Section 376.995

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS

Chapter 376

Effective - 28 Aug 1997   

  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. — 1.  This section shall be known as the "Limited Mandate Health Insurance Act".

  2.  Limited mandate health insurance policies and contracts shall mean those policies and contracts of health insurance as defined in section 376.960 and which cover individuals and their families (but not including any Medicare supplement policy or contract) and groups sponsored by an employer who employs fifty or fewer persons.

  3.  No law requiring the coverage of a particular health care service or benefit, or requiring the reimbursement, utilization or inclusion of a specific category of licensed health care practitioner, shall apply to limited mandate health insurance policies and contracts, except the following provisions:

  (1)  Subsection 1 of section 354.095, to the extent that it regulates maternity benefits;

  (2)  Section 375.995;

  (3)  Section 376.406;

  (4)  Section 376.428;

  (5)  Section 376.782;

  (6)  Section 376.816;

  (7)  Section 376.1210;

  (8)  Section 376.1215; and

  (9)  Section 376.1219.

  4.  In order for an insurer as defined in section 376.960 to be eligible to market, sell or issue limited mandate health insurance, the insurer shall:

  (1)  Restrict its marketing and sales efforts to only those persons or groups as defined in subsection 2 of this section which currently do not have health insurance coverage or to those persons or employers which certify in writing to the insurer that they will terminate the coverage they currently have at the time they would otherwise renew coverage because of cost;

  (2)  Fully and clearly disclose to the person or group to whom the limited mandate health insurance policy or contract is to be issued that the reason coverage for this product is less expensive than other coverage is because the policy or contract does not contain coverages or health professional payment mechanisms that are required by subsection 3 of this section;

  (3)  Clearly disclose in all sales, promotional and advertising material related thereto that the product is a limited mandate health insurance policy or contract.

  5.  The provisions of section 376.441 shall not apply to any group which replaces its current coverage with a limited mandate health insurance policy or contract if the benefit to be extended is one for services which are not covered by the replacing policy or contract.

  6.  Notwithstanding any other provision of this section to the contrary, the provisions of paragraph (b) of subdivision (11) of section 375.936 shall apply to limited mandate health insurance policies with respect to physician services covered under such policies, which can be provided by persons licensed pursuant to section 332.181.

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(L. 1990 H.B. 998 § 15, A.L. 1992 S.B. 796, A.L. 1996 H.B. 904, et al. merged with H.B. 1069, A.L. 1997 H.B. 600 & 388)