Health Maintenance Organizations—Reinsurance Agreements

PURPOSE: This rule sets forth the requirements that relate to the filing of reinsurance agreements with the Department of Commerce and Insurance. This rule is promulgated pursuant to section 354.485, RSMo and implements sections 354.405.5. and 354.410.1(3)(c) and (6), RSMo. (1) Definition. As used in this rule, a contract of reinsurance means the entire contract, including the signatures of the representatives of the health maintenance organization (HMO) and the reinsurer, and any binders, certificates, attachments, amendments or modifications to the contract. (2) Filing. A contract of reinsurance shall be submitted to the Department of Commerce and Insurance for filing and approval no later than ten (10) working days after receipt by the HMO. If it appears there will be a substantial delay between the issuance of a binder and all other documents connected with the contract of reinsurance, or difficulty in obtaining a contract of reinsurance as evidenced by the negotiation process, the HMO shall file a copy of the binder or a letter signed by an officer of the reinsurer explaining the circumstances pertaining to the delay. After filing this binder or letter, the HMO shall file its contract of reinsurance ten (10) working days after receipt of the contract. Proof of coverage shall be filed no later than ten (10) working days after its effective date. (3) Provisions. A contract of reinsurance shall not contain a provision stating that the contract of reinsurance will not apply or will become ineffective in the event the HMO is unable to meet its financial obligations or is insolvent. (4) Requests. Upon request by the director of the Department of Commerce and Insurance or his/her appointee, the HMO shall provide promptly to the Department of Commerce and Insurance all contracts of reinsurance required by this section and available to the HMO. (5) Discipline. The director of the Department of Commerce and Insurance may institute disciplinary action for violation of this rule in accordance with the provisions of section 354.500, RSMo and any other applicable law. AUTHORITY: sections 354.405, 354.410 and 354.485, RSMo 1986.* Original rule filed April 14, 1992, effective Feb. 26, 1993. Nonsubstantive change filed Sept. 11, 2019, published Oct. 31, 2019. *Original authority: 354.405, RSMo 1983; 354.410, RSMo 1983; and 354.458, RSMo 1983. 1983.