Title XXIV — BUSINESS AND FINANCIAL INSTITUTIONS

376.1065. Official notification communications, contracting entity requirements. — 1. As used in this section, the following terms shall mean: (1) "Contracting entity", any health carrier, as such term is defined in section 376.1350, subject to the jurisdiction of the department …

376.1075. Definitions. — As used in sections 376.1075 to 376.1095, the following terms mean: (1) "Administrator", "third-party administrator" or "TPA", a person who directly or indirectly solicits or effects coverage of, underwrites, collects charges or premiums from, or adjusts …

376.1077. Administrator to have agreement with insurer, form, contents — termination, how. — 1. No administrator shall act as such without a written agreement between the administrator and the insurer, and such written agreement shall be retained as part of the official records o…

376.1080. Payments of premiums and claims deemed paid, when. — If an insurer uses the services of an administrator, the payment to the administrator of any premiums or charges for insurance by or on behalf of the insured party shall be deemed to have been received by the insurer,…

376.1082. Records maintained by administrator for insurer — director may examine records — records owned by insurer, transfer allowed, when. — 1. Every administrator shall maintain and make available to the insurer complete books and records of all transactions performed on behal…

376.1083. Advertising restrictions for administrator. — An administrator may use only such advertising pertaining to the business underwritten by an insurer as has been approved in writing by the insurer in advance of its use. ­­-------- (L. 1993 H.B. 709 § 45)

376.1084. Insurer responsible for benefits and underwriting practices — insurer to conduct review of administrator, when. — 1. If an insurer uses the services of an administrator, the insurer shall be responsible for determining the benefits, premium rates, underwriting criteria …

376.1085. Premiums held in fiduciary capacity, duties — financial records, duties — withdrawals from fiduciary account by agreement only, contents — payment of claims. — 1. All insurance charges or premiums collected by an administrator on behalf of or for an insurer or insurers,…

376.1087. Commissions not to be contingent on savings in payment of claims — may be based on premiums collected. — 1. An administrator shall not enter into any agreement or understanding with an insurer in which the effect is to make the amount of the administrator's commissions,…

376.1088. Notice to policyholder of administrator, contents, required — disclosure of receipts to insurer. — 1. When the services of an administrator are used, the administrator shall provide a written notice to, and approved by, the insurer to covered individuals advising them o…

376.1090. Materials delivered to administrator for insured to be promptly delivered. — Any policies, certificates, booklets, termination notices or other written communications delivered by the insurer to the administrator for delivery to insured parties or covered individuals sh…

376.1092. Certificate of authority, required, application, contents, fee — refusal to issue, when — renewal — bond, required when. — 1. No person shall act as, or offer to act as, or hold himself out to be an administrator in this state without a valid certificate of authority as…

376.1093. Annual report filed with director, when — contents — filing fee, amount. — 1. Each administrator shall file an annual report for the preceding calendar year with the director on or before March first of each year, or within such extension of time therefor as the directo…

376.1094. Certificate of authority, suspension or revocation, grounds — civil action, when. — 1. The director shall suspend or revoke the certificate of authority of an administrator if the director finds that the administrator: (1) Is in an unsound financial condition; (2) Is us…

376.1095. Rules and regulations, promulgation. — The director shall have the power to promulgate such rules and regulations as are necessary to implement the provisions of sections 376.1075 to 376.1095. No rule or portion of a rule promulgated under the authority of sections 376.…

376.110. To be submitted to attorney general. — Whenever the corporators have filed the declaration required by section 376.050 and also proof of the publication therein required by the affidavit of the publisher of the newspaper in which the publication was made, his foreman or …

376.1100. Law, how cited — definitions. — 1. Sections 376.1100 to 376.1130 may be known and cited as the "Long-term Care Insurance Act". 2. As used in sections 376.1100 to 376.1130, unless the context requires otherwise, the following terms mean: (1) "Applicant": (a) In the case …

376.1103. Laws applicable, Medicare supplement laws not applicable — purpose — policies or riders must be in compliance. — 1. The provisions of sections 376.1100 to 376.1130 shall apply to policies delivered or issued for delivery in this state on or after August 28, 2002. Sectio…

376.1106. Policies issued in other states may be issued to residents of Missouri if in compliance with Missouri regulations. — No group long-term care insurance coverage may be offered to a resident of this state under a group policy issued in another state to a group described i…

376.1109. Policies, content requirements, provisions prohibited — rules authorized — cancellation, refund required — limitation on rate increases. — 1. The director may adopt regulations that include standards for full and fair disclosure setting forth the manner, content and req…

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…