reglab/statecodes huggingface dataset:
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1183 - Breast examinations, no cost-sharing requirements.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2023
376.1183. Breast examinations, no cost-sharing requirements. —
1. For purposes of this section, the following terms mean:
(1)
"Cost-sharing requirement"
, any deductible, coinsurance, co-payment, or maximum limitation on the application of such deductible, coinsurance, co-payment, or similar out-of-pocket expense;
(2)
"Diagnostic breast examination"
, any medically necessary and appropriate examination of the breast, including such an examination using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound, that is:
(a) Used to evaluate an abnormality seen or suspected from a screening examination for breast cancer; or
(b) Used to evaluate an abnormality detected by another means of examination;
(3)
"Health benefit plan"
, the same meaning given to the term in section 376.1350;
(4)
"Health carrier"
, the same meaning given to the term in section 376.1350;
(5)
"Supplemental breast examination"
, any medically necessary and appropriate examination of the breast, including such an examination using breast magnetic resonance imaging or breast ultrasound, that is:
(a) Used to screen for breast cancer when there is no abnormality seen or suspected; and
(b) Based on personal or family medical history or any additional factors that may increase the patient's risk of breast cancer.
2. Each health carrier or health benefit plan that offers or issues health benefit plans that are delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2024, and that provide coverage for diagnostic breast examinations, coverage for supplemental breast examinations, coverage required under section 376.782, or any combination of such coverages shall not impose any cost-sharing requirements with respect to any such coverage.
3. If, under federal law, application of the requirement under subsection 2 of this section would result in health savings account ineligibility under Section 223 of the Internal Revenue Code, the requirement under subsection 2 of this section shall apply to health savings account-qualified high deductible health plans with respect to the deductible of such a plan after the enrollee has satisfied the minimum deductible under Section 223, except with respect to items or services that are preventive care under Section 223(c)(2)(C) of the Internal Revenue Code, in which case the requirement of subsection 2 of this section shall apply regardless of whether the minimum deductible under Section 223 has been satisfied.
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(L. 2023 S.B. 106)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1190 - Health care mandates — review by oversight division — actuarial analysis.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
Effective - 28 Aug 2011
376.1190. Health care mandates — review by oversight division — actuarial analysis. —
Any health care benefit mandate proposed after August 28, 2011, shall be subject to review by the oversight division of the joint committee on legislative research. The oversight division shall perform an actuarial analysis of the cost impact to private and public payers of any new or revised mandated health care benefit proposed by the general assembly after August 28, 2011, and a recommendation shall be delivered to the speaker and the president pro tem prior to mandate being enacted.
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(L. 2011 S.B. 62 § 376.1190, subsec. 3)
CROSS REFERENCE:
Nonseverability clause, 190.840
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1209 - Mastectomy — mandatory insurance coverage for prosthetic devices and reconstructive surgery — no time limit to be imposed.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
Effective - 28 Aug 2001
376.1209. Mastectomy — mandatory insurance coverage for prosthetic devices and reconstructive surgery — no time limit to be imposed. —
1. Each entity offering individual and group health insurance policies providing coverage on an expense-incurred basis, individual and group service or indemnity type contracts issued by a nonprofit corporation, individual and group service contracts issued by a health maintenance organization, all self-insured group arrangements to the extent not preempted by federal law, and all managed health care delivery entities of any type or description, that provide coverage for the surgical procedure known as a mastectomy, and which are delivered, issued for delivery, continued or renewed in this state on or after January 1, 1998, shall provide coverage for prosthetic devices or reconstructive surgery necessary to restore symmetry as recommended by the oncologist or primary care physician for the patient incident to the mastectomy. Coverage for prosthetic devices and reconstructive surgery shall be subject to the same deductible and coinsurance conditions applied to the mastectomy and all other terms and conditions applicable to other benefits with the exception that no time limit shall be imposed on an individual for the receipt of prosthetic devices or reconstructive surgery and if such individual changes his or her insurer, then the new policy subject to the federal Women's Health and Cancer Rights Act (Sections 901-903 of P.L. 105-277), as amended, shall provide coverage consistent with the federal Women's Health and Cancer Rights Act (Sections 901-903 of P.L. 105-277), as amended, and any regulations promulgated pursuant to such act.
