reglab/statecodes huggingface dataset:
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1010 - Excess stop-loss coverage maintained by plan.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1993
376.1010. Excess stop-loss coverage maintained by plan. —
A multiple employer self-insured health plan shall maintain aggregate excess stop-loss coverage and individual excess stop-loss coverage provided by an insurer licensed by the state to write accident and health insurance on a direct basis. Aggregate excess stop-loss coverage shall include provisions to cover incurred, unpaid claim liability in the event of plan termination. The excess or stop-loss insurer shall bear the risk of coverage for any member employer of the plan that becomes insolvent with outstanding contributions due. In addition, the plan shall have a participating employer's fund in an amount at least equal to the point at which the excess or stop-loss insurer shall assume one hundred percent of additional liability. A plan shall submit its proposed excess or stop-loss insurance contract to the director at least thirty days prior to the proposed plan's effective date and at least thirty days subsequent to any renewal date. The director shall review the contract to determine whether it meets the standards established by sections 376.1000 to 376.1045 and respond within a thirty-day period. Any excess or stop-loss insurance plan must be noncancelable for a minimum term of two years.
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(L. 1993 H.B. 709 § 26)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1012 - Funds collected from employers held in trust — requirements — board of trustees, elected, duties — annual report, filed when.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2007
376.1012. Funds collected from employers held in trust — requirements — board of trustees, elected, duties — annual report, filed when. —
Funds collected from the participating employers under multiple employer self-insured health plans shall be held in trust subject to the following requirements:
(1) A board of trustees elected by participating employers shall serve as fund managers on behalf of participants. Trustees shall be plan participants. No participating employer may be represented by more than one trustee. No trustee may represent more than one employer. A minimum of three and a maximum of seven trustees may be elected. Trustees may not receive remuneration but they may be reimbursed for actual and reasonable expenses incurred in connection with duties as trustee. A trustee may not be an agent, or broker for or an owner, officer or employee of any third-party administrator, insurance agency or insurer utilized by the plan. The trustees shall have the authority to approve applications of association members for participation in the arrangement and to contract with a licensed third-party administrator to administer the day-to-day affairs of the plan;
(2) Each trustee shall be bonded in an amount of not less than one hundred fifty thousand dollars by a licensed insurer;
(3) Investment of plan funds is subject to the same restrictions which are applicable to insurers pursuant to sections 376.291 to 376.307; provided, however, that no foreign plan shall be exempt under section 376.310 from the investment laws of this state unless such plan is subject to laws in its state of domicile which are substantially similar to sections 376.1032 to 376.1045. All investments shall be managed by a bank or other investment entity licensed to operate in Missouri;
(4) Trustees, on behalf of the plan, shall file an annual report with the director of the department of commerce and insurance by March first showing the condition and affairs of the plan as of the preceding thirty-first day of December. The report shall be made on forms prescribed by the director. The report shall summarize the financial condition of the fund, itemize collections from participating employers, detail all fund expenditures and provide any additional information which the director requires. More frequent reports may be required at the discretion of the director.
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(L. 1993 H.B. 709 § 27, A.L. 2007 S.B. 66)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1015 - Department not to grant approval, when.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1993
376.1015. Department not to grant approval, when. —
The department shall not grant or renew approval as to any plan if the department determines:
(1) Any trustee is incompetent or untrustworthy;
(2) That any trustee has been found guilty of, or has pled guilty or no contest to a felony, a crime involving moral turpitude, or a crime punishable by imprisonment of one year or more under the law of any state, territory, or country, whether or not a judgment of conviction has been entered;
(3) That any trustee has had any type of insurance license revoked, suspended, or disciplined in this or any other state; or
(4) That the business operations of the plan are or have been marked, to the detriment of the employers participating in the plan, of persons receiving benefits from the plan, or of creditors or the public, by the improper manipulation of assets, accounts, or specific or aggregate excess incurrence or by bad faith or if the number of covered employees in
*
any calendar quarter is found to be less than two hundred fifty.
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(L. 1993 H.B. 709 § 28)
*Word "in" does not appear in original rolls.
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1017 - Plan to establish loss reserves — plan to establish surplus account, amount.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1993
376.1017. Plan to establish loss reserves — plan to establish surplus account, amount. —
1. A plan shall establish loss reserves for all incurred losses, both reported and unreported, and for unearned premiums.
