reglab/statecodes huggingface dataset:
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2222b Healthcare coverage; premium tax, rate, computation, return and payment; exemptions.

40-2222b. Healthcare coverage; premium tax, rate, computation, return and payment; exemptions.
(a) (1) Except as provided in subsection (b), as a condition precedent to continuation of the exemption provided by K.S.A. 40-2222, and amendments thereto, each person or entity described in K.S.A. 40-2222, and amendments thereto, shall, no later than May 1 of each year, pay a tax at the rate of 1% per annum upon the annual Kansas gross premium collected during the preceding calendar year. For persons or entities that have a principal office within a metropolitan area that has boundaries in Kansas and associations that have their principal office located within the borders of this state and offer policies to non-residents of Kansas, the tax owed under this section shall be based upon the gross premium collected during the preceding year relating to health benefit plans issued to members that have a principal place of business in Kansas. In the computation of the tax, such persons or entities shall be entitled to deduct any annual Kansas gross premiums returned on account of cancellation or dividends returned to members or expenditures used for the purchase of reinsurance or stop-loss coverage.
(2) Every person or entity subject to taxation under the provisions of this subsection shall pay the tax imposed and make a return under oath to the commissioner of insurance under such rules and regulations and in such form and manner as the commissioner may prescribe.
(b) A person or entity described in K.S.A. 40-2222, and amendments thereto, shall be exempt from subsection (a) if it provides health benefits through a self-funded health plan and is therefore exempt from the jurisdiction of the commissioner pursuant to the employee retirement income security act of 1974, as in effect on July 1, 2022.
History:
L. 1991, ch. 135, § 3; L. 2014, ch. 44, § 3; L. 2019, ch. 54, § 16; L. 2019, ch. 54, § 17; L. 2022, ch. 10, § 1; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2223 Same; examination; subject to insurance laws.

40-2223.
Same; examination; subject to insurance laws.
Any person or entity unable to show under K.S.A. 40-2222 that it is subject to the jurisdiction of an agency of this state or the federal government shall: (a) Submit to an examination by the insurance commissioner to determine the organization and solvency of the person or the entity; (b) be subject to all applicable provisions of chapter 40 of the Kansas Statutes Annotated. Any examination conducted under this section shall be performed in accordance with K.S.A. 40-222 and 40-223, and amendments thereto.
History:
L. 1983, ch. 150, § 2; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2224 Same; disclosure to purchaser required.

40-2224.
Same; disclosure to purchaser required.
Any person who advertises, sells, transacts or administers coverage in this state described in K.S.A. 40-2222, shall, if that coverage is not fully insured by an insurer authorized to transact insurance business in this state, advise any purchaser, prospective purchaser and covered person of such lack of insurance or other coverage.
History:
L. 1983, ch. 150, § 3; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2225 Long-term care insurance; name and citation of act.

40-2225.
Long-term care insurance; name and citation of act.
This act may be known and cited as the long-term care insurance act.
History: L. 1987, ch. 156, § 1; January 1, 1988.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2226 Same; application and construction of act.

40-2226.
Same; application and construction of act.
The requirements of this act shall apply to policies delivered or issued for delivery in this state on or after the effective date of this act. This act is not intended to supersede the obligation of entities subject to this act to comply with the substance of other applicable insurance laws insofar as they do not conflict with this act, except that laws and rules and regulations designed and intended to apply to medicare supplement insurance policies shall not be applied to long-term care insurance. A policy which is not primarily advertised, marketed or offered as long-term care insurance need not meet the requirements of this act.
History: L. 1987, ch. 156, § 2; January 1, 1988.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2227 Same; definitions.

