Missouri Chapter 376 — Life, Health and Accident Insurance
- § 376.010. — Who may form company--purposes.
- § 376.015. — Involuntary unemployment insurance may be issued in connection with extension of credit, requirements.
- § 376.020. — Various companies defined.
- § 376.050. — Declaration of corporators.
- § 376.060. — Stock companies--content of charter.
- § 376.070. — To be submitted to attorney general.
- § 376.080. — Director to examine, when.
- § 376.090. — To furnish certificate of deposit, when.
- § 376.100. — Mutual companies--contents of charter.
- § 376.110. — To be submitted to attorney general.
- § 376.120. — Director to examine and certify, when.
- § 376.130. — To furnish certificate of deposit, when.
- § 376.142. — Stock company may become mutual--procedure--policyholders' meeting--acquisition of stock.
- § 376.143. — Stock company may acquire its own shares to be held in trust for mutual--appointment, powers and duties of trustees.
- § 376.144. — Acquisition of shares of dissenting stockholders, procedure --abandonment of mutualization.
- § 376.145. — Officers of stock company to continue as officers of mutual.
- § 376.146. — Board of directors or trustees of mutual, membership qualifications, term of office.
- § 376.147. — Meetings of board of mutual, notice--executive committee of board, powers.
- § 376.148. — Policyholders are members of mutual--voting rights--directors may alter articles--additional assessments prohibited.
- § 376.150. — Stock and mutual companies--content of charter.
- § 376.160. — Formation of stock and mutual companies.
- § 376.170. — Special deposits for registered policies and annuity bonds.
- § 376.180. — Certificates as to registration and reserves on policy--policies exempt, exceptions.
- § 376.190. — Additional deposits required.
- § 376.200. — Definition of net value.
- § 376.210. — Excess deposits.
- § 376.220. — May use realty to secure notes and bonds.
- § 376.230. — Changing of securities on deposit.
- § 376.240. — Deposits to be held in trust by director.
- § 376.250. — Deposits to be kept separate.
- § 376.260. — Fees collected by director of revenue.
- § 376.270. — Director may proceed against depositary companies.
- § 376.280. — Capital necessary to do business--how invested.
- § 376.290. — Deposit and transfer of securities.
- § 376.300. — Investment of surplus and reserve funds.
- § 376.301. — Investments in Canadian securities, limitation.
- § 376.303. — Investments in evidences of indebtedness of certain international and foreign banks authorized, restrictions on.
- § 376.305. — Investments in common stocks--qualifications--limitations.
- § 376.307. — Limits on investments which are not eligible for state deposit.
- § 376.308. — Secondary mortgage market act, not to preempt health insurer, when.
- § 376.309. — Separate account defined--establishment of account and special voting or control rights authorized--approved investments--approval of director required.
- § 376.310. — Investment of surplus and reserve funds by foreign companies.
- § 376.311. — Investment of capital reserve and surplus of life insurance companies in investment pools--definitions--qualifications--requirements.
- § 376.320. — Bonds and evidences of debt to be valued, how.
- § 376.330. — Securities may be changed.
- § 376.350. — Reports to director.
- § 376.360. — Distribution of surplus funds to participating policyholders--method.
- § 376.370. — Director to value reserves, methods.
- § 376.380. — Legal minimum standards for valuation--procedures--reserves required --life insurance company to submit opinion of actuary, contents.
- § 376.383. — Health care claims for reimbursement, how paid, when--definitions --interest on unpaid claims--effective, when--penalties for unpaid claims, when--fraudulent claims, notification to the department, procedure--requests for additional information, contents.
- § 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.
- § 376.385. — Diabetes--insurance coverage for equipment, supplies and self-management training.
- § 376.390. — Reserve liability for group insurance--how computed.
- § 376.395. — Definitions for group health conversion policy requirements.
- § 376.397. — Converted policy to be offered on termination of group health coverage, when--exceptions--terms and conditions.
- § 376.398. — Application to all group policies--effective, when.
- § 376.401. — Conversion rights--retirees--dependents of insured.
- § 376.403. — Benefit levels--group coverage may be provided in lieu of converted policy--delivery outside state, form.
- § 376.404. — Specific requirement requests of policyholder may be met by alteration.
