☰ Revisor of Missouri
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 Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS

 Chapter 376 Life, Health and Accident Insurance ^!
GENERAL PROVISIONS
376.005   Definitions. (8/28/2008)
376.010   Who may form company — purposes. (8/28/2012)
376.015   Involuntary unemployment insurance may be issued in connection with extension of credit or certain group life insurance, requirements. (8/28/2012)
376.020   Various companies defined. (8/28/1939)
376.050   Declaration of corporators. (8/28/1939)
376.060   Stock companies — content of charter. (8/28/1943)
376.070   To be submitted to attorney general. (8/28/1957)
376.080   Director to examine, when. (8/28/1967)
376.090   To furnish certificate of deposit, when. (8/28/1939)
376.100   Mutual companies — contents of charter. (8/28/1951)
376.110   To be submitted to attorney general. (8/28/1957)
376.120   Director to examine and certify, when. (8/28/1939)
376.130   To furnish certificate of deposit, when. (8/28/1939)
376.142   Stock company may become mutual — procedure — policyholders' meeting — acquisition of stock. (8/28/1957)
376.143   Stock company may acquire its own shares to be held in trust for mutual — appointment, powers and duties of trustees. (8/28/1957)
376.144   Acquisition of shares of dissenting stockholders, procedure — abandonment of mutualization. (8/28/1957)
376.145   Officers of stock company to continue as officers of mutual. (8/28/1957)
376.146   Board of directors or trustees of mutual, membership qualifications, term of office. (8/28/1976)
376.147   Meetings of board of mutual, notice — executive committee of board, powers. (8/28/1957)
376.148   Policyholders are members of mutual — voting rights — directors may alter articles — additional assessments prohibited. (8/28/1957)
376.150   Stock and mutual companies — content of charter. (8/28/1939)
376.160   Formation of stock and mutual companies. (8/28/1939)
376.170   Special deposits for registered policies and annuity bonds. (8/28/2007)
376.180   Certificates as to registration and reserves on policy — policies exempt, exceptions. (8/28/1969)
376.190   Additional deposits required. (8/28/2007)
376.200   Definition of net value. (8/28/1939)
376.210   Excess deposits. (8/28/1939)
376.220   May use realty to secure notes and bonds. (8/28/1939)
376.230   Changing of securities on deposit. (8/28/1939)
376.240   Deposits to be held in trust by director. (8/28/1939)
376.250   Deposits to be kept separate. (8/28/1939)
376.260   Fees collected by director of revenue. (8/28/1945)
376.270   Director may proceed against depositary companies. (8/28/1939)
376.280   Capital necessary to do business — how invested. (8/28/2007)
376.290   Deposit and transfer of securities. (8/28/1982)
376.291   Applicability and inapplicability. (8/28/2007)
376.292   Definitions. (8/28/2007)
376.293   Permissible investments — written plan for investments required. (8/28/2007)
376.294   Prohibited acts. (8/28/2007)
376.295   Additional prohibited acts — authorized actions. (8/28/2007)
376.296   Value of investments, how calculated. (8/28/2007)
376.297   Investment subsidiaries not permitted, when. (8/28/2007)
376.298   Acquisition of rate credit instruments, when. (8/28/2007)
376.300   Equity interests permitted, when. (8/28/2007)
376.301   Tangible personal property interests permitted, when. (8/28/2007)
376.302   Mortgage interests, may be acquired, when — other real estate interests. (8/28/2007)
376.303   Lending and repurchase, permitted when. (8/28/2007)
376.304   Acquisition of foreign investments, when. (8/28/2007)
376.305   Rulemaking authority. (8/28/2007)
376.306   Cash surrender value, life insurer may lend to policyholder, when. (8/28/2007)
376.307   Limits on acquisition of certain investments. (8/28/2012)
376.308   Secondary mortgage market act, not to preempt health insurer, when. (8/28/1991)
376.309   Separate account defined — establishment of account and special voting or control rights authorized — approved investments — approval of director required. (8/28/2007)
376.310   Investment of surplus and reserve funds by foreign companies. (8/28/1945)
376.311   Investment of capital reserve and surplus of life insurance companies in investment pools — definitions — qualifications — requirements. (8/28/2002)
376.325   Any willing provider provision — definitions. (8/28/2013)
376.330   Securities may be changed. (8/28/1939)
376.350   Reports to director. (8/28/2000)
376.360   Distribution of surplus funds to participating policyholders — method. (8/28/1945)
376.365   Standard valuation law — definitions. (8/28/2015)
376.370   Director to value reserves, methods. (8/28/2015)
376.379   Medication synchronization services, offer of coverage required. (8/28/2016)
376.380   Legal minimum standards for valuation — interest rates — valuation manual, operative date, effect of — reserves required. (8/28/2015)
376.381   Health insurance products, department duties. (7/12/2013)
