Chapter 695A - FRATERNAL BENEFIT SOCIETIES

Section 695A.001 - Definitions
Section 695A.003 - "Benefit contract" defined
Section 695A.004 - "Benefit member" defined
Section 695A.006 - "Certificate" defined
Section 695A.010 - "Fraternal benefit society" defined
Section 695A.014 - "Insurer" defined
Section 695A.016 - "Laws" defined
Section 695A.018 - "Lodge" defined
Section 695A.020 - "Lodge system" defined
Section 695A.023 - "Medicaid" defined
Section 695A.027 - "Order for medical coverage" defined
Section 695A.030 - "Premiums" defined
Section 695A.040 - "Representative form of government" defined
Section 695A.042 - "Rules" defined
Section 695A.044 - "Society" defined
Section 695A.050 - Organization: Preparation and contents of articles of incorporation
Section 695A.060 - Organization: Filing of documents and bond with Commissioner; preliminary certificate of authority
Section 695A.070 - Organization: Solicitation of members; collection of advance premiums; reports to Commissioner
Section 695A.080 - Certificate of authority: Issuance and renewal; effect; record; copies; fees
Section 695A.090 - General powers and duties of society
Section 695A.095 - Contracts between society and provider of health care: Prohibiting society from charging provider of health care fee for inclusion on list of providers given to insureds; society required to use form to obtain information on provider of health care; modification; submission by society of schedule of payments to provider
Section 695A.110 - Unincorporated or voluntary association prohibited from transacting business as society
Section 695A.120 - Location of principal office; meetings of supreme governing body; minutes of certain proceedings; official publications; grievances by benefit members
Section 695A.130 - Consolidation; merger
Section 695A.140 - Conversion of fraternal benefit society into mutual life insurer
Section 695A.150 - Qualifications for and rights and privileges of membership
Section 695A.151 - Effect of eligibility for medical assistance under Medicaid on eligibility for coverage; assignment of rights to state agency
Section 695A.152 - Society required to comply with certain provisions concerning portability and availability of health insurance
Section 695A.153 - Society prohibited from asserting certain grounds to deny enrollment of child of insured pursuant to order
Section 695A.155 - Certain accommodations required to be made by society when child is covered under policy of noncustodial parent
Section 695A.157 - Society required to authorize enrollment of child of parent who is required by order to provide medical coverage under certain circumstances; termination of coverage of child
Section 695A.160 - Amendment of laws of society: Manner; approval by Commissioner; provision to members
Section 695A.180 - Scope of contractual benefits
Section 695A.184 - Benefit contract covering prescription drugs prohibited from limiting or excluding coverage for prescription drug previously approved for medical condition of insured; exception
Section 695A.1843 - Coverage for drugs, laboratory testing and certain services related to human immunodeficiency virus and hepatitis C required; reimbursement of certain providers of health care for certain services; prohibited acts
Section 695A.1844 - Coverage for testing, treatment and prevention of sexually transmitted diseases required; coverage for condoms for certain insureds required
Section 695A.1845 - Coverage for certain tests and vaccines relating to human papillomavirus required; prohibited acts
Section 695A.1853 - Coverage for screening, genetic counseling and testing related to BRCA gene required in certain circumstances
Section 695A.1855 - Coverage for certain screenings and tests for breast cancer required; prohibited acts
Section 695A.1856 - Coverage for examination of person who is pregnant for certain diseases required
Section 695A.1857 - Benefit contract covering maternity care: Prohibited acts by society if insured is acting as gestational carrier; child deemed child of intended parent for purposes of benefit contract
Section 695A.1859 - Coverage for biomarker testing for diagnosis, treatment, management and monitoring of cancer required in certain circumstances; establishment of process to request exception or appeal denial of coverage; time for responding to request for prior authorization
Section 695A.1865 - Coverage for drug or device for contraception and related health services required in benefit contract covering prescription drugs or devices; prohibited acts; exceptions
Section 695A.1867 - Coverage for medically necessary treatment of conditions relating to gender dysphoria and gender incongruence required; restriction on refusal to cover certain treatments; authority of society to prescribe requirements for covering surgical treatment for minors; determination of medical necessity
Section 695A.1873 - Coverage for management and treatment of sickle cell disease and its variants required; coverage for medically necessary prescription drugs to treat sickle cell disease and its variants required in benefit contract covering prescription drugs
