reglab/housing_qa huggingface dataset:
MO Rev Stat § 376.1385 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1385 - Second-level review procedures.

Effective - 28 Aug 2019, 2 histories   376.1385. Second-level review procedures. — 1. Upon receipt of a request for second-level review, a health carrier shall submit the grievance to a grievance advisory panel consisting of:  (1) Other enrollees; and  (2) Representatives of the health carrier that were not involved in the circumstances giving rise to the grievance or in any subsequent investigation or determination of the grievance.  2. Where the grievance involves an adverse determination, and the grievance advisory panel makes a preliminary decision that the determination should be upheld, the health* carrier shall submit the grievance for review to two independent clinical peers in the same or similar specialty as would typically manage the case being reviewed who were not involved in the circumstances giving rise to the grievance or in any subsequent investigation or determination of the grievance. In the event that both independent reviews concur with the grievance advisory panel's preliminary decision, the panel's decision shall stand. In the event that both independent reviewers disagree with the grievance advisory panel's preliminary decision, the initial** adverse determination shall be overturned. In the event that one of the two independent reviewers disagrees with the grievance advisory panel's preliminary decision, the panel shall reconvene and make a final decision in its discretion.  3. Review by the grievance advisory panel shall follow the same time frames as a first level review, except as provided for in section 376.1389 if applicable. Any decision of the grievance advisory panel shall include notice of the enrollee's or the health carrier's or plan sponsor's rights to file an appeal with the director's office of the grievance advisory panel's decision. The notice shall contain the toll-free telephone number and address of the director's office. ­­-------- (L. 1997 H.B. 335, A.L. 2019 S.B. 514)  *Word "heath" appears in original rolls. **Word "intitial" appears in original rolls.
MO Rev Stat § 376.1387 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1387 - Appeals of grievances determined by the director.

Effective - 28 Aug 1997   376.1387. Appeals of grievances determined by the director. — 1. The director shall resolve any grievance regarding an adverse determination as to covered services appealed by an enrollee or health carrier or plan sponsor through any means not specifically prohibited by law but if the grievance is unresolved by the director then it shall be resolved by referral of such grievance to an independent review organization. The director shall establish the qualifications for such review organizations(s) and shall seek the services of such organization(s) by competitive bid pursuant to chapter 34. The director shall enter into contracts with such organization(s) as deemed necessary to conduct the adverse determination appeals process set forth in this section. Any request for an adverse determination appeal shall be assigned on a rotational basis. The organization's decision as to the resolution of the grievance shall be based upon a review of the written record before it. The grievance and resolution of such grievance shall not be considered a contested case within the meaning of section 536.010, but the resolution of such grievance by the panel shall be considered a final agency decision within the director's discretion, binding upon the enrollee and health carrier, and subject to judicial review if:  (1) Action for such review is filed within thirty days of the final agency decision; and  (2) Judicial review is limited to the record before the director; and  (3) The enrollee and health carrier are deemed real parties in interest; and  (4) The scope of judicial review extends only to a determination of whether the action of the director is unconstitutional, unlawful, unreasonable, arbitrary, or capricious or involves an abuse of discretion or is in excess of the statutory authority or jurisdiction of the director.  2. Nothing in this section is intended to restrict the director's authority to investigate and resolve any complaint against a health carrier that does not constitute a grievance within the meaning of section 376.1350.  3. Any grievance involving coverage provided pursuant to a Medicaid program, however, shall be resolved in accordance with the rules and procedures established for the Medicaid program. ­­-------- (L. 1997 H.B. 335)
MO Rev Stat § 376.1389 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1389 - Expedited grievance review procedure.

Effective - 28 Aug 1997   376.1389. Expedited grievance review procedure. — 1. A health carrier shall establish written procedures for the expedited review of a grievance involving a situation where the time frame of the standard grievance procedures set forth in sections 376.1382 and 376.1385 would seriously jeopardize the life or health of an enrollee or would jeopardize the enrollee's ability to regain maximum function. A request for an expedited review may be submitted orally or in writing. However, for purposes of the grievance register requirements in section 376.1375, the request shall not be considered a grievance unless the request is submitted in writing. Expedited review procedures shall be available to an enrollee, the representative of an enrollee and to the provider acting on behalf of an enrollee.  2. A health carrier shall notify an enrollee orally within seventy-two hours after receiving a request for an expedited review of the carrier's determination, and shall provide written confirmation of its decision covering an expedited review within three working days of providing notification of the determination. The provisions of sections 376.1350 to 376.1390 are not applicable to health indemnity plans without a managed care component as defined in 376.1350. ­­-------- (L. 1997 H.B. 335)
MO Rev Stat § 376.1399 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1399 - Rules, effective, when — rules invalid and void, when.

