reglab/statecodes huggingface dataset:
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.755 - Advertising, use of guaranty association prohibited.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2018, 2 histories
376.755. Advertising, use of guaranty association prohibited. —
No person, including a member insurer, agent or affiliate of an insurer shall make, publish, disseminate, circulate, or place before the public, or cause directly or indirectly, to be made, published, disseminated, circulated or placed before the public, in any newspaper, magazine or other publication, or in the form of a notice, circular, pamphlet, letter or poster, or over any radio station or television station, or in any other way, any advertisement, announcement or statement, written or oral, which uses the existence of the insurance guaranty association of this state for the purpose of sales, solicitation, or inducement to purchase any form of insurance or other coverage covered by sections 376.715 to 376.758. If a policy exceeds the limitations of coverage under sections 376.715 to 376.758, the insurer shall prominently inscribe on an endorsement to the insurance contract the limitations of coverage provided by the guaranty association. This section shall not apply to the Missouri Life and Health Insurance Guaranty Association or any other entity which does not sell or solicit insurance or coverage by a health maintenance organization.
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(L. 1988 S.B. 430 § 35, A.L. 1991 H.B. 385, et al., A.L. 2018 H.B. 1690)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.758 - Law inapplicable to insolvent insurers on effective date of law.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2018, 2 histories
376.758. Law inapplicable to insolvent insurers on effective date of law. —
1. Sections 376.715 to 376.758 shall not apply to any insurer which is insolvent or unable to fulfill its contractual obligations on August 13, 1988.
2. Sections 376.715 to 376.758 shall be liberally construed to effect the purpose under subsection 2 of section 376.715 which shall constitute an aid and guide to interpretation.
3. The amendments to sections 376.715 to 376.758 which become effective on August 28, 2010, shall not apply to any member insurer that is an impaired or insolvent insurer prior to August 28, 2010.
4. The amendments to sections 376.715 to 376.758, which become effective on August 28, 2018, shall not apply to any member insurer that is an impaired or insolvent insurer prior to August 28, 2018.
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(L. 1988 S.B. 430 § 37, A.L. 2010 S.B. 583, A.L. 2018 H.B. 1690)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.770 - Title of law.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1959
376.770. Title of law. —
Sections 376.770 to 376.800 may be cited as the "Uniform Individual Accident and Sickness Insurance Law".
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(L. 1959 H.B. 252 § 1)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.773 - Definitions.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1959
376.773. Definitions. —
1. The word
"insurer"
as used in sections 376.770 to 376.800 shall mean any insurance company issuing or writing any policy of accident and sickness insurance which is subject to the provisions of sections 376.770 to 376.800.
2. The term
"policy of accident and sickness insurance"
as used in sections 376.770 to 376.800 includes any policy or contract of insurance against loss resulting from sickness or from bodily injury or death by accident, or both, issued or written by any insurance company authorized under the laws of the state of Missouri to transact such insurance in this state or issued by any insurance company to a resident of the state of Missouri.
3. The term
"director of insurance"
as used in sections 376.770 to 376.800 shall mean the director of the department of commerce and insurance.
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(L. 1959 H.B. 252 § 2)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.776 - Hospital and medical expense provisions extended for certain handicapped and dependent children past normal coverage age.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 01 Jan 2008, see footnote
376.776. Hospital and medical expense provisions extended for certain handicapped and dependent children past normal coverage age. —
1. This section applies to the hospital and medical expense provisions of an accident or sickness insurance policy.
2. If a policy provides that coverage of a dependent child terminates upon attainment of the limiting age for dependent children specified in the policy, such policy so long as it remains in force shall be deemed to provide that attainment of such limiting age does not operate to terminate the hospital and medical coverage of such child while the child is and continues to be both incapable of self-sustaining employment by reason of mental or physical handicap and chiefly dependent upon the policyholder for support and maintenance. Proof of such incapacity and dependency must be furnished to the insurer by the policyholder at least thirty-one days after the child's attainment of the limiting age. The insurer may require at reasonable intervals during the two years following the child's attainment of the limiting age subsequent proof of the child's disability and dependency. After such two-year period, the insurer may require subsequent proof not more than once each year.
