reglab/statecodes huggingface dataset:
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 5 - Advertising and Material Disclosures › Section 20 CSR 400-5.100 - Advertisements of Life Insurance and Annuities

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment will make this rule
				  consistent with the 2015 version of the National Association of Insurance
				  Commissioners (NAIC) Advertisements of Life Insurance and Annuities Model
				  Regulation #570.
PURPOSE:
The purpose of this rule is
				  to set forth minimum standards and guidelines to assure a full and truthful
				  disclosure to the public of material and relevant information in the
				  advertising of life insurance policies and annuity contracts. This rule was
				  adopted pursuant to the provisions of section
				  374.045,
				  RSMo and effectuates and aids in the interpretation of sections
				  375.934
				  and
				  375.936,
				  RSMo.
(1) Definitions. For
				the purpose of this rule-
(A) "Advertisement"
				means material designed to create public interest in life insurance or
				annuities or in an insurer or to induce the public to purchase, increase,
				modify, reinstate, or retain a policy including:
1. Printed and published material,
				audio-visual material, and descriptive literature of an insurer used in direct
				mail, newspapers, magazines, radio and television scripts, telemarketing
				scripts, billboards and similar displays, and the Internet or any other mass
				communication media;
2. Descriptive
				literature and sales aids of all kinds authored by the insurer, its insurance
				producers, or third parties, issued, distributed, or used by the insurer or
				insurance producer; including, but not limited to, circulars, leaflets,
				booklets, depictions, illustrations, and form letters;
3. Material used for the recruitment,
				training, and education of an insurer's insurance producers which is designed
				to be used or is used to induce the public to purchase, increase, modify,
				reinstate, borrow on, replace, or retain a policy;
4. Prepared sales talks, presentations, and
				materials for use by insurance producers;
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 5 - Advertising and Material Disclosures › Section 20 CSR 400-5.300

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 374.045, RSMo 1967, amended 1993, 1995
					 and 375.012-375.158, see Missouri Revised
					 Statutes.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 5 - Advertising and Material Disclosures › Section 20 CSR 400-5.310 - Deceptive or Unfair Military Sales Practices

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule describes specific acts and
				  practices that constitute deceptive or unfair trade practices and is based upon
				  the Military Sales Practices Model Regulation adopted by the NAIC during July
				  2007. The specific prohibitions are not intended to be an all-inclusive list of
				  conduct which might violate sections
				  375.144
				  or
				  375.934,
				  RSMo, but rather provide clear notice to insurers and insurance producers of
				  conduct that would constitute a deceptive or unfair trade
				  practice.
(1) Unfair Trade
				Practices on a Military Installation.
(A)
				Untrue, Deceptive or Misleading Representations. The following acts or
				practices in connection with the solicitation, offer to sell or sale to a
				service member when committed on a military installation by an insurer or
				insurance producer with respect to the in-person, face-to-face solicitation of
				life insurance constitute a deceptive sales practice under section
				375.144,
				RSMo or an unfair trade practice under section
				375.936(4),
				RSMo:
1. Knowingly soliciting the purchase of
				any life insurance product "door to door" or without first establishing a
				specific appointment for each meeting with the prospective purchaser;
2. Soliciting service members in a group or
				"mass" audience or in a "captive" audience where attendance is not
				voluntary;
3. Knowingly making
				appointments with or soliciting service members during their normally scheduled
				duty hours;
4. Making appointments
				with or soliciting service members in barracks, day rooms, unit areas, or
				transient personnel housing or other areas where the installation commander has
				prohibited solicitation;
5.
				Soliciting the sale of life insurance without first obtaining permission from
				the installation commander or the commander's designee;
6. Posting unauthorized bulletins, notices or
				advertisements;
7. Failing to
				present DD Form 2885, Personal Commercial Solicitation Evaluation, to service
				members solicited or encouraging service members solicited not to complete or
				submit a DD Form 2885; or
8.
				Knowingly accepting an application for life insurance or issuing a policy of
				life insurance on the life of an enlisted member of the United States Armed
				Forces without first obtaining for the insurer's files a completed copy of any
				required form which confirms that the applicant has received counseling or
				fulfilled any other similar requirement for the sale of life insurance
				established by regulations, directives or rules of the Department of Defense
				(DoD) or any branch of the Armed Forces.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 5 - Advertising and Material Disclosures › Section 20 CSR 400-5.400 - Life Insurance and Annuities Replacement