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. (8/28/2020)
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. (1/1/2002)
376.385   Diabetes — insurance coverage for equipment, supplies and self-management training. (8/28/1997)
376.386   Prescription drugs, one co-payment for dosage prescribed. (8/28/2006)
376.387   Pharmacy benefits manager, limitations and restrictions — enforcement. (8/28/2020)
376.388   Maximum allowable costs — definitions — contract requirements — reimbursement — appeals process required. (8/28/2016)
376.390   Reserve liability for group insurance — how computed. (8/28/1943)
376.391   Co-payments for chiropractic services, cap. (8/28/2009)
376.392   Prescription drug formularies, enrollees to be notified of changes to, when. (1/1/2008)
376.393   Pharmacy benefits manager, license required — definitions — complaints, procedure. (8/28/2020)
376.395   Definitions for group health conversion policy requirements. (1/1/1983)
376.397   Converted policy to be offered on termination of group health coverage, when — exceptions — terms and conditions. (1/1/1983)
376.398   Application to all group policies — effective, when. (1/1/1983)
376.401   Conversion rights — retirees — dependents of insured. (1/1/1983)
376.403   Benefit levels — group coverage may be provided in lieu of converted policy — delivery outside state, form. (1/1/1983)
376.404   Specific requirement requests of policyholder may be met by alteration. (1/1/1983)
376.405   Group health and accident policies, approval required — exempt, when, director's powers. (8/28/2013)
376.406   Newborn child to be covered under health policies, extent of coverage — notification of birth, when, effect of — definitions. (8/28/2001)
376.407   Advance practice nurse, claims for service to be reimbursed, when. (8/28/1998)
376.410   Insurance companies to maintain reserves — exemptions. (8/28/1945)
376.421   Group health insurance, authorized categories. (8/28/2009)
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. (8/28/1985)
376.423   Health insurance, claims for chiropractic services denial, qualified chiropractor to review, qualifications — investigation by department, when. (8/28/1997)
376.424   Group health insurance policies may be extended to insure family members or dependents. (8/28/1985)
376.425   Student accident policies, may not limit surgical benefits, when. (1/1/1993)
376.426   Group health policies, required provisions. (8/28/2013)
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. (8/28/2018)
376.428   Federal COBRA provisions to apply to group health insurance policies. (6/26/2009)
376.429   Coverage for certain clinical trials for prevention, early detection and treatment of cancer, restrictions — definitions — exclusions. (8/28/2006)
376.431   Employees or members of unions or associations, group or group-type basis coverage, sections 376.431 to 376.442 to apply. (8/28/1999)
376.432   Group-type basis, defined. (8/28/1999)
376.433   Self-insurance plans for health care, public entities — subject to Medicaid rights, obligations, and remedies. (8/28/2004)
376.434   Carrier liable for claims incurred during grace period, when — exceptions. (8/28/1985)
376.435   Claim information to be reported, when — covered lives defined. (8/28/2007)
376.436   Discontinuance notice by carrier, contents — notice forms furnished by carrier for distribution to policyholders. (8/28/1999)
376.438   Group policies, modifying or amending benefits shall provide extension of benefits in event of total disability at date of termination or discontinuance. (8/28/1999)
376.441   Carrier contract replaced by similar benefit plan of another carrier — liability of prior carrier — succeeding carrier coverage requirements. (8/28/1999)
376.442   Rules and regulations, procedure. (8/28/1993)
376.446   Enrollee cost-sharing responsibilities, health carriers to provide timely information — exceptions. (8/28/2011)
376.450   Citation of law — definitions (Missouri HIPAA). (1/1/2008)
376.451   Standards prohibiting discrimination. (1/1/2008)
376.452   Large group market, renewal or continuation of coverage required — nonrenewal or discontinuation permitted, when — conditions for discontinuation. (1/1/2008)
376.453   Premium — only cafeteria plans required, when. (1/1/2008)
376.454   Individual market, renewal or continuation at option of individual — nonrenewal or discontinuation permitted, when — discontinuation of a type of coverage, procedure. (1/1/2008)
376.465   Missouri health insurance rate transparency act — definitions — rate filing requirements, procedure — rulemaking authority. (8/28/2016)
376.480   Domestic companies may assume risks of foreign companies — duties of director. (8/28/1939)
376.500   Discriminations, rebates and favors prohibited — contracts to conform to policy. (8/28/1965)
376.502   Life insurers not to discriminate based on lawful travel destinations — violations, penalty. (8/28/2009)
376.510   Penalty for violation of section 376.500. (8/28/1939)
