reglab/statecodes huggingface dataset:
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.300 - Equity interests permitted, when.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2007, 2 histories
376.300. Equity interests permitted, when. —
1. Subject to the limitations of section 376.297, an insurer may acquire equity interests in business entities organized under the laws of any domestic jurisdiction.
2. An insurer shall not acquire an investment under this section if as a result of and after giving effect to the investment the aggregate amount of investments then held by the insurer under this section would exceed twenty percent of its admitted assets, or except for mutual funds, the amount of equity interests then held by the insurer that are not listed on a qualified exchange would exceed five percent of its admitted assets.
3. An insurer shall not acquire under this section any investment that the insurer may acquire under section 376.302.
4. An insurer shall not short sell equity interests unless the insurer covers the short sale by owning the equity interest or an unrestricted right to the equity interest exercisable within six months of the short sale.
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(RSMo 1939 § 6032, A.L. 1943 p. 608, A.L. 1945 p. 995, A.L. 1945 p. 1004, A.L. 1949 p. 305, A.L. 1953 p. 235, A.L. 1961 p. 171, A.L. 1963 p. 492, A.L. 1973 H.B. 111, A.L. 1979 S.B. 322, A.L. 1982 S.B. 726, A.L. 1985 H.B. 823, A.L. 1995 S.B. 170, A.L. 2000 H.B. 1739, A.L. 2005 H.B. 69 merged with S.B. 131, A.L. 2007 S.B. 66)
Prior revision: 1929 § 5921
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.301 - Tangible personal property interests permitted, when.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2007
376.301. Tangible personal property interests permitted, when. —
1. (1) Subject to the limitations of section 376.297, an insurer may acquire tangible personal property or equity interest therein located or used wholly or in part within a domestic jurisdiction directly or indirectly through limited partnership interest and general partnership interest not otherwise prohibited by subsection 4 of section 376.294, joint ventures, stock of an investment subsidiary or membership interests in a limited liability company, trust certificates, or other similar instruments.
(2) Investments acquired under subdivision (1) of this subsection shall be eligible only if:
(a) The property is subject to a lease or other agreement with a person whose rated credit instruments in the amount of the purchase prices of the personal property the insurer could then acquire under section 376.298; and
(b) The lease or other agreement provides the insurer the right to receive rental, purchase, or other fixed payments for this use or purchase of the property and the aggregate value of the payments, together with the estimated residual value of the property at the end of its useful life and the estimated tax benefits to the insurer resulting from ownership of the property shall be adequate to return the cost of the insurer's investment in the property plus a return deemed adequate by the insurer.
2. An insurer shall compute the amount of each investment under this section on the basis of the out-of-pocket purchase price and applicable related expenses paid by the insurer for the investment, net of each borrowing made to finance the purchase price, and expenses to the extent the borrowing is without recourse to the insurer.
3. An insurer shall not acquire an investment under this section if as a result of and after giving effect to the investment the aggregate amount of all investments then held by the insurer under this section would exceed:
(1) Two percent of its admitted assets; or
(2) One-half of one percent of its admitted assets as to any single item of tangible personal property.
4. For purposes of determining compliance with the limitations of section 376.297, investments acquired by an insurer under this section shall be aggregated with those acquired under section 376.298 and each lessee of the property under a lease referred to in this section shall be deemed the issuer of an obligation in the amount of the investment of the insurer in the property determined as provided in subsection 2 of this section.
5. Nothing in this section shall be applicable to tangible personal property lease arrangements between an insurer and its subsidiaries and affiliates under a cost-sharing arrangement or agreement permitted under chapter 382.
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(L. 1953 p. 234 §§ 1, 2, A.L. 1967 p. 516, A.L. 2007 S.B. 66)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.305 - Rulemaking authority.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2007
376.305. Rulemaking authority. —
The director may promulgate rules to implement the provisions of sections 376.291 to 376.307. Any rule or portion of a rule, as that term is defined in section 536.010, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536 and, if applicable, section 536.028. This section and chapter 536 are nonseverable and if any of the powers vested with the general assembly under chapter 536 to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2007, shall be invalid and void.
