Chapter 695C Health Maintenance Organizations

Sections

695C.010
Short title.
695C.020
Legislative declaration.
695C.030
Definitions.
695C.050
Applicability of certain provisions.
695C.055
Applicability of certain other provisions.
695C.057
Applicability of certain provisions concerning portability and availability of health insurance.
695C.060
Establishment of organization.
695C.070
Certificate of authority: Application.
695C.080
Certificate of authority: Evaluation of application.
695C.090
Certificate of authority: Issuance.
695C.100
Certificate of authority: Denial.
695C.110
Governing body: Composition; participation by enrollees.
695C.120
Powers of organization.
695C.123
Contracts with certain federally qualified health centers.
695C.125
Contract between health maintenance organization and provider of health care: Form to obtain information on provider of health care; modification; provision of schedule of fees.
695C.128
Contracts to provide services pursuant to certain state programs: Payment of interest on claims.
695C.130
Notice and approval required for exercise of powers; rules or regulations.
695C.140
Notice and approval required for modification of operations; regulations.
695C.145
Accounting principles required for certain reports and transactions; health maintenance organization subject to requirements for certain insurers.
695C.150
Fiduciary responsibilities.
695C.160
Investments.
695C.161
Eligibility for coverage: Definitions.
695C.163
Eligibility for coverage: Effect of eligibility for medical assistance under Medicaid; assignment of rights to state agency.
695C.165
Eligibility for coverage: Organization prohibited from asserting certain grounds to deny enrollment of child pursuant to order if parent is enrolled in health care plan.
695C.167
Eligibility for coverage: Certain accommodations to be made when child is covered under health care plan of noncustodial parent.
695C.169
Eligibility for coverage: Organization to authorize enrollment of child of parent who is required by order to provide medical coverage under certain circumstances; termination of coverage of child.
695C.170
Evidence of coverage: Issuance; form and contents.
695C.171
Required provision concerning coverage relating to mastectomy.
695C.172
Required provision concerning coverage relating to complications of pregnancy.
695C.173
Required provision concerning coverage for newly born and adopted children and children placed for adoption.
695C.176
Required provision concerning coverage for hospice care.
695C.177
Reimbursement for treatments by licensed psychologist.
695C.178
Reimbursement for treatment by chiropractor.
695C.179
Reimbursement for services provided by certain nurses; prohibited limitations; exceptions.
695C.185
Approval or denial of claims; payment of claims and interest; requests for additional information; award of costs and attorney’s fees; compliance with requirements.
695C.187
Schedule for payment of claims: Mandatory inclusion in arrangements for provision of health care.
695C.190
Commissioner may require submission of information.
695C.200
Approval of forms and schedules.
695C.201
Offering policy of health insurance for purposes of establishing health savings account.
695C.203
Denying coverage solely because person was victim of domestic violence prohibited.
695C.205
Denying coverage solely because insured was intoxicated or under the influence of controlled substance prohibited; exceptions.
695C.207
Requiring or using information concerning genetic testing.
695C.210
Annual report and financial statement required; administrative penalty for failure to file report or statement.
695C.220
Applications, filings and reports open to public inspection.
695C.230
Fees.
695C.240
Information required to be available for inspection.
695C.260
Complaint system.
695C.265
Required procedure for arbitration of disputes concerning independent medical, dental or chiropractic evaluations.
695C.267
Provision requiring binding arbitration authorized; procedures for arbitration; declaratory relief.
695C.270
Bond required; waiver.
695C.275
Commissioner to adopt regulations for licensing of provider-sponsored organizations.
695C.280
Commissioner authorized to adopt regulations for licensing of agents or brokers.
695C.290
Insurance company may establish or contract with health maintenance organization.
695C.300
Prohibited practices.
695C.310
Examinations.
695C.311
Periodic examination by Commissioner to determine financial condition of health maintenance organization.
695C.313
Financial examination: Procedure; appointment of examiner; maintenance and use of records; penalty for obstruction or interference.