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule regulates the activities of
				  insurers, agents, and brokers with respect to the replacement of existing life
				  insurance and annuities and protects the interests of life insurance and
				  annuity purchasers by establishing minimum standards of conduct to be observed
				  in replacement transactions. This rule effectuates and aids in the
				  interpretation of sections
				  375.934,
				  375.936, and
				  375.948, RSMo.
(1) Purpose and Scope.
(A) The purpose of this rule is-
1. To regulate the activities of insurers and
				producers with respect to the replacement of existing life insurance and
				annuities; and
2. To protect the
				interests of life insurance and annuity purchasers by establishing minimum
				standards of conduct to be observed in replacement or financed purchase
				transactions. It will-
A. Assure that
				purchasers receive information with which a decision can be made in his or her
				own best interest; and
B. Reduce
				the opportunity for misrepresentation and incomplete disclosure.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 5 - Advertising and Material Disclosures › Section 20 CSR 400-5.410

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 374.040, RSMo 1939, amended 1967;
					 374.045, RSMo 1967, amended 1993, 1995; 375.013, RSMo 1993, amended 1995;
					 375.144, RSMo 2005; and 375.936, RSMo 1959, amended 1967, 1969, 1971, 1976,
					 1978, 1983, 1991.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 5 - Advertising and Material Disclosures › Section 20 CSR 400-5.700 - Accident and Sickness Insurance Advertising

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule effectuates or aids in the
				  interpretation of and carries out the provisions of sections
				  354.460,
				  375.936,
				  376.405,
				  376.777, 376.850-376.890 and 379.922, RSMo.
PUBLISHER'S NOTE: The secretary of state has
				  determined that the publication of the entire text of the material which is
				  incorporated by reference as a portion of this rule would be unduly cumbersome
				  or expensive. Therefore, the material which is so incorporated is on file with
				  the agency who filed this rule, and with the Office of the Secretary of State.
				  Any interested person may view this material at either agency's headquarters or
				  the same will be made available at the Office of the Secretary of State at a
				  cost not to exceed actual cost of copy reproduction. The entire text of the
				  rule is printed here. This note refers only to the incorporated by reference
				  material.
(1) Responsibility
				of Insurer.
(A) These rules shall apply to
				any accident and sickness insurance advertisement, as that term is defined in
				this rule, intended for presentation, distribution, dissemination or other
				advertising use in this state, when this use is made either directly or
				indirectly by or on behalf of that insurer.
(B) Every insurer shall establish and at all
				times maintain a system of control over the content, form and method of
				dissemination of all advertisements of its policies. The insurer whose policies
				are so advertised shall be deemed responsible for all these advertisements,
				regardless of by whom written, created, presented or distributed.
(C) Each health service corporation licensed
				under Chapter 354, RSMo shall be considered within the full scope of this rule
				and consider itself an insurer issuing policies when doing any advertising as
				defined in this rule.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 5 - Advertising and Material Disclosures › Section 20 CSR 400-5.900 - Suitability in Annuity Transactions

