Section 374.194

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS

Chapter 374

Effective - 28 Aug 1991   

  374.194.  Health coverage providers to be subject to jurisdiction of department, exceptions — examination to be performed, when — requirements of health coverage providers. — 1.  Notwithstanding any other provision of law to the contrary, and except as provided in this section, any person or other entity which provides coverage in this state for medical, surgical, chiropractic, physical therapy, 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 the jurisdiction of the department of commerce and insurance, unless the person or other entity shows that while providing such services it is subject to the jurisdiction of another agency of this state, any subdivision thereof, or the federal government.

  2.  A person or entity may show that it is subject to the jurisdiction of another agency of this state, any subdivision thereof, or the federal government, by providing to the director of the department of commerce and insurance the appropriate certificate, license or other document issued by the other governmental agency which permits or qualifies it to provide those services.

  3.  Any person or entity which is unable to show under subsection 2 of this section that it is subject to the jurisdiction of another agency of this state, any subdivision thereof, or the federal government, shall submit to an examination by the director of the department of commerce and insurance to determine the organization and solvency of the person or the entity, and to determine whether or not such person or entity complies with the applicable provisions of chapters 374 to 385.

  4.  Any person or entity unable to show that it is subject to the jurisdiction of another agency of this state, any subdivision thereof, or the federal government, shall be subject to all appropriate provisions of chapters 374 to 385 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 1 of this section and which is required to submit to an examination by the director of the department of commerce and insurance under subsection 3 of this section, if such coverage is not fully insured or otherwise fully covered by an admitted life of disability insurer, nonprofit health services plan, or nonprofit health care plan shall advise every purchaser, prospective purchaser, and covered person of such lack of insurance or other coverage.  Any administrator which advertises or administers the coverage in this state described in subsection 1 of this section and which is required to submit to an examination by the director of the department of commerce and insurance under subsection 3 of this section shall advise any production agency of the elements of the coverage, including the amount of stop-loss insurance in effect.

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(L. 1991 H.B. 385, et al. § 113)