40-2227. Same; definitions.
As used in this act, unless the context requires otherwise:
(a) "Long-term care insurance" means any insurance policy primarily advertised, marketed, offered or designed to provide coverage for each covered person on an expense incurred, indemnity, prepaid, or other basis, for one or more necessary or diagnostic, preventive, therapeutic, rehabilitative, maintenance, custodial, residential or personal care services, provided in a setting other than an acute care unit of a hospital. "Long-term care insurance" includes group and individual policies or riders whether issued by insurers, fraternal benefit societies, nonprofit medical and hospital service corporations, prepaid health plans, health maintenance organizations, or any similar organization. "Long-term care insurance" shall not include any insurance policy that is offered primarily to provide basic medicare supplement coverage, basic hospital expense coverage, basic medical-surgical expense coverage, hospital confinement indemnity coverage, major medical expense coverage, disability income protection coverage, accident-only coverage, specified disease or specified accident coverage, or limited benefit health coverage, but the inclusion or attachment of long-term care insurance coverage to one of the foregoing products shall not exempt it from the requirements of this act.
(b) "Applicant" means:
(1) In the case of an individual long-term care insurance policy, the person who seeks to contract for such benefits; and
(2) in the case of a group long-term care insurance policy, the proposed certificateholder.
(c) "Certificate" means any certificate issued under a group long-term care insurance policy that has been delivered or issued for delivery in this state.
(d) "Commissioner" means the commissioner of insurance.
(e) "Group long-term care insurance" means a long-term care insurance policy delivered or issued for delivery in this state and issued to a group as defined in K.S.A. 40-2209, and amendments thereto. No group long-term care insurance coverage may be offered to a resident of this state under a group policy issued in another state to a group defined in K.S.A. 40-2209, and amendments thereto, unless this state, or another state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in this state, has made a determination that such requirements have been met.
(f) "Policy" means, except as otherwise provided in subsection (e), any individual or group policy, contract, subscriber agreement, rider or endorsement delivered or issued for delivery in this state by an insurer, fraternal benefit society, nonprofit medical and hospital service corporation, prepaid health plan, health maintenance organization or any similar organization.
History:
L. 1987, ch. 156, § 3; L. 1997, ch. 8, § 9; L. 2020, ch. 10, § 6; June 11.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2228a Long-term care policies and certificates; reinstatement of lapsed policies or certificates due to cognitive impairment or loss of functional capacity.

40-2228a.
Long-term care policies and certificates; reinstatement of lapsed policies or certificates due to cognitive impairment or loss of functional capacity.
The provisions of K.S.A. 40-2228a through 40-2228e shall apply to all individual and group long-term care policies or certificates that are issued to residents of this state on and after the effective date of this act.
History:
L. 1996, ch. 182, § 1; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2228b Same; notice of lapse or termination; designation of person in addition to applicant to receive notice, waiver; change of designation.

40-2228b.
Same; notice of lapse or termination; designation of person in addition to applicant to receive notice, waiver; change of designation.
(a) No long-term care policy or certificate shall be issued until the insurer has received from the applicant either a written designation of at least one person, in addition to the applicant, who is to receive notice of lapse or termination of the policy or certificate for nonpayment of premium, or a written waiver dated and signed by the applicant electing not to designate additional persons to receive such notice.
(b) The applicant has the right to designate at least one person who is to receive the notice of termination, in addition to the insured. Designation of an additional person to receive notice of lapse or termination shall not constitute acceptance of any liability by such person for services provided to the insured. The designation shall include the full name and home address of such additional person.
(c) The policy or certificate shall include a waiver stated in clear terms in the case of an applicant who elects not to designate an additional person. The waiver shall state that the applicant has the right to designate at least one person other than the applicant who will receive notice of any lapse or termination of the long-term care policy or certificate and that the applicant elects not to designate an additional person to receive such notice.
(d) The insurer shall notify the insured of the right to change this written designation, no less often than once every two years.
History:
L. 1996, ch. 182, § 2; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2228c Same; payment of premiums through payroll or pension deduction plan; requirements under K.S.A. 40-2228b; application or enrollment form.

40-2228c.
Same; payment of premiums through payroll or pension deduction plan; requirements under K.S.A. 40-2228b; application or enrollment form.
When the policyholder or certificateholder pays premiums for a long-term care insurance policy or certificate through a payroll or pension deduction plan, the requirements contained in K.S.A. 40-2228b need not be met until 60 days after the policyholder or certificateholder is no longer on such a payment plan. The application or enrollment form for such policies or certificates shall clearly indicate the payment plan selected by the applicant.
History:
L. 1996, ch. 182, § 3; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2228d Same; lapse or termination of policy or certificate; requirements; notice.

40-2228d.
Same; lapse or termination of policy or certificate; requirements; notice.
No long-term care policy or certificate shall lapse or be terminated for nonpayment of premium unless the insurer, at least 30 days before the effective date of the lapse or termination, has given notice by first-class mail to the insured at the insured's last known address and to any person designated by the insured pursuant to K.S.A. 40-2228b to receive notice of lapse or termination. Notice shall not be given until 30 days after a premium is due and unpaid and will be deemed to have been given five days after the date of mailing.
History:
L. 1996, ch. 182, § 4; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2228e Same; reinstatement, conditions.