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(L. 1957 p. 222 §§ 1, 2, A.L. 1969 H.B. 296, A.L. 1985 H.B. 823, A.L. 2007 S.B. 66)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.306 - Cash surrender value, life insurer may lend to policyholder, when.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2007
376.306. Cash surrender value, life insurer may lend to policyholder, when. —
A life insurer may lend to a policyholder on the security of the cash surrender value of the policyholder's policy a sum not to exceed the legal reserve that the insurer is required to maintain on the policy.
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(L. 2007 S.B. 66)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.308 - Secondary mortgage market act, not to preempt health insurer, when.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1991
376.308. Secondary mortgage market act, not to preempt health insurer, when. —
No requirement for the making of any investment or holding any asset by an insurer, health services corporation, health maintenance organization or other entity regulated by the department of commerce and insurance pursuant to chapter 354 or chapters 374 to 385 shall be preempted by the provisions of section 106 of Title I of the federal Secondary Mortgage Market Act of 1984, as codified and may be amended from time to time.
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(L. 1991 H.B. 385, et al. § 115)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.310 - Investment of surplus and reserve funds by foreign companies.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1945
376.310. Investment of surplus and reserve funds by foreign companies. —
Any life insurance company organized under the laws of another state, and admitted to do business in the state of Missouri, shall have power to invest its capital, reserve and surplus funds in the same manner, to the same extent and in the same investments as are permitted to domestic life insurance companies organized under the laws of this state; provided, that nothing herein contained shall be so construed as to prohibit any such foreign company from investing its capital, reserve and surplus funds as permitted by its charter and the laws of its domiciliary state.
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(L. 1945 p. 1012 § 6032A)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.325 - Any willing provider provision — definitions.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2013
376.325. Any willing provider provision — definitions. —
1. To the extent a health carrier has developed a closed or exclusive provider network as provided in subdivision (19) of section 376.426 through contractual arrangements with selected providers, such health carrier shall accept into such closed or exclusive network any willing licensed physician who agrees to accept a fee schedule, payment, or reimbursement rate that is fifteen percent less than the health carrier's standard prevailing or market fee schedule, payment, or reimbursement rate for such network in the specific geography of the licensed physician's practice.
2. This section shall not apply to any licensed physician who does not meet the health carrier's selection standards and credentialing criteria or who has not entered into the health carrier's standard participating provider agreement.
3. As used in this section, the term
"health carrier"
shall have the same meaning ascribed to it in section 376.1350. The term
"physician"
shall mean a physician licensed to practice in Missouri under the provisions of chapter 334. As used in this section, a
"closed or exclusive provider network"
is a network for a health benefit plan that requires all health care services to be delivered by a participating provider in the health carrier's network, except for emergency services, as defined in section 376.1350, and the services described in subsection 4 of section 376.811.
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(L. 2013 S.B. 262)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.330 - Securities may be changed.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1939
376.330. Securities may be changed. —
Any company organized under the laws of this state, or doing in this state any business mentioned in section 376.010, may at any time change the securities in which its capital or any part thereof is invested, whether the same are deposited with the director of the department of commerce and insurance or elsewhere, for any other securities; provided, that the amount or value of the securities required by sections 376.010 to 376.670 to be deposited with said director shall in no case be diminished or impaired.
