Effective - 28 Aug 1993
376.1092. Certificate of authority, required, application, contents, fee — refusal to issue, when — renewal — bond, required when. — 1. No person shall act as, or offer to act as, or hold himself out to be an administrator in this state without a valid certificate of authority as an administrator issued by the director.
2. Applicants to be an administrator shall make an application to the director upon a form to be furnished by the director. The application shall include or be accompanied by the following information and documents:
(1) All basic organizational documents of the administrator, including, but not limited to, any articles of incorporation, articles of association, partnership agreement, trade name certificate, trust agreement, shareholder agreement and other applicable documents and all amendments to such documents;
(2) The bylaws, rules, regulations or similar documents regulating the internal affairs of the administrator;
(3) The names, addresses, official positions and professional qualifications of the individuals who are responsible for the conduct of affairs of the administrator, including all members of the board of directors, board of trustees, executive committee or other governing board or committee; the principal officers in the case of a corporation or the partners or members in the case of a partnership or association; shareholders holding directly or indirectly ten percent or more of the voting securities of the administrator; and any other person who exercises control or influence over the affairs of the administrator;
(4) Annual financial statements or reports for the two most recent years which prove that the applicant is solvent and such information as the director may require in order to review the current financial condition of the applicant;
(5) A statement describing the business plan including information on staffing levels and activities proposed in this state and nationwide. The plan shall provide details setting forth the administrator's capability for providing a sufficient number of experienced and qualified personnel in the areas of claims processing, record keeping and underwriting;
(6) If the applicant will be managing the solicitation of new or renewal business, proof that it employs or has contracted with an agent licensed by this state for solicitation and taking of applications. Any applicant which intends to directly solicit insurance contracts or to otherwise act as an insurance agent must provide proof that it has a license as an insurance agent or agency, or as an insurance agent and agency, as applicable, in this state;
(7) An application fee of one thousand dollars;
(8) Such other pertinent information as may be required by the director.
3. The applicant shall make available for inspection by the director copies of all contracts with insurers or other persons using the services of the administrator.
4. The director may refuse to issue a certificate of authority if the director determines that the administrator or any individual responsible for the conduct of affairs of the administrator as described in subdivision (3) of subsection 2 of this section is not competent, trustworthy, financially responsible or of good personal and business reputation, has had an insurance or an administrator license denied or revoked for cause by any state or been subject to any form of criminal, civil or administrative action by any federal or state court or agency resulting* in some form of discipline or sanction.
5. Such certificate shall be renewable annually on the first day of July of each calendar year following the calendar year in which the certificate of registration was originally issued, upon application by the administrator and upon payment of the renewal fee of two hundred fifty dollars, provided that the director of the department of commerce and insurance is satisfied that none of the facts specified in sections 376.1075 to 376.1095 as grounds for revoking a certificate of registration exist, and any bond required by sections 376.1075 to 376.1095 is in force. Failure to hold such a certificate shall subject the administrator to an administrative penalty of not more than fifty thousand dollars.
6. An administrator shall immediately notify the director of any material change in its ownership, control, or other fact or circumstance affecting its qualification for a certificate of authority in this state.
7. Every administrator, except as hereinafter provided, shall file with the director a surety bond in the amount and form as prescribed by the director. Such bond shall be obtained from an insurance company licensed or approved to do business in the state of Missouri. Any affiliate or subsidiary of an insurance company licensed in this state shall not be required to file such a bond so long as the director is satisfied with the financial condition of such insurance company.
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(L. 1993 H.B. 709 § 51)
*Word "result" appears in original rolls.
Structure Missouri Revised Statutes
Title XXIV - Business and Financial Institutions
Chapter 376 - Life, Health and Accident Insurance
Section 376.005 - Definitions.
Section 376.010 - Who may form company — purposes.
Section 376.020 - Various companies defined.
Section 376.050 - Declaration of corporators.
