Chapter 376 - Life, Health and Accident Insurance

Section 376.005 Definitions.
Section 376.010 Who may form company — purposes.
Section 376.015 Involuntary unemployment insurance may be issued in connection with extension of credit or certain group life insurance, requirements.
Section 376.020 Various companies defined.
Section 376.050 Declaration of corporators.
Section 376.060 Stock companies — content of charter.
Section 376.070 To be submitted to attorney general.
Section 376.080 Director to examine, when.
Section 376.090 To furnish certificate of deposit, when.
Section 376.100 Mutual companies — contents of charter.
Section 376.110 To be submitted to attorney general.
Section 376.120 Director to examine and certify, when.
Section 376.130 To furnish certificate of deposit, when.
Section 376.142 Stock company may become mutual — procedure — policyholders' meeting — acquisition of stock.
Section 376.143 Stock company may acquire its own shares to be held in trust for mutual — appointment, powers and duties of trustees.
Section 376.144 Acquisition of shares of dissenting stockholders, procedure — abandonment of mutualization.
Section 376.145 Officers of stock company to continue as officers of mutual.
Section 376.146 Board of directors or trustees of mutual, membership qualifications, term of office.
Section 376.147 Meetings of board of mutual, notice — executive committee of board, powers.
Section 376.148 Policyholders are members of mutual — voting rights — directors may alter articles — additional assessments prohibited.
Section 376.150 Stock and mutual companies — content of charter.
Section 376.160 Formation of stock and mutual companies.
Section 376.170 Special deposits for registered policies and annuity bonds.
Section 376.180 Certificates as to registration and reserves on policy — policies exempt, exceptions.
Section 376.190 Additional deposits required.
Section 376.200 Definition of net value.
Section 376.210 Excess deposits.
Section 376.220 May use realty to secure notes and bonds.
Section 376.230 Changing of securities on deposit.
Section 376.240 Deposits to be held in trust by director.
Section 376.250 Deposits to be kept separate.
Section 376.260 Fees collected by director of revenue.
Section 376.270 Director may proceed against depositary companies.
Section 376.280 Capital necessary to do business — how invested.
Section 376.290 Deposit and transfer of securities.
Section 376.291 Applicability and inapplicability.
Section 376.292 Definitions.
Section 376.293 Permissible investments — written plan for investments required.
Section 376.294 Prohibited acts.
Section 376.295 Additional prohibited acts — authorized actions.
Section 376.296 Value of investments, how calculated.
Section 376.297 Investment subsidiaries not permitted, when.
Section 376.298 Acquisition of rate credit instruments, when.
Section 376.300 Equity interests permitted, when.
Section 376.301 Tangible personal property interests permitted, when.
Section 376.302 Mortgage interests, may be acquired, when — other real estate interests.
Section 376.303 Lending and repurchase, permitted when.
Section 376.304 Acquisition of foreign investments, when.
Section 376.305 Rulemaking authority.
Section 376.306 Cash surrender value, life insurer may lend to policyholder, when.
Section 376.307 Limits on acquisition of certain investments.
Section 376.308 Secondary mortgage market act, not to preempt health insurer, when.
Section 376.309 Separate account defined — establishment of account and special voting or control rights authorized — approved investments — approval of director required.
Section 376.310 Investment of surplus and reserve funds by foreign companies.
Section 376.311 Investment of capital reserve and surplus of life insurance companies in investment pools — definitions — qualifications — requirements.
Section 376.325 Any willing provider provision — definitions.
Section 376.330 Securities may be changed.
Section 376.350 Reports to director.
Section 376.360 Distribution of surplus funds to participating policyholders — method.
Section 376.365 Standard valuation law — definitions.
Section 376.370 Director to value reserves, methods.
Section 376.379 Medication synchronization services, offer of coverage required.
Section 376.380 Legal minimum standards for valuation — interest rates — valuation manual, operative date, effect of — reserves required.
Section 376.381 Health insurance products, department duties.