2. As used in this section, the term
"mastectomy"
means the removal of all or part of the breast for medically necessary reasons, as determined by a physician licensed pursuant to chapter 334.
3. The provisions of this section shall not apply to a supplemental insurance policy, including a life care contract, accident-only policy, specified disease policy, hospital policy providing a fixed daily benefit only, Medicare supplement policy or long-term care policy.
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(L. 1997 H.B. 129, A.L. 2001 H.B. 762)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1215 - Immunizations, mandated coverage, exceptions, rulemaking.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1996
376.1215. Immunizations, mandated coverage, exceptions, rulemaking. —
1. All individual and group health insurance policies providing coverage on an expense-incurred basis, individual and group service or indemnity type contracts issued by a health services corporation, individual and group service contracts issued by a health maintenance organization and all self-insured group arrangements to the extent not preempted by federal law and all managed health care delivery entities of any type or description shall provide coverage for immunizations of a child from birth to five years of age as provided by department of health and senior services regulations.
2. Such coverage shall not be subject to any deductible or co-payment limits.
3. The contract issued by a health maintenance organization may provide that the benefits required pursuant to this section shall be covered benefits only if the services are rendered by a provider who is designated by and affiliated with the health maintenance organization, except that the health maintenance organization shall, as a condition of participation, comply with the immunization requirements of state or federally funded health programs.
4. This section shall not apply to supplemental insurance policies, including life care contracts, accident-only policies, specified disease policies, hospital policies providing a fixed daily benefit only, Medicare supplement policies, long-term care policies, coverage issued as a supplement to liability insurance, short-term major medical policies of six months or less duration and other supplemental policies as determined by the department of commerce and insurance.
5. The department of health and senior services shall promulgate rules and regulations to determine which immunizations shall be covered by policies, plans or contracts described in this section. No rule or portion of a rule promulgated under the authority of this section shall become effective unless it has been promulgated pursuant to the provisions of section 536.024.
6. No health care provider shall charge more than one hundred percent of the reasonable and customary charges for providing any immunization.
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(L. 1996 H.B. 904, et al. § 1)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1219 - PKU formula and low protein modified food products covered by insurance, when — exceptions.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2002
376.1219. PKU formula and low protein modified food products covered by insurance, when — exceptions. —
1. Each policy issued by an entity offering individual and group health insurance which provides coverage on an expense-incurred basis, individual and group health service or indemnity type contracts issued by a nonprofit corporation, individual and group service contracts issued by a health maintenance organization, all self-insured group health arrangements to the extent not preempted by federal law, and all health care plans provided by managed health care delivery entities of any type or description, that are delivered, issued for delivery, continued or renewed in this state on or after September 1, 1997, shall provide coverage for formula and low protein modified food products recommended by a physician for the treatment of a patient with phenylketonuria or any inherited disease of amino and organic acids who is covered under the policy, contract, or plan and who is less than six years of age.
2. For purposes of this section,
"low protein modified food products"
means foods that are specifically formulated to have less than one gram of protein per serving and are intended to be used under the direction of a physician for the dietary treatment of any inherited metabolic disease. Low protein modified food products do not include foods that are naturally low in protein.
3. The coverage required by this section may be subject to the same deductible for similar health care services provided by the policy, contract, or plan as well as a reasonable coinsurance or co-payment on the part of the insured, which shall not be greater than fifty percent of the cost of the formula and food products, and may be subject to an annual benefit maximum of not less than five thousand dollars per covered child. Nothing in this section shall prohibit a carrier from using individual case management or from contracting with vendors of the formula and food products.
4. This section shall not apply to a supplemental insurance policy, including a life care contract, accident-only policy, specified disease policy, hospital policy providing a fixed daily benefit only, Medicare supplement policy, long-term care policy, or any other supplemental policy as determined by the director of the department of commerce and insurance.