Effective - 28 Aug 2007   376.1399. Rules, effective, when — rules invalid and void, when. — Any rule or portion of a rule promulgated pursuant to this act shall become effective only as provided pursuant to chapter 536, including, but not limited to, section 536.028, if applicable, after August 28, 1997. All rulemaking authority delegated prior to August 28, 1997, is of no force and effect and repealed. The provisions of this section are nonseverable and if any of the powers vested with the general assembly pursuant to section 536.028, if applicable, to review, to delay the effective date, or to disapprove and annul a rule or portion of a rule are held unconstitutional or invalid, the purported grant of rulemaking authority and any rule so proposed and contained in the order of rulemaking shall be invalid and void. ­­-------- (L. 1997 H.B. 335, A.L. 1997 H.B. 600, et al., § 376.1399 and § 14, A.L. 2007 S.B. 613 Revision)
MO Rev Stat § 376.1400 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1400 - Explanation of benefits, standardized information used, contents, when.

Effective - 28 Aug 1999   376.1400. Explanation of benefits, standardized information used, contents, when. — 1. Every health insurance carrier offering policies of insurance in this state shall use standardized information for the explanation of benefits given to the health care provider whenever a claim is paid or denied. As used in this section, the term "health insurance carrier" shall have the meaning given to "health carrier" in section 376.1350. Nothing in this section shall apply to accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, short-term major medical policies of six months or less duration, other limited benefit health insurance policies.  2. The standardized information shall contain the following:  (1) The name of the insured;  (2) The insured's identification number;  (3) The date of service;  (4) Amount of charge;  (5) Explanation for any denial;  (6) The amount paid;  (7) The patient's full name;  (8) The name and address of the insurer; and  (9) The phone number to contact for questions on explanation of benefits.  3. All health insurance carriers shall use the standard explanation of benefits information after January 1, 2002. ­­-------- (L. 1999 H.B. 191)
MO Rev Stat § 376.1403 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1403 - Referrals, standardized information used, content, when.

Effective - 28 Aug 1999   376.1403. Referrals, standardized information used, content, when. — 1. Every health care provider and health carrier that conducts business in this state shall use standardized information for referrals. As used in this section, the terms "health care provider" and "health carrier" shall have the meaning given to such terms in section 376.1350.  2. The referral information shall contain the following:  (1) The name of the insured;  (2) The name, address and phone number of the health carrier;  (3) The identification number and group number of the insured;  (4) The type of referral;  (5) The name, address and phone number of the health care provider referring the insured;  (6) The name, address and phone number of the health care provider to whom the insured was referred to;  (7) The number of visits requested and authorized; and  (8) The health carrier's authorization number.  3. All health care providers and health carriers shall use the standardized referral information after January 1, 2002. ­­-------- (L. 1999 H.B. 191 § 376.1406)
MO Rev Stat § 376.1450 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1450 - Enrollee's right to receive documents and materials in printed or electronic form, when.

Effective - 28 Aug 2010   376.1450. Enrollee's right to receive documents and materials in printed or electronic form, when. — An enrollee, as defined in section 376.1350, may receive documents and materials from a managed care entity in printed or electronic form so long as such documents and materials are readily accessible in printed form upon request. A request by the enrollee may include written, oral, or electronic means. Such requested printed form shall be provided to the enrollee within fifteen business days. For purposes of this section, "managed care entity" includes, but is not limited to, a health maintenance organization, preferred provider organization, point of service organization and any other managed health care delivery entity of any type or description. ­­-------- (L. 2002 H.B. 1473, A.L. 2010 S.B. 583)
MO Rev Stat § 376.1502 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1502 - Requirements for transaction of business.

Effective - 28 Aug 2007   376.1502. Requirements for transaction of business. — 1. It is unlawful to transact business in this state as a discount medical plan organization, unless the organization is a corporation, limited liability corporation, partnership, limited liability partnership or other legal entity organized under the laws of this state or, if a foreign entity, authorized to transact business in this state, and is registered as a discount medical plan organization with the director or duly authorized by the director as an insurance company, licensed health maintenance organization, licensed group health service organization, or licensed third-party administrator.  2. An individual person, employee, or agent of a registered entity described in subsection 1 of this section may also transact business in this state on behalf of such entity. ­­-------- (L. 2007 H.B. 818 merged with S.B. 66)  Effective 8-28-07 (S.B. 66;) 1-01-08 (H.B. 818)
MO Rev Stat § 376.1504 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1504 - Registration requirements — term of registration — renewal.

