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Missouri Laws > Title XXIV > Chapter 376 - Life, Health and Accident Insurance
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Search the Missouri Revised Statutes
Missouri Laws > Title XXIV > Chapter 376 - Life, Health and Accident Insurance
Missouri Laws
>
Title XXIV
> Chapter 376 - Life, Health and Accident Insurance
Current as of: 2009
Check for updates
§ 376.005
Definitions
§ 376.010
Who may form company--purposes
§ 376.015
Involuntary unemployment insurance may be issued in connection with extension of credit, requirements
§ 376.020
Various companies defined
§ 376.050
Declaration of corporators
§ 376.060
Stock companies--content of charter
§ 376.070
To be submitted to attorney general
§ 376.080
Director to examine, when
§ 376.090
To furnish certificate of deposit, when
§ 376.100
Mutual companies--contents of charter
§ 376.110
To be submitted to attorney general
§ 376.120
Director to examine and certify, when
§ 376.130
To furnish certificate of deposit, when
§ 376.142
Stock company may become mutual--procedure--policyholders' meeting--acquisition of stock
§ 376.143
Stock company may acquire its own shares to be held in trust for mutual--appointment, powers and duties of trustees
§ 376.144
Acquisition of shares of dissenting stockholders, procedure--abandonment of mutualization
§ 376.145
Officers of stock company to continue as officers of mutual
§ 376.146
Board of directors or trustees of mutual, membership qualifications, term of office
§ 376.147
Meetings of board of mutual, notice--executive committee of board, powers
§ 376.148
Policyholders are members of mutual--voting rights--directors may alter articles--additional assessments prohibited
§ 376.150
Stock and mutual companies--content of charter
§ 376.160
Formation of stock and mutual companies
§ 376.170
Special deposits for registered policies and annuity bonds
§ 376.180
Certificates as to registration and reserves on policy--policies exempt, exceptions
§ 376.190
Additional deposits required
§ 376.200
Definition of net value
§ 376.210
Excess deposits
§ 376.220
May use realty to secure notes and bonds
§ 376.230
Changing of securities on deposit
§ 376.240
Deposits to be held in trust by director
§ 376.250
Deposits to be kept separate
§ 376.260
Fees collected by director of revenue
§ 376.270
Director may proceed against depositary companies
§ 376.280
Capital necessary to do business--how invested
§ 376.290
Deposit and transfer of securities
§ 376.291
Applicability and inapplicability
§ 376.292
Definitions
§ 376.293
Permissible investments--written plan for investments required
§ 376.294
Prohibited acts
§ 376.295
Additional prohibited acts--authorized actions
§ 376.296
Value of investments, how calculated
§ 376.297
Investment subsidiaries not permitted, when
§ 376.298
Acquisition of rate credit instruments, when
§ 376.300
Equity interests permitted, when
§ 376.301
Tangible personal property interests permitted, when
§ 376.302
Mortgage interests, may be acquired, when--other real estate interests
§ 376.303
Lending and repurchase, permitted when
§ 376.304
Acquisition of foreign investments, when
§ 376.305
Rulemaking authority
§ 376.306
Cash surrender value, life insurer may lend to policyholder, when
§ 376.307
Limits on acquisition of certain investments
§ 376.308
Secondary mortgage market act, not to preempt health insurer, when
§ 376.309
Separate account defined--establishment of account and special voting or control rights authorized--approved investments--approval of director required
§ 376.310
Investment of surplus and reserve funds by foreign companies
§ 376.311
Investment of capital reserve and surplus of life insurance companies in investment pools--definitions--qualifications--requirements
§ 376.330
Securities may be changed
§ 376.350
Reports to director
§ 376.360
Distribution of surplus funds to participating policyholders--method
§ 376.370
Director to value reserves, methods
§ 376.380
Legal minimum standards for valuation--procedures--reserves required--life insurance company to submit opinion of actuary, contents
§ 376.383
Health care claims for reimbursement, how paid, when--definitions--interest on unpaid claims--effective, when--penalties for unpaid claims, when--fraudulent claims, notification to the department, procedure--requests for additional information, contents
§ 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
§ 376.385
Diabetes--insurance coverage for equipment, supplies and self-management training
§ 376.386
Prescription drugs, one co-payment for dosage prescribed