Section 376.383 Health care claims for reimbursement, how paid, when — definitions — clean claims, procedure — unpaid claims, procedure — fraudulent claims, notification to the department, procedure — requests for additional information, contents.
Section 376.384 Reimbursement of claims, duties of health carriers — claims submitted in electronic format, when — compliance monitored by department — complaint procedures developed — standard medical code sets required, when — rulemaking authority.
Section 376.385 Diabetes — insurance coverage for equipment, supplies and self-management training.
Section 376.386 Prescription drugs, one co-payment for dosage prescribed.
Section 376.387 Pharmacy benefits manager, limitations and restrictions — enforcement.
Section 376.388 Maximum allowable costs — definitions — contract requirements — reimbursement — appeals process required.
Section 376.390 Reserve liability for group insurance — how computed.
Section 376.391 Co-payments for chiropractic services, cap.
Section 376.392 Prescription drug formularies, enrollees to be notified of changes to, when.
Section 376.395 Definitions for group health conversion policy requirements.
Section 376.397 Converted policy to be offered on termination of group health coverage, when — exceptions — terms and conditions.
Section 376.398 Application to all group policies — effective, when.
Section 376.401 Conversion rights — retirees — dependents of insured.
Section 376.403 Benefit levels — group coverage may be provided in lieu of converted policy — delivery outside state, form.
Section 376.404 Specific requirement requests of policyholder may be met by alteration.
Section 376.405 Group health and accident policies, approval required — exempt, when, director's powers.
Section 376.406 Newborn child to be covered under health policies, extent of coverage — notification of birth, when, effect of — definitions.
Section 376.407 Advance practice nurse, claims for service to be reimbursed, when.
Section 376.410 Insurance companies to maintain reserves — exemptions.
Section 376.421 Group health insurance, authorized categories.
Section 376.422 Direct response solicitation and sponsoring or endorsing entity, defined — certain group or individual insurers paying compensation to policyholder or sponsoring entity to notify policyholders.
Section 376.423 Health insurance, claims for chiropractic services denial, qualified chiropractor to review, qualifications — investigation by department, when.
Section 376.424 Group health insurance policies may be extended to insure family members or dependents.
Section 376.425 Student accident policies, may not limit surgical benefits, when.
Section 376.426 Group health policies, required provisions.
Section 376.427 Assignment of benefits made by insured to provider — payment, how made — exceptions — all claims to be paid, when — out-of-network services, how paid.
Section 376.428 Federal COBRA provisions to apply to group health insurance policies.
Section 376.429 Coverage for certain clinical trials for prevention, early detection and treatment of cancer, restrictions — definitions — exclusions.
Section 376.431 Employees or members of unions or associations, group or group-type basis coverage, sections 376.431 to 376.442 to apply.
Section 376.432 Group-type basis, defined.
Section 376.433 Self-insurance plans for health care, public entities — subject to Medicaid rights, obligations, and remedies.
Section 376.434 Carrier liable for claims incurred during grace period, when — exceptions.
Section 376.435 Claim information to be reported, when — covered lives defined.
Section 376.436 Discontinuance notice by carrier, contents — notice forms furnished by carrier for distribution to policyholders.
Section 376.438 Group policies, modifying or amending benefits shall provide extension of benefits in event of total disability at date of termination or discontinuance.
Section 376.441 Carrier contract replaced by similar benefit plan of another carrier — liability of prior carrier — succeeding carrier coverage requirements.
Section 376.442 Rules and regulations, procedure.
Section 376.446 Enrollee cost-sharing responsibilities, health carriers to provide timely information — exceptions.
Section 376.450 Citation of law — definitions (Missouri HIPAA).
Section 376.451 Standards prohibiting discrimination.
Section 376.452 Large group market, renewal or continuation of coverage required — nonrenewal or discontinuation permitted, when — conditions for discontinuation.
Section 376.453 Premium — only cafeteria plans required, when.
Section 376.454 Individual market, renewal or continuation at option of individual — nonrenewal or discontinuation permitted, when — discontinuation of a type of coverage, procedure.
Section 376.465 Missouri health insurance rate transparency act — definitions — rate filing requirements, procedure — rulemaking authority.
