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Get MO 20 CSR 400-7 2019-2024

500 RSMo and any other applicable law. RSMo 1986. Original rule filed April 14 1992 effective Feb. 26 1993. 485 RSMo and implements section 354. 420 RSMo. A Enrollee means an individual who is covered by a health maintenance organization HMO. 3 Refunds. An HMO shall refund any premium payment net of copayments due made to cover the period after disenrollment. 4 Copayment Notification. Upon request an HMO shall inform an enrollee if s/he has reached his/her copayment maximum. HMO must use its true name for its certificate of authority to conduct business as an HMO in this state. 615 RSMo Supp. 1997. Original rule filed Nov. 3 1997 effective May 30 1998. 1997 354. 603 RSMo 1997 and 354. C Disenrollment means a health maintenance organization s HMO termination of an enrollee s eligibility for service. The enrollee also must receive written notice from the HMO stating the disenrollment will occur unless arrangements for payment of the copayment are made within ten 10 working days after receipt of the notice. 3 Refunds. An HMO shall refund any premium payment net of copayments due made to cover the period after disenrollment. 5 20 CSR 400-7. 095 Provider Network Adequacy Standards. 6 20 CSR 400-7. 120 Health Maintenance Organizations Enrollee Participation.. 425 and 354. 485 RSMo 1986. This rule was previously filed as 4 CSR 19015. 080. Original rule filed Nov. 2 1987 effective April 11 1988. 010 Forms Which Must be Approved Prior to Use. 3 of Authority. 3 of Coverage. 4 Evidences of Coverage. 24 Title 20 DEPARTMENT OF INSURANCE Organizations Approved Prior to Use PURPOSE This rule describes the forms which must be filed by a health maintenance organization with the Department of Insurance for approval prior to use. disapproved by the director within thirty 30 days after filing the modification shall be deemed approved* 354. 4 Claim Filing Procedure. A provision setting forth the procedure for filing claims including A How when and where to obtain claim forms if required and B The requirements for providing proper notice of claim and proof of loss. Failure to furnish the notice or proof within the time required shall not invalidate or reduce any claim if it was not reasonably possible to give notice or proof within this time. 5 Definitions. A provision defining any words in the evidence of coverage which have other than the usual meaning. 6 Effective Date. A statement of the effective date requirements for various classes of 7 Eligibility. The coverage for newly born children shall consist of coverage of injury or sickness including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities. 11 Exclusions and Limitations. A provision setting forth any exclusions and limitations on health care services. Note This section does not apply if the same form is used for both the group contract and the evidence of coverage. 3 New Employees. A provision specifying may be added to those originally covered will be effective.

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