2. A plan also shall establish a surplus account equal to the greater of the following:
(1) Three times the average paid monthly premium during the plan's most recent fund year;
(2) For plans which do not yet have one fund year's experience, three times estimated monthly premium; or
(3) Six hundred thousand dollars.
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(L. 1993 H.B. 709 § 29)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1020 - Plan to maintain principal place of business in Missouri, exception.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1993
376.1020. Plan to maintain principal place of business in Missouri, exception. —
Each multiple employer self-insured health plan shall have and maintain its principal place of business in this state or shall appoint the director of the department of commerce and insurance as its agent for service of process, and shall thereby make available to the department complete records of its assets, transactions, and affairs with such methods and systems as are customary for, or suitable to, the kind or kinds of business transacted. The director or his representative shall inspect these records at least every three years. The information from these records shall be furnished to the director or his representatives on demand and the original books or records shall be open to examination by the director or his representatives when demanded. Examinations shall be conducted pursuant to sections 374.160, 374.162, 374.190, 374.202 to 374.207 and 374.220.
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(L. 1993 H.B. 709 § 30)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1022 - Dissolution of plan, application, procedure, granted when — distribution of assets, procedures.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1993
376.1022. Dissolution of plan, application, procedure, granted when — distribution of assets, procedures. —
1. A plan that desires to cease existence shall apply to the director for authority to dissolve. Applications to dissolve shall be on forms prescribed by the director and shall be approved or disapproved by the director within sixty days of receipt. Dissolution without authorization is prohibited and does not absolve a plan or its participants from fulfilling the plan's continuing obligations. An application to dissolve shall be granted if either of the following conditions is met:
(1) The plan demonstrates that it has no outstanding liabilities, including incurred but not reported liabilities; or
(2) The plan has obtained an irrevocable commitment from a licensed insurer which provides for payment of all outstanding liabilities and for providing all related services, including payment of claims, preparation of reports and administration of transactions associated with the period when the plan provided coverage.
2. Upon dissolution, after payment of all outstanding liabilities and indebtedness, the assets of the plan shall be distributed to all employers participating in the plan during the last five years immediately preceding dissolution. The distributive share of each employer shall be in the proportion that all contributions made by the employer during such five-year period bear to the total contributions made by all participating employers during such five-year period.
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(L. 1993 H.B. 709 § 31)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1025 - Director may adopt rules.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1995
376.1025. Director may adopt rules. —
The director may adopt regulations which are necessary to implement the provisions of sections 376.1000 to 376.1045 and to ensure the safe and proper operation of multiple employer self-insured health plans in this state. 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.
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(L. 1993 H.B. 709 § 32, A.L. 1995 S.B. 3)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1027 - Plan in unsound condition, powers of director.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1993
376.1027. Plan in unsound condition, powers of director. —
1. If the director is of the opinion that a multiple employer self-insured health plan is in an unsound condition, that it has failed to comply with the law or any applicable regulations or orders issued by the director, or that it is in a condition which renders its proceedings hazardous to the public or to persons covered under the plan, the director may, after notice and opportunity for a hearing, revoke or suspend the license of the plan or, in lieu thereof, bring a civil action in the county which has venue of an action against the multiple employer self-insured health plan under other provisions of law. The court may impose a fine not to exceed fifty thousand dollars for each violation or ground.
2. If the director is of the opinion that any of the grounds set forth in subsection 1 of this section exist regarding a plan domiciled in this state, he may commence delinquency proceedings against the plan and supervise, rehabilitate, or liquidate such plan in accordance with the procedures set forth in sections 375.1150 to 375.1246.
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(L. 1993 H.B. 709 § 33)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1030 - Agreement of employer to pay benefits, requirements, form — copy filed with director — no excuse from liability.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1993
376.1030. Agreement of employer to pay benefits, requirements, form — copy filed with director — no excuse from liability. —
1. A multiple employer self-insured health plan shall require each employer, as a condition of participation in the plan, to execute an agreement by which the employer agrees personally to pay all claims for benefits covered under the plan which are incurred by his or its covered employees and their covered dependents, but which the plan or its stop-loss insurer has failed to pay. Such agreements shall be made on forms prescribed by the director and shall extend to all unpaid claims for benefits incurred by the employer's employees and their dependents during the time such employees and dependents were covered under the plan.