695C.315
Financial examination: Payment of expense.
695C.317
Statutory procedures required for examination and hearing.
695C.318
Insolvency; determination of financial condition; regulations.
695C.319
Power of Commissioner to order corrective action for hazardous operation or violation of law; regulations.
695C.320
Rehabilitation, liquidation or conservation.
695C.325
Authorization to offer health care plan to small employer for purpose of establishing medical savings accounts.
695C.326
Health maintenance organization to provide data relating to claims and costs to person responsible for overseeing health care plan upon request; annual report; format.
695C.328
Disclosure of data relating to claims and costs prohibited; exceptions; penalties for unauthorized disclosure.
695C.330
Disciplinary proceedings: Grounds; effect of suspension or revocation.
695C.340
Disciplinary proceedings: Notice; hearing; judicial review.
695C.350
Violations: Remedies; penalties.
695C.1691
Required provision concerning coverage for continued medical care.
695C.1693
Required provision concerning coverage for treatment received as part of clinical trial or study.
695C.1694
Required provision concerning coverage of hormone replacement therapy in certain circumstances; prohibited actions by health maintenance organization; exception.
695C.1695
Required provision concerning coverage of health care services related to hormone replacement therapy in certain circumstances; prohibited actions by health maintenance organization.
695C.1696
Required provision concerning coverage for drug or device for contraception and related health services; prohibited actions by health maintenance organization; exceptions.
695C.1698
Required provision concerning coverage for certain services, screenings and tests relating to wellness; prohibited actions by health maintenance organization.
695C.1703
Coverage for prescription drugs: Provision of notice and information regarding use of formulary.
695C.1705
Group health care plan issued to replace discontinued policy or coverage: Requirements; notice of reduction of benefits; statement of benefits; applicability to self-insured employer.
695C.1708
Required provision concerning coverage for services provided through telehealth.
695C.1709
Required provision concerning coverage for enrollee on leave without pay as result of total disability.
695C.1713
Required provision concerning coverage of certain gynecological and obstetrical services without authorization or referral from primary care physician.
695C.1717
Required provision concerning coverage for autism spectrum disorders.
695C.1723
Required provision concerning coverage for treatment of certain inherited metabolic diseases.
695C.1727
Required provision concerning coverage for management and treatment of diabetes.
695C.1731
Required provision concerning coverage for screening for colorectal cancer.
695C.1733
Required provision concerning coverage for certain drugs for treatment of cancer.
695C.1734
Required provision concerning coverage for prescription drug previously approved for medical condition of enrollee.
695C.1735
Required provision concerning coverage for mammograms for certain women; prohibited acts.
695C.1745
Required provision concerning coverage for certain tests and vaccines relating to human papillomavirus; prohibited acts.
695C.1751
Required provision concerning coverage for prostate cancer screening.
695C.1755
Required provision concerning coverage for treatment of temporomandibular joint.
695C.1757
Required provision concerning coverage for early refills of topical ophthalmic products.
695C.1765
Reimbursement for acupuncture.
695C.1773
Reimbursement for treatment by licensed marriage and family therapist or licensed clinical professional counselor.
695C.1775
Reimbursement for treatment by licensed associate in social work, social worker, independent social worker or clinical social worker.
695C.1783
Reimbursement for treatment by podiatrist.
695C.1789
Reimbursement for treatment by licensed clinical alcohol and drug abuse counselor.
695C.1795
Reimbursement to provider of medical transportation.
695C.3175
Required contract with insurance company for provision of insurance, indemnity or reimbursement against cost of health care services; required provisions.
695C.3185
Plan for continuation of benefits if health maintenance organization becomes insolvent or impaired; approval by Commissioner; contents.
695C.3195
Conservation, rehabilitation or liquidation of health maintenance organization: Powers of Commissioner; claims of enrollees; distribution of general assets.
695C.17335
Required provision concerning coverage for orally administered chemotherapy.
695C.17345
Required provision concerning coverage for prescription drugs irregularly dispensed for purpose of synchronization of chronic medications.