Missouri Revised Statutes

Chapter 376
Life, Health and Accident Insurance

(View Entire Chapter)

August 28, 2013

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,
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,
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
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.
376.320. (Repealed L. 2007 S.B. 66 A)
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.
376.370. Director to value reserves, methods.
376.380. Legal minimum standards for valuation--procedures--reserves
required--life insurance company to submit opinion of actuary,
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.
376.390. 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,
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
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,
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
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.
376.480. Domestic companies may assume risks of foreign companies--duties of
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.
376.530. (Repealed L. 2007 S.B. 613 Revision A)
376.531. Life insurance policies, consent of insured required,
exceptions--employers have insurable interest in employees, when,
376.540. Policy, to whom payable.
376.550. (Repealed L. 2007 S.B. 613 Revision A)
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,
376.670. Provisions which shall be contained in life insurance policies,
376.671. Provisions which shall be contained in annuity
contracts--inapplicability date.
376.672. (Repealed L. 2007 S.B. 66 A)
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
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,
376.680. Assignment of incidents of ownership, group life policy, effect of.
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
376.697. Required provisions for group life policies.
376.699. Person insured by group policy entitled to individual life policy,
notice requirements.
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.
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
376.724. Impaired insurers, association's options, duties--insolvent insurers,
association's options, duties--alternative policies,
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
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
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
376.758. Law inapplicable to insolvent insurers on effective date of law.
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.
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
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.
376.800. 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,
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. Division of medical services 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.
376.825. Title.
376.826. Definitions.
376.827. Requirements for mental illness coverage--parity with coverage
provided for physical conditions.
376.830. Services administered and delivered by whom--contracted services
permitted, when.
376.833. Inapplicability of section 376.827, when--waiver granted to
policyholder, when.
376.836. Effective date--study conducted by director, contents, report to
general assembly--exclusions--expiration date.
376.840. (Repealed L. 2004 H.B. 855 A)
376.850. Law, how cited.
376.854. Definitions.
376.859. Medicare supplement law applicable to what policies--policies not
376.864. Policies not to duplicate benefits provided by Medicare--preexisting
conditions, limitations on--director to issue rules establishing
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
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,
376.894. Amount of premium, date of payment--termination of right of
continuation of coverage, grounds.
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.
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)
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,
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
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.
376.990. (Repealed L. 2010 H.B. 1516 Revision A merged with H.B. 1965 A)
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.
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,
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.
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
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,
376.1094. Certificate of authority, suspension or revocation, grounds--civil
action, when.
376.1095. Rules and regulations, promulgation.
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.
376.1186. State-based health benefit exchanges prohibited without statutory
authority--executive order to establish prohibited--state agency
restrictions--taxpayer standing--definitions.
376.1190. Health care mandates--review by oversight division--actuarial
376.1192. Mandated health insurance coverage--actuarial analysis by oversight
division--cost--expiration date.
376.1199. Coverage for certain obstetrical/gynecological services--exclusion of
contraceptive coverage permitted, when--rulemaking authority.
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.
376.1210. Maternity benefits, minimum hospital stays, exceptions--notice of
benefits, contents--attending physician defined--rulemaking.
376.1215. Immunizations, mandated coverage, exceptions, rulemaking.
376.1218. Insurance coverage for children enrolled in the Part C early
intervention system (First Steps).
376.1219. PKU formula and low protein modified food products covered by
insurance, when--exceptions.
376.1220. Insurance coverage for newborn hearing screenings mandated.
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.
376.1224. Definitions--insurance coverage required--limitations on
coverage--maximum benefit amount, adjustments--reimbursements,
how made--applicability to plans--waiver, when--report.
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
376.1230. Chiropractic care coverage, rates, terms, conditions, limits,
and exclusions.
376.1232. Insurers to offer coverage for prosthetics.
376.1235. No co-payments or coinsurance for physical therapy services,
when--actuarial analysis of cost, when.
376.1237. Refills for prescription eye drops, required,
when--definitions--termination date.
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.
376.1275. Coverage for human leukocyte antigen testing for bone marrow
transplantation required, when--exceptions.
376.1290. Coverage for lead testing.
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
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.
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
376.1375. Registry of grievances maintained, procedures--definitions.
376.1378. Grievances and certificate of compliance filed with the director,
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.
376.1399. Rules, effective, when--rules invalid and void, when.
376.1400. Explanation of benefits, standardized information used, contents,
376.1403. Referrals, standardized information used, content, when.
376.1450. Enrollee's right to receive documents and materials in printed or
electronic form, when.
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.
376.1550. Mental health coverage, requirements--definitions--exclusions.
376.1575. Definitions
376.1578. Credentialing procedure, health carrier duties--violations, mechanism
for reporting.
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.
376.1753. Services related to pregnancy, persons holding ministerial or
tocological certification may provide.
376.1900. Definitions--reimbursement for telehealth services, when.
376.2000. Citation of law--definitions.
376.2002. Navigators, license required--permitted acts--prohibited
376.2004. Application procedure.
376.2006. Term of licensure--renewal--continuing education.
376.2008. Consultation with licensed insurance producer, navigator to advise,
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.

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