Effective - 28 Aug 1997
354.551. Health maintenance organizations may offer point of service (POS) riders, when. — 1. Missouri licensed health maintenance organizations shall be permitted to offer point of service riders (POS) to their approved health plan products, without being required to obtain a separate license as a health insurer pursuant to chapter 376, so long as medical and hospital expenses incurred under the POS rider do* not exceed ten percent of total medical and hospital expenses incurred for all health plan products sold.
2. Health maintenance organizations which have been licensed for at least one calendar year, who choose to insure the POS rider, shall maintain a net worth of the greater of:
(1) One million two hundred thousand dollars; or
(2) Two percent of total premium revenue for the immediately preceding twelve months plus fifty percent of uncovered liabilities as reported in the immediately preceding calendar quarter.
3. Health maintenance organizations which have been licensed for less than one calendar year, who choose to insure the POS rider, shall maintain a net worth of the greater of:
(1) One million two hundred thousand dollars; or
(2) Ten percent of the yearly average of the three-year annual premium plus fifty percent of its average annual uncovered liabilities as projected in its application for a certificate of authority.
4. The department of commerce and insurance may modify the net worth requirements for a health maintenance organization which has been licensed for less than one calendar year if its actual results deviate materially from its projections. In addition to any other deposit required of a licensed health maintenance organization pursuant to section 354.410, any health maintenance organization which chooses to issue a POS rider shall deposit an additional six hundred thousand dollars** with the director of the department of commerce and insurance. Any health maintenance organization which issues a POS rider whose medical and hospital expenses incurred under the POS rider exceed*** ten percent of total medical and hospital expenses incurred for all health plan products sold shall either cease insuring new POS riders until it comes into compliance with the ten percent limitation of this section or meet the minimum net worth requirements and all other statutory and regulatory requirements of a Missouri domestic life insurance company.
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(L. 1997 H.B. 335 § 11)
*Word "does" appears in original rolls.
**Word "dollars" does not appear in original rolls.
***Word "exceeds" appears in original rolls.
Structure Missouri Revised Statutes
Title XXIII - Corporations, Associations and Partnerships
Chapter 354 - Health Services Corporations — Health Maintenance Organizations — Prepaid Dental Plans
Section 354.010 - Definitions.
Section 354.015 - Health services corporations, laws applicable to — exceptions.
Section 354.020 - Preexisting health services corporation to amend articles, effect of.
Section 354.025 - Corporate purposes and authority.
Section 354.030 - For-profit corporations excluded from act.
Section 354.035 - Procedure for organization of corporation.
Section 354.040 - Articles of incorporation, required information and contents.
Section 354.045 - Issuance of certificate, effect of.
Section 354.050 - General powers of corporation.
Section 354.055 - Certificate of authority required — expiration of, extended how.
Section 354.060 - Director to issue certificate, when.
Section 354.065 - Articles of incorporation, how amended — copy to director, when.
Section 354.070 - Certificate of authority automatically extended, when.
Section 354.075 - Capital required to do business.
Section 354.080 - Reserves required, how computed.
Section 354.090 - Health services corporation contracts, purposes, parties to.
Section 354.095 - Limitation of membership and benefits — certain benefits to be provided, when.
Section 354.105 - Annual report required, contents of.
Section 354.120 - Rules and regulations by director authorized — procedure, review.
Section 354.130 - Exemption from certain taxes, exceptions.
Section 354.140 - Dissolution, liquidation or rehabilitation of corporation, procedure for.
Section 354.145 - Appeal from director's actions or decisions, how taken.
Section 354.150 - Fees — waiver, when.
Section 354.155 - Disclaimer as to nonhealth services corporations.
Section 354.165 - Certain organizations exempt.
Section 354.175 - Wage continuation plans by employer exempt.
Section 354.180 - Administrative order, director to issue, when.
Section 354.190 - Examinations, procedures.
Section 354.195 - Records of examination, duty to keep.
Section 354.200 - Examinations, false testimony, penalty.
Section 354.205 - Examinations — costs, how paid.
Section 354.210 - Director may seek relief, when.
Section 354.215 - Examiner's sick leave to apply to health services corporations.
Section 354.220 - Director may bring suit to recover fees or sums.
