reglab/statecodes huggingface dataset:
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,133 Same; utilization by insurer; acts required to be performed by and prohibitions on insurer.

40-2,133.
Same; utilization by insurer; acts required to be performed by and prohibitions on insurer.
(a) No insurer may utilize or continue to utilize the services of an MGA on and after the effective date of this act unless such utilization is in compliance with this act.
(b) The insurer shall have on file an independent financial examination in a form acceptable to the commissioner of each MGA with which it has done business.
(c) If an MGA establishes loss reserves, the insurer shall annually obtain the opinion of an actuary attesting to the adequacy of loss reserves established for losses incurred and outstanding on business produced by the MGA. Such requirement shall be in addition to any other required loss reserve certification.
(d) The insurer shall periodically, but not less frequently than semi-annually, conduct an on-site review of the underwriting and claims processing operations of the MGA.
(e) Binding authority for all reinsurance contracts or participation in insurance or reinsurance syndicates shall rest with an officer of the insurer who shall not be affiliated with the MGA.
(f) Within 30 days of entering into or termination of a contract with an MGA, the insurer shall provide written notification of such appointment or termination to the commissioner. Notices of appointment of an MGA shall include (1) a statement of duties which the applicant is expected to perform on behalf of the insurer, (2) the lines of insurance for which the applicant is to be authorized to act, (3) a notification fee in the amount of $100, (4) and any other information the commissioner may request.
(g) An insurer shall each quarter review its books and records to determine if any agent or broker has become, by operation of subsection (d) of K.S.A. 40-2,130, and amendments thereto, an MGA as defined in that subsection. If the insurer determines that an agent or broker has become an MGA pursuant to the above, the insurer shall promptly notify the agent or broker and the commissioner of such determination, and the insurer and agent or broker shall fully comply with the provisions of this act within 30 days.
(h) An insurer shall not appoint to its board of directors an officer, director, employee or controlling shareholder of its MGAs. This subsection shall not apply to relationships governed by the applicable provisions of article 33 of chapter 40 of the Kansas Statutes Annotated.
History:
L. 1990, ch. 158, § 5; L. 1992, ch. 154, § 4; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,134 Same; acts deemed to be acts of insurer; examination.

40-2,134.
Same; acts deemed to be acts of insurer; examination.
The acts of the MGA are considered to be the acts of the insurer on whose behalf it is acting. An MGA may be examined pursuant to K.S.A. 40-222 and 40-223, and amendments thereto, as if it were the insurer.
History: L. 1990, ch. 158, § 6; January 1, 1991.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,135 Same; sanctions for violations; rights of policyholders, claimants and auditors not restricted.

40-2,135.
Same; sanctions for violations; rights of policyholders, claimants and auditors not restricted.
(a) If the commissioner finds after a hearing conducted in accordance with the Kansas administrative procedure act that any person has violated any provision of this act, the commissioner may order each of the following, any combination thereof or all of the following:
(1) For each separate violation, a penalty in an amount of $5,000;
(2) revocation or suspension of the agent's or broker's license;
(3) the MGA to reimburse the insurer, the rehabilitator or liquidator of the insurer for any losses incurred by the insurer caused by a violation of this act committed by the MGA.
(b) Nothing contained in this act is intended to or shall in any manner limit or restrict the rights of policyholders, claimants and auditors.
History:
L. 1990, ch. 158, § 7; L. 1994, ch. 47, § 2; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,137 Assessment of costs of certain administrative hearings, guidelines, procedure.

40-2,137.
Assessment of costs of certain administrative hearings, guidelines, procedure.
(a) The costs incurred by the department of insurance in conducting any administrative hearing authorized by article 33 of chapter 40 of the Kansas Statutes Annotated, and amendments thereto, shall be assessed against insurers or rating organizations that are parties to the hearing in such proportion as the commissioner of insurance may determine upon consideration of all relevant circumstances including: (1) The nature of the hearing; (2) whether the hearing was instigated by, or for the benefit of a particular party or parties; (3) whether there is a successful party on the merits of the proceeding; (4) the relative levels of participation by the parties; and (5) with the exception of hearings held under article 33 of chapter 40 of the Kansas Statutes Annotated, only when the disapproval of rates in question is upheld, a rating organization's license is suspended or revoked or a penalty is imposed as a result of the hearing.
(b) For purposes of this section costs incurred shall mean the presiding officer fees, cost of making a record and publishing notices, and travel expenses of department of insurance officers and employees, but costs incurred shall not include presiding officer fees or cost of making a record unless the department has retained the services of the office of administrative hearings or outside experts to perform such functions.
(c) Any costs assessed hereunder shall be made by the commissioner as part of the final order or decision arising out of the proceeding. Such order or decision shall include findings and conclusions in support of the assessment of costs. This section shall not be construed as permitting the payment of travel expenses unless calculated in accordance with the applicable laws and rules and regulations of the state of Kansas. The commissioner as part of such order or decision may require all assessments for presiding officer fees and cost of making a record, if any, to be paid directly to the office of administrative hearings by the party or parties assessed for such costs.
History:
L. 1990, ch. 173, § 3; L. 1990, ch. 159, § 1; L. 2004, ch. 145, § 13; July 1, 2005.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,138 Investments by insurance companies governed by state law notwithstanding federal preemption.

