KANSAS INSURANCE DEPARTMENT HEALTH COVERAGE COMPLIANCE GUIDE FOR

GROUP ACCIDENT & HEALTH COVERAGES

 

In recognizing the complexity of insurance law, the Kansas Insurance Department has compiled the following listing of statutory cites to provide guidance to health insurance entities in determining if their group health forms are in compliance with Kansas State insurance laws and regulations.

 

THIS LISTING HIGHLIGHTS THE REQUIREMENTS IN PLACE AS OF OCTOBER 2007, BUT IT IS NOT INCLUSIVE OF ALL LAWS RELEVANT TO GROUP HEALTH INSURANCE CONTRACTS.  IT IS THE CARRIER’S RESPONSIBILITY TO STAY INFORMED OF CHANGES TO THE KANSAS INSURANCE LAWS AND REGULATIONS. 

 

 

 - MAJOR LEGAL REQUIREMENTS

- STANDARD PROVISIONS –

K.S.A. 40-2209(g)(3) &

Open enrollment                                         K.S.A. 40-2209a

Notice of claim                                K.S.A. 40-2203(A)(5)

Waiting Period                                      K.S.A. 40-2209a(4)(A)&(G)

Proofs of loss                                  K.S.A. 40-2203(A)(7)

Late enrollee                                                K.S.A. 40-2209d(o)

Claim forms                                    K.S.A. 40-2203(A)(6)

Pregnancy (no pre-ex allowed)                   K.S.A. 40-2209(a)(6)

Physical exam and autopsy            K.S.A. 40-2203(A)(10)

Continuation & Conversion                        K.S.A. 40-2209(i)& (j)

Payment of claims                          K.S.A. 40-2203(A)(8)

Subrogation (not allowed)                           K.A.R. 40-1-20

Legal actions (5 years)                    K.S.A. 40-2203(A)(11)

Arbitration (not allowed)                            K.S.A. 5-401

Entire Contact; Changes                 K.S.A. 40-2203(A)(1)

*Workers compensation                             K.S.A. 40-2215(d)(2)

 

Extension of hospital stay                          K.S.A. 40-2254

- MANDATES -

Usual Customary & Reasonable charges    K.S.A. 40-2202(a)(8)

Diabetes coverage                                      K.S.A. 40-2,163

Prohibitive eligibility requirements              K.S.A. 40-2209(e)

Cancer Rx  (if Rx provided)                       K.S.A. 40-2,167

Pre ex condition definition – LG Grp.        K.S.A. 40-2209(a)(4)(A)

Prostate coverage                                       K.S.A. 40-2,164

Pre ex condition definition - SM Grp          K.S.A. 40-2209(f)(a)

Anesthesia coverage                                   K.S.A. 40-2,165

Coordination of benefits                                         K.A.R. 40-4-34

Mastectomy coverage                                K.S.A. 40-2,166

Spinal Manipulation                                               K.S.A. 40-2,100

Newborn infant and adopted child            K.S.A. 40-2,102

Medicaid                                                                  K.S.A. 40-2,154

K.S.A. 40-2209(k)(1) & K.S.A. 40-2203(H)(1) & K.S.A. 40-2,154

Grievance & Appeals                                              K.S.A. 40-4606

Routine and necessary immunizations      K.S.A. 40-2,102

Nervous & Mental Parity – Lg. Grp         K.S.A. 40-2258

            (Revised by 2002 House Bill No. 2640 Section 19)

External Review                                                       K.A.R. 40-4-42

Prior Creditable Coverage                                K.S.A. 40-2209(a)(8)

Privacy of protected medical records                     K.A.R. 40-1-46

Nervous/Mental Conditions & Substance Abuse                                                                      K.S.A. 40-2,105

Mental Illness                                          K.S.A. 40-2,105a

Psychotherapeutic Rx (If Rx provided)   K.S.A. 40-2,105b

OB/GYN one in-network self-referral        K.S.A 40-4609

Application of KS Insurance laws to out of state contracts

                                              K.S.A. 40-2215(b) & K.S.A. 40-2,103

Mammogram & Pap smear:

                                      K.S.A. 40-2229K.S.A. 40-2230

 

* Can only exclude to the extent required to participate

Definition of Physician                             K.S.A. 40-2,100,                        40-2,101,  40-2,104,  40-2,114 and 40-2250

Osteoporosis Screening                           K.S.A. 40-2,166a