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: The purpose of the rule is to require
				  insurers to establish a system to supervise recommendations and to set forth
				  standards and procedures for recommendations to consumers that result in
				  transactions involving annuity products so that the insurance needs and
				  financial objectives of consumers at the time of the transaction are
				  appropriately addressed. Nothing herein shall be construed to create or imply a
				  private cause of action for a violation of this rule. This rule implements the
				  National Association of Insurance Commissioners (NAIC) Suitability in Annuity
				  Transactions Model Regulation #275. This rule identifies and defines conduct
				  that constitutes unfair trade practices under the Unfair Trade Practice Act,
				  sections 375.930-375.948, RSMo, and effectuates and aids in the interpretation
				  of sections 375.141.1(8) and 375.143, RSMo, with respect to the demonstration
				  of incompetence, untrustworthiness, financial irresponsibility, and customer
				  suitability in the offer, sale, or exchange of annuity
				  products.
(1) Scope. This
				rule shall apply to any recommendation to purchase, exchange, or replace an
				annuity made to a consumer by an insurance producer, or an insurer where no
				producer is involved, that results in the purchase, exchange, or replacement
				recommended.
(2) Exemptions. Unless
				otherwise specifically included, this rule shall not apply to transactions
				involving-
(A) Direct response solicitations
				where there is no recommendation based on information collected from the
				consumer pursuant to this rule;
(B)
				Contracts used to fund-
1. An employee
				pension or welfare benefit plan that is covered by the Employee Retirement and
				Income Security Act (ERISA);
2. A
				plan described by Sections 401(a), 401(k), 403(b), 408(k), or 408(p) of the
Internal Revenue Code
(IRC), as amended, if established or
				maintained by an employer;
3. A
				government or church plan defined in Section 414 of the IRC, a government or
				church welfare benefit plan, or a deferred compensation plan of a state or
				local government, or tax exempt organization under Section 457 of the
				IRC;
4. A nonqualified deferred
				compensation arrangement established or maintained by an employer or plan
				sponsor;
5. Settlements of or
				assumptions of liabilities associated with personal injury litigation or any
				dispute or claim resolution process; or
6. Formal prepaid funeral
				contracts.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 5 - Advertising and Material Disclosures › Section 20 CSR 400-5.900 - Suitability in Annuity Transactions

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: The purpose of this amendment is to require producers, as defined in this rule, to act in the best interests of the consumer when making a recommendation of an annuity and to require insurers to establish and maintain a system to supervise recommendations so that the insurance needs and financial objectives of consumers at the time of the transaction are effectively addressed. Nothing herein shall be construed to create or imply a private cause of action for a violation of this rule or to subject a producer to civil liability under the best interests standards of care outlined in this rule, or under standards governing the conduct of a fiduciary or a fiduciary relationship. This rule implements the National Association of Insurance Commissioners (NAIC) Suitability in Annuity Transactions Model Regulation #275.
(1) Scope. This rule shall apply to any sale or recommendationto purchase, exchange, or replace of an annuity.
(2) Exemptions. Unless otherwise specifically included, this rule shall not apply to transactions involving-
(A) Direct response solicitations where there is no recommendation based on information collected from the consumer pursuant to this rule;
(B) Contracts used to fund-
1. An employee pension or welfare benefit plan that is covered by the Employee Retirement and Income Security Act (ERISA);
2. A plan described by Sections  401(a),  401(k),  403(b),  408(k), or  408(p) of the Internal Revenue Code (IRC), as amended, if established or maintained by an employer;
3. A government or church plan defined in Section  414 of the IRC, a government or church welfare benefit plan, or a deferred compensation plan of a state or local government, or tax exempt organization under Section  457 of the IRC; or
4. A nonqualified deferred compensation arrangement established or maintained by an employer or plan sponsor;
(C) Settlements of or assumptions of liabilities associated with personal injury litigation or any dispute or claim resolution process; or
(D) Formal prepaid funeral contracts.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 6 - Health Services Corporations › Section 20 CSR 400-6.100 - Establishment and Computation of Reserves

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment removes outdated
				  language.
PURPOSE: This regulation describes the method of
				  establishment and computation of reserves for health services corporations.
				  This regulation is adopted pursuant to section
				  354.120,
				  RSMo and to implement section
				  354.080,
				  RSMo.
(1) Reserves Computed.
(A) Any corporation subject to Chapter 354,
				RSMo which has been in existence more than twelve (12) months must file all
				financial statements necessary to document its dues income and benefit payments
				and administrative expenses for the preceding fiscal year with its application
				for a certificate of authority.
(B)
				Any such corporation with a corporate history of less than twelve (12) months
				must file this information for the period of its existence with a projection to
				cover the remainder of a twelve (12)-month period from its inception. If the
				corporation has been in existence less than three (3) months, a six (6)-month
				projection will be acceptable for these purposes.
(C) The information submitted should also
				describe any factors which would allow pro-ration of the amounts payable under
				the terms of the health service contracts or any other factors having a bearing
				upon the reserve computation.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 6 - Health Services Corporations › Section 20 CSR 400-6.200

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 354.080, RSMo 1973 and 354.120, RSMo
					 1973.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 6 - Health Services Corporations › Section 20 CSR 400-6.300

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 197.240, RSMo 1975; 354.085, RSMo
					 1973; 354.090, RSMo 1973; and 354.120, RSMo
					 1973.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 6 - Health Services Corporations › Section 20 CSR 400-6.400