§ 376.390
Reserve liability for group insurance--how computed
§ 376.391
Co-payments for chiropractic services, cap
§ 376.392
Prescription drug formularies, enrollees to be notified of changes to, when
§ 376.395
Definitions for group health conversion policy requirements
§ 376.397
Converted policy to be offered on termination of group health coverage, when--exceptions--terms and conditions
§ 376.398
Application to all group policies--effective, when
§ 376.401
Conversion rights--retirees--dependents of insured
§ 376.403
Benefit levels--group coverage may be provided in lieu of converted policy--delivery outside state, form
§ 376.404
Specific requirement requests of policyholder may be met by alteration
§ 376.405
Group health and accident policies, approval required--exempt, when, director's powers
§ 376.406
Newborn child to be covered under health policies, extent of coverage--notification of birth, when, effect of--definitions
§ 376.407
Advance practice nurse, claims for service to be reimbursed, when
§ 376.410
Insurance companies to maintain reserves--exemptions
§ 376.421
Group health insurance, authorized categories
§ 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
§ 376.423
Health insurance, claims for chiropractic services denial, qualified chiropractor to review, qualifications--investigation by department, when
§ 376.424
Group health insurance policies may be extended to insure family members or dependents
§ 376.425
Student accident policies, may not limit surgical benefits, when
§ 376.426
Group health policies, required provisions
§ 376.427
Assignment of benefits made by insured to provider--payment, how made--exceptions--all claims to be paid, when
§ 376.428
Federal COBRA provisions to apply to group health insurance policies
§ 376.429
Coverage for certain clinical trials for prevention, early detection and treatment of cancer, restrictions--definitions--exclusions
§ 376.431
Employees or members of unions or associations, group or group-type basis coverage, sections 376.431 to 376.442 to apply
§ 376.432
Group-type basis, defined
§ 376.433
Self-insurance plans for health care, public entities--subject to Medicaid rights, obligations, and remedies
§ 376.434
Carrier liable for claims incurred during grace period, when--exceptions
§ 376.435
Claim information to be reported, when--covered lives defined
§ 376.436
Discontinuance notice by carrier, contents--notice forms furnished by carrier for distribution to policyholders
§ 376.438
Group policies, modifying or amending benefits shall provide extension of benefits in event of total disability at date of termination or discontinuance
§ 376.441
Carrier contract replaced by similar benefit plan of another carrier--liability of prior carrier--succeeding carrier coverage requirements
§ 376.442
Rules and regulations, procedure
§ 376.450
Citation of law--definitions (MISSOURI HIPAA)
§ 376.451
Standards prohibiting discrimination
§ 376.452
Large group market, renewal or continuation of coverage required--nonrenewal or discontinuation permitted, when--conditions for discontinuation
§ 376.453
Premium--only cafeteria plans required, when
§ 376.454
Individual market, renewal or continuation at option of individual--nonrenewal or discontinuation permitted, when--discontinuation of a type of coverage, procedure
§ 376.480
Domestic companies may assume risks of foreign companies--duties of director
§ 376.500
Discriminations, rebates and favors prohibited--contracts to conform to policy
§ 376.502
Life insurers not to discriminate based on lawful travel destinations--violations, penalty
§ 376.510
Penalty for violation of section 376.500
§ 376.531
Life insurance policies, consent of insured required, exceptions--employers have insurable interest in employees, when, effects
§ 376.540
Policy, to whom payable
§ 376.562
Charitable, benevolent, educational and religious organizations may be beneficiary or owner of policy, life insurance, when--fraud or coercion, exception
§ 376.570
Foreign executor or administrator
§ 376.580
Misrepresentation
§ 376.590
Misrepresentations, false estimates and circulars prohibited--agents--notes to be held until policy delivered
§ 376.600
Penalty for violating section 376.590
§ 376.610
Defense in case of suits
§ 376.620
Suicide, effect on liability--refund of premiums, when
§ 376.630
Life insurance policies not to be forfeited or become invalid, when
§ 376.640
Paid-up policy may be demanded, when
§ 376.650
Rules of payment on commuted policy
§ 376.660
Foregoing provisions inapplicable, when