40-2228e.
Same; reinstatement, conditions.
Long-term care insurance policies or certificates shall include a provision which provides for reinstatement of coverage, in the event of lapse if the insurer is provided proof of cognitive impairment or the loss of functional capacity. This option shall be available to the insured if requested within five months after termination and shall allow for the collection of past due premium, where appropriate. The standard of proof of cognitive impairment or loss of functional capacity shall not be more stringent than the benefit eligibility criteria for cognitive impairment or the loss of functional capacity contained in the policy or certificate.
History:
L. 1996, ch. 182, § 5; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2228f Long-term care insurance prompt payment act; effective date.

40-2228f.
Long-term care insurance prompt payment act; effective date.
(a) K.S.A. 40-2228f through 40-2228h, and amendments thereto, shall be known as the Kansas long-term care insurance prompt payment act and shall apply to any policy of long-term care insurance issued or renewed in this state.
(b) The provisions of the Kansas long-term care prompt payment act shall take effect and be in force on and after January 1, 2008.
History:
L. 2007, ch. 150, § 5; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2228g Same; definitions.

40-2228g.
Same; definitions.
As used in K.S.A. 40-2228f through 40-2228h, and amendments thereto:
(a) The term "clean claim" means a claim that has no defect or impropriety, including any lack of required substantiating documentation, or particular circumstance requiring special treatment that prevents timely payment from being made on the claim under the Kansas long-term care insurance prompt payment act.
(b) The term "claim" means a written proof of loss as defined in paragraph (7) of subsection (A) of K.S.A. 40-2203, and amendments thereto, or an electronic proof of loss which contains the information required by paragraph (7) of subsection (A) of K.S.A. 40-2203, and amendments thereto.
(c) The term "long-term care insurance" shall have the meaning ascribed to it in K.S.A. 40-2227, and amendments thereto.
History:
L. 2007, ch. 150, § 6; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2229 Mammogram and pap smear coverage; policies to which mandated coverage applicable.

40-2229.
Mammogram and pap smear coverage; policies to which mandated coverage applicable.
Except as otherwise provided, this act applies to any individual, group or blanket policy of accident and sickness, medical or surgical expense coverage and any provision of a policy, contract, plan or agreement for medical service including any contract of a health maintenance organization as defined by K.S.A. 40-3202, and amendments thereto, delivered, renewed or issued for delivery on or after the effective date of this act within or outside of this state or used within this state by or for an individual who resides or is employed in this state. 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. 1988, ch. 158, § 1; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2230 Same; when reimbursement or indemnification required; deductibles, coinsurance and other limitations permissible.

40-2230.
Same; when reimbursement or indemnification required; deductibles, coinsurance and other limitations permissible.
Notwithstanding any provision of any policy, provision, contract, plan or agreement to which this act applies, whenever reimbursement or indemnity for laboratory or x-ray services are covered, reimbursement or indemnification shall not be denied for mammograms or pap smears when performed at the direction of a person licensed to practice medicine and surgery by the board of healing arts within the lawful scope of such person's license, including services performed at a mobile facility certified by the federal health care financing administration and performing mammography testing by American cancer society guidelines. A policy, provision, contract, plan or agreement may apply to mammograms or pap smears the same deductibles, coinsurance and other limitations as apply to other covered services.
History:
L. 1988, ch. 158, § 2; L. 1994, ch. 141, § 1; April 14.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2231 Continuing care contracts; definitions.

40-2231.
Continuing care contracts; definitions.
As used in this act:
(a) "Continuing care contract" means an agreement pursuant to which a provider undertakes to furnish to a person, not related by consanguinity or affinity to the provider, shelter and medical or nursing services or other health-related benefits which require a present or deferred transfer of assets or an entrance fee in the amount of $5,000 or equivalent value or such greater amount as set by the commissioner in rules and regulations in addition to or in lieu of periodic charges. Continuing care contract shall also mean an agreement of any other provider who voluntarily applies for a certificate pursuant to K.S.A. 40-2235.
(b) "Entrance fee" means the total of any initial or deferred transfer to, or for the benefit of, a provider of a sum of money or other property made or promised to be made as full or partial consideration for acceptance of a person as a resident pursuant to a continuing care contract.
(c) "Home" means the facility or facilities occupied, or planned to be occupied, by five or more residents where the provider undertakes pursuant to the continuing care contract to provide continuing care to such residents.
(d) "Provider" or "continuing care provider" means the person, corporation, partnership, association or other legal entity which agrees to provide continuing care to residents in a home.
(e) "Resident" means an individual or individuals who have entered into an agreement with a provider for continuing care in a home.
(f) "Commissioner" means commissioner of insurance of the state of Kansas.
History:
L. 1989, ch. 73, § 1; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2233 Same; annual disclosure statement, contract and annual audit; filing with commissioner.

