376.405. Group health and accident policies, approval required--exempt, when, director's powers.

MISSOURI STATUTES AND CODES

376.405. Group health and accident policies, approval required--exempt, when, director's powers.

Group health and accident policies, approval required--exempt, when,director's powers.

376.405. 1. No insurance company licensed to transact business in thisstate shall deliver or issue for delivery in this state any policy of groupaccident or group health insurance, or group accident and health insurance,including insurance against hospital, medical or surgical expenses, covering agroup in this state, unless such policy form shall have been approved by thedirector of the department of insurance, financial institutions andprofessional registration of the state of Missouri.

2. The director of the department of insurance, financial institutionsand professional registration shall have authority to make such reasonablerules and regulations concerning the filing and submission of such policyforms as are necessary, proper or advisable. Such rules and regulations shallprovide, among other things, that if a policy form is disapproved, the reasonstherefor shall be stated in writing; that a hearing shall be granted upon suchdisapproval, if so requested; and that the failure of the director of thedepartment of insurance, financial institutions and professional registrationto take action approving or disapproving a submitted policy form within astipulated time, not to exceed sixty days from the date of filing, shall bedeemed an approval thereof until such time as the director of the departmentof insurance, financial institutions and professional registration shallnotify the submitting company, in writing, of his disapproval thereof.

3. The director of the department of insurance, financial institutionsand professional registration shall approve only those policy forms which arein compliance with the insurance laws of this state and which contain suchwords, phraseology, conditions and provisions which are specific, certain andunambiguous and reasonably adequate to meet needed requirements for theprotection of those insured. The disapproval of any policy form shall bebased upon the requirements of the laws of this state or of any regulationlawfully promulgated thereunder.

4. The director of the department of insurance, financial institutionsand professional registration may, by order or bulletin, exempt from theapproval requirements of this section for so long as he deems proper anyinsurance policy, document, or form or type thereof, as specified in suchorder or bulletin, to which, in his opinion, this section may not practicablybe applied, or the approval of which is, in his opinion, not desirable ornecessary for the protection of the public.