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 354.110, RSMo 1973; 354.115, RSMo
					 1973; 354.120, RSMo 1973; and 354.170, RSMo
					 1973.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 6 - Health Services Corporations › Section 20 CSR 400-6.500 - Bylaws Required to be Filed

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE. This regulation specifies that current
				  bylaws must be filed with the Department of Insurance. This regulation is
				  adopted pursuant to section
				  354.120,
				  RSMo 1986 and to implement sections
				  354.095,
				  354.105
				  and 354.110, RSMo 1986.
(1)
				Bylaws to be Filed.
(A) A current copy of all
				bylaws of any health service corporation requesting a certificate of authority
				pursuant to section
				354.060,
				RSMo 1986 shall be included with that corporation's application for the
				certificate of authority.
(B) A
				copy of any amendment to the bylaws of this corporation shall be filed with the
				Department of Insurance not later than sixty (60) days after the effective
				date.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 6 - Health Services Corporations › Section 20 CSR 400-6.600

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 354.085, RSMo 1973 and 354.120, RSMo
					 1973.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 7 - Health Maintenance Organizations › Section 20 CSR 400-7.010

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 354.405, RSMo 1983 and 354.485, RSMo
					 1983.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 7 - Health Maintenance Organizations › Section 20 CSR 400-7.020

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 354.405, RSMo 1983; 354.410, RSMo
					 1983; 354.425, RSMo, 1983; and 354.485, RSMo
					 1983.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 7 - Health Maintenance Organizations › Section 20 CSR 400-7.030 - Mandatory Provisions- All Contracts

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule sets forth the provisions which
				  must be present in an evidence of coverage. This rule is promulgated pursuant
				  to sections
				  354.430
				  and
				  354.485,
				  RSMo.
(1) All group and
				individual contracts and all evidences of coverage must contain in substance
				the following provisions, or provisions which in the opinion of the director of
				insurance are more favorable to the enrollee or at least as favorable to the
				enrollee and more favorable to the contract holder: name, address and telephone
				number of the administrative offices of the health maintenance organization
				(HMO) must appear on the face page; the face page is the first page that
				contains any written material; and if in booklet form, the first page inside
				the cover is the face page.
(2)
				Benefits. A description of all health care services available to an enrollee
				under the health care plan, including any copayments or other charges for which
				the member may be responsible.
(3)
				Cancellation. A statement that the HMO must give the group contract holder, in
				the case of group coverage, or the enrollee, in the case of individual
				coverage, at least thirty-one (31) days' prior notice of any cancellation or
				termination except termination for nonpayment of premium. In the case of group
				coverage, the HMO may not terminate the contract prior to the first anniversary
				date except for nonpayment of the required premium or the failure to meet
				continued underwriting standards.
(4) Claim Filing Procedure. A provision
				setting forth the procedure for filing claims, including:
(A) How, when and where to obtain claim
				forms, if required; and
(B) The
				requirements for providing proper notice of claim and proof of loss. Failure to
				furnish the notice or proof within the time required shall not invalidate or
				reduce any claim, if it was not reasonably possible to give notice or proof
				within this time.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 7 - Health Maintenance Organizations › Section 20 CSR 400-7.040 - Additional Mandatory Provisions-Group Contracts and Evidences of Coverage

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule sets forth provisions which must
				  be included in group contracts and evidences of coverage in addition to the
				  provisions set forth in
				  20 CSR
				  400-7.030. This rule is promulgated pursuant to
				  sections
				  354.430
				  and
				  354.485,
				  RSMo.
(1) Group contracts and
				evidences of coverage must contain in substance the following provision(s)
				which, in the opinion of the director of insurance, are more favorable to the
				enrollee or at least as favorable to the enrollee and more favorable to the
				contract holder in addition to those set out in
				20 CSR
				400-7.030.
(2) Evidence of Coverage. Provisions that the
				group contract holder must be provided with evidence of coverage to be
				delivered to each enrollee, that the evidence of coverage is a part of the
				group contract as if fully incorporated in the contract; and that any direct
				conflict between the group contract and the evidence of coverage will be
				resolved according to the terms which are most favorable to the enrollee. Note:
				This section does not apply if the same form is used for both the group
				contract and the evidence of coverage.
(3) New Employees. A provision specifying the
				conditions under which new enrollees may be added to those originally covered,
				including the terms under which coverage will be effective.
(4) Grace Period. A provision for a grace
				period of at least thirty-one (31) days for the payment of any premium falling
				due after the first premium, during which time the coverage remains in effect.
				Coverage may be terminated at the end of the grace period and, if services are
				rendered during the grace period, the group will be responsible for either the
				premium due or the value of services received.
*Original authority: 354.430, RSMo 1983, and 354.485, RSMo
					 1983.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 7 - Health Maintenance Organizations › Section 20 CSR 400-7.050 - Additional Mandatory Provisions-Individual Contracts and Evidences of Coverage