40-2233.
Same; annual disclosure statement, contract and annual audit; filing with commissioner.
A provider shall file with the commissioner within four months of completion of such provider's fiscal year the annual disclosure statement referred to in K.S.A. 40-2232, the continuing care contract referred to in K.S.A. 40-2234 and an annual audit certified by a certified public accountant.
History:
L. 1989, ch. 73, § 3; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2234 Same; providing form to commissioner; contents and attachments.

40-2234.
Same; providing form to commissioner; contents and attachments.
The provider shall provide the commissioner a copy of any continuing care contract form entered into on or after the effective date of this act or entered into between the provider and any resident which shall include or have attached thereto:
(a) A description of all fees and or charges required of residents, a description of all services to be provided or committed to providing in the future and a description of any services for which an extra charge is made over and above entrance fees and periodic charges that are provided for in the contract;
(b) A listing of the terms and conditions under which the agreement may be cancelled by either party to the agreement or by which any or all of the entrance fee or transfer of assets would be refunded, less the value of any services received; and
(c) A statement describing health and financial conditions required to continue as a resident, including any changes in either health or financial conditions of the resident.
History:
L. 1989, ch. 73, § 4; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2235 Same; certificate of registration, application, fee, renewal.

40-2235.
Same; certificate of registration, application, fee, renewal.
No provider shall act as or hold themselves out to be a continuing care provider, as defined in this act, in this state, unless the provider shall hold a certificate of registration as a continuing care provider issued by the commissioner of insurance. Application for such certificate shall be made to the commissioner on a form prescribed by such commissioner and shall be accompanied by a filing fee of $50. Such certificate may be continued for successive annual periods by notifying the commissioner of insurance of such intent and payment of a $25 continuation fee. Such certificate shall be issued to a continuing care provider or continued by the commissioner unless the commissioner after due notice and hearing shall have determined that the continuing care provider is not in compliance with this act.
History:
L. 1989, ch. 73, § 5; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2237 Same; change of ownership or management of provider or home.

40-2237.
Same; change of ownership or management of provider or home.
If there is a change of ownership, or management of the provider or home, the new owners must file all required documents of this act within 90 days of change.
History:
L. 1989, ch. 73, § 7; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2239 Small employer health benefit plans; definitions.

40-2239.
Small employer health benefit plans; definitions.
As used in this act, unless the context requires otherwise:
(a) "Carrier" means an insurance company, medical or hospital service corporation, medical and hospital service corporation or health maintenance organization which holds a valid certificate of authority from the insurance commissioner.
(b) "Commissioner" means the commissioner of insurance.
(c) "Eligible employee" means an employee who is employed by the employer for an average of at least 30 hours per week and who elects to participate in one of the benefit plans provided under this act, and includes individuals who are sole proprietors, business partners and limited partners. The term "eligible employee" does not include individuals:
(1) Engaged as independent contractors;
(2) whose periods of employment are on an intermittent or irregular basis; or
(3) who have been employed by the employer for fewer than 90 days.
(d) "Family member" means an eligible employee's spouse and any unmarried dependent child or stepchild.
(e) "Health benefit plan" means a contract for group medical, surgical, hospital or any other remedial care recognized by state law and related services and supplies.
(f) "Health savings account" means a trust created or organized in the United States as a health savings account exclusively for the purpose of paying the qualified medical expenses of the account beneficiary, but only if the written governing instrument creating the trust meets the requirements specified by the medicare, prescription drug, improvement and modernization act of 2003, Pub. L. No. 108-173, 117 Stat. 2067.
(g) "Premium" means the monthly or other periodic charge for a health benefit plan.
(h) "Small employer health benefit plan" means an arrangement providing a health benefit plan for the purpose described in K.S.A. 40-2240, and amendments thereto.
History:
L. 1990, ch. 157, § 1; L. 1999, ch. 110, § 1; L. 2005, ch. 118, § 1; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2240 Same; establishment; assistance by commissioner.