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(L. 1997 H.B. 600 & 388, A.L. 2002 S.B. 1026)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1220 - Insurance coverage for newborn hearing screenings mandated.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1999
376.1220. Insurance coverage for newborn hearing screenings mandated. —
1. Each policy issued by an entity offering individual and group health insurance which provides coverage on an expense-incurred basis, individual or group health service, or indemnity contracts issued by a nonprofit corporation, individual and group service contracts issued by a health maintenance organization, all self-insured group health arrangements to the extent not preempted by federal law, and all health care plans provided by managed health care delivery entities of any type or description that are delivered, issued for delivery, continued or renewed in this state shall provide coverage for newborn hearing screening, necessary rescreening, audiological assessment and follow-up, and initial amplification.
2. The health care service required by this section shall not be subject to any greater deductible or co-payment than other similar health care services provided by the policy, contract or plan.
3. This section shall not apply to a supplemental insurance policy, including a life care contract, accident-only policy, specified disease policy, hospital policy providing a fixed daily benefit only, Medicare supplement policy, long-term care policy, short-term major medical policies of six months or less duration, or any other supplemental policy as determined by the director of the department of commerce and insurance.
4. Coverage for newborn hearing screening and any necessary rescreening and audiological assessment shall be provided to newborns eligible for medical assistance pursuant to section 208.151, and the children's health program pursuant to sections 208.631 to 208.660, with payment for the newborn hearing screening required in section 191.925, and any necessary rescreening, audiological assessment and follow-up, and amplification as described in section 191.928.
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(L. 1999 H.B. 401 § 376.685)
CROSS REFERENCE:
Rulemaking authority, 191.937
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 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.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
Effective - 28 Aug 2003
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. —
1. Any health insurance policy through the Medicaid program pursuant to chapter 208, the children's health insurance program pursuant to sections 208.631 to 208.660, and any health care plans issued to employees under the Missouri consolidated health care plan established pursuant to chapter 103 that are delivered, issued for delivery, continued or renewed in this state on or after January 1, 2004, shall provide coverage for prostheses and expenses for scalp hair prostheses worn for hair loss suffered as a result of alopecia areata or alopecia totalis for persons eighteen years of age or younger who are covered under a policy, program or plan pursuant to this section.
2. For purposes of this section, the following terms mean:
(1)
"Prostheses"
, artificial appliances used to replace lost natural structures;
(2)
"Scalp hair prostheses"
, artificial substitutes for scalp hair that are made specifically for a particular individual.
3. The coverage required by this section shall not be more than a maximum benefit amount of two hundred dollars per calendar year or exceed a lifetime maximum benefit amount of three thousand two hundred dollars for those persons who select a more permanent scalp hair prosthesis. A person may request a one-time expenditure of up to three thousand two hundred dollars. The benefits required by this section shall expire when total benefits paid reach three thousand two hundred dollars or when such person listed in subsection 1 of this section reaches eighteen years of age.
4. The health care service required by this section shall not be subject to any greater deductible or co-payment than other similar health care services provided by the policy, program, or plan.
5. Nothing in this section shall prohibit a health insurer or health benefit plan from providing coverage that is greater than or more favorable to persons than the coverage provided by this section.
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(L. 2003 H.B. 455)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1225 - Mandated coverage for general anesthesia and hospital charges for dental care, when — prior authorization required, when — exceptions.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
Effective - 28 Aug 1998
376.1225. Mandated coverage for general anesthesia and hospital charges for dental care, when — prior authorization required, when — exceptions. —
1. All individual and group health insurance policies providing coverage on an expense-incurred basis, individual and group service or indemnity type contracts issued by a nonprofit corporation, individual and group service contracts issued by a health maintenance organization, all self-insured group arrangements to the extent not preempted by federal law and all managed health care delivery entities of any type or description, that are delivered, issued for delivery, continued or renewed on or after August 28, 1998, shall provide coverage for administration of general anesthesia and hospital charges for dental care provided to the following covered persons:
(1) A child under the age of five;
(2) A person who is severely disabled; or
(3) A person who has a medical or behavioral condition which requires hospitalization or general anesthesia when dental care is provided.