Section 376.060 - Stock companies — content of charter.
Section 376.070 - To be submitted to attorney general.
Section 376.080 - Director to examine, when.
Section 376.090 - To furnish certificate of deposit, when.
Section 376.100 - Mutual companies — contents of charter.
Section 376.110 - To be submitted to attorney general.
Section 376.120 - Director to examine and certify, when.
Section 376.130 - To furnish certificate of deposit, when.
Section 376.145 - Officers of stock company to continue as officers of mutual.
Section 376.147 - Meetings of board of mutual, notice — executive committee of board, powers.
Section 376.150 - Stock and mutual companies — content of charter.
Section 376.160 - Formation of stock and mutual companies.
Section 376.170 - Special deposits for registered policies and annuity bonds.
Section 376.190 - Additional deposits required.
Section 376.200 - Definition of net value.
Section 376.210 - Excess deposits.
Section 376.220 - May use realty to secure notes and bonds.
Section 376.230 - Changing of securities on deposit.
Section 376.240 - Deposits to be held in trust by director.
Section 376.250 - Deposits to be kept separate.
Section 376.260 - Fees collected by director of revenue.
Section 376.270 - Director may proceed against depositary companies.
Section 376.280 - Capital necessary to do business — how invested.
Section 376.290 - Deposit and transfer of securities.
Section 376.291 - Applicability and inapplicability.
Section 376.292 - Definitions.
Section 376.293 - Permissible investments — written plan for investments required.
Section 376.294 - Prohibited acts.
Section 376.295 - Additional prohibited acts — authorized actions.
Section 376.296 - Value of investments, how calculated.
Section 376.297 - Investment subsidiaries not permitted, when.
Section 376.298 - Acquisition of rate credit instruments, when.
Section 376.300 - Equity interests permitted, when.
Section 376.301 - Tangible personal property interests permitted, when.
Section 376.302 - Mortgage interests, may be acquired, when — other real estate interests.
Section 376.303 - Lending and repurchase, permitted when.
Section 376.304 - Acquisition of foreign investments, when.
Section 376.305 - Rulemaking authority.
Section 376.306 - Cash surrender value, life insurer may lend to policyholder, when.
Section 376.307 - Limits on acquisition of certain investments.
Section 376.308 - Secondary mortgage market act, not to preempt health insurer, when.
Section 376.310 - Investment of surplus and reserve funds by foreign companies.
Section 376.325 - Any willing provider provision — definitions.
Section 376.330 - Securities may be changed.
Section 376.350 - Reports to director.
Section 376.360 - Distribution of surplus funds to participating policyholders — method.
Section 376.365 - Standard valuation law — definitions.
Section 376.370 - Director to value reserves, methods.
Section 376.379 - Medication synchronization services, offer of coverage required.
Section 376.381 - Health insurance products, department duties.
Section 376.386 - Prescription drugs, one co-payment for dosage prescribed.
Section 376.387 - Pharmacy benefits manager, limitations and restrictions — enforcement.
Section 376.390 - Reserve liability for group insurance — how computed.
Section 376.391 - Co-payments for chiropractic services, cap.
Section 376.392 - Prescription drug formularies, enrollees to be notified of changes to, when.
Section 376.393 - Pharmacy benefits manager, license required — definitions — complaints, procedure.
Section 376.395 - Definitions for group health conversion policy requirements.
Section 376.398 - Application to all group policies — effective, when.
Section 376.401 - Conversion rights — retirees — dependents of insured.
Section 376.404 - Specific requirement requests of policyholder may be met by alteration.
Section 376.407 - Advance practice nurse, claims for service to be reimbursed, when.
Section 376.410 - Insurance companies to maintain reserves — exemptions.
Section 376.421 - Group health insurance, authorized categories.
Section 376.425 - Student accident policies, may not limit surgical benefits, when.
Section 376.426 - Group health policies, required provisions.