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(RSMo 1939 § 5827)
Prior revisions: 1929 § 5716; 1919 § 6127; 1909 § 6921
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.350 - Reports to director.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2000
376.350. Reports to director. —
1. It shall be the duty of the president or vice president and secretary or actuary, or a majority of the directors, of every life assurance company organized pursuant to sections 376.010 to 376.670 or pursuant to the laws of this state, or any such company incorporated by or organized pursuant to the laws of the United States or any other state, and doing business in this state, annually, on the first day of January, or within sixty days thereafter, to prepare under oath, and deposit in the office of the director of the department of commerce and insurance, a statement made up for the year ending the thirty-first day of December next preceding, showing:
(1) The number of policies issued during the year;
(2) The amount of assurance effected thereby;
(3) The amount of premiums received during the year;
(4) The amount received for interest, and all other receipts during the year, classifying the items;
(5) The amount of losses paid during the year;
(6) The amount of losses unpaid, giving the reason for such nonpayment;
(7) The amount of expenses, classifying the items;
(8) The whole number of policies in force, specifying the description;
(9) The amount of liabilities or risks thereon, and of all other liabilities;
(10) The amount of capital stock and how invested;
(11) The amount of assets other than capital, specifying the particular sources from whence they have been derived, and the manner in which they are invested, and what amount is invested in real estate, in stocks, promissory notes and other securities, and what amount is loaned on bonds and mortgages, or deeds of trust, stocks, policies of the company and other securities, specifying the kinds and amounts;
(12) The amount of dividend declared to stockholders and policyholders, respectively, and how much remains unpaid; and
(13) A statement of any other facts or information concerning the affairs of said company which may be required by the director.
2. Notwithstanding any other provision of law to the contrary, information regarding compensation of any employee or officer contained within a statement required to be filed pursuant to this section shall not be subject to disclosure to any person other than employees of the department.
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(RSMo 1939 § 5829, A.L. 2000 S.B. 896)
Prior revisions: 1929 § 5718; 1919 § 6129; 1909 § 6923
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.379 - Medication synchronization services, offer of coverage required.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2016
*376.379. Medication synchronization services, offer of coverage required. —
1. A health carrier or managed care plan offering a health benefit plan in this state that provides prescription drug coverage shall offer, as part of the plan, medication synchronization services developed by the health carrier or managed care plan that allow for the alignment of refill dates for an enrollee's prescription drugs that are covered benefits.
2. Under its medication synchronization services, a health carrier or managed care plan shall:
(1) Not charge an amount in excess of the otherwise applicable co-payment amount under the health benefit plan for dispensing a prescription drug in a quantity that is less than the prescribed amount if:
(a) The pharmacy dispenses the prescription drug in accordance with the medication synchronization services offered under the health benefit plan; and
(b) A participating provider dispenses the prescription drug; and
(2) Provide a full dispensing fee to the pharmacy that dispenses the prescription drug to the covered person.
3. For purposes of this section, the terms "health carrier", "managed care plan", "health benefit plan", "enrollee", and "participating provider" shall have the same meanings given to such terms under section 376.1350.
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(L. 2016 S.B. 608 merged with S.B. 865 & 866)
Effective 8-28-16 (S.B. 865 & 866); *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 376.381 - Health insurance products, department duties.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 12 Jul 2013, 2 histories, see footnote
376.381. Health insurance products, department duties. —
Notwithstanding any other provision of law to the contrary, the department of commerce and insurance shall exercise its authority and responsibility over health insurance product form filings, consumer complaints, and investigations into compliance with state law, regardless as to how a health insurance product may be sold or marketed in this state or to residents of this state.
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(L. 2013 S.B. 262 § 1)
Effective 7-12-13
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.385 - Diabetes — insurance coverage for equipment, supplies and self-management training.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1997
376.385. Diabetes — insurance coverage for equipment, supplies and self-management training. —
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, 1998, shall offer coverage for all physician-prescribed medically appropriate and necessary equipment, supplies and self-management training used in the management and treatment of diabetes. Coverage shall include persons with gestational, type I or type II diabetes.
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 may reduce or eliminate coverage due to 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. 1997 S.B. 24)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.386 - Prescription drugs, one co-payment for dosage prescribed.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2006
376.386. Prescription drugs, one co-payment for dosage prescribed. —
For any health carrier or health benefit plan, as defined in section 376.1350, that provides prescription drug coverage, if a prescription drug covered by a health carrier or health benefit plan is prescribed in a single dosage amount for which the particular prescription drug is not manufactured in such single dosage amount and requires dispensing the particular prescription drug in a combination of different manufactured dosage amounts, the health carrier or health benefit plan shall only impose one co-payment for the dispensing of the combination of manufactured dosages that equal the prescribed dosage for such prescription drug. Such co-payment requirement shall not apply to prescriptions in excess of a one-month supply. If technology does not permit such adjudication, the health carrier or health benefit plan shall provide reimbursement forms for the patient.