3. If a policy provides that coverage of a dependent child terminates upon attainment of the limiting age for dependent children specified in the policy, such policy, so long as it remains in force until the dependent child attains the limiting age, shall remain in force at the option of the policyholder. The policyholder's election for continued coverage under this section shall be furnished by the policyholder to the insurer within thirty-one days after the child's attainment of the limiting age. As used in this subsection, a dependent child is a person who:
(1) Is a resident of this state;
(2) Is unmarried and no more than twenty-five years of age; and
(3) Not provided coverage as a named subscriber, insured, enrollee, or covered person under any group or individual health benefit plan, or entitled to benefits under Title XVIII of the Social Security Act, P.L. 89-97, 42 U.S.C. Section 1395, et seq.
4. This section applies only to policies delivered or issued for delivery in this state more than one hundred twenty days after October 13, 1967.
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(L. 1967 p. 577, A.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 376.778 - Payment direct to public hospitals or clinics with or without assignment, when — provisions required in contracts.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1983
376.778. Payment direct to public hospitals or clinics with or without assignment, when — provisions required in contracts. —
1. As used in this section, the following words mean:
(1)
"Assignment"
, authorization by an insured to pay health insurance benefits directly to the provider of services;
(2)
"Claim"
, forms, bills, itemized charges and other documents required by an insurance company or health services corporation to pay benefits under a contract, and a notice that direct payment is demanded pursuant to this section;
(3)
"Contract"
, an individual or group health insurance policy or contract providing coverage on an expense incurred basis issued by an insurance company or a health services corporation doing business in this state;
(4)
"Insured"
, a person covered under a contract issued by an insurance company or health services corporation.
2. Every contract subject to this section shall contain a provision whereby the benefits payable thereunder to an insured shall be paid, with or without an assignment from the insured, to public hospitals or clinics for services and supplies provided to the insured if a proper claim is submitted by the public hospital or clinic. No benefits shall be paid under this section to the public hospital or clinic if such benefits have been paid to the insured prior to receipt of the claim by the insurance company or health services corporation. Payment to the public hospital or clinic of benefits pursuant to this section shall discharge the insurance company or health services corporation from all liability to the insured to the extent of the benefits so paid. Nothing in this section shall be construed to require payment of benefits for the same services or supplies to both the insured and the public hospital or clinic.
3. This section shall apply to every contract issued, amended, or renewed after September 28, 1983, by an insurance company or a health services corporation doing business in this state.
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(L. 1983 H.B. 699 § 1)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.780 - Limits on provisions, effect of conflict of policy with law.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1959
376.780. Limits on provisions, effect of conflict of policy with law. —
1. Other policy provisions. No policy provision which is not subject to section 376.777 shall make a policy, or any portion thereof, less favorable in any respect to the insured or the beneficiary than the provisions thereof which are subject to sections 376.770 to 376.800.
2. Policy conflicting with sections 376.770 to 376.800. A policy delivered or issued for delivery to any person in this state in violation of sections 376.770 to 376.800 shall be held valid but shall be construed as provided in sections 376.770 to 376.800. When any provision in a policy subject to sections 376.770 to 376.800 is in conflict with any provision of sections 376.770 to 376.800, the rights, duties and obligations of the insurer, the insured and the beneficiary shall be governed by the provisions of sections 376.770 to 376.800.
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(L. 1959 H.B. 252 § 5)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.781 - Speech and hearing disorders, companies to offer coverage, when — rules, procedure.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1995
376.781. Speech and hearing disorders, companies to offer coverage, when — rules, procedure. —
1. All group health insurance policies providing coverage on an expense-incurred basis, all group service or indemnity contracts issued by a not-for-profit health service corporation, all self-insured group health benefit plans of any type or description, and all such health plans or policies that are individually underwritten or provide for such coverage for specific individuals and the members of their families as nongroup policies, which provide for hospital treatment, shall offer coverage for the necessary care and treatment of loss or impairment of speech or hearing subject to the same durational limits, dollar limits, deductibles and coinsurance factors as other covered services in such policies or contracts. All Missouri group contracts issued or renewed on or after December 31, 1984, shall be subject to this section. Notwithstanding any construction or relationship of interdependent contracts or plans affecting coverage and payment of reimbursement prerequisites under the policy or contract, coverage required by this section shall be included in the policy or contract and payment provided as for other coverage in the same policy or contract.