Effective - 28 Aug 2007   376.1504. Registration requirements — term of registration — renewal. — 1. To register as a discount medical plan organization, an applicant shall:  (1) File with the director an application on a form approved and adopted by the director; and  (2) Pay to the director an application fee of two hundred fifty dollars.  2. A registration is valid for a one-year term and expires one year following the registration date unless it is renewed as provided in this section.  3. Before it expires, a registrant may renew the registration for an additional one-year term if the registrant:  (1) Otherwise is qualified to receive a registration;  (2) Files with the director a renewal application on a form approved and adopted by the director; and  (3) Pays a renewal fee of two hundred fifty dollars.  4. All amounts collected as registration or renewal fees shall be deposited into the insurance dedicated fund.  5. Nothing in this subsection shall require a provider who provides discounts to his or her own patients to obtain and maintain a registration as a discount medical plan organization. ­­-------- (L. 2007 H.B. 818 merged with S.B. 66)  Effective 8-28-07 (S.B. 66); 1-01-08 (H.B. 818)
MO Rev Stat § 376.1506 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1506 - Violations, penalty.

Effective - 28 Aug 2007   376.1506. Violations, penalty. — 1. If the director has a reason to believe that the discount medical plan organization is not complying with the requirements of sections 376.1500 to 376.1532, the director may examine or investigate the business and affairs of any discount medical plan organization under the authority of sections 374.190 and 374.202 to 374.207. The director may require any discount medical plan organization or applicant to produce any records, books, files, advertising and solicitation materials, or other information and may take statements under oath to determine whether the discount medical plan organization or applicant is in violation of the law. Reasonable expenses incurred in conducting any examination shall be paid by the discount medical plan organization under sections 374.202 to 374.207.  2. Failure by the discount medical plan organization to pay the expenses incurred under this subsection shall be grounds for denial or revocation of the discount medical plan organization's registration. ­­-------- (L. 2007 H.B. 818 merged with S.B. 66)  Effective 8-28-07 (S.B. 66); 1-01-08 (H.B. 818)
MO Rev Stat § 376.1508 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1508 - Processing fee — cancellation of membership, effect of.

Effective - 28 Aug 2007   376.1508. Processing fee — cancellation of membership, effect of. — 1. A discount medical plan organization may charge a reasonable one-time processing fee and a periodic charge as long as the fee is disclosed to the applicant.  2. If the member cancels the membership within the first thirty days after receipt of the discount card and other membership materials, the member shall receive a reimbursement of all periodic charges paid. The return of all periodic charges shall be made within thirty days of the date of the cancellation. If all of the periodic charges have not been paid within thirty days, interest shall be assessed and paid on the proceeds at a rate of the treasury bill rate of the preceding calendar year, plus two percentage points.  3. The right of cancellation shall be set out in the written membership materials on the first page, in ten-point type or larger.  4. If a discount medical plan organization cancels a membership for any reason other than nonpayment of charges by the member, the discount medical plan organization shall make a pro rata reimbursement of all periodic charges to the member. ­­-------- (L. 2007 H.B. 818 merged with S.B. 66)  Effective 8-28-07 (S.B. 66); 1-01-08 (H.B. 818)
MO Rev Stat § 376.1510 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1510 - Prohibited acts.

Effective - 28 Aug 2007   376.1510. Prohibited acts. — A discount medical plan organization shall not:  (1) Use in its advertisements, marketing material, brochures, and discount cards the terms "health plan", "coverage", "co-pay", "co-payments", "preexisting conditions", "guaranteed issue", "premium", "PPO", "preferred provider organization", or other terms in a manner that could reasonably mislead a person to believe that the discount medical plan is health insurance;  (2) Except for hospital services, have restrictions on free access to plan providers including waiting periods and notification periods;  (3) Pay providers any fees for medical services;  (4) Collect or accept money from a member for payment to a provider for specific medical services furnished or to be furnished to the member, unless the organization is licensed by the director to act as an administrator; or  (5) Except as otherwise provided in sections 376.1500 to 376.1532, as a disclaimer of any relationship between discount medical plan benefits and insurance, or as a description of an insurance product connected with a discount medical plan, use in its advertisements, marketing material, brochures, and discount cards the term "insurance". ­­-------- (L. 2007 H.B. 818 merged with S.B. 66)  Effective 8-28-07 (S.B. 66); 1-01-08 (H.B. 818)
MO Rev Stat § 376.1512 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1512 - Required disclosures.