§ 376.669
Annuity contract requirements--paid-up annuity benefits, how calculated--cash surrender benefits, how calculated--applicable, when
§ 376.670
Provisions which shall be contained in life insurance policies, exceptions
§ 376.671
Provisions which shall be contained in annuity contracts--expiration date
§ 376.673
Life insurance policies, regulations relative to
§ 376.674
Life insurance policies, no cash surrender value, regulations relative to
§ 376.675
Life insurance policies and annuity contracts to be approved--exemption, when--director's powers--judicial review of disapproval
§ 376.676
Regulation of the valuation of life insurance policies--may adopt NAIC model regulation
§ 376.677
Life policies may be issued that have no cash surrender value prior to death--no policy loans so law regulating not applicable--requirements to issue
§ 376.678
Life insurance policies and annuity contracts, annual statement to holder required--company to furnish policy or contract information to holder upon request
§ 376.679
Life insurance company may reinsure for risks involving aircraft, limitation
§ 376.680
Assignment of incidents of ownership, group life policy, effect of
§ 376.691
Group life policies, eligible groups authorized for issue--premiums, how paid
§ 376.693
Special group life policies, requirements--director's approval
§ 376.694
Group life, definitions of direct response solicitation and sponsoring or endorsing entity--certain insurers required to give notice of compensation to policyholder or endorsing entity
§ 376.695
Extension of policy to insure for loss due to death of spouse or dependent children, requirements, limitations
§ 376.696
Political subdivisions purchasing any insurance policies to submit to competitive bidding, when--renewal between bidding periods deemed extension
§ 376.697
Required provisions for group life policies
§ 376.699
Person insured by group policy entitled to individual life policy, notice requirements
§ 376.700
Purpose--use of additional material
§ 376.702
Application of law--exceptions
§ 376.704
Definitions
§ 376.706
Delivery of guide and summary required, when
§ 376.708
Required presentations and statements--company to maintain file
§ 376.710
Effect of omission
§ 376.712
Effective date
§ 376.714
Contents and form of buyer's guide
§ 376.715
Citation of law, purpose
§ 376.717
Coverages provided, persons covered--coverage not provided, when--maximum benefits allowable
§ 376.718
Definitions
§ 376.720
Association, created--accounts--director to supervise
§ 376.722
Board of directors, established, members, how selected--expense reimbursement
§ 376.724
Impaired insurers, association's options, duties--insolvent insurers, association's options, duties--alternative policies, requirements
§ 376.725
Terminated coverage, reissuance of, premium set, how
§ 376.726
Nonpayment of premiums, effect of
§ 376.728
Law not applicable, when
§ 376.730
Liens, association may impose, when
§ 376.732
Director to have association's powers and duties, when--association may appear in court, when
§ 376.733
Assignment of rights to association by persons receiving benefits, when
§ 376.734
Powers of association--legal counsel, who may be retained
§ 376.735
Assessments against members, when due, classes--amounts, how determined
§ 376.737
Deferment of assessment, how, when--maximum assessment--refund of, when--members may increase premiums to cover assessments
§ 376.738
Certificate of contribution, when issued
§ 376.740
Plan of operation, required, approval of director--provisions of plan
§ 376.742
Director, powers and duties
§ 376.743
Board of directors, powers--examinations by director, when
§ 376.745
Assessments, offset against tax liability, when, how
§ 376.746
Records of association meetings to be kept--association deemed creditor of insolvent or impaired insured
§ 376.747
Distribution of member insurer assets upon liquidation, priority of association
§ 376.748
Liquidation, recovery of distributions, when, exceptions, limitations
§ 376.750
Financial report, submitted to director, when--tax exempt status--immunity from liability
§ 376.752
Member insurer's deposit with director, exemption from, amount
§ 376.754
Stay of proceedings, insolvent insurer, when
§ 376.755
Advertising, use of guaranty association prohibited
§ 376.756
Summary document, association to prepare, when, contents--policy not covered by guaranty association to contain notice, form determined by director
§ 376.758
Law inapplicable to insolvent insurers on effective date of law
§ 376.770
Title of law
§ 376.773
Definitions