2. The offer of benefits under subsection 1 of this section shall be in writing and may be rejected by the individual or group policyholder.
3. Nothing in this section shall prohibit the insurance company or not-for-profit health service corporation from including any coverage for loss or impairment of speech, language or hearing as standard coverage in their policies or contracts, but same shall not contain terms contrary to this section.
4. The phrase
"loss or impairment of speech or hearing"
shall include those communicative disorders generally treated by a speech pathologist, audiologist or speech/language pathologist licensed by the state board of healing arts or certified by the American Speech-Language and Hearing Association (ASHA), or both, and which fall within the scope of his or her license or certification.
5. Any provision in a health insurance policy contrary to or in conflict with the provisions of this section shall, to the extent of the conflict, be void, but such invalidity shall not offset the validity of the other provisions of such policy.
6. The department of commerce and insurance may issue rules necessary to carry out the provisions of this section. No rule or portion of a rule promulgated under the authority of this section shall become effective unless it has been promulgated pursuant to the provisions of section 536.024.
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(L. 1984 S.B. 522 § 1, A.L. 1995 S.B. 3)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.783 - Insured bound only if copy of application attached to policy.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1959
376.783. Insured bound only if copy of application attached to policy. —
1. The insured shall not be bound by any statement made in an application for a policy unless a copy of such application is attached to or endorsed on the policy when issued as a part thereof, or the insurer furnishes a true copy of such application with, and at the time of, any denial of liability or reduction in benefits based thereon. If any such policy delivered or issued for delivery to any person in this state shall be reinstated or renewed, and the insured or the beneficiary or assignee of such policy shall make written request to the insurer for a copy of the application, if any, for such reinstatement or renewal, the insurer shall within fifteen days after the receipt of such request at its home office or any branch office of the insurer, deliver or mail to the person making such request, a copy of such application. If such copy shall not be so delivered or mailed, the insurer shall be precluded from introducing such application as evidence in any action or proceeding based upon or involving such policy or its reinstatement or renewal.
2. No alteration of any written application for any such policy shall be made by any person other than the applicant without his written consent, except that insertions may be made by the insurer, for administrative purposes only, in such manner as to indicate clearly that such insertions are not to be ascribed to the applicant.
3. The falsity of any statement in the application for any policy covered by sections 376.770 to 376.800 may not bar the right to recovery thereunder unless such false statement materially affected either the acceptance of the risk or the hazard assumed by the insurer.
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(L. 1959 H.B. 252 § 6)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.785 - What does not constitute waiver of defenses.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1959
376.785. What does not constitute waiver of defenses. —
The acknowledgment by an insurer of the receipt of notice given under any policy covered by sections 376.770 to 376.800, or the furnishing of forms for filing proofs of loss, or the acceptance of such proofs, or the investigation of any claim thereunder shall not operate as a waiver of any of the rights of the insurer in defense of any claim arising under such policy.
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(L. 1959 H.B. 252 § 7)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.787 - Effect of age limit provision.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1959
376.787. Effect of age limit provision. —
If any such policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if such date falls within a period for which premium is accepted by the insurer or if the insurer accepts a premium after such date, the coverage provided by the policy will continue in force subject to any right of cancellation until the end of the period for which premium has been accepted. In the event the age of the insured has been misstated and if, according to the correct age of the insured, the coverage provided by the policy would not have become effective, or would have ceased prior to the acceptance of such premium or premiums, then the liability of the insurer shall be limited to the refund, upon request, of all premiums paid for the period not covered by the policy.
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(L. 1959 H.B. 252 § 8)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.789 - Definition of actual charge and actual fee.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2009
376.789. Definition of actual charge and actual fee. —
1. (1) This section applies to an individual or a group specified disease insurance policy issued to any person that contains the terms "actual charge" or "actual fee" without containing an express definition of the term.
(2)
"Actual charge"
or
"actual fee"
when used in an individual specified disease insurance policy in connection with the benefits payable for services rendered by a health care provider or other designated person or entity means the amount the health care provider or other designated person or entity:
(a) Agrees to accept under a network or other participation agreement with the health insurer, third-party administrator, or other third-party payor, or other person, including the insured, as payment in full for the treatment, goods, or services provided to the insured; or
(b) Agrees, or as obligated by operation of law, to accept as payment in full for the treatment, goods, or services provided to the insured under a provider, participation, or supplier agreement under Medicare, Medicaid, or any other government-administered health care program where the insured is covered or reimbursed by this program.