2. Each plan as described in this section must provide coverage for administration of general anesthesia and hospital or office charges for treatment rendered by a dentist, regardless of whether the services are provided in a participating hospital or surgical center or office.
3. Nothing in this section shall prevent a health carrier from requiring prior authorization for hospitalization for dental care procedures in the same manner that prior authorization is required for hospitalization for other covered diseases or conditions.
4. Nothing in this section shall apply to accident-only, dental-only plans or other specified disease, hospital indemnity, Medicare supplement or long-term care policies, or short-term major medical policies of six months or less in duration.
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(L. 1998 H.B. 1302 § 8)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1226 - Fee schedule for services not covered under health benefit plans — definitions.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
Effective - 28 Aug 2013
376.1226. Fee schedule for services not covered under health benefit plans — definitions. —
1. No contract between a health carrier or health benefit plan and a dentist for the provision of dental services under a dental plan shall require that the dentist provide dental services to insureds in the dental plan at a fee established by the health carrier or health benefit plan if such dental services are not covered services under the dental plan.
2. For purposes of this section, the following terms shall mean:
(1)
"Covered services"
, services reimbursable by a health carrier or health benefit plan under an applicable dental plan, subject to such contractual limitations on benefits as may apply, including but not limited to deductibles, waiting periods, or frequency limitations;
(2)
"Dental plan"
, any policy or contract of insurance which provides for coverage of dental services;
(3)
"Health benefit plan"
, the same meaning as such term is defined in section 376.1350;
(4)
"Health carrier"
, the same meaning as such term is defined in section 376.1350.
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(L. 2013 H.B. 315)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1228 - Hearing aids coverage for children required — amount of coverage — exclusions — additional state costs subject to appropriations.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
Effective - 28 Aug 2021
376.1228. Hearing aids coverage for children required — amount of coverage — exclusions — additional state costs subject to appropriations. —
1. For purposes of this section, the terms
"health carrier"
and
"health benefit plan"
shall have the same meanings given to the terms under section 376.1350, and the term
"hearing aid"
shall have the same meaning given to the term under section 345.015.
2. Each health carrier or health benefit plan that offers or issues health benefit plans that are delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2022, shall, at a minimum, provide coverage to children under eighteen years of age for all hearing aids covered for children who receive MO HealthNet benefits under section 208.151.
3. The provisions of this section shall not apply to a supplemental insurance policy, including a life care contract, accident-only policy, specified disease policy, hospital policy providing a fixed daily benefit only, Medicare supplement policy, long-term care policy, short-term major medical policies of six months' or less duration, or any other supplemental policy as determined by the director of the department of commerce and insurance.
4. Any additional costs to the state created under the provisions of this section shall be subject to appropriation. If any agency of the federal government determines that this section violates 42 U.S.C. Section 18116 relating to nondiscrimination, the provisions of this section shall be null and void.
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(L. 2021 H.B. 432)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1230 - Chiropractic care coverage, rates, terms, conditions, limits, and exclusions.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
Effective - 28 Aug 2003
376.1230. Chiropractic care coverage, rates, terms, conditions, limits, and exclusions. —
1. Every policy issued by a health carrier, as defined in section 376.1350, shall provide coverage for chiropractic care delivered by a licensed chiropractor acting within the scope of his or her practice as defined in chapter 331. The coverage shall include initial diagnosis and clinically appropriate and medically necessary services and supplies required to treat the diagnosed disorder, subject to the terms and conditions of the policy. The coverage may be limited to chiropractors within the health carrier's network, and nothing in this section shall be construed to require a health carrier to contract with a chiropractor not in the carrier's network nor shall a carrier be required to reimburse for services rendered by a nonnetwork chiropractor unless prior approval has been obtained from the carrier by the enrollee. An enrollee may access chiropractic care within the network for a total of twenty-six chiropractic physician office visits per policy period, but may be required to provide the health carrier with notice prior to any additional visit as a condition of coverage. A health carrier may require prior authorization or notification before any follow-up diagnostic tests are ordered by a chiropractor or for any office visits for treatment in excess of twenty-six in any policy period. The certificate of coverage for any health benefit plan issued by a health carrier shall clearly state the availability of chiropractic coverage under the policy and any limitations, conditions, and exclusions.