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(L. 2006 S.B. 567 & 792 § 376.392)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.387 - Pharmacy benefits manager, limitations and restrictions — enforcement.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2020, 2 histories
376.387. Pharmacy benefits manager, limitations and restrictions — enforcement. —
1. For purposes of this section, the following terms shall mean:
(1)
"Covered person"
, the same meaning as such term is defined in section 376.1257;
(2)
"Health benefit plan"
, the same meaning as such term is defined in section 376.1350;
(3)
"Health carrier"
or
"carrier"
, the same meaning as such term is defined in section 376.1350;
(4)
"Pharmacy"
, the same meaning as such term is defined in chapter 338;
(5)
"Pharmacy benefits manager"
, the same meaning as such term is defined in section 376.388.
2. No pharmacy benefits manager shall include a provision in a contract entered into or modified on or after August 28, 2018, with a pharmacy or pharmacist that requires a covered person to make a payment for a prescription drug at the point of sale in an amount that exceeds the lesser of:
(1) The copayment amount as required under the health benefit plan; or
(2) The amount an individual would pay for a prescription if that individual paid with cash.
3. A pharmacy or pharmacist shall have the right to provide to a covered person information regarding the amount of the covered person's cost share for a prescription drug, the covered person's cost of an alternative drug, and the covered person's cost of the drug without adjudicating the claim through the pharmacy benefits manager. Neither a pharmacy nor a pharmacist shall be proscribed by a pharmacy benefits manager from discussing any such information or from selling a more affordable alternative to the covered person.
4. No pharmacy benefits manager shall, directly or indirectly, charge or hold a pharmacist or pharmacy responsible for any fee amount related to a claim that is not known at the time of the claim's adjudication, unless the amount is a result of improperly paid claims or charges for administering a health benefit plan.
5. This section shall not apply with respect to claims under Medicare Part D, or any other plan administered or regulated solely under federal law, and to the extent this section may be preempted under the Employee Retirement Income Security Act of 1974 for self-funded employer-sponsored health benefit plans.
6. A pharmacy benefits manager shall notify in writing any health carrier with which it contracts if the pharmacy benefits manager has a conflict of interest, any commonality of ownership, or any other relationship, financial or otherwise, between the pharmacy benefits manager and any other health carrier with which the pharmacy benefits manager contracts.
7. The department of commerce and insurance shall enforce this section.
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(L. 2018 S.B. 826, A.L. 2020 H.B. 1682)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.390 - Reserve liability for group insurance — how computed.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1943
376.390. Reserve liability for group insurance — how computed. —
The reserve liability for group insurance written by any life insurance company doing business in this state shall be computed upon such tables and basis as may be approved by the director of the department of commerce and insurance.
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(RSMo 1939 § 5832, A.L. 1943 p. 596)
Prior revision: 1929 § 5721
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.391 - Co-payments for chiropractic services, cap.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2009
376.391. Co-payments for chiropractic services, cap. —
A health benefit plan or health carrier, as defined in section 376.1350, including but not limited to preferred provider organizations, independent physicians associations, third-party administrators, or any entity that contracts with licensed health care providers shall not impose any co-payment that exceeds fifty percent of the total cost of providing any single chiropractic service to its enrollees.
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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 376.392 - Prescription drug formularies, enrollees to be notified of changes to, when.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 01 Jan 2008, see footnote
376.392. Prescription drug formularies, enrollees to be notified of changes to, when. —
For any health carrier or health benefit plan, as defined in section 376.1350, that provides prescription drug coverage or contracts with a third-party for prescription drug services, the health carrier or health benefit plan shall notify enrollees presently taking a prescription drug electronically, or in writing, upon request of the enrollee, at least thirty days prior to any deletions, other than generic substitutions, in the health carrier's or health benefit plan's prescription drug formulary that affect such enrollees.