40-2240.
Same; establishment; assistance by commissioner.
(a) Any small employer as defined in subsection (4) of K.S.A. 40-2209d, and amendments thereto, may establish a small employer health benefit plan for the purpose of providing a health benefit plan as described in subsection (u) of K.S.A. 40-2209d, and amendments thereto, covering such employers' eligible employees and such employees' family members. If an association or trust is used for such purposes, the association or trust may not condition eligibility or membership on the health status of members or employees.
(b) The commissioner shall provide assistance to employers desiring to organize and maintain any such benefit plan and may aid in the acquisition of the health care insurance by the small employer health benefit plan.
History:
L. 1990, ch. 157, § 2; L. 1999, ch. 110, § 2; L. 2002, ch. 158, § 18; L. 2005, ch. 118, § 2; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2241 Same; contracts with carriers; coverage options; application of K.S.A. 40-2209 and 40-2215.

40-2241.
Same; contracts with carriers; coverage options; application of K.S.A. 40-2209 and 40-2215.
(a) Any small employer health benefit plan organized for the purposes described in K.S.A. 40-2240 and amendments thereto shall be authorized to enter into contracts with carriers for the health care insurance described in K.S.A. 40-2209d, and amendments thereto, or health care providers for services on behalf of its member employees. A small employer health benefit plan may contract with more than one carrier to provide insurance.
(b) Where appropriate, the small employer health benefit plan shall provide options under which eligible employees may arrange coverage for their family members. Options for additional coverage for employees and their family members at an additional cost or premium may be provided.
(c) The provisions of K.S.A. 40-2209 and 40-2215, and amendments thereto, shall apply to all contracts issued under this section or the act of which this section is a part and to health benefit plans as defined in K.S.A. 40-2239, and amendments thereto, and the provisions of such sections shall apply to small employer health benefit plans.
History:
L. 1990, ch. 157, § 3; L. 1991, ch. 134, § 9; L. 1998, ch. 174, § 12; L. 1999, ch. 110, § 5; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2242 Same; qualification for employer participation.

40-2242.
Same; qualification for employer participation.
As a condition to participation as a member of any small employer health benefit plan as provided in K.S.A. 40-2240, and amendments thereto, an employer shall have not contributed within the preceding two years to any health insurance premium or health savings account on behalf of an employee who is to be covered by the employer's contribution other than a contribution by an employer to a health insurance premium or health savings account within the preceding two years solely for the benefit of the employer or the employer's dependents.
History:
L. 1990, ch. 157, § 4; L. 1992, ch. 56, § 1; L. 1999, ch. 110, § 3; L. 2005, ch. 118, § 3; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2243 Same; employee and employer contributions; employee's enrollment in multiple options; enrollment not required, when; payroll deductions.

40-2243.
Same; employee and employer contributions; employee's enrollment in multiple options; enrollment not required, when; payroll deductions.
(a) The monthly contribution of each eligible employee for health benefit plan coverage under this act shall be the total cost per month of the benefit coverage afforded under the plan or plans, for which the employee exercises the option, including the administrative expenses therefor less the portion thereof contributed by the employer. An employee may enroll in more than one option at a time so long as such options do not offer overlapping services.
(b) The employer contribution shall be the amount necessary to pay the cost of the health benefit plan covering the employer's covered employees for which the employer does not require the employee to pay, including the administrative expenses therefor. An employer is not required to enroll an employee who is already enrolled in a health benefit plan other than the small employer health benefit plan.
(c) Payroll deductions for such costs payable by the employee shall be made by the employer upon receipt of a signed authorization from the employee indicating an election to participate in the small employer health benefit plan.
History:
L. 1990, ch. 157, § 5; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2248 Mandated health benefits; impact report to be submitted prior to legislative consideration.

40-2248.
Mandated health benefits; impact report to be submitted prior to legislative consideration.
Prior to the legislature's consideration of any bill that mandates health insurance coverage for specific health services, specific diseases, or for certain providers of health care services as part of individual, group or blanket health insurance policies, the person or organization which seeks sponsorship of such proposal shall submit to the legislative committees to which the proposal is assigned an impact report that assesses both the social and financial effects of the proposed mandated coverage. For purposes of this act, mandated health insurance coverage shall include mandated optional benefits. It shall be the duty of the commissioner of insurance to cooperate with, assist and provide information to any person or organization required to submit an impact report under the provisions of this act.
History:
L. 1990, ch. 162, § 1; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2249 Same; contents.

