Title XXIII — CORPORATIONS, ASSOCIATIONS AND PARTNERSHIPS

354.300. Certificate of authority suspended or revoked, when. — Other provisions of law notwithstanding, the director may suspend or revoke, after a hearing, the certificate of authority or license of any corporation subject to the provisions of sections 354.010 to 354.380 for th…

354.305. Corporation advertising assets also to show liabilities — penalties. — 1. Whenever any corporation subject to the provisions of sections 354.010 to 354.380 doing business in this state advertises its assets, either in any newspaper or periodical, or by any sign, circular…

354.315. Data processing system authorized, cost, amount allowed — amortization not to exceed ten years. — Notwithstanding any prohibitions or restrictions contained in the statutes, any corporation subject to the provisions of sections 354.010 to 354.380 may acquire by purchase …

354.320. Corporate funds and securities use for private gain by officers and employees prohibited, penalty. — No officer, enrollment representative or employee of any corporation subject to the provisions of sections 354.010 to 354.380, formed under the laws of this state, or doi…

354.325. Investigation by director of investments — records to be kept by division — criminal action, when. — 1. The director of the department of commerce and insurance shall, as often as he may deem proper, make careful inquiry and investigation as to the manner in which the mo…

354.330. Public official failing to perform duties as to investment violations, penalty. — Any public official failing, neglecting or refusing to comply with any of the provisions of sections 354.320 and 354.325 shall be deemed guilty of a misdemeanor, and, upon conviction, shall…

354.335. Damages allowed if corporation without reasonable cause refuses to pay. — In any action against any corporation subject to the provisions of sections 354.010 to 354.380 to recover the amount of any loss under a policy of health insurance, if it appears from the evidence …

354.340. Unsatisfied judgments against corporation — suspension or revocation of certificate of authority until judgment satisfied. — Whenever any judgment shall be obtained in any of the courts of this state against any corporation subject to the provisions of sections 354.010 t…

354.345. Court decree of specific performance — membership contract, failure of corporation to comply, procedure, effect. — Any person, who has heretofore obtained or may hereafter obtain, in any of the courts of this state, a decree against any corporation subject to the provisi…

354.350. Fraudulent or bad faith conduct — investigation by division — hearing, procedure. — 1. It is unlawful for any corporation subject to the provisions of sections 354.010 to 354.380 transacting business in this state to: (1) Conduct its business fraudulently; (2) Fail to ca…

354.355. Injunctions, permanent or temporary, grounds, procedure — dissolution of corporation or rehabilitation, procedure. — Whenever it shall appear to the director of the department of commerce and insurance, from any examination made by himself, or from the report of a person…

354.357. Receivership, grounds, procedure. — 1. Whenever the director institutes proceedings under section 354.355, he may also institute proceedings in the same case for receivership for any organization or corporation having the exclusive or dominant right to manage or control …

354.362. Newborn child coverage required — notice of birth, when, effect. — The provisions of section 376.406 shall apply to all health services corporations subject to the provisions of sections 354.010 to 354.380. ­­-------- (L. 1983 H.B. 127)

354.380. Certain provisions of insurance law to be applicable. — The provisions of sections 375.936 and 376.770 to 376.800 shall apply to all health services corporations subject to the provisions of sections 354.010 to 354.380. ­­-------- (L. 1983 H.B. 127)

354.400. Definitions. — As used in sections 354.400 to 354.636, the following terms shall mean: (1) "Basic health care services", health care services which an enrolled population might reasonably require in order to be maintained in good health, including, as a minimum, emergenc…

354.405. Certificate of authority, who may make application — foreign corporation may qualify, requirements — procedure. — 1. Notwithstanding any law of this state to the contrary, any person may apply to the director for a certificate of authority to establish and operate a heal…

354.407. PACE projects not deemed health maintenance organizations, when. — Notwithstanding the provisions of section 354.405 to the contrary, a program for all-inclusive care for the elderly (PACE) project sponsored by a religious or charitable organization that is itself or is …

354.410. Certificate issued, when — annual deposit, requirements — capital account, amount, contents. — 1. The director shall issue or deny a certificate of authority to any person filing an application pursuant to section 354.405. Issuance of a certificate of authority may then …

354.415. Powers of organization. — 1. The powers of a health maintenance organization include, but are not limited to, the power to: (1) Purchase, lease, construct, renovate, operate, and maintain hospitals, medical facilities, or both, and their ancillary equipment, and such pro…

354.420. Advisory panels to afford enrollees participation in policy decisions. — The governing body of each health maintenance organization shall establish a mechanism to afford the enrollees an opportunity to participate in matters of policy and operation through the establishm…

354.425. Bonding of officers who disburse or invest funds — bond requirements. — Any director, officer or partner of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of such organization shall be fiduciaries o…

354.430. Evidence of coverage, requirements — rights of enrollee — toll-free telephone number required. — 1. Every enrollee residing in this state is entitled to evidence of coverage. If the enrollee obtains coverage through an insurance policy or a contract issued by a health se…

354.435. Annual reports filed with director, when — content — forms. — 1. Every health maintenance organization shall annually, on or before March first, file a report, verified by at least two principal officers, with the director, covering its preceding calendar year. 2. Such r…

354.440. Information to be available to enrollees. — Every health maintenance organization shall make available to its enrollees: (1) The most recent annual statement of financial condition, including a balance sheet and summary of receipts and disbursements; (2) A description of…

354.441. Disclosures to subscribers shall not be prohibited or restricted. — No health maintenance organization plan, medical group/staff model, independent practice association or any other entity shall prohibit or restrict any provider from disclosing to any subscriber, enrolle…

