reglab/statecodes huggingface dataset:
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-18 - Accident and health insurance companies; releases; requirements

Current through Register Vol. 43, No. 28, July 11, 2024
Each insurance company writing health and accident insurance
				shall not limit or attempt to limit its liability under a contract by obtaining
				a release from the insured either in the form of enclosed check, proof of loss,
				or other release. The payment of benefits shall not be withheld on the grounds
				that the insured will not sign a release. Releases shall be permitted only
				where there is a definite question of liability and a compromise settlement is
				to be effected.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-21 - Accident and health insurance; reserve standards for individual policies

Current through Register Vol. 43, No. 28, July 11, 2024
The national association of insurance commissioners' reserve
				standards for individual health insurance policies, June 1985 edition, are
				hereby adopted by reference.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-22 - Accident and health insurance policies; right to return policy

Current through Register Vol. 43, No. 28, July 11, 2024
Each individual accident and health policy, except travel
				accident policies or policies of a similar type, issued for delivery in this
				state, shall have printed on, or attached to the first page of the policy, a
				notice stating that the person to whom the policy is issued shall be permitted
				to return the policy or contract within at least 10 days of its delivery to the
				purchaser and to have the premium paid refunded if purchaser dissatisfaction
				exists. The notice shall be printed in not less than 10 point type and shall be
				printed in bold face type or in some other manner that distinguishes it from
				the print otherwise appearing in the policy. When a policyholder or purchaser,
				pursuant to the notice, returns the policy to the company or association at its
				home or branch office or to the agent through whom it was purchased, the policy
				shall be void from the beginning and the parties shall be in the same position
				as if no policy or contract had been issued.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-25 - Accident and sickness insurance standards for benefits

Current through Register Vol. 43, No. 28, July 11, 2024
(a) K.A.R. 40-4-26
			 through 40-4-33 shall apply to each individual accident and sickness insurance
			 policy and subscriber contract of hospital and medical and dental service
			 corporations delivered or issued for delivery in this state. These regulations
			 shall not apply to the following:
(1) A
			 credit accident and health insurance policy subject to K.A.R. 40-5-102 through
			 40-5-110;
(2) an individual policy
			 or contract issued pursuant to a conversion privilege under a policy or
			 contract of group or individual insurance when this group or individual policy
			 or contract includes provisions that are inconsistent with the requirements of
			 these regulations;
(3) a policy
			 being issued to employees or members as additions to franchise plans in
			 existence on the effective date of these regulations; and
(4) medicare supplement policies as defined
			 in K.A.R. 40-4-35.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-26 - Same; basic hospital expense coverage

Current through Register Vol. 43, No. 28, July 11, 2024
(a) "Basic hospital
			 expense coverage" means a policy of accident and sickness insurance which
			 provides coverage for a period of not less than 31 days during any one period
			 of confinement, for each person insured under the policy, and for expenses
			 incurred for necessary treatment and services rendered as a result of accident
			 and sickness. Minimum basic hospital expense coverage shall include the
			 following:
(1) Daily hospital room and board
			 in an amount not less than the lesser of:
(A)
			 80 percent of the charges for semi-private room accommodations; or
(B) $100 per day;
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-27 - Same; basic medical-surgical expense coverage

Current through Register Vol. 43, No. 28, July 11, 2024
"Basic medical-surgical expense coverage" means a policy of
				accident and sickness insurance which, for each person insured under the
				policy, provides coverage for the expenses incurred in providing the necessary
				services, rendered by a legally qualified physician, for treatment of an injury
				or sickness. Basic medical-surgical expense coverage shall provide at least the
				following:
(a) Surgical services
			 consisting of benefits providing not less than:
(1) an amount for any procedure at least
			 equal to $1,000, based on the relative values contained in the "relative value
			 study" of the Kansas medical society, adopted May 5, 1966, as amended May 19,
			 1968; or
(2) 80 percent of the
			 reasonable charges;
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-28 - Same; hospital confinement indemnity coverage

Current through Register Vol. 43, No. 28, July 11, 2024
"Hospital confinement indemnity coverage" means a policy of
				accident and sickness insurance which provides, for each person insured under
				the policy, daily benefits for hospital confinement, on an indemnity basis, in
				an amount not less than $50 per day and for not less than 31 days during any
				one period of confinement.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-29 - Same; major medical expense coverage

Current through Register Vol. 43, No. 28, July 11, 2024
(a) "Major medical
			 expense coverage" means an accident and sickness insurance policy which:
(1) Provides hospital, medical and surgical
			 expense coverage to an aggregate maximum of not less than $25,000;
(2) is not subject to a co-payment by the
			 covered person of more than 25 percent of covered charges; and
(3) limits any deductible, stated on a per
			 person, per family, per illness, per benefit period, or per year basis, or a
			 combination of these bases, to five percent of the aggregate maximum limit
			 under the policy.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-29a - Same; renewability of individual hospital, medical, or surgical expense policy

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Except as
			 specifically authorized by
			 K.S.A.
			 40-2257(b) and amendments
			 thereto, an insurer shall not terminate an individual hospital, medical, or
			 surgical expense policy for any insured who is eligible for medicare if the
			 insured wishes to continue the individual's coverage.
(b) Each insurer shall mail to its current
			 individual medical policyholders approaching the age of 65 or medicare
			 eligibility a notice provided by the Kansas insurance department explaining the
			 options available to them.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-30 - Same; disability income protection coverage

