reglab/statecodes huggingface dataset:
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 1 - Life Insurance and Annuity Standards › Appendix I

Current through Register Vol. 49, No. 14, July 15, 2024
2012 IAM Period Table Female, Age Nearest Birthday
AGE
1000 *
						  qx2012
AGE
1000 *
						  qx2012
AGE
1000 *
						  qx2012
AGE
1000 *
						  qx2012
0
1.621
30
0.300
60
3.460
90
88.377
1
0.405
31
0.321
61
3.916
91
97.491
2
0.259
32
0.338
62
4.409
92
107.269
3
0.179
33
0.351
63
4.933
93
118.201
4
0.137
34
0.365
64
5.507
94
130.969
5
0.125
35
0.381
65
6.146
95
146.449
6
0.117
36
0.402
66
6.551
96
163.908
7
0.110
37
0.429
67
7.039
97
179.695
8
0.095
38
0.463
68
7.628
98
196.151
9
0.088
39
0.504
69
8.311
99
213.150
10
0.085
40
0.552
70
9.074
100
230.722
11
0.086
41
0.600
71
9.910
101
251.505
12
0.094
42
0.650
72
10.827
102
273.007
13
0.108
43
0.697
73
11.839
103
295.086
14
0.131
44
0.740
74
12.974
104
317.591
15
0.156
45
0.780
75
14.282
105
340.362
16
0.179
46
0.825
76
15.799
106
362.371
17
0.198
47
0.885
77
17.550
107
384.113
18
0.211
48
0.964
78
19.582
108
400.000
19
0.221
49
1.051
79
21.970
109
400.000
20
0.228
50
1.161
80
24.821
110
400.000
21
0.234
51
1.308
81
28.351
111
400.000
22
0.240
52
1.460
82
32.509
112
400.000
23
0.245
53
1.613
83
37.329
113
400.000
24
0.247
54
1.774
84
42.830
114
400.000
25
0.250
55
1.950
85
48.997
115
400.000
26
0.256
56
2.154
86
55.774
116
400.000
27
0.261
57
2.399
87
63.140
117
400.000
28
0.270
58
2.700
88
71.066
118
400.000
29
0.281
59
3.054
89
79.502
119
400.000
120
1000.000
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 1 - Life Insurance and Annuity Standards › Appendix II

Current through Register Vol. 49, No. 14, July 15, 2024
2012 IAM Period Table Male, Age Nearest Birthday
AGE
1000 *
						  qx2012
AGE
1000 *
						  qx2012
AGE
1000 *
						  qx2012
AGE
1000 *
						  qx2012
0
1.605
30
0.741
60
5.096
90
109.993
1
0.401
31
0.751
61
5.614
91
123.119
2
0.275
32
0.754
62
6.169
92
137.168
3
0.229
33
0.756
63
6.759
93
152.171
4
0.174
34
0.756
64
7.398
94
168.194
5
0.168
35
0.756
65
8.106
95
185.260
6
0.165
36
0.756
66
8.548
96
197.322
7
0.159
37
0.756
67
9.076
97
214.751
8
0.143
38
0.756
68
9.708
98
232.507
9
0.129
39
0.800
69
10.463
99
250.397
10
0.113
40
0.859
70
11.357
100
268.607
11
0.111
41
0.926
71
12.418
101
290.016
12
0.132
42
0.999
72
13.675
102
311.849
13
0.169
43
1.069
73
15.150
103
333.962
14
0.213
44
1.142
74
16.860
104
356.207
15
0.254
45
1.219
75
18.815
105
380.000
16
0.293
46
1.318
76
21.031
106
400.000
17
0.328
47
1.454
77
23.540
107
400.000
18
0.359
48
1.627
78
26.375
108
400.000
19
0.387
49
1.829
79
29.572
109
400.000
20
0.414
50
2.057
80
33.234
110
400.000
21
0.443
51
2.302
81
37.533
111
400.000
22
0.473
52
2.545
82
42.261
112
400.000
23
0.513
53
2.779
83
47.441
113
400.000
24
0.554
54
3.011
84
53.233
114
400.000
25
0.602
55
3.254
85
59.855
115
400.000
26
0.655
56
3.529
86
67.514
116
400.000
27
0.688
57
3.845
87
76.340
117
400.000
28
0.710
58
4.213
88
86.388
118
400.000
29
0.727
59
4.631
89
97.634
119
400.000
120
1000.000
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 1 - Life Insurance and Annuity Standards › Appendix III