Section 376.480 Domestic companies may assume risks of foreign companies — duties of director.
Section 376.500 Discriminations, rebates and favors prohibited — contracts to conform to policy.
Section 376.502 Life insurers not to discriminate based on lawful travel destinations — violations, penalty.
Section 376.510 Penalty for violation of section 376.500.
Section 376.531 Life insurance policies, consent of insured required, exceptions — employers have insurable interest in employees, when, effects.
Section 376.540 Policy, to whom payable.
Section 376.562 Charitable, benevolent, educational and religious organizations may be beneficiary or owner of policy, life insurance, when — fraud or coercion, exception.
Section 376.570 Foreign executor or administrator.
Section 376.580 Misrepresentation.
Section 376.590 Misrepresentations, false estimates and circulars prohibited — agents — notes to be held until policy delivered.
Section 376.600 Penalty for violating section 376.590.
Section 376.610 Defense in case of suits.
Section 376.620 Suicide, effect on liability — refund of premiums, when.
Section 376.630 Life insurance policies not to be forfeited or become invalid, when.
Section 376.640 Paid-up policy may be demanded, when.
Section 376.650 Rules of payment on commuted policy.
Section 376.660 Foregoing provisions inapplicable, when.
Section 376.669 Annuity contract requirements — paid-up annuity benefits, how calculated — cash surrender benefits, how calculated — applicable, when.
Section 376.670 Provisions which shall be contained in life insurance policies, exceptions.
Section 376.671 Provisions which shall be contained in annuity contracts — inapplicability date.
Section 376.673 Life insurance policies, regulations relative to.
Section 376.674 Life insurance policies, no cash surrender value, regulations relative to.
Section 376.675 Life insurance policies and annuity contracts to be approved — exemption, when — director's powers — judicial review of disapproval.
Section 376.676 Regulation of the valuation of life insurance policies — may adopt NAIC model regulation.
Section 376.677 Life policies may be issued that have no cash surrender value prior to death — no policy loans so law regulating not applicable — requirements to issue.
Section 376.678 Life insurance policies and annuity contracts, annual statement to holder required — company to furnish policy or contract information to holder upon request.
Section 376.679 Life insurance company may reinsure for risks involving aircraft, limitation.
Section 376.680 Assignment of incidents of ownership, group life policy, effect of.
Section 376.685 Optometrists, health insurance plans not to limit fees charged unless reimbursed by plan — requirements — definitions.
Section 376.690 Unanticipated out-of-network care, claim procedure — definitions — limitation on amount billed to patient — external arbitration process — rulemaking authority.
Section 376.691 Group life policies, eligible groups authorized for issue — premiums, how paid.
Section 376.693 Special group life policies, requirements — director's approval.
Section 376.694 Group life, definitions of direct response solicitation and sponsoring or endorsing entity — certain insurers required to give notice of compensation to policyholder or endorsing entity.
Section 376.695 Extension of policy to insure for loss due to death of spouse or dependent children, requirements, limitations.
Section 376.696 Political subdivisions purchasing any insurance policies to submit to competitive bidding, when — renewal between bidding periods deemed extension.
Section 376.697 Required provisions for group life policies.
Section 376.699 Person insured by group policy entitled to individual life policy, notice requirements.
Section 376.700 Purpose — use of additional material.
Section 376.702 Application of law — exceptions.
Section 376.704 Definitions.
Section 376.706 Delivery of guide and summary required, when.
Section 376.708 Required presentations and statements — company to maintain file.
Section 376.710 Effect of omission.
Section 376.712 Effective date.
Section 376.714 Contents and form of buyer's guide.
Section 376.715 Citation of law, purpose.
Section 376.717 Coverages provided, persons covered — coverage not provided, when — maximum benefits allowable.
Section 376.718 Definitions.
Section 376.720 Association, created — accounts — director to supervise.
Section 376.722 Board of directors, established, members, how selected — expense reimbursement.
Section 376.724 Impaired insurers, association's options, duties — insolvent insurers, association's options, duties — alternative policies, requirements.