Section 376.428 - Federal COBRA provisions to apply to group health insurance policies.
Section 376.432 - Group-type basis, defined.
Section 376.434 - Carrier liable for claims incurred during grace period, when — exceptions.
Section 376.435 - Claim information to be reported, when — covered lives defined.
Section 376.442 - Rules and regulations, procedure.
Section 376.450 - Citation of law — definitions (Missouri HIPAA).
Section 376.451 - Standards prohibiting discrimination.
Section 376.453 - Premium — only cafeteria plans required, when.
Section 376.480 - Domestic companies may assume risks of foreign companies — duties of director.
Section 376.500 - Discriminations, rebates and favors prohibited — contracts to conform to policy.
Section 376.510 - Penalty for violation of section 376.500.
Section 376.540 - Policy, to whom payable.
Section 376.570 - Foreign executor or administrator.
Section 376.580 - Misrepresentation.
Section 376.600 - Penalty for violating section 376.590.
Section 376.610 - Defense in case of suits.
Section 376.620 - Suicide, effect on liability — refund of premiums, when.
Section 376.630 - Life insurance policies not to be forfeited or become invalid, when.
Section 376.640 - Paid-up policy may be demanded, when.
Section 376.650 - Rules of payment on commuted policy.
Section 376.660 - Foregoing provisions inapplicable, when.
Section 376.670 - Provisions which shall be contained in life insurance policies, exceptions.
Section 376.671 - Provisions which shall be contained in annuity contracts — inapplicability date.
Section 376.673 - Life insurance policies, regulations relative to.
Section 376.674 - Life insurance policies, no cash surrender value, regulations relative to.
Section 376.679 - Life insurance company may reinsure for risks involving aircraft, limitation.
Section 376.680 - Assignment of incidents of ownership, group life policy, effect of.
Section 376.691 - Group life policies, eligible groups authorized for issue — premiums, how paid.
Section 376.693 - Special group life policies, requirements — director's approval.
Section 376.697 - Required provisions for group life policies.
Section 376.700 - Purpose — use of additional material.
Section 376.702 - Application of law — exceptions.
Section 376.704 - Definitions.
Section 376.706 - Delivery of guide and summary required, when.
Section 376.708 - Required presentations and statements — company to maintain file.
Section 376.710 - Effect of omission.
Section 376.712 - Effective date.
Section 376.714 - Contents and form of buyer's guide.
Section 376.715 - Citation of law, purpose.
Section 376.718 - Definitions.
Section 376.720 - Association, created — accounts — director to supervise.
Section 376.722 - Board of directors, established, members, how selected — expense reimbursement.
Section 376.726 - Nonpayment of premiums, effect of.
Section 376.728 - Law not applicable, when.
Section 376.730 - Liens, association may impose, when.
Section 376.734 - Additional powers of association.
Section 376.735 - Assessments against members, when due, classes — amounts, how determined.
Section 376.738 - Certificate of contribution, when issued.
Section 376.740 - Plan of operation, required, approval of director — provisions of plan.
Section 376.742 - Director, powers and duties.
Section 376.743 - Board of directors, powers.
Section 376.745 - Assessments, offset against tax liability, when, how.
Section 376.747 - Distribution of member insurer assets upon liquidation, priority of association.
Section 376.748 - Liquidation, recovery of distributions, when, exceptions, limitations.
Section 376.752 - Member insurer's deposit with director, exemption from, amount.
Section 376.754 - Stay of proceedings, insolvent insurer, when.
Section 376.755 - Advertising, use of guaranty association prohibited.
Section 376.758 - Law inapplicable to insolvent insurers on effective date of law.
Section 376.770 - Title of law.
Section 376.773 - Definitions.
Section 376.775 - Matters required in policies.
Section 376.780 - Limits on provisions, effect of conflict of policy with law.
Section 376.783 - Insured bound only if copy of application attached to policy.