2. A clear and legible copy of each agreement executed by each participating employer shall be filed with the director by the plan as part of its application for a license. No license shall be issued unless copies of such agreements are filed. With respect to an employer who joins the plan after a license has been issued, the plan shall file a copy of the agreement executed by the employer within ten days after the employer joins the plan.
3. Neither failure of an employer to execute an agreement, nor failure of the plan to require such execution, shall excuse the employer from liability for unpaid claims incurred by covered employees and dependents. An employer shall be deemed to have notice of the requirements of this section, and upon joining the plan, the employer shall be deemed to have agreed to liability for unpaid claims of his covered employees and their dependents in the same manner as if an agreement had been executed.
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(L. 1993 H.B. 709 § 34)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1032 - Plan considered insurer, when.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1993
376.1032. Plan considered insurer, when. —
For the purposes of sections 375.930 to 375.948 and sections 375.1000 to 375.1018, a multiple employer self-insured health plan shall be considered an "insurer".
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(L. 1993 H.B. 709 § 35)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1035 - Chapter 376 applicable to plan.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1993
376.1035. Chapter 376 applicable to plan. —
The provisions of this chapter relating to group health and group accident insurance, including policy approval provisions, shall apply to all multiple employer self-insured health plans licensed to do business in this state.
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(L. 1993 H.B. 709 § 36)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1037 - Plan subject to premium taxes.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1993
376.1037. Plan subject to premium taxes. —
Multiple employer self-insured health plans licensed in this state shall be subject to those taxes set out in sections 148.310 to 148.461.
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(L. 1993 H.B. 709 § 37)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1040 - Plan not to be offered to public — marketing restrictions — exemption — use of brokers authorized.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2019, 2 histories
376.1040. Plan not to be offered to public — marketing restrictions — exemption — use of brokers authorized. —
1. No multiple employer self-insured health plan shall be offered or advertised to the public. No plan shall be sold, solicited, or marketed by persons or entities defined in section 375.012 or sections 376.1075 to 376.1095. Multiple employer self-insured health plans with a certificate of authority approved by the director under section 376.1002 shall be exempt from the restrictions set forth in this section.
2. A health carrier acting as an administrator for a multiple employer self-insured health plan shall permit any willing licensed broker to quote, sell, solicit, or market such plan to the extent permitted by this section; provided that such broker is appointed and in good standing with the health carrier and completes all required training.
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(L. 1993 H.B. 709 § 38, A.L. 2019 S.B. 514)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1042 - Marketing by agent, agency or broker violation of law.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2019, 2 histories
376.1042. Marketing by agent, agency or broker violation of law. —
The sale, solicitation or marketing of any plan in violation of section 376.1040 by an agent, agency or broker shall constitute a violation of section 375.141.
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(L. 1993 H.B. 709 § 39, A.L. 2019 S.B. 514)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1045 - Injunctive relief, director may seek, when — procedures.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1993
376.1045. Injunctive relief, director may seek, when — procedures. —
The director may, in addition to any other remedy or sanction authorized under the insurance laws of this state, seek injunctive relief against any unauthorized insurer under section 375.786 or any unauthorized multiple employer self-insured health plan under sections 376.1000 to 376.1045. Pursuant to such injunctive relief, the court may order such unauthorized insurer or plan to pay money sufficient to pay for the outstanding claims of residents of this state against such insurer or plan and for the adjustment of such claims and the administration of such claims and adjustment. The money shall be payable to any fund established by the director for the purposes of this section. Such fund shall be controlled and administered by the director and his appointees, subject to the supervision of the court. The director and his appointees shall be subject to judicial immunity for any acts or omissions within the scope of establishing, controlling or administering such fund.
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(L. 1993 H.B. 709 § 40)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1065 - Official notification communications, contracting entity requirements.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
Effective - 28 Aug 2018
376.1065. Official notification communications, contracting entity requirements. —
1. As used in this section, the following terms shall mean:
(1)
"Contracting entity"
, any health carrier, as such term is defined in section 376.1350, subject to the jurisdiction of the department engaged in the act of contracting with providers for the delivery of dental services, or the selling or assigning of dental network plans to other entities under the jurisdiction of the department;
(2)
"Department"
, the department of commerce and insurance;
(3)
"Official notification"
, written communication by a provider or participating provider to a contracting entity describing such provider's or participating provider's change in contact information or participation status with the contracting entity;
(4)
"Participating provider"
, a provider who has an agreement with a contracting entity to provide dental services with an expectation of receiving payment, other than coinsurance, co-payments, or deductibles, directly or indirectly from such contracting entity;
(5)
"Provider"
, any person licensed under chapter 332.