(3)
"Payment in full"
includes the actual charge or actual fee that was actually paid for the health care provider's treatment, goods, or services on behalf of the insured by Medicare, Medicaid, any other government-administered health care program, any other health insurer, thirty-party administrator, or other third-party payor and, where applicable, any remaining portion of the actual charge or actual fee that was applied or assessed against the insured by Medicare, Medicaid, any other government-administered health care program, any other health insurer, third-party administrator, or other third-party payor for the applicable deductions, coinsurance requirements, or co-pay requirements.
(4) If paragraphs (a) and (b) of subdivision (2) of this subsection apply, the actual charge or actual fee shall be the lesser of the amounts determined under such paragraphs.
2. Notwithstanding any other provision of law, after August 28, 2009, an insurer or issuer of an individual or group specified disease insurance policy shall not pay a claim of benefit under the applicable policy in an amount in excess of the actual charge or actual fee as defined in this section.
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(L. 2009 H.B. 481)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.790 - Limits on applicability of law.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1959
376.790. Limits on applicability of law. —
Nothing in sections 376.770 to 376.800 shall apply to or affect (1) any policy of workers' compensation insurance or any policy of liability insurance with or without supplementary expense coverage therein; or (2) any policy or contract of reinsurance; or (3) any blanket or group policy of insurance; or (4) life insurance endowment or annuity contracts or contracts supplemental thereto which contain only such provisions relating to accident and sickness insurance as (a) provide additional benefits in case of death or dismemberment or loss of sight by accident, or as (b) operate to safeguard such contracts against lapse, or to give a special surrender value or special benefit or an annuity in the event that the insured or annuitant shall become totally and permanently disabled, as defined by the contract or supplemental contract.
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(L. 1959 H.B. 252 § 9)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.791 - Portion of section 376.777 not applicable to individual health insurance coverage.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2015
376.791. Portion of section 376.777 not applicable to individual health insurance coverage. —
1. The provisions of subdivisions (4) and (5) of subsection 2 of section 376.777 shall not apply to any individual health insurance coverage. The term "individual health insurance coverage" shall have the meaning assigned to it in section 376.450.
2. The director shall promulgate rules and regulations to implement and administer the provisions of this section prior to January 1, 2016. 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 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, 2015, shall be invalid and void.
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(L. 2015 H.B. 709)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.800 - Misrepresentation made in obtaining individual accident and health policy no defense, exception.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1967
376.800. Misrepresentation made in obtaining individual accident and health policy no defense, exception. —
Anything in the law to the contrary notwithstanding, no misrepresentation made in obtaining or securing a policy of insurance covered by sections 376.770 to 376.800 shall be deemed material or render the policy void, or constitute a defense to a claim thereunder unless the matter misrepresented shall have actually contributed to the contingency or event on which any claim thereunder is to become due and payable, and whether it so contributed in any case shall be a question for the jury.
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(L. 1967 p. 516 § C)
(1994) In claim for vexatious refusal to pay medical benefits against group health medical insurer, statute is preempted by Federal Employee Retirement Income Security Act (ERISA). Statute is not a statute which regulates insurance, therefore, does not come under the savings clause of ERISA preemption that expressly exempts state laws that regulate insurance. Coots v. United Employers Federation, 865 F.Supp 596 (E.D. Mo).
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.805 - Elective abortion to be by optional rider and requires additional premium — elective abortion defined — health insurance exchanges not to offer coverage for elective abortions.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2010
376.805. Elective abortion to be by optional rider and requires additional premium — elective abortion defined — health insurance exchanges not to offer coverage for elective abortions. —
1. No health insurance contracts, plans, or policies delivered or issued for delivery in the state shall provide coverage for elective abortions except by an optional rider for which there must be paid an additional premium. For purposes of this section, an
"elective abortion"
means an abortion for any reason other than a spontaneous abortion or to prevent the death of the female upon whom the abortion is performed.