- § 376.405. — Group health and accident policies, approval required--exempt, when, director's powers.
- § 376.406. — Newborn child to be covered under health policies, extent of coverage--notification of birth, when, effect of--definitions.
- § 376.407. — Advance practice nurse, claims for service to be reimbursed, when.
- § 376.410. — Insurance companies to maintain reserves--exemptions.
- § 376.421. — Group health insurance, authorized categories.
- § 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.
- § 376.423. — Health insurance, claims for chiropractic services denial, qualified chiropractor to review, qualifications--investigation by department, when.
- § 376.424. — Group health insurance policies may be extended to insure family members or dependents.
- § 376.425. — Student accident policies, may not limit surgical benefits, when.
- § 376.426. — Group health policies, required provisions.
- § 376.427. — Assignment of benefits made by insured to provider--payment, how made--exceptions--all claims to be paid, when.
- § 376.428. — Group health policies to continue for a period of time after termination of employment or membership in health service or maintenance organizations--state law to apply, when.
- § 376.429. — Coverage for certain clinical trials for prevention, early detection and treatment of cancer, restrictions--definitions--exclusions.
- § 376.431. — Employees or members of unions or associations, group or group-type basis coverage, sections 376.431 to 376.442 to apply.
- § 376.432. — Group-type basis, defined.
- § 376.433. — Self-insurance plans for health care, public entities--subject to Medicaid rights, obligations, and remedies.
- § 376.434. — Carrier liable for claims incurred during grace period, when --exceptions.
- § 376.436. — Discontinuance notice by carrier, contents--notice forms furnished by carrier for distribution to policyholders.
- § 376.438. — Group policies, modifying or amending benefits shall provide extension of benefits in event of total disability at date of termination or discontinuance.
- § 376.441. — Carrier contract replaced by similar benefit plan of another carrier --liability of prior carrier--succeeding carrier coverage requirements.
- § 376.442. — Rules and regulations, procedure.
- § 376.480. — Domestic companies may assume risks of foreign companies--duties of director.
- § 376.500. — Discriminations, rebates and favors prohibited--contracts to conform to policy.
- § 376.510. — Penalty for violation of section 376.500.
- § 376.530. — Married woman may insure life of husband.
- § 376.531. — Life insurance policies, consent of insured required, exceptions--employers have insurable interest in employees, when, effects.
- § 376.540. — Policy, to whom payable.
- § 376.550. — Unmarried woman may insure whom.
- § 376.562. — Charitable, benevolent, educational and religious organizations may be beneficiary or owner of policy, life insurance, when--fraud or coercion, exception.
- § 376.570. — Foreign executor or administrator.
- § 376.580. — Misrepresentation.
- § 376.590. — Misrepresentations, false estimates and circulars prohibited--agents --notes to be held until policy delivered.
- § 376.600. — Penalty for violating section 376.590.
- § 376.610. — Defense in case of suits.
- § 376.620. — Suicide no defense, when.
- § 376.630. — Life insurance policies not to be forfeited or become invalid, when.
- § 376.640. — Paid-up policy may be demanded, when.
- § 376.650. — Rules of payment on commuted policy.
- § 376.660. — Foregoing provisions inapplicable, when.
- § 376.669. — Annuity contract requirements--paid-up annuity benefits, how calculated--cash surrender benefits, how calculated--applicable, when.
- § 376.670. — Provisions which shall be contained in life insurance policies, exceptions.
- § 376.671. — Provisions which shall be contained in annuity contracts--expiration date.
- § 376.672. — Policy loan interest rates, terms and conditions established by director, how, when.
- § 376.673. — Life insurance policies, regulations relative to.
- § 376.674. — Life insurance policies, no cash surrender value, regulations relative to.
- § 376.675. — Life insurance policies and annuity contracts to be approved --exemption, when--director's powers--judicial review of disapproval.
- § 376.676. — Regulation of the valuation of life insurance policies--may adopt NAIC model regulation.
- § 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.
- § 376.678. — Life insurance policies and annuity contracts, annual statement to holder required--company to furnish policy or contract information to holder upon request.
- § 376.679. — Life insurance company may reinsure for risks involving aircraft, limitation.
