Title XXIV — BUSINESS AND FINANCIAL INSTITUTIONS

376.1112. Director to provide buyer's guide — content — advertising of long-term care policies to contain notice of availability of guide. — The director shall prepare a guide that explains the factors to be considered in selecting long-term care insurance and the consequences of…

376.1115. Coverage outline to be delivered to applicants, when, content. — 1. An outline of coverage shall be delivered to a prospective applicant for long-term care insurance at the time of initial solicitation through means which prominently direct the attention of the recipien…

376.1118. Benefits funded by a life insurance death benefit acceleration, reports to policyholder required, content. — Any time a long-term care benefit, funded through a life insurance vehicle by the acceleration of the death benefit, is in benefit payment status, a monthly repo…

376.1121. Denial of claim, long-term care insurance, duties of issuer. — If a claim under a long-term care insurance contract is denied, the issuer shall, within sixty days of the date of a written request by the policyholder or certificate holder, or a representative thereof: (1…

376.1124. Rescinding of a long-term care policy, permitted when — grounds for contesting — no field issuance, when. — 1. For a policy or certificate that has been in force less than six months, an insurer may rescind a long-term care insurance policy or certificate, or deny an ot…

376.1127. Nonforfeiture benefit option required for long-term care insurance policies, requirements of offer — rulemaking authority. — 1. Except as provided in subsection 2 of this section, a long-term care insurance policy shall not be delivered or issued for delivery in this st…

376.1130. Rulemaking authority. — 1. The director shall promulgate reasonable rules to promote premium adequacy and to provide alternatives for the policyholder in the event of substantial rate increases, and to establish minimum standards for marketing practices, agent testing, …

376.1183. Breast examinations, no cost-sharing requirements. — 1. For purposes of this section, the following terms mean: (1) "Cost-sharing requirement", any deductible, coinsurance, co-payment, or maximum limitation on the application of such deductible, coinsurance, co-payment,…

376.1186. State-based health benefit exchanges prohibited without statutory authority — executive order to establish prohibited — state agency restrictions — taxpayer standing — definitions. — 1. No state-based health benefit exchange may be established, created, or operated with…

376.1190. Health care mandates — review by oversight division — actuarial analysis. — Any health care benefit mandate proposed after August 28, 2011, shall be subject to review by the oversight division of the joint committee on legislative research. The oversight division shall …

*376.1199. Coverage for certain obstetrical/gynecological services — exclusion of contraceptive coverage permitted, when — rulemaking authority. — 1. Each health carrier or health benefit plan that offers or issues health benefit plans providing obstetrical/gynecological benefits…

376.120. Director to examine and certify, when. — Upon being notified that the proposals and agreements for assurance named in the charter have been made, and the amount of premiums therein mentioned has been received, the director shall make an examination, or cause one to be ma…

376.1200. Certain policies to offer coverage for treatment of breast cancer — limitation on deductible, lifetime maximum benefit — administration of benefits — application, effect. — 1. Each entity offering individual and group health insurance policies providing coverage on an e…

376.1209. Mastectomy — mandatory insurance coverage for prosthetic devices and reconstructive surgery — no time limit to be imposed. — 1. Each entity offering individual and group health insurance policies providing coverage on an expense-incurred basis, individual and group serv…

376.1210. Maternity benefits, minimum hospital stays, exceptions — notice of benefits, contents — attending physician defined — rulemaking. — 1. Each entity offering individual and group health insurance policies providing coverage on an expense-incurred basis, individual and gro…

376.1215. Immunizations, mandated coverage, exceptions, rulemaking. — 1. All individual and group health insurance policies providing coverage on an expense-incurred basis, individual and group service or indemnity type contracts issued by a health services corporation, individua…

376.1218. Insurance coverage for children enrolled in the Part C early intervention system (First Steps). — 1. Any health carrier or health benefit plan that offers or issues health benefit plans, other than Medicaid health benefit plans, which are delivered, issued for delivery,…

376.1219. PKU formula and low protein modified food products covered by insurance, when — exceptions. — 1. Each policy issued by an entity offering individual and group health insurance which provides coverage on an expense-incurred basis, individual and group health service or i…

376.1220. Insurance coverage for newborn hearing screenings mandated. — 1. Each policy issued by an entity offering individual and group health insurance which provides coverage on an expense-incurred basis, individual or group health service, or indemnity contracts issued by a n…

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. — 1. Any health insurance policy through the Medicaid program pursuant to cha…

376.1224. Definitions — insurance coverage required — limitations on coverage — maximum benefit amount, adjustments — reimbursements, how made — applicability to plans. — 1. For purposes of this section, the following terms shall mean: (1) "Applied behavior analysis", the design,…

376.1225. Mandated coverage for general anesthesia and hospital charges for dental care, when — prior authorization required, when — exceptions. — 1. All individual and group health insurance policies providing coverage on an expense-incurred basis, individual and group service o…

376.1226. Fee schedule for services not covered under health benefit plans — definitions. — 1. No contract between a health carrier or health benefit plan and a dentist for the provision of dental services under a dental plan shall require that the dentist provide dental services…

376.1228. Hearing aids coverage for children required — amount of coverage — exclusions — additional state costs subject to appropriations. — 1. For purposes of this section, the terms "health carrier" and "health benefit plan" shall have the same meanings given to the terms unde…

376.1230. Chiropractic care coverage, rates, terms, conditions, limits, and exclusions. — 1. Every policy issued by a health carrier, as defined in section 376.1350, shall provide coverage for chiropractic care delivered by a licensed chiropractor acting within the scope of his o…

