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 Title XXIII CORPORATIONS, ASSOCIATIONS AND PARTNERSHIPS

 Chapter 354 Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans ^  !
HEALTH SERVICES CORPORATIONS
354.010   Definitions. (8/28/1983)
354.015   Health services corporations, laws applicable to — exceptions. (8/28/1983)
354.020   Preexisting health services corporation to amend articles, effect of. (8/28/1983)
354.025   Corporate purposes and authority. (8/28/1983)
354.027   Discrimination in coverage or reimbursement for covered service by licensed persons, prohibited. (8/28/1993)
354.030   For-profit corporations excluded from act. (8/28/1983)
354.035   Procedure for organization of corporation. (8/28/1983)
354.040   Articles of incorporation, required information and contents. (8/28/1983)
354.045   Issuance of certificate, effect of. (8/28/1983)
354.050   General powers of corporation. (8/28/1983)
354.055   Certificate of authority required — expiration of, extended how. (8/28/1983)
354.060   Director to issue certificate, when. (8/28/1983)
354.065   Articles of incorporation, how amended — copy to director, when. (8/28/2007)
354.070   Certificate of authority automatically extended, when. (8/28/1983)
354.075   Capital required to do business. (8/28/1983)
354.080   Reserves required, how computed. (8/28/1973)
354.085   Membership contract forms, approval by director, when — time for filing — time for disapproval. (8/28/2003)
354.090   Health services corporation contracts, purposes, parties to. (8/28/1983)
354.095   Limitation of membership and benefits — certain benefits to be provided, when. (8/28/1983)
354.105   Annual report required, contents of. (8/28/1983)
354.115   Member's grievance, how and where filed — director may investigate, court action not barred. (8/28/1983)
354.120   Rules and regulations by director authorized — procedure, review. (8/28/1995)
354.125   Corporation not liable for injuries resulting from medical services rendered members. (8/28/1973)
354.130   Exemption from certain taxes, exceptions. (8/28/1983)
354.140   Dissolution, liquidation or rehabilitation of corporation, procedure for. (8/28/1983)
354.145   Appeal from director's actions or decisions, how taken. (8/28/1983)
354.150   Fees — waiver, when. (1/1/2019)
354.152   Premiums, dues or fees subject to restrictions — violation, hearing — order prohibiting. (8/28/1979)
354.155   Disclaimer as to nonhealth services corporations. (8/28/1983)
354.165   Certain organizations exempt. (8/28/1983)
354.175   Wage continuation plans by employer exempt. (8/28/1983)
354.180   Administrative order, director to issue, when. (8/28/2007)
354.190   Examinations, procedures. (8/28/1983)
354.195   Records of examination, duty to keep. (8/28/1983)
354.200   Examinations, false testimony, penalty. (8/28/1983)
354.205   Examinations — costs, how paid. (8/28/1983)
354.207   Second medical opinion to be allowed by health services corporations, procedure, costs. (8/28/1998)
354.210   Director may seek relief, when. (8/28/2007)
354.215   Examiner's sick leave to apply to health services corporations. (8/28/1983)
354.220   Director may bring suit to recover fees or sums. (8/28/1983)
354.225   Enrollment representative, defined — annual report to furnish information — solicitors of members to be insurance agent or broker, exception. (8/28/1993)
354.230   License required for enrollment representative. (8/28/1983)
354.235   Enrollment representative — license issued when, qualifications. (8/28/1993)
354.240   Nonresident may be licensed — examination waived, when. (8/28/1983)
354.265   Nonrenewable temporary license issued, when. (8/28/1983)
354.275   Violations by enrollment representatives, penalties. (8/28/1983)
354.280   Officers of corporation found to be of known bad character or incompetent — authority to transact business, effect. (8/28/1983)
354.285   Management agreements to control corporation, notice to department, when — examination requirements — violations. (8/28/1983)
354.290   Examiner's duties — examination contents — hearing on reports allowed — publication of report, when. (8/28/1983)
354.295   Certificate of authority not to be issued if controlling management involved in improper actions. (8/28/1983)
354.300   Certificate of authority suspended or revoked, when. (8/28/1983)
354.305   Corporation advertising assets also to show liabilities — penalties. (8/28/2008)
354.315   Data processing system authorized, cost, amount allowed — amortization not to exceed ten years. (8/28/1983)
354.320   Corporate funds and securities use for private gain by officers and employees prohibited, penalty. (1/1/2017)
354.325   Investigation by director of investments — records to be kept by division — criminal action, when. (8/28/1983)
354.330   Public official failing to perform duties as to investment violations, penalty. (8/28/1983)
354.335   Damages allowed if corporation without reasonable cause refuses to pay. (8/28/1983)
354.340   Unsatisfied judgments against corporation — suspension or revocation of certificate of authority until judgment satisfied. (8/28/1983)
354.345   Court decree of specific performance — membership contract, failure of corporation to comply, procedure, effect. (8/28/1983)