40-2249.
Same; contents.
The report required under K.S.A. 40-2248 for assessing the impact of a proposed mandate of health coverage shall include at the minimum and to the extent that information is available, the following:
(a) The social impact, including:
(1) The extent to which the treatment or service is generally utilized by a significant portion of the population;
(2) the extent to which such insurance coverage is already generally available;
(3) if coverage is not generally available, the extent to which the lack of coverage results in persons being unable to obtain necessary health care treatment;
(4) if the coverage is not generally available, the extent to which the lack of coverage results in unreasonable financial hardship on those persons needing treatment;
(5) the level of public demand for the treatment or service;
(6) the level of public demand for individual or group insurance coverage of the treatment or service;
(7) the level of interest of collective bargaining organizations in negotiating privately for inclusion of this coverage in group contracts; and
(8) the impact of indirect costs which are costs other than premiums and administrative costs, on the question of the costs and benefits of coverage.
(b) The financial impact, including:
(1) The extent to which insurance coverage of the kind proposed would increase or decrease the cost of the treatment or service;
(2) the extent to which the proposed coverage might increase the use of the treatment or service;
(3) the extent to which the mandated treatment or service might serve as an alternative for more expensive treatment or service;
(4) the extent to which insurance coverage of the health care service or provider can be reasonably expected to increase or decrease the insurance premium and administrative expenses of policyholders; and
(5) the impact of this coverage on the total cost of health care.
History: L. 1990, ch. 162, § 2; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2249a Same; state employee group pilot project for new mandated health benefits.

40-2249a.
Same; state employee group pilot project for new mandated health benefits.
(a) After July 1, 1999, in addition to the requirements of K.S.A. 40-2248 and 40-2249, and amendments thereto, any new mandated health insurance coverage for specific health services, specific diseases or for certain providers of health care services approved by the legislature shall apply only to the state health care benefits program, K.S.A. 75-6501 et seq., and amendments thereto, for a period of at least one year beginning with the first anniversary date of the state health care benefits program subsequent to approval of the mandate by the legislature. On or before March 1, after the one year period for which the mandate has been applied, the Kansas state employees health care commission shall submit to the president of the senate and to the speaker of the house of representatives, a report indicating the impact such mandated coverage has had on the state health care benefits program, including data on the utilization and costs of such mandated coverage. Such report shall also include a recommendation whether such mandated coverage should continue for the state health care benefits program or whether additional utilization and cost data is required.
(b) The legislature shall periodically review all health insurance coverages mandated by state law.
History:
L. 1999, ch. 162, § 5; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2250 Insurance coverage to include reimbursement for services performed by advanced practice registered nurses.

40-2250. Insurance coverage to include reimbursement for services performed by advanced practice registered nurses.
Notwithstanding any provision of an individual or group policy or contract for health and accident insurance delivered within the state, whenever such policy or contract shall provide for reimbursement for any services within the lawful scope of practice of a licensed advanced practice registered nurse within the state of Kansas, the insured, or any other person covered by the policy or contract, shall be allowed and entitled to reimbursement for such service irrespective of whether it was provided or performed by a duly licensed physician or a licensed advanced practice registered nurse.
History:
L. 1990, ch. 162, § 3; L. 1993, ch. 137, § 1; L. 2011, ch. 114, § 53; January 1, 2012.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2252 Same; rules and regulations.

40-2252. Same; rules and regulations.
The commissioner and the secretary of health and environment, jointly, may adopt rules and regulations necessary to effect the purposes of K.S.A. 40-19c09 and 40-2251, and amendments thereto.
History:
L. 1990, ch. 170, § 3; L. 1994, ch. 238, § 14; L. 2007, ch. 46, § 1; L. 2012, ch. 102, § 19; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2253 Universal accident and sickness insurance claim forms, design and use; acceptance of claims by insurer; uniform electronic data interchange formats and standards.

40-2253.
Universal accident and sickness insurance claim forms, design and use; acceptance of claims by insurer; uniform electronic data interchange formats and standards.
(a) The commissioner of insurance shall devise universal forms to be utilized by every insurance company, including health maintenance organizations where applicable, offering any type of accident and sickness policy covering individuals residing in this state for the purpose of receiving every claim under such policy by persons covered thereunder. In the preparation of such forms, the commissioner may confer with representatives of insurance companies, health maintenance organizations, trade associations and other interested parties. Upon completion and final adoption of such forms by the commissioner, the commissioner shall notify those companies affected by sending them a copy of such forms and an explanation of the requirements of this section. Every such company shall implement utilization of such forms not later than six months following the date of the commissioner's notification.
(b) An accident and sickness insurer may not refuse to accept a claim submitted on duly promulgated uniform claim forms. An insurer may accept claims submitted on any other form.
(c) An accident and sickness insurer does not violate subsection (a) by using a document that the accident and sickness insurer has been required to use by the federal government or the state.
(d) The commissioner of insurance shall report to the governor and to the legislature, no later than the commencement of the 1993 regular session of the Kansas legislature, regarding the development of uniform electronic data interchange formats and standards, along with a proposed plan, including an analysis of the cost impact thereof.
History:
L. 1991, ch. 133, § 1; L. 1992, ch. 73, § 1; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2254 Group accident and sickness insurance; extension of payment of benefits.

