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| § 689C.015 |
Definitions |
| § 689C.017 |
‘Affiliated’ defined |
| § 689C.019 |
‘Affiliation period’ defined |
| § 689C.023 |
‘Bona fide association’ defined |
| § 689C.025 |
‘Carrier’ defined |
| § 689C.045 |
‘Class of business’ defined |
| § 689C.047 |
‘Control’ defined |
| § 689C.053 |
‘Creditable coverage’ defined |
| § 689C.055 |
‘Dependent’ defined |
| § 689C.065 |
‘Eligible employee’ defined |
| § 689C.066 |
‘Employee leasing company’ defined. [Repealed.] |
| § 689C.071 |
‘Geographic rating area’ defined |
| § 689C.072 |
‘Geographic service area’ defined |
| § 689C.073 |
‘Group health plan’ defined |
| § 689C.075 |
‘Health benefit plan’ defined |
| § 689C.077 |
‘Network plan’ defined |
| § 689C.078 |
‘Open enrollment’ defined |
| § 689C.079 |
‘Plan for coverage of a bona fide association’ defined |
| § 689C.081 |
‘Plan sponsor’ defined |
| § 689C.082 |
‘Preexisting condition’ defined. [Repealed.] |
| § 689C.083 |
‘Producer’ defined |
| § 689C.0835 |
‘Professional employer organization’ defined |
| § 689C.085 |
‘Rating period’ defined |
| § 689C.095 |
‘Small employer’ defined |
| § 689C.104 |
‘Voluntary purchasing group’ defined |
| § 689C.106 |
‘Waiting period’ defined |
| § 689C.1065 |
Applicability |
| § 689C.109 |
Certain plan, fund or program established or maintained by partnership required to be treated as employee welfare benefit plan which is group health plan; partnership deemed employer of each partner |
| § 689C.111 |
Professional employer organization deemed large employer in certain circumstances |
| § 689C.113 |
Requirements for employee welfare benefit plan for providing benefits for employees of more than one employer |
| § 689C.115 |
Mandatory and optional coverage |
| § 689C.125 |
Rating factors for determining premiums; rating periods |
| § 689C.131 |
Contracts between carrier and providers of health care: Prohibiting carrier from charging provider of health care fee for inclusion on list of providers given to insureds; carrier required to use form to obtain information on provider of health ca |
| § 689C.135 |
Effect of provision in health benefit plan for restricted network on determination of rates |
| § 689C.143 |
Offering of policy of health insurance for purposes of establishing health savings account |
| § 689C.155 |
Regulations |
| § 689C.156 |
Each health benefit plan marketed in this State required to be offered to small employers; issuance; carrier required to provide system for resolving complaints of employees if services provided or paid for through managed care |
| § 689C.1565 |
Coverage to small employers not required under certain circumstances; notice required to Commissioner of and prohibition on writing new business after election not to offer new coverage required |
| § 689C.158 |
Producer authorized only to market to or sign up small employers and eligible employees in bona fide associations if employers and employees are actively engaged in or directly related to bona fide association |
| § 689C.159 |
Certain provisions inapplicable to plan that carrier makes available only through bona fide association |
| § 689C.160 |
Carrier must uniformly apply requirements to determine whether to provide coverage |
| § 689C.165 |
Carrier prohibited from modifying plan to restrict or exclude coverage or benefits for specific diseases, medical conditions or services otherwise covered by plan; exceptions |
| § 689C.1655 |
Coverage for autism spectrum disorders for certain persons required; prohibited acts |
| § 689C.166 |
Coverage for alcohol or substance use disorder: Required in group health insurance policy |
| § 689C.167 |
Coverage for alcohol or substance use disorders: Benefits provided by group health insurance policy |
| § 689C.1671 |
Coverage for drugs, laboratory testing and certain services related to human immunodeficiency virus required; reimbursement of pharmacist for certain services |
| § 689C.1672 |
Coverage for certain tests and vaccines relating to human papillomavirus required; prohibited acts |
| § 689C.1673 |
Coverage for screening, genetic counseling and testing related to BRCA gene required in certain circumstances |
| § 689C.1674 |
Coverage for mammograms for certain women required; prohibited acts |
| § 689C.1675 |
Coverage for examination of person who is pregnant for certain diseases required |
| § 689C.1676 |
Coverage for drug or device for contraception and related health services required; prohibited acts; exceptions |
| § 689C.1678 |
Coverage for certain services, screenings and tests relating to wellness required; prohibited acts |
| § 689C.1679 |
Plan covering prescription drugs: Required actions by carrier related to acquisition of prescription drugs for certain insureds residing in area for which emergency or disaster has been declared |
| § 689C.168 |
Plan covering prescription drugs prohibited from limiting or excluding coverage for prescription drug previously approved for medical condition of insured; exception |
| § 689C.1683 |
Coverage for prescription drugs irregularly dispensed for purpose of synchronization of chronic medications required in plan covering prescription drugs; prohibited acts; exception |
| § 689C.1684 |
Plan covering prescription drug for treatment of cancer or cancer symptom that is part of step therapy protocol: Carrier required to allow insured or attending practitioner to apply for exemption from step therapy protocol in certain circumstances; |