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(L. 2007 H.B. 818)
Effective 1-01-08
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.393 - Pharmacy benefits manager, license required — definitions — complaints, procedure.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2020
376.393. Pharmacy benefits manager, license required — definitions — complaints, procedure. —
1. As used in this section, the following terms shall mean:
(1)
"Health carrier"
or
"carrier"
, the same meaning as is ascribed to such term in section 376.1350;
(2)
"Pharmacy benefits manager"
, the same meaning as is ascribed to such term in section 376.388.
2. No entity subject to the jurisdiction of this state shall act as a pharmacy benefits manager without a license issued by the department. The department shall establish by rule the application process and license fee for pharmacy benefits managers.
3. The department may cause a complaint to be filed with the administrative hearing commission as provided in chapter 621 against any holder of a license issued under this section for:
(1) Violation of the laws or regulations of any state or of the United States, where the offense is reasonably related to the qualifications, functions, or duties of a pharmacy benefits
*
manager, including, but not limited to, where an essential element of the offense is fraud, dishonesty, or an act of violence, or where the offense involves moral turpitude, or where the offense involves failure to comply with a requirement of this chapter, whether or not sentence or penalty is imposed;
(2) Use of fraud, deception, misrepresentation, or bribery for any reason;
(3) Obtaining or attempting to obtain any fee, charge, tuition, or other compensation by fraud, deception, or misrepresentation;
(4) Incompetence, misconduct, gross negligence, or dishonesty in the performance of the functions or duties of a pharmacy benefits manager or other regulated profession or activity; or
(5) Disciplinary action taken against the holder of a license or other right to practice as a pharmacy benefits manager or other regulated profession.
­­After the filing of such complaint, the proceedings shall be conducted in accordance with the provisions of chapter 621. Upon a finding by the administrative hearing commission that grounds provided in this subsection for disciplinary action are met, the department may, singly or in combination, censure or place the person named in the complaint on probation with such terms and conditions as the department deems appropriate for a period not to exceed five years, or may suspend, for a period not to exceed three years, or revoke the license, certificate, or permit. An individual whose license has been revoked shall wait at least one year from the date of revocation to apply for relicensure. Relicensure shall be at the discretion of the department.
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(L. 2020 H.B. 1682)
*Word "benefit" appears in original rolls.
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.395 - Definitions for group health conversion policy requirements.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 01 Jan 1983, see footnote
376.395. Definitions for group health conversion policy requirements. —
As used in sections 376.395 to 376.404 the following terms shall mean:
(1)
"Group policy"
, a group health insurance policy issued by an insurance company and a group contract issued by a health service corporation, a health maintenance organization or a similar corporation or organization;
(2)
"Group policyholder"
, the entity purchasing the group policy from the insurer;
(3)
"Individual policy"
or
"converted policy"
, an individual health insurance policy issued by an insurance company or an individual health services contract issued by a health service corporation, a health maintenance organization or a similar corporation or organization;
(4)
"Insurer"
, the entity issuing a group policy or an individual or converted policy;
(5)
"Medicare"
, Title XVIII of the United States Social Security Act as added by the Social Security Amendments of 1965 or as later amended or superseded;
(6)
"Premium"
, any premium or other consideration payable for coverage under a group or individual policy.
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(L. 1981 S.B. 58 § 1)
Effective 1-01-83
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.398 - Application to all group policies — effective, when.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 01 Jan 1983, see footnote
376.398. Application to all group policies — effective, when. —
The provisions of sections 376.395 to 376.404 shall become effective January 1, 1983, and shall apply to all group policies delivered, issued for delivery or amended on or after January 1, 1983.
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(L. 1981 S.B. 58 § A)
Effective 1-01-83
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.401 - Conversion rights — retirees — dependents of insured.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 01 Jan 1983, see footnote
376.401. Conversion rights — retirees — dependents of insured. —
1. In the event coverage would be continued under the group policy on an employee following his retirement, but prior to the time he is or could be covered by Medicare, the employee or member may elect, in lieu of such continuation of group insurance, to have the same conversion rights as would apply had that insurance terminated at retirement. The converted policy may provide for reduction or termination of coverage of any person upon his eligibility for coverage under Medicare or under any other state or federal law providing for benefits similar to those provided by the converted policy.
