Section 376.801

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS

Chapter 376

Effective - 28 Aug 1989   

  376.801.  Coverage for child health supervision services required — definitions — permitted limitations on benefits. — 1.  This section shall be known and may be cited as the "Child Health Insurance Reform Plan".

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

  (1)  "Child health supervision services", the periodic review of a child's physical and emotional status by a physician or pursuant to a physician's supervision.  A review shall include a history, complete physical examination, developmental assessment, anticipatory guidance, appropriate immunizations and laboratory tests in keeping with prevailing medical standards;

  (2)  "Health care insurer", any entity regulated by the Missouri department of commerce and insurance, including, but not limited to, insurance companies, nonprofit health services corporations, health maintenance organizations, or any self-insured plans or groups;

  (3)  "Health insurance policy", any group insurance policy providing coverage on an expense-incurred basis, any group service or indemnity contract issued by a not-for-profit health services corporation or any self-insured group health benefit plan of any type or description.  Such phrase shall not include policies which cover only specified diseases, accidents or confinement in an intensive care unit.

  3.  All health insurance policies which provide coverage for a family member of the insured or subscriber shall offer coverage for child health supervision services.  Such services shall include coverage from the moment of birth through the age of twelve years.  Each such policy or contract shall, at a minimum, provide benefits for child health supervision services at approximately the following age intervals:  birth, two months, four months, six months, nine months, twelve months, eighteen months, two years, three years, four years, five years, six years, eight years, ten years, and twelve years.  A health insurance policy may provide that child health supervision services which are rendered during a periodic review shall only be covered to the extent that services are provided by or under the supervision of a single physician during the course of one visit.  Benefits for such services shall be subject to the same durational limits, dollar limits, deductibles and coinsurance factors as other covered services in such health insurance policies.  All Missouri health insurance policies delivered, issued for delivery, modified or renewed on or after January 1, 1990, shall be subject to this section.

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

  5.  Nothing in this section shall prohibit the health care insurer from including any or all coverage for child health supervision services as standard coverage in their policies or contracts.

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(L. 1989 H.B. 795 §§ 1, 2, 3)