2. A health benefit plan shall provide coverage for treatment of a chiropractic care condition and shall not establish any rate, term, or condition that places a greater financial burden on an insured for access to treatment for a chiropractic care condition than for access to treatment for another physical health condition.
3. The provisions of this section shall not apply to any health plan or contract that is individually underwritten.
4. The provisions of this section shall not apply to benefits provided under the Medicaid program.
5. The provisions of this section shall not apply to a supplemental insurance policy, including a life care contract, accident-only policy, specified disease policy, hospital policy providing a fixed daily benefit only, Medicare supplement policy, long-term care policy, short-term major medical policy of six months' or less duration, or any other similar supplemental policy.
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(L. 2003 H.B. 121 §§ 376.1230 and 376.1231)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1232 - Insurers to offer coverage for prosthetics.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
Effective - 28 Aug 2009
376.1232. Insurers to offer coverage for prosthetics. —
1. Each health carrier or health benefit plan that offers or issues health benefit plans which are delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2010, shall offer coverage for prosthetic devices and services, including original and replacement devices, as prescribed by a physician acting within the scope of his or her practice.
2. For the purposes of this section, "health carrier" and "health benefit plan" shall have the same meaning as defined in section 376.1350.
3. The amount of the benefit for prosthetic devices and services under this section shall be no less than the annual and lifetime benefit maximums applicable to the basic health care services required to be provided under the health benefit plan. If the health benefit plan does not include any annual or lifetime maximums applicable to basic health care services, the amount of the benefit for prosthetic devices and services shall not be subject to an annual or lifetime maximum benefit level. Any co-payment, coinsurance, deductible, and maximum out-of-pocket amount applied to the benefit for prosthetic devices and services shall be no more than the most common amounts applied to the basic health care services required to be provided under the health benefit plan.
4. The provisions of this section shall not apply to a supplemental insurance policy, including a life care contract, accident-only policy, specified disease policy, hospital policy providing a fixed daily benefit only, Medicare supplement policy, long-term care policy, short-term major medical policies of six months or less duration, or any other supplemental policy as determined by the director of the department of commerce and insurance.
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(L. 2009 H.B. 577)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1235 - No co-payments or coinsurance for physical or occupational therapy services, when — actuarial analysis of cost, when.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
Effective - 28 Aug 2016, 2 histories
*376.1235. No co-payments or coinsurance for physical or occupational therapy services, when — actuarial analysis of cost, when. —
1. No health carrier or health benefit plan, as defined in section 376.1350, shall impose a co-payment or coinsurance percentage charged to the insured for services rendered for each date of service by a physical therapist licensed under chapter 334 or an occupational therapist licensed under chapter 324, for services that require a prescription, that is greater than the co-payment or coinsurance percentage charged to the insured for the services of a primary care physician licensed under chapter 334 for an office visit.
2. A health carrier or health benefit plan shall clearly state the availability of physical therapy and occupational therapy coverage under its plan and all related limitations, conditions, and exclusions.
3. Beginning September 1, 2016, the oversight division of the joint committee on legislative research shall perform an actuarial analysis of the cost impact to health carriers, insureds with a health benefit plan, and other private and public payers if the provisions of this section regarding occupational therapy coverage were enacted. By December 31, 2016, the director of the oversight division of the joint committee on legislative research shall submit a report of the actuarial findings prescribed by this section to the speaker, the president pro tem, and the chairpersons of both the house of representatives and senate standing committees having jurisdiction over health insurance matters. If the fiscal note cost estimation is less than the cost of an actuarial analysis, the actuarial analysis requirement shall be waived.
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(L. 2013 S.B. 159, A.L. 2016 S.B. 608 merged with S.B. 635)
Effective 8-28-16 (S.B. 635); *10-14-16 (S.B. 608), see § 21.250
*S.B. 608 was vetoed July 5, 2016. The veto was overridden on September 14, 2016.
