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§ 695G.110 |
Medical director required to be physician licensed in this State |
§ 695G.120 |
Utilization review: Development and maintenance of written policies and procedures for use by managed care organization and subcontractors |
§ 695G.125 |
Contracts with certain federally qualified health centers |
§ 695G.127 |
Contracts between managed care organization and provider of health care: Managed care organization required to use form to obtain information on provider of health care; modification; submission by managed care organization of schedule of payments |
§ 695G.130 |
Report regarding methods for reviewing quality of health care services: Form of report; availability for public inspection |
§ 695G.140 |
Certain persons in managed care organization in fiduciary relationship to insured |
§ 695G.150 |
Authorization of recommended and covered health care services required |
§ 695G.155 |
Managed care organization required to offer and issue plan regardless of health status of persons; prohibited acts; authority to include wellness program in plan that offers discounts based on health status under certain circumstances |
§ 695G.160 |
Written criteria concerning coverage of health care services and standards for quality of health care services |
§ 695G.162 |
Required provision concerning coverage for services provided through telehealth to same extent and in same amount as though provided in person or by other means; exception; prohibited acts. [Effective through May 19, 2023.] |
§ 695G.162 v2 |
Required provision concerning coverage for services provided through telehealth 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.] |
§ 695G.162 v3 |
Required provision concerning coverage for services provided through telehealth to same extent as though provided in person or by other means; prohibited acts. [Effective July 1, 2023.] |
§ 695G.163 |
Plan covering prescription drugs: Provision of notice and information regarding use of formulary |
§ 695G.1635 |
Plan covering prescription drugs: Required actions by managed care organization related to acquisition of prescription drugs for certain insureds residing in area for which emergency or disaster has been declared |
§ 695G.164 |
Required provision in certain plans concerning coverage for continued medical treatment; exceptions; regulations |
§ 695G.1645 |
Required provision in plan for group coverage concerning coverage for autism spectrum disorders for certain persons; prohibited acts |
§ 695G.166 |
Plan covering prescription drugs prohibited from limiting or excluding coverage for prescription drug previously approved for medical condition of insured; exceptions |
§ 695G.1665 |
Required provision in plan covering prescription drugs concerning coverage for prescription drugs irregularly dispensed for purpose of synchronization of chronic medications; prohibited acts; exception |
§ 695G.167 |
Plan covering treatment of cancer through use of chemotherapy: Prohibited acts related to orally administered chemotherapy |
§ 695G.1675 |
Plan covering prescription drug for treatment of cancer or cancer symptom that is part of step therapy protocol: Managed care organization required to allow insured or attending practitioner to apply for exemption from step therapy protocol in certa |
§ 695G.168 |
Required provision in plan covering treatment of colorectal cancer concerning coverage for colorectal cancer screening |
§ 695G.170 |
Required provision concerning coverage for medically necessary emergency services at any hospital; prohibited acts |
§ 695G.1705 |
Required provision concerning coverage for drugs, laboratory testing and certain services related to human immunodeficiency virus; reimbursement of pharmacist for certain services |
§ 695G.171 |
Required provision concerning coverage for certain tests and vaccines relating to human papillomavirus; prohibited acts |
§ 695G.1712 |
Required provision concerning coverage for screening, genetic counseling and testing related to BRCA gene in certain circumstances |
§ 695G.1713 |
Required provision concerning coverage for mammograms for certain women; prohibited acts |
§ 695G.1714 |
Required provision concerning coverage for examination of person who is pregnant for certain diseases |
§ 695G.1715 |
Required provision concerning coverage for drug or device for contraception and related health services; prohibited acts; exceptions |
§ 695G.1716 |
Health care plan covering maternity care: Prohibited acts by managed care organization if insured is acting as gestational carrier; child deemed child of intended parent for purposes of plan |
§ 695G.1717 |
Required provision concerning coverage for certain services, screenings and tests relating to wellness; prohibited acts |
§ 695G.172 |
Plan covering prescription drugs: Denial of coverage prohibited for early refills of otherwise covered topical ophthalmic products |
§ 695G.173 |
Required provision concerning coverage for certain treatment received as part of clinical trial or study for treatment of cancer or chronic fatigue syndrome; authority of managed care organization to require certain information; immunity from liab |
§ 695G.174 |
Required provision concerning coverage for management and treatment of sickle cell disease and its variants; plan covering prescription drugs required to provide coverage for medically necessary prescription drugs to treat sickle cell disease and |
§ 695G.175 |
Contracts for provision of emergency medical services, outpatient services or inpatient services with hospital or other facility that provides acute care in smaller city or county: Prohibited acts |
§ 695G.176 |
Plan covering anatomical gifts, organ transplants or treatments or services related to organ transplants: Prohibited acts by managed care organization if insured is person with disability |
§ 695G.177 |
Required provision in plans covering treatment of prostate cancer concerning coverage for prostate cancer screening; prohibited acts |