Title XXIV, BUSINESS AND FINANCIAL INSTITUTIONS

376.325. Any willing provider provision — definitions. — 1. To the extent a health carrier has developed a closed or exclusive provider network as provided in subdivision (19) of section 376.426 through contractual arrangements with selected providers, such health carrier shall a…

376.330. Securities may be changed. — Any company organized under the laws of this state, or doing in this state any business mentioned in section 376.010, may at any time change the securities in which its capital or any part thereof is invested, whether the same are deposited w…

376.350. Reports to director. — 1. It shall be the duty of the president or vice president and secretary or actuary, or a majority of the directors, of every life assurance company organized pursuant to sections 376.010 to 376.670 or pursuant to the laws of this state, or any suc…

376.360. Distribution of surplus funds to participating policyholders — method. — 1. All life insurance companies organized under the laws of this state shall ascertain and distribute annually, and not otherwise, beginning not later than the end of the third policy year, the prop…

376.365. Standard valuation law — definitions. — 1. Sections 376.365 to 376.380 shall be known and may be cited as the "Standard Valuation Law". 2. As used in sections 376.365 to 376.380, the following terms shall mean and apply on or after the operative date of the valuation man…

376.370. Director to value reserves, methods. — 1. (1) The director of the department of commerce and insurance shall annually value, or cause to be valued, the reserve liabilities, herein called reserves, for all outstanding life insurance policies and annuity and pure endowment…

*376.379. Medication synchronization services, offer of coverage required. — 1. A health carrier or managed care plan offering a health benefit plan in this state that provides prescription drug coverage shall offer, as part of the plan, medication synchronization services develo…

376.380. Legal minimum standards for valuation — interest rates — valuation manual, operative date, effect of — reserves required — confidential information — exemptions for specific product forms or product lines. — 1. The legal minimum standard for valuation of policies and con…

376.381. Health insurance products, department duties. — Notwithstanding any other provision of law to the contrary, the department of commerce and insurance shall exercise its authority and responsibility over health insurance product form filings, consumer complaints, and inves…

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. — 1. For purposes of this section and s…

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. — 1. All health carriers shall: (1) …

376.385. Diabetes — insurance coverage for equipment, supplies and self-management training. — 1. Each entity offering individual and group health insurance policies providing coverage on an expense-incurred basis, individual and group service or indemnity type contracts issued b…

376.386. Prescription drugs, one co-payment for dosage prescribed. — For any health carrier or health benefit plan, as defined in section 376.1350, that provides prescription drug coverage, if a prescription drug covered by a health carrier or health benefit plan is prescribed in…

376.387. Pharmacy benefits manager, limitations and restrictions — enforcement. — 1. For purposes of this section, the following terms shall mean: (1) "Covered person", the same meaning as such term is defined in section 376.1257; (2) "Health benefit plan", the same meaning as su…

*376.388. Maximum allowable costs — definitions — contract requirements — reimbursement — appeals process required. — 1. As used in this section, unless the context requires otherwise, the following terms shall mean: (1) "Contracted pharmacy" or "pharmacy", a pharmacy located in …

376.390. Reserve liability for group insurance — how computed. — The reserve liability for group insurance written by any life insurance company doing business in this state shall be computed upon such tables and basis as may be approved by the director of the department of comme…

376.391. Co-payments for chiropractic services, cap. — A health benefit plan or health carrier, as defined in section 376.1350, including but not limited to preferred provider organizations, independent physicians associations, third-party administrators, or any entity that contr…

376.392. Prescription drug formularies, enrollees to be notified of changes to, when. — For any health carrier or health benefit plan, as defined in section 376.1350, that provides prescription drug coverage or contracts with a third-party for prescription drug services, the heal…

376.393. Pharmacy benefits manager, license required — definitions — complaints, procedure. — 1. As used in this section, the following terms shall mean: (1) "Health carrier" or "carrier", the same meaning as is ascribed to such term in section 376.1350; (2) "Pharmacy benefits ma…

376.395. Definitions for group health conversion policy requirements. — As used in sections 376.395 to 376.404 the following terms shall mean: (1) "Group policy", a group health insurance policy issued by an insurance company and a group contract issued by a health service corpor…

376.397. Converted policy to be offered on termination of group health coverage, when — exceptions — terms and conditions. — 1. A group policy delivered or issued for delivery in this state which insures employees or members for hospital, surgical or major medical insurance on an…

376.398. Application to all group policies — effective, when. — The provisions of sections 376.395 to 376.404 shall become effective January 1, 1983, and shall apply to all group policies delivered, issued for delivery or amended on or after January 1, 1983. ­­-------- (L. 1981 S…

376.401. Conversion rights — retirees — dependents of insured. — 1. In the event coverage would be continued under the group policy on an employee following his retirement, but prior to the time he is or could be covered by Medicare, the employee or member may elect, in lieu of s…

