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Revised Statutes of Missouri

Chapter 354

Mo. Rev. Stat. ch. 354

Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans

354.010Definitions 354.015Health services corporations, laws applicable to — exceptions 354.020Preexisting health services corporation to amend articles, effect of 354.025Corporate purposes and authority 354.027Discrimination in coverage or reimbursement for covered service by licensed persons, prohibited 354.030For-profit corporations excluded from act 354.035Procedure for organization of corporation 354.040Articles of incorporation, required information and contents 354.045Issuance of certificate, effect of 354.050General powers of corporation 354.055Certificate of authority required — expiration of, extended how 354.060Director to issue certificate, when 354.065Articles of incorporation, how amended — copy to director, when 354.070Certificate of authority automatically extended, when 354.075Capital required to do business 354.080Reserves required, how computed 354.085Membership contract forms, approval by director, when — time for filing — time for disapproval 354.090Health services corporation contracts, purposes, parties to 354.095Limitation of membership and benefits — certain benefits to be provided, when 354.100(Repealed L. 1983 H.B. 127 § 1)Repealed 354.105Annual report required, contents of 354.110(Repealed L. 1983 H.B. 127 § 1)Repealed 354.115Member's grievance, how and where filed — director may investigate, court action not barred 354.120Rules and regulations by director authorized — procedure, review 354.125Corporation not liable for injuries resulting from medical services rendered members 354.130Exemption from certain taxes, exceptions 354.135(Repealed L. 1983 H.B. 126 § 1)Repealed 354.140Dissolution, liquidation or rehabilitation of corporation, procedure for 354.145Appeal from director's actions or decisions, how taken 354.150Fees — waiver, when 354.152Premiums, dues or fees subject to restrictions — violation, hearing — order prohibiting 354.155Disclaimer as to nonhealth services corporations 354.160(Repealed L. 1983 H.B. 127 § 1)Repealed 354.165Certain organizations exempt 354.170(Repealed L. 1983 H.B. 127 § 1)Repealed 354.175Wage continuation plans by employer exempt 354.180Administrative order, director to issue, when 354.190Examinations, procedures 354.195Records of examination, duty to keep 354.200Examinations, false testimony, penalty 354.205Examinations — costs, how paid 354.207Second medical opinion to be allowed by health services corporations, procedure, costs 354.210Director may seek relief, when 354.215Examiner's sick leave to apply to health services corporations 354.220Director may bring suit to recover fees or sums 354.225Enrollment representative, defined — annual report to furnish information — solicitors of members to be insurance agent or broker, exception 354.230License required for enrollment representative 354.235Enrollment representative — license issued when, qualifications 354.240Nonresident may be licensed — examination waived, when 354.245(Repealed L. 1993 H.B. 709 § A)Repealed 354.255(Repealed L. 1993 H.B. 709 § A)Repealed 354.260(Repealed L. 1993 H.B. 709 § A)Repealed 354.265Nonrenewable temporary license issued, when 354.270(Repealed L. 1993 H.B. 709 § A)Repealed 354.275Violations by enrollment representatives, penalties 354.280Officers of corporation found to be of known bad character or incompetent — authority to transact business, effect 354.285Management agreements to control corporation, notice to department, when — examination requirements — violations 354.290Examiner's duties — examination contents — hearing on reports allowed — publication of report, when 354.295Certificate of authority not to be issued if controlling management involved in improper actions 354.300Certificate of authority suspended or revoked, when 354.305Corporation advertising assets also to show liabilities — penalties 354.315Data processing system authorized, cost, amount allowed — amortization not to exceed ten years 354.320Corporate funds and securities use for private gain by officers and employees prohibited, penalty 354.325Investigation by director of investments — records to be kept by division — criminal action, when 354.330Public official failing to perform duties as to investment violations, penalty 354.335Damages allowed if corporation without reasonable cause refuses to pay 354.340Unsatisfied judgments against corporation — suspension or revocation of certificate of authority until judgment satisfied 354.345Court decree of specific performance — membership contract, failure of corporation to comply, procedure, effect 354.350Fraudulent or bad faith conduct — investigation by division — hearing, procedure 354.355Injunctions, permanent or temporary, grounds, procedure — dissolution of corporation or rehabilitation, procedure 354.357Receivership, grounds, procedure 354.362Newborn child coverage required — notice of birth, when, effect 354.380Certain provisions of insurance law to be applicable 354.400Definitions 354.405Certificate of authority, who may make application — foreign corporation may qualify, requirements — procedure 354.407PACE projects not deemed health maintenance organizations, when 354.410Certificate issued, when — annual deposit, requirements — capital account, amount, contents 354.415Powers of organization 354.420Advisory panels to afford enrollees participation in policy decisions 354.425Bonding of officers who disburse or invest funds — bond requirements 354.430Evidence of coverage, requirements — rights of enrollee — toll-free telephone number required 