2. Subsection 1 of this section shall be applicable to all contracts, plans or policies of:
(1) All health insurers subject to this chapter; and
(2) All nonprofit hospital, medical, surgical, dental, and health service corporations subject to chapter 354; and
(3) All health maintenance organizations.
3. No health insurance exchange established within this state or any health insurance exchange administered by the federal government or its agencies within this state shall offer health insurance contracts, plans, or policies that provide coverage for elective abortions, nor shall any health insurance exchange operating within this state offer coverage for elective abortions through the purchase of an optional rider.
4. This section shall be applicable only to contracts, plans or policies written, issued, renewed or revised after September 28, 1983. For the purposes of this subsection, if new premiums are charged for a contract, plan or policy, it shall be determined to be a new contract, plan or policy.
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(L. 1983 S.B. 222 § 1, A.L. 2010 S.B. 793)
(1992) Where statute prohibits insurance coverage for elective abortion unless coverage is provided in optional rider with separate premium, it does not impose an undue burden on a woman's abortion decision and it is rationally related to Missouri's interest in protecting the interest of citizens who object to subsidizing abortions through payment of their insurance premiums. Coe v. Melahn, 958 F.2d 223 (8th Cir.).
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.806 - Refund of health insurance unearned premium on notice of death of insured — refunded to whom — definitions — exception — failure to notify within one year.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1991
376.806. Refund of health insurance unearned premium on notice of death of insured — refunded to whom — definitions — exception — failure to notify within one year. —
1. As used in this section, the following terms mean:
(1)
"Health insurance contract"
, any one of the following when providing coverage to a resident of this state:
(a) Individual insurance policies providing coverage on an expense incurred basis;
(b) Individual indemnity type contracts issued by a health services corporation;
(c) Any individual contract issued by a health maintenance organization;
(d) Any self-insured health benefit plan, except to the extent preempted by federal law;
(e) Group health insurance in which the insured pays the full premium directly to the insurer, health services corporation or health maintenance corporation;
(2)
"Health insurer"
, any entity issuing a health insurance contract.
2. A health insurer shall refund promptly any premium which it did not earn, upon notification of the death of any person covered under the health insurer's health insurance contract. The health insurer shall earn only that part of the premiums paid on behalf of the decedent which the period of coverage during which the decedent was alive bears to the whole period for which premiums were paid.
3. The refund of premiums shall be made directly to:
(1) The decedent's spouse at the time of the decedent's death;
(2) The primary insured person under the health insurance contract, if the decedent was not married at the time of death and was covered under the health insurance contract as a dependent;
(3) The decedent's estate, if neither subdivision (1) nor (2) of this subsection is applicable.
4. This section does not apply if the notification of the death of an insured person is given to the health insurer more than one year after the death of the decedent.
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(L. 1991 H.B. 561 § 1)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.807 - Policies not to reduce or deny benefits to persons eligible for medical assistance — deemed primary contract.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
Effective - 28 Aug 1988
376.807. Policies not to reduce or deny benefits to persons eligible for medical assistance — deemed primary contract. —
1. No contract of medical expense insurance, delivered or issued for delivery, amended or renewed in this state after August 13, 1988, by a self-insured or self-funded plan, prepaid health plan, health maintenance organization plan, health services corporation plan or insurance company licensed to issue policies in this state, shall contain any provision denying or reducing benefits because services are rendered to an insured or dependent who is eligible for or receiving medical assistance pursuant to chapter 208.
2. All such contracts shall be deemed to be the primary coverage of an insured or dependent who is eligible for or receiving medical assistance pursuant to chapter 208.
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(L. 1988 S.B. 430 § 38)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.814 - Rules and regulations authorized, department of mental health to advise department — procedure.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1993
376.814. Rules and regulations authorized, department of mental health to advise department — procedure. —
1. The department of commerce and insurance shall promulgate rules and regulations, pursuant to section 376.982 and chapter 536, and the department of mental health shall advise the department of commerce and insurance on the promulgation of said rules and regulations as they pertain to the development and implementation of all standards and guidelines for managed care as set out in sections 376.810 to 376.814, to ensure that all mental health services provided pursuant to sections 376.810 to 376.814 are provided in accordance with chapters 197, 334, 337, and section 630.655, provided however, that nothing in this act
*
shall prohibit department of mental health licensed or certified facilities or programs from using qualified mental health professionals or other specialty staff persons.