376.403. Benefit levels — group coverage may be provided in lieu of converted policy — delivery outside state, form. — 1. If the benefit levels required in subdivision (9) of subsection 1 of section 376.397 exceed the benefit levels provided under the group policy, the converted …

376.404. Specific requirement requests of policyholder may be met by alteration. — Upon written request by the group policyholder, the coverages required in section 376.397 may be changed or altered to meet the specific requirements of such group policyholder. ­­-------- (L. 1981…

376.405. Group health and accident policies, approval required — exempt, when, director's powers. — 1. No insurance company licensed to transact business in this state shall deliver or issue for delivery in this state any policy of group accident or group health insurance, or gro…

376.406. Newborn child to be covered under health policies, extent of coverage — notification of birth, when, effect of — definitions. — 1. All health benefit plans which provide coverage for a family member of an enrollee shall, as to such family member's coverage, also provide …

376.407. Advance practice nurse, claims for service to be reimbursed, when. — Any health insurer, as defined in section 376.806, nonprofit health service plan or health maintenance organization shall reimburse a claim for services provided by an advance practice nurse, as defined…

376.410. Insurance companies to maintain reserves — exemptions. — Except as provided in subdivision (6) of this section, all companies organized under the laws of this state, and engaged in writing policies of accident or health insurance, or combination policies of accident and …

376.414. 340B drugs — definitions — acquisition not to be restricted, when — complaint procedure — rulemaking authority. — 1. For purposes of this section, the following terms mean: (1) "340B drug", a drug that: (a) Is a covered outpatient drug within the meaning of Section 340B …

376.417. 340B drugs — definitions — discrimination prohibited — civil penalties — rules. — 1. As used in this section, the following terms mean: (1) "340B drug", the same meaning given to the term in section 376.414; (2) "Covered entity", any entity described in subparagraphs (A)…

376.421. Group health insurance, authorized categories. — 1. Except as provided in subsection 2 of this section, no policy of group health insurance shall be delivered in this state unless it conforms to one of the following descriptions: (1) A policy issued to an employer, or to…

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. — 1. As used in this section, the following terms shall mean: (1) "Direct res…

376.423. Health insurance, claims for chiropractic services denial, qualified chiropractor to review, qualifications — investigation by department, when. — 1. Beginning January 1, 1993, any consultant retained by any insurance company, health services corporation and any self-ins…

376.424. Group health insurance policies may be extended to insure family members or dependents. — Except for a policy issued under subdivision (2) of subsection 1 of section 376.421, a group health insurance policy may be extended to insure the employees and members with respect…

376.425. Student accident policies, may not limit surgical benefits, when. — 1. As used in this section, the following terms mean: (1) "Institution of higher learning", any college or university, or "institution" as that term is defined in section 173.510; (2) "Sponsoring or endo…

376.426. Group health policies, required provisions. — No policy of group health insurance shall be delivered in this state unless it contains in substance the following provisions, or provisions which in the opinion of the director of the department of commerce and insurance are…

376.427. Assignment of benefits made by insured to provider — payment, how made — exceptions — all claims to be paid, when — out-of-network services, how paid. — 1. As used in this section, the following terms mean: (1) "Health benefit plan", as such term is defined in section 37…

376.428. Federal COBRA provisions to apply to group health insurance policies. — 1. A group policy delivered or issued for delivery in this state by a health carrier or health benefit plan, as defined in section 376.1350, which insures employees or members and their eligible depe…

376.429. Coverage for certain clinical trials for prevention, early detection and treatment of cancer, restrictions — definitions — exclusions. — 1. All health benefit plans, as defined in section 376.1350, that are delivered, issued for delivery, continued or renewed on or after…

376.431. Employees or members of unions or associations, group or group-type basis coverage, sections 376.431 to 376.442 to apply. — The provisions of sections 376.431 to 376.442 are applicable to all insurance policies and contracts issued or provided by an insurance company, he…

376.432. Group-type basis, defined. — As used in sections 376.431 to 376.442, the term "group-type basis" means a benefit plan, other than salary budget plans utilizing individual insurance policies or contracts, which meets the following conditions: (1) Coverage is provided thro…

376.433. Self-insurance plans for health care, public entities — subject to Medicaid rights, obligations, and remedies. — 1. Any public entity which provides, furnishes, or pays for hospital, medical, surgical, or other health care services under a plan of self-insurance to an em…

376.434. Carrier liable for claims incurred during grace period, when — exceptions. — 1. If a policy or contract subject to sections 376.431 to 376.442 provides for automatic discontinuance of the policy or contract after a premium or subscription charge has remained unpaid throu…

376.435. Claim information to be reported, when — covered lives defined. — 1. Beginning January 1, 2008, a health carrier providing a group health benefit plan or plans, as such terms are defined in section 376.1350, to an employer who meets the requirements specified in subsecti…

376.436. Discontinuance notice by carrier, contents — notice forms furnished by carrier for distribution to policyholders. — 1. Any notice of discontinuance so given by the carrier shall include a request to the group policyholder or other entity involved to notify employees cove…