Missouri Revised Statutes
Chapter 354
Health Services Corporations--Health Maintenance Organizations--Prepaid Dental Plans
←354.410
Section 354.415.1
354.420→
August 28, 2015
Powers of organization.
354.415. 1. The powers of a health maintenance organization include,
but are not limited to, the power to:
(1) Purchase, lease, construct, renovate, operate, and maintain
hospitals, medical facilities, or both, and their ancillary equipment, and
such property as may reasonably be required for the organization's
principal office or for such other purposes as may be necessary in the
transaction of the business of the organization;
(2) Make loans to a medical group under contract with it in
furtherance of its program, or to make loans to any corporation under its
control for the purpose of acquiring or constructing medical facilities and
hospitals or in the furtherance of a program providing health care services
to enrollees;
(3) Furnish health care services through providers which are under
contract with, or employed by, the health maintenance organization;
(4) Contract with any person for the performance, on the
organization's behalf, of certain functions such as marketing, enrollment,
and administration;
(5) Contract with an insurance company licensed in this state, or
with a health services corporation authorized to do business in this state,
for the provision of insurance, indemnity, or reimbursement against the
cost of health care services provided by the health maintenance
organization;
(6) Offer, in addition to basic health care services:
(a) Additional health care services;
(b) Indemnity benefits covering out-of-area or emergency services;
and
(c) Indemnity benefits, in addition to those relating to out-of-area
and emergency services, provided through insurers or health services
corporations;
(7) Offer as an option one or more health benefit plans which contain
deductibles, coinsurance, coinsurance differentials, or variable
co-payments. Health benefit plans offered under this section that contain
deductibles shall be permitted only when combined with any health savings
account or health reimbursement account as described in the Medicare Reform
Act, P.L. No. 108-173, Title XII, Section 1201, provided that:
(a) The total out-of-pocket expenses paid for the receipt of basic
health services under the plan shall not exceed the annual contribution
limits for health savings accounts as determined by the Internal Revenue
Service;
(b) The health savings account or health reimbursement account must
be funded at a level equal to or greater than the out-of-pocket maximum
limits defined for the high deductible health plan; and
(c) A distribution from the health savings account or health
reimbursement account to pay a health care provider for a qualified medical
expense is made within thirty days of the submission of a claim.
2. Prior to the exercise of any power granted in subdivision (1) or
(2) of subsection 1 of this section, involving an amount in excess of five
hundred thousand dollars, a health maintenance organization shall file
notice, with adequate supporting information, with the director. The
director shall disapprove such exercise of power if, in his opinion, it
would substantially and adversely affect the financial soundness of the
health maintenance organization and endanger its ability to meet its
obligations. If the director does not disapprove such exercise of power
within sixty days of the filing, it shall be deemed approved.
3. The director may exempt from the filing requirement of subsection
2 of this section those activities having minimal effect.
(L. 1983 H.B. 127, A. L. 2013 S.B. 262)
1991
1991
354.415. 1. The powers of a health maintenance organization include, but
are not limited to, the power to:
(1) Purchase, lease, construct, renovate, operate, and maintain
hospitals, medical facilities, or both, and their ancillary equipment, and
such property as may reasonably be required for the organization's principal
office or for such other purposes as may be necessary in the transaction of
the business of the organization;
(2) Make loans to a medical group under contract with it in furtherance
of its program, or to make loans to any corporation under its control for the
purpose of acquiring or constructing medical facilities and hospitals or in
the furtherance of a program providing health care services to enrollees;
(3) Furnish health care services through providers which are under
contract with, or employed by, the health maintenance organization;
(4) Contract with any person for the performance, on the organization's
behalf, of certain functions such as marketing, enrollment, and
administration;
(5) Contract with an insurance company licensed in this state, or with a
health services corporation authorized to do business in this state, for the
provision of insurance, indemnity, or reimbursement against the cost of
health care services provided by the health maintenance organization;
(6) Offer, in addition to basic health care services:
(a) Additional health care services;
(b) Indemnity benefits covering out-of-area or emergency services; and
(c) Indemnity benefits, in addition to those relating to out-of-area and
emergency services, provided through insurers or health services corporations.
2. Prior to the exercise of any power granted in subdivision (1) or (2)
of subsection 1 of this section, involving an amount in excess of five
hundred thousand dollars, a health maintenance organization shall file
notice, with adequate supporting information, with the director. The
director shall disapprove such exercise of power if, in his opinion, it would
substantially and adversely affect the financial soundness of the health
maintenance organization and endanger its ability to meet its obligations. If
the director does not disapprove such exercise of power within sixty days of
the filing, it shall be deemed approved.
3. The director may exempt from the filing requirement of subsection 2
of this section those activities having minimal effect.
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