Title XXIV, BUSINESS AND FINANCIAL INSTITUTIONS

376.818. Eligibility for Medicaid may not be considered by insurers. — No individual or group insurance policy providing coverage on an expense-incurred basis, no individual or group service or indemnity contract issued by a not-for-profit health services corporation, no health m…

376.819. MO HealthNet division to have right to payment for health care services provided. — To the extent that payment has been made by the MO HealthNet division for health care items or services furnished to a Medicaid-eligible individual, the MO HealthNet division is considere…

376.820. Insurers may not deny coverage of child because of marital status of parents, residence or income tax dependency claim. — No individual or group insurance policy providing coverage on an expense-incurred basis, no individual or group service or indemnity contract issued …

376.821. Insurers may not cancel health or dental insurance solely because the insured is incarcerated — insurer, defined. — 1. As used in this section, the term "insurer" means any person, reciprocal exchange, interinsurer, Lloyds insurer, fraternal benefit society, and any othe…

376.823. Prohibition on kickbacks not applicable for rebates for certain chronic illnesses. — Section 191.905 shall not apply to programs established by pharmaceutical companies for the purposes of providing a partial rebate of private health insurance co-payments and coinsurance…

376.845. Definitions — eating disorders, coverage for diagnosis and treatment of — limitations on coverage. — 1. For the purposes of this section the following terms shall mean: (1) "Eating disorder", pica, rumination disorder, avoidant/restrictive food intake disorder, anorexia …

376.850. Law, how cited. — Sections 376.850 to 376.890 may be cited as the "Missouri Medicare Supplement Insurance Act". ­­-------- (L. 1981 S.B. 347 § 1, A.L. 1989 H.B. 615 & 563)

376.854. Definitions. — As used in sections 376.850 to 376.890, the following terms mean: (1) "Applicant": (a) In the case of an individual Medicare supplement policy, the person who seeks to contract for insurance benefits; and (b) In the case of a group Medicare supplement poli…

376.859. Medicare supplement law applicable to what policies — policies not included. — 1. Except as otherwise specifically provided, sections 376.850 to 376.890 shall apply to: (1) All Medicare supplement policies delivered or issued for delivery in this state on or after August…

376.864. Policies not to duplicate benefits provided by Medicare — preexisting conditions, limitations on — director to issue rules establishing standards. — 1. No Medicare supplement policy or certificate in force in the state shall contain benefits that duplicate benefits provi…

376.869. Standards for policies, minimum, director to adopt. — The director shall adopt reasonable regulations to establish minimum standards for benefits, claims payment, marketing practices, compensation arrangements and reporting practices for Medicare supplement policies. ­­-…

376.874. Requirements of policy, return to policyholders. — Medicare supplement policies shall return to policyholders benefits which are reasonable in relation to the premium charged. The director shall issue reasonable regulations to establish minimum standards for loss ratios …

376.879. Outline of coverage for fair disclosure — furnished to each applicant — format and content — rules and standards. — 1. In order to provide for full and fair disclosure in the sale of Medicare supplement policies, no Medicare supplement policy or certificate shall be deli…

376.881. Policy certificate front page to contain notice of right to return and receive premium refund. — Medicare supplement policies and certificates shall have a notice prominently printed on the first page of the policy or certificate or attached thereto stating in substance …

376.882. Cancellation of policy, refund required — notification. — 1. If a Medicare supplement policy issued, delivered, or renewed in this state on or after January 1, 2011, is cancelled for any reason, the insurer shall refund the unearned portion of any premium paid beyond the…

376.884. Advertisement to be reviewed by director. — Every issuer of Medicare supplement insurance policies or certificates in this state shall provide a copy of any Medicare supplement advertisement intended for use in this state whether through written, radio or television medi…

376.886. Regulations, requirements — rules, procedure. — Regulations adopted pursuant to sections 376.850 to 376.890 shall be subject to the provisions of section 376.982, section 536.021 and section 536.024. Any regulation adopted pursuant to sections 376.850 to 376.890 shall co…

376.889. Violations, penalty. — 1. If the director determines that a person has engaged, is engaging in, or has taken a substantial step toward engaging in an act, practice or course of business constituting a violation of sections 376.850 to 376.890 or a rule adopted or order is…

376.890. Invalidity of any section regulating Medicare supplement not to affect others. — If any provision of sections 376.850 to 376.890 or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of sections 376.850 to 376.890 an…

376.891. Definitions. — As used in sections 376.891 to 376.894, the following terms mean: (1) "Certificate holder", a person who receives health care benefits or services pursuant to a policy, contract or plan; (2) "Plan administrator": (a) The person designated as the plan admin…

376.892. Surviving spouse may continue coverage, when — divorced or separated spouse may continue coverage, when — services offered. — 1. Any policy, contract or plan offered, issued or renewed in this state after August 28, 1993, providing coverage for hospital or medical expens…

