth, when, effect.
354.380. Certain provisions of insurance law to be applicable.
   
HEALTH MAINTENANCE ORGANIZATIONS
Cross Reference

Termination, coverage to continue for period after termination, 376.428 ***

354.400. Definitions.
354.405. Certificate of authority, who may make application--foreign corporation may qualify, requirements--procedure.
354.407. PACE projects not deemed health maintenance organizations, when.
354.410. Certificate issued, when--annual deposit, requirements--capital account, amount, contents.
354.415. Powers of organization.
354.420. Advisory panels to afford enrollees participation in policy decisions.
354.425. Bonding of officers who disburse or invest funds--bond requirements.
354.430. Evidence of coverage, requirements--rights of enrollee--toll-free telephone number required.
354.435. Annual reports filed with director, when--content--forms.
354.440. Information to be available to enrollees.
354.441. Disclosures to subscribers shall not be prohibited or restricted.
354.442. Disclosure information to enrollees required, when.
354.443. Financial disclosures to the department required by health maintenance organizations, when.
354.444. Administrative orders for violations--voluntary forfeitures, civil actions.
354.445. Complaints by enrollees, organization to establish system.
354.450. Investments authorized.
354.455. Deposit required, how made.
354.460. Advertising not to be untrue or misleading--deceptive solicitation--prohibited--how determined.
354.462. Enrollee, grounds for disenrollment.
354.464. Names not authorized for use, exceptions.
354.465. Examinations by division, when--costs, how paid.
354.470. Suspension or revocation, when--effect.
354.475. Insurance companies or health service company may organize and operate a health maintenance organization.
354.480. Rehabilitation, liquidation, or conservation, grounds, procedure--enrollee's priorities--claims, priority.
354.485. Rules and regulations authorized.
354.490. Certificate of authority, denial, suspension or revocation, grounds--procedure.
354.495. Fees to be paid to director.
354.500. Conferences called by director as to suspected or potential violations.
354.505. Laws regulating insurance or health service corporations not to apply, exceptions.
354.510. Public documents, all filings and required reports.
354.515. Confidential information, diagnosis, treatment, health of enrollees or applicants, exceptions.
354.520. Mergers, consolidations, control of organization, requirements.
354.525. Health provision collective bargaining agreements or contracts--charge for coverage, how determined.
354.530. Severability clause.
354.535. Pharmacist, emergency situation, may take an assignment of enrollee's right to reimbursement--health maintenance organizations shall only contract with entities licensed by the board of pharmacy--requirements for drug prescriptions, exceptions.
354.536. Continuation of dependent child coverage, when--dependent child defined.
354.540. Health maintenance organization of bordering states may be admitted to do business--procedure.
354.545. Exempt plans and companies.
354.546. Second medical opinion to be allowed by health maintenance organizations, procedure, costs.
354.550. Laws not applicable to community health companies.
354.551. Health maintenance organizations may offer point of service (POS) riders, when.
   
COMMUNITY-BASED HEALTH MAINTENANCE ORGANIZATIONS
354.552. Community-based health maintenance organizations, requirements.
354.554. Standing referrals for certain members of community-based health maintenance organizations, when.
354.556. Trustees, vacancies, elections.
354.558. Materials provided to prospective purchasers.
354.559. Disclosure to members, restrictions and prohibitions.
354.560. Payment arrangements, department to adopt rules--disclosure of financial arrangements--confidentiality.
354.562. Grievance procedures, rulemaking authority.
354.563. Medicare rules to apply to community-based health maintenance organizations, when.
354.565. Community-based health maintenance organization designation given, when--revocation.
354.567. Community-based health maintenance organizations subject to other laws regarding health maintenance organizations.
354.570. Rulemaking--procedure.
354.600. Definitions.
354.603. Sufficiency of health carrier network, requirements, criteria--access plan filed with the department, when.
354.606. Providers notified of specific covered services, when--hold harmless provision--cessation of operations procedure--selection standards for health care professionals, filing with the department.
354.609. Termination of a contract, procedure.
354.612. Continuation of care after provider termination, when.
354.615. Referrals to appropriate providers, when.
354.618. Open referral health plans offered, when--definitions--obstetrician/ gynecologist services to be offered, when--eye care providers, discrimination against, prohibited--exemptions.
354.621. Intermediary and participating provider requirements.
354.624. Proposed provider contract forms filed with the director--contracts maintained at place of business, available for review, when.
354.627. Liability of a health carrier, when.
354.636. Contract requirements after January 1, 1998.
   
ESSENTIAL COMMUNITY PROVIDERS
354.650. Definitions.
354.652. Designation as essential community provider, procedure, qualifications.
354.654. Department of health and senior services, duties--rulemaking authority.
354.656. Inclusion of essential community providers in health care network, exceptions.
354.658. Designation nontransferable, site specific--annual affidavit required--notice of certain changes, required when.
   
PREPAID DENTAL PLANS
354.700. Definitions.
354.702. Prepaid dental plans, who may offer--certificate of authority required--certain state laws not to apply.
354.703. Director may order violators to cease and desist, hearing--noncompliance, director's remedies.
354.704. Application for certificate of authority, content.
354.705. Certificate of authority granted, when.
354.707. Capital, surplus, security required--cash, securities, bond to be deposited or filed with director, director to return deposit, when--security subject to final judgments--security not required for prepaid dental plans funded by government--director may waive capital, surplus, security requirements, when.
354.710. Reserve requirements--reserve not required for prepaid dental plans funded by government--surplus requirement for prepaid dental plans in existence January 1, 1987, additional time.
354.712. Contract or contract certificate to be issued to enrollees, content, copy to be filed with director--newborn child to be covered, when, extent of coverage, notification of birth and additional premium, when, effect of.
354.715. Providers of dental care, written contract with prepaid dental plan corporations, review and mediation procedures for enrollees required.
354.717. Director, powers--financial examinations, when, by whom made and paid.
354.720. Annual report, required, content.
354.721. Agents, registration required--rules and regulations authorized.
354.722. Revocation or suspension of certificate of authority, when--notice, civil suit authorized--suspension, revocation, activity permitted.
354.723. Rulemaking authorized.
354.725. Exclusion, labor organization's health plans.

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