Effective - 28 Aug 1987
354.712. Contract or contract certificate to be issued to enrollees, content, copy to be filed with director — newborn child to be covered, when, extent of coverage, notification of birth and additional premium, when, effect of. — 1. Every enrollee in a prepaid dental plan corporation shall be issued a contract setting out the dental care benefits covered by his prepayment or fee. If the enrollee is a beneficiary under a group contract, then the enrollee may alternatively be issued a contract certificate summarizing the dental care benefits covered by the prepayment.
2. Any contract that provides family coverage shall, as to such coverage of individuals in the family, also provide that the benefits applicable for children shall be payable with respect to a newly born child of the insured from the instant of such child's birth to the same extent that such coverage applies to other individuals in the family. If payment of a specific premium or capitation amount is required to provide coverage for a child, the contract may require notification of birth of a newly born child and payment of the required premium or capitation amount shall be furnished to the corporation within thirty-one days after the date of birth in order to have the coverage continue beyond the thirty-one-day period.
3. No enrollee contract, contract certificate, or contract amendment shall be issued or delivered to any person in this state until a copy of the form has been filed with the director.
4. All enrollee contracts or contract certificates shall clearly set forth:
(1) The prepaid dental care benefits to which the enrollee is entitled;
(2) Any limitations of the benefits to be provided, including any deductible or co-payment feature;
(3) Where and in what manner information is available as to how services may be obtained; and
(4) The enrollee's obligation respecting charges for the prepaid dental plan contract.
5. Enrollee contracts, contract certificates, advertising matter, and sales material shall not contain any provision or statements that are deceptive, ambiguous, or misleading.
6. No enrollee contract, contract certificate, or contract amendments shall be used until such form is approved by the director. If the director does not approve or disapprove any such form within thirty days after its filing, it shall be deemed approved. If the director disapproves a form, the director shall notify the prepaid dental plan corporation in writing and specify the reasons for disapproval. The director shall grant a hearing on such disapproval within fifteen days after a request in writing is received from the prepaid dental plan corporation.
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(L. 1987 S.B. 272 § 7)
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.