376.1232. Insurers to offer coverage for prosthetics. — 1. Each health carrier or health benefit plan that offers or issues health benefit plans which are delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2010, shall offer coverage for pro…

*376.1235. No co-payments or coinsurance for physical or occupational therapy services, when — actuarial analysis of cost, when. — 1. No health carrier or health benefit plan, as defined in section 376.1350, shall impose a co-payment or coinsurance percentage charged to the insur…

376.1237. Refills for prescription eye drops, required, when — definitions. — 1. Each health carrier or health benefit plan that offers or issues health benefit plans which are delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2014, and th…

376.1240. Hormonal contraceptives, self-administered, coverage required, when. — 1. For purposes of this section, terms shall have the same meanings as ascribed to them in section 376.1350, and the term "self-administered hormonal contraceptive" shall mean a drug that is composed…

376.1250. Cancer screening, health insurance coverage required, when, types. — 1. All individual and group health insurance policies providing coverage on an expense-incurred basis, individual and group service or indemnity type contracts issued by a nonprofit corporation, indivi…

376.1253. Second opinion, right of newly diagnosed cancer patients, attending physician to inform — insurance coverage for such second opinions required, when. — 1. Each physician attending any patient with a newly diagnosed cancer shall inform the patient that the patient has th…

376.1257. Orally administered anticancer medications, plan to provide coverage no less favorable than IV or injected medications — definitions — requirements — effective date. — 1. As used in this section the following terms shall mean: (1) "Anticancer medications", medications u…

376.1275. Coverage for human leukocyte antigen testing for bone marrow transplantation required, when — exceptions. — 1. Each health carrier or health benefit plan that offers or issues health benefit plans which are delivered, issued for delivery, continued, or renewed in this s…

376.1290. Coverage for lead testing. — 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 by a health services corporation, individual and group se…

376.130. To furnish certificate of deposit, when. — When the corporators have fully complied with the requirements of the preceding sections, and the laws of this state governing the organization of private corporations, and said corporation has deposited with the director of the…

376.1300. Reorganization of a domestic mutual life insurance company, authority. — A domestic mutual life insurance company organized and operating pursuant to this chapter may reorganize by forming a mutual life insurance holding company as described in section 376.1309 or by me…

376.1305. Formation of holding company, application — shareholder approval. — 1. A mutual life insurance company proposing to reorganize pursuant to sections 376.1300 to 376.1322 shall form a mutual life insurance holding company, which may hereafter be referred to as a mutual ho…

376.1307. Issuance of shares. — All of the shares, if any are issued, of the capital stock of the reorganized life insurance company shall be issued to the mutual holding company, which shall at all times own a majority of the voting shares of the capital stock of the reorganized…

376.1309. Member's interest — nontransference of membership — immunity from liability — assessments, not imposed — security, membership interest. — 1. The membership interest of the policyholders of a reorganized life insurance company shall become membership interests in the mut…

376.1312. Nonapplicability of certain provisions of insurance holding companies law. — Sections 382.040, 382.060, and 382.095 shall not apply to a reorganization or merger pursuant to the provisions of sections 376.1300 to 376.1322. ­­-------- (L. 1996 S.B. 759)

376.1315. Incorporation of mutual holding company, authority, approval. — Notwithstanding any provision of this chapter to the contrary, a mutual holding company organized pursuant to section 376.1300 shall be incorporated pursuant to this chapter. The articles of incorporation a…

376.1318. Powers of mutual holding company, engaging in business of insurance, no authority, affiliation and merger agreements. — A mutual holding company shall have the same powers granted to domestic insurance companies pursuant to chapter 382 relating to insurance holding comp…

376.1322. Mutual holding company subject to supervision of director, dissolution or liquidation — demutualization. — 1. A mutual holding company is subject to the supervision of the director of the department of commerce and insurance in the same manner as an insurer subject to t…

376.1345. Method of reimbursement not to require fee, discount, or remuneration — notification requirements — electronic funds transfer, when — overpayment, procedure — violation, penalty. — 1. As used in this section, unless the context clearly indicates otherwise, terms shall h…

376.1350. Definitions. — For purposes of sections 376.1350 to 376.1390*, the following terms mean: (1) "Adverse determination", a determination by a health carrier or a utilization review entity that an admission, availability of care, continued stay or other health care service …

376.1353. Utilization review activities monitored. — A health carrier shall be responsible for monitoring all utilization review activities carried out by, or on behalf of, the health carrier and for ensuring that all requirements of sections 376.1350 to 376.1390 and applicable r…

376.1356. Utilization review entity monitored, when. — Whenever a health carrier contracts to have a utilization review entity perform the utilization review functions required by sections 376.1350 to 376.1390* or applicable rules and regulations, the health carrier shall be resp…

376.1359. Written utilization program implemented, filed with the director. — 1. A health carrier that conducts utilization review shall implement a written utilization review program that describes all review activities, both delegated and nondelegated, for covered services prov…

376.1361. Documented clinical review criteria used in a utilization program — medical director qualifications — compensation of utilization review services. — 1. A utilization review program shall use documented clinical review criteria that are based on sound clinical evidence a…

376.1363. Utilization review decisions, procedures. — 1. A health carrier shall maintain written procedures for making utilization review decisions and for notifying enrollees and providers acting on behalf of enrollees of its decisions. For purposes of this section, "enrollee" i…