Missouri Code of State Regulations › Title 22 - MISSOURI CONSOLIDATED HEALTH CARE PLAN › Division 10 - Health Care Plan › Chapter 2 - State Membership › Section 22 CSR 10-2.080 - Miscellaneous Provisions

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment revises the names of the
				  medical plans.
(1) Termination
				of the Plan. Any other provision of this plan to the contrary notwithstanding,
				no benefit will be paid for charges incurred by a member or former member after
				the termination of this plan.
(2)
				Facility of Payment. Plan benefits will be paid to the subscriber if living and
				capable of giving a valid release for the payment due. If the subscriber, while
				living, is physically, mentally, or for any other reason incapable of giving a
				valid release for any payment due, the claims administrator at his/her option,
				unless and until request is made by the duly appointed guardian, may pay
				benefits which may become due to any blood relative or relative connected by
				marriage to the subscriber, or to any other person or institution appearing to
				the claims administrator to have assumed responsibility for the affairs of the
				subscriber. Any payments made by the claims administrator in good faith
				pursuant to this provision shall fully discharge the claims administrator to
				the extent of the payment. Any benefit unpaid at the time of the subscriber's
				death will be paid to the subscriber's estate. If any benefits shall be payable
				to the estate of the subscriber, the claims administrator may pay these
				benefits to any relative by blood or connection by marriage of the subscriber
				who is deemed by the claims administrator to be equitably entitled to it. Any
				payments made by the claims administrator in good faith pursuant to this
				provision shall fully discharge the claims administrator to the extent of this
				payment. Subject to any acceptable written direction and assignment by the
				subscriber, any benefits provided, at the claims administrator's option, may be
				paid directly to an eligible provider rendering covered services; but it is not
				required that the service be rendered by a particular provider.
(3) Confidentiality of Records. The health
				records of the members in the plan are confidential and shall not be used or
				disclosed unless such use or disclosure is in compliance with the Health
				Insurance Portability and Accountability Act.
(4) Should any provision of this plan
				conflict with the requirements of federal or state law, including but not
				limited to the Health Insurance Portability and Accountability Act, Family and
				Medical Leave Act, the Americans with Disabilities Act or the Older Workers
				Benefit Protection Act, the plan shall be administered in such a way as to
				comply with the requirements of law, and will be deemed amended to conform with
				law.
(5) The PPO 750 Plan, PPO 1250
				Plan, and Health Savings Account Plan benefits including pharmacy are
				self-funded by the plan. MCHCP has subrogation rights under section
				376.433,
				RSMo for any amounts expended for these benefits.
(6) The board of trustees has the right to
				suspend, revise, or remove eligibility and benefit requirements in the case of
				a disaster or emergency situation.
*Original authority: 103.059, RSMo
					 1992.