2. Any person who serves or served on a quality assessment and assurance committee required under 42 U.S.C. Sec. 1396r(b)(1)(B) and 42 CFR Sec. 483.75(r), or as amended, shall be immune from civil liability only for acts done directly as a member of such committee so long as the acts are performed in good faith, without malice and are required by the activities of such committee as defined in 42 CFR Sec. 483.75(r).
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(L. 1991 S.B. 352 § 7 subsecs. 5, 6, 7, A.L. 1993 S.B. 52)
*"This act" (S.B. 351, 1991) contained numerous sections. Consult Disposition of Sections table for a definitive listing.
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.816 - Adopted children to be provided health care coverage on the same basis as other dependents — effective from date of birth or on placement — placement defined.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 2010
376.816. Adopted children to be provided health care coverage on the same basis as other dependents — effective from date of birth or on placement — placement defined. —
1. No health carrier or health benefit plan that offers or issues health benefit plans, other than Medicaid health benefit plans, shall deliver, issue for delivery, continue, or renew a health benefit plan to a Missouri resident on or after January 1, 2011, unless the health benefit plan covers adopted children of the insured, subscriber or enrollee on the same basis as other dependents.
2. The coverage required by subsection 1 of this section is effective:
(1) From the date of birth if a petition for adoption is filed within thirty days of the birth of such child; or
(2) From the date of placement for the purpose of adoption if a petition for adoption is filed within thirty days of placement of such child.
­­Such coverage shall continue unless the placement is disrupted prior to legal adoption and the child is removed from placement. Coverage shall include the necessary care and treatment of medical conditions existing prior to the date of placement.
3. As used in this section, the following terms shall mean:
(1)
"Health benefit plan"
, the same meaning as such term is defined in section 376.1350;
(2)
"Health carrier"
, the same meaning as such term is defined in section 376.1350;
(3)
"Placement"
, in the physical custody of the adoptive parent.
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(L. 1991 S.B. 352 § 8, A.L. 1998 S.B. 674, A.L. 2010 S.B. 583)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.818 - Eligibility for Medicaid may not be considered by insurers.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
Effective - 01 Jul 1994, see footnote
376.818. Eligibility for Medicaid may not be considered by insurers. —
No individual or group insurance policy providing coverage on an expense-incurred basis, no individual or group service or indemnity contract issued by a not-for-profit health services corporation, no health maintenance organization nor any self-insured group health benefit plan of any type or description shall be offered, issued or renewed in this state by any insurer on or after July 1, 1994, if any insurer, including a group health plan, as defined in section 607(1) of the federal Employee Retirement Income Security Act of 1974, takes into account that an individual is eligible for or is provided medical assistance under Medicaid (Title XIX) when enrolling an individual or in making payment for benefits to the individual or on the individual's behalf.
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(L. 1994 H.B. 1491 & 1134 merged with S.B. 508)
Effective 7-01-94
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.819 - MO HealthNet division to have right to payment for health care services provided.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
Effective - 28 Aug 2014
376.819. MO HealthNet division to have right to payment for health care services provided. —
To the extent that payment has been made by the MO HealthNet division for health care items or services furnished to a Medicaid-eligible individual, the MO HealthNet division is considered to have acquired the rights of the Medicaid-eligible individual to payment by any insurer or other party obligated to cover such health care items or services.
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(L. 1994 H.B. 1491 & 1134 merged with S.B. 508, A.L. 2014 H.B. 1299 Revision)
CROSS REFERENCE:
Subrogation rights of department of social services, liens, recovery of medical expenses, 208.215
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.820 - Insurers may not deny coverage of child because of marital status of parents, residence or income tax dependency claim.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
Effective - 01 Jul 1994, see footnote
376.820. Insurers may not deny coverage of child because of marital status of parents, residence or income tax dependency claim. —
No individual or group insurance policy providing coverage on an expense-incurred basis, no individual or group service or indemnity contract issued by a not-for-profit health services corporation, no health maintenance organization nor any self-insured group health benefit plan of any type or description shall be offered, issued or renewed in this state on or after July 1, 1994, by an insurer, including a group health plan, as defined in section 607(1) of the federal Employee Retirement Income Security Act of 1974, that denies enrollment of a child under the health coverage of the child's parent on the grounds that:
(1) The child was born out of wedlock; or
(2) The child is not claimed as a dependent on the parent's federal income tax return; or
(3) The child does not reside with the parent or in the insurer's service area.