Current through Register Vol. 49, No. 14, July 15, 2024
Projection Scale G2 Female, Age Nearest Birthday
AGE
G2x
AGE
G2x
AGE
G2x
AGE
G2x
0
0.010
30
0.010
60
0.013
90
0.006
1
0.010
31
0.010
61
0.013
91
0.006
2
0.010
32
0.010
62
0.013
92
0.005
3
0.010
33
0.010
63
0.013
93
0.005
4
0.010
34
0.010
64
0.013
94
0.004
5
0.010
35
0.010
65
0.013
95
0.004
6
0.010
36
0.010
66
0.013
96
0.004
7
0.010
37
0.010
67
0.013
97
0.003
8
0.010
38
0.010
68
0.013
98
0.003
9
0.010
39
0.010
69
0.013
99
0.002
10
0.010
40
0.010
70
0.013
100
0.002
11
0.010
41
0.010
71
0.013
101
0.002
12
0.010
42
0.010
72
0.013
102
0.001
13
0.010
43
0.010
73
0.013
103
0.001
14
0.010
44
0.010
74
0.013
104
0.000
15
0.010
45
0.010
75
0.013
105
0.000
16
0.010
46
0.010
76
0.013
106
0.000
17
0.010
47
0.010
77
0.013
107
0.000
18
0.010
48
0.010
78
0.013
108
0.000
19
0.010
49
0.010
79
0.013
109
0.000
20
0.010
50
0.010
80
0.013
110
0.000
21
0.010
51
0.010
81
0.012
111
0.000
22
0.010
52
0.011
82
0.012
112
0.000
23
0.010
53
0.011
83
0.011
113
0.000
24
0.010
54
0.011
84
0.010
114
0.000
25
0.010
55
0.012
85
0.010
115
0.000
26
0.010
56
0.012
86
0.009
116
0.000
27
0.010
57
0.012
87
0.008
117
0.000
28
0.010
58
0.012
88
0.007
118
0.000
29
0.010
59
0.013
89
0.007
119
0.000
120
0.000
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 1 - Life Insurance and Annuity Standards › Appendix IV

Current through Register Vol. 49, No. 14, July 15, 2024
Projection Scale G2 Male, Age Nearest Birthday
AGE
G2x
AGE
G2x
AGE
G2x
AGE
G2x
0
0.010
30
0.010
60
0.015
90
0.007
1
0.010
31
0.010
61
0.015
91
0.007
2
0.010
32
0.010
62
0.015
92
0.006
3
0.010
33
0.010
63
0.015
93
0.005
4
0.010
34
0.010
64
0.015
94
0.005
5
0.010
35
0.010
65
0.015
95
0.004
6
0.010
36
0.010
66
0.015
96
0.004
7
0.010
37
0.010
67
0.015
97
0.003
8
0.010
38
0.010
68
0.015
98
0.003
9
0.010
39
0.010
69
0.015
99
0.002
10
0.010
40
0.010
70
0.015
100
0.002
11
0.010
41
0.010
71
0.015
101
0.002
12
0.010
42
0.010
72
0.015
102
0.001
13
0.010
43
0.010
73
0.015
103
0.001
14
0.010
44
0.010
74
0.015
104
0.000
15
0.010
45
0.010
75
0.015
105
0.000
16
0.010
46
0.010
76
0.015
106
0.000
17
0.010
47
0.010
77
0.015
107
0.000
18
0.010
48
0.010
78
0.015
108
0.000
19
0.010
49
0.010
79
0.015
109
0.000
20
0.010
50
0.010
80
0.015
110
0.000
21
0.010
51
0.011
81
0.014
111
0.000
22
0.010
52
0.011
82
0.013
112
0.000
23
0.010
53
0.012
83
0.013
113
0.000
24
0.010
54
0.012
84
0.012
114
0.000
25
0.010
55
0.013
85
0.011
115
0.000
26
0.010
56
0.013
86
0.010
116
0.000
27
0.010
57
0.014
87
0.009
117
0.000
28
0.010
58
0.014
88
0.009
118
0.000
29
0.010
59
0.015
89
0.008
119
0.000
120
0.000
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 2 - Accident and Health Insurance in General › Section 20 CSR 400-2.010 - Insured's Right to Examination of Accident and Sickness Coverage

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule allows persons ten days following
				  the date of delivery in which to examine accident or health insurance coverage
				  and to return that coverage for a full refund of premium.
(1) Applicability. This rule applies to all
				individual policies subject to sections 376.770-376.795, RSMo and all group
				insurance certificates defined in section 376.421.2, RSMo which are mass
				marketed or marketed on an individual basis to citizens of this state. This
				rule does not apply to single premium short duration trip or travel-type
				coverage. Mass-marketed health insurance, for purposes of this rule, means the
				insurance under any individual, franchise, group or blanket policy of accident
				or health insurance which is offered by means of direct response solicitation
				through a sponsoring organization or through the mails or other mass
				communications media and under which the insured person pays all or
				substantially all of the cost of his/her insurance.
(2) The face page of all individual contacts
				and group certificates which are subject to this rule must contain a
				conspicuous and clearly captioned paragraph stating in substance that-
(A) The person to whom the coverage is issued
				may return the policy or certificate within at least ten (10) days of delivery
				for a full refund of all premiums paid; and
(B) Any coverage returned for a refund of
				premium will be null and void from its inception.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 2 - Accident and Health Insurance in General › Section 20 CSR 400-2.020 - Hospital Indemnity Contracts Not Affected by Government Hospital