§ 376.775
Matters required in policies
§ 376.776
Hospital and medical expense provisions extended for certain handicapped and dependent children past normal coverage age
§ 376.777
Specifically required provisions--exemptions, when--director's powers
§ 376.778
Payment direct to public hospitals or clinics with or without assignment, when--provisions required in contracts
§ 376.779
Health insurance policies to offer coverage for treatment of alcoholism--exclusions
§ 376.780
Limits on provisions, effect of conflict of policy with law
§ 376.781
Speech and hearing disorders, companies to offer coverage, when--rules, procedure
§ 376.782
Mammography--low-dose screening, defined--health care policies to provide required coverage
§ 376.783
Insured bound only if copy of application attached to policy
§ 376.785
What does not constitute waiver of defenses
§ 376.787
Effect of age limit provision
§ 376.789
Definition of actual charge and actual fee
§ 376.790
Limits on applicability of law
§ 376.800
Misrepresentation made in obtaining individual accident and health policy no defense, exception
§ 376.801
Coverage for child health supervision services required--definitions--permitted limitations on benefits
§ 376.805
Elective abortion to be by optional rider and requires additional premium--elective abortion defined
§ 376.806
Refund of health insurance unearned premium on notice of death of insured--refunded to whom--definitions--exception--failure to notify within one year
§ 376.807
Policies not to reduce or deny benefits to persons eligible for medical assistance--deemed primary contract
§ 376.810
Definitions for policy requirements for chemical dependency
§ 376.811
Coverage required for chemical dependency by all insurance and health service corporations--minimum standards--offer of coverage may be accepted or rejected by policyholders, companies may offer as standard coverage--mental health benefits provided, when-
§ 376.814
Rules and regulations authorized, department of mental health to advise department--procedure
§ 376.816
Adopted children to be provided health care coverage on the same basis as other dependents--effective from date of birth or on placement--placement defined
§ 376.818
Eligibility for Medicaid may not be considered by insurers
§ 376.819
Division of medical services to have right to payment for health care services provided
§ 376.820
Insurers may not deny coverage of child because of marital status of parents, residence or income tax dependency claim
§ 376.821
Insurers may not cancel health or dental insurance solely because the insured is incarcerated--insurer, defined
§ 376.823
Prohibition on kickbacks not applicable for rebates for certain chronic illnesses
§ 376.825
Title
§ 376.826
Definitions
§ 376.827
Requirements for mental illness coverage--parity with coverage provided for physical conditions
§ 376.830
Services administered and delivered by whom--contracted services permitted, when
§ 376.833
Inapplicability of section 376.827, when--waiver granted to policyholder, when
§ 376.836
Effective date--study conducted by director, contents, report to general assembly--exclusions--expiration date
§ 376.850
Law, how cited
§ 376.854
Definitions
§ 376.859
Medicare supplement law applicable to what policies--policies not included
§ 376.864
Policies not to duplicate benefits provided by Medicare--preexisting conditions, limitations on--director to issue rules establishing standards
§ 376.869
Standards for policies, minimum, director to adopt
§ 376.874
Requirements of policy, return to policyholders
§ 376.879
Outline of coverage for fair disclosure--furnished to each applicant--format and content--rules and standards
§ 376.881
Policy certificate front page to contain notice of right to return and receive premium refund
§ 376.884
Advertisement to be reviewed by director
§ 376.886
Regulations, requirements--rules, procedure
§ 376.889
Violations, penalty
§ 376.890
Invalidity of any section regulating Medicare supplement not to affect others
§ 376.891
Definitions
§ 376.892
Surviving spouse may continue coverage, when--divorced or separated spouse may continue coverage, when--services offered
§ 376.893
Divorced or separated spouse, continuation of coverage, notice--contents of notice--failure to elect, effect--application
§ 376.894
Amount of premium, date of payment--termination of right of continuation of coverage, grounds
§ 376.900
Definitions
§ 376.905
Administration by department, powers, duties--fees
§ 376.910
Certificate of authority required
§ 376.915