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule sets forth provisions which must
				  be included in individual contracts and evidences of coverage in addition to
				  the provisions set forth in
				  20 CSR
				  400-7.030. This rule is promulgated pursuant to
				  sections
				  354.430
				  and
				  354.485,
				  RSMo.
(1) Individual
				contracts and evidences of coverage must contain in substance the following
				provision(s) which, in the opinion of the director of insurance, are at least
				as or more favorable to the enrollee, in addition to those set out in
				20 CSR
				400-7.030.
(2) Reinstatement. A provision that clearly
				sets forth the requirements for reinstatement and discloses how reinstatement
				changes or affects the rights and coverages originally provided. New evidence
				on insurability may be required.
(3) Ten (10) Days to Examine Agreement. A
				provision stating that the enrollee to whom the evidence of coverage is issued
				shall be permitted to return the evidence of coverage within ten (10) days of
				receiving it and have the premium paid refunded to them if, after examination
				of the agreement, the enrollee is not satisfied with it for any reason. If the
				enrollee, pursuant to provision, returns the evidence of coverage to the
				issuing health maintenance organization (HMO) or to the insurance producer or
				representative through whom it was purchased, it is considered void from the
				beginning and the parties are in the same position as if no evidence of
				coverage had been issued. If services are rendered or claims paid by the HMO
				during the ten (10) days, the person shall not be permitted to return the
				contract and receive a refund of the premium paid.
(4) Original Premium. The original premium
				for coverage must be stated in the evidence of coverage or in the
				application.
(5) Grace Period. A
				provision for a grace period of at least ten (10) days, for payment of any
				premium falling due after the first premium, during which time the coverage
				remains in effect. If payment is not received within ten (10) days, coverage
				may be cancelled after the tenth day. The terminated enrollee will be
				responsible for the cost of services received during the grace period if this
				requirement is disclosed in the evidence of coverage.
*Original authority: 354.430, RSMo 1983, amended 1997;
					 354.485, RSMo 1983; and 374.045, RSMo 1967, amended 1993,
					 1995.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 7 - Health Maintenance Organizations › Section 20 CSR 400-7.070

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 354.425, RSMo 1983 and 354.485, RSMo
					 1983.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 7 - Health Maintenance Organizations › Section 20 CSR 400-7.090 - Service Area Expansion

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule sets forth the information to be
				  provided to the director by a health maintenance organization seeking to expand
				  its service area. This rule is promulgated pursuant to sections
				  354.430
				  and
				  354.485,
				  RSMo.
(1) For a contiguous
				service area expansion request to be approved, the health maintenance
				organization (HMO) must provide the director with the following information in
				support of the request:
(A) If prior action
				of the HMO's board is required, minutes of the board meeting at which expansion
				was authorized and any related amendments to the basic organization document or
				bylaws;
(B) A map of the new
				service area showing locations of primary care physicians, hospitals and
				emergency care facilities;
(C) Any
pro forma
contracts or agreements with physicians and other
				providers in the new area; and
(D)
				A list of all physicians and other providers who have agreed to provide
				services in the new area.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 7 - Health Maintenance Organizations › Section 20 CSR 400-7.100

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 354.430, RSMo 1983 and 354.485, RSMo,
					 1983.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 7 - Health Maintenance Organizations › Section 20 CSR 400-7.110

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 354.430, RSMo 1983; 354.445, RSMo
					 1983; and 354.485, RSMo 1983.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 7 - Health Maintenance Organizations › Section 20 CSR 400-7.120 - Health Maintenance Organization-Enrollee Participation