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule prohibits insurers from refusing
				  to pay benefits under certain contracts because of hospitalization in
				  government hospitals and was promulgated pursuant to the provisions of section
				  374.045,
				  RSMo and implements sections
				  376.405
				  and
				  376.777,
				  RSMo.
(1) The term hospital
				indemnity policy includes all insurance contracts, riders or forms
				supplementary to them, where the contingency insured against is loss of time
				due to or resulting from hospitalization, with cash benefits derived being
				payable daily, weekly or monthly or in any other manner.
(2) No policy, rider endorsement or other
				form supplemental to them will be approved for sale in this state, if the
				policy or form excludes any indemnity payments for time spent in a veterans' or
				any other government-sponsored or supported hospital. Nor shall indemnity
				benefits be reduced or altered because of confinement in a government-sponsored
				or supported institution which otherwise meets the definition of hospital in
				the contract. Existing contracts excluding indemnity payments shall be
				disapproved for sale in Missouri until the exclusion is deleted. Disapprovals
				of policies under this rule shall be effected as provided in section
				376.405
				or 376.777(7), RSMo (1986).
*Original authority: 374.045, RSMo 1967; 376.405, RSMo
					 1959; 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 2 - Accident and Health Insurance in General › Section 20 CSR 400-2.030 - Group Coordination of Benefits

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule restricts the use of coordination
				  of benefits provisions in group health insurance plans to those situations
				  where they may be equitably applied.
(1) Applicability. The purpose of this rule
				is to-
(A) Permit, but not require, plans to
				include a coordination of benefits (COB) provision;
(B) Establish an order in which plans pay
				their claims;
(C) Provide the
				authority for orderly transfer of information needed to pay claims
				promptly;
(D) Reduce duplication of
				benefits by permitting a reduction of the benefits paid by a plan where the
				plan, pursuant to rules established by this rule, does not have to pay its
				benefits first;
(E) Reduce claims
				payment delays; and
(F) Make all
				contracts that contain a COB provision consistent with this rule.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 2 - Accident and Health Insurance in General › Section 20 CSR 400-2.040

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 374.045, RSMo 1967; 376.405, RSMo
					 1959, 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 2 - Accident and Health Insurance in General › Section 20 CSR 400-2.050

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 374.045 and 375.445, RSMo 1967; 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 2 - Accident and Health Insurance in General › Section 20 CSR 400-2.060 - Policy Approval Criteria

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule specifies the criteria that must
				  be found in policies of accident and health insurance before the director will
				  approve these policies for use in this state. This rule is adopted pursuant to
				  the provisions of section
				  374.045,
				  RSMo and implements and defines sections
				  375.936,
				  376.405,
				  376.775
				  and 376.777, RSMo.
(1)
				Application. From the effective date of this rule, application forms, policies,
				riders and endorsements to policies of health and accident insurance will not
				be approved for use in this state unless they conform to the criteria stated.
				This disapproval shall meet the statutory procedural requirements of sections
				376.405
				and
				376.777,
				RSMo.
(2) Definitions in Policy
				Submittals.
(A) Alcoholism treatment facility
				shall be substantially defined in policies as a residential or nonresidential
				facility certified by the Department of Mental Health for treatment of
				alcoholism.
(B) Hospital shall be
				substantially defined in policies as a legally constituted institution (or an
				institution which operates pursuant to law) having organized facilities for the
				care and treatment of sick and injured persons on a resident or inpatient
				basis, including facilities for diagnosis and surgery under the supervision of
				a staff of one (1) or more licensed physicians and which provides twenty-four
				(24)-hour nursing service by registered nurses on duty or call. It does not
				mean convalescent, nursing, rest or extended care facilities or facilities
				operated exclusively for treatment of the aged, drug addict or alcoholic, even
				though the facilities are operated as a separate institution by a hospital.
				Notwithstanding any other language in this rule, the definition of hospital
				contained in this rule shall not apply to Medicare supplement
				policies.
(C) Intensive care unit
				shall be substantially defined in policies as that part of a hospital service
				specifically designed as an intensive care unit permanently equipped and
				staffed to provide more extensive care for critically ill or injured patients
				than available in other hospital rooms or wards, the care to include close
				observation by trained and qualified personnel whose duties are primarily
				confined to the part of the hospital for which an additional charge is
				made.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 2 - Accident and Health Insurance in General › Section 20 CSR 400-2.070

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 374.045, RSMo 1967; 376.405, RSMo
					 1939, amended 1967; 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 2 - Accident and Health Insurance in General › Section 20 CSR 400-2.080