40-2,138.
Investments by insurance companies governed by state law notwithstanding federal preemption.
Notwithstanding the provisions of section 106 of the secondary mortgage market enhancement act of 1984, P.L. 98-440 (15 U.S.C. § 77r-1), the provisions of articles 2a and 2b of chapter 40 of the Kansas Statutes Annotated relating to the qualifications, limitations and kinds of investments that insurance companies domiciled in Kansas may purchase and hold shall apply.
History:
L. 1991, ch. 122, § 1; L. 1992, ch. 118, § 3; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,154 Medicaid eligibility and coverage; prohibitions.

40-2,154.
Medicaid eligibility and coverage; prohibitions.
No insurance company, health maintenance organization, nonprofit medical and hospital, dental, optometric, or pharmacy corporations, or self-funded health benefit plan whether an employee welfare benefit plan pursuant to section 607(1) of the employee retirement income security act of 1974 (ERISA) as amended or not, shall:
(a) (1) Refuse to insure, refuse to continue to insure;
(2) limit the amount, extent or kind of coverage available; or
(3) charge a different rate for the same coverage;
to any individual solely because of medicaid eligibility of the individual covered or applying for coverage or any relative of such individual.
(b) Impose requirements on any agency or official assigned the rights of any individual eligible for or covered by medicaid that are different from requirements applicable to an agent or assignee of any other individual.
(c) Exclude, limit or otherwise restrict coverage because medicaid benefits as permitted by title XIX of the social security act of 1965 are or may be available for the same accident or illness.
History:
L. 1994, ch. 18, § 1; March 17.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,155 Motor vehicle glass replacement; prohibitions; rights of the insured.

40-2,155.
Motor vehicle glass replacement; prohibitions; rights of the insured.
(a) Any insurance company, including such company's agents and adjusters, that issues or renews a policy of insurance in this state covering, in whole or in part, a motor vehicle may not:
(1) Require that a person insured under such policy use a particular company or location for providing motor vehicle glass replacement, glass repair services or glass products insured in whole or in part by such policy; or
(2) engage in any act or practice of intimidation, coercion or threat for or against an insured person or infer or mislead such insured person to use a particular company or location to provide motor vehicle glass replacement, glass repair services or glass products insured in whole or in part under the terms of an insurance policy.
(b) (1) An insurance company may provide an insured with a list that includes the names of particular companies or locations providing motor vehicle glass replacement, glass repair services or glass products if some of the listed companies or locations are reasonably close and convenient to the insured. The insurance company may restrict the list to those companies or locations that meet reasonable standards of quality, service and safety.
(2) The insured may use a nonlisted company or location at the insured's sole discretion, and subject to the provisions of paragraph (3) of this subsection and subsection (c), the insurance company will fully and promptly pay for the cost of motor vehicle glass replacement, glass repair services or glass products provided, less any deductible under the terms of the policy.
(3) If the insured does not use a list as provided in paragraph (1) of subsection (b), the insurer may require the insured to obtain not more than three competitive bids to establish the cost of motor vehicle glass replacement, glass repair services or glass products provided.
(c) This section does not require an insurer to pay more for motor vehicle glass replacement, glass repair services or glass products than the lowest prevailing market price.
(d) Notwithstanding the provisions of this section, an insurance company may agree to pay the full cost of glass replacement or repair.
(e) For purposes of this section, "lowest prevailing market price" means the lowest market price in a local area.
History:
L. 1994, ch. 302, § 11; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,156 Acquisitions and dispositions of assets or nonrenewals, cancellations or revisions of reinsurance agreements; report; confidential.