2. A contracting entity shall, upon official notification, make changes contained in the official notification to their electronic provider material and their next edition of paper material made available to plan members or other potential plan members.
3. The department, when determining the result of a market conduct examination under sections 374.202 to 374.207, shall consider violations of this section by a contracting entity.
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(L. 2018 S.B. 982)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1077 - Administrator to have agreement with insurer, form, contents — termination, how.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1993
376.1077. Administrator to have agreement with insurer, form, contents — termination, how. —
1. No administrator shall act as such without a written agreement between the administrator and the insurer, and such written agreement shall be retained as part of the official records of both the insurer and the administrator for the duration of the agreement and five years thereafter. The agreement shall contain all provisions required by sections 376.1075 to 376.1095, except insofar as those requirements do not apply to the functions performed by the administrator.
2. The written agreement shall include a statement of duties which the administrator is expected to perform on behalf of the insurer and the lines, classes or types of insurance for which the administrator is to be authorized to administer. The agreement shall make provision with respect to underwriting or other standards pertaining to the business underwritten by such insurer.
3. The insurer or administrator may, with written notice, terminate the written agreement for cause as provided in the agreement. The insurer may suspend the underwriting authority of the administrator during the pendency of any dispute regarding the cause for termination of the written agreement. The insurer shall fulfill any lawful obligations with respect to policies affected by the written agreement, regardless of any dispute between the insurer and the administrator.
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(L. 1993 H.B. 709 § 42)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1080 - Payments of premiums and claims deemed paid, when.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1993
376.1080. Payments of premiums and claims deemed paid, when. —
If an insurer uses the services of an administrator, the payment to the administrator of any premiums or charges for insurance by or on behalf of the insured party shall be deemed to have been received by the insurer, and the payment of return premiums or claim payments forwarded by the insurer to the administrator shall not be deemed to have been paid to the insured party or claimant until such payments are received by the insured party or claimant. Nothing in this section limits any right of the insurer against the administrator resulting from the failure of the administrator to make payments to the insurer, insured parties or claimants.
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(L. 1993 H.B. 709 § 43)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1082 - Records maintained by administrator for insurer — director may examine records — records owned by insurer, transfer allowed, when.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1993
376.1082. Records maintained by administrator for insurer — director may examine records — records owned by insurer, transfer allowed, when. —
1. Every administrator shall maintain and make available to the insurer complete books and records of all transactions performed on behalf of the insurer. The books and records shall be maintained in accordance with prudent standards of insurance record keeping and shall be maintained for a period of not less than five years from the date of their creation.
2. The director shall have access to books and records maintained by an administrator for the purposes of examination, audit and inspection. Any trade secrets contained in such books and records, including the identity and addresses of policyholders and certificate holders, shall be kept confidential, except that the director may use such information in any proceeding instituted against the administrator. Examinations shall be conducted pursuant to sections 374.160, 374.162, 374.190, 374.202 to 374.207 and 374.220.
3. The insurer shall own the records generated by the administrator pertaining to the insurer; however, the administrator shall retain the right to continuing access to books and records to permit the administrator to fulfill all of its contractual obligations to insured parties, claimants, and the insurer.
4. In the event the insurer and the administrator cancel their agreement, notwithstanding the provisions of subsection 1 of this section, the administrator may, by written agreement with the insurer, transfer all records to a new administrator rather than retain them for five years. In such cases, the new administrator shall acknowledge, in writing, that he is responsible for retaining the records of the prior administrator as required in subsection 1 of this section.
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(L. 1993 H.B. 709 § 44)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1083 - Advertising restrictions for administrator.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1993
376.1083. Advertising restrictions for administrator. —
An administrator may use only such advertising pertaining to the business underwritten by an insurer as has been approved in writing by the insurer in advance of its use.
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(L. 1993 H.B. 709 § 45)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1084 - Insurer responsible for benefits and underwriting practices — insurer to conduct review of administrator, when.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1993
376.1084. Insurer responsible for benefits and underwriting practices — insurer to conduct review of administrator, when. —
1. If an insurer uses the services of an administrator, the insurer shall be responsible for determining the benefits, premium rates, underwriting criteria and claims payment procedures applicable to such coverage and for securing reinsurance, if any. The rules pertaining to these matters shall be provided, in writing, by the insurer to the administrator. The responsibilities of the administrator as to any of these matters shall be set forth in the written agreement between the administrator and the insurer.
