376.833. Inapplicability of section 376.827, when--waiver granted to policyholder, when.
Inapplicability of section 376.827, when--waiver granted topolicyholder, when.
376.833. 1. The provisions of section 376.827 shall not be violatedif the insurer decides to apply different limits or exclude entirely fromcoverage the following:
(1) Marital, family, educational, or training services unlessmedically necessary and clinically appropriate;
(2) Services rendered or billed by a school or halfway house;
(3) Care that is custodial in nature;
(4) Services and supplies that are not medically necessary norclinically appropriate; or
(5) Treatments that are considered experimental.
2. The director shall grant a policyholder a waiver from theprovisions of section 376.827 if the policyholder demonstrates to thedirector by actual experience over any consecutive twenty-four-month periodthat compliance with sections 376.825 to 376.840 has increased the cost ofthe health insurance policy by an amount that results in a two percentincrease in premium costs to the policyholder.
(L. 1999 H.B. 191 § 376.829)Expires 1-01-11