354.350   Fraudulent or bad faith conduct — investigation by division — hearing, procedure. (8/28/2007)
354.355   Injunctions, permanent or temporary, grounds, procedure — dissolution of corporation or rehabilitation, procedure. (8/28/1983)
354.357   Receivership, grounds, procedure. (8/28/1983)
354.362   Newborn child coverage required — notice of birth, when, effect. (8/28/1983)
354.380   Certain provisions of insurance law to be applicable. (8/28/1983)
HEALTH MAINTENANCE ORGANIZATIONS

Termination, coverage to continue for period after termination, 376.428

354.400   Definitions. (8/28/2007)
354.405   Certificate of authority, who may make application — foreign corporation may qualify, requirements — procedure. (8/28/2003)
354.407   PACE projects not deemed health maintenance organizations, when. (8/28/2002)
354.410   Certificate issued, when — annual deposit, requirements — capital account, amount, contents. (8/28/2013)
354.415   Powers of organization. (8/28/2013)
354.420   Advisory panels to afford enrollees participation in policy decisions. (8/28/1983)
354.425   Bonding of officers who disburse or invest funds — bond requirements. (8/28/1983)
354.430   Evidence of coverage, requirements — rights of enrollee — toll-free telephone number required. (8/28/2013)
354.435   Annual reports filed with director, when — content — forms. (8/28/2007)
354.440   Information to be available to enrollees. (8/28/1983)
354.441   Disclosures to subscribers shall not be prohibited or restricted. (8/28/1997)
354.442   Disclosure information to enrollees required, when. (8/28/2010)
354.443   Financial disclosures to the department required by health maintenance organizations, when. (8/28/1997)
354.444   Administrative orders for violations — voluntary forfeitures, civil actions. (8/28/2007)
354.445   Complaints by enrollees, organization to establish system. (8/28/1983)
354.450   Investments authorized. (8/28/1983)
354.455   Deposit required, how made. (8/28/2007)
354.460   Advertising not to be untrue or misleading — deceptive solicitation — prohibited — how determined. (8/28/2007)
354.462   Enrollee, grounds for disenrollment. (8/28/1983)
354.464   Names not authorized for use, exceptions. (8/28/2007)
354.465   Examinations by division, when — costs, how paid. (8/28/2014)
354.470   Suspension or revocation, when — effect. (8/28/1997)
354.475   Insurance companies or health service company may organize and operate a health maintenance organization. (8/28/2007)
354.480   Rehabilitation, liquidation, or conservation, grounds, procedure — enrollee's priorities — claims, priority. (8/28/1983)
354.485   Rules and regulations authorized. (8/28/2007)
354.490   Certificate of authority, denial, suspension or revocation, grounds — procedure. (8/28/1997)
354.495   Fees to be paid to director. (1/1/2019)
354.500   Conferences called by director as to suspected or potential violations. (8/28/2007)
354.505   Laws regulating insurance or health service corporations not to apply, exceptions. (8/28/1997)
354.510   Public documents, all filings and required reports. (8/28/2007)
354.515   Confidential information, diagnosis, treatment, health of enrollees or applicants, exceptions. (8/28/1997)
354.520   Mergers, consolidations, control of organization, requirements. (8/28/1983)
354.525   Health provision collective bargaining agreements or contracts — charge for coverage, how determined. (8/28/1983)
354.530   Severability clause. (8/28/2007)
354.535   Pharmacist, emergency situation, may take an assignment of enrollee's right to reimbursement — health maintenance organizations shall only contract with entities licensed by the board of pharmacy — requirements for drug prescriptions, exceptions. (8/28/1998)
354.536   Continuation of dependent child coverage, when — dependent child defined. (1/1/2008)
354.540   Health maintenance organization of bordering states may be admitted to do business — procedure. (8/28/2007)
354.545   Exempt plans and companies. (8/28/2007)
354.546   Second medical opinion to be allowed by health maintenance organizations, procedure, costs. (8/28/1998)
354.550   Laws not applicable to community health companies. (8/28/2007)
354.551   Health maintenance organizations may offer point of service (POS) riders, when. (8/28/1997)
COMMUNITY-BASED HEALTH MAINTENANCE ORGANIZATIONS
354.552   Community-based health maintenance organizations, requirements. (8/28/1997)
354.554   Standing referrals for certain members of community-based health maintenance organizations, when. (8/28/1997)
354.556   Trustees, vacancies, elections. (8/28/1997)
354.558   Materials provided to prospective purchasers. (8/28/1997)
354.559   Disclosure to members, restrictions and prohibitions. (8/28/1997)
354.560   Payment arrangements, department to adopt rules — disclosure of financial arrangements — confidentiality. (8/28/1997)
354.562   Grievance procedures, rulemaking authority. (8/28/1997)
354.563   Medicare rules to apply to community-based health maintenance organizations, when. (8/28/1997)
354.565   Community-based health maintenance organization designation given, when — revocation. (8/28/1997)
354.567   Community-based health maintenance organizations subject to other laws regarding health maintenance organizations. (8/28/1997)
