HEALTH BENEFIT PLANS
- 689C.015 - Definitions.
- 689C.017 - “Affiliated” defined.
- 689C.019 - “Affiliation period” defined.
- 689C.021 - “Basic health benefit plan” defined.
- 689C.023 - “Bona fide association” defined.
- 689C.025 - “Carrier” defined.
- 689C.035 - “Characteristics” defined.
- 689C.045 - “Class of business” defined.
- 689C.047 - “Control” defined.
- 689C.051 - “Converted policy” defined.
- 689C.053 - “Creditable coverage” defined.
- 689C.055 - “Dependent” defined.
- 689C.065 - “Eligible employee” defined.
- 689C.067 - “Established geographic service area” defined.
- 689C.071 - “Geographic area” defined.
- 689C.073 - “Group health plan” defined.
- 689C.075 - “Health benefit plan” defined.
- 689C.076 - “Health status-related factor” defined.
- 689C.077 - “Network plan” defined.
- 689C.078 - “Open enrollment” defined.
- 689C.079 - “Plan for coverage of a bona fide association” defined.
- 689C.081 - “Plan sponsor” defined.
- 689C.082 - “Preexisting condition” defined.
- 689C.083 - “Producer” defined.
- 689C.084 - “Program of Reinsurance” defined.
- 689C.085 - “Rating period” defined.
- 689C.089 - “Risk-assuming carrier” defined.
- 689C.095 - “Small employer” defined.
- 689C.099 - “Standard health benefit plan” defined.
- 689C.105 - “Supplemental coverage” defined.
- 689C.106 - “Waiting period” defined.
- 689C.1065 - Applicability.
- 689C.107 - Affiliated carriers deemed one carrier in certain circumstances; affiliated carrier that is health maintenance organization considered separate carrier; ceding arrangement prohibited in cer
- 689C.109 - Certain plan, fund or program to be treated as employee welfare benefit plan which is group health plan; partnership deemed employer of each partner.
- 689C.111 - Determination of whether employer is small or large; applicability of provisions after employer is deemed large.
- 689C.113 - Requirements for employee welfare benefit plan for providing benefits for employees of more than one employer.
- 689C.115 - Mandatory and optional coverage.
- 689C.125 - Rating factors for determining premiums.
- 689C.135 - Effect of provision in health benefit plan for restricted network on determination of rates.
- 689C.143 - Offering of policy of health insurance for purposes of establishing health savings account.
- 689C.145 - Characteristics that carrier may use to determine rating factors for establishing premiums.
- 689C.155 - Regulations.
- 689C.156 - Each health benefit plan marketed in this State required to be offered to small employers.
- 689C.1565 - Coverage to small employers not required under certain circumstances; notice to Commissioner of and prohibition on writing new business after election not to offer new coverage required.
- 689C.157 - Requirement to file basic and standard health benefit plans with Commissioner; disapproval of plan.
- 689C.158 - Producer may only sign up small employers and eligible employees in bona fide associations if employers and employees are actively engaged in or related to bona fide association.
- 689C.159 - Certain provisions inapplicable to plan that carrier makes available only through bona fide association.
- 689C.160 - Carrier must uniformly apply requirements to determine whether to provide coverage.
- 689C.165 - Carrier prohibited from modifying plan to restrict or exclude coverage for certain services.
- 689C.1655 - Coverage for autism spectrum disorders. [Effective January 1, 2011.]
- 689C.166 - Coverage for abuse of alcohol or drugs: Required.
- 689C.167 - Coverage for abuse of alcohol or drugs: Benefits.
- 689C.168 - Coverage for prescription drug previously approved for medical condition of insured.
- 689C.169 - Coverage for severe mental illness.
- 689C.170 - Authorized variation of minimum participation and contributions; denial of coverage based on industry prohibited.
- 689C.180 - Carrier to offer same coverage to all eligible employees; denial of coverage to otherwise eligible employee.
