Learn More
Log In
Sign Up
Mo. Rev. Stat. ch. 354 – Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans | Midpage
Collections
Revised Statutes of Missouri
Title XXIII
Chapter 354
Mo. Rev. Stat. ch. 354
Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans
354.010
Definitions
354.015
Health services corporations, laws applicable to — exceptions
354.020
Preexisting health services corporation to amend articles, effect of
354.025
Corporate purposes and authority
354.027
Discrimination in coverage or reimbursement for covered service by licensed persons, prohibited
354.030
For-profit corporations excluded from act
354.035
Procedure for organization of corporation
354.040
Articles of incorporation, required information and contents
354.045
Issuance of certificate, effect of
354.050
General powers of corporation
354.055
Certificate of authority required — expiration of, extended how
354.060
Director to issue certificate, when
354.065
Articles of incorporation, how amended — copy to director, when
354.070
Certificate of authority automatically extended, when
354.075
Capital required to do business
354.080
Reserves required, how computed
354.085
Membership contract forms, approval by director, when — time for filing — time for disapproval
354.090
Health services corporation contracts, purposes, parties to
354.095
Limitation of membership and benefits — certain benefits to be provided, when
354.105
Annual report required, contents of
354.115
Member's grievance, how and where filed — director may investigate, court action not barred
354.120
Rules and regulations by director authorized — procedure, review
354.125
Corporation not liable for injuries resulting from medical services rendered members
354.130
Exemption from certain taxes, exceptions
354.140
Dissolution, liquidation or rehabilitation of corporation, procedure for
354.145
Appeal from director's actions or decisions, how taken
354.150
Fees — waiver, when
354.152
Premiums, dues or fees subject to restrictions — violation, hearing — order prohibiting
354.155
Disclaimer as to nonhealth services corporations
354.165
Certain organizations exempt
354.175
Wage continuation plans by employer exempt
354.180
Administrative order, director to issue, when
354.190
Examinations, procedures
354.195
Records of examination, duty to keep
354.200
Examinations, false testimony, penalty
354.205
Examinations — costs, how paid
354.207
Second medical opinion to be allowed by health services corporations, procedure, costs
354.210
Director may seek relief, when
354.215
Examiner's sick leave to apply to health services corporations
354.220
Director may bring suit to recover fees or sums
354.225
Enrollment representative, defined — annual report to furnish information — solicitors of members to be insurance agent or broker, exception
354.230
License required for enrollment representative
354.235
Enrollment representative — license issued when, qualifications
354.240
Nonresident may be licensed — examination waived, when
354.265
Nonrenewable temporary license issued, when
354.275
Violations by enrollment representatives, penalties
354.280
Officers of corporation found to be of known bad character or incompetent — authority to transact business, effect
354.285
Management agreements to control corporation, notice to department, when — examination requirements — violations
354.290
Examiner's duties — examination contents — hearing on reports allowed — publication of report, when
354.295
Certificate of authority not to be issued if controlling management involved in improper actions
354.300
Certificate of authority suspended or revoked, when
354.305
Corporation advertising assets also to show liabilities — penalties
354.315
Data processing system authorized, cost, amount allowed — amortization not to exceed ten years
354.320
Corporate funds and securities use for private gain by officers and employees prohibited, penalty
354.325
Investigation by director of investments — records to be kept by division — criminal action, when
354.330
Public official failing to perform duties as to investment violations, penalty
354.335
Damages allowed if corporation without reasonable cause refuses to pay
354.340
Unsatisfied judgments against corporation — suspension or revocation of certificate of authority until judgment satisfied
354.345
Court decree of specific performance — membership contract, failure of corporation to comply, procedure, effect
354.350
Fraudulent or bad faith conduct — investigation by division — hearing, procedure
354.355
Injunctions, permanent or temporary, grounds, procedure — dissolution of corporation or rehabilitation, procedure
354.357
Receivership, grounds, procedure
354.362
Newborn child coverage required — notice of birth, when, effect
354.380
Certain provisions of insurance law to be applicable
354.400
Definitions
354.405
Certificate of authority, who may make application — foreign corporation may qualify, requirements — procedure
354.407
PACE projects not deemed health maintenance organizations, when
354.410
Certificate issued, when — annual deposit, requirements — capital account, amount, contents
354.415
Powers of organization
354.420
Advisory panels to afford enrollees participation in policy decisions
354.425
Bonding of officers who disburse or invest funds — bond requirements
354.430
Evidence of coverage, requirements — rights of enrollee — toll-free telephone number required
354.435
Annual reports filed with director, when — content — forms
354.440
Information to be available to enrollees
354.441
Disclosures to subscribers shall not be prohibited or restricted
354.442
Disclosure information to enrollees required, when
354.443
Financial disclosures to the department required by health maintenance organizations, when
354.444
Administrative orders for violations — voluntary forfeitures, civil actions
354.445