376.531   Life insurance policies, consent of insured required, exceptions — employers have insurable interest in employees, when, effects. (8/28/1994)
376.540   Policy, to whom payable. (8/28/1983)
376.562   Charitable, benevolent, educational and religious organizations may be beneficiary or owner of policy, life insurance, when — fraud or coercion, exception. (8/28/1997)
376.570   Foreign executor or administrator. (8/28/1939)
376.580   Misrepresentation. (8/28/1939)
376.590   Misrepresentations, false estimates and circulars prohibited — agents — notes to be held until policy delivered. (8/28/1939)
376.600   Penalty for violating section 376.590. (8/28/1939)
376.610   Defense in case of suits. (8/28/1939)
376.620   Suicide, effect on liability — refund of premiums, when. (8/28/2017)
376.630   Life insurance policies not to be forfeited or become invalid, when. (8/28/1943)
376.640   Paid-up policy may be demanded, when. (8/28/1943)
376.650   Rules of payment on commuted policy. (8/28/1943)
376.660   Foregoing provisions inapplicable, when. (8/28/1943)
376.669   Annuity contract requirements — paid-up annuity benefits, how calculated — cash surrender benefits, how calculated — applicable, when. (6/21/2004)
376.670   Provisions which shall be contained in life insurance policies, exceptions. (8/28/2015)
376.671   Provisions which shall be contained in annuity contracts — inapplicability date. (8/28/2010)
376.673   Life insurance policies, regulations relative to. (8/28/1967)
376.674   Life insurance policies, no cash surrender value, regulations relative to. (8/28/1987)
376.675   Life insurance policies and annuity contracts to be approved — exemption, when — director's powers — judicial review of disapproval. (8/28/1984)
376.676   Regulation of the valuation of life insurance policies — may adopt NAIC model regulation. (6/27/2000)
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. (8/28/1987)
376.678   Life insurance policies and annuity contracts, annual statement to holder required — company to furnish policy or contract information to holder upon request. (8/28/1987)
376.679   Life insurance company may reinsure for risks involving aircraft, limitation. (1/1/1993)
376.680   Assignment of incidents of ownership, group life policy, effect of. (8/28/1971)
376.685   Optometrists, health insurance plans not to limit fees charged unless reimbursed by plan — requirements — definitions. (8/28/2016)
376.690   Unanticipated out-of-network care, claim procedure — definitions — limitation on amount billed to patient — external arbitration process — rulemaking authority. (8/28/2019)
GROUP LIFE INSURANCE
376.691   Group life policies, eligible groups authorized for issue — premiums, how paid. (8/28/1987)
376.693   Special group life policies, requirements — director's approval. (8/28/1982)
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. (8/28/1985)
376.695   Extension of policy to insure for loss due to death of spouse or dependent children, requirements, limitations. (8/28/1985)
376.696   Political subdivisions purchasing any insurance policies to submit to competitive bidding, when — renewal between bidding periods deemed extension. (8/28/1985)
376.697   Required provisions for group life policies. (8/28/1982)
376.699   Person insured by group policy entitled to individual life policy, notice requirements. (8/28/1982)
BUYER'S GUIDE
376.700   Purpose — use of additional material. (8/28/1979)
376.702   Application of law — exceptions. (8/28/1979)
376.704   Definitions. (8/28/1979)
376.706   Delivery of guide and summary required, when. (8/28/1979)
376.708   Required presentations and statements — company to maintain file. (8/28/1979)
376.710   Effect of omission. (8/28/1979)
376.712   Effective date. (8/28/1979)
376.714   Contents and form of buyer's guide. (8/28/1979)
GUARANTY ASSOCIATION — LIFE AND HEALTH INSURANCE

Effective date of certain amendments, 376.758

376.715   Citation of law, purpose. (8/28/2018)
376.717   Coverages provided, persons covered — coverage not provided, when — maximum benefits allowable. (8/28/2018)
376.718   Definitions. (8/28/2018)
376.720   Association, created — accounts — director to supervise. (8/28/2018)
376.722   Board of directors, established, members, how selected — expense reimbursement. (8/28/2018)
376.724   Impaired insurers, association's options, duties — insolvent insurers, association's options, duties — alternative policies, requirements. (8/28/2018)
376.725   Terminated coverage, reissuance of, premium set, how — obligation to cease, date — interest rate, guaranteed minimum. (8/28/2018)
376.726   Nonpayment of premiums, effect of. (8/28/2018)
376.728   Law not applicable, when. (8/28/1988)
376.730   Liens, association may impose, when. (8/28/1988)
376.732   Director to have association's powers and duties, when — association may appear in court, when. (8/28/2010)
376.733   Assignment of rights to association by persons receiving benefits, when — subrogation rights. (8/28/2018)