40-2,156.
Acquisitions and dispositions of assets or nonrenewals, cancellations or revisions of reinsurance agreements; report; confidential.
(a) Every insurer domiciled in this state shall file a report with the commissioner disclosing material acquisitions and dispositions of assets or material nonrenewals, cancellations or revisions of ceded reinsurance agreements unless such acquisitions and dispositions of assets or material nonrenewals, cancellations or revisions of ceded reinsurance agreements have been submitted to the commissioner for review, approval or information purposes pursuant to other provisions of chapter 40 of the Kansas Statutes Annotated and amendments thereto and rules and regulations of the commissioner or other requirements.
(b) The report required in subsection (a) is due within 15 days after the end of the calendar month in which any of the transactions specified in subsection (c) occur.
(c) One complete copy of the report, including any exhibits or other attachments filed as part thereof, shall be filed with:
(1) The insurance department of the insurer's state of domicile; and
(2) the national association of insurance commissioners.
(d) All reports obtained by or disclosed to the commissioner pursuant to this act, shall be given confidential treatment and shall not be subject to subpoena and shall not be made public by the commissioner, the national association of insurance commissioners or any other person, except to insurance departments of other states, without the prior written consent of the insurer to which the report pertains unless the commissioner, after giving the insurer who would be affected thereby, notice and an opportunity to be heard, determines that the interest of policyholders, shareholders or the public will be served by the publication of such report, in which event the commissioner may publish all or any part thereof as the commissioner deems appropriate.
History: L. 1994, ch. 89, § 1; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,157 Material acquisitions or dispositions of assets, defined; assets subject to act; information required to be disclosed.

40-2,157.
Material acquisitions or dispositions of assets, defined; assets subject to act; information required to be disclosed.
(a) Acquisitions or dispositions of assets need not be reported pursuant to subsection (a) of K.S.A. 40-2,156, if the acquisitions or dispositions are not material. For purposes of this act, a material acquisition or disposition is one, or the aggregate of a series of related acquisitions or dispositions in a 30 day period, that is non-recurring, not in the ordinary course of business and involves more than 5% of the reporting insurer's total admitted assets as reported in its most recent statement of financial condition filed with the commissioner.
(b) (1) Asset acquisitions subject to this act include every purchase, lease, exchange, merger, consolidation, succession or other acquisition except the construction or development of real property by or for the reporting insurer or the acquisition of materials for such purpose.
(2) Asset dispositions subject to this act include every sale, lease, exchange, merger, consolidation, mortgage, hypothecation, assignment (whether for the benefit of creditors or otherwise), abandonment, destruction or other disposition.
(c) The following information is required to be disclosed in any report of a material acquisition or disposition of assets:
(1) Date of the transaction;
(2) manner of acquisition or disposition;
(3) description of the assets involved;
(4) nature and amount of the consideration given or received;
(5) purpose of, or reason for, the transaction;
(6) manner by which the amount of consideration was determined;
(7) gain or loss recognized or realized as a result of the transaction; and
(8) name or names of the person or persons from whom the assets were acquired or to whom they were disposed.
History:
L. 1994, ch. 89, § 2; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,159 Reports on a nonconsolidated basis; exception.

40-2,159.
Reports on a nonconsolidated basis; exception.
Insurers are required to report all material acquisitions and dispositions of assets and all material nonrenewals, cancellations or revisions of ceded reinsurance agreements on a nonconsolidated basis unless the insurer is part of a consolidated group of insurers which utilizes a pooling arrangement or 100% reinsurance agreement that affects the solvency and integrity of the insurer's reserves and the insurer ceded substantially all of its direct and assumed business to the pool. An insurer is deemed to have ceded substantially all of its direct and assumed business to a pool if the insurer has less than $1,000,000 total direct plus assumed written premiums during a calendar year that are not subject to a pooling arrangement and the net income of the business not subject to the pooling arrangement represents less than 5% of the insurer's capital and surplus.
History:
L. 1994, ch. 89, § 4; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,160 Coverage for minimum inpatient care following birth of child.