Section 376.785 - What does not constitute waiver of defenses.
Section 376.787 - Effect of age limit provision.
Section 376.789 - Definition of actual charge and actual fee.
Section 376.790 - Limits on applicability of law.
Section 376.791 - Portion of section 376.777 not applicable to individual health insurance coverage.
Section 376.810 - Definitions for policy requirements for chemical dependency.
Section 376.818 - Eligibility for Medicaid may not be considered by insurers.
Section 376.819 - MO HealthNet division to have right to payment for health care services provided.
Section 376.823 - Prohibition on kickbacks not applicable for rebates for certain chronic illnesses.
Section 376.850 - Law, how cited.
Section 376.854 - Definitions.
Section 376.859 - Medicare supplement law applicable to what policies — policies not included.
Section 376.869 - Standards for policies, minimum, director to adopt.
Section 376.874 - Requirements of policy, return to policyholders.
Section 376.882 - Cancellation of policy, refund required — notification.
Section 376.884 - Advertisement to be reviewed by director.
Section 376.886 - Regulations, requirements — rules, procedure.
Section 376.889 - Violations, penalty.
Section 376.890 - Invalidity of any section regulating Medicare supplement not to affect others.
Section 376.891 - Definitions.
Section 376.900 - Definitions.
Section 376.905 - Administration by department, powers, duties — fees.
Section 376.910 - Certificate of authority required.
Section 376.920 - Annual statement, form, contents.
Section 376.925 - Seven-day rescission period, all money or property to be refunded.
Section 376.930 - Insured to be furnished application for certificate and annual statement, when.
Section 376.940 - Escrow account for entrance fees required, released when.
Section 376.945 - Escrow account, amount required — principal, how released, investment.
Section 376.950 - Board of directors, one member to be resident of facility.
Section 376.960 - Definitions.
Section 376.965 - Board members not civilly liable for performance of duties, exception.
Section 376.982 - Rulemaking procedure.
Section 376.989 - No liability, criminal or civil, for participation in pool by members.
Section 376.1000 - Multiple employer self-insured health plan, defined.
Section 376.1007 - Plan to file copy of bylaws, coverage and agreements with director.
Section 376.1010 - Excess stop-loss coverage maintained by plan.
Section 376.1015 - Department not to grant approval, when.
Section 376.1017 - Plan to establish loss reserves — plan to establish surplus account, amount.
Section 376.1020 - Plan to maintain principal place of business in Missouri, exception.
Section 376.1025 - Director may adopt rules.
Section 376.1027 - Plan in unsound condition, powers of director.
Section 376.1032 - Plan considered insurer, when.
Section 376.1035 - Chapter 376 applicable to plan.
Section 376.1037 - Plan subject to premium taxes.
Section 376.1042 - Marketing by agent, agency or broker violation of law.
Section 376.1045 - Injunctive relief, director may seek, when — procedures.
Section 376.1065 - Official notification communications, contracting entity requirements.
Section 376.1075 - Definitions.
Section 376.1077 - Administrator to have agreement with insurer, form, contents — termination, how.
Section 376.1080 - Payments of premiums and claims deemed paid, when.
Section 376.1083 - Advertising restrictions for administrator.
Section 376.1090 - Materials delivered to administrator for insured to be promptly delivered.
Section 376.1093 - Annual report filed with director, when — contents — filing fee, amount.
Section 376.1094 - Certificate of authority, suspension or revocation, grounds — civil action, when.
Section 376.1095 - Rules and regulations, promulgation.
Section 376.1100 - Law, how cited — definitions.
Section 376.1115 - Coverage outline to be delivered to applicants, when, content.
Section 376.1121 - Denial of claim, long-term care insurance, duties of issuer.
Section 376.1130 - Rulemaking authority.
Section 376.1190 - Health care mandates — review by oversight division — actuarial analysis.
Section 376.1215 - Immunizations, mandated coverage, exceptions, rulemaking.