- § 376.680. — Assignment of incidents of ownership, group life policy, effect of.
- § 376.691. — Group life policies, eligible groups authorized for issue--premiums, how paid.
- § 376.693. — Special group life policies, requirements--director's approval.
- § 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.
- § 376.695. — Extension of policy to insure for loss due to death of spouse or dependent children, requirements, limitations.
- § 376.696. — Political subdivisions purchasing any insurance policies to submit to competitive bidding, when--renewal between bidding periods deemed extension.
- § 376.697. — Required provisions for group life policies.
- § 376.699. — Person insured by group policy entitled to individual life policy, notice requirements.
- § 376.700. — Purpose--use of additional material.
- § 376.702. — Application of law--exceptions.
- § 376.704. — Definitions.
- § 376.706. — Delivery of guide and summary required, when.
- § 376.708. — Required presentations and statements--company to maintain file.
- § 376.710. — Effect of omission.
- § 376.712. — Effective date.
- § 376.714. — Contents and form of buyer's guide.
- § 376.715. — Citation of law, purpose.
- § 376.717. — Coverages provided, persons covered--coverage not provided, when --maximum benefits allowable.
- § 376.718. — Definitions.
- § 376.720. — Association, created--accounts--director to supervise.
- § 376.722. — Board of directors, established, members, how selected--expense reimbursement.
- § 376.724. — Impaired insurers, association's options, duties--insolvent insurers, association's options, duties--alternative policies, requirements.
- § 376.725. — Terminated coverage, reissuance of, premium set, how.
- § 376.726. — Nonpayment of premiums, effect of.
- § 376.728. — Law not applicable, when.
- § 376.730. — Liens, association may impose, when.
- § 376.732. — Director to have association's powers and duties, when--association may appear in court, when.
- § 376.733. — Assignment of rights to association by persons receiving benefits, when.
- § 376.734. — Powers of association--legal counsel, who may be retained.
- § 376.735. — Assessments against members, when due, classes--amounts, how determined.
- § 376.737. — Deferment of assessment, how, when--maximum assessment--refund of, when--members may increase premiums to cover assessments.
- § 376.738. — Certificate of contribution, when issued.
- § 376.740. — Plan of operation, required, approval of director--provisions of plan.
- § 376.742. — Director, powers and duties.
- § 376.743. — Board of directors, powers--examinations by director, when.
- § 376.745. — Assessments, offset against tax liability, when, how.
- § 376.746. — Records of association meetings to be kept--association deemed creditor of insolvent or impaired insured.
- § 376.747. — Distribution of member insurer assets upon liquidation, priority of association.
- § 376.748. — Liquidation, recovery of distributions, when, exceptions, limitations.
- § 376.750. — Financial report, submitted to director, when--tax exempt status --immunity from liability.
- § 376.752. — Member insurer's deposit with director, exemption from, amount.
- § 376.754. — Stay of proceedings, insolvent insurer, when.
- § 376.755. — Advertising, use of guaranty association prohibited.
- § 376.756. — Summary document, association to prepare, when, contents--policy not covered by guaranty association to contain notice, form determined by director.
- § 376.758. — Law inapplicable to insolvent insurers on effective date of law.
- § 376.770. — Title of law.
- § 376.773. — Definitions.
- § 376.775. — Matters required in policies.
- § 376.776. — Hospital and medical expense provisions extended for certain handicapped children past normal coverage age.
- § 376.777. — Specifically required provisions--exemptions, when--director's powers.
- § 376.778. — Payment direct to public hospitals or clinics with or without assignment, when--provisions required in contracts.
- § 376.779. — Health insurance policies to offer coverage for treatment of alcoholism--exclusions.
- § 376.780. — Limits on provisions, effect of conflict of policy with law.
- § 376.781. — Speech and hearing disorders, companies to offer coverage, when --rules, procedure.
- § 376.782. — Mammography--low-dose screening, defined--health care policies to provide required coverage.
- § 376.783. — Insured bound only if copy of application attached to policy.
- § 376.785. — What does not constitute waiver of defenses.
- § 376.787. — Effect of age limit provision.
- § 376.790. — Limits on applicability of law.