40-2,160.
Coverage for minimum inpatient care following birth of child.
(a) As used in this section:
(1) "Health plan" means any insurer or corporation which issues individual and group health insurance policies providing coverage on an expense-incurred basis, individual and group service or indemnity-type contracts issued by a profit or nonprofit corporation and all contracts issued by health maintenance organizations organized or authorized to transact business in this state;
(2) "attending physician" means the person licensed to practice medicine and surgery who is responsible for the care provided to the mother or newborn.
(b) Any health plan which provides coverage for maternity services, including benefits for childbirth, shall provide coverage for at least 48 hours of inpatient care following a vaginal delivery and at least 96 hours of inpatient care following delivery by caesarean section for a mother and newly born child in a medical care facility.
(c) Any decision to shorten the length of inpatient stay to less than that provided under subsection (b) shall be made by the attending physician. No health plan may terminate the service of, penalize or otherwise provide financial disincentives in response to any attending physician who orders care consistent with the provisions of this section.
(d) Notwithstanding the provisions of subsection (b), any health plan which provides coverage for postdelivery care provided to a mother and newly born child in the home, shall not be required to provide coverage of inpatient care under subsection (b), unless such inpatient care is determined to be medically necessary by the attending physician.
(e) All health plans shall provide written notice, as currently required, to all enrollees, insureds or subscribers regarding the coverage required by this section.
History: L. 1996, ch. 96, § 1; April 11.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,161 Coverage for children in the custody of the commissioner of juvenile justice.

40-2,161.
Coverage for children in the custody of the commissioner of juvenile justice.
On and after July 1, 1997:
(a) All individual and group health insurance policies providing coverage on an expense incurred basis, individual and group service or indemnity type contracts issued by a profit or nonprofit corporation and all contracts issued by health maintenance organizations organized or authorized to transact business in this state which provides coverage for a family member of the enrollee, insured or subscriber shall, as to such family members' coverage, also provide that the health insurance benefits applicable for children shall be payable with respect to a child in the custody of the commissioner of juvenile justice.
(b) The contract issued by a health maintenance organization may provide that the benefits required pursuant to this subsection shall be covered benefits only if the services are rendered by a provider who is designated by and affiliated with the health maintenance organization.
History:
L. 1996, ch. 229, § 15; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,163 Coverage for certain expenses relating to care and treatment of diabetes; educational expenses; exceptions.

40-2,163.
Coverage for certain expenses relating to care and treatment of diabetes; educational expenses; exceptions.
(a) This section shall be known and may be cited as the "diabetes coverage act."
(b) Any individual or group health insurance policy, medical service plan, contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society or health maintenance organization which provides coverage for accident and health services and which is delivered, issued for delivery, amended or renewed on or after January 1, 1999, also, shall provide coverage for equipment, and supplies, limited to hypodermic needles and supplies used exclusively with diabetes management and outpatient self-management training and education, including medical nutrition therapy, for the treatment of insulin dependent diabetes, insulin-using diabetes, gestational diabetes and noninsulin using diabetes if prescribed by a health care professional legally authorized to prescribe such services and supplies under the law. Such coverage shall include coverage for insulin only if such coverage also includes coverage of prescription drugs.
(c) Diabetes outpatient self-management training and education shall be provided by a certified, registered or licensed health care professional with expertise in diabetes. The coverage for outpatient self-management training and education shall be required pursuant to this section only if ordered by a health care professional legally authorized to prescribe such services and the diabetic: (1) Is treated at a program approved by the American diabetes association; (2) is treated by a person certified by the national certification board for diabetes educators; or (3) is, as to nutritional education, treated by a licensed dietitian pursuant to a treatment plan authorized by such healthcare professional.
(d) (1) The benefits provided in this act shall be subject to the same annual deductible or co-insurance and the same requirement of medical necessity established for all other covered benefits within a given policy. In the case of a policy requiring that services be provided by or upon referral from a primary care physician, the benefits provided by this act shall be subject to such requirement.
(2) Private third party payors may not reduce or eliminate coverage due to the requirements of this act.
(3) Enforcement of the provisions of this act shall be performed by the commissioner of insurance.
(e) The provisions of this act shall not apply to any medicare supplement policy of insurance, as defined by the commissioner of insurance by rule and regulation, any policy of long-term care insurance, as defined by K.S.A. 40-2227, and amendments thereto, any specified disease or specified accident coverage or any accident only coverage as defined by the commissioner of insurance by rule and regulation, whether written on a group, blanket, or individual basis.
History:
L. 1998, ch. 174, § 28; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,164 Coverage of prostate cancer screening.