376.734   Additional powers of association. (8/28/2018)
376.735   Assessments against members, when due, classes — amounts, how determined. (8/28/2018)
376.737   Deferment of assessment, how, when — maximum assessment — refund of, when — members may increase premiums to cover assessments. (8/28/2018)
376.738   Certificate of contribution, when issued. (8/28/2018)
376.740   Plan of operation, required, approval of director — provisions of plan. (8/28/2010)
376.742   Director, powers and duties. (8/28/2018)
376.743   Board of directors, powers. (8/28/2018)
376.745   Assessments, offset against tax liability, when, how. (8/28/1988)
376.746   Records of association meetings to be kept — association deemed creditor of insolvent or impaired insured. (8/28/2018)
376.747   Distribution of member insurer assets upon liquidation, priority of association. (8/28/2018)
376.748   Liquidation, recovery of distributions, when, exceptions, limitations. (8/28/2018)
376.750   Financial report, submitted to director, when — tax exempt status — immunity from liability. (8/28/1988)
376.752   Member insurer's deposit with director, exemption from, amount. (8/28/1988)
376.754   Stay of proceedings, insolvent insurer, when. (8/28/1988)
376.755   Advertising, use of guaranty association prohibited. (8/28/2018)
376.756   Summary document, association to prepare, contents — policy not covered by guaranty association to contain notice, form determined by director. (8/28/2018)
376.758   Law inapplicable to insolvent insurers on effective date of law. (8/28/2018)
INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE
376.770   Title of law. (8/28/1959)
376.773   Definitions. (8/28/1959)
376.775   Matters required in policies. (8/28/1959)
376.776   Hospital and medical expense provisions extended for certain handicapped and dependent children past normal coverage age. (1/1/2008)
376.777   Specifically required provisions — exemptions, when — director's powers — inapplicability of certain provisions to individual health insurance coverage. (8/28/2013)
376.778   Payment direct to public hospitals or clinics with or without assignment, when — provisions required in contracts. (8/28/1983)
376.779   Health insurance policies to offer coverage for treatment of alcoholism — exclusions. (8/28/2004)
376.780   Limits on provisions, effect of conflict of policy with law. (8/28/1959)
376.781   Speech and hearing disorders, companies to offer coverage, when — rules, procedure. (8/28/1995)
376.782   Mammography — low-dose screening, defined — health care policies to provide required coverage. (8/28/2020)
376.783   Insured bound only if copy of application attached to policy. (8/28/1959)
376.785   What does not constitute waiver of defenses. (8/28/1959)
376.787   Effect of age limit provision. (8/28/1959)
376.789   Definition of actual charge and actual fee. (8/28/2009)
376.790   Limits on applicability of law. (8/28/1959)
376.791   Portion of section 376.777 not applicable to individual health insurance coverage. (8/28/2015)
376.800   Misrepresentation made in obtaining individual accident and health policy no defense, exception. (8/28/1967)
376.801   Coverage for child health supervision services required — definitions — permitted limitations on benefits. (8/28/1989)
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. (8/28/2010)
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. (8/28/1991)
376.807   Policies not to reduce or deny benefits to persons eligible for medical assistance — deemed primary contract. (8/28/1988)
376.810   Definitions for policy requirements for chemical dependency. (8/28/2014)
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. (8/28/2018)
376.814   Rules and regulations authorized, department of mental health to advise department — procedure. (8/28/1993)
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. (8/28/2010)
376.818   Eligibility for Medicaid may not be considered by insurers. (7/1/1994)
376.819   MO HealthNet division to have right to payment for health care services provided. (8/28/2014)
376.820   Insurers may not deny coverage of child because of marital status of parents, residence or income tax dependency claim. (7/1/1994)
376.821   Insurers may not cancel health or dental insurance solely because the insured is incarcerated — insurer, defined. (8/28/1995)
376.823   Prohibition on kickbacks not applicable for rebates for certain chronic illnesses. (8/28/2005)
EATING DISORDERS
376.845   Definitions — eating disorders, coverage for diagnosis and treatment of — limitations on coverage. (8/28/2015)
MEDICARE SUPPLEMENT INSURANCE
376.850   Law, how cited. (8/28/1989)
376.854   Definitions. (4/26/1996)
376.859   Medicare supplement law applicable to what policies — policies not included. (4/26/1996)
376.864   Policies not to duplicate benefits provided by Medicare — preexisting conditions, limitations on — director to issue rules establishing standards. (4/26/1996)
376.869   Standards for policies, minimum, director to adopt. (4/26/1996)
