PURPOSE: This regulation sets out the approval criteria for membership benefits. Those persons who purchase membership contracts from health services corporations are motivated by the same desire to prepay the cost of any illness as are those persons who purchase accident and sickness insurance from insurance companies. Both groups deserve an equal opportunity to receive benefits commensurate with the charges they pay and to know the meaning of those benefits provided. This regulation is adopted pursuant to section 354.120, RSMo 1986 and to implement section 354.085, RSMo 1986.

1. (1) Membership Contract Approval Criteria. The director of insurance in approving membership contract forms shall take into consideration the following: sections 375.930–375.948, 376.405 and 376.776–376.800, RSMo and 20 CSR 400-2.010 (Insured’s Right to Examination of Individual Accident and Sickness Coverage), 20 CSR 400-5.700 (Accident and Sickness Insurance Advertising), 20 CSR 400-2.030 (Coordination of Benefits), 20 CSR 400-2.050 (Notice of Renewal Dates on Renewable Policies) and 20 CSR 400-2.060 (Policy Approval Criteria) where applicable, provided s/he may also consider future enactments pertaining to this subject.

2. (2) Hearing Provided.

   1. (A) If any health service corporation is adversely affected by the application of any of these statutes or regulations to its membership contracts, it may request a hearing under 20 CSR 400-6

the procedures contained in 20 CSR 800- 1.010.

1. (B) The director shall hold the requested hearing pursuant to the provisions of 20 CSR 800-1.010. At that hearing the affected health service corporation must substantiate its claim that any such statute or regulation is not applicable to any or all of its membership contracts. The director shall issue an order finding the statute or regulation applicable or not applicable to the approval of the contracts.

AUTHORITY: sections 354.085 and 354.120, RSMo 1986.* This rule was previously filed as 4 CSR 190-15.020. Original rule filed Sept. 26, 1974, effective Oct. 6, 1974.

*Original authority: 354.080, RSMo 1973 and 354.120, RSMo 1973. Op. Atty. Gen. No. 112, Edmiston, 6-21-76. Insurance companies are required to pay a filing fee pursuant to section 374.230(6), RSMo for documents filed with the director of the Division of Insurance pursuant to sections 376.405, 376.675, 376.777, RSMo (1969) and section 379.321, RSMo (Supp. 1975). The filing fee imposed by section 374.230(6) is for each document and not each page of each document. The filing fee paid pursuant to section 374.230(6) is not, pursuant to section 148.400, RSMo, deductible from the premium tax payable by such companies.