Section 354.230 - License required for enrollment representative.
Section 354.235 - Enrollment representative — license issued when, qualifications.
Section 354.240 - Nonresident may be licensed — examination waived, when.
Section 354.265 - Nonrenewable temporary license issued, when.
Section 354.275 - Violations by enrollment representatives, penalties.
Section 354.300 - Certificate of authority suspended or revoked, when.
Section 354.305 - Corporation advertising assets also to show liabilities — penalties.
Section 354.330 - Public official failing to perform duties as to investment violations, penalty.
Section 354.335 - Damages allowed if corporation without reasonable cause refuses to pay.
Section 354.350 - Fraudulent or bad faith conduct — investigation by division — hearing, procedure.
Section 354.357 - Receivership, grounds, procedure.
Section 354.362 - Newborn child coverage required — notice of birth, when, effect.
Section 354.380 - Certain provisions of insurance law to be applicable.
Section 354.400 - Definitions.
Section 354.407 - PACE projects not deemed health maintenance organizations, when.
Section 354.415 - Powers of organization.
Section 354.420 - Advisory panels to afford enrollees participation in policy decisions.
Section 354.425 - Bonding of officers who disburse or invest funds — bond requirements.
Section 354.435 - Annual reports filed with director, when — content — forms.
Section 354.440 - Information to be available to enrollees.
Section 354.441 - Disclosures to subscribers shall not be prohibited or restricted.
Section 354.442 - Disclosure information to enrollees required, when.
Section 354.444 - Administrative orders for violations — voluntary forfeitures, civil actions.
Section 354.445 - Complaints by enrollees, organization to establish system.
Section 354.450 - Investments authorized.
Section 354.455 - Deposit required, how made.
Section 354.462 - Enrollee, grounds for disenrollment.
Section 354.464 - Names not authorized for use, exceptions.
Section 354.465 - Examinations by division, when — costs, how paid.
Section 354.470 - Suspension or revocation, when — effect.
Section 354.485 - Rules and regulations authorized.
Section 354.490 - Certificate of authority, denial, suspension or revocation, grounds — procedure.
Section 354.495 - Fees to be paid to director.
Section 354.500 - Conferences called by director as to suspected or potential violations.
Section 354.505 - Laws regulating insurance or health service corporations not to apply, exceptions.
Section 354.510 - Public documents, all filings and required reports.
Section 354.520 - Mergers, consolidations, control of organization, requirements.
Section 354.530 - Severability clause.
Section 354.536 - Continuation of dependent child coverage, when — dependent child defined.
Section 354.545 - Exempt plans and companies.
Section 354.550 - Laws not applicable to community health companies.
Section 354.551 - Health maintenance organizations may offer point of service (POS) riders, when.
Section 354.552 - Community-based health maintenance organizations, requirements.
Section 354.556 - Trustees, vacancies, elections.
Section 354.558 - Materials provided to prospective purchasers.
Section 354.559 - Disclosure to members, restrictions and prohibitions.
Section 354.562 - Grievance procedures, rulemaking authority.
Section 354.563 - Medicare rules to apply to community-based health maintenance organizations, when.
Section 354.570 - Rulemaking — procedure.
Section 354.600 - Definitions.
Section 354.609 - Termination of a contract, procedure.
Section 354.612 - Continuation of care after provider termination, when.
Section 354.615 - Referrals to appropriate providers, when.
Section 354.621 - Intermediary and participating provider requirements.
Section 354.627 - Liability of a health carrier, when.
Section 354.636 - Contract requirements after January 1, 1998.
Section 354.650 - Definitions.
Section 354.652 - Designation as essential community provider, procedure, qualifications.
Section 354.654 - Department of health and senior services, duties — rulemaking authority.
Section 354.656 - Inclusion of essential community providers in health care network, exceptions.
Section 354.700 - Definitions.
Section 354.704 - Application for certificate of authority, content.
Section 354.705 - Certificate of authority granted, when.
Section 354.717 - Director, powers — financial examinations, when, by whom made and paid.
Section 354.720 - Annual report, required, content.
Section 354.721 - Agents, registration required — rules and regulations authorized.
Section 354.723 - Rulemaking authorized.
Section 354.725 - Exclusion, labor organization's health plans.