2. It is the sole responsibility of the insurer to provide for competent administration of its programs.
3. In cases where an administrator administers benefits for more than one hundred certificate holders on behalf of an insurer, the insurer shall, at least semiannually, conduct a review of the operations of the administrator. At least one such review shall be an on-site audit of the operations of the administrator.
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(L. 1993 H.B. 709 § 46)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1085 - Premiums held in fiduciary capacity, duties — financial records, duties — withdrawals from fiduciary account by agreement only, contents — payment of claims.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1993
376.1085. Premiums held in fiduciary capacity, duties — financial records, duties — withdrawals from fiduciary account by agreement only, contents — payment of claims. —
1. All insurance charges or premiums collected by an administrator on behalf of or for an insurer or insurers, and the return of premiums received from that insurer or insurers, shall be held by the administrator in a fiduciary capacity. Such funds shall be immediately remitted to the person or persons entitled to them or shall be deposited promptly in a fiduciary account established and maintained by the administrator in a federally or state insured financial institution. The written agreement between the administrator and the insurer shall provide for the administrator to render periodically an accounting to the insurer detailing all transactions performed by the administrator pertaining to the business underwritten by the insurer.
2. If charges or premiums deposited in a fiduciary account have been collected on behalf of or for one or more insurers, the administrator shall keep records clearly recording the deposits in and withdrawals from the account on behalf of each insurer. The administrator shall keep copies of all the records and, upon request of an insurer, shall furnish the insurer with copies of the records pertaining to such deposits and withdrawals.
3. The administrator shall not pay any claim by withdrawals from a fiduciary account in which premiums or charges are deposited. Withdrawals from such account shall be made as provided in the written agreement between the administrator and the insurer. The written agreement shall address, but not be limited to, the following:
(1) Remittance to an insurer entitled to remittance;
(2) Deposit in an account maintained in the name of the insurer;
(3) Transfer to and deposit in a claims-paying account, with claims to be paid as provided for in subsection 4 of this section;
(4) Payment to a group policyholder for remittance to the insurer entitled to such remittance;
(5) Payment to the administrator of its commissions, fees or charges; or
(6) Remittance of return premium to the person or persons entitled to such return premium.
4. All claims paid by the administrator from funds collected on behalf of or for an insurer shall be paid only on drafts or checks of, and as authorized by, the insurer.
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(L. 1993 H.B. 709 § 47)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1087 - Commissions not to be contingent on savings in payment of claims — may be based on premiums collected.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1993
376.1087. Commissions not to be contingent on savings in payment of claims — may be based on premiums collected. —
1. An administrator shall not enter into any agreement or understanding with an insurer in which the effect is to make the amount of the administrator's commissions, fees or charges contingent upon savings effected in the adjustment, settlement and payment of losses covered by the insurer's obligations. This provision shall not prohibit an administrator from receiving performance based compensation for providing hospital or other auditing services.
2. This section shall not prevent the compensation of an administrator from being based on premiums or charges collected or the number of claims paid or processed.
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(L. 1993 H.B. 709 § 48)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1088 - Notice to policyholder of administrator, contents, required — disclosure of receipts to insurer.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1993
376.1088. Notice to policyholder of administrator, contents, required — disclosure of receipts to insurer. —
1. When the services of an administrator are used, the administrator shall provide a written notice to, and approved by, the insurer to covered individuals advising them of the identity of, and relationship among, the administrator, the policyholder and any insurer.
2. When an administrator collects funds, the reason for collection of each item shall be identified to the insured party and each item shall be shown separately from any premium. Additional charges may not be made for services to the extent the services have been paid for by the insurer.
3. The administrator shall disclose to the insurer all charges, fees and commissions received from all services in connection with the provision of administrative services for the insurer, including any fees or commissions paid by insurers providing reinsurance, stop loss coverage, or other form of insured benefit.
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(L. 1993 H.B. 709 § 49)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1090 - Materials delivered to administrator for insured to be promptly delivered.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1993
376.1090. Materials delivered to administrator for insured to be promptly delivered. —
Any policies, certificates, booklets, termination notices or other written communications delivered by the insurer to the administrator for delivery to insured parties or covered individuals shall be delivered by the administrator promptly after receipt of instructions from the insurer to deliver them.