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule sets forth the health maintenance
				  organization's method for enrollees to participate in matters of policy and
				  operation. This rule is promulgated pursuant to section
				  354.485,
				  RSMo and implements section
				  354.420,
				  RSMo.
(1) Definitions.
(A) Enrollee means an individual who is
				covered by a health maintenance organization (HMO).
(B) Evidence of coverage means any
				certificate, agreement or contract issued to an enrollee which sets out the
				coverage to which the enrollee is entitled under the HMO contract which covers
				the enrollee.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 7 - Health Maintenance Organizations › Section 20 CSR 400-7.130

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 354.410, RSMo 1983; 354.470, RSMo
					 1983; and 354.485, RSMo 1983.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 7 - Health Maintenance Organizations › Section 20 CSR 400-7.140 - Health Maintenance Organizations-Reinsurance Agreements

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule sets forth the requirements that
				  relate to the filing of reinsurance agreements with the Department of Commerce
				  and Insurance. This rule is promulgated pursuant to section 354.485, RSMo and
				  implements sections 354.405.5. and 354.410.1(3)(c) and (6),
				  RSMo.
(1) Definition. As used
				in this rule, a contract of reinsurance means the entire contract, including
				the signatures of the representatives of the health maintenance organization
				(HMO) and the reinsurer, and any binders, certificates, attachments, amendments
				or modifications to the contract.
(2) Filing. A contract of reinsurance shall
				be submitted to the Department of Insurance for filing and approval no later
				than ten (10) working days after receipt by the HMO. If it appears there will
				be a substantial delay between the issuance of a binder and all other documents
				connected with the contract of reinsurance, or difficulty in obtaining a
				contract of reinsurance as evidenced by the negotiation process, the HMO shall
				file a copy of the binder or a letter signed by an officer of the reinsurer
				explaining the circumstances pertaining to the delay. After filing this binder
				or letter, the HMO shall file its contract of reinsurance ten (10) working days
				after receipt of the contract. Proof of coverage shall be filed no later than
				ten (10) working days after its effective date.
(3) Provisions. A contract of reinsurance
				shall not contain a provision stating that the contract of reinsurance will not
				apply or will become ineffective in the event the HMO is unable to meet its
				financial obligations or is insolvent.
(4) Requests. Upon request by the director of
				the Department of Insurance or his/her appointee, the HMO shall provide
				promptly to the Department of Insurance all contracts of reinsurance required
				by this section and available to the HMO.
(5) Discipline. The director of the
				Department of Insurance may institute disciplinary action for violation of this
				rule in accordance with the provisions of section
				354.500,
				RSMo and any other applicable law.
*Original authority: 354.405, RSMo 1983; 354.410, RSMo
					 1983; and 354.458, RSMo 1983. 1983.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 7 - Health Maintenance Organizations › Section 20 CSR 400-7.150

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 354.462, RSMo 1983 and 354.485, RSMo
					 1983.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 7 - Health Maintenance Organizations › Section 20 CSR 400-7.160

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 374.045, RSMo 1967, amended
					 1993.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 7 - Health Maintenance Organizations › Section 20 CSR 400-7.170

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 354.442, RSMo 1997 and 354.485, RSMo
					 1983.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 7 - Health Maintenance Organizations › Section 20 CSR 400-7.180 - Standard Form To Establish Credentials

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule sets forth the standard form which
				  shall be used by all health carriers when soliciting the credentials of a
				  health care professional in a managed care plan. This rule is promulgated
				  pursuant to section
				  354.485,
				  RSMo, and implements section 354.442.1(15), RSMo.
PUBLISHER'S NOTE: The secretary of state has
				  determined that the publication of the entire text of the material which is
				  incorporated by reference as a portion of this rule would be unduly cumbersome
				  or expensive. This material as incorporated by reference in this rule shall be
				  maintained by the agency at its headquarters and shall be made available to the
				  public for inspection and copying at no more than the actual cost of
				  reproduction. This note applies only to the reference material. The entire text
				  of the rule is printed here.
(1) Definitions.
(A) Health care professional means a
				physician or other appropriately licensed health care practitioner.
(B) Health carrier means a health maintenance
				organization as organized pursuant to sections
				354.400 through
				354.636,
				RSMo.
(C) Managed care plan means a
				health benefit plan that either requires an enrollee to use, or creates
				incentives, including financial incentives, for an enrollee to use health care
				providers managed, owned, under contract with or employed by the health
				carrier.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 7 - Health Maintenance Organizations › Section 20 CSR 400-7.200