Section 376.725 Terminated coverage, reissuance of, premium set, how — obligation to cease, date — interest rate, guaranteed minimum.
Section 376.726 Nonpayment of premiums, effect of.
Section 376.728 Law not applicable, when.
Section 376.730 Liens, association may impose, when.
Section 376.732 Director to have association's powers and duties, when — association may appear in court, when.
Section 376.733 Assignment of rights to association by persons receiving benefits, when — subrogation rights.
Section 376.734 Additional powers of association.
Section 376.735 Assessments against members, when due, classes — amounts, how determined.
Section 376.737 Deferment of assessment, how, when — maximum assessment — refund of, when — members may increase premiums to cover assessments.
Section 376.738 Certificate of contribution, when issued.
Section 376.740 Plan of operation, required, approval of director — provisions of plan.
Section 376.742 Director, powers and duties.
Section 376.743 Board of directors, powers.
Section 376.745 Assessments, offset against tax liability, when, how.
Section 376.746 Records of association meetings to be kept — association deemed creditor of insolvent or impaired insured.
Section 376.747 Distribution of member insurer assets upon liquidation, priority of association.
Section 376.748 Liquidation, recovery of distributions, when, exceptions, limitations.
Section 376.750 Financial report, submitted to director, when — tax exempt status — immunity from liability.
Section 376.752 Member insurer's deposit with director, exemption from, amount.
Section 376.754 Stay of proceedings, insolvent insurer, when.
Section 376.755 Advertising, use of guaranty association prohibited.
Section 376.756 Summary document, association to prepare, contents — policy not covered by guaranty association to contain notice, form determined by director.
Section 376.758 Law inapplicable to insolvent insurers on effective date of law.
Section 376.770 Title of law.
Section 376.773 Definitions.
Section 376.775 Matters required in policies.
Section 376.776 Hospital and medical expense provisions extended for certain handicapped and dependent children past normal coverage age.
Section 376.777 Specifically required provisions — exemptions, when — director's powers — inapplicability of certain provisions to individual health insurance coverage.
Section 376.778 Payment direct to public hospitals or clinics with or without assignment, when — provisions required in contracts.
Section 376.779 Health insurance policies to offer coverage for treatment of alcoholism — exclusions.
Section 376.780 Limits on provisions, effect of conflict of policy with law.
Section 376.781 Speech and hearing disorders, companies to offer coverage, when — rules, procedure.
Section 376.782 Mammography — low-dose screening, defined — health care policies to provide required coverage.
Section 376.783 Insured bound only if copy of application attached to policy.
Section 376.785 What does not constitute waiver of defenses.
Section 376.787 Effect of age limit provision.
Section 376.789 Definition of actual charge and actual fee.
Section 376.790 Limits on applicability of law.
Section 376.791 Portion of section 376.777 not applicable to individual health insurance coverage.
Section 376.800 Misrepresentation made in obtaining individual accident and health policy no defense, exception.
Section 376.801 Coverage for child health supervision services required — definitions — permitted limitations on benefits.
Section 376.805 Elective abortion to be by optional rider and requires additional premium — elective abortion defined — health insurance exchanges not to offer coverage for elective abortions.
Section 376.806 Refund of health insurance unearned premium on notice of death of insured — refunded to whom — definitions — exception — failure to notify within one year.
Section 376.807 Policies not to reduce or deny benefits to persons eligible for medical assistance — deemed primary contract.
Section 376.810 Definitions for policy requirements for chemical dependency.
Section 376.811 Coverage required for chemical dependency by all insurance and health service corporations — minimum standards — offer of coverage may be accepted or rejected by policyholders, companies may offer as standard coverage — mental health benefits provided, when — exclusions.
Section 376.814 Rules and regulations authorized, department of mental health to advise department — procedure.
Section 376.816 Adopted children to be provided health care coverage on the same basis as other dependents — effective from date of birth or on placement — placement defined.
Section 376.818 Eligibility for Medicaid may not be considered by insurers.