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(L. 1993 H.B. 709 § 50)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1093 - Annual report filed with director, when — contents — filing fee, amount.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1993
376.1093. Annual report filed with director, when — contents — filing fee, amount. —
1. Each administrator shall file an annual report for the preceding calendar year with the director on or before March first of each year, or within such extension of time therefor as the director for good cause may grant. The report shall be in the form and contain such matters as the director prescribes and shall be verified by at least two officers of the administrator.
2. The annual report shall include the complete names and addresses of all insurers and trusts with which the administrator had an agreement during the preceding fiscal year.
3. The annual report shall identify which insurers or trusts are fully insured by an insurer licensed to transact business in this state, self-insured, or have stop-loss coverage.
4. For those insurers or trusts which are fully insured or which possess stop-loss coverage, the annual report shall identify the carrier and policy or certificate number.
5. At the time of filing its annual report, the administrator shall pay a filing fee of two hundred fifty dollars.
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(L. 1993 H.B. 709 § 52)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1095 - Rules and regulations, promulgation.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1995
376.1095. Rules and regulations, promulgation. —
The director shall have the power to promulgate such rules and regulations as are necessary to implement the provisions of sections 376.1075 to 376.1095. No rule or portion of a rule promulgated under the authority of sections 376.1075 to 376.1095 shall become effective unless it has been promulgated pursuant to the provisions of section 536.024.
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(L. 1993 H.B. 709 § 54, A.L. 1995 S.B. 3)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1103 - Laws applicable, Medicare supplement laws not applicable — purpose — policies or riders must be in compliance.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2002
376.1103. Laws applicable, Medicare supplement laws not applicable — purpose — policies or riders must be in compliance. —
1. The provisions of sections 376.1100 to 376.1130 shall apply to policies delivered or issued for delivery in this state on or after August 28, 2002. Sections 376.1100 to 376.1130 are not intended to supersede the obligations of entities subject to the provisions of sections 376.1100 to 376.1130 to comply with the substance of other applicable insurance laws insofar as they do not conflict with the provisions of sections 376.1100 to 376.1130, except that laws and regulations designed and intended to apply to Medicare supplement insurance policies shall not be applied to long-term care insurance.
2. The purposes of the provisions of sections 376.1100 to 376.1130 are to promote the public interest, to promote the availability of long-term care insurance policies, to protect applicants for long-term care insurance, as defined, from unfair or deceptive sales or enrollment practices, to establish standards for long-term care insurance, to facilitate public understanding and comparison of long-term care insurance policies, and to facilitate flexibility and innovation in the development of long-term care insurance coverage.
3. Any policy or rider advertised, marketed or offered as long-term care or nursing home insurance shall comply with the provisions of sections 376.1100 to 376.1130.
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(L. 1990 S.B. 765 §§ 3, 8, A.L. 2002 H.B. 1568 merged with S.B. 1009)
Transferred 2002; formerly 376.952
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1106 - Policies issued in other states may be issued to residents of Missouri if in compliance with Missouri regulations.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1990
376.1106. Policies issued in other states may be issued to residents of Missouri if in compliance with Missouri regulations. —
No group long-term care insurance coverage may be offered to a resident of this state under a group policy issued in another state to a group described in paragraph (d) of subdivision (4) of subsection 2 of section 376.1100, unless this state or another state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in this state has made a determination that such requirements have been met.
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(L. 1990 S.B. 765 § 4)
Transferred 2002; formerly 376.953.
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1112 - Director to provide buyer's guide — content — advertising of long-term care policies to contain notice of availability of guide.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1990
376.1112. Director to provide buyer's guide — content — advertising of long-term care policies to contain notice of availability of guide. —
The director shall prepare a guide that explains the factors to be considered in selecting long-term care insurance and the consequences of particular clauses and exclusions. The guide shall be made available to the public and to interested organizations upon request. Any advertisement in this state relating to long-term care insurance shall include notice of availability of this guide from the director.
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(L. 1990 S.B. 765 § 6 subsec. 1)
Transferred 2002; formerly 376.956
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1118 - Benefits funded by a life insurance death benefit acceleration, reports to policyholder required, content.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1990
376.1118. Benefits funded by a life insurance death benefit acceleration, reports to policyholder required, content. —
Any time a long-term care benefit, funded through a life insurance vehicle by the acceleration of the death benefit, is in benefit payment status, a monthly report shall be provided to the policyholder. Such report shall include:
(1) Any long-term care benefits paid out during the month;
(2) An explanation of any changes in the policy, such as death benefits or cash values, due to long-term care benefits being paid out; and
(3) The amount of long-term care benefits existing or remaining.