Application for certificate, content--renewal, content, filed when--extensions, fee
§ 376.920
Annual statement, form, contents
§ 376.925
Seven-day rescission period, all money or property to be refunded
§ 376.930
Insured to be furnished application for certificate and annual statement, when
§ 376.935
Certificates issued for one year--nontransferable--not endorsement by department
§ 376.940
Escrow account for entrance fees required, released when
§ 376.945
Escrow account, amount required--principal, how released, investment
§ 376.950
Board of directors, one member to be resident of facility
§ 376.960
Definitions
§ 376.961
Missouri health insurance pool created--members to be all health insurers in state--board of directors, members, terms, qualifications
§ 376.962
Plan of operation to be submitted by board--effective when--failure to submit, director's duty to develop rules--plan content
§ 376.964
Board, powers and duties--including providing for issuing policies and reinsuring risks--staff appointment--rulemaking authority
§ 376.965
Board members not civilly liable for performance of duties, exception
§ 376.966
No employee to lose coverage by enrolling in pool--eligibility for pool coverage, ineligibility--medical underwriting considerations, notification required, when
§ 376.968
Administration of pool by insurer or insurers by competitive bids--insurer's qualifications--board to establish criteria for bid content
§ 376.970
Administering insurer to serve for three years subject to removal for cause--duties--reports
§ 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
§ 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
§ 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
§ 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 succeeding years until excess is exhausted
§ 376.982
Rulemaking procedure
§ 376.984
Abatement or deferring all or part of assessment of member, when--amount abated or deferred may be assessed against other members--deficiency liability
§ 376.986
Pool to offer medical coverage--premiums, how established--standard risk rate, how calculated--director to approve rates--exclusions--benefits reduced by other insurance or workers' compensation--medical expense to include prayer for spiritual healing
§ 376.987
High deductible health plans and establishment of health savings plans to be offered as options--definitions--rulemaking authority
§ 376.989
No liability, criminal or civil, for participation in pool by members
§ 376.990
Study to be conducted on financing of the state health insurance pool, contents, report
§ 376.995
Limited mandate health insurance policies defined--certain sections not to apply to limited mandate health insurance policies, exceptions--requirements to sell or issue--certain law to apply
§ 376.1000
Multiple employer self-insured health plan, defined
§ 376.1002
Certificate of authority required--penalty for noncompliance--law inapplicable, when--exempt organizations
§ 376.1005
Application for certificate of authority, form--fee--policy or other evidence of coverage provided to employees, form
§ 376.1007
Plan to file copy of bylaws, coverage and agreements with director
§ 376.1010
Excess stop-loss coverage maintained by plan
§ 376.1012
Funds collected from employers held in trust--requirements--board of trustees, elected, duties--annual report, filed when
§ 376.1015
Department not to grant approval, when
§ 376.1017
Plan to establish loss reserves--plan to establish surplus account, amount
§ 376.1020
Plan to maintain principal place of business in Missouri, exception
§ 376.1022
Dissolution of plan, application, procedure, granted when--distribution of assets, procedures
§ 376.1025
Director may adopt rules
§ 376.1027
Plan in unsound condition, powers of director
§ 376.1030
Agreement of employer to pay benefits, requirements, form--copy filed with director--no excuse from liability
§ 376.1032
Plan considered insurer, when
§ 376.1035
Chapter 376 applicable to plan
§ 376.1037
Plan subject to premium taxes
§ 376.1040
Plan not to be offered to general public--marketing restrictions
§ 376.1042
Marketing by agent, agency or broker violation of law
§ 376.1045
Injunctive relief, director may seek, when--procedures
§ 376.1075
Definitions
§ 376.1077
Administrator to have agreement with insurer, form, contents--termination, how
§ 376.1080
Payments of premiums and claims deemed paid, when
§ 376.1082
Records maintained by administrator for insurer--director may examine records--records owned by insurer, transfer allowed, when
§ 376.1083
Advertising restrictions for administrator
