354.558. Materials provided to prospective purchasers. - Missouri Statutes

Materials provided to prospective purchasers.

354.558. A community-based health maintenance organization shall provideeach prospective purchaser of its services with the following marketingmaterials prior to enrollment:

(1) A list of the health care providers who have a contractual agreementto provide services under the plan of coverage. It shall be a violation ofthe unfair trade practices act for a community-based health maintenanceorganization to falsely list that a provider has a contractual agreement toprovide services under its plan of coverage;

(2) Information to describe how the community-based health maintenanceorganization will use utilization management to promote efficiency in thedelivery of services in accordance with the terms of the contract forcoverage. This information shall explain how the community-based healthmaintenance organization will encourage the use of treatment options thatproduce the most cost-effective results. The format and content of thedescriptive information disclosed under this subdivision shall be approved bythe department of insurance, financial institutions and professionalregistration and shall include information regarding covered benefitsavailable under the plan;

(3) Disclosure of grievance procedures established in accordance withregulations promulgated by the department of insurance, financial institutionsand professional registration for community-based health maintenanceorganizations. Included in this information shall be notification of how andwhen to contact the health plan and the department of insurance, financialinstitutions and professional registration regarding a grievance; and

(4) Notice of the availability of coverage as described in section354.554.

(L. 1997 H.B. 335 § 4)