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 354.485, RSMo 1983; 354.606, RSMo
					 1997, amended 2001; and 374.045, RSMo 1967, 1993,
					 1995.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 8 - Forms, Procedures, and Fees › Section 20 CSR 400-8.100

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 287.310, RSMo 1939, amended 1992;
					 374.045, RSMo 1967, amended 1993; 374.230, RSMo 1939, amended 1945, 1949, 1967,
					 1989; 375.920, RSMo 1979; 376.405, RSMo 1959, amended 1984; 376.675, RSMo 1963,
					 amended 1984; 376.777, RSMo 1959, amended 1984; 379.160, RSMo 1939, amended
					 1957, 1963; and 379.321, RSMo 1972.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 8 - Forms, Procedures, and Fees › Section 20 CSR 400-8.200

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 354.485, RSMo 1983, amended 2007;
					 354.624, RSMo 1997, 374.045, RSMo 1967, amended 1993, 1995, 2008; 374.056, RSMo
					 2008; 376.405, RSMo 1959, amended 1984, 376.670, RSMo 1943, amended 1959, 1961,
					 1965, 1975, 1979, 1982; 376.675, RSMo 1963, amended 1984; and 376.777, RSMo
					 1959, amended 1984.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 8 - Forms, Procedures, and Fees › Section 20 CSR 400-8.300

Current through Register Vol. 49, No. 14, July 15, 2024
The secretary of state has determined that the publication
					 of this rule in its entirety would be unduly cumbersome or expensive. The
					 entire text of the material referenced has been filed with the secretary of
					 state. This material may be found at the Office of the Secretary of State or at
					 the headquarters of the agency and is available to any interested person at a
					 cost established by state law.
*Original authority 1992.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 9 - Individual Medical Accounts › Section 20 CSR 400-9.100

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 143.999, RSMo 1993 and 374.045, RSMo
					 1967, amended 1993.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 10 - Health Carrier Utilization Review Activities › Section 20 CSR 400-10.010 - Requirements of Utilization Review Program Documents

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule defines the contents of written
				  utilization review program documents required of certain health carriers by
				  section
				  376.1359,
				  RSMo, H.B. 335 (First Regular Session of the 89th General Assembly
				  1997).
(1) The written
				utilization review program document required of health carriers by section
				376.1359.1, RSMo, H.B. 335 (First Regular Session of the 89th General Assembly
				1997), for plans containing a managed care component shall describe-
(A) Policies, processes and procedures which
				govern all aspects of the utilization review process, including but not limited
				to:
1. Scope and objectives;
2. Program organization;
3. Monitoring and oversight
				mechanisms;
4. Evaluation and
				organizational improvement of clinical review activities; and
5. Delegation of responsibility for
				utilization review activities;
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 10 - Health Carrier Utilization Review Activities › Section 20 CSR 400-10.020 - Annual Reporting Requirements for Health Carriers Regarding Utilization Review Activities

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule sets forth the reporting
				  requirements of health carriers, pursuant to sections
				  376.1359,
				  376.1369
				  and
				  376.1378,
				  RSMo, found in H.B. 335, 1997, regarding utilization review
				  activities.
(1) All health
				carriers which market health care plans which have a managed care component
				shall make the following report regarding utilization review activities to the
				director, annually, on or before March 1:
(A)
				Where the health carrier is acting as a utilization review agent, the health
				carrier shall file a report of its utilization review activities, which report
				shall include a summary of the types of utilization review activities and any
				other information the director may require;
(B) Where the health carrier has contracted
				with an outside utilization review organization, or otherwise delegated its
				utilization review activities, the health carrier shall file a report of the
				utilization review activities, which report shall include a summary of the
				types of utilization review activities and a list of the entities or
				organizations conducting the utilization review activities, including the
				address of the utilization review agent or organization used; and
(C) The director may allow a health carrier
				to file, in lieu of the report otherwise required, a copy of a health carrier's
				report to another agency, provided such report contains the information
				required by this rule.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 10 - Health Carrier Utilization Review Activities › Section 20 CSR 400-10.100 - Minimum Time Allowed for a Consumer to File a Grievance