40-2,164.
Coverage of prostate cancer screening.
(a) Any individual or group health insurance policy, medical service plan, contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society or health maintenance organization which provides coverage for accident and health services and which is delivered, issued for delivery, amended or renewed on or after July 1, 1998, also, shall provide coverage for prostate cancer screening for men 40 years of age or over who are symptomatic or in a high-risk category and for all men 50 years of age or older. The screening shall consist, at a minimum, of a prostate-specific antigen blood test and a digital rectal examination. A policy, provision, contract, plan or agreement may apply to prostate cancer screening the same deductibles, coinsurance and other limitations as apply to other covered services.
(b) The provisions of this section shall not apply to any medicare supplement policy of insurance, as defined by the commissioner of insurance by rule and regulation, any policy of long-term care insurance, as defined by K.S.A. 40-2227, and amendments thereto, any specified disease or specified accident coverage or any accident only coverage as defined by the commissioner of insurance by rule and regulation, whether written on a group, blanket or individual basis.
History:
L. 1998, ch. 174, § 30; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,165 Coverage of general anesthesia in conjunction with dental care for certain individuals.

40-2,165.
Coverage of general anesthesia in conjunction with dental care for certain individuals.
(a) Any individual or group health insurance policy, medical service plan, contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society or health maintenance organization which provides coverage for accident and health services and which is delivered, issued for delivery, amended or renewed on or after July 1, 1999, also, shall provide coverage for the administration of general anesthesia and medical care facility charges for dental care provided to the following covered persons:
(1) A child five years of age and under; or
(2) a person who is severely disabled; or
(3) a person has a medical or behavioral condition which requires hospitalization or general anesthesia when dental care is provided.
(b) A policy, provision, contract, plan or agreement may:
(1) Apply to the covered procedures under this section the same deductibles, coinsurance, network requirements and other limitations, including but not limited to medical necessity determinations, as apply to other covered services;
(2) require prior authorization for hospitalization for the covered procedures under this section in the same manner that prior authorization is required for hospitalization for other covered diseases or conditions.
(c) The provisions of this section shall not apply to any policy or certificate providing coverage for any specified disease, specified accident or accident-only coverage, credit, dental, disability income, hospital indemnity, long-term care, as defined by K.S.A. 40-2227, and amendments thereto, medicare supplement, as defined by the commissioner of insurance by rules and regulations, vision care or other limited-benefit supplemental insurance, nor any coverage issued as a supplement to liability insurance, workers' compensation or similar insurance, automobile medical-payment insurance, or any insurance under which benefits are payable with or without regard to fault, whether written on a group, blanket or individual basis.
(d) Nothing herein shall be construed to require any individual or group health insurance policy, medical service plan, contract, hospital service corporation contract, fraternal benefit society or health maintenance organization to provide benefits for any dental procedures.
(e) The provisions of this section shall apply to the state health care benefits program and municipal self-funded pools.
(f) As used in this section "medical care facility" shall have the meaning ascribed to the term in K.S.A. 65-425, and amendments thereto.
History:
L. 1999, ch. 162, § 1; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,166a Coverage for osteoporosis.

40-2,166a.
Coverage for osteoporosis.
(a) Any individual or group health insurance policy, medical service plan, contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society or health maintenance organization, municipal group-funded pool and the state employee health care benefits plan which provides coverage for hospital, medical and surgical services, other than medicare supplement or accident-only policies which are delivered, issued for delivery, amended or renewed on or after July 1, 2001, shall include coverage for services related to diagnosis, treatment and management of osteoporosis when such services are provided by a person licensed to practice medicine and surgery in this state, for individuals with a condition or medical history for which bone mass measurement is medically necessary for such individual. Such policy, provision, contract, plan or agreement may apply to such services the same deductibles, coinsurance and other limitations as apply to other covered services.
(b) The provisions of this section shall not apply to any policy or certificate which provides coverage for any specified disease, specified accident or accident only coverage, credit, dental, disability income, hospital indemnity, long-term care insurance as defined by K.S.A. 40-2227, and amendments thereto, vision care or any other limited supplemental benefit nor to any medicare supplement policy of insurance as defined by the commissioner of insurance by rule and regulation, any coverage issued as a supplement to liability insurance, workers compensation or similar insurance, automobile medical-payment insurance or any insurance under which benefits are payable with or without regard to fault, whether written on a group, blanket or individual basis.
History:
L. 2001, ch. 198, § 2; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,167 Off-label use of prescription drugs; definitions.