§ 376.1084
Insurer responsible for benefits and underwriting practices--insurer to conduct review of administrator, when
§ 376.1085
Premiums held in fiduciary capacity, duties--financial records, duties--withdrawals from fiduciary account by agreement only, contents--payment of claims
§ 376.1087
Commissions not to be contingent on savings in payment of claims--may be based on premiums collected
§ 376.1088
Notice to policyholder of administrator, contents, required--disclosure of receipts to insurer
§ 376.1090
Materials delivered to administrator for insured to be promptly delivered
§ 376.1092
Certificate of authority, required, application, contents, fee--refusal to issue, when--renewal--bond, required when
§ 376.1093
Annual report filed with director, when--contents--filing fee, amount
§ 376.1094
Certificate of authority, suspension or revocation, grounds--civil action, when
§ 376.1095
Rules and regulations, promulgation
§ 376.1100
Law, how cited--definitions
§ 376.1103
Laws applicable, Medicare supplement laws not applicable--purpose--policies or riders must be in compliance
§ 376.1106
Policies issued in other states may be issued to residents of Missouri if in compliance with Missouri regulations
§ 376.1109
Policies, content requirements, provisions prohibited--rules authorized
§ 376.1112
Director to provide buyer's guide--content--advertising of long-term care policies to contain notice of availability of guide
§ 376.1115
Coverage outline to be delivered to applicants, when, content
§ 376.1118
Benefits funded by a life insurance death benefit acceleration, reports to policyholder required, content
§ 376.1121
Denial of claim, long-term care insurance, duties of issuer
§ 376.1124
Rescinding of a long-term care policy, permitted when--grounds for contesting--no field issuance, when
§ 376.1127
Nonforfeiture benefit option required for long-term care insurance policies, requirements of offer--rulemaking authority
§ 376.1130
Rulemaking authority
§ 376.1199
Coverage for certain obstetrical/gynecological services--exclusion of contraceptive coverage permitted, when--rulemaking authority
§ 376.1200
Certain policies to offer coverage for treatment of breast cancer--limitation on deductible, lifetime maximum benefit--administration of benefits--application, effect
§ 376.1209
Mastectomy--mandatory insurance coverage for prosthetic devices and reconstructive surgery--no time limit to be imposed
§ 376.1210
Maternity benefits, minimum hospital stays, exceptions--notice of benefits, contents--attending physician defined--rulemaking
§ 376.1215
Immunizations, mandated coverage, exceptions, rulemaking
§ 376.1218
Insurance coverage for children enrolled in the Part C early intervention system (First Steps)
§ 376.1219
PKU formula and low protein modified food products covered by insurance, when--exceptions
§ 376.1220
Insurance coverage for newborn hearing screenings mandated
§ 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
§ 376.1225
Mandated coverage for general anesthesia and hospital charges for dental care, when--prior authorization required, when--exceptions
§ 376.1230
Chiropractic care coverage, rates, terms, conditions, limits, and exclusions
§ 376.1232
Insurers to offer coverage for prosthetics
§ 376.1250
Cancer screening, health insurance coverage required, when, types--department of health and senior services duties
§ 376.1253
Second opinion, right of newly diagnosed cancer patients, attending physician to inform--insurance coverage for such second opinions required, when
§ 376.1275
Coverage for human leukocyte antigen testing for bone marrow transplantation required, when--exceptions
§ 376.1290
Coverage for lead testing
§ 376.1300
Reorganization of a domestic mutual life insurance company, authority
§ 376.1305
Formation of holding company, application--shareholder approval
§ 376.1307
Issuance of shares
§ 376.1309
Member's interest--nontransference of membership--immunity from liability--assessments, not imposed--security, membership interest
§ 376.1312
Nonapplicability of certain provisions of insurance holding companies law
§ 376.1315
Incorporation of mutual holding company, authority, approval
§ 376.1318
Powers of mutual holding company, engaging in business of insurance, no authority, affiliation and merger agreements
§ 376.1322
Mutual holding company subject to supervision of director, dissolution or liquidation--demutualization
§ 376.1350
Definitions
§ 376.1353
Utilization review activities monitored
§ 376.1356
Utilization review organization monitored, when
§ 376.1359