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(L. 1994 H.B. 1491 & 1134 merged with S.B. 508)
Effective 7-01-94
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.821 - Insurers may not cancel health or dental insurance solely because the insured is incarcerated — insurer, defined.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
Effective - 28 Aug 1995
376.821. Insurers may not cancel health or dental insurance solely because the insured is incarcerated — insurer, defined. —
1. As used in this section, the term
"insurer"
means any person, reciprocal exchange, interinsurer, Lloyds insurer, fraternal benefit society, and any other legal entity engaged in the business of insurance, including agents, brokers, adjusters and third-party administrators. "Insurer" also includes health services corporations, health maintenance organizations, prepaid limited health care service plans, dental, optometric and other similar health service plans. For purposes of sections 375.930 to 375.948, such entities shall be deemed to be engaged in the business of insurance. "Insurer" shall also include all companies organized, incorporated or doing business under the provisions of chapters 325, 375, 376, 377, 378, 379, 381, and 383.
2. No insurer shall cancel or deny coverage on a contract or policy of health insurance or dental insurance to any person solely on the grounds that the person is incarcerated under authority of law.
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(L. 1995 H.B. 424 § 5)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.823 - Prohibition on kickbacks not applicable for rebates for certain chronic illnesses.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
Effective - 28 Aug 2005
376.823. Prohibition on kickbacks not applicable for rebates for certain chronic illnesses. —
Section 191.905 shall not apply to programs established by pharmaceutical companies for the purposes of providing a partial rebate of private health insurance co-payments and coinsurance to patients with multiple sclerosis or other chronic, potentially disabling, or life-threatening conditions who have been prescribed disease-managing medicines for which there are no generic equivalents.
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(L. 2005 H.B. 56)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.850 - Law, how cited.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 28 Aug 1989
376.850. Law, how cited. —
Sections 376.850 to 376.890 may be cited as the "Missouri Medicare Supplement Insurance Act".
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(L. 1981 S.B. 347 § 1, A.L. 1989 H.B. 615 & 563)
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.854 - Definitions.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 26 Apr 1996, see footnote
376.854. Definitions. —
As used in sections 376.850 to 376.890, the following terms mean:
(1)
"Applicant"
:
(a) In the case of an individual Medicare supplement policy, the person who seeks to contract for insurance benefits; and
(b) In the case of a group Medicare supplement policy, the proposed certificate holder;
(2)
"Certificate"
, any certificate delivered or issued for delivery in this state under a group Medicare supplement policy;
(3)
"Certificate form"
, the form on which the certificate is delivered or issued for delivery by the issuer;
(4)
"Director"
, the director of the department of commerce and insurance;
(5)
"Issuer"
includes insurance companies, fraternal benefit societies, health care service plans, health maintenance organizations, and any other entity delivering or issuing for delivery in this state Medicare supplement policies or certificates;
(6)
"Medicare"
, the Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended;
(7)
"Medicare supplement policy"
, a group or individual policy of insurance or a subscriber contract, other than a policy issued pursuant to a contract under section 1876 of the federal Social Security Act, 42 U.S.C. section 1395, et seq., or an issued policy under a demonstration project specified in 42 U.S.C. section 1395ss(g)(1), which is advertised, marketed or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical or surgical expenses of persons eligible for Medicare;
(8)
"Policy form"
, the form on which the policy is delivered or issued for delivery by the issuer.
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(L. 1989 H.B. 615 & 563, A.L. 1992 H.B. 1574, A.L. 1996 S.B. 883)
Effective 4-26-96
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.859 - Medicare supplement law applicable to what policies — policies not included.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 26 Apr 1996, see footnote
376.859. Medicare supplement law applicable to what policies — policies not included. —
1. Except as otherwise specifically provided, sections 376.850 to 376.890 shall apply to:
(1) All Medicare supplement policies delivered or issued for delivery in this state on or after August 28, 1992; and
(2) All certificates issued under group Medicare supplement policies, when certificates have been delivered or issued for delivery in this state.