- 689C.183 - Plan and carrier required to permit employee or dependent of employee to enroll for coverage under certain circumstances.
- 689C.187 - Manner and period for enrolling dependent of covered employee; period of special enrollment.
- 689C.190 - Coverage of preexisting conditions; period of exclusion for preexisting condition; when health maintenance organization may require affiliation period.
- 689C.191 - Determination of applicable creditable coverage of person; determining period of creditable coverage of person; required statement.
- 689C.192 - Written certification of coverage required for purpose of determining period of creditable coverage accumulated by person.
- 689C.193 - Carrier prohibited from imposing restriction on participation inconsistent with certain sections; restrictions on rules of eligibility that may be established; premiums to be equitable.
- 689C.194 - Plan that includes coverage for maternity and pediatric care: Required to allow minimum stay in hospital in connection with childbirth; prohibited acts.
- 689C.196 - Insurer prohibited from denying coverage solely because person was victim of domestic violence.
- 689C.197 - Carrier prohibited from denying coverage because insured was intoxicated or under influence of controlled substance; exceptions.
- 689C.198 - Insurer prohibited from requiring or using information concerning genetic testing; exceptions.
- 689C.200 - When carrier is not required to offer coverage.
- 689C.203 - Denial of application for coverage from small employer; regulations.
- 689C.207 - Regulations concerning reissuance of health benefit plan.
- 689C.210 - Procedure for increasing premium rates.
- 689C.220 - Adjustment in rates to be applied uniformly.
- 689C.230 - Determination and application of index rate.
- 689C.240 - Use of industry classifications as rating factor.
- 689C.250 - Required disclosures to Commissioner; when disclosures constitute trade secret.
- 689C.260 - Manner in which carrier may establish separate class of business; transferring small employer into or out of class of business.
- 689C.265 - Carrier authorized to modify coverage for insurance product under certain circumstances.
- 689C.270 - Regulations concerning disclosures by carrier to small employer; copy of disclosure to be made available to small employer.
- 689C.280 - Carrier to provide required disclosures to small employer before issuing policy of insurance.
- 689C.281 - Coverage for prescription drugs: Provision of notice and information regarding use of formulary.
- 689C.283 - Election to operate as risk-assuming carrier or reinsuring carrier: Notice to Commissioner; effective date; change in status.
- 689C.287 - Election to act as risk-assuming carrier: Suspension by Commissioner; applicable statutes.
- 689C.290 - Commissioner authorized to suspend restriction on increase of premiums for new rating period based on new business for policy.
- 689C.300 - Carrier to file actuarial certification annually with Commissioner.
- 689C.310 - Renewal of health benefit plan; discontinuing issuance and renewal of coverage, plan or form of product of health benefit plan.
- 689C.320 - Required notification when carrier discontinues transacting insurance in this State; restrictions on carrier that discontinues transacting insurance.
- 689C.325 - Coverage offered through network plan not required to be offered to eligible employee who does not reside or work in established geographic service area or if carrier lacks capacity to deli
- 689C.327 - Carrier that offers network plan: Contracts with certain federally qualified health centers.
- 689C.330 - When insurer is required to allow employee to continue coverage after employee is no longer covered by health benefit plan.
- 689C.340 - Required provisions in health benefit plan of employer who employs less than 20 employees related to continuation of coverage.
- 689C.342 - Notice of election and payment of premium.
- 689C.344 - Amount of premium for continuation of coverage; change in rates; payment to insurer; termination.
- 689C.346 - Effect of change in insurer during period of continued coverage.
- 689C.348 - Continued coverage ceases before end of established period under certain circumstances.
- 689C.350 - Health benefit plan with preferred providers of health care: Deductible; percentage rate of payment; when coinsurance is no longer required; when service is deemed to be provided by preferr
- 689C.355 - Prohibited acts of carrier or producer; denial of application for coverage; violation may constitute unfair trade practice; applicability of section.