376.801. Coverage for child health supervision services required--definitions--permitted limitations on benefits. - Missouri Statutes

Coverage for child health supervision servicesrequired--definitions--permitted limitations on benefits.

376.801. 1. This section shall be known and may be cited as the "ChildHealth Insurance Reform Plan".

2. As used in this section, the following terms mean:

(1) "Child health supervision services", the periodic review of achild's physical and emotional status by a physician or pursuant to aphysician's supervision. A review shall include a history, complete physicalexamination, developmental assessment, anticipatory guidance, appropriateimmunizations and laboratory tests in keeping with prevailing medicalstandards;

(2) "Health care insurer", any entity regulated by the Missouridepartment of insurance, financial institutions and professional registration,including, but not limited to, insurance companies, nonprofit health servicescorporations, health maintenance organizations, or any self-insured plans orgroups;

(3) "Health insurance policy", any group insurance policy providingcoverage on an expense-incurred basis, any group service or indemnity contractissued by a not-for-profit health services corporation or any self-insuredgroup health benefit plan of any type or description. Such phrase shall notinclude policies which cover only specified diseases, accidents or confinementin an intensive care unit.

3. All health insurance policies which provide coverage for a familymember of the insured or subscriber shall offer coverage for child healthsupervision services. Such services shall include coverage from the moment ofbirth through the age of twelve years. Each such policy or contract shall, ata minimum, provide benefits for child health supervision services atapproximately the following age intervals: birth, two months, four months,six months, nine months, twelve months, eighteen months, two years, threeyears, four years, five years, six years, eight years, ten years, and twelveyears. A health insurance policy may provide that child health supervisionservices which are rendered during a periodic review shall only be covered tothe extent that services are provided by or under the supervision of a singlephysician during the course of one visit. Benefits for such services shall besubject to the same durational limits, dollar limits, deductibles andcoinsurance factors as other covered services in such health insurancepolicies. All Missouri health insurance policies delivered, issued fordelivery, modified or renewed on or after January 1, 1990, shall be subject tothis section.

4. The offer of benefits under subsection 3 of this section shall be inwriting and may be rejected by the individual or group policyholder orcontractholder.

5. Nothing in this section shall prohibit the health care insurer fromincluding any or all coverage for child health supervision services asstandard coverage in their policies or contracts.

(L. 1989 H.B. 795 §§ 1, 2, 3)