40-2254.
Group accident and sickness insurance; extension of payment of benefits.
Every issuer of a group policy and certificate of accident and sickness insurance providing inpatient hospital, medical-surgical benefits issued or renewed within this state or issued or renewed outside this state covering residents within this state shall:
(a) Include in its contracts a provision extending payment of such benefits until discharged or for a period not less than 31 days following the expiration date of the policy, whichever is earlier, for covered insureds confined in a hospital on the date of termination;
(b) not fail to enroll in a replacement group policy, contract or certificate without any gap in coverage any individual who is confined to a hospital or otherwise disabled at the time such individual's prior group policy, contract or certificate terminates;
(c) provide that payment of benefits under any subsequent replacement policy, contract or certificate that is intended to afford continuous coverage will commence immediately following expiration of any prior policy, contract or certificate.
History:
L. 1993, ch. 231, § 1; L. 2001, ch. 40, § 1; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2260 Group health benefit plan option to establish premium only cafeteria plan.

40-2260.
Group health benefit plan option to establish premium only cafeteria plan.
(a) An insurer shall provide, in conjunction with a group health benefit plan, the option of establishing a premium only cafeteria plan as permitted under federal law, 26 U.S.C. section 125.
(b) As used in this section "insurer" means any insurance company, fraternal benefit society, health maintenance organization and nonprofit hospital and medical service corporation authorized to transact health insurance business in this state.
(c) An insurer that establishes or facilitates the establishment of a premium only cafeteria plan or other payroll deduction program pursuant to 26 U.S.C. section 125 does not violate K.S.A. 40-2404, and amendments thereto.
(d) Nothing in this section shall be construed as prohibiting an insurer from:
(1) Charging a fee for establishing or facilitating the establishment of a premium only cafeteria plan pursuant to this section, and amendments thereto; or
(2) utilizing a vendor to facilitate the establishment of a premium only cafeteria plan pursuant to this section, and amendments thereto.
(e) The provisions of this section shall not take effect until July 1, 2008.
History:
L. 2008, ch. 164, § 1; May 29.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22 - Uniform Policy Provisions › 40-2261 Employer providing certain health insurance coverage may offer cafeteria plan; employer not restricted in providing such benefits or coverage; definitions.

40-2261.
Employer providing certain health insurance coverage may offer cafeteria plan; employer not restricted in providing such benefits or coverage; definitions.
(a) An employer that provides health insurance coverage for which any portion of the premium is payable by an employee may also offer a premium only cafeteria plan as permitted under 26 U.S.C. section 125. The provisions of this subsection shall not apply to any employer who offers health insurance through any self-insured or self-funded group health benefit plan of any type or description.
(b) No provision of this section shall prohibit or otherwise restrict an employer's ability to either provide a group health benefit plan or create a premium only cafeteria plan with defined contributions and in which the employee purchases the policy.
(c) For the purposes of this section:
(1) "Health benefit plan" means any hospital or medical expense policy, health, hospital or medical service corporation contract and a plan provided by a municipal group-funded pool or a health maintenance organization contract offered by an employer or any certificate issued under any such policies, contracts or plans. Health benefit plan also includes a cafeteria plan authorized by 26 U.S.C. section 125. The cafeteria plan may offer the option of paying all or any portion of the health insurance premium or the option of receiving health insurance coverage through a high deductible health plan and the establishment of a health savings account. In order for an eligible individual to obtain a high deductible health plan through the cafeteria plan, such individual shall present evidence to the employer that such individual has established a health savings account in compliance with 26 U.S.C. section 223 and any amendments and regulations. "Health benefit plan" does not include policies or certificates covering only accident, credit, dental, disability income, long-term care, hospital indemnity, medicare supplement, specified disease, vision care, coverage issued as a supplement to liability insurance, insurance arising out of a workers compensation or similar law, automobile medical-payment insurance or insurance under which benefits are payable with or without regard to fault and which is statutorily required to be contained in any liability insurance policy or equivalent self-insurance.
(2) "Health savings account" shall have the same meaning ascribed to it as in subsection (d) of 26 U.S.C. section 223.
(3) "High deductible health plan" shall mean a policy or contract of health insurance or health care plan that meets the criteria established in subsection (c) of 26 U.S.C. section 223 and any amendments and regulations.
(d) The provisions of this section shall not take effect until July 1, 2008.
History:
L. 2008, ch. 164, § 2; May 29.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22a - Utilization Review › 40-22a02 Same; purpose.

