Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans

  1. Law
  2. Missouri Revised Statutes
  3. Corporations, Associations and Partnerships
  4. Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans

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Section
354.010

Definitions.

Section
354.015

Health services corporations, laws applicable to — exceptions.

Section
354.020

Preexisting health services corporation to amend articles, effect of.

Section
354.025

Corporate purposes and authority.

Section
354.027

Discrimination in coverage or reimbursement for covered service by licensed persons, prohibited.

Section
354.030

For-profit corporations excluded from act.

Section
354.035

Procedure for organization of corporation.

Section
354.040

Articles of incorporation, required information and contents.

Section
354.045

Issuance of certificate, effect of.

Section
354.050

General powers of corporation.

Section
354.055

Certificate of authority required — expiration of, extended how.

Section
354.060

Director to issue certificate, when.

Section
354.065

Articles of incorporation, how amended — copy to director, when.

Section
354.070

Certificate of authority automatically extended, when.

Section
354.075

Capital required to do business.

Section
354.080

Reserves required, how computed.

Section
354.085

Membership contract forms, approval by director, when — time for filing — time for disapproval.

Section
354.090

Health services corporation contracts, purposes, parties to.

Section
354.095

Limitation of membership and benefits — certain benefits to be provided, when.

Section
354.105

Annual report required, contents of.

Section
354.115

Member's grievance, how and where filed — director may investigate, court action not barred.

Section
354.120

Rules and regulations by director authorized — procedure, review.

Section
354.125

Corporation not liable for injuries resulting from medical services rendered members.

Section
354.130

Exemption from certain taxes, exceptions.

Section
354.140

Dissolution, liquidation or rehabilitation of corporation, procedure for.

Section
354.145

Appeal from director's actions or decisions, how taken.

Section
354.150

Fees — waiver, when.

Section
354.152

Premiums, dues or fees subject to restrictions — violation, hearing — order prohibiting.

Section
354.155

Disclaimer as to nonhealth services corporations.

Section
354.165

Certain organizations exempt.

Section
354.175

Wage continuation plans by employer exempt.

Section
354.180

Administrative order, director to issue, when.

Section
354.190

Examinations, procedures.

Section
354.195

Records of examination, duty to keep.

Section
354.200

Examinations, false testimony, penalty.

Section
354.205

Examinations — costs, how paid.

Section
354.207

Second medical opinion to be allowed by health services corporations, procedure, costs.

Section
354.210

Director may seek relief, when.

Section
354.215

Examiner's sick leave to apply to health services corporations.

Section
354.220

Director may bring suit to recover fees or sums.

Section
354.225

Enrollment representative, defined — annual report to furnish information — solicitors of members to be insurance agent or broker, exception.

Section
354.230

License required for enrollment representative.

Section
354.235

Enrollment representative — license issued when, qualifications.

Section
354.240

Nonresident may be licensed — examination waived, when.

Section
354.265

Nonrenewable temporary license issued, when.

Section
354.275

Violations by enrollment representatives, penalties.

Section
354.280

Officers of corporation found to be of known bad character or incompetent — authority to transact business, effect.

Section
354.285

Management agreements to control corporation, notice to department, when — examination requirements — violations.

Section
354.290

Examiner's duties — examination contents — hearing on reports allowed — publication of report, when.

Section
354.295

Certificate of authority not to be issued if controlling management involved in improper actions.

Section
354.300

Certificate of authority suspended or revoked, when.

Section
354.305

Corporation advertising assets also to show liabilities — penalties.

Section
354.315

Data processing system authorized, cost, amount allowed — amortization not to exceed ten years.

Section
354.320

Corporate funds and securities use for private gain by officers and employees prohibited, penalty.

Section
354.325

Investigation by director of investments — records to be kept by division — criminal action, when.

Section
354.330

Public official failing to perform duties as to investment violations, penalty.

Section
354.335

Damages allowed if corporation without reasonable cause refuses to pay.

Section
354.340

Unsatisfied judgments against corporation — suspension or revocation of certificate of authority until judgment satisfied.

Section
354.345

Court decree of specific performance — membership contract, failure of corporation to comply, procedure, effect.

Section
354.350

Fraudulent or bad faith conduct — investigation by division — hearing, procedure.

Section
354.355

Injunctions, permanent or temporary, grounds, procedure — dissolution of corporation or rehabilitation, procedure.

Section
354.357

Receivership, grounds, procedure.

Section
354.362

Newborn child coverage required — notice of birth, when, effect.

Section
354.380

Certain provisions of insurance law to be applicable.

Section
354.400

Definitions.

Section
354.405

Certificate of authority, who may make application — foreign corporation may qualify, requirements — procedure.

Section
354.407

PACE projects not deemed health maintenance organizations, when.

Section
354.410

Certificate issued, when — annual deposit, requirements — capital account, amount, contents.

Section
354.415

Powers of organization.

Section
354.420

Advisory panels to afford enrollees participation in policy decisions.

Section
354.425

Bonding of officers who disburse or invest funds — bond requirements.