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1237 - Refills for prescription eye drops, required, when — definitions.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
Effective - 28 Aug 2018, 3 histories
376.1237. Refills for prescription eye drops, required, when — definitions. —
1. Each health carrier or health benefit plan that offers or issues health benefit plans which are delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2014, and that provides coverage for prescription eye drops shall provide coverage for the refilling of an eye drop prescription prior to the last day of the prescribed dosage period without regard to a coverage restriction for early refill of prescription renewals as long as the prescribing health care provider authorizes such early refill, and the health carrier or the health benefit plan is notified.
2. For the purposes of this section, health carrier and health benefit plan shall have the same meaning as defined in section 376.1350.
3. The coverage required by this section shall not be subject to any greater deductible or co-payment than other similar health care services provided by the health benefit plan.
4. The provisions of this section shall not apply to a supplemental insurance policy, including a life care contract, accident-only policy, specified disease policy, hospital policy providing a fixed daily benefit only, Medicare supplement policy, long-term care policy, short-term major medical policies of six months' or less duration, or any other supplemental policy as determined by the director of the department of commerce and insurance.
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(L. 2013 H.B. 315, A.L. 2016 H.B. 1682 merged with H.B. 1816 merged with S.B. 608 merged with S.B. 635 merged with S.B. 865 & 866 merged with S.B. 973, A.L. 2018 S.B. 718 merged with S.B. 826)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1250 - Cancer screening, health insurance coverage required, when, types.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
Effective - 28 Aug 2011
376.1250. Cancer screening, health insurance coverage required, when, types. —
1. All individual and group health insurance policies providing coverage on an expense-incurred basis, individual and group service or indemnity type contracts issued by a nonprofit corporation, individual and group service contracts issued by a health maintenance organization, all self-insured group arrangements to the extent not preempted by federal law and all managed health care delivery entities of any type or description, that are delivered, issued for delivery, continued or renewed on or after August 28, 1999, and providing coverage to any resident of this state shall provide benefits or coverage for:
(1) A pelvic examination and pap smear for any nonsymptomatic woman covered under such policy or contract, in accordance with the current American Cancer Society guidelines;
(2) A prostate examination and laboratory tests for cancer for any nonsymptomatic man covered under such policy or contract, in accordance with the current American Cancer Society guidelines; and
(3) A colorectal cancer examination and laboratory tests for cancer for any nonsymptomatic person covered under such policy or contract, in accordance with the current American Cancer Society guidelines.
2. Coverage and benefits related to the examinations and tests as required by this section shall be at least as favorable and subject to the same dollar limits, deductible, and co-payments as other covered benefits or services.
3. Nothing in this act shall apply to accident-only, hospital indemnity, Medicare supplement, long-term care, or other limited benefit health insurance policies.
4. The provisions of this section shall not apply to short-term major medical policies of six months or less duration.
5. The attending physician shall advise the patient of the advantages, disadvantages, and risks, including cancer, associated with breast implantation prior to such operation.
6. Nothing in this section shall alter, impair or otherwise affect claims, rights or remedies available pursuant to law.
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(L. 1999 H.B. 191 § 1, A.L. 2011 H.B. 388)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1253 - Second opinion, right of newly diagnosed cancer patients, attending physician to inform — insurance coverage for such second opinions required, when.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
Effective - 28 Aug 2002
376.1253. Second opinion, right of newly diagnosed cancer patients, attending physician to inform — insurance coverage for such second opinions required, when. —
1. Each physician attending any patient with a newly diagnosed cancer shall inform the patient that the patient has the right to a referral for a second opinion by an appropriate board-certified specialist prior to any treatment. If no specialist in that specific cancer diagnosis area is in the provider network, a referral shall be made to a nonnetwork specialist in accordance with this section.
2. Each health carrier or health benefit plan, as defined in section 376.1350, that offers or issues health benefit plans which are delivered, issued for delivery, continued or renewed in this state on or after January 1, 2003, shall provide coverage for a second opinion rendered by a specialist in that specific cancer diagnosis area when a patient with a newly diagnosed cancer is referred to such specialist by his or her attending physician. Such coverage shall be subject to the same deductible and coinsurance conditions applied to other specialist referrals and all other terms and conditions applicable to other benefits, including the prior authorization and/or referral authorization requirements as specified in the applicable health insurance policy.