Complaints by enrollees, organization to establish system
354.450
Investments authorized
354.455
Deposit required, how made
354.460
Advertising not to be untrue or misleading — deceptive solicitation — prohibited — how determined
354.462
Enrollee, grounds for disenrollment
354.464
Names not authorized for use, exceptions
354.465
Examinations by division, when — costs, how paid
354.470
Suspension or revocation, when — effect
354.475
Insurance companies or health service company may organize and operate a health maintenance organization
354.480
Rehabilitation, liquidation, or conservation, grounds, procedure — enrollee's priorities — claims, priority
354.485
Rules and regulations authorized
354.490
Certificate of authority, denial, suspension or revocation, grounds — procedure
354.495
Fees to be paid to director
354.500
Conferences called by director as to suspected or potential violations
354.505
Laws regulating insurance or health service corporations not to apply, exceptions
354.510
Public documents, all filings and required reports
354.515
Confidential information, diagnosis, treatment, health of enrollees or applicants, exceptions
354.520
Mergers, consolidations, control of organization, requirements
354.525
Health provision collective bargaining agreements or contracts — charge for coverage, how determined
354.530
Severability clause
354.535
Pharmacist, emergency situation, may take an assignment of enrollee's right to reimbursement — health maintenance organizations shall only contract with entities licensed by the board of pharmacy — requirements for drug prescriptions, exceptions
354.536
Continuation of dependent child coverage, when — dependent child defined
354.540
Health maintenance organization of bordering states may be admitted to do business — procedure
354.545
Exempt plans and companies
354.546
Second medical opinion to be allowed by health maintenance organizations, procedure, costs
354.550
Laws not applicable to community health companies
354.551
Health maintenance organizations may offer point of service (POS) riders, when
354.552
Community-based health maintenance organizations, requirements
354.554
Standing referrals for certain members of community-based health maintenance organizations, when
354.556
Trustees, vacancies, elections
354.558
Materials provided to prospective purchasers
354.559
Disclosure to members, restrictions and prohibitions
354.560
Payment arrangements, department to adopt rules — disclosure of financial arrangements — confidentiality
354.562
Grievance procedures, rulemaking authority
354.563
Medicare rules to apply to community-based health maintenance organizations, when
354.565
Community-based health maintenance organization designation given, when — revocation
354.567
Community-based health maintenance organizations subject to other laws regarding health maintenance organizations
354.570
Rulemaking — procedure
354.600
Definitions
354.603
Sufficiency of health carrier network, requirements, criteria — access plan filed with the department, when
354.606
Providers notified of specific covered services, when — hold harmless provision — cessation of operations procedure — selection standards for health care professionals, filing with the department
354.609
Termination of a contract, procedure
354.612
Continuation of care after provider termination, when
354.615
Referrals to appropriate providers, when
354.618
Open referral health plans offered, when — definitions — obstetrician/ gynecologist services to be offered, when — eye care providers, discrimination against, prohibited — exemptions
354.621
Intermediary and participating provider requirements
354.624
Proposed provider contract forms filed with the director — contracts maintained at place of business, available for review, when
354.627
Liability of a health carrier, when
354.636
Contract requirements after January 1, 1998
354.650
Definitions
354.652
Designation as essential community provider, procedure, qualifications
354.654
Department of health and senior services, duties — rulemaking authority
354.656
Inclusion of essential community providers in health care network, exceptions
354.658
Designation nontransferable, site specific — annual affidavit required — notice of certain changes, required when
354.700
Definitions
354.702
Prepaid dental plans, who may offer — certificate of authority required — certain state laws not to apply
354.703
Director may order violators to cease and desist, hearing — noncompliance, director's remedies
354.704
Application for certificate of authority, content
354.705
Certificate of authority granted, when
354.707
Capital, surplus, security required — cash, securities, bond to be deposited or filed with director, director to return deposit, when — security subject to final judgments — security not required for prepaid dental plans funded by government — director may waive capital, surplus, security requirements, when
354.710
Reserve requirements — reserve not required for prepaid dental plans funded by government — surplus requirement for prepaid dental plans in existence January 1, 1987, additional time
354.712
Contract or contract certificate to be issued to enrollees, content, copy to be filed with director — newborn child to be covered, when, extent of coverage, notification of birth and additional premium, when, effect of
354.715
Providers of dental care, written contract with prepaid dental plan corporations, review and mediation procedures for enrollees required
354.717
Director, powers — financial examinations, when, by whom made and paid
354.720
Annual report, required, content
354.721
Agents, registration required — rules and regulations authorized
354.722
Revocation or suspension of certificate of authority, when — notice, civil suit authorized — suspension, revocation, activity permitted
354.723
Rulemaking authorized
354.725
Exclusion, labor organization's health plans