354.570   Rulemaking — procedure. (8/28/1997)
354.600   Definitions. (8/28/2007)
354.603   Sufficiency of health carrier network, requirements, criteria — access plan filed with the department, when. (8/28/2018)
354.606   Providers notified of specific covered services, when — hold harmless provision — cessation of operations procedure — selection standards for health care professionals, filing with the department. (8/28/2001)
354.609   Termination of a contract, procedure. (8/28/1997)
354.612   Continuation of care after provider termination, when. (8/28/1997)
354.615   Referrals to appropriate providers, when. (8/28/1997)
354.618   Open referral health plans offered, when — definitions — obstetrician/ gynecologist services to be offered, when — eye care providers, discrimination against, prohibited — exemptions. (8/28/1999)
354.621   Intermediary and participating provider requirements. (8/28/1997)
354.624   Proposed provider contract forms filed with the director — contracts maintained at place of business, available for review, when. (8/28/1997)
354.627   Liability of a health carrier, when. (8/28/1997)
354.636   Contract requirements after January 1, 1998. (8/28/1997)
ESSENTIAL COMMUNITY PROVIDERS
354.650   Definitions. (8/28/1998)
354.652   Designation as essential community provider, procedure, qualifications. (8/28/1998)
354.654   Department of health and senior services, duties — rulemaking authority. (8/28/1998)
354.656   Inclusion of essential community providers in health care network, exceptions. (8/28/1998)
354.658   Designation nontransferable, site specific — annual affidavit required — notice of certain changes, required when. (8/28/1998)
PREPAID DENTAL PLANS
354.700   Definitions. (8/28/1992)
354.702   Prepaid dental plans, who may offer — certificate of authority required — certain state laws not to apply. (8/28/1987)
354.703   Director may order violators to cease and desist, hearing — noncompliance, director's remedies. (8/28/1989)
354.704   Application for certificate of authority, content. (8/28/1987)
354.705   Certificate of authority granted, when. (8/28/1987)
354.707   Capital, surplus, security required — cash, securities, bond to be deposited or filed with director, director to return deposit, when — security subject to final judgments — security not required for prepaid dental plans funded by government — director may waive capital, surplus, security requirements, when. (8/28/1987)
354.710   Reserve requirements — reserve not required for prepaid dental plans funded by government — surplus requirement for prepaid dental plans in existence January 1, 1987, additional time. (8/28/1997)
354.712   Contract or contract certificate to be issued to enrollees, content, copy to be filed with director — newborn child to be covered, when, extent of coverage, notification of birth and additional premium, when, effect of. (8/28/1987)
354.715   Providers of dental care, written contract with prepaid dental plan corporations, review and mediation procedures for enrollees required. (8/28/1987)
354.717   Director, powers — financial examinations, when, by whom made and paid. (8/28/1987)
354.720   Annual report, required, content. (8/28/1987)
354.721   Agents, registration required — rules and regulations authorized. (8/28/1987)
354.722   Revocation or suspension of certificate of authority, when — notice, civil suit authorized — suspension, revocation, activity permitted. (8/28/2007)
354.723   Rulemaking authorized. (8/28/1987)
354.725   Exclusion, labor organization's health plans. (8/28/1987)
 - Cross References
Adopted children coverage on placement required, placement defined, 376.816
Adopted children, health coverage to be same as other children, 376.816
Advance practice nurse, coverage required, when, 376.1230
Annual statement convention blank to be filed by insurers with the N.A.I.C., failure to comply, effect, 375.041
Chiropractic services, claim denial, qualified chiropractor to view claim, chiropractor's qualifications to review, 376.423
Dental coverage required, general anesthesia and hospital stay, when, 376.1225
Documents and materials, enrollee's right to receive waived, when, 376.1450
Elective abortions, by optional rider only, additional premium required, 376.805
Health care assistance payments fraud and abuse, 191.900 to 191.910
Health coverage provider subject to jurisdiction and examination of department of insurance, 374.194
Hearing disorders, companies to provide coverage, when, 376.781
Insurers may not cancel health or dental coverage solely because the insured is incarcerated, 376.821
Mammography, low dose screening, health insurance and plans to provide coverage, 376.782
Patient satisfaction and quality of health care, report of department of insurance, 374.426
Payment direct to public hospitals or clinics with or without assignment, when, provisions required in contracts, 376.778
Refund of unearned premiums on death of insured, 376.806
Reimbursement of claims, how paid, when, 376.383
Secondary mortgage market act not to preempt, 376.308
Speech, loss or impairment, companies to offer coverage, when, 376.781
Utilization review agents certification requirements, violations, penalties, 374.500 to 374.515

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