Title XXIV — BUSINESS AND FINANCIAL INSTITUTIONS

376.1364. Unique confirmation number required, prior authorization review — secure electronic transmission for prior authorizations — single cover page, contents. — 1. Any utilization review entity performing prior authorization review shall provide a unique confirmation number t…

376.1365. Reconsideration of an adverse determination, when. — 1. In a case involving an initial determination or a concurrent review determination, a health carrier shall give the provider rendering the service an opportunity to request on behalf of the enrollee a reconsideratio…

376.1367. Emergency services benefit determination, coverage required, when. — When conducting utilization review or making a benefit determination for emergency services: (1) A health carrier shall cover emergency services necessary to screen and stabilize an enrollee, as determ…

376.1369. Certification of compliance, when. — A health carrier shall annually provide a written certification to the director that the utilization review program of the health carrier or its designee complies with all applicable state and federal laws establishing confidentialit…

376.1372. Certification and member handbook to include utilization review procedures — website or provider portal, prior authorization requirements available on. — 1. In the certificate of coverage and the member handbook provided to enrollees, a health carrier shall include a cl…

376.1375. Registry of grievances maintained, procedures — definitions. — 1. A health carrier shall maintain a written register of all grievances in a manner consistent with the requirements for maintaining complaint records pursuant to section 354.445. The grievance register shal…

376.1378. Grievances and certificate of compliance filed with the director, when. — 1. A copy of the grievance procedures, including all forms used to process a grievance, shall be filed with the director. Any subsequent material modifications to the documents also shall be filed…

376.1382. First- and second-level grievance review for managed care plans, first-level procedures. — 1. A health carrier that offers managed care plans shall establish a first-level and second-level grievance review process for its managed care plans. A grievance may be submitted…

376.1385. Second-level review procedures. — 1. Upon receipt of a request for second-level review, a health carrier shall submit the grievance to a grievance advisory panel consisting of: (1) Other enrollees; and (2) Representatives of the health carrier that were not involved in …

376.1387. Appeals of grievances determined by the director. — 1. The director shall resolve any grievance regarding an adverse determination as to covered services appealed by an enrollee or health carrier or plan sponsor through any means not specifically prohibited by law but i…

376.1389. Expedited grievance review procedure. — 1. A health carrier shall establish written procedures for the expedited review of a grievance involving a situation where the time frame of the standard grievance procedures set forth in sections 376.1382 and 376.1385 would serio…

376.1399. Rules, effective, when — rules invalid and void, when. — Any rule or portion of a rule promulgated pursuant to this act shall become effective only as provided pursuant to chapter 536, including, but not limited to, section 536.028, if applicable, after August 28, 1997.…

376.1400. Explanation of benefits, standardized information used, contents, when. — 1. Every health insurance carrier offering policies of insurance in this state shall use standardized information for the explanation of benefits given to the health care provider whenever a claim…

376.1403. Referrals, standardized information used, content, when. — 1. Every health care provider and health carrier that conducts business in this state shall use standardized information for referrals. As used in this section, the terms "health care provider" and "health carri…

376.142. Stock company may become mutual — procedure — policyholders' meeting — acquisition of stock. — 1. Any domestic stock life insurance corporation, incorporated under a general law, may become a mutual life insurance corporation, and to that end may carry out a plan for the…

376.143. Stock company may acquire its own shares to be held in trust for mutual — appointment, powers and duties of trustees. — 1. If a domestic stock life insurance corporation determines to become a mutual life insurance corporation, it may, in carrying out any plan to that en…

376.144. Acquisition of shares of dissenting stockholders, procedure — abandonment of mutualization. — 1. If a stockholder of any domestic stock life insurance corporation planning to become a mutual life insurance corporation under section 376.142 files with the corporation prio…

376.145. Officers of stock company to continue as officers of mutual. — When a domestic stock life insurance corporation has become converted into a mutual life insurance corporation, the officers and directors or trustees of the original corporation shall remain as the officers …

376.1450. Enrollee's right to receive documents and materials in printed or electronic form, when. — An enrollee, as defined in section 376.1350, may receive documents and materials from a managed care entity in printed or electronic form so long as such documents and materials a…

376.146. Board of directors or trustees of mutual, membership qualifications, term of office. — 1. The corporate powers of a mutual life insurance corporation shall be exercised by, and its business and affairs shall be controlled by, a board of directors or trustees composed of …

376.147. Meetings of board of mutual, notice — executive committee of board, powers. — 1. Meetings of the board of directors or trustees of any mutual life insurance corporation shall be upon such notice as the articles of agreement prescribe. Attendance of a director or trustee …

376.148. Policyholders are members of mutual — voting rights — directors may alter articles — additional assessments prohibited. — 1. The articles of agreement of any mutual life insurance corporation shall provide that each policyholder of the corporation shall be a member of th…

376.150. Stock and mutual companies — content of charter. — When such corporators propose to form a stock and mutual company for the purposes designated in section 376.010, the charter comprised in the declaration named in section 376.050 shall set forth all the particulars menti…

376.1500. Definitions. — As used in sections 376.1500 to 376.1532, the following words or phrases mean: (1) "Director", the director of the department of commerce and insurance; (2) "Discount card", a card or any other purchasing mechanism or device, which is not insurance, that …

376.1502. Requirements for transaction of business. — 1. It is unlawful to transact business in this state as a discount medical plan organization, unless the organization is a corporation, limited liability corporation, partnership, limited liability partnership or other legal e…