Section 376.819 MO HealthNet division to have right to payment for health care services provided.
Section 376.820 Insurers may not deny coverage of child because of marital status of parents, residence or income tax dependency claim.
Section 376.821 Insurers may not cancel health or dental insurance solely because the insured is incarcerated — insurer, defined.
Section 376.823 Prohibition on kickbacks not applicable for rebates for certain chronic illnesses.
Section 376.845 Definitions — eating disorders, coverage for diagnosis and treatment of — limitations on coverage.
Section 376.850 Law, how cited.
Section 376.854 Definitions.
Section 376.859 Medicare supplement law applicable to what policies — policies not included.
Section 376.864 Policies not to duplicate benefits provided by Medicare — preexisting conditions, limitations on — director to issue rules establishing standards.
Section 376.869 Standards for policies, minimum, director to adopt.
Section 376.874 Requirements of policy, return to policyholders.
Section 376.879 Outline of coverage for fair disclosure — furnished to each applicant — format and content — rules and standards.
Section 376.881 Policy certificate front page to contain notice of right to return and receive premium refund.
Section 376.882 Cancellation of policy, refund required — notification.
Section 376.884 Advertisement to be reviewed by director.
Section 376.886 Regulations, requirements — rules, procedure.
Section 376.889 Violations, penalty.
Section 376.890 Invalidity of any section regulating Medicare supplement not to affect others.
Section 376.891 Definitions.
Section 376.892 Surviving spouse may continue coverage, when — divorced or separated spouse may continue coverage, when — services offered.
Section 376.893 Divorced or separated spouse, continuation of coverage, notice — contents of notice — failure to elect, effect — application.
Section 376.894 Amount of premium, date of payment — termination of right of continuation of coverage, grounds.
Section 376.900 Definitions.
Section 376.905 Administration by department, powers, duties — fees.
Section 376.910 Certificate of authority required.
Section 376.915 Application for certificate, content — renewal, content, filed when — extensions, fee.
Section 376.920 Annual statement, form, contents.
Section 376.925 Seven-day rescission period, all money or property to be refunded.
Section 376.930 Insured to be furnished application for certificate and annual statement, when.
Section 376.935 Certificates issued for one year — nontransferable — not endorsement by department.
Section 376.940 Escrow account for entrance fees required, released when.
Section 376.945 Escrow account, amount required — principal, how released, investment.
Section 376.950 Board of directors, one member to be resident of facility.
Section 376.960 Definitions.
Section 376.961 Missouri health insurance pool created — members to be all health insurers in state — board of directors, members, terms, qualifications — transitioning resources.
Section 376.962 Plan of operation to be submitted by board — effective when — failure to submit, director's duty to develop rules — plan content — amendments, procedure.
Section 376.964 Board, powers and duties — including providing for issuing policies and reinsuring risks — staff appointment — rulemaking authority.
Section 376.965 Board members not civilly liable for performance of duties, exception.
Section 376.966 No employee to lose coverage by enrolling in pool — eligibility for pool coverage, ineligibility — medical underwriting considerations, notification required, when — expiration date.
Section 376.968 Administration of pool by insurer or insurers by competitive bids — insurer's qualifications — board to establish criteria for bid content.
Section 376.970 Administering insurer to serve for three years subject to removal for cause — duties — reports — bidding process.
Section 376.973 Administering insurer at close of fiscal year to make accounting and assessment — how calculated — excess to be held at interest for future losses or to reduce premiums — future losses, defined — assessments, continuation of.
Section 376.975 Member's proportion of participation in pool to be determined annually — deficits to be recouped by proportioned assessment — amount of assessment to be offset against certain taxes.
Section 376.978 Director of revenue to determine reduced amount in county foreign insurance tax fund, state treasurer to reimburse fund by reducing amount to general revenue.
Section 376.980 Pool member exempt from taxation of financial institution, may be allowed to offset against sales or use tax, when — excess of assessment over sales or use tax payable in any one year a credit in succeeding years until excess is exhausted.
Section 376.982 Rulemaking procedure.