- § 376.800. — Misrepresentation made in obtaining individual accident and health policy no defense, exception.
- § 376.801. — Coverage for child health supervision services required--definitions --permitted limitations on benefits.
- § 376.805. — Elective abortion to be by optional rider and requires additional premium--elective abortion defined.
- § 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.
- § 376.807. — Policies not to reduce or deny benefits to persons eligible for medical assistance--deemed primary contract.
- § 376.810. — Definitions for policy requirements for chemical dependency.
- § 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.
- § 376.814. — Rules and regulations authorized, department of mental health to advise department of insurance--procedure.
- § 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.
- § 376.818. — Eligibility for Medicaid may not be considered by insurers.
- § 376.819. — Division of medical services to have right to payment for health care services provided.
- § 376.820. — Insurers may not deny coverage of child because of marital status of parents, residence or income tax dependency claim.
- § 376.821. — Insurers may not cancel health or dental insurance solely because the insured is incarcerated--insurer, defined.
- § 376.823. — Prohibition on kickbacks not applicable for rebates for certain chronic illnesses.
- § 376.825. — Title.
- § 376.826. — Definitions.
- § 376.827. — Requirements for mental illness coverage--parity with coverage provided for physical conditions.
- § 376.830. — Services administered and delivered by whom--contracted services permitted, when.
- § 376.833. — Inapplicability of section 376.827, when--waiver granted to policyholder, when.
- § 376.836. — Effective date--study conducted by director, contents, report to general assembly--exclusions--expiration date.
- § 376.840. — (Repealed L. 2004 H.B. 855 § A)
- § 376.850. — Law, how cited.
- § 376.854. — Definitions.
- § 376.859. — Medicare supplement law applicable to what policies--policies not included.
- § 376.864. — Policies not to duplicate benefits provided by Medicare--preexisting conditions, limitations on--director to issue rules establishing standards.
- § 376.869. — Standards for policies, minimum, director to adopt.
- § 376.874. — Requirements of policy, return to policyholders.
- § 376.879. — Outline of coverage for fair disclosure--furnished to each applicant --format and content--rules and standards.
- § 376.881. — Policy certificate front page to contain notice of right to return and receive premium refund.
- § 376.884. — Advertisement to be reviewed by director.
- § 376.886. — Regulations, requirements--rules, procedure.
- § 376.889. — Violations, penalty.
- § 376.890. — Invalidity of any section regulating Medicare supplement not to affect others.
- § 376.891. — Definitions.
- § 376.892. — Surviving spouse may continue coverage, when--divorced or separated spouse may continue coverage, when--services offered.
- § 376.893. — Divorced or separated spouse, continuation of coverage, notice --contents of notice--failure to elect, effect--application.
- § 376.894. — Amount of premium, date of payment--termination of right of continuation of coverage, grounds.
- § 376.900. — Definitions.
- § 376.905. — Administration by department of insurance, powers, duties--fees.
- § 376.910. — Certificate of authority required.
- § 376.915. — Application for certificate, content--renewal, content, filed when --extensions, fee.
- § 376.920. — Annual statement, form, contents.
- § 376.925. — Seven-day rescission period, all money or property to be refunded.
- § 376.930. — Insured to be furnished application for certificate and annual statement, when.
- § 376.935. — Certificates issued for one year--nontransferable--not endorsement by department.
- § 376.940. — Escrow account for entrance fees required, released when.
- § 376.945. — Escrow account, amount required--principal, how released, investment.
- § 376.950. — Board of directors, one member to be resident of facility.
- § 376.951. — (Transferred 2002; now 376.1100) (Transferred 2002; now 376.1103) (Transferred 2002; now 376.1106) (Transferred 2002; now 376.1109) (Transferred 2002; now 376.1112) (Transferred 2002; now 376.1115) (Transferred 2002; now 376.1118)
- § 376.960. — Definitions.
- § 376.961. — Missouri health insurance pool created--members to be all health insurers in state--organizational meeting--board of directors, members, qualifications, selection or appointment--administrator, appointment.
- § 376.962. — Plan of operation to be submitted by board--effective when--failure to submit, director's duty to develop rules--plan content.
- § 376.964. — Board, powers and duties--including providing for issuing policies and reinsuring risks--staff appointment--rulemaking authority.