2. Subject to the conditions set forth in this section and section 376.397, the conversion privilege shall also be available to:
(1) The surviving spouse, if any, at the death of the employee or member, with respect to the spouse and such children whose coverage under the group policy terminates by reason of such death, or if the group policy provides for continuation of dependents coverage following the employee's or member's death, at the end of such continuation;
(2) The spouse of the employee or member upon termination of coverage of the spouse, while the employee or member remains insured under the group policy, with respect to the spouse and such children whose coverage under the group policy terminates at the same time; or
(3) A child, solely with respect to himself, upon termination of his coverage by reason of ceasing to be a qualified family member under the group policy, if a conversion privilege is not otherwise provided in sections 376.395 to 376.404 with respect to such termination.
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(L. 1981 S.B. 58 § 3)
Effective 1-01-83
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.403 - Benefit levels — group coverage may be provided in lieu of converted policy — delivery outside state, form.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 01 Jan 1983, see footnote
376.403. Benefit levels — group coverage may be provided in lieu of converted policy — delivery outside state, form. —
1. If the benefit levels required in subdivision (9) of subsection 1 of section 376.397 exceed the benefit levels provided under the group policy, the converted policy may offer benefits which are substantially similar to those provided under the group policy in lieu of those required in subdivision (9) of subsection 1 of section 376.397.
2. The insurer may elect to provide group insurance coverage in lieu of the issuance of an individual converted policy.
3. A converted policy which is delivered outside this state may be on a form which could be delivered in such other jurisdiction as a converted policy had the group policy been issued in that jurisdiction.
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(L. 1981 S.B. 58 § 4)
Effective 1-01-83
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.404 - Specific requirement requests of policyholder may be met by alteration.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 01 Jan 1983, see footnote
376.404. Specific requirement requests of policyholder may be met by alteration. —
Upon written request by the group policyholder, the coverages required in section 376.397 may be changed or altered to meet the specific requirements of such group policyholder.
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(L. 1981 S.B. 58 § 5)
Effective 1-01-83
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.407 - Advance practice nurse, claims for service to be reimbursed, when.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1998
376.407. Advance practice nurse, claims for service to be reimbursed, when. —
Any health insurer, as defined in section 376.806, nonprofit health service plan or health maintenance organization shall reimburse a claim for services provided by an advance practice nurse, as defined in section 335.016, if such services are within the scope of practice of such nurse.
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(L. 1998 H.B. 1302 § 9)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.410 - Insurance companies to maintain reserves — exemptions.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1945
376.410. Insurance companies to maintain reserves — exemptions. —
Except as provided in subdivision (6) of this section, all companies organized under the laws of this state, and engaged in writing policies of accident or health insurance, or combination policies of accident and health insurance, and all other companies transacting such kinds of business in this state, shall maintain reserves thereon in accordance with the following requirements:
(1) On all such policies actually written there shall be maintained an unearned gross premium reserve which reserve may be computed on a pro rata basis or such reserve may be computed at not less than fifty percent of the gross premiums in force;
(2) On all such policies written on a noncancellable plan and under the terms of which the company is obligated to renew or continue for a stated period, or to a stated age or for life, there shall be maintained active life reserves and reserves for losses in amounts not less than such minimum standards which the director of the department of commerce and insurance shall determine and prescribe after giving proper consideration to the terms and conditions of the policies involved;
(3) On all such policies other than those written on a noncancellable plan there shall be maintained reserves for losses in amounts not less than the minimum standards which the director of the department of commerce and insurance shall determine and prescribe after giving proper consideration to the terms and conditions of the policies involved;
(4) In the calculation of reserves required to be maintained under this section, proper credit shall be allowed for reinsurance in other companies licensed to do business in this state;
(5) In addition to the minimum reserves mentioned above the director of the department of commerce and insurance may also require such companies to maintain reserves for extraordinary losses in amounts not less than such minimum standards which the director of the department of commerce and insurance shall determine and prescribe after giving proper consideration to the terms and conditions of the policies involved;
(6) This section shall not be applicable to total and permanent disability benefits, or to accidental death benefits, contained in or supplementary to life insurance policies or other contracts and for which benefits the standard of valuation is prescribed by section 376.380.
