STOP-LOSS INSURANCE

Section 687B.600 - Definitions
Section 687B.602 - "Administrator" defined
Section 687B.605 - "Covered person" defined
Section 687B.606 - "Dental care" defined
Section 687B.607 - "Direct notification" defined
Section 687B.610 - "Evidence of coverage" defined
Section 687B.615 - "Health benefit plan" defined
Section 687B.620 - "Health care services" defined
Section 687B.625 - "Health carrier" defined
Section 687B.630 - "Intermediary" defined
Section 687B.635 - "Medically necessary" defined
Section 687B.640 - "Network" defined
Section 687B.645 - "Network plan" defined
Section 687B.650 - "Participating provider of health care" defined
Section 687B.655 - "Primary care physician" defined
Section 687B.658 - "Provider network contract" defined
Section 687B.660 - "Provider of health care" defined
Section 687B.664 - "Third party" defined
Section 687B.665 - "Utilization review" defined
Section 687B.670 - Requirements to offer or issue network plan
Section 687B.675 - Provision of information to Office for Consumer Health Assistance
Section 687B.680 - Health carrier required to establish mechanism for ongoing notification of participating providers of health care of services covered by network plan and for which provider is responsible
Section 687B.690 - Required provisions in contract between participating provider of health care and health carrier
Section 687B.693 - Access to services and contractual discounts of a provider of health care: Inapplicability of provisions
Section 687B.694 - Access to services and contractual discounts of a provider of health care: Requirements for granting access; termination; confidentiality
Section 687B.695 - Access to services and contractual discounts of a provider of health care: Obligations of third party that grants access to another third party
Section 687B.696 - Access to services and contractual discounts of a provider of health care: Information required to be provided to health carrier and providers of health care by third parties; update of information
Section 687B.697 - Access to services and contractual discounts of a provider of health care: Obligations of health carrier and third parties concerning remittance advice or explanation of payment; refusal of discount taken on such advice or explanation by provider of health care; correction of error in advice or explanation; requirements of third party for such access
Section 687B.700 - Contract required to provide requirement that participating provider of health care continue delivery of services if health carrier or intermediary insolvent or ceases operations for specified period; billing of covered person
Section 687B.710 - Certain provisions included in contract required to be construed in favor of covered person, survive termination of contract and supersede certain contrary agreements
Section 687B.720 - Contract required to provide for notice of insolvency or cessation of operations of health carrier or intermediary to participating provider of health care
Section 687B.723 - Claim for dental care: Health carrier or administrator of health benefit plan prohibited from denying claim for which prior authorization has been granted; exceptions
Section 687B.725 - Claim for dental care: Requirements and limitations related to recovery of overpayments
Section 687B.730 - Health carrier required to notify participating provider of health care of administrative policies and programs of carrier
Section 687B.740 - Inducement to provide less than medically necessary health care services prohibited
Section 687B.750 - Health carrier not to prohibit certain actions by participating provider of health care
Section 687B.760 - Health records; confidentiality
Section 687B.770 - Assignment or delegation of rights and responsibilities without prior written consent prohibited
Section 687B.780 - Health carrier required to ensure that participating providers of health care furnish covered services to all covered persons; exception
Section 687B.790 - Health carrier required to notify participating providers of health care of obligation to collect coinsurance, copayment or deductible or notify covered person of obligation for services not covered
Section 687B.800 - Retaliation for good faith reporting to state or federal authority prohibited
Section 687B.810 - Health carrier required to establish mechanism to allow participating provider of health care to determine whether a person is a covered person or within grace period for payment of premium
Section 687B.820 - Procedures for resolution of disputes
Section 687B.830 - Contract for purposes of network plan prohibited from conflicting with network plan or law; notice of provisions and incorporated documents; notice of changes
Section 687B.840 - Health carrier required to inform participating provider of health care of status and inclusion on certain lists maintained by health carrier upon request or change in such status or inclusion
Section 687B.850 - Regulations