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

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.