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(L. 1945 p. 1000 § 6077a)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 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.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1985
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. —
1. As used in this section, the following terms shall mean:
(1)
"Direct response solicitation"
, a solicitation through a sponsoring or endorsing entity or through the mails, telephone, or other mass communications medium;
(2)
"Sponsoring or endorsing entity"
, an organization which has arranged for the offering of a program of insurance in a manner which communicates that eligibility for participation in the program is dependent upon affiliation with such organization or that it endorses participation in the program.
2. With respect to a program of insurance, whether issued on an individual basis or a group basis, which would not qualify under subdivisions (1), (2), (3), (4) and (6) of subsection 1 of section 376.421, if issued on a group basis, if compensation of any kind will or may be paid to a policyholder in the case of a group policy, or a sponsoring or endorsing entity in the case of individual, blanket or franchise policies marketed by means of direct response solicitation, the insurer shall cause to be distributed to prospective insureds a written notice that compensation will or may be paid. Such notice shall be distributed whether compensation is direct or indirect and whether such compensation is paid to or retained by the policyholder or sponsoring or endorsing entity or paid to or retained by a third party at the direction of the policyholder or sponsoring or endorsing entity or any entity affiliated therewith by way of ownership, contract or employment. The notice required by this subsection shall be placed on or shall accompany any application or enrollment form provided prospective insureds.
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(L. 1985 H.B. 623)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.424 - Group health insurance policies may be extended to insure family members or dependents.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1985
376.424. Group health insurance policies may be extended to insure family members or dependents. —
Except for a policy issued under subdivision (2) of subsection 1 of section 376.421, a group health insurance policy may be extended to insure the employees and members with respect to their family members or dependents, or any class or classes thereof, subject to the following:
(1) The premium for the insurance shall be paid either from funds contributed by the employer, union, association or other person to whom the policy has been issued or from funds contributed by the covered persons, or from both. Except as provided in subdivision (2) of this section, a policy on which no part of the premium for the family members' or dependents' coverage is to be derived from funds contributed by the covered persons must insure all eligible employees or members with respect to their family members or dependents, or any class or classes thereof;
(2) An insurer may exclude or limit the coverage on any family member or dependent as to whom evidence of individual insurability is not satisfactory to the insurer, subject to sections 376.406 and 376.776 in a policy insuring fewer than ten employees or members and in a policy insuring ten or more employees or members if:
(a) Application is not made within thirty-one days after the date of eligibility for insurance; or
(b) The employee or member voluntarily terminated the insurance of the family member or dependent while such family member or dependent continues to be eligible for insurance under the policy; or
(c) After the expiration of an open enrollment period during which the family member or dependent could have been enrolled for the insurance or could have been enrolled for another level of benefits under the policy.
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(L. 1985 H.B. 623)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.425 - Student accident policies, may not limit surgical benefits, when.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 01 Jan 1993, see footnote
376.425. Student accident policies, may not limit surgical benefits, when. —
1. As used in this section, the following terms mean:
(1)
"Institution of higher learning"
, any college or university, or "institution" as that term is defined in section 173.510;
(2)
"Sponsoring or endorsing entity"
, the same as that term is defined in section 376.422;
(3)
"Student accident policy"
, any individual, franchise, group or blanket policy of accident or health insurance which policy is offered to students of a sponsoring or endorsing entity which is an institution of higher learning and under which policy the insured person pays all or substantially all of the cost of his insurance.
2. No student accident policy issued or delivered for issuance in this state shall limit or exclude surgical benefits to one procedure when multiple procedures are done in one operating session.