3. The provisions of this section shall not apply to a supplemental insurance policy, including a life care contract, accident-only policy, specified disease policy, hospital policy providing a fixed daily benefit only, Medicare supplement policy, long-term care policy, short-term major medical policies of six months' or less duration, or any other supplemental policy as determined by the director of the department of commerce and insurance.
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(L. 2002 S.B. 1026)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1275 - Coverage for human leukocyte antigen testing for bone marrow transplantation required, when — exceptions.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
Effective - 28 Aug 2002
376.1275. Coverage for human leukocyte antigen testing for bone marrow transplantation required, when — exceptions. —
1. Each health carrier or health benefit plan that offers or issues health benefit plans which are delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2003, shall include coverage for their members for the cost for human leukocyte antigen testing, also referred to as histocompatibility locus antigen testing, for A, B, and DR antigens for utilization in bone marrow transplantation. The testing must be performed in a facility which is accredited by the American Association of Blood Banks or its successors, and is licensed under the Clinical Laboratory Improvement Act, 42 U.S.C. Section 263a, as amended, and is accredited by the American Association of Blood Banks or its successors, the College of American Pathologists, the American Society for Histocompatibility and Immunogenetics (ASHI) or any other national accrediting body with requirements that are substantially equivalent to or more stringent than those of the College of American Pathologists. At the time of testing, the person being tested must complete and sign an informed consent form which also authorizes the results of the test to be used for participation in the National Marrow Donor Program. The health benefit plan may limit each enrollee to one such testing per lifetime to be reimbursed at a cost of no greater than seventy-five dollars by the health carrier or health benefit plan.
2. For the purposes of this section, "health carrier" and "health benefit plan" shall have the same meaning as defined in section 376.1350.
3. The health care service required by this section shall not be subject to any greater deductible or co-payment than other similar health care services provided by the health benefit plan.
4. The provisions of this section shall not apply to a supplemental insurance policy, including a life care contract, accident-only policy, specified disease policy, hospital policy providing a fixed daily benefit only, Medicare supplement policy, long-term care policy, short-term major medical policies of six months' or less duration, or any other supplemental policy as determined by the director of the department of commerce and insurance.
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(L. 2002 S.B. 1026)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1290 - Coverage for lead testing.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
Effective - 28 Aug 2001
376.1290. Coverage for lead testing. —
1. Each entity offering individual and group health insurance policies providing coverage on an expense-incurred basis, individual and group service or indemnity type contracts issued by a health services corporation, individual and group service contracts issued by a health maintenance organization, all self-insured group arrangements, to the extent not preempted by federal law, and all managed health care delivery entities of any type or description that are delivered, issued for delivery, continued or renewed in this state on or after January 1, 2002, shall offer coverage for testing pregnant women for lead poisoning and for all testing for lead poisoning authorized by sections 701.340 to 701.349 or by rule of the department of health and senior services promulgated pursuant to sections 701.340 to 701.349.
2. Health care services required by this section shall not be subject to any greater deductible or co-payment than any other health care service provided by the policy, contract or plan.
3. No entity enumerated in subsection 1 of this section shall reduce or eliminate coverage as a result of the requirements of this section.
4. Nothing in this section shall apply to accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care or other limited benefit health insurance policies.
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(L. 2001 S.B. 266)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1300 - Reorganization of a domestic mutual life insurance company, authority.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1996
376.1300. Reorganization of a domestic mutual life insurance company, authority. —
A domestic mutual life insurance company organized and operating pursuant to this chapter may reorganize by forming a mutual life insurance holding company as described in section 376.1309 or by merging its policyholders' memberships into such a mutual life insurance holding company. The reorganized life insurance company shall continue its corporate existence, either at the time of the reorganization or at some later time, as a stock life insurance company or as a mutual life insurance company. The authority granted such companies pursuant to sections 376.1300 to 376.1322 shall be in addition to any powers granted pursuant to chapter 382.