Section 695A.1874 - Coverage for certain drugs and services related to substance use disorder and opioid use disorder required; reimbursement of pharmacists and pharmacies for certain services; prohibited acts
Section 695A.1875 - Coverage for certain services, screenings and tests relating to wellness required; prohibited acts
Section 695A.188 - Approval or denial of claim; interest on unpaid claim; request for additional information; payment of claim; costs and attorney's fees
Section 695A.195 - Society prohibited from denying coverage solely because claim involves act that constitutes domestic violence or applicant or insured was victim of domestic violence
Section 695A.197 - Society prohibited from denying coverage solely because applicant or insured was intoxicated or under the influence of controlled substance; exceptions
Section 695A.198 - Society prohibited from discriminating against person with respect to participation or coverage on basis of gender identity or expression
Section 695A.200 - Nonforfeiture benefits, cash surrender values, certificate loans and other options
Section 695A.210 - Beneficiaries; funeral benefits
Section 695A.220 - Benefits not liable to attachment, garnishment or other process
Section 695A.230 - Terms and conditions of benefit contracts
Section 695A.232 - Society required to offer and issue plan regardless of health status of persons; prohibited acts
Section 695A.235 - Offering policy of health insurance for purposes of establishing health savings account
Section 695A.240 - Approval and contents of certificates
Section 695A.255 - Benefit contract covering prescription drugs: Provision of notice and information regarding use of formulary
Section 695A.256 - Benefit contract covering prescription drugs: Submission to step therapy protocol for drug to treat psychiatric condition prohibited in certain circumstances
Section 695A.257 - Benefit contract covering prescription drugs: Required actions by society related to acquisition of prescription drugs for certain insureds residing in area for which emergency or disaster has been declared
Section 695A.258 - Benefit contract covering prescription drug for treatment of medical condition that is part of step therapy protocol: Use of certain guidelines required; establishment of process to request exemption from step therapy protocol required; granting of request; applicability of provisions
Section 695A.259 - Benefit contract covering prescription drug for treatment of cancer or cancer symptom that is part of step therapy protocol: Society required to allow insured or attending practitioner to apply for exemption from step therapy protocol in certain circumstances; procedure for applying for and granting exemption
Section 695A.261 - Benefit contract covering anatomical gifts, organ transplants or treatments or services related to organ transplants: Prohibited acts by society if insured is person with disability
Section 695A.265 - Coverage for services provided through telehealth required to same extent as though provided in person or by other means; reimbursement for certain services provided through telehealth required in same amount as though provided in person or by other means; prohibited acts
Section 695A.270 - Authority to prohibit in society's laws waiver of provisions of society's laws
Section 695A.280 - Reinsurance
Section 695A.300 - Foreign or alien society: License required to transact business; required information
Section 695A.310 - Injunction against, liquidation of or appointment of receiver for domestic society
Section 695A.320 - Suspension, revocation or refusal of license of foreign or alien society
Section 695A.330 - Licensing of insurance agents of society; persons exempt from licensing
Section 695A.400 - Service of process on society
Section 695A.410 - Injunctions against societies
Section 695A.420 - Judicial review of Commissioner's findings and decisions
Section 695A.430 - Assets, funds and accounts of society
Section 695A.440 - Investments
Section 695A.450 - Annual statement of financial condition, transactions and affairs: Filing; fee; contents; provision to members; valuation of certificates
Section 695A.460 - Annual statement of financial condition, transactions and affairs: Penalties for failure to file properly
Section 695A.475 - Liability of directors, officers, employees, members and volunteers; indemnification and reimbursement of directors, officers, employees and agents
Section 695A.490 - Standards of valuation for certificates; excess reserves
Section 695A.500 - Examination of societies transacting or applying to transact business in State
Section 695A.530 - Applicability of provisions relating to trade practices and frauds
Section 695A.550 - Exemption of societies from certain taxes
Section 695A.555 - Nonexemption of societies from certain fees
Section 695A.560 - Exemption of societies from other insurance laws; exceptions
Section 695A.570 - Applicability of chapter; effect of exemption
Section 695A.580 - Penalties