376.874   Requirements of policy, return to policyholders. (7/6/1992)
376.879   Outline of coverage for fair disclosure — furnished to each applicant — format and content — rules and standards. (4/26/1996)
376.881   Policy certificate front page to contain notice of right to return and receive premium refund. (7/6/1992)
376.882   Cancellation of policy, refund required — notification. (8/28/2010)
376.884   Advertisement to be reviewed by director. (7/6/1992)
376.886   Regulations, requirements — rules, procedure. (4/26/1996)
376.889   Violations, penalty. (8/28/2007)
376.890   Invalidity of any section regulating Medicare supplement not to affect others. (8/28/1989)
SPOUSAL COVERAGE CONTINUATION
376.891   Definitions. (8/28/1993)
376.892   Surviving spouse may continue coverage, when — divorced or separated spouse may continue coverage, when — services offered. (8/28/1993)
376.893   Divorced or separated spouse, continuation of coverage, notice — contents of notice — failure to elect, effect — application. (8/28/1996)
376.894   Amount of premium, date of payment — termination of right of continuation of coverage, grounds. (8/28/1993)
LIFE CARE CONTRACTS
376.900   Definitions. (8/28/1981)
376.905   Administration by department, powers, duties — fees. (8/28/1981)
376.910   Certificate of authority required. (8/28/1981)
376.915   Application for certificate, content — renewal, content, filed when — extensions, fee. (8/28/1981)
376.920   Annual statement, form, contents. (8/28/1981)
376.925   Seven-day rescission period, all money or property to be refunded. (8/28/1981)
376.930   Insured to be furnished application for certificate and annual statement, when. (8/28/1981)
376.935   Certificates issued for one year — nontransferable — not endorsement by department. (8/28/1981)
376.940   Escrow account for entrance fees required, released when. (8/28/1981)
376.945   Escrow account, amount required — principal, how released, investment. (8/28/2020)
376.950   Board of directors, one member to be resident of facility. (8/28/1981)
HEALTH INSURANCE POOL
376.960   Definitions. (1/1/2008)
376.961   Missouri health insurance pool created — members to be all health insurers in state — board of directors, members, terms, qualifications — transitioning resources. (8/28/2013)
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. (8/28/2013)
376.964   Board, powers and duties — including providing for issuing policies and reinsuring risks — staff appointment — rulemaking authority. (8/28/2013)
376.965   Board members not civilly liable for performance of duties, exception. (8/28/1991)
376.966   No employee to lose coverage by enrolling in pool — eligibility for pool coverage, ineligibility — medical underwriting considerations, notification required, when — expiration date. (8/28/2013)
376.968   Administration of pool by insurer or insurers by competitive bids — insurer's qualifications — board to establish criteria for bid content. (8/28/2013)
376.970   Administering insurer to serve for three years subject to removal for cause — duties — reports — bidding process. (8/28/2013)
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. (8/28/2013)
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. (1/1/1991)
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. (1/1/1991)
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. (1/1/1991)
376.982   Rulemaking procedure. (8/28/1995)
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. (1/1/1991)
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. (1/1/2008)
376.987   High deductible health plans and establishment of health savings plans to be offered as options — definitions — rulemaking authority. (1/1/2008)
376.989   No liability, criminal or civil, for participation in pool by members. (1/1/2008)
LIMITED MANDATE HEALTH INSURANCE
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. (8/28/1997)
EXCEPTED BENEFIT PLANS
376.998   Health insurance mandate exemption for excepted benefit plans — definitions — procedure to exempt. (8/28/2016)
MULTIPLE EMPLOYER SELF-INSURED HEALTH PLANS
376.1000   Multiple employer self-insured health plan, defined. (8/28/1993)
376.1002   Certificate of authority required — penalty for noncompliance — law inapplicable, when — exempt organizations. (8/28/1993)
376.1005   Application for certificate of authority, form — fee — policy or other evidence of coverage provided to employees, form. (8/28/1993)
376.1007   Plan to file copy of bylaws, coverage and agreements with director. (8/28/1993)
376.1010   Excess stop-loss coverage maintained by plan. (8/28/1993)
376.1012   Funds collected from employers held in trust — requirements — board of trustees, elected, duties — annual report, filed when. (8/28/2007)
376.1015   Department not to grant approval, when. (8/28/1993)
376.1017   Plan to establish loss reserves — plan to establish surplus account, amount. (8/28/1993)
376.1020   Plan to maintain principal place of business in Missouri, exception. (8/28/1993)