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(L. 1996 S.B. 759)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1305 - Formation of holding company, application — shareholder approval.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1996
376.1305. Formation of holding company, application — shareholder approval. —
1. A mutual life insurance company proposing to reorganize pursuant to sections 376.1300 to 376.1322 shall form a mutual life insurance holding company, which may hereafter be referred to as a mutual holding company, and shall file an application with the director of the department of commerce and insurance which shall contain such insurer's plan of reorganization. The director shall review the application, and may retain such consultants as may be reasonably necessary, at the expense of the applicant; conduct an adequate review to assure that policyholders' interests are protected and may conduct a public hearing. The director shall approve the formation of the mutual holding company and the plan of reorganization if the director finds that the plan is fair and equitable to the policyholders. The director may condition such approval on adoption of modifications to the plan if the director finds such modifications are necessary for the protection of the policyholders' interests.
2. No mutual life insurance company may reorganize pursuant to sections 376.1300 to 376.1322 unless the reorganization plan is approved by a majority of the policyholders voting in person or by proxy at a special meeting called for that purpose. Any group of at least one hundred policyholders having a right to vote at such special meeting shall be entitled at their own expense to have the secretary of the company mail informational materials to all policyholders provided that such materials and the cost thereof are presented to the secretary at least forty-five days before the special meeting.
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(L. 1996 S.B. 759)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1307 - Issuance of shares.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1996
376.1307. Issuance of shares. —
All of the shares, if any are issued, of the capital stock of the reorganized life insurance company shall be issued to the mutual holding company, which shall at all times own a majority of the voting shares of the capital stock of the reorganized life insurance company; except that, either at the time of the reorganization, or at some later time with the approval of the director, the mutual holding company may create a stock holding company pursuant to chapter 351 for the purpose of owning all of the stock of the reorganized life insurance company, so long as the mutual holding company at all times owns a majority of the voting shares of the capital stock of the stock holding company. Any subsidiaries of the reorganized life insurance company may remain as subsidiaries of such company or become subsidiaries of the mutual or stock holding company provided that, if such subsidiaries shall become subsidiaries of a stock holding company then the reorganized life insurance company shall be reimbursed the fair market value of its holdings in such subsidiaries in the event shares of the stock holding company are or have been issued to other than the mutual holding company.
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(L. 1996 S.B. 759)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1309 - Member's interest — nontransference of membership — immunity from liability — assessments, not imposed — security, membership interest.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1996
376.1309. Member's interest — nontransference of membership — immunity from liability — assessments, not imposed — security, membership interest. —
1. The membership interest of the policyholders of a reorganized life insurance company shall become membership interests in the mutual holding company. Policyholders of the reorganized life insurance company shall be members of the mutual holding company in accordance with the articles of incorporation and bylaws of the mutual holding company and the applicable provisions of this chapter relating to mutual life insurance companies.
2. No member of a mutual holding company may transfer membership in the holding company or any right arising from such membership.
3. A member of a mutual holding company is not, as a member, personally liable for the acts, debts, liabilities or obligations of the company.
4. No assessments of any kind may be imposed upon the members of a mutual holding company by the directors or members, or because of any liability of any company owned or controlled by the mutual holding company or because of any act, debt or liability of the mutual holding company itself.
5. A membership interest in a domestic mutual holding company shall not constitute a security under the laws of this state.
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(L. 1996 S.B. 759)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1312 - Nonapplicability of certain provisions of insurance holding companies law.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1996
376.1312. Nonapplicability of certain provisions of insurance holding companies law. —
Sections 382.040, 382.060, and 382.095 shall not apply to a reorganization or merger pursuant to the provisions of sections 376.1300 to 376.1322.
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(L. 1996 S.B. 759)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1315 - Incorporation of mutual holding company, authority, approval.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1996
376.1315. Incorporation of mutual holding company, authority, approval. —
Notwithstanding any provision of this chapter to the contrary, a mutual holding company organized pursuant to section 376.1300 shall be incorporated pursuant to this chapter. The articles of incorporation and any amendments to such articles of the mutual holding company shall be subject to approval of the director of the department of commerce and insurance and the attorney general in the same manner as those of a mutual life insurance company.
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(L. 1996 S.B. 759)