Section
354.430

Evidence of coverage, requirements — rights of enrollee — toll-free telephone number required.

Section
354.435

Annual reports filed with director, when — content — forms.

Section
354.440

Information to be available to enrollees.

Section
354.441

Disclosures to subscribers shall not be prohibited or restricted.

Section
354.442

Disclosure information to enrollees required, when.

Section
354.443

Financial disclosures to the department required by health maintenance organizations, when.

Section
354.444

Administrative orders for violations — voluntary forfeitures, civil actions.

Section
354.445

Complaints by enrollees, organization to establish system.

Section
354.450

Investments authorized.

Section
354.455

Deposit required, how made.

Section
354.460

Advertising not to be untrue or misleading — deceptive solicitation — prohibited — how determined.

Section
354.462

Enrollee, grounds for disenrollment.

Section
354.464

Names not authorized for use, exceptions.

Section
354.465

Examinations by division, when — costs, how paid.

Section
354.470

Suspension or revocation, when — effect.

Section
354.475

Insurance companies or health service company may organize and operate a health maintenance organization.

Section
354.480

Rehabilitation, liquidation, or conservation, grounds, procedure — enrollee's priorities — claims, priority.

Section
354.485

Rules and regulations authorized.

Section
354.490

Certificate of authority, denial, suspension or revocation, grounds — procedure.

Section
354.495

Fees to be paid to director.

Section
354.500

Conferences called by director as to suspected or potential violations.

Section
354.505

Laws regulating insurance or health service corporations not to apply, exceptions.

Section
354.510

Public documents, all filings and required reports.

Section
354.515

Confidential information, diagnosis, treatment, health of enrollees or applicants, exceptions.

Section
354.520

Mergers, consolidations, control of organization, requirements.

Section
354.525

Health provision collective bargaining agreements or contracts — charge for coverage, how determined.

Section
354.530

Severability clause.

Section
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.

Section
354.536

Continuation of dependent child coverage, when — dependent child defined.

Section
354.540

Health maintenance organization of bordering states may be admitted to do business — procedure.

Section
354.545

Exempt plans and companies.

Section
354.546

Second medical opinion to be allowed by health maintenance organizations, procedure, costs.

Section
354.550

Laws not applicable to community health companies.

Section
354.551

Health maintenance organizations may offer point of service (POS) riders, when.

Section
354.552

Community-based health maintenance organizations, requirements.

Section
354.554

Standing referrals for certain members of community-based health maintenance organizations, when.

Section
354.556

Trustees, vacancies, elections.

Section
354.558

Materials provided to prospective purchasers.

Section
354.559

Disclosure to members, restrictions and prohibitions.

Section
354.560

Payment arrangements, department to adopt rules — disclosure of financial arrangements — confidentiality.

Section
354.562

Grievance procedures, rulemaking authority.

Section
354.563

Medicare rules to apply to community-based health maintenance organizations, when.

Section
354.565

Community-based health maintenance organization designation given, when — revocation.

Section
354.567

Community-based health maintenance organizations subject to other laws regarding health maintenance organizations.

Section
354.570

Rulemaking — procedure.

Section
354.600

Definitions.

Section
354.603

Sufficiency of health carrier network, requirements, criteria — access plan filed with the department, when.

Section
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.

Section
354.609

Termination of a contract, procedure.

Section
354.612

Continuation of care after provider termination, when.

Section
354.615

Referrals to appropriate providers, when.

Section
354.618

Open referral health plans offered, when — definitions — obstetrician/ gynecologist services to be offered, when — eye care providers, discrimination against, prohibited — exemptions.

Section
354.621

Intermediary and participating provider requirements.

Section
354.624

Proposed provider contract forms filed with the director — contracts maintained at place of business, available for review, when.

Section
354.627

Liability of a health carrier, when.

Section
354.636

Contract requirements after January 1, 1998.

Section
354.650

Definitions.

Section
354.652

Designation as essential community provider, procedure, qualifications.

Section
354.654

Department of health and senior services, duties — rulemaking authority.

Section
354.656

Inclusion of essential community providers in health care network, exceptions.

Section
354.658

Designation nontransferable, site specific — annual affidavit required — notice of certain changes, required when.

Section
354.700

Definitions.

Section
354.702

Prepaid dental plans, who may offer — certificate of authority required — certain state laws not to apply.

Section
354.703

Director may order violators to cease and desist, hearing — noncompliance, director's remedies.

Section
354.704

Application for certificate of authority, content.

Section
354.705

Certificate of authority granted, when.

Section
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.

Section
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.

Section
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.

Section
354.715

Providers of dental care, written contract with prepaid dental plan corporations, review and mediation procedures for enrollees required.

Section
354.717

Director, powers — financial examinations, when, by whom made and paid.

Section
354.720

Annual report, required, content.

Section
354.721

Agents, registration required — rules and regulations authorized.

Section
354.722

Revocation or suspension of certificate of authority, when — notice, civil suit authorized — suspension, revocation, activity permitted.

Section
354.723

Rulemaking authorized.

Section
354.725

Exclusion, labor organization's health plans.