- § 376.965. — Board members not civilly liable for performance of duties, exception.
- § 376.966. — Residents of state to be eligible, exceptions--no employee to lose coverage by enrolling in pool--rules, to enforce.
- § 376.968. — Administration of pool by insurer or insurers by competitive bids --insurer's qualifications--board to establish criteria for bid content.
- § 376.970. — Administering insurer to serve for three years subject to removal for cause--duties--reports.
- § 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.
- § 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.
- § 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.
- § 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 succeeding years until excess is exhausted.
- § 376.982. — Rulemaking procedure.
- § 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.
- § 376.986. — Pool to offer medical coverage--premiums, how set--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.
- § 376.989. — No liability, criminal or civil, for participation in pool by members.
- § 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.
- § 376.1000. — Multiple employer self-insured health plan, defined.
- § 376.1002. — Certificate of authority required--penalty for noncompliance--law inapplicable, when--exempt organizations.
- § 376.1005. — Application for certificate of authority, form--fee--policy or other evidence of coverage provided to employees, form.
- § 376.1007. — Plan to file copy of bylaws, coverage and agreements with director.
- § 376.1010. — Excess stop-loss coverage maintained by plan.
- § 376.1012. — Funds collected from employers held in trust--requirements--board of trustees, elected, duties--annual report, filed when.
- § 376.1015. — Department not to grant approval, when.
- § 376.1017. — Plan to establish loss reserves--plan to establish surplus account, amount.
- § 376.1020. — Plan to maintain principal place of business in Missouri, exception.
- § 376.1022. — Dissolution of plan, application, procedure, granted when --distribution of assets, procedures.
- § 376.1025. — Director may adopt rules.
- § 376.1027. — Plan in unsound condition, powers of director.
- § 376.1030. — Agreement of employer to pay benefits, requirements, form--copy filed with director--no excuse from liability.
- § 376.1032. — Plan considered insurer, when.
- § 376.1035. — Chapter 376, RSMo, applicable to plan.
- § 376.1037. — Plan subject to premium taxes.
- § 376.1040. — Plan not to be offered to general public--marketing restrictions.
- § 376.1042. — Marketing by agent, agency or broker violation of law.
- § 376.1045. — Injunctive relief, director may seek, when--procedures.
- § 376.1075. — Definitions.
- § 376.1077. — Administrator to have agreement with insurer, form, contents --termination, how.
- § 376.1080. — Payments of premiums and claims deemed paid, when.
- § 376.1082. — Records maintained by administrator for insurer--director may examine records--records owned by insurer, transfer allowed, when.
- § 376.1083. — Advertising restrictions for administrator.
- § 376.1084. — Insurer responsible for benefits and underwriting practices--insurer to conduct review of administrator, when.
- § 376.1085. — Premiums held in fiduciary capacity, duties--financial records, duties--withdrawals from fiduciary account by agreement only, contents--payment of claims.
- § 376.1087. — Commissions not to be contingent on savings in payment of claims--may be based on premiums collected.
- § 376.1088. — Notice to policyholder of administrator, contents, required --disclosure of receipts to insurer.
- § 376.1090. — Materials delivered to administrator for insured to be promptly delivered.
- § 376.1092. — Certificate of authority, required, application, contents, fee --refusal to issue, when--renewal--bond, required when.
- § 376.1093. — Annual report filed with director, when--contents--filing fee, amount.
- § 376.1094. — Certificate of authority, suspension or revocation, grounds--civil action, when.
- § 376.1095. — Rules and regulations, promulgation.
- § 376.1100. — Law, how cited--definitions.
- § 376.1103. — Laws applicable, Medicare supplement laws not applicable--purpose--policies or riders must be in compliance.
- § 376.1106. — Policies issued in other states may be issued to residents of Missouri if in compliance with Missouri regulations.
- § 376.1109. — Policies, content requirements, provisions prohibited--rules authorized.
- § 376.1112. — Director to provide buyer's guide--content--advertising of long-term care policies to contain notice of availability of guide.
- § 376.1115. — Coverage outline to be delivered to applicants, when, content.
- § 376.1118. — Benefits funded by a life insurance death benefit acceleration, reports to policyholder required, content.