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 354.120, RSMo 1973 amended 1983;
					 374.045, RSMo 1967; 376.395, 376.397, 376.398, 376.401, 376.403, RSMo 1981; and
					 376.404, RSMo 1959, amended 1984.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 2 - Accident and Health Insurance in General › Section 20 CSR 400-2.090 - Group Health Classification

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule implements the provisions of
				  sections
				  375.786
				  (unauthorized insurers), 375.791.2 (foreign insurers), 375.014 (agent
				  licensing), 375.071 (broker licensing), 376.405 (group insurance form filing
				  and approval) and 376.421, RSMo (authorized group insurance), defines certain
				  underwriting and rating practices as prohibited pursuant to section
				  375.936,
				  RSMo (unfair trade practices) and ensures that group health insurance coverages
				  solicited and sold in the state conform to applicable Missouri
				  requirements.
(1) No health
				insurance of any kind may be solicited or sold, or both, to an employer, union
				or similar organizational unit located in Missouri unless the insurer for which
				it is being solicited or sold, or both, has a valid certificate of authority in
				accordance with the requirements of sections
				375.786
				and
				375.791.2,
				RSMo.
(2) No health insurance of
				any kind may be solicited or sold, or both, to an employer, union or similar
				organizational unit located in Missouri unless the person or entity making
				these solicitations or sales, or both, is a duly licensed insurance producer in
				accordance with the requirements of sections
				375.014
				and
				375.071,
				RSMo and holds a current and valid appointment with the insurer for which these
				solicitations or sales, or both, are made.
(3) Section 376.421.1, RSMo defines those
				entities eligible for group health insurance issued in Missouri. Section
				376.421.2, RSMo applies to group coverages offered or provided in Missouri
				other than specifically authorized in section 376.421.1, RSMo. Individual
				evidence of insurability may be required as to both section 376.421.1 and
				376.421.2,
				RSMo groups and these groups may exclude or limit coverage as to any individual
				as to whom evidence of insurability is unsatisfactory.
(4) Group policies issued to a multiple
				employer or union trust in Missouri or any other state as described in section
				376.421.1(4), RSMo under which coverages are solicited and sold to employer,
				union or other organizational units located in Missouri shall be subject to the
				following requirements of this section:
(A)
				The following practices based solely on individual health conditions,
				individual claims experience or deterioration of health shall be deemed an
				unfair discrimination in violation of section
				375.936(11)(b),
				RSMo:
1. Any adjustment of premium
				contribution applicable to an individual within a unit of the group;
2. Any requirement that an individual(s)
				within a unit of the group must be reinstated or reunderwritten as a condition
				of continued eligibility in the group; and
3. The termination of eligibility of any
				individual within a unit of the group;
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 2 - Accident and Health Insurance in General › Section 20 CSR 400-2.100

Current through Register Vol. 49, No. 14, July 15, 2024
*Original authority: 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 2 - Accident and Health Insurance in General › Section 20 CSR 400-2.130 - Group Health Filings

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule effectuates or aids in the
				  interpretation of section
				  376.421,
				  RSMo. The rule specifies how the Department of Commerce and Insurance will
				  determine whether group health coverage provided, solicited or issued in
				  Missouri complies with the descriptions of groups in section
				  376.421,
				  RSMo.
(1) As used in this
				rule, the following terms mean:
(A)
				Discretionary group, any group not described in section 376.421.1,
				RSMo;
(B) DCI, the Missouri
				Department of Commerce and Insurance; and
(C) True group, any group described in
				section 376.421.1, RSMo.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 2 - Accident and Health Insurance in General › Section 20 CSR 400-2.135 - Health Benefit Plans Issued to Associations with Small and Large Employers

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule establishes the requirements for
				  health carriers seeking an exemption under section 376.421.1(5)(e), (HB 1827,
				  93rd General Assembly, Second Regular Session (2006)).
(1) Definitions. When used in this
				regulation-
(A) "Health benefit plan" shall
				have the definition as found in section
				376.1350,
				RSMo;
(B) "Health carrier" shall
				have the definition as found in section
				376.1350,
				RSMo;
(C) "Producer" shall have the
				definition as found in section
				375.012, RSMo;
				and
(D) "Small employer" shall have
				the definition as found in section 379.930.2, RSMo.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 2 - Accident and Health Insurance in General › Section 20 CSR 400-2.150 - Stop-Loss Coverage for Self-Insured Health Plans

Current through Register Vol. 49, No. 14, July 15, 2024
The Circuit Court of Cole County issued a decision
					 regarding docket number CV195-1326CC on December 27, 1995, finding that
					 Department of Insurance rule
					 20 CSR
					 400-2.150 was void because it is contrary to state law
					 and is preempted by federal law. The director of the Department of Insurance
					 was permanently enjoined from enforcing this rule. The director has decided to
					 appeal the decision of the circuit
					 court.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 2 - Accident and Health Insurance in General › Section 20 CSR 400-2.160 - Mental Health Services Allowed Out-of-Network