376.1022   Dissolution of plan, application, procedure, granted when — distribution of assets, procedures. (8/28/1993)
376.1025   Director may adopt rules. (8/28/1995)
376.1027   Plan in unsound condition, powers of director. (8/28/1993)
376.1030   Agreement of employer to pay benefits, requirements, form — copy filed with director — no excuse from liability. (8/28/1993)
376.1032   Plan considered insurer, when. (8/28/1993)
376.1035   Chapter 376 applicable to plan. (8/28/1993)
376.1037   Plan subject to premium taxes. (8/28/1993)
376.1040   Plan not to be offered to public — marketing restrictions — exemption — use of brokers authorized. (8/28/2019)
376.1042   Marketing by agent, agency or broker violation of law. (8/28/2019)
376.1045   Injunctive relief, director may seek, when — procedures. (8/28/1993)
DENTAL SERVICES
376.1060   Access to dental services not to be sold, assigned, or granted access without express authorization — definitions — requirements. (8/28/2014)
376.1065   Official notification communications, contracting entity requirements. (8/28/2018)
ADMINISTRATORS, CERTAIN INSURANCE POLICIES
376.1075   Definitions. (8/28/1998)
376.1077   Administrator to have agreement with insurer, form, contents — termination, how. (8/28/1993)
376.1080   Payments of premiums and claims deemed paid, when. (8/28/1993)
376.1082   Records maintained by administrator for insurer — director may examine records — records owned by insurer, transfer allowed, when. (8/28/1993)
376.1083   Advertising restrictions for administrator. (8/28/1993)
376.1084   Insurer responsible for benefits and underwriting practices — insurer to conduct review of administrator, when. (8/28/1993)
376.1085   Premiums held in fiduciary capacity, duties — financial records, duties — withdrawals from fiduciary account by agreement only, contents — payment of claims. (8/28/1993)
376.1087   Commissions not to be contingent on savings in payment of claims — may be based on premiums collected. (8/28/1993)
376.1088   Notice to policyholder of administrator, contents, required — disclosure of receipts to insurer. (8/28/1993)
376.1090   Materials delivered to administrator for insured to be promptly delivered. (8/28/1993)
376.1092   Certificate of authority, required, application, contents, fee — refusal to issue, when — renewal — bond, required when. (8/28/1993)
376.1093   Annual report filed with director, when — contents — filing fee, amount. (8/28/1993)
376.1094   Certificate of authority, suspension or revocation, grounds — civil action, when. (8/28/2007)
376.1095   Rules and regulations, promulgation. (8/28/1995)
LONG-TERM CARE
376.1100   Law, how cited — definitions. (8/28/2002)
376.1103   Laws applicable, Medicare supplement laws not applicable — purpose — policies or riders must be in compliance. (8/28/2002)
376.1106   Policies issued in other states may be issued to residents of Missouri if in compliance with Missouri regulations. (8/28/1990)
376.1109   Policies, content requirements, provisions prohibited — rules authorized — cancellation, refund required. (8/28/2010)
376.1112   Director to provide buyer's guide — content — advertising of long-term care policies to contain notice of availability of guide. (8/28/1990)
376.1115   Coverage outline to be delivered to applicants, when, content. (8/28/2002)
376.1118   Benefits funded by a life insurance death benefit acceleration, reports to policyholder required, content. (8/28/1990)
376.1121   Denial of claim, long-term care insurance, duties of issuer. (8/28/2002)
376.1124   Rescinding of a long-term care policy, permitted when — grounds for contesting — no field issuance, when. (8/28/2002)
376.1127   Nonforfeiture benefit option required for long-term care insurance policies, requirements of offer — rulemaking authority. (8/28/2002)
376.1130   Rulemaking authority. (8/28/2002)
HEALTH BENEFIT EXCHANGES
376.1186   State-based health benefit exchanges prohibited without statutory authority — executive order to establish prohibited — state agency restrictions — taxpayer standing — definitions. (11/6/2012)
HEALTH CARE MANDATE REVIEW
376.1190   Health care mandates — review by oversight division — actuarial analysis. (8/28/2011)
WOMEN'S HEALTH
376.1199   Coverage for certain obstetrical/gynecological services — exclusion of contraceptive coverage permitted, when — rulemaking authority. (10/12/2012)
BREAST CANCER, OFFER OF COVERAGE
376.1200   Certain policies to offer coverage for treatment of breast cancer — limitation on deductible, lifetime maximum benefit — administration of benefits — application, effect. (8/28/1995)
376.1209   Mastectomy — mandatory insurance coverage for prosthetic devices and reconstructive surgery — no time limit to be imposed. (8/28/2001)
MATERNITY BENEFITS, MANDATED HOSPITAL CARE
376.1210   Maternity benefits, minimum hospital stays, exceptions — notice of benefits, contents — attending physician defined — rulemaking. (8/28/1996)
IMMUNIZATIONS, MANDATED COVERAGE
