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
- 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 |
Mammogram
& Pap smear: |
*
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 |
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