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(L. 1990 S.B. 765 § 7)
Transferred 2002; formerly 376.958
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1121 - Denial of claim, long-term care insurance, duties of issuer.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2002
376.1121. Denial of claim, long-term care insurance, duties of issuer. —
If a claim under a long-term care insurance contract is denied, the issuer shall, within sixty days of the date of a written request by the policyholder or certificate holder, or a representative thereof:
(1) Provide a written explanation of the reasons for the denial; and
(2) Make available all information directly related to the denial.
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(L. 2002 H.B. 1568 merged with S.B. 1009)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1124 - Rescinding of a long-term care policy, permitted when — grounds for contesting — no field issuance, when.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2002
376.1124. Rescinding of a long-term care policy, permitted when — grounds for contesting — no field issuance, when. —
1. For a policy or certificate that has been in force less than six months, an insurer may rescind a long-term care insurance policy or certificate, or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is material to the acceptance for coverage.
2. For a policy or certificate that has been in force for at least six months but less than two years, an insurer may rescind a long-term care insurance policy or certificate, or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is both material to the acceptance of coverage and which pertains to the conditions for which benefits are sought.
3. After a policy or certificate has been in force for two years, such policy or certificate is not contestable upon the grounds of misrepresentation alone. Such policy or certificate may be contested only upon a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured's health.
4. No long-term care insurance policy or certificate shall be field issued based on medical or health status. For purposes of this subsection,
"field issued"
means a policy or certificate issued by an agent or third-party administrator pursuant to the underwriting authority granted to the agent or third-party administrator by an insurer.
5. If an insurer has paid benefits under the long-term care insurance policy or certificate, the benefit payments shall not be recovered by the insurer if such policy or certificate is rescinded.
6. In the event of the death of the insured, this section shall not apply to the remaining death benefit of a life insurance policy that accelerates benefits for long-term care. In this situation, the remaining death benefits under these such policies shall be governed by the contestability provisions otherwise applicable in the policy to life insurance benefits. In all other situations, this section shall apply to life insurance policies that accelerate benefits for long-term care.
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(L. 2002 H.B. 1568 merged with S.B. 1009)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1127 - Nonforfeiture benefit option required for long-term care insurance policies, requirements of offer — rulemaking authority.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2002
376.1127. Nonforfeiture benefit option required for long-term care insurance policies, requirements of offer — rulemaking authority. —
1. Except as provided in subsection 2 of this section, a long-term care insurance policy shall not be delivered or issued for delivery in this state unless the policyholder or certificate holder has been offered the option of purchasing a policy or certificate including a nonforfeiture benefit. The offer of a nonforfeiture benefit may be in the form of a rider that is attached to the policy. If a policyholder or certificate holder declines the nonforfeiture benefit, the insurer shall provide a contingent benefit upon lapse that will be available for a specified period of time following a substantial increase in premium rates.
2. When a group long-term care insurance policy is issued, the offer required in subsection 1 of this section shall be made to the group policyholder; except that, if the policy is issued as a group long-term care insurance, as defined in section 376.1100, other than to a continuing care retirement community or other similar entity, the offering shall be made to each proposed certificate holder.
3. The director shall promulgate rules specifying the type or types of nonforfeiture benefits to be offered as part of long-term care insurance policies and certificates, the standards for nonforfeiture benefits, and the rules regarding contingent benefit upon lapse, including a determination of the specified period of time during which a contingent benefit upon lapse will be available and the substantial premium rate increase that triggers a contingent benefit upon lapse as described in subsection 1 of this section.
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(L. 2002 H.B. 1568 merged with S.B. 1009)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.1130 - Rulemaking authority.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2002
376.1130. Rulemaking authority. —
1. The director shall promulgate reasonable rules to promote premium adequacy and to provide alternatives for the policyholder in the event of substantial rate increases, and to establish minimum standards for marketing practices, agent testing, penalties, and reporting practices for long-term care insurance.
2. Any rule or portion of a rule, as that term is defined in section 536.010, that is created under the authority delegated in sections 376.1121 to 376.1130 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 pursuant to 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, 2002, shall be invalid and void.
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(L. 2002 H.B. 1568 merged with S.B. 1009)