- § 376.1121. — Denial of claim, long-term care insurance, duties of issuer.
- § 376.1124. — Rescinding of a long-term care policy, permitted when--grounds for contesting--no field issuance, when.
- § 376.1127. — Nonforfeiture benefit option required for long-term care insurance policies, requirements of offer--rulemaking authority.
- § 376.1130. — Rulemaking authority.
- § 376.1199. — Coverage for certain obstetrical/gynecological services--exclusion of contraceptive coverage permitted, when--rulemaking authority.
- § 376.1200. — Certain policies to offer coverage for treatment of breast cancer--limitation on deductible, lifetime maximum benefit--administration of benefits--application, effect.
- § 376.1209. — Mastectomy--mandatory insurance coverage for prosthetic devices and reconstructive surgery--no time limit to be imposed.
- § 376.1210. — Maternity benefits, minimum hospital stays, exceptions--notice of benefits, contents--attending physician defined--rulemaking.
- § 376.1215. — Immunizations, mandated coverage, exceptions, rulemaking.
- § 376.1218. — Insurance coverage for children enrolled in the Part C early intervention system (First Steps).
- § 376.1219. — PKU formula and low protein modified food products covered by insurance, when--exceptions.
- § 376.1220. — Insurance coverage for newborn hearing screenings mandated.
- § 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.
- § 376.1225. — Mandated coverage for general anesthesia and hospital charges for dental care, when--prior authorization required, when--exceptions.
- § 376.1230. — Chiropractic care coverage, rates, terms, conditions, limits, and exclusions.
- § 376.1250. — Cancer screening, health insurance coverage required, when, types --department of health and senior services duties.
- § 376.1253. — Second opinion, right of newly diagnosed cancer patients, attending physician to inform--insurance coverage for such second opinions required, when.
- § 376.1275. — Coverage for human leukocyte antigen testing for bone marrow transplantation required, when--exceptions.
- § 376.1290. — Coverage for lead testing.
- § 376.1300. — Reorganization of a domestic mutual life insurance company, authority.
- § 376.1305. — Formation of holding company, application--shareholder approval.
- § 376.1307. — Issuance of shares.
- § 376.1309. — Member's interest--nontransference of membership--immunity from liability--assessments, not imposed--security, membership interest.
- § 376.1312. — Nonapplicability of certain provisions of insurance holding companies law.
- § 376.1315. — Incorporation of mutual holding company, authority, approval.
- § 376.1318. — Powers of mutual holding company, engaging in business of insurance, no authority, affiliation and merger agreements.
- § 376.1322. — Mutual holding company subject to supervision of director, dissolution or liquidation--demutualization.
- § 376.1350. — Definitions.
- § 376.1353. — Utilization review activities monitored.
- § 376.1356. — Utilization review organization monitored, when.
- § 376.1359. — Written utilization program implemented, filed with the director.
- § 376.1361. — Documented clinical review criteria used in a utilization program --medical director qualifications--compensation of utilization review services.
- § 376.1363. — Utilization review decisions, procedures.
- § 376.1365. — Reconsideration of an adverse determination, when.
- § 376.1367. — Emergency services benefit determination, coverage required, when.
- § 376.1369. — Certification of compliance, when.
- § 376.1372. — Certification and member handbook to include utilization review procedures.
- § 376.1375. — Registry of grievances maintained, procedures--definitions.
- § 376.1378. — Grievances and certificate of compliance filed with the director, when.
- § 376.1382. — First- and second-level grievance review for managed care plans, first-level procedures.
- § 376.1385. — Second-level review procedures.
- § 376.1387. — Appeals of grievances determined by the director.
- § 376.1389. — Expedited grievance review procedure.
- § 376.1399. — Rules, effective, when--rules invalid and void, when--rulemaking procedure--subsections 2 through 5 of this section terminate July 27, 1997.
- § 376.1400. — Explanation of benefits, standardized information used, contents, when.
- § 376.1403. — Referrals, standardized information used, content, when.
- § 376.1450. — Waiver of enrollee's right to receive documents and materials in printed form, when.
- § 376.1550. — Mental health coverage, requirements--definitions--exclusions.