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(L. 1992 S.B. 831 §§ A, 1)
Effective 1-01-93
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.428 - Federal COBRA provisions to apply to group health insurance policies.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 26 Jun 2009, see footnote
376.428. Federal COBRA provisions to apply to group health insurance policies. —
1. A group policy delivered or issued for delivery in this state by a health carrier or health benefit plan, as defined in section 376.1350, which insures employees or members and their eligible dependents for hospital, surgical or major medical insurance on an expense-incurred or service basis, other than for specific diseases or for accidental injuries only, shall provide that employees or members whose coverage under the group policy, which includes coverage for their eligible dependents, would otherwise terminate because of termination of employment or membership shall be entitled to continue their hospital, surgical or major medical coverage, including coverage for their eligible dependents, under that group policy in the same manner as continuation of coverage is required under the continuation of coverage provisions set forth in the federal Consolidated Omnibus Budget Reconciliation Act (COBRA), as amended.
2. The spouse of an employee or member whose coverage under the group policy would otherwise terminate due to dissolution of marriage or death of the employee or member shall have the same continuation privilege accorded under sections 376.421 to 376.442, 376.694 to 376.696, and 376.779 to the employee or member upon termination of employment or membership.
3. The right to a converted policy pursuant to sections 376.395 to 376.404 for an employee or member entitled to continuation of coverage under sections 376.421 to 376.442, 376.694 to 376.696, and 376.779 shall commence upon termination of the continued coverage provided for in sections 376.421 to 376.442, 376.694 to 376.696, and 376.779.
4. This section shall only apply to those persons who are not subject to the continuation and conversion provisions set forth in Title I, Subtitle B, Part 6 of the Employment Retirement Income Security Act of 1974 or Title XXII of the Public Health Service Act, as said acts were in effect on January 1, 1987.
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(L. 1985 H.B. 623, A.L. 1987 S.B. 337, A.L. 1988 H.B. 1242 Revision, A.L. 1991 H.B. 385, et al., A.L. 2009 H.B. 231)
Effective 6-26-09
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.431 - Employees or members of unions or associations, group or group-type basis coverage, sections 376.431 to 376.442 to apply.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1999
376.431. Employees or members of unions or associations, group or group-type basis coverage, sections 376.431 to 376.442 to apply. —
The provisions of sections 376.431 to 376.442 are applicable to all insurance policies and contracts issued or provided by an insurance company, health services corporation or health maintenance organization on a group or group-type basis covering persons as employees of employers or as members of unions or associations.
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(L. 1985 H.B. 623 § 376.430, A.L. 1999 H.B. 903)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.432 - Group-type basis, defined.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1999
376.432. Group-type basis, defined. —
As used in sections 376.431 to 376.442, the term
"group-type basis"
means a benefit plan, other than salary budget plans utilizing individual insurance policies or contracts, which meets the following conditions:
(1) Coverage is provided through insurance policies or contracts to classes of employees or members defined in terms of conditions pertaining to employment or membership;
(2) The coverage is not available to the general public and can be obtained and maintained only because of the covered person's membership in or connection with the particular organization or group;
(3) There are arrangements for bulk payment of premiums or subscription charges to the insurer or health services corporation; and
(4) There is sponsorship of the plan by the employer, union or association.
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(L. 1985 H.B. 623, A.L. 1999 H.B. 903)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.433 - Self-insurance plans for health care, public entities — subject to Medicaid rights, obligations, and remedies.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2004
376.433. Self-insurance plans for health care, public entities — subject to Medicaid rights, obligations, and remedies. —
1. Any public entity which provides, furnishes, or pays for hospital, medical, surgical, or other health care services under a plan of self-insurance to an employee or to any other person covered under the public entity's plan of self-insurance shall have the same rights and obligations, and be subject to the same remedies, as the department of social services has with Medicaid, as provided in section 208.215.
2. As used in this section, the term
"public entity"
shall have the same meaning ascribed to it in section 107.170.
3. This section shall not apply to limited benefit supplemental health insurance policies paid for entirely by an employee of the public entity.
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(L. 2004 H.B. 1233)