SECONDREGULARSESSION
HOUSECOMMITTEESUBSTITUTEFOR
HOUSEBILLNO.2743
101STGENERALASSEMBLY
5658H.03C DANARADEMANMILLER,ChiefClerk
ANACT
Torepealsection376.427,RSMo,andtoenactinlieuthereofonenewsectionrelatingto
prepaiddentalplans.
BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
SectionA.Section376.427,RSMo,isrepealedandonenewsectionenactedinlieu
2thereof,tobeknownassection376.427,toreadasfollows:
376.427.1.Asusedinthissection,thefollowingtermsmean:
2 (1)"Healthbenefitplan",assuchtermisdefinedinsection376.1350. Theterm
3"healthbenefitplan"shallalsoincludeaprepaiddentalplan,asdefinedinsection
4354.700;
5 (2)"Healthcareservices",medical,surgical,dental,podiatric,pharmaceutical,
6chiropractic,licensedambulanceservice,andoptometricservices;
7 (3)"Healthcarrier"or"carrier",assuchtermisdefinedinsection376.1350. The
8term"healthcarrier"or"carrier"shallalsoincludeaprepaiddentalplancorporation,
9asdefinedinsection354.700;
10 (4)"Insured",anypersonentitledtobenefitsunderacontractofaccidentandsickness
11insurance,ormedical-paymentinsuranceissuedasasupplementtoliabilityinsurancebutnot
12includinganyothercoveragescontainedinaliabilityoraworkers'compensationpolicy,
13issuedbyaninsurer;
14 (5)"Insurer",anyperson,reciprocalexchange,interinsurer,fraternalbenefitsociety,
15healthservicescorporation,self-insuredgrouparrangementtotheextentnotprohibitedby
16federallaw,prepaiddentalplancorporationasdefinedinsection354.700,oranyother
17legalentityengagedinthebusinessofinsurance;
EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 18 (6)"Provider",aphysician,hospital,dentist,podiatrist,chiropractor,pharmacy,
19licensedambulanceservice,oroptometrist,licensedbythisstate.
20 2.Uponreceiptofanassignmentofbenefitsmadebytheinsuredtoaprovider,the
21insurershallissuetheinstrumentofpaymentforaclaimforpaymentforhealthcareservices
22inthenameoftheprovider.Allclaimsshallbepaidwithinthirtydaysofthereceiptbythe
23insurerofalldocumentsreasonablyneededtodeterminetheclaim.
24 3.Nothinginthissectionshallprecludeaninsurerfromvoluntarilyissuingan
25instrumentofpaymentinthesinglenameoftheprovider.
26 4.Exceptasprovidedinsubsection5ofthissection,thissectionshallnotrequireany
27insurer,healthservicescorporation,prepaiddentalplanasdefinedinsection354.700,
28healthmaintenancecorporationorpreferredproviderorganizationwhichdirectlycontracts
29withcertainmembersofaclassofprovidersforthedeliveryofhealthcareservicestoissue
30paymentasprovidedpursuanttothissectiontothosemembersoftheclasswhichdonothave
31acontractwiththeinsurer.
32 5.Whenapatient'shealthbenefitplandoesnotincludeorrequirepaymenttoout-of-
33networkprovidersforallormostcoveredservices,whichwouldotherwisebecoveredifthe
34patientreceivedsuchservicesfromaproviderinthe[carrier's] healthbenefitplan's
35network,includingbutnotlimitedtohealthmaintenanceorganizationplans,assuchtermis
36definedinsection354.400,orahealthbenefitplanofferedbyacarrierconsistentwith
37subdivision(19)ofsection376.426,paymentforallservicesshallbemadedirectlytothe
38providerswhenthehealthcarrierhasauthorizedsuchservicestobereceivedfromaprovider
39outsidethe[carrier's] healthbenefitplan'snetwork.
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HCSHB2743 2