376.1504. Registration requirements — term of registration — renewal. — 1. To register as a discount medical plan organization, an applicant shall: (1) File with the director an application on a form approved and adopted by the director; and (2) Pay to the director an application…

376.1506. Violations, penalty. — 1. If the director has a reason to believe that the discount medical plan organization is not complying with the requirements of sections 376.1500 to 376.1532, the director may examine or investigate the business and affairs of any discount medica…

376.1508. Processing fee — cancellation of membership, effect of. — 1. A discount medical plan organization may charge a reasonable one-time processing fee and a periodic charge as long as the fee is disclosed to the applicant. 2. If the member cancels the membership within the f…

376.1510. Prohibited acts. — A discount medical plan organization shall not: (1) Use in its advertisements, marketing material, brochures, and discount cards the terms "health plan", "coverage", "co-pay", "co-payments", "preexisting conditions", "guaranteed issue", "premium", "PP…

376.1512. Required disclosures. — 1. The following disclosures, to be printed in bold and in not less than twelve-point type, shall be made in writing to any prospective member and shall appear on the first page or first content page of any advertisements, marketing materials or …

376.1514. Written agreement required, contents. — 1. All providers offering medical services to members under a discount medical plan shall provide such services pursuant to a written agreement. The agreement may be entered into directly by the health care provider or by a health…

*376.1516. Written membership materials, required contents — forms to be filed with director, fee. — 1. Each benefit under the discount medical plan and every disclosure required under sections 376.1500 to 376.1532, shall be included in the written membership materials between th…

376.1518. Net worth to be maintained, amount. — 1. Each discount medical plan organization registered pursuant to sections* 376.1500 to 376.1532 shall at all times maintain a net worth of at least one hundred fifty thousand dollars. 2. The director may not allow a registration un…

376.1520. Notice of changes. — Each discount medical plan organization required to be registered pursuant to this section shall provide the director at least thirty days' advance notice of any change in the discount medical plan organization's name, address, principal business ad…

376.1522. List of providers to be maintained on website. — Each discount medical plan organization shall maintain a current list of the names and addresses of the providers with which it has contracted on a website page, the address of which shall be prominently displayed on all …

376.1524. Advertising and marketing materials, approval in writing required. — 1. All advertisements, marketing materials, brochures and discount cards used by marketers shall be approved in writing for such use by the discount medical plan organization. 2. The discount medical p…

376.1528. Rulemaking authority. — The director under the provisions of section 374.045 may promulgate rules to administer and interpret the provisions of sections 376.1500 to 376.1532. ­­-------- (L. 2007 H.B. 818 merged with S.B. 66) Effective 8-28-07 (S.B. 66); 1-01-08 (H.B. 81…

376.1530. Denial and refusal to issue registrations, when. — 1. The director may deny a registration to an applicant or refuse to renew, suspend, or revoke the registration of a registrant if the applicant or registrant, or an officer, director, or employee of the applicant or re…

376.1532. Violations, penalties. — 1. If the director determines that a person has engaged, is engaging, or has taken a substantial step toward engaging in a violation of sections 376.1500 to 376.1532, or a rule adopted or order issued pursuant thereto, or that a person has mater…

376.1550. Mental health coverage, requirements — definitions — exclusions. — 1. Notwithstanding any other provision of law to the contrary, each health carrier that offers or issues health benefit plans which are delivered, issued for delivery, continued, or renewed in this state…

376.1551. Federal mental health parity and addiction equity requirements — inapplicable, when — rulemaking authority. — 1. As used in this section, the following terms mean: (1) "Health benefit plan", the same meaning given to the term in section 376.1350; (2) "Health carrier", t…

376.1575. Definitions. — As used in sections 376.1575 to 376.1580*, the following terms shall mean: (1) "Completed application", a practitioner's application to a health carrier that seeks the health carrier's authorization for the practitioner to provide patient care services as…

376.1578. Credentialing procedure, health carrier duties — covered health services, payment, when — violations, mechanism for reporting. — 1. Within two working days after receipt of a credentialing application, the health carrier shall send a notice of receipt to the practitione…

376.1590. Status as living organ donor not sole factor for insurance coverage. — 1. As used in this section, the term "insurance policy" means a policy or other contract of life insurance as such term is defined in section 376.365, a policy of accident and sickness insurance as s…

376.160. Formation of stock and mutual companies. — The provisions of sections 376.070 to 376.090, relating to the formation of joint stock companies, shall apply, in all respects, to the formation of stock and mutual companies; and a certified copy of the articles shall be filed…

376.170. Special deposits for registered policies and annuity bonds. — All life insurance companies organized under the provisions of sections 376.010 to 376.670 shall deposit with the director of the department of commerce and insurance, in addition to other amounts required by …

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. — 1. The provisions of this chapter relating to health insurance, health maintenance organizations, health benefit…

376.1753. Services related to pregnancy, persons holding ministerial or tocological certification may provide. — Notwithstanding any law to the contrary, any person who holds current ministerial or tocological certification by an organization accredited by the National Organizati…

376.180. Certificates as to registration and reserves on policy — policies exempt, exceptions. — 1. After making the deposits mentioned in section 376.170, the company shall issue its policies of insurance or annuity bonds and each policy may have set out in the body thereof the …

[Repealed or reserved.]