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule sets forth with greater
				  specificity the breadth of options available for the provision of mental health
				  services. This rule is promulgated pursuant to section
				  376.814,
				  RSMo, and implements section 376.811.4, RSMo.
Pursuant to section 376.811.4, RSMo Supp. 2012, an insurance
				  company, health services corporation or health maintenance organization, must
				  offer in all health insurance policies at least two (2) sessions per year for
				  the purpose of diagnosis or assessment of mental health. This offer may not
				  limit the choice of psychiatrist, licensed psychologist, licensed professional
				  counselor or licensed clinical social worker, or, subject to contractual
				  provisions, a licensed marital and family therapist who provides the service.
				  An insured or enrollee may seek these services outside an insurer's network if
				  he or she is covered by an insurance company, a health services corporation, or
				  a point of service plan provided by a health maintenance
				  organization.
*Original authority: 376.811 , RSMo 1991, amended 1997,
					 1999, 2004, 2009 and 376.814, RSMo 1991, amended
					 1993.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 2 - Accident and Health Insurance in General › Section 20 CSR 400-2.165 - Access to Providers for Treatment of Mental Health Conditions

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule describes timely and appropriate
				  access to mental health care, adequate distribution of the quantity, location
				  and specialty of mental health care providers, and administrative and clinical
				  protocols that protect access to medically necessary mental health treatment
				  for any insured. This rule is promulgated pursuant to section
				  376.1550,
				  RSMo.
(1) Definitions.
(A) "Administrative protocols" include, but
				are not limited to, a provider network, referral requirements, prior
				authorization requirements, and utilization review.
(B) "Clinical protocols" include, but are not
				limited to, visit limitations, length-of-stay limitations, formularies,
				step-therapy requirements, and drug quantity limitations.
(C) Categories of counties-
1. Urban counties-Counties with a population
				of two hundred thousand (200,000) or more persons;
2. Basic counties-Counties with a population
				between fifty thousand (50,000) persons and one hundred ninety-nine thousand
				nine hundred ninety-nine (199,999) persons;
3. Rural counties-Counties with a population
				of fewer than fifty thousand (50,000) persons; and
4. Population figures shall be based on
				census data as reported in the latest edition of the
Official Manual
				State of Missouri
.
(D) "Director" means the director of the
				Department of Commerce and Insurance.
(E) "Health benefit plan" has the same
				meaning as stated at section
				376.1350,
				RSMo.
(F) "Health carrier" has the
				same meaning as stated at section
				376.1350,
				RSMo.
(G) "HMO" means health
				maintenance organizations licensed pursuant to Chapter 354, RSMo.
(H) "Insured" means any person entitled to
				benefits under a health benefit plan.
(I) "Insurer" means a health carrier that is
				not an HMO.
(J) "Mental health
				condition" means any condition or disorder defined by the most recent edition
				of the
Diagnostic and Statistical Manual of Mental Disorders
except for chemical dependency.
(K)
				"Provider" means any professional or institution which is licensed or otherwise
				authorized in this or any other state to furnish health care
				services.
(L) "Utilization review"
				has the same meaning as stated at section
				376.1350,
				RSMo.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 2 - Accident and Health Insurance in General › Section 20 CSR 400-2.170 - Early Intervention Part C Coverage

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule implements the requirements of
				  section
				  376.1218,
				  RSMo, with respect to the Missouri early intervention system and clarifies
				  insurance carriers' obligations under the new law.
(1) Definitions: The terms used in this rule
				or in section
				376.1218,
				RSMo, shall have the following meanings:
(A)
				"Assistive technology device" means any item, piece of equipment, or product
				system, whether acquired commercially off the shelf, modified, or customized,
				that is used to increase, maintain or improve the functional capabilities of
				children with disabilities.
(B)
				"Direct written premium" means:
1. The total
				amount of premium reported for health benefit plans, as defined in 376.1350,
				RSMo, on the Annual Statement Supplement for the State of Missouri for health
				carriers required to file this supplement; or
2. The total amount of premium reported for
				health benefit plans, as defined in 376.1350, RSMo, on the Exhibit of Premiums,
				Enrollment, and Utilization for the State of Missouri included in the health
				carrier's annual financial statement, for all other health carriers not covered
				in paragraph (1)(B)1.
(C) "Early intervention services" means
				medically necessary speech and language therapy, occupational therapy, physical
				therapy, and assistive technology devices for children from birth to age three
				(3) who are identified by the Part C early intervention system as eligible for
				services under Part C of the Individuals with Disabilities Education Act,
				20 U.S.C. Section
				1431, et seq.
(D) "First Steps" refers to the Missouri
				early intervention system under the federal Infant and Toddler Program, Part C
				of the Individuals with Disabilities Act,
				20 U.S.C. Section
				1431, et seq.
(E) "Group of carriers affiliated by or under
				common ownership or control" means health carriers with a common four (4)-digit
				group code as assigned by the National Association of Insurance
				Commissioners.
(F) "Health benefit
				plan," "health care professional," and "health carrier" shall each have their
				respective meanings as such terms are defined in 376.1350, RSMo.
(G) "Individualized family service plan"
				means a written plan for providing early intervention services to an eligible
				child and the child's family, that is adopted in accordance with
				20 U.S.C. Section
				1436.
(H) "Participating provider" means a provider
				who, under a contract with the health carrier or with its contractor or
				subcontractor, has agreed to provide health care services to enrollees with an
				expectation of receiving payment, other than coinsurance, co-payments or
				deductibles, directly or indirectly from the health
				carrier.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 2 - Accident and Health Insurance in General › Section 20 CSR 400-2.180 - Offer of Coverage for Prosthetic Devices and Services