40-2,167.
Off-label use of prescription drugs; definitions.
As used in K.S.A. 40-2,167 through 40-2,170, and amendments thereto, unless the context clearly indicates otherwise:
(a) "Peer-reviewed medical literature" means a published scientific study in a journal or other publication in which original manuscripts have been published only after having been critically reviewed for scientific accuracy, validity and reliability by unbiased independent experts, and that has been determined by the international committee of medical journal editors to have met the uniform requirements for manuscripts submitted to biomedical journals. Peer-reviewed medical literature does not include publications or supplements to publications that are sponsored to a significant extent by a pharmaceutical manufacturing company or health carrier.
(b) "Off-label use of drugs" means prescribing prescription drugs for treatments other than those stated in the labeling approved by the federal food and drug administration.
(c) "Standard reference compendia" means the United States pharmacopeia drug information, the American hospital formulary service drug information or the American Medical Association drug evaluation.
History:
L. 1999, ch. 128, § 1; May 6.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,168 Same; coverage for cancer treatment; exclusion from coverage prohibited.

40-2,168.
Same; coverage for cancer treatment; exclusion from coverage prohibited.
An insurance company, nonprofit health service corporation, nonprofit medical and hospital service corporation or health maintenance organization that provides coverage for prescription drugs may not issue, deliver, execute or renew any health insurance policy or health service contract on an individual, group, blanket, franchise or association basis which excludes coverage of a prescription drug for cancer treatment on the grounds the prescription drug has not been approved by the federal food and drug administration for that covered indication if the prescription drug is recognized for treatment of the indication in one of the standard reference compendia or in substantially accepted peer-reviewed medical literature. The prescribing physician shall submit to the insurer documentation supporting the proposed off-label use or uses if requested by the insurer.
History:
L. 1999, ch. 128, § 2; May 6.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,169 Same; commissioner of insurance, powers.

40-2,169.
Same; commissioner of insurance, powers.
The commissioner of insurance may direct an insurer or contractor regulated by this act to make payments as required by this act.
History:
L. 1999, ch. 128, § 3; May 6.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,170 Same; coverage not affected, when.

40-2,170.
Same; coverage not affected, when.
This act shall not be construed to affect the prescribing and coverage of off-label use of drugs for any indication not specified in K.S.A. 40-2,168, nor does this act alter existing law regarding provisions limiting the coverage of prescription drugs that have not been approved by the federal food and drug administration; does not require coverage for any prescription drug when the federal food and drug administration has determined its use to be contraindicated; and does not require coverage for experimental drugs not otherwise approved for any indication by the federal food and drug administration.
History:
L. 1999, ch. 128, § 4; May 6.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,184 Coverage for orally administered anticancer medication.

40-2,184.
Coverage for orally administered anticancer medication.
(a) Any individual or group health insurance policy, medical service plan, contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society or health maintenance organization, municipal group-funded pool and the state employee health care benefits plan which provides coverage for prescription drugs and which is delivered, issued for delivery, amended or renewed on and after July 1, 2011, shall provide coverage for a prescribed, orally administered anticancer medication used to kill or slow the growth of cancerous cells on a basis no less favorable than intravenously administered or injected cancer medications that are covered as medical benefits.
(b) Any policy, provision, contract, plan or agreement under this section may apply the same deductibles, coinsurance and other limitations as apply to other covered services.
(c) (1) From and after the effective date of this act, the provisions of this section shall apply to the state employees health care benefits program.
(2) Pursuant to the provisions of K.S.A. 40-2249a, and amendments thereto, on or before March 1, 2011, the state health care benefits commission shall submit to the president of the senate and to the speaker of the house of representatives, a report indicating the impact the provisions of this section has had on the state health care benefits program, including data on the utilization and costs of such coverage. Such report shall also include a recommendation whether such coverage should continue for the state health care benefits program or whether additional utilization and cost data is required.
History:
L. 2010, ch. 120, § 3; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,185 Dental health insurance; fee setting provision, limitation on.

40-2,185.
Dental health insurance; fee setting provision, limitation on.
No contract issued or renewed after July 1, 2010, between a health insurer and a dentist who is a participating provider with respect to such health insurer's health benefit plan shall contain any provision which requires the dentist who provides any service to an insured under such health benefit plan at a fee set or prescribed by the health insurer unless such service is a covered service.
History:
L. 2010, ch. 91, § 1; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,186 Same; definitions.