Written utilization program implemented, filed with the director
§ 376.1361
Documented clinical review criteria used in a utilization program--medical director qualifications--compensation of utilization review services
§ 376.1363
Utilization review decisions, procedures
§ 376.1365
Reconsideration of an adverse determination, when
§ 376.1367
Emergency services benefit determination, coverage required, when
§ 376.1369
Certification of compliance, when
§ 376.1372
Certification and member handbook to include utilization review procedures
§ 376.1375
Registry of grievances maintained, procedures--definitions
§ 376.1378
Grievances and certificate of compliance filed with the director, when
§ 376.1382
First- and second-level grievance review for managed care plans, first-level procedures
§ 376.1385
Second-level review procedures
§ 376.1387
Appeals of grievances determined by the director
§ 376.1389
Expedited grievance review procedure
§ 376.1399
Rules, effective, when--rules invalid and void, when
§ 376.1400
Explanation of benefits, standardized information used, contents, when
§ 376.1403
Referrals, standardized information used, content, when
§ 376.1450
Waiver of enrollee's right to receive documents and materials in printed form, when
§ 376.1500
Definitions. Definitions
§ 376.1502
Requirements for transaction of business
§ 376.1504
Registration requirements--term of registration--renewal
§ 376.1506
Violations, penalty
§ 376.1508
Processing fee--cancellation of membership, effect of
§ 376.1510
Prohibited acts
§ 376.1512
Required disclosures
§ 376.1514
Written agreement required, contents
§ 376.1516
Written membership materials, required contents--forms to be filed with director, fee. Written membership materials, required contents--forms to be submitted to director
§ 376.1518
Net worth to be maintained, amount
§ 376.1520
Notice of changes
§ 376.1522
List of providers to be maintained on web site
§ 376.1524
Advertising and marketing materials, approval in writing required
§ 376.1528
Rulemaking authority
§ 376.1530
Denial and refusal to issue registrations, when
§ 376.1532
Violations, penalties
§ 376.1550
Mental health coverage, requirements--definitions--exclusions
§ 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
§ 376.1753
Services related to pregnancy, persons holding ministerial or tocological certification may provide
________________________________________________________________________
Questions & Answers: Insurance
Nicole, You can find a list of phone numbers for substance abuse treatment here. http://www.bhddh.ri.gov/serviceproviders/BH_ProviderSubAbuseList.pdf Steve Daily LawServer.com...
We have 1 year to file a medical claim to most insurance companies. What is the time frame that the insurance companies have to as for a recoupment?...
I lost my job after breast cancer and have now exhausted Cobra. I am denied any policy by all insurers I have asked. Where, as a recent breast cancer survivor, is health insurance ...
Does this law apply or not apply to state insurances (MassHealth and the like?) The reason I ask is while complete MassHealth provides hospice benefits, MassHealth Limited does no...
Does 1641 statute apply to property claims adjusters?...
I've been told that the wind mitigation inspection form that I submitted to my insurance co. is no longer valid. The inspection was done in July 2011 on a form that says "this ver...
Missouri Laws: Insurance
Missouri Laws > Title XXIV > Chapter 375 - Provisions Applicable to All Insurance Companies
Missouri Laws > Title XXIV > Chapter 376 - Life, Health and Accident Insurance
Missouri Laws > Title XXIV > Chapter 379 - Insurance Other Than Life
Missouri Laws > Title XXIV > Chapter 382 - Insurance Holding Companies
Missouri Laws > Title XXIV > Chapter 384 - Surplus Lines Insurance
Missouri Laws > Title XXIV > Chapter 385 - Credit Insurance and Service Contracts
U.S. Code Provisions: Insurance
U.S. Code Title 12 > Chapter 13 > Subchapter IX-C - National Insurance Development Program
U.S. Code > Title 15 > Chapter 20 - Regulation Of Insurance
U.S. Code > Title 15 > Chapter 93 - Insurance
U.S. Code > Title 42 > Chapter 25 - Federal Flood Insurance
U.S. Code > Title 42 > Chapter 50 - National Flood Insurance
Federal Regulations: Insurance
CFR > Title 12 > Chapter I > Part 14 - Consumer protection in sales of insurance
CFR > Title 12 > Chapter III > Part 343 - Consumer protection in sales of insurance
CFR > Title 12 > Chapter V > Part 536 - Consumer protection in sales of insurance
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