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule defines "prosthetic devices and
				  services" for purposes of the mandated offer of coverage required under section
				  376.1232,
				  RSMo, and clarifies the related obligations for health carriers and health
				  benefit plans.
(1) As used in
				this rule and section
				376.1232,
				RSMo, the term "prosthetic devices" shall have the same meaning as described in
				the federal Medicare program definitions under 42 U.S.C. section 1395x(s)(8)
				and (9).
(2) As used in this rule
				and section
				376.1232,
				RSMo, the term "services" means-
(A) Design,
				fabrication, and customization of the prosthetic device;
(B) Required visits or fittings with the
				prosthetics device supplier prior to receiving the prosthetic device;
(C) Proper fitting of the prosthetic
				device;
(D) Visits with qualified
				medical professionals, where such visits are necessary to train the recipient
				of the prosthetic device in the use of the prosthetic device, and visits
				necessary to train family members or care-givers, if applicable;
(E) Post-fitting and adjustment visits after
				receiving the prosthetic device, no less than annually or more frequently if
				necessary;
(F) Necessary
				modifications after receiving the prosthetic device because of physical changes
				or excessive stump shrinkage;
(G)
				Repair or replacement due to defects in materials and workmanship, to the
				extent that such is not already covered by a warranty offered by the
				manufacturer or supplier of the prosthetic device;
(H) Repair or replacement due to structural
				integrity issues; and/or
(I)
				Periodic evaluation and patient care in order to assess the prosthetic device's
				effect on the patient's tissues and to assure continued proper fit and
				function.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 3 - Medicare Supplement Insurance › Section 20 CSR 400-3.100 - Rule to Implement Transitional Requirements for the Conversion of Medicare Supplement Insurance Benefits and Premiums to Conform to Medicare Program Revisions

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule attempts to assure the orderly
				  implementation and conversion of Medicare supplement insurance benefits and
				  premiums due to changes in the federal Medicare program; provides for the
				  reasonable standardization of the coverage, terms and benefits of Medicare
				  supplement policies or contracts; facilitates public understanding of these
				  policies or contracts; eliminates provisions contained in these policies or
				  contracts which may be misleading or confusing in connection with the purchase
				  of these policies or contracts to eliminate policy or contract provisions which
				  may duplicate Medicare benefits; provides full disclosure of policy or contract
				  benefits and benefit changes; and provides for refunds of premiums associated
				  with benefits duplicating Medicare program benefits. This rule is promulgated
				  pursuant to sections 376.850-376.890, RSMo.
(1) Applicability and Scope. This regulation
				shall take precedence over other rules and requirements relating to Medicare
				supplement policies or contracts only to the extent necessary to assure that
				benefits are not duplicated, that applicants receive adequate notice and
				disclosure of changes in Medicare supplement policies and contracts, that
				appropriate premium adjustments are made in a timely manner and that premiums
				are reasonable in relation to benefits. Except as otherwise provided, this rule
				shall apply to-
(A) All Medicare supplement
				policies and contracts delivered, or issued for delivery, or which are
				otherwise subject to the jurisdiction of this state on or after October 27,
				1988; and
(B) All certificates
				issued under group Medicare supplement policies as provided in subsection
				(1)(A).
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 3 - Medicare Supplement Insurance › Section 20 CSR 400-3.200 - Medicare Supplement Insurance Minimum Standards

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule provides for the reasonable
				  standardization of coverage and simplification of terms and benefits of
				  Medicare supplement policies; facilitates public understanding and comparison
				  of these policies; eliminates provisions contained in the policies which may be
				  misleading or confusing in connection with the purchase of the policies or with
				  the settlement of claims; and provides for full disclosure in the sale of
				  accident and sickness insurance coverages to persons eligible for Medicare by
				  reason of age.
(1)
				Applicability and Scope. Except as otherwise specifically provided, this rule
				shall-
(A) Apply to all Medicare supplement
				policies and subscriber contracts delivered or issued for delivery in this
				state on or after November 1, 1989;
(B) Apply to all certificates issued under
				group Medicare supplement policies or subscriber contracts, which certificates
				have been delivered or issued for delivery in this state; and
(C) Not apply to a policy or contract of one
				(1) or more employers or labor organizations, or of the trustees of a fund
				established by one (1) or more employers or labor organizations or combination
				of them, for employees or former employees or a combination of them, or for
				members or former members or combination of them of the labor
				organizations.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 3 - Medicare Supplement Insurance › Section 20 CSR 400-3.400 - Model Rule to Implement Transitional Requirements for the Conversion of Medicare Supplement Insurance Benefits and Premiums to Conform to Repeal of Medicare Catastrophic Coverage Act