40-2,186.
Same; definitions.
For the purposes of this act:
(a) "Covered service" means a service which is reimbursable under the health benefit plan subject to any deductible, coinsurance, waiting period, frequency limitation, annual or lifetime benefit maximum or other contractual limitation contained in the health benefit plan.
(b) "Health benefit plan" shall have the meaning ascribed to it in K.S.A. 40-4602, and amendments thereto. Health benefit plan shall also include:
(1) Any subscription agreement issued by a nonprofit dental service corporation.
(2) Any policy of health insurance purchased by an individual.
(3) To the extent permitted by law, the health insurance plan for Kansas children established pursuant to K.S.A. 38-2001 et seq., and amendments thereto.
(4) To the extent permitted by law, the state medical assistance program under medicaid established pursuant to K.S.A. 39-708c, and amendments thereto.
(c) "Health insurer" shall have the meaning ascribed to it in K.S.A. 40-4602, and amendments thereto. Health insurer shall also include a nonprofit dental service corporation as such term is used in K.S.A. 40-19a01 et seq., and amendments thereto.
(d) "Insured" shall have the meaning ascribed to it in K.S.A. 40-4602, and amendments thereto. Insured shall also include a subscriber to a subscription agreement issued by a nonprofit dental service corporation as such term is used in K.S.A. 40-19a01 et seq., and amendments thereto.
(e) "Participating provider" shall have the meaning ascribed to it in K.S.A. 40-4602, and amendments thereto. Participating provider shall also include any dentist who has entered into a participation agreement with a nonprofit dental service corporation.
(f) "Provider" shall have the meaning ascribed to it in K.S.A. 40-4602, and amendments thereto. Provider shall also include any dentist licensed by the Kansas dental board.
History:
L. 2010, ch. 91, § 2; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,190 Health insurance abortion coverage; separate coverage; when required.

40-2,190. Health insurance abortion coverage; separate coverage; when required.
(a) Any individual or group health insurance policy, medical service plan, contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society or health maintenance organization, municipal group-funded pool and the state employee health care benefits plan which is delivered, issued for delivery, amended or renewed on or after July 1, 2011, shall exclude coverage for elective abortions, unless the procedure is necessary to preserve the life of the mother. Coverage for abortions may be obtained through an optional rider for which an additional premium is paid. The premium for the optional rider shall be calculated so that it fully covers the estimated cost of covering elective abortions per enrollee as determined on an average actuarial basis.
(b) No health insurance exchange established within this state or any health insurance exchange administered by the federal government or its agencies within this state shall offer health insurance contracts, plans, or policies that provide coverage for elective abortions, nor shall any health insurance exchange operating within this state offer coverage for elective abortions through the purchase of an optional rider.
(c) For the purposes of this section:
(1) "Abortion" means the same as defined in K.S.A. 65-6701, and amendments thereto.
(2) "Elective" means an abortion for any reason other than to prevent the death of the mother upon whom the abortion is performed, except that an abortion may not be deemed one to prevent the death of the mother based on a claim or diagnosis that such mother will engage in conduct that will result in such mother's death.
History:
L. 2011, ch. 111, § 8; L. 2023, ch. 88, § 2; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,191 Same; severability clause.

40-2,191. Same; severability clause.
From and after July 1, 2011, any provisions of K.S.A. 40-2,190, and amendments thereto, or the application thereof to any person or circumstances is held invalid, the invalidity shall not affect other provisions or applications of such section which can be given effect without the invalid provisions or application, and to this end, the provisions of K.S.A. 40-2,190, and amendments thereto, are severable.
History:
L. 2011, ch. 111, § 11; June 2.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,192 Mandate lite health benefit plan act.