376.1215   Immunizations, mandated coverage, exceptions, rulemaking. (8/28/1996)
PART C OF IDEA (FIRST STEPS PROGRAM) COVERAGE
376.1218   Insurance coverage for children enrolled in the Part C early intervention system (First Steps). (8/28/2007)
PKU FORMULA, MANDATED COVERAGE
376.1219   PKU formula and low protein modified food products covered by insurance, when — exceptions. (8/28/2002)
NEWBORN HEARING SCREENINGS, MANDATED COVERAGE
376.1220   Insurance coverage for newborn hearing screenings mandated. (8/28/1999)
SCALP HAIR PROSTHESES
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. (8/28/2003)
AUTISM SPECTRUM DISORDER
376.1224   Definitions — insurance coverage required — limitations on coverage — maximum benefit amount, adjustments — reimbursements, how made — applicability to plans. (8/28/2019)
DENTAL CARE, ANESTHESIA AND HOSPITALIZATION, MANDATED COVERAGE
376.1225   Mandated coverage for general anesthesia and hospital charges for dental care, when — prior authorization required, when — exceptions. (8/28/1998)
376.1226   Fee schedule for services not covered under health benefit plans — definitions. (8/28/2013)
CHIROPRACTIC CARE
376.1230   Chiropractic care coverage, rates, terms, conditions, limits, and exclusions. (8/28/2003)
PROSTHETICS, OFFER OF COVERAGE
376.1232   Insurers to offer coverage for prosthetics. (8/28/2009)
PHYSICAL THERAPY SERVICES
376.1235   No co-payments or coinsurance for physical or occupational therapy services, when — actuarial analysis of cost, when. (8/28/2016)
PRESCRIPTION EYE DROPS
376.1237   Refills for prescription eye drops, required, when — definitions. (8/28/2018)
CANCER COVERAGE
376.1250   Cancer screening, health insurance coverage required, when, types. (8/28/2011)
376.1253   Second opinion, right of newly diagnosed cancer patients, attending physician to inform — insurance coverage for such second opinions required, when. (8/28/2002)
376.1257   Orally administered anticancer medications, plan to provide coverage no less favorable than IV or injected medications — definitions — requirements — effective date. (1/1/2015)
BONE MARROW TRANSPLANTS
376.1275   Coverage for human leukocyte antigen testing for bone marrow transplantation required, when — exceptions. (8/28/2002)
LEAD TESTING
376.1290   Coverage for lead testing. (8/28/2001)
REORGANIZATION OF DOMESTIC MUTUAL LIFE INSURANCE COMPANY
376.1300   Reorganization of a domestic mutual life insurance company, authority. (8/28/1996)
376.1305   Formation of holding company, application — shareholder approval. (8/28/1996)
376.1307   Issuance of shares. (8/28/1996)
376.1309   Member's interest — nontransference of membership — immunity from liability — assessments, not imposed — security, membership interest. (8/28/1996)
376.1312   Nonapplicability of certain provisions of insurance holding companies law. (8/28/1996)
376.1315   Incorporation of mutual holding company, authority, approval. (8/28/1996)
376.1318   Powers of mutual holding company, engaging in business of insurance, no authority, affiliation and merger agreements. (8/28/1996)
376.1322   Mutual holding company subject to supervision of director, dissolution or liquidation — demutualization. (8/28/1996)
REIMBURSEMENT
376.1345   Method of reimbursement not to require fee, discount, or remuneration — notification requirements — electronic funds transfer, when — overpayment, procedure — violation, penalty. (8/28/2020)
HEALTH CARE UTILIZATION REVIEW
376.1350   Definitions. (8/28/2019)
376.1353   Utilization review activities monitored. (8/28/1997)
376.1356   Utilization review entity monitored, when. (8/28/2019)
376.1359   Written utilization program implemented, filed with the director. (8/28/1997)
376.1361   Documented clinical review criteria used in a utilization program — medical director qualifications — compensation of utilization review services. (8/28/1997)
376.1363   Utilization review decisions, procedures. (8/28/2019)
376.1364   Unique confirmation number required, prior authorization review — secure electronic transmission for prior authorizations — single cover page, contents. (8/28/2019)
376.1365   Reconsideration of an adverse determination, when. (8/28/1997)
376.1367   Emergency services benefit determination, coverage required, when. (8/28/2018)
376.1369   Certification of compliance, when. (8/28/1997)
376.1372   Certification and member handbook to include utilization review procedures — website or provider portal, prior authorization requirements available on. (8/28/2019)
376.1375   Registry of grievances maintained, procedures — definitions. (8/28/1997)
376.1378   Grievances and certificate of compliance filed with the director, when. (8/28/1997)
376.1382   First- and second-level grievance review for managed care plans, first-level procedures. (8/28/1997)
376.1385   Second-level review procedures. (8/28/2019)
376.1387   Appeals of grievances determined by the director. (8/28/1997)
376.1389   Expedited grievance review procedure. (8/28/1997)