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule assures the orderly implementation
				  and conversion of Medicare supplement insurance benefits, coverage and premiums
				  due to changes in the federal Medicare program.
(1) This rule shall apply to all Medicare
				supplement coverage delivered or issued for delivery in this state. The
				provisions of this rule shall have precedence over the provisions of any other
				regulation of this state to the extent necessary to assure that-
(A) Benefits do not duplicate benefits
				payable by Medicare;
(B) Benefits
				are adjusted to reflect changes in Medicare benefits;
(C) Applicants receive adequate notice and
				disclosure of changes in their Medicare supplement coverage; and
(D) Appropriate premium adjustments are made
				in a timely manner.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 3 - Medicare Supplement Insurance › Section 20 CSR 400-3.500 - Medicare Supplement Insurance Minimum Standards-December 31, 1990 to July 29, 1992

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule provides for the reasonable
				  standardization of coverage and simplification of terms and benefits of
				  Medicare supplement policies; facilitates public understanding and comparison
				  of these policies; eliminates provisions contained in the policies which may be
				  misleading or confusing in connection with the purchase of the policies or with
				  the settlement of claims; and provides for full disclosures in the sale of
				  accident and sickness insurance coverages to persons eligible for Medicare by
				  reason of age.
(1)
				Applicability and Scope. Except as otherwise specifically provided in sections
				(8) and (9), this rule shall-
(A) Apply to
				all Medicare supplement policies and subscriber contracts delivered or issued
				for delivery in this state on or after the effective date of this rule,
				December 31, 1990 and before July 30, 1992 except to the extent modified by 20
				CSR 400-3.600(5);
(B) Apply to all
				certificates delivered or issued for delivery in this state under group
				Medicare supplement policies or subscriber contracts; and
(C) Not apply to a policy or contract of one
				(1) or more employers or labor organizations, or of the trustees of a fund
				established by one (1) or more employers or labor organizations, or a
				combination of them, for employees or former employees or a combination of
				them, or for members or former members, or a combination of them, of the labor
				organizations.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 3 - Medicare Supplement Insurance › Section 20 CSR 400-3.650 - Medicare Supplement Insurance Minimum Standards Act

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment makes changes to Missouri's
				  rules related to Medicare Supplement policies that are consistent with changes
				  made by Congress when it enacted the Medicare Access and CHIP Reauthorization
				  Act of 2015 (MACRA) in 2015. MACRA made changes to Medicare Supplement policies
				  that cover Part B deductibles for individuals newly eligible for Medicare on or
				  after January 1, 2020. This proposed amendment makes changes to the current
				  Medicare Supplement regulation to specify that first dollar Part B coverage
				  Medicare Supplement plans (Plans C, F, and F High Deductible) cannot be sold to
				  individuals newly eligible for Medicare on or after January 1, 2020. It also
				  makes Plans D and G the guarantee issue plans for individuals who are newly
				  eligible for Medicare on or after January 1, 2020. Finally, it reflects the
				  newly-created Plan G High Deductible option.
(1) Applicability and Scope.
(A) Except as otherwise specifically provided
				in sections (5), (13), (14), (17), and (24), this rule shall apply to-
1. All Medicare supplement policies delivered
				or issued for delivery in this state on or after the effective date of this
				rule; and
2. All certificates
				issued under group Medicare supplement policies which certificates have been
				delivered or issued for delivery in this state.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 4 - Long-Term Care › Section 20 CSR 400-4.100 - Long-Term Care Insurance

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule implements sections
				  376.1100-376.1130, RSMo, to promote the public interest, to promote the
				  availability of long-term care insurance coverage, to protect applicants for
				  long-term care insurance, as defined, from unfair or deceptive sales or
				  enrollment practices, to facilitate public understanding and comparison of
				  long-term care insurance coverages, and to facilitate flexibility and
				  innovation in the development of long-term care insurance.
(1) Applicability and Scope. This regulation
				is based upon the Long-Term Care Insurance Model Regulation adopted by the
				National Association of Insurance Commissioners (NAIC), Model #641, published
				October 2007 ("2007 LTC Model").
(A) Except as
				otherwise specifically provided, this regulation applies to all long-term care
				insurance policies, including qualified long-term care contracts and life
				insurance policies that accelerate benefits for long-term care delivered or
				issued for delivery in this state on or after January 1, 2004, by insurers,
				fraternal benefit societies, nonprofit health, hospital and medical service
				corporations, prepaid health plans, health maintenance organizations and all
				similar organizations. Certain provisions of this regulation apply only to
				qualified long-term care insurance contracts as noted.
(B) Additionally, this regulation is intended
				to apply to policies having indemnity benefits that are triggered by activities
				of daily living and sold as disability income insurance, if:
1. The benefits of the disability income
				policy are dependent upon or vary in amount based on the receipt of long-term
				care services;
2. The disability
				income policy is advertised, marketed or offered as insurance for long-term
				care services; or
3. Benefits under
				the policy may commence after the policyholder has reached Social Security's
				normal retirement age unless benefits are designed to replace lost income or
				pay for specific expenses other than long-term care services.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 4 - Long-Term Care › Section 20 CSR 400-4.110 - Qualified Long-Term Care Partnership Program