| § 689C.1685 |
Plan covering prescription drugs: Denial of coverage prohibited for early refills of otherwise covered topical ophthalmic products |
| § 689C.1687 |
Coverage for management and treatment of sickle cell disease and its variants required; coverage for medically necessary prescription drugs to treat sickle cell disease and its variants required in plan covering prescription drugs |
| § 689C.169 |
Coverage for severe mental illness required under group health insurance policy |
| § 689C.170 |
Authorized variation of minimum participation and contributions; denial of coverage based on industry prohibited |
| § 689C.180 |
Carrier to offer same coverage to all eligible employees; denial of coverage to otherwise eligible employee |
| § 689C.183 |
Plan and carrier required to permit employee or dependent of employee to enroll for coverage under certain circumstances |
| § 689C.187 |
Manner and period for enrolling dependent of covered employee; period of special enrollment |
| § 689C.190 |
Carrier required to offer and issue plan regardless of health status of employees; prohibited acts; authority to include wellness program in plan that offers discounts based on health status under certain circumstances |
| § 689C.191 |
Determination of applicable creditable coverage of person; determining period of creditable coverage of person; required statement for certain election by carrier; applicability |
| § 689C.192 |
Written certification of coverage required for purpose of determining period of creditable coverage accumulated by person |
| § 689C.193 |
Carrier prohibited from imposing restriction on being participant of or beneficiary of plan inconsistent with certain provisions; restrictions on rules of eligibility that may be established |
| § 689C.194 |
Plan covering maternity and pediatric care: Required to allow minimum stay in hospital in connection with childbirth; exceptions; prohibited acts |
| § 689C.1945 |
Plan covering maternity care: Prohibited acts by carrier if insured is acting as gestational carrier; child deemed child of intended parent for purposes of plan |
| § 689C.1947 |
Plan covering anatomical gifts, organ transplants or treatments or services related to organ transplants: Prohibited acts by carrier if insured is person with disability |
| § 689C.195 |
Coverage for services provided through telehealth required to same extent and in same amount as though provided in person or by other means; exception; prohibited acts. [Effective through May 19, 2023.] |
| § 689C.195 v2 |
Coverage for services provided through telehealth required to same extent and in same amount as though provided in person or by other means; exception; prohibited acts. [Effective May 20, 2023, through June 30, 2023.] |
| § 689C.195 v3 |
Coverage for services provided through telehealth required to same extent as though provided in person or by other means; prohibited acts. [Effective July 1, 2023.] |
| § 689C.196 |
Insurer prohibited from denying coverage solely because claim involves act that constitutes domestic violence or applicant or insured was victim of domestic violence |
| § 689C.197 |
Carrier prohibited from denying coverage because applicant or insured was intoxicated or under influence of controlled substance; exceptions |
| § 689C.198 |
Insurer prohibited from requiring or using information concerning genetic testing; exceptions |
| § 689C.200 |
Circumstances in which carrier is not required to offer coverage |
| § 689C.203 |
Requirement for denial of application for coverage from small employer; regulations setting standards for fair marketing and broad availability of plans |
| § 689C.207 |
Regulations concerning reissuance of health benefit plan |
| § 689C.220 |
Adjustment in rates required to be applied uniformly |
| § 689C.265 |
Carrier authorized to modify coverage for insurance product under certain circumstances |
| § 689C.281 |
Plan covering prescription drugs: Provision of notice and information regarding use of formulary |
| § 689C.310 |
Renewal of plan; discontinuance of issuance or renewal of coverage or of plan offered only through bona fide association; discontinuance of product; applicability |
| § 689C.320 |
Required notification when carrier discontinues transacting insurance in this State or particular geographic service area of state; restrictions on carrier that discontinues transacting insurance |
| § 689C.325 |
Coverage offered through network plan not required to be offered to eligible employee who does not reside or work in geographic service area or if carrier lacks capacity to deliver adequate service to additional employers and employees |
| § 689C.335 |
Approval or denial of claims; payment of claims and interest; requests for additional information; award of costs and attorney’s fees; compliance with requirements; imposition of administrative fine or suspension or revocation of certificate of au |
| § 689C.350 |
Health benefit plan which offers difference of payment between preferred providers of health care and providers who are not preferred: Limitations on deductibles and copayments; circumstances in which service is deemed to be provided by preferred |
| § 689C.355 |
Prohibited acts of carrier or producer related to encouraging or directing small employer to take certain actions; exceptions; prohibited acts by carrier related to contract or agreement with producer; violation may constitute unfair trade practic |
