374.194. Health coverage providers to be subject to jurisdiction of department, exceptions--examination to be performed, when--requirements of health coverage providers.

MISSOURI STATUTES AND CODES

374.194. Health coverage providers to be subject to jurisdiction of department, exceptions--examination to be performed, when--requirements of health coverage providers.

Health coverage providers to be subject to jurisdiction of department,exceptions--examination to be performed, when--requirements ofhealth coverage providers.

374.194. 1. Notwithstanding any other provision of law to the contrary,and except as provided in this section, any person or other entity whichprovides coverage in this state for medical, surgical, chiropractic, physicaltherapy, speech pathology, audiology, professional mental health, dental,hospital, or optometric expenses, whether such coverage is by direct payment,reimbursement, or otherwise, shall be presumed to be subject to thejurisdiction of the department of insurance, financial institutions andprofessional registration, unless the person or other entity shows that whileproviding such services it is subject to the jurisdiction of another agency ofthis state, any subdivision thereof, or the federal government.

2. A person or entity may show that it is subject to the jurisdiction ofanother agency of this state, any subdivision thereof, or the federalgovernment, by providing to the director of the department of insurance,financial institutions and professional registration the appropriatecertificate, license or other document issued by the other governmental agencywhich permits or qualifies it to provide those services.

3. Any person or entity which is unable to show under subsection 2 ofthis section that it is subject to the jurisdiction of another agency of thisstate, any subdivision thereof, or the federal government, shall submit to anexamination by the director of the department of insurance, financialinstitutions and professional registration to determine the organization andsolvency of the person or the entity, and to determine whether or not suchperson or entity complies with the applicable provisions of chapters 374 to385, RSMo.

4. Any person or entity unable to show that it is subject to thejurisdiction of another agency of this state, any subdivision thereof, or thefederal government, shall be subject to all appropriate provisions of chapters374 to 385, RSMo, regarding the conduct of its business.

5. Any production agency or administrator which advertises, sells,transacts or administers the coverage of this state described in subsection 1of this section and which is required to submit to an examination by thedirector of the department of insurance, financial institutions andprofessional registration under subsection 3 of this section, if such coverageis not fully insured or otherwise fully covered by an admitted life ofdisability insurer, nonprofit health services plan, or nonprofit health careplan shall advise every purchaser, prospective purchaser, and covered personof such lack of insurance or other coverage. Any administrator whichadvertises or administers the coverage in this state described in subsection 1of this section and which is required to submit to an examination by thedirector of the department of insurance, financial institutions andprofessional registration under subsection 3 of this section shall advise anyproduction agency of the elements of the coverage, including the amount ofstop-loss insurance in effect.