RULEMAKING AUTHORITY
376.1399   Rules, effective, when — rules invalid and void, when. (8/28/2007)
STANDARDIZATION OF INFORMATION
376.1400   Explanation of benefits, standardized information used, contents, when. (8/28/1999)
376.1403   Referrals, standardized information used, content, when. (8/28/1999)
DOCUMENTS AND MATERIALS
376.1450   Enrollee's right to receive documents and materials in printed or electronic form, when. (8/28/2010)
DISCOUNT MEDICAL PLANS
376.1500   Definitions. (8/28/2007)
376.1502   Requirements for transaction of business. (8/28/2007)
376.1504   Registration requirements — term of registration — renewal. (8/28/2007)
376.1506   Violations, penalty. (8/28/2007)
376.1508   Processing fee — cancellation of membership, effect of. (8/28/2007)
376.1510   Prohibited acts. (8/28/2007)
376.1512   Required disclosures. (8/28/2007)
376.1514   Written agreement required, contents. (8/28/2007)
376.1516   Written membership materials, required contents — forms to be filed with director, fee. (1/1/2008)
376.1516   Written membership materials, required contents — forms to be submitted to director. (8/28/2007)
376.1518   Net worth to be maintained, amount. (8/28/2007)
376.1520   Notice of changes. (8/28/2007)
376.1522   List of providers to be maintained on website. (8/28/2007)
376.1524   Advertising and marketing materials, approval in writing required. (8/28/2007)
376.1528   Rulemaking authority. (8/28/2007)
376.1530   Denial and refusal to issue registrations, when. (8/28/2007)
376.1532   Violations, penalties. (8/28/2007)
MENTAL HEALTH COVERAGE
376.1550   Mental health coverage, requirements — definitions — exclusions. (8/28/2018)
CREDENTIALING OF PRACTITIONERS
376.1575   Definitions (1/1/2014)
376.1578   Credentialing procedure, health carrier duties — covered health services, payment, when — violations, mechanism for reporting. (8/28/2020)
LIVING ORGAN DONORS
376.1590   Status as living organ donor not sole factor for insurance coverage. (8/28/2020)
HEALTH CARE SHARING MINISTRY
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. (8/28/2007)
SERVICES RELATED TO PREGNANCY
376.1753   Services related to pregnancy, persons holding ministerial or tocological certification may provide. (8/28/2007)
MEDICAL RETAINER AGREEMENTS
376.1800   Definitions — medical retainer agreements not insurance — agreement requirements — use of health savings accounts for fees. (8/28/2015)
TELEHEALTH
376.1900   Definitions — reimbursement for telehealth services, when. (1/1/2014)
HEALTH INSURANCE MARKETPLACE INNOVATION ACT
376.2000   Citation of law — definitions. (7/12/2013)
376.2002   Navigators, license required — permitted acts — prohibited acts — exemptions. (7/12/2013)
376.2004   Application procedure. (7/12/2013)
376.2006   Term of licensure — renewal — continuing education. (7/12/2013)
376.2008   Consultation with licensed insurance producer, navigator to advise, when. (7/12/2013)
376.2010   Sanction of license, when — restitution required, when — examination and investigation of records. (7/12/2013)
376.2011   Violations, administrative orders, civil actions — penalty. (7/12/2013)
376.2012   Navigators duty to report, when. (7/12/2013)
376.2014   Applicability — severability — rulemaking authority. (7/12/2013)
DISCLOSURE OF COSTS
376.2020   Contracts prohibiting disclosure of certain payments and costs are unenforceable. (10/14/2016)
STEP THERAPY
376.2030   Definitions. (8/28/2016)
376.2034   Restriction on step therapy protocol, patient to have access to override exception determination — procedure. (8/28/2016)
376.2036   Enforcement — applicability to health insurance plans, when. (8/28/2016)
UNCLAIMED LIFE INSURANCE BENEFITS ACT
376.2050   Citation of act. (8/28/2016)
376.2051   Definitions. (8/28/2016)
376.2052   Comparison of in-force policies to death master file — violation deemed an unfair trade practice. (8/28/2016)
376.2053   Exemption from requirements, when. (8/28/2016)
 - Cross References
All license, permit and certificate applications shall contain the Social Security number of the applicant, 324.024
Annual statement convention blank to be filed by insurers with the N.A.I.C., failure to comply, effect, 375.041
Group service or indemnity contracts to cover newborn child, 376.406
Health coverage provider subject to jurisdiction and examination of department of insurance, 374.194
Incorporation of insurance companies other than life, may issue life policy, 379.010
Injured employees, insurance, payment of fees and integration of systems of insurers and entities administering claims, department rules not applicable, when, 375.427
Insurer, defined, 375.932
Penalty for unauthorized person or corporation transacting insurance business, 375.310
Reduction of capital stock where not fully subscribed, 375.231
Second mortgages, insurance coverage authorized as additional charge, 408.233
Unfair practices and frauds, 375.930 to 375.948
Withdrawal of securities, 375.480

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