PURPOSE: This rule sets forth the documents which must be submitted to the Department of Insurance prior to any changes becoming effective. This rule is promulgated pursuant to sections 354.405, 354.410, 354.425 and 354.485, RSMo.

1. (1) Every health maintenance organization

2. (HMO) shall file with the director notice of its intention to modify or change the documents and mechanisms approved in conjunction with the HMO’s application for a certificate of authority pursuant to sections 354.400–354.550, RSMo. This notice shall be filed prior to the actual modification. These documents and mechanisms include, but are not limited to:

   1. (A) Articles of incorporation, articles of association, partnership agreement or trust agreement;
   2. (B) Bylaws, rules or similar documents regulating the HMO’s internal affairs;
   3. (C) Grievance procedure and complaint mechanisms;
   4. (D) Enrollee participation mechanism;
   5. (E) Reinsurance contracts; and
   6. (F) Bonds (surety and fidelity).
3. (2) The documents and mechanisms, as modified, shall be promptly filed with the director for approval. If the modification is not disapproved by the director within thirty (30) days after filing, the modification shall be deemed approved.

AUTHORITY: sections 354.405, 354.410, 354.425 and 354.485, RSMo 1986.* This rule was previously filed as 4 CSR 190- 15.080. Original rule filed Nov. 2, 1987, effective April 11, 1988.

*Original authority: 354.405, RSMo 1983; 354.410, RSMo 1983; 354.425, RSMo, 1983; and 354.485, RSMo 1983.