Chapter 695C - Health Maintenance Organizations
- COVERAGE GENERALLY
- 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 drug or device for contraception and of hormone replacement therapy in certain circumstances; prohibited actions by health maintenance organizatio
- 695C.1695 - Required provision concerning coverage of health care services related to contraceptives and hormone replacement therapy in certain circumstances; prohibited actions by health maintenance
- 695C.170 - Evidence of coverage: Issuance; form and contents.
- 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.1707 - Required provision for continuation of coverage.
- 695C.1709 - Required provision concerning coverage for enrollee on leave without pay as result of total disability.
- 695C.171 - Required provision concerning coverage relating to mastectomy.
- 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. [Effective January 1, 2011.]
- 695C.172 - Required provision concerning coverage relating to complications of pregnancy.
- 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.173 - Required provision concerning coverage for newly born and adopted children and children placed for adoption.
- 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 cytologic screening tests and mammograms for certain women.
- 695C.1738 - Required provision concerning coverage for treatment of conditions relating to severe mental illness.
- 695C.174 - Required provision concerning benefits for treatment of abuse of alcohol or drugs.
- 695C.1745 - Required provision concerning coverage for human papillomavirus vaccine.
- 695C.1751 - Required provision concerning coverage for prostate cancer screening.
- 695C.1755 - Required provision concerning coverage for treatment of temporomandibular joint.
- ELIGIBILITY FOR COVERAGE
- 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 o
- GENERAL PROVISIONS
- 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.
- MISCELLANEOUS PROVISIONS
- 695C.180 - Schedule of charges.
- 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.193 - Summary of coverage: Contents of disclosure; approval by Commissioner; regulations.
- 695C.195 - Summary of coverage: Copy to be provided before policy issued; policy not to be offered unless summary approved by Commissioner.
- 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.250 - Open enrollment.
- 695C.260 - Complaint system.
- 695C.265 - Required procedure for arbitration of disputes concerning independent medical 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.320 - Rehabilitation, liquidation or conservation.
- 695C.325 - Authorization to offer health care plan to small employer for purpose of establishing medical savings accounts.
- 695C.330 - Disciplinary proceedings: Grounds; effect of suspension or revocation.
- 695C.340 - Disciplinary proceedings: Notice; hearing; judicial review.
- 695C.350 - Violations: Remedies; penalties.
- REIMBURSEMENT
- 695C.1765 - Reimbursement for acupuncture.
- 695C.177 - Reimbursement for treatments by licensed psychologist.
- 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.178 - Reimbursement for treatment by chiropractor.
- 695C.1783 - Reimbursement for treatment by podiatrist.
- 695C.1789 - Reimbursement for treatment by licensed clinical alcohol and drug abuse counselor.
- 695C.179 - Reimbursement for services provided by certain nurses; prohibited limitations; exceptions.
- 695C.1795 - Reimbursement to provider of medical transportation.