Section 376.984 Abatement or deferring all or part of assessment of member, when — amount abated or deferred may be assessed against other members — deficiency liability.
Section 376.986 Pool to offer medical coverage — premiums, how established — standard risk rate, how calculated — director to approve rates — exclusions — benefits reduced by other insurance or workers' compensation — medical expense to include prayer for spiritual healing.
Section 376.987 High deductible health plans and establishment of health savings plans to be offered as options — definitions — rulemaking authority.
Section 376.989 No liability, criminal or civil, for participation in pool by members.
Section 376.995 Limited mandate health insurance policies defined — certain sections not to apply to limited mandate health insurance policies, exceptions — requirements to sell or issue — certain law to apply.
Section 376.998 Health insurance mandate exemption for excepted benefit plans — definitions — procedure to exempt.
Section 376.1000 Multiple employer self-insured health plan, defined.
Section 376.1002 Certificate of authority required — penalty for noncompliance — law inapplicable, when — exempt organizations.
Section 376.1005 Application for certificate of authority, form — fee — policy or other evidence of coverage provided to employees, form.
Section 376.1007 Plan to file copy of bylaws, coverage and agreements with director.
Section 376.1010 Excess stop-loss coverage maintained by plan.
Section 376.1012 Funds collected from employers held in trust — requirements — board of trustees, elected, duties — annual report, filed when.
Section 376.1015 Department not to grant approval, when.
Section 376.1017 Plan to establish loss reserves — plan to establish surplus account, amount.
Section 376.1020 Plan to maintain principal place of business in Missouri, exception.
Section 376.1022 Dissolution of plan, application, procedure, granted when — distribution of assets, procedures.
Section 376.1025 Director may adopt rules.
Section 376.1027 Plan in unsound condition, powers of director.
Section 376.1030 Agreement of employer to pay benefits, requirements, form — copy filed with director — no excuse from liability.
Section 376.1032 Plan considered insurer, when.
Section 376.1035 Chapter 376 applicable to plan.
Section 376.1037 Plan subject to premium taxes.
Section 376.1040 Plan not to be offered to public — marketing restrictions — exemption — use of brokers authorized.
Section 376.1042 Marketing by agent, agency or broker violation of law.
Section 376.1045 Injunctive relief, director may seek, when — procedures.
Section 376.1060 Access to dental services not to be sold, assigned, or granted access without express authorization — definitions — requirements.
Section 376.1065 Official notification communications, contracting entity requirements.
Section 376.1075 Definitions.
Section 376.1077 Administrator to have agreement with insurer, form, contents — termination, how.
Section 376.1080 Payments of premiums and claims deemed paid, when.
Section 376.1082 Records maintained by administrator for insurer — director may examine records — records owned by insurer, transfer allowed, when.
Section 376.1083 Advertising restrictions for administrator.
Section 376.1084 Insurer responsible for benefits and underwriting practices — insurer to conduct review of administrator, when.
Section 376.1085 Premiums held in fiduciary capacity, duties — financial records, duties — withdrawals from fiduciary account by agreement only, contents — payment of claims.
Section 376.1087 Commissions not to be contingent on savings in payment of claims — may be based on premiums collected.
Section 376.1088 Notice to policyholder of administrator, contents, required — disclosure of receipts to insurer.
Section 376.1090 Materials delivered to administrator for insured to be promptly delivered.
Section 376.1092 Certificate of authority, required, application, contents, fee — refusal to issue, when — renewal — bond, required when.
Section 376.1093 Annual report filed with director, when — contents — filing fee, amount.
Section 376.1094 Certificate of authority, suspension or revocation, grounds — civil action, when.
Section 376.1095 Rules and regulations, promulgation.
Section 376.1100 Law, how cited — definitions.
Section 376.1103 Laws applicable, Medicare supplement laws not applicable — purpose — policies or riders must be in compliance.
Section 376.1106 Policies issued in other states may be issued to residents of Missouri if in compliance with Missouri regulations.
Section 376.1109 Policies, content requirements, provisions prohibited — rules authorized — cancellation, refund required.
