376.1215. Immunizations, mandated coverage, exceptions, rulemaking.
Immunizations, mandated coverage, exceptions, rulemaking.
376.1215. 1. All individual and group health insurance policiesproviding coverage on an expense-incurred basis, individual and group serviceor indemnity type contracts issued by a health services corporation,individual and group service contracts issued by a health maintenanceorganization and all self-insured group arrangements to the extent notpreempted by federal law and all managed health care delivery entities of anytype or description shall provide coverage for immunizations of a child frombirth to five years of age as provided by department of health and seniorservices regulations.
2. Such coverage shall not be subject to any deductible or co-paymentlimits.
3. The contract issued by a health maintenance organization may providethat the benefits required pursuant to this section shall be covered benefitsonly if the services are rendered by a provider who is designated by andaffiliated with the health maintenance organization, except that the healthmaintenance organization shall, as a condition of participation, comply withthe immunization requirements of state or federally funded health programs.
4. This section shall not apply to supplemental insurance policies,including life care contracts, accident-only policies, specified diseasepolicies, hospital policies providing a fixed daily benefit only, Medicaresupplement policies, long-term care policies, coverage issued as a supplementto liability insurance, short-term major medical policies of six months orless duration and other supplemental policies as determined by the departmentof insurance, financial institutions and professional registration.
5. The department of health and senior services shall promulgate rulesand regulations to determine which immunizations shall be covered by policies,plans or contracts described in this section. No rule or portion of a rulepromulgated under the authority of this section shall become effective unlessit has been promulgated pursuant to the provisions of section 536.024, RSMo.
6. No health care provider shall charge more than one hundred percent ofthe reasonable and customary charges for providing any immunization.
(L. 1996 H.B. 904, et al. § 1)