STATE STATUTES & CODES

MISSOURI STATUTES AND CODES

Chapter 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.
• 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 p
• 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 departmen
• 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 require
• 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 additiona
• 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.

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