Missouri Code of State Regulations
Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE
Division 200 - Insurance Solvency and Company Regulation
Chapter 1 - Financial Solvency and Accounting Standards
Section 20 CSR 200-1.040 - Financial Standards for Health Maintenance Organizations
Current through Register Vol. 49, No. 6, March 15, 2024
PURPOSE: This rule implements sections 354.410, 354.415, 354.450, 354.455, 354.470.1(4) and 354.480, RSMo as this rule is necessary and proper to carry out the provisions of sections 354.400-354.550, RSMo
(1) A health maintenance organization (HMO) must maintain a capital account pursuant to section 354.410.6, RSMo. The capital account is the equivalent of net worth and shall be equal to the assets of the HMO less its liabilities, which is also the equivalent of "net of any accrued liabilities" as used in section 354.410.6, RSMo. Assets and liabilities will be admitted and determined under the provisions of this rule.
(2) Assets of an HMO will be admitted and included in determining the financial condition of the HMO only if included within one (1) or more of the following list of admissible assets:
(3) No asset shall be admissible except as stated in section (2) and in accordance with the statements of statutory accounting principles.
(4) Liabilities shall be determined in accordance with the statements of statutory accounting principles.
(5) In determining whether an HMO is financially responsible and may reasonably be expected to meet its obligations to enrollees and prospective enrollees under sections 354.410.1(3) and 354.470.1(4), RSMo and whether the continued operation of the HMO would be hazardous either to the enrollees or to the people of this state under section 354.480, RSMo, the director will consider compliance with the standards of sections 354.410, 375.539, and 375.1250-375.1275, RSMo.
(6) On any policy of insolvency insurance, the named insured must include the director of the department and his/her successor(s) in office.
*Original authority: 354.485, RSMo 1983.