354.442. Disclosure information to enrollees required, when. — 1. Each enrollee, and upon request each prospective enrollee prior to enrollment, shall be supplied with written disclosure information. In the event of any inconsistency between any separate written disclosure statem…

354.443. Financial disclosures to the department required by health maintenance organizations, when. — 1. A health maintenance organization shall disclose to the department of commerce and insurance all financial arrangements, financial interest in, or contractual provisions with…

354.444. Administrative orders for violations — voluntary forfeitures, civil actions. — 1. If the director determines that a person has engaged, is engaged in, or has taken a substantial step toward engaging in an act, practice or course of business constituting a violation of se…

354.445. Complaints by enrollees, organization to establish system. — Every health maintenance organization shall establish and maintain a complaint system which provides reasonable procedures for the resolution of written complaints initiated by enrollees. ­­-------- (L. 1983 H.…

354.450. Investments authorized. — With the exception of investments made in accordance with subdivisions (1) and (2) of subsection 1 of section 354.415 and subsection 2 of section 354.415, the investable funds of a health maintenance organization shall be invested only in securi…

354.455. Deposit required, how made. — Unless otherwise provided in sections 354.400 to 354.636, each health maintenance organization shall deposit with the director, or with any organization or trustee acceptable to him through which a custodial or controlled account is utilized…

354.460. Advertising not to be untrue or misleading — deceptive solicitation — prohibited — how determined. — No health maintenance organization, or representative thereof, may cause or knowingly permit the use of advertising which is untrue or misleading, solicitation which is u…

354.462. Enrollee, grounds for disenrollment. — An enrollee may not be disenrolled nor denied renewal except for the failure to pay the charge for such coverage, for fraudulent misuse of the system, for abusive conduct, for failure to establish a proper patient-physician relation…

354.464. Names not authorized for use, exceptions. — No health maintenance organization, unless licensed as an insurer, may use in its name, contracts, or literature any of the words "insurance", "casualty", "surety", "mutual", or any other words descriptive of the insurance, cas…

354.465. Examinations by division, when — costs, how paid. — 1. The director, or any duly appointed representative, may make an examination of the affairs of any health maintenance organization as often as he deems it necessary for the protection of the interests of the people of…

354.470. Suspension or revocation, when — effect. — 1. The director may suspend, revoke or place conditions or restrictions on any certificate of authority issued to a health maintenance organization pursuant to sections 354.400 to 354.636 if the director finds that any of the fo…

354.475. Insurance companies or health service company may organize and operate a health maintenance organization. — 1. An insurance company licensed in this state, or a health services corporation authorized to do business in this state, may directly or through a subsidiary or a…

354.480. Rehabilitation, liquidation, or conservation, grounds, procedure — enrollee's priorities — claims, priority. — 1. Any rehabilitation, liquidation, or conservation of a health maintenance organization shall be deemed to be the rehabilitation, liquidation, or conservation …

354.485. Rules and regulations authorized. — The director may promulgate such reasonable rules and regulations in accordance with chapter 536 as are necessary or proper to carry out the provisions of sections 354.400 to 354.636. ­­-------- (L. 1983 H.B. 127, A.L. 2007 S.B. 66)

354.490. Certificate of authority, denial, suspension or revocation, grounds — procedure. — 1. When the director has cause to believe that grounds for the denial of an application for a certificate of authority exist, that grounds for the suspension or revocation of a certificate…

354.495. Fees to be paid to director. — Every health maintenance organization subject to sections 354.400 to 354.636 shall pay to the director the fees specified in section 374.230. ­­-------- (L. 1983 H.B. 127, A.L. 2007 S.B. 66, A.L. 2018 S.B. 982) Effective 1-01-19

354.500. Conferences called by director as to suspected or potential violations. — If the director shall for any reason have cause to believe that any violation of sections 354.400 to 354.636 has occurred or is about to occur, the director may give notice to the health maintenanc…

354.505. Laws regulating insurance or health service corporations not to apply, exceptions. — 1. Provisions of the insurance law and provisions of health services corporation laws shall not be applicable to any health maintenance organization granted a certificate of authority un…

354.510. Public documents, all filings and required reports. — Unless otherwise provided, all applications, filings, and reports required under sections 354.400 to 354.636 shall be treated as public documents. ­­-------- (L. 1983 H.B. 127, A.L. 2007 S.B. 66)

354.515. Confidential information, diagnosis, treatment, health of enrollees or applicants, exceptions. — 1. Any data or information pertaining to the diagnosis, treatment, or health of any enrollee or applicant obtained from such person, or from any provider, by any health maint…

354.520. Mergers, consolidations, control of organization, requirements. — No person may take a tender for, or a request or invitation for tenders of, or enter into an agreement to exchange securities for, or acquire in the open market or otherwise, any voting security of a healt…

354.525. Health provision collective bargaining agreements or contracts — charge for coverage, how determined. — No employer in this state shall be required to pay more for health benefits as a result of the application of this section than would otherwise be required by any prev…

354.530. Severability clause. — If any section, term, or provision of sections 354.400 to 354.636 shall be adjudged invalid for any reason, such judgment shall not affect, impair, or invalidate any other section, term, or provision of sections 354.400 to 354.636, but the remainin…

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. — 1. If a pharmacy, oper…

354.536. Continuation of dependent child coverage, when — dependent child defined. — 1. If a health maintenance organization plan provides that coverage of a dependent child terminates upon attainment of the limiting age for dependent children, such coverage shall continue while …