40-2,192. Mandate lite health benefit plan act.
(a) This section shall apply to all insurers transacting business in the state offering individual or group sickness and accident insurance. Such insurers also may offer a mandate lite health benefit plan. A group or individual carrier may also offer a mandate lite health benefit plan.
(b) A mandate lite health benefit plan means an individual or group sickness and accident insurance plan that does not contain one or more of the Kansas-mandated benefits other than K.S.A. 40-2,100 and 40-2,166, and amendments thereto.
(c) The mandate lite health benefit plan shall contain the definitions of group or individual sickness and accident insurance with respect to major medical benefits and standard provisions or rights of coverage.
(d) The mandate lite health benefit plan may be issued on a group or individual basis.
(e) The insured shall be provided with a written notice that one or more of the state-mandated benefits are not included in the mandate lite health benefit plan.
(1) The mandate lite health benefit plan shall specify the health services that are included and shall specifically list the health services that will be limited or not covered from the list of state-mandated coverage other than K.S.A. 40-2,100 and 40-2,166, and amendments thereto.
(2) The insurer is required to retain a signed copy of this notice on file as a part of the original application as evidence that the insured has acknowledged such notice.
(3) Such signed copy may be in original form, electronic file form or in any other reproducible file form as may be consistent with the insurer's method of retaining application copies.
(f) The definition of preexisting conditions may not be more restrictive than the definition of preexisting conditions normally used for the corresponding regular individual or group insurance contracts.
(g) The mandate lite health benefit plan may offer:
(1) Various optional combinations of coverage for generic, formulary and non-formulary drugs.
(2) The mandate lite health benefit plan may offer drug discount plans.
(h) A mandate lite health benefit plan may charge additional premiums for each optional benefit offered. Optional benefits may include mandated benefits that are not included in the mandate lite health benefit plan.
(i) This section shall be known and may be cited as the mandate lite health benefit plan act.
History:
L. 2013, ch. 97, § 12; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,193 Specially designed policies; short-term policies.

40-2,193. Specially designed policies; short-term policies.
(a) For the purposes of this section:
(1) "Specially designed policy'' means an insurance policy that by design may not meet all or part of the definitions of a group or individual sickness and accident insurance policy and includes temporary sickness and accident insurance on a short-term basis.
(2) "Short-term'' means an insurance policy period of six months or 12 months, based upon policy design, which offers not more than one renewal period with or without a requirement of medical re-underwriting or medical requalification.
(A) Because a short-term policy addresses the special needs for temporary coverage, a short-term policy is not subject to continuation provisions of the health insurance portability and accountability act of 1996 (public law 104-191).
(B) Because a short-term policy addresses the special needs for temporary coverage, a short-term policy shall be exempt from medical loss ratio calculations associated with individual sickness and accident insurance issued within the state unless such calculation excludes any monthly administration fee associated with the sale of such policy.
(b) Specially designed policies shall include policies designed to provide sickness and accident insurance for specific coverage of benefits or services that may be excluded as benefits or services cited under K.S.A. 40-2,192, and amendments thereto. Specially designed policies may include the following stand-alone policies and coverages:
(1) Chiropractic plans;
(2) acupuncture coverage plans;
(3) holistic medical treatment plans;
(4) podiatrist plans;
(5) pharmacy plans;
(6) psychiatric plans;
(7) allergy plans; and
(8) such other stand-alone plans or combinations of plans of accepted traditional and nontraditional medical practice as shall be allowable for exclusion from group or individual plans under K.S.A. 40-2,192, and amendments thereto.
(c) No specially designed policy shall be deemed to be included under the definition of group sickness and accident insurance, including short-term, limited-duration health insurance, issued or renewed inside or outside of this state and covering persons residing in this state.
History:
L. 2013, ch. 97, § 14; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 2 - General Provisions › 40-2,195 Exclusive provider organization policy; requirements; exceptions; definitions.

40-2,195. Exclusive provider organization policy; requirements; exceptions; definitions.
(a) (1) A health carrier may offer a policy of accident and sickness insurance that requires some or all health care services to be rendered by participating providers, except that emergency services must be covered regardless of whether they are delivered by a participating provider.
(2) Such policy may include a gatekeeper requirement.
(3) To the extent the policy provides coverage for services rendered by nonparticipating providers, such coverage may be subject to a deductible, copayments or coinsurance as determined by the health carrier. Notwithstanding any other provision of law to the contrary, such cost-sharing shall not be limited based on the deductible, coinsurance or copayments required for services rendered by participating providers.
(b) For purposes of this section:
(1) "Gatekeeper requirement" means a requirement in which the insured is required to obtain a referral from a primary care professional in order to access specialty care;
(2) "primary care professional" means a participating provider designated by the health carrier to supervise, coordinate or provide initial care or continuing care to an insured and who may be required by the health carrier to initiate a referral for specialty care;
(3) "participating provider" shall have the meaning ascribed to it in K.S.A. 40-4602, and amendments thereto;
(4) "emergency services" shall have the meaning ascribed to it in K.S.A. 40-4602, and amendments thereto; and
(5) "health carrier" means any insurance company, nonprofit medical and hospital corporation, municipal group funded-pool or fraternal benefit society which offers a policy of accident and sickness insurance subject to chapter 40 of the Kansas Statutes Annotated, and amendments thereto.
History:
L. 2016, ch. 17, § 1; April 7.