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule prescribes the additional
				  requirements for Qualified Long-Term Care Partnership Plans.
(1) Requirements. For the purposes of this
				section, "Qualified Long-Term Care Partnership coverage" shall mean any
				long-term care coverage that is intended to be marketed as part of a long-term
				care partnership program, as outlined in sections
				208.690
				to
				208.698, known
				as the "Missouri Long-Term Care Partnership Program Act."
(A) Coverage Requirements. Coverage will be
				considered meeting the requirements of the Missouri Long-Term Care Partnership
				Program if the following requirements are met:
1. The insured was a resident of this state
				when coverage first became effective;
2. The coverage is a qualified long-term care
				insurance policy (as defined in section 7702B(b) of the
Internal
				Revenue Code
of 1986);
3.
				The coverage meets the requirements of the Deficit Reduction Act of 2005,
				except for Subchapter B, Section 6021(a)(1)(iii)(IV) as stated in section
				208.696.1(2), RSMo; and
4. The
				coverage includes inflation protection no less favorable than the following:
A. For a person who is less than sixty-one
				(61) years of age as of the date of purchase, the coverage provides compound
				annual inflation protection; and
B.
				For a person who is at least sixty-one (61) years of age but less than
				seventy-six (76) years of age, the policy provides some level of inflation
				protection; and
C. For any person
				who has attained the age of seventy-six (76), inflation protection may be
				provided but is not required.
D. In
				order for coverage to meet the requirements of subparagraph (1)(A)4.A., if the
				required inflation protection offer of five percent (5%) compound annual
				inflation protection referenced in
				20 CSR
				400-4.100(11) is rejected, the
				inflation protection included shall:
(I)
				Provide automatic annual compounded inflation increases at a rate not less than
				three percent (3%); or
(II) Provide
				automatic annual compound inflation increases at a rate based on changes in the
				consumer price index. "Consumer price index" means consumer price index for all
				urban consumers, U.S. city average, all items, as determined by the Bureau of
				Labor Statistics of the United States Department of Labor; or
(III) The director may approve an alternative
				inflation protection method so long as such method is submitted to the director
				with an explanation and demonstration as to how the alternative method provides
				for meaningful benefits which are in the best interest of the consumer and
				provides assurances that the policy or certificate will remain a partnership
				plan.
Missouri Code of State Regulations › Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE › Division 400 - Life, Annuities and Health › Chapter 4 - Long-Term Care › Section 20 CSR 400-4.120 - Producer Training and Continuing Education

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule prescribes the producer training
				  requirements for long-term care insurance generally and for Qualified Long-Term
				  Care Partnership Plans.
(1)
				Licensing. Pursuant to section 208.696.1(1), RSMo, a producer shall not sell,
				solicit or negotiate long-term care insurance, unless licensed under section
				375.018,
				RSMo, 20 CSR 400.4-100(14) and this rule and the individual has been qualified
				for both the life and health lines of authority.
(2) Initial Training.
(A) Prior to selling a Qualified Long-Term
				Care Partnership Plan, a producer shall complete an initial training course no
				less than eight (8) hours in duration, which has been approved by the director
				under section 375.020.9(2), RSMo.
(B) In addition to the requirements in
				section
				375.020,
				RSMo, the curriculum for an initial training course shall consist of topics
				related to long-term care insurance, long-term care services and, if
				applicable, Qualified Long-Term Care Partnership Programs, including, but not
				limited to:
1. State and federal regulations
				and requirements and the relationship between qualified state long-term care
				insurance partnership programs and other public and private coverage of
				long-term care services, including Medicaid;
2. Available long-term services and
				providers;
3. Changes of
				improvements in long-term care services or providers;
4. Alternatives to the purchase of private
				long-term care insurance;
5. The
				effect of inflation protection on benefits and the importance of inflation
				protection; and
6. Consumer
				suitability standards and guidelines, including
				20
				CSR 700-1.152.
(C) The training required by this section
				shall not include training that is insurer or company product specific or that
				includes sales or marketing information, materials or training, other than
				those required by state or federal law.