2. Medicare supplement policies do not include a policy of one or more employers or labor organizations, or of the trustees of a fund established by one or more employers or labor organizations, or combination thereof, for employees or former employees or a combination thereof or for members or former members, or a combination thereof, of the labor organizations.
3. The provisions of sections 376.850 to 376.890 are not intended to prohibit or apply to insurance policies or health care benefit plans, including group conversion policies, provided to Medicare eligible persons when policies are not marketed or held to be Medicare supplement policies or benefit plans.
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(L. 1989 H.B. 615 & 563, A.L. 1992 H.B. 1574, A.L. 1996 S.B. 883)
Effective 4-26-96
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.869 - Standards for policies, minimum, director to adopt.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 26 Apr 1996, see footnote
376.869. Standards for policies, minimum, director to adopt. —
The director shall adopt reasonable regulations to establish minimum standards for benefits, claims payment, marketing practices, compensation arrangements and reporting practices for Medicare supplement policies.
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(L. 1989 H.B. 615 & 563, A.L. 1990 H.B. 1630, A.L. 1992 H.B. 1574, A.L. 1996 S.B. 883)
Effective 4-26-96
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.874 - Requirements of policy, return to policyholders.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 06 Jul 1992, see footnote
376.874. Requirements of policy, return to policyholders. —
Medicare supplement policies shall return to policyholders benefits which are reasonable in relation to the premium charged. The director shall issue reasonable regulations to establish minimum standards for loss ratios of Medicare supplement policies on the basis of incurred claims experience, or incurred health care expenses where coverage is provided by a health maintenance organization on a service rather than reimbursement basis, and earned premiums in accordance with accepted actuarial principles and practices.
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(L. 1989 H.B. 615 & 563, A.L. 1990 H.B. 1630, A.L. 1992 H.B. 1574)
Effective 7-06-92
2023 Missouri Revised Statutes › Title XXIV - Business and Financial Institutions › Chapter 376 - Life, Health and Accident Insurance › Section 376.879 - Outline of coverage for fair disclosure — furnished to each applicant — format and content — rules and standards.

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS
Chapter 376
• Effective - 26 Apr 1996, see footnote
376.879. Outline of coverage for fair disclosure — furnished to each applicant — format and content — rules and standards. —
1. In order to provide for full and fair disclosure in the sale of Medicare supplement policies, no Medicare supplement policy or certificate shall be delivered in this state unless an outline of coverage is delivered to the applicant at the time application is made.
2. The director shall prescribe the format and content of the outline of coverage required by subsection 1 of this section. For purposes of this section,
"format"
means style, arrangements and overall appearance, including such items as the size, color and prominence of type and arrangement of text and captions. Such outline of coverage shall include:
(1) A description of the principal benefits and coverage provided in the policy;
(2) A statement of the renewal provisions, including any reservation by the issuer of a right to change premiums; and disclosure of the existence of any automatic renewal premium increases based on the policyholder's age;
(3) A statement that the outline of coverage is a summary of the policy issued or applied for and that the policy should be consulted to determine governing contractual provisions.
3. The director may prescribe by regulation a standard form and the contents of an informational brochure for persons eligible for Medicare, which is intended to improve the buyer's ability to select the most appropriate coverage and improve the buyer's understanding of Medicare. Except in the case of direct response insurance policies, the director may require by regulation that the information brochure be provided to any prospective insureds eligible for Medicare concurrently with delivery of the outline of coverage. With respect to direct response insurance policies, the director may require by regulation that the prescribed brochure be provided upon request to any prospective insureds eligible for Medicare, but in no event later than the time of policy delivery.
4. The director may adopt regulations for captions or notice requirements, determined to be in the public interest and designed to inform prospective insureds that particular insurance coverages are not Medicare supplement coverages, for all accident and sickness insurance policies sold to persons eligible for Medicare, other than:
(1) Medicare supplement policies;
(2) Disability income policies.
5. The director may adopt reasonable regulations to govern the full and fair disclosure of the information in connection with the replacement of accident and sickness policies, subscriber contracts or certificates by persons eligible for Medicare.
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(L. 1989 H.B. 615 & 563, A.L. 1992 H.B. 1574, A.L. 1996 S.B. 883)
Effective 4-26-96