376.893. Divorced or separated spouse, continuation of coverage, notice — contents of notice — failure to elect, effect — application. — 1. Within sixty days of legal separation or the entry of a decree of dissolution of marriage or prior to the expiration of a thirty-six month f…

376.894. Amount of premium, date of payment — termination of right of continuation of coverage, grounds. — If a legally separated, divorced or surviving spouse elects continuation of coverage under section 376.893: (1) During the period of time covered by the federal Consolidated…

376.900. Definitions. — For the purpose of sections 376.900 to 376.950 the following words and terms mean: (1) "Care for a term of years", an agreement between a resident and a provider whereby the resident pays a fee for the right to occupy space in a designated facility, and to…

376.905. Administration by department, powers, duties — fees. — The administration of sections 376.900 to 376.950 is vested in the division, which shall: (1) Prepare and furnish all forms necessary under the provisions of sections 376.900 to 376.950 in relation to applications fo…

376.910. Certificate of authority required. — No provider shall engage in the business of providing continuing care in this state without a certificate of authority therefor obtained from the department as provided in sections 376.900 to 376.950. ­­-------- (L. 1981 S.B. 84 § 3)…

376.915. Application for certificate, content — renewal, content, filed when — extensions, fee. — 1. A provider shall file an application for a certificate of authority on a form prescribed by the department, and the application shall be accompanied by the annual statement and ot…

376.920. Annual statement, form, contents. — The annual statement shall be in such form as the department shall elect. The proposed provider shall include as an exhibit a copy of the proposed form of life care contract to be entered into with residents at each facility. The annua…

376.925. Seven-day rescission period, all money or property to be refunded. — The life care contract shall provide that any person entering into the contract shall have a period of seven days beginning with the first full calendar day following the last to occur of the execution …

376.930. Insured to be furnished application for certificate and annual statement, when. — At the time of or prior to the execution of a life care contract and the transfer of any money or other property to a provider pursuant thereto, the provider shall deliver to the person wit…

376.935. Certificates issued for one year — nontransferable — not endorsement by department. — 1. Upon receipt of a completed application for a certificate of authority and exhibits and payment of the fee by the applicant, and proof of compliance by the applicant with the provisi…

376.940. Escrow account for entrance fees required, released when. — 1. As a condition for the issuance of a certificate of authority pursuant to section 376.935, the department shall require that the provider establish an escrow account with a licensed agent which provides that …

376.945. Escrow account, amount required — principal, how released, investment. — 1. The department shall, as a condition of the issuance of a certificate of authority pursuant to section 376.935, require that the provider establish a reserve of an amount equal to at least fifty …

376.950. Board of directors, one member to be resident of facility. — At least one member of the board of directors shall be a resident of the facility under a standard agreement offered by the provider. ­­-------- (L. 1981 S.B. 84 § 8)

376.960. Definitions. — As used in sections 376.960 to 376.989, the following terms mean: (1) "Benefit plan", the coverages to be offered by the pool to eligible persons pursuant to the provisions of section 376.986; (2) "Board", the board of directors of the pool; (3) "Church pl…

376.961. Missouri health insurance pool created — members to be all health insurers in state — board of directors, members, terms, qualifications — transitioning resources. — 1. There is hereby created a nonprofit entity to be known as the "Missouri Health Insurance Pool". All in…

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. — 1. The board of directors on behalf of the pool shall submit to the director a plan of operation for the pool and a…

376.964. Board, powers and duties — including providing for issuing policies and reinsuring risks — staff appointment — rulemaking authority. — The board of directors and administering insurers of the pool shall have the general powers and authority granted under the laws of this…

376.965. Board members not civilly liable for performance of duties, exception. — No member of the board of directors of the Missouri health insurance pool shall be civilly liable, either jointly or separately, as a result of any act, omission or decision in performance of his du…

376.966. No employee to lose coverage by enrolling in pool — eligibility for pool coverage, ineligibility — medical underwriting considerations, notification required, when — expiration date. — 1. No employee shall involuntarily lose his or her group coverage by decision of his o…

376.968. Administration of pool by insurer or insurers by competitive bids — insurer's qualifications — board to establish criteria for bid content. — The board shall select an insurer, insurers, or third-party administrators through a competitive bidding process to administer th…

376.970. Administering insurer to serve for three years subject to removal for cause — duties — reports — bidding process. — 1. The administering insurer shall serve for a period of three years subject to removal for cause. At least one year prior to the expiration of each three-…

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. — 1. Following the close of each fiscal year,…

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 taxes. — Each member's proportion of participation in the pool shall be determined annually by …

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. — The director of revenue shall determine the difference between the amount of money the state treasurer, pursua…

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 in succeeding years until excess is exhausted. — Each pool member exempt from …