Section 376.1220 - Insurance coverage for newborn hearing screenings mandated.
Section 376.1226 - Fee schedule for services not covered under health benefit plans — definitions.
Section 376.1230 - Chiropractic care coverage, rates, terms, conditions, limits, and exclusions.
Section 376.1232 - Insurers to offer coverage for prosthetics.
Section 376.1237 - Refills for prescription eye drops, required, when — definitions.
Section 376.1250 - Cancer screening, health insurance coverage required, when, types.
Section 376.1290 - Coverage for lead testing.
Section 376.1300 - Reorganization of a domestic mutual life insurance company, authority.
Section 376.1305 - Formation of holding company, application — shareholder approval.
Section 376.1307 - Issuance of shares.
Section 376.1312 - Nonapplicability of certain provisions of insurance holding companies law.
Section 376.1315 - Incorporation of mutual holding company, authority, approval.
Section 376.1350 - Definitions.
Section 376.1353 - Utilization review activities monitored.
Section 376.1356 - Utilization review entity monitored, when.
Section 376.1359 - Written utilization program implemented, filed with the director.
Section 376.1363 - Utilization review decisions, procedures.
Section 376.1365 - Reconsideration of an adverse determination, when.
Section 376.1367 - Emergency services benefit determination, coverage required, when.
Section 376.1369 - Certification of compliance, when.
Section 376.1375 - Registry of grievances maintained, procedures — definitions.
Section 376.1378 - Grievances and certificate of compliance filed with the director, when.
Section 376.1385 - Second-level review procedures.
Section 376.1387 - Appeals of grievances determined by the director.
Section 376.1389 - Expedited grievance review procedure.
Section 376.1399 - Rules, effective, when — rules invalid and void, when.
Section 376.1400 - Explanation of benefits, standardized information used, contents, when.
Section 376.1403 - Referrals, standardized information used, content, when.
Section 376.1500 - Definitions.
Section 376.1502 - Requirements for transaction of business.
Section 376.1504 - Registration requirements — term of registration — renewal.
Section 376.1506 - Violations, penalty.
Section 376.1508 - Processing fee — cancellation of membership, effect of.
Section 376.1510 - Prohibited acts.
Section 376.1512 - Required disclosures.
Section 376.1514 - Written agreement required, contents.
Section 376.1518 - Net worth to be maintained, amount.
Section 376.1520 - Notice of changes.
Section 376.1522 - List of providers to be maintained on website.
Section 376.1524 - Advertising and marketing materials, approval in writing required.
Section 376.1528 - Rulemaking authority.
Section 376.1530 - Denial and refusal to issue registrations, when.
Section 376.1532 - Violations, penalties.
Section 376.1550 - Mental health coverage, requirements — definitions — exclusions.
Section 376.1575 - Definitions.
Section 376.1590 - Status as living organ donor not sole factor for insurance coverage.
Section 376.1900 - Definitions — reimbursement for telehealth services, when.
Section 376.2000 - Citation of law — definitions.
Section 376.2002 - Navigators, license required — permitted acts — prohibited acts — exemptions.
Section 376.2004 - Application procedure.
Section 376.2006 - Term of licensure — renewal — continuing education.
Section 376.2008 - Consultation with licensed insurance producer, navigator to advise, when.
Section 376.2011 - Violations, administrative orders, civil actions — penalty.
Section 376.2012 - Navigators duty to report, when.
Section 376.2014 - Applicability — severability — rulemaking authority.
Section 376.2020 - Contracts prohibiting disclosure of certain payments and costs are unenforceable.
Section 376.2030 - Definitions.
Section 376.2036 - Enforcement — applicability to health insurance plans, when.
Section 376.2050 - Citation of act.
Section 376.2051 - Definitions.
Section 376.2053 - Exemption from requirements, when.
Section 376.2080 - Funding agreement defined — authority to issue — rulemaking authority.