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Requirements for the Provision of a Disclosure Statement by Health Maintenance Organizations - Mo. Rev. Stat. §354.442

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All health maintenance organizations (HMOs) are required to provide enrollees with a written disclosure statement outlining the specific terms of coverage.  The law outlines the specific elements that the written disclosure statement must include.  Some key elements are:

  1. Description of coverage provisions, benefits, and exclusions;
  2. Description of utilization review policies and procedures;
  3. Appeal rights for a denial of coverage;
  4. Grievance procedures;
  5. Confidentiality of medical records provisions.

Current as of June 2015