Section 376.1112 Director to provide buyer's guide — content — advertising of long-term care policies to contain notice of availability of guide.
Section 376.1115 Coverage outline to be delivered to applicants, when, content.
Section 376.1118 Benefits funded by a life insurance death benefit acceleration, reports to policyholder required, content.
Section 376.1121 Denial of claim, long-term care insurance, duties of issuer.
Section 376.1124 Rescinding of a long-term care policy, permitted when — grounds for contesting — no field issuance, when.
Section 376.1127 Nonforfeiture benefit option required for long-term care insurance policies, requirements of offer — rulemaking authority.
Section 376.1130 Rulemaking authority.
Section 376.1186 State-based health benefit exchanges prohibited without statutory authority — executive order to establish prohibited — state agency restrictions — taxpayer standing — definitions.
Section 376.1190 Health care mandates — review by oversight division — actuarial analysis.
Section 376.1199 Coverage for certain obstetrical/gynecological services — exclusion of contraceptive coverage permitted, when — rulemaking authority.
Section 376.1200 Certain policies to offer coverage for treatment of breast cancer — limitation on deductible, lifetime maximum benefit — administration of benefits — application, effect.
Section 376.1209 Mastectomy — mandatory insurance coverage for prosthetic devices and reconstructive surgery — no time limit to be imposed.
Section 376.1210 Maternity benefits, minimum hospital stays, exceptions — notice of benefits, contents — attending physician defined — rulemaking.
Section 376.1215 Immunizations, mandated coverage, exceptions, rulemaking.
Section 376.1218 Insurance coverage for children enrolled in the Part C early intervention system (First Steps).
Section 376.1219 PKU formula and low protein modified food products covered by insurance, when — exceptions.
Section 376.1220 Insurance coverage for newborn hearing screenings mandated.
Section 376.1222 Prostheses and scalp prostheses to be provided for children under eighteen by Medicaid, children's health insurance and the consolidated plan — no additional insurance cost — amount allowable.
Section 376.1224 Definitions — insurance coverage required — limitations on coverage — maximum benefit amount, adjustments — reimbursements, how made — applicability to plans.
Section 376.1225 Mandated coverage for general anesthesia and hospital charges for dental care, when — prior authorization required, when — exceptions.
Section 376.1226 Fee schedule for services not covered under health benefit plans — definitions.
Section 376.1230 Chiropractic care coverage, rates, terms, conditions, limits, and exclusions.
Section 376.1232 Insurers to offer coverage for prosthetics.
Section 376.1235 No co-payments or coinsurance for physical or occupational therapy services, when — actuarial analysis of cost, when.
Section 376.1237 Refills for prescription eye drops, required, when — definitions.
Section 376.1250 Cancer screening, health insurance coverage required, when, types.
Section 376.1253 Second opinion, right of newly diagnosed cancer patients, attending physician to inform — insurance coverage for such second opinions required, when.
Section 376.1257 Orally administered anticancer medications, plan to provide coverage no less favorable than IV or injected medications — definitions — requirements — effective date.
Section 376.1275 Coverage for human leukocyte antigen testing for bone marrow transplantation required, when — exceptions.
Section 376.1290 Coverage for lead testing.
Section 376.1300 Reorganization of a domestic mutual life insurance company, authority.
Section 376.1305 Formation of holding company, application — shareholder approval.
Section 376.1307 Issuance of shares.
Section 376.1309 Member's interest — nontransference of membership — immunity from liability — assessments, not imposed — security, membership interest.
Section 376.1312 Nonapplicability of certain provisions of insurance holding companies law.
Section 376.1315 Incorporation of mutual holding company, authority, approval.
Section 376.1318 Powers of mutual holding company, engaging in business of insurance, no authority, affiliation and merger agreements.
Section 376.1322 Mutual holding company subject to supervision of director, dissolution or liquidation — demutualization.
Section 376.1345 Method of reimbursement not to require fee, discount, or remuneration — notification requirements — electronic funds transfer, when — violation, penalty.
Section 376.1350 Definitions.
Section 376.1353 Utilization review activities monitored.