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule sets forth the minimum amount of
				  time a health carrier that offers a managed care plan can require an enrollee o
				  rmember to file an appeal. This rule is promulgated pursuant to section
				  376.1399,
				  RSMo, and implements sections
				  376.1382
				  and
				  376.1385,
				  RSMo.
(1) Definitions.
(A) "Adverse determination" shall have the
				same meaning as found in section
				376.1350,
				RSMo.
(B) "Grievance" shall have
				the same meaning as found in section
				376.1350,
				RSMo.
(C) "Health carrier" shall
				have the same meaning as found in section
				376.1350,
				RSMo.
(D) "Managed care component"
				shall mean a plan that offers an incentive to use specific providers or
				requires the use of utilization review.
(E) "Utilization review" shall have the same
				meaning as found in section
				376.1350,
				RSMo.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 10 - Health Carrier Utilization Review Activities › Section 20 CSR 400-10.200 - Authorization For Health Care Services Not To Be Withdrawn After the Services Have Been Provided, Exceptions

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSES: This rule interprets sections
				  376.1350(4),
				  376.1359,
				  376.1361.12
				  and 376.1361.13, RSMo Supp. 1997.
(1) Utilization review by health carriers for
				plans containing a managed care component is performed only for covered
				services, section
				376.1359,
				RSMo Supp. 1997. Therefore, a benefits determination must be performed prior to
				utilization review under sections
				376.1350(4),
				376.1361.12
				and 376.1361.13, RSMo Supp. 1997. Because a benefits determination must be made
				prior to utilization review, certification will be deemed to be an
				authorization of a covered benefit. If an authorized representative of a health
				carrier authorizes the provision of a health care service, the health carrier
				shall not subsequently retract its authorization after the health care service
				has been provided, or reduce payment for an item or service furnished in
				reliance on approval, unless-
(A) Such
				authorization is based on a material misrepresentation or omission about the
				treated person's health condition or the cause of the health condition;
				or
(B) The health benefit plan
				terminates before the health care services are provided; or
(C) The covered person's coverage under the
				health benefit plan terminates before the health care services are
				provided.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 10 - Health Carrier Utilization Review Activities › Section 20 CSR 400-10.250 - Electronic Confirmation of Utilization Review Determinations Deemed Made When

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule describes the conditions under
				  which an electronic notice of a utilization review determination will be deemed
				  to have been made.
(1) When a
				health carrier is required by section
				376.1363,
				RSMo, H.B. 335 (First Regular Session of the 89th General Assembly 1997), to
				provide written or electronic confirmation of its utilization review
				determinations to providers, enrollees or certificate holders (enrollees and
				certificate holders hereinafter collectively referred to as enrollees), for
				plans containing a managed care component, an electronic confirmation will be
				deemed by the department to have been made if the confirmation is available to
				the provider and enrollee on an interactive voice response telephone system or
				other electronic notification system which is universally accessible and
				compatible with the Telecommunication Device for the Deaf, if-
(A) The system has a security component to
				prevent enrollees' confidential information from being accessed by unauthorized
				individuals; and
(B) The
				confirmation can be accessed by the enrollee and the enrollee's provider for a
				minimum of sixty (60) days after the determination is made; and
(C) Written confirmation of the determination
				may be requested by the enrollee or provider by means of the system;
				and
(D) All requests made by
				enrollees and providers for written confirmation are honored within the time
				limits imposed by section
				376.1363,
				376.1365
				or
				376.1367,
				RSMo Supp. 1997; and
(E) The system
				may be accessed by enrollees and providers by means of a toll-free number;
				and
(F) All determinations and
				notifications are archived by the health carrier for a period of three (3)
				years after the determinations are made.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 11 - Navigators › Section 20 CSR 400-11.100 - Navigator Examination and Licensing Procedures and Standards

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule prescribes the application
				  process, fees, examination, and initial training for
				  navigators.
(1) Application
				and Fees. Application for a navigator license shall include the following, as
				applicable:
(A) Initial Licensure.
1. Individual navigator.
A. A completed application form, which is
				included herein as Exhibit 1 of this rule revised July 24, 2013, or any form
				which substantially comports with the specified form.
B. Twenty-five dollar ($25) application
				fee.