40-22a02.
Same; purpose.
The legislature finds that in order to promote the delivery of quality health care services in a cost effective manner, it is necessary to encourage greater coordination between health care providers and those agencies performing utilization review of health care services. Effective standards for utilization review activities will protect patients while reducing administrative costs associated with the review and approval of health care services provided to patients.
History:
L. 1994, ch. 238, § 2; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22a - Utilization Review › 40-22a03 Same; definitions.

40-22a03.
Same; definitions.
For the purposes of this act:
(a) "Commissioner" means the commissioner of insurance.
(b) "Utilization review" means the evaluation of the necessity, appropriateness and efficiency of the use of health care services, procedures and facilities.
(c) "Utilization review organization" means any entity which conducts utilization review and determines certification of an admission, extension of stay or other health care service.
(d) "Health care provider" means a licensed medical care facility, a licensed health maintenance organization, or a person licensed or registered to engage in an occupation which renders health care services.
History:
L. 1994, ch. 238, § 3; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22a - Utilization Review › 40-22a04 Utilization review organization act; standards; rules and regulations; certificate; conditions; annual fee; suspension or revocation of certificate.

40-22a04. Utilization review organization act; standards; rules and regulations; certificate; conditions; annual fee; suspension or revocation of certificate.
(a) The commissioner shall adopt rules and regulations establishing standards governing the conduct of utilization review activities performed in this state or affecting residents or healthcare providers of this state by utilization review organizations. Unless granted an exemption under K.S.A. 40-22a06, and amendments thereto, no utilization review organization may conduct utilization review services in this state or affecting residents of this state without first obtaining a certificate from the commissioner.
(b) The commissioner shall not issue a certificate to a utilization review organization until the applicant:
(1) Files a formal application for certification in such form and detail as required by the commissioner and such application has been executed under oath by the chief executive officer, president or other head official of the applicant;
(2) files with the commissioner a certified copy of its charter or articles of incorporation and bylaws, if any;
(3) states the location of the office or offices of the utilization review organization where utilization review affecting residents or health care providers of this state will be principally performed;
(4) provides a summary of the qualifications and experience of persons performing utilization review affecting the persons and at the locations identified pursuant to paragraph (3);
(5) makes payment of a certification fee of $100 to the commission; and
(6) provides such other information or documentation as the commissioner requires.
(c) Certificates issued by the commissioner pursuant to this act shall remain effective until suspended, surrendered or revoked subject to payment of an annual continuation fee of $50.
(d) The commissioner may suspend or revoke the certificate or any exemption from certification requirements upon determination that the interests of Kansas insureds are not being properly served under such certificate or exemption. Any such action shall be taken only after a hearing conducted in accordance with the provisions of the Kansas administrative procedure act.
History:
L. 1994, ch. 238, § 4; L. 2021, ch. 108, § 7; July 1.
2023 Kansas Statutes › Chapter 40 - Insurance › Article 22a - Utilization Review › 40-22a05 Same; act not applicable to certain reviews and programs.

40-22a05. Same; act not applicable to certain reviews and programs.
The utilization review organization act shall not apply to:
(a) Utilization review of health care services provided to patients under the authority of the Kansas workers compensation act, K.S.A. 44-501 et seq., and amendments thereto;
(b) reviews conducted by any insurance company, health maintenance organization, prepaid service plan, group-funded self-insured plan or similar entity solely for the purpose of determining compliance with the specific terms and conditions of an insurance policy, agreement or contract as a part of the normal claim settlement process; or
(c) any medical programs operated by the secretary for aging and disability services or any entity to the extent it is acting under contract with the secretary.
History:
L. 1994, ch. 238, § 5; L. 2014, ch. 115, § 189; L. 2021, ch. 108, § 8; July 1.