Effective - 28 Aug 2007   376.1512. Required disclosures. — 1. The following disclosures, to be printed in bold and in not less than twelve-point type, shall be made in writing to any prospective member and shall appear on the first page or first content page of any advertisements, marketing materials or brochures relating to a discount medical plan:  (1) The plan is not insurance;  (2) The plan provides discounts with certain health care providers for medical services;  (3) The plan does not make payments directly to the providers of medical services;  (4) The plan member is obligated to pay for all health care services but will receive a discount from those health care providers who have contracted with the discount plan organization; and  (5) The name and the location of the registered discount medical plan organization, including the current telephone number of the registered discount medical plan organization or other entity responsible for customer service for the plan, if different from the registered discount medical plan organization.  2. If the discount medical plan is sold, marketed, or solicited by telephone, the disclosures required by this section shall be made orally and provided in the initial written materials that describe the benefits under the discount medical plan provided to the prospective or new member.  3. Each discount card or any other plan identifier issued to a plan member shall state in bold and prominent type on the front face of the card that "THIS IS NOT INSURANCE". ­­-------- (L. 2007 H.B. 818 merged with S.B. 66)  Effective 8-28-07 (S.B. 66); 1-01-08 (H.B. 818)
MO Rev Stat § 376.1514 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1514 - Written agreement required, contents.

Effective - 28 Aug 2007   376.1514. Written agreement required, contents. — 1. All providers offering medical services to members under a discount medical plan shall provide such services pursuant to a written agreement. The agreement may be entered into directly by the health care provider or by a health care provider network to which the provider belongs if the provider network has contracts with the health care provider that allow the provider network to contract on behalf of the health care provider.  2. A health care provider agreement shall provide the following:  (1) A description of the services and products to be provided at a discount;  (2) The amount or amounts of the discounts or, alternatively, a fee schedule which reflects the health care provider's discounted rates; and  (3) A provision that the health care provider will not charge members more than the discounted rates.  3. A health care provider agreement with a health care provider network shall require that the health care provider network have written agreements with its health care providers that:  (1) Contain the terms described in this subsection;  (2) Authorize the health care provider network to contract with the discount medical plan organization on behalf of the provider; and  (3) Require the network to maintain an up-to-date list of its contracted health care providers and to provide that list on a quarterly basis to the discount medical plan organization.  4. A health care provider agreement between a discount medical plan organization and an entity that contracts with a health care provider network shall require that the entity, in its contract with the health care provider network, require the health care provider network to have written agreements with its providers that comply with subsection 3 of this section.  5. The discount medical plan organization shall maintain a copy of each active health care provider agreement into which it has entered. ­­-------- (L. 2007 H.B. 818 merged with S.B. 66)  Effective 8-28-07 (S.B. 66); 1-01-08 (H.B. 818)
MO Rev Stat § 376.1516 (2021)
2021 Missouri Revised Statutes|Title XXIV - Business and Financial Institutions|Chapter 376 - Life, Health and Accident Insurance|Section 376.1516 - Written membership materials, required contents — forms to be filed with director, fee.

 There are multiple enactments of 376.1516Effective - 01 Jan 2008, 2 histories   *376.1516. Written membership materials, required contents — forms to be filed with director, fee. — 1. Each benefit under the discount medical plan and every disclosure required under sections 376.1500 to 376.1532, shall be included in the written membership materials between the discount medical plan organization and the member. The written membership materials shall also include a statement notifying the members of their right to cancel under section 376.1508, and such materials shall also list all of the disclosures required by section 376.1512.  2. All forms used, including written membership materials, shall be filed with the director prior to any sale, marketing or advertising of the discount medical plan in this state. Every form filed shall be identified by a unique form number placed in the lower left corner of each form. A filing fee of twenty-five dollars per form shall be payable to the director for deposit into the insurance dedicated fund. ­­-------- (L. 2007 H.B. 818)  Effective 1-01-08  *This section was enacted by H.B. 818 and S.B. 66 during the First Regular Session of the 94th General Assembly, 2007. Due to possible conflict, both versions are printed here.