Section 376.1356 Utilization review entity monitored, when.
Section 376.1359 Written utilization program implemented, filed with the director.
Section 376.1361 Documented clinical review criteria used in a utilization program — medical director qualifications — compensation of utilization review services.
Section 376.1363 Utilization review decisions, procedures.
Section 376.1364 Unique confirmation number required, prior authorization review — secure electronic transmission for prior authorizations — single cover page, contents.
Section 376.1365 Reconsideration of an adverse determination, when.
Section 376.1367 Emergency services benefit determination, coverage required, when.
Section 376.1369 Certification of compliance, when.
Section 376.1372 Certification and member handbook to include utilization review procedures — website or provider portal, prior authorization requirements available on.
Section 376.1375 Registry of grievances maintained, procedures — definitions.
Section 376.1378 Grievances and certificate of compliance filed with the director, when.
Section 376.1382 First- and second-level grievance review for managed care plans, first-level procedures.
Section 376.1385 Second-level review procedures.
Section 376.1387 Appeals of grievances determined by the director.
Section 376.1389 Expedited grievance review procedure.
Section 376.1399 Rules, effective, when — rules invalid and void, when.
Section 376.1400 Explanation of benefits, standardized information used, contents, when.
Section 376.1403 Referrals, standardized information used, content, when.
Section 376.1450 Enrollee's right to receive documents and materials in printed or electronic form, when.
Section 376.1500 Definitions.
Section 376.1502 Requirements for transaction of business.
Section 376.1504 Registration requirements — term of registration — renewal.
Section 376.1506 Violations, penalty.
Section 376.1508 Processing fee — cancellation of membership, effect of.
Section 376.1510 Prohibited acts.
Section 376.1512 Required disclosures.
Section 376.1514 Written agreement required, contents.
Section 376.1516 Written membership materials, required contents — forms to be filed with director, fee.
Section 376.1516 Written membership materials, required contents — forms to be submitted to director.
Section 376.1518 Net worth to be maintained, amount.
Section 376.1520 Notice of changes.
Section 376.1522 List of providers to be maintained on website.
Section 376.1524 Advertising and marketing materials, approval in writing required.
Section 376.1528 Rulemaking authority.
Section 376.1530 Denial and refusal to issue registrations, when.
Section 376.1532 Violations, penalties.
Section 376.1550 Mental health coverage, requirements — definitions — exclusions.
Section 376.1575 Definitions
Section 376.1578 Credentialing procedure, health carrier duties — violations, mechanism for reporting.
Section 376.1750 Health care sharing ministry, provisions not to apply to — ministry not engaging in the business of insurance, when — health care sharing ministry defined.
Section 376.1753 Services related to pregnancy, persons holding ministerial or tocological certification may provide.
Section 376.1800 Definitions — medical retainer agreements not insurance — agreement requirements — use of health savings accounts for fees.
Section 376.1900 Definitions — reimbursement for telehealth services, when.
Section 376.2000 Citation of law — definitions.
Section 376.2002 Navigators, license required — permitted acts — prohibited acts — exemptions.
Section 376.2004 Application procedure.
Section 376.2006 Term of licensure — renewal — continuing education.
Section 376.2008 Consultation with licensed insurance producer, navigator to advise, when.
Section 376.2010 Sanction of license, when — restitution required, when — examination and investigation of records.
Section 376.2011 Violations, administrative orders, civil actions — penalty.
Section 376.2012 Navigators duty to report, when.
Section 376.2014 Applicability — severability — rulemaking authority.
Section 376.2020 Contracts prohibiting disclosure of certain payments and costs are unenforceable.
Section 376.2030 Definitions.
Section 376.2034 Restriction on step therapy protocol, patient to have access to override exception determination — procedure.
Section 376.2036 Enforcement — applicability to health insurance plans, when.
Section 376.2050 Citation of act.
Section 376.2051 Definitions.
Section 376.2052 Comparison of in-force policies to death master file — violation deemed an unfair trade practice.
Section 376.2053 Exemption from requirements, when.