354.435Annual reports filed with director, when — content — forms 354.440Information to be available to enrollees 354.441Disclosures to subscribers shall not be prohibited or restricted 354.442Disclosure information to enrollees required, when 354.443Financial disclosures to the department required by health maintenance organizations, when 354.444Administrative orders for violations — voluntary forfeitures, civil actions 354.445Complaints by enrollees, organization to establish system 354.450Investments authorized 354.455Deposit required, how made 354.460Advertising not to be untrue or misleading — deceptive solicitation — prohibited — how determined 354.462Enrollee, grounds for disenrollment 354.464Names not authorized for use, exceptions 354.465Examinations by division, when — costs, how paid 354.470Suspension or revocation, when — effect 354.475Insurance companies or health service company may organize and operate a health maintenance organization 354.480Rehabilitation, liquidation, or conservation, grounds, procedure — enrollee's priorities — claims, priority 354.485Rules and regulations authorized 354.490Certificate of authority, denial, suspension or revocation, grounds — procedure 354.495Fees to be paid to director 354.500Conferences called by director as to suspected or potential violations 354.505Laws regulating insurance or health service corporations not to apply, exceptions 354.510Public documents, all filings and required reports 354.515Confidential information, diagnosis, treatment, health of enrollees or applicants, exceptions 354.520Mergers, consolidations, control of organization, requirements 354.525Health provision collective bargaining agreements or contracts — charge for coverage, how determined 354.530Severability clause 354.535Pharmacist, 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 354.536Continuation of dependent child coverage, when — dependent child defined 354.540Health maintenance organization of bordering states may be admitted to do business — procedure 354.545Exempt plans and companies 354.546Second medical opinion to be allowed by health maintenance organizations, procedure, costs 354.550Laws not applicable to community health companies 354.551Health maintenance organizations may offer point of service (POS) riders, when 354.552Community-based health maintenance organizations, requirements 354.554Standing referrals for certain members of community-based health maintenance organizations, when 354.556Trustees, vacancies, elections 354.558Materials provided to prospective purchasers 354.559Disclosure to members, restrictions and prohibitions 354.560Payment arrangements, department to adopt rules — disclosure of financial arrangements — confidentiality 354.562Grievance procedures, rulemaking authority 354.563Medicare rules to apply to community-based health maintenance organizations, when 354.565Community-based health maintenance organization designation given, when — revocation 354.567Community-based health maintenance organizations subject to other laws regarding health maintenance organizations 354.570Rulemaking — procedure 354.600Definitions 354.603Sufficiency of health carrier network, requirements, criteria — access plan filed with the department, when 354.606Providers notified of specific covered services, when — hold harmless provision — cessation of operations procedure — selection standards for health care professionals, filing with the department 354.609Termination of a contract, procedure 354.612Continuation of care after provider termination, when 354.615Referrals to appropriate providers, when 354.618Open referral health plans offered, when — definitions — obstetrician/ gynecologist services to be offered, when — eye care providers, discrimination against, prohibited — exemptions 354.621Intermediary and participating provider requirements 354.624Proposed provider contract forms filed with the director — contracts maintained at place of business, available for review, when 354.627Liability of a health carrier, when 354.636Contract requirements after January 1, 1998 354.650Definitions 354.652Designation as essential community provider, procedure, qualifications 354.654Department of health and senior services, duties — rulemaking authority 354.656Inclusion of essential community providers in health care network, exceptions 354.658Designation nontransferable, site specific — annual affidavit required — notice of certain changes, required when 354.700Definitions 354.702Prepaid dental plans, who may offer — certificate of authority required — certain state laws not to apply 354.703Director may order violators to cease and desist, hearing — noncompliance, director's remedies 354.704Application for certificate of authority, content 354.705Certificate of authority granted, when 354.707Capital, 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 354.710Reserve requirements — reserve not required for prepaid dental plans funded by government — surplus requirement for prepaid dental plans in existence January 1, 1987, additional time 354.712Contract 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 354.715Providers of dental care, written contract with prepaid dental plan corporations, review and mediation procedures for enrollees required 354.717Director, powers — financial examinations, when, by whom made and paid 354.720Annual report, required, content 354.721Agents, registration required — rules and regulations authorized 354.722Revocation or suspension of certificate of authority, when — notice, civil suit authorized — suspension, revocation, activity permitted 354.723Rulemaking authorized 354.725Exclusion, labor organization's health plans