Current through Register Vol. 43, No. 28, July 11, 2024
(a) "Disability
			 income protection coverage" means a policy which provides for weekly or monthly
			 payments, for a specified period during the continuance of disability resulting
			 from either sickness or injury, or a combination of both, and which:
(1) Provides that periodic payments which are
			 payable at ages after 62 and reduced solely on the basis of age are at least 50
			 percent of amounts payable immediately prior to 62;
(2) Contains an elimination period no greater
			 than:
(A) 90 days, in the case of coverage
			 providing a benefit of one year or less;
(B) 180 days, in the case of coverage
			 providing a benefit of more than one year but not greater than two years; or
(C) 365 days in all other cases.
(3) Has a maximum
			 period of time for which benefits are payable during disability of at least six
			 months. Reduction in benefits shall not be put into effect because of an
			 increase in social security or similar benefits during a benefit period.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-31 - Same; standards for benefits, accident only coverage

Current through Register Vol. 43, No. 28, July 11, 2024
"Accident only coverage" means a policy of accident insurance
				which provides coverage, singly or in combination, for death, dismemberment,
				disability or hospital and medical care caused by accident. Accidental death
				and double dismemberment amounts under such policy shall be at least $1,000 and
				a single dismemberment amount shall be at least $500.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-32 - Same; standards for benefits; specified disease coverage

Current through Register Vol. 43, No. 28, July 11, 2024
"Specified disease coverage" means a policy which meets one of
				the following definitions:
(a) A
			 policy which provides coverage, for each person insured under the policy, for a
			 specifically named disease or diseases with a deductible amount not in excess
			 of $250, an overall aggregate benefit limit of no less than $10,000 and a
			 benefit period of not less than two years for the following incurred expenses:
(1) Hospital room and board and any other
			 hospital-furnished medical services or supplies;
(2) treatment by a legally qualified
			 physician or surgeon;
(3) private
			 duty services of a registered nurse (R.N.);
(4) x-ray, radium and other therapy
			 procedures used in diagnosis and treatment;
(5) professional ambulance for local service
			 to and from a local hospital;
(6)
			 blood transfusions, including expense incurred for blood donors;
(7) drugs and medicines prescribed by a
			 physician;
(8) rental of an iron
			 lung or similar mechanical apparatus;
(9) braces, crutches and wheelchairs, as
			 deemed necessary by the attending physician, for the treatment of the disease;
			 and
(10) emergency transportation,
			 if in the opinion of the attending physician, the insured requires
			 transportation to another locality for treatment of the disease.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-33 - Same; standards for benefits; specified accident coverage

Current through Register Vol. 43, No. 28, July 11, 2024
"Specified accident coverage" means an accident insurance
				policy which provides coverage for a specifically identified kind of accident
				or accidents for each person insured under the policy for accidental death or
				accidental death and dismemberment combined, with a benefit amount not less
				than:
(a) $1,000 for accidental
			 death;
(b) $1,000 for double
			 dismemberment; and
(c) $500 for
			 single dismemberment.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-34 - Accident and health insurance; coordination of benefits

Current through Register Vol. 43, No. 28, July 11, 2024
The Kansas insurance department's "policy and procedure
				relating to coordination of benefits," dated January 27, 2016, including the
				appendices, is hereby adopted by reference.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-35 - Medicare supplement policies; minimum standards

Current through Register Vol. 43, No. 28, July 11, 2024
(a) The Kansas insurance department's "policy
			 and procedure to implement medicare supplement insurance minimum standards,"
			 including the appendices, dated May 18, 2017, is hereby adopted by reference,
			 except for sections 1, 2, 25, and 26 and page 651-120.
(b) This regulation shall supersede any other
			 Kansas insurance department regulation to the extent that the other regulation
			 or any provision of it is inconsistent with or contrary to this
			 regulation.
(c) If any provision of
			 the document adopted in subsection (a) or the application of any provision of
			 this document to any person or circumstance is for any reason deemed invalid,
			 the remainder of this regulation and the application of the provision to other
			 persons or circumstances shall not be affected.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-35a - Medicare supplement policies; medicare catastrophic coverage repeal act of 1989; transitional requirements

Current through Register Vol. 43, No. 28, July 11, 2024
Sections 3, 4, 5, 6, 7, 8, 9, 10 and appendix A of the national
				association of insurance commissioner's model regulation to implement
				transitional requirements for the conversion of medicare supplement insurance
				benefits and premiums to conform to repeal of medicare catastrophic coverage
				act, December 1989 edition, are hereby adopted by reference, subject to the
				following additions or exceptions:
(a)
			 Section 5C.(2) is hereby amended to read as follows: "(2) Coverage for all of
			 the medicare part A inpatient hospital deductible amount."
(b) Section 5D. (1) is hereby amended to read
			 as follows: "(1) No later than January 31, 1990, every insurer, health care
			 service plan or other entity providing medicare supplement insurance or
			 benefits to a resident of this state shall notify its policyholders, contract
			 holders and certificate holders of modifications it has made to medicare
			 supplement insurance policies or contracts. Such notice shall be in the format
			 adopted by the NAIC as appendix A."
(c) Section 5D.(1) (b) is hereby amended to
			 read as follows: "(b) The notice shall inform each covered person as to when
			 any premium adjustment resulting from changes in medicare benefits will be
			 effective."
(d) Section 6C. is
			 hereby amended to read as follows: "C. Any premium adjustments shall produce an
			 expected loss ratio under such policy or contract necessary to conform with
			 minimum loss ratio standards for medicare supplement policies and shall result
			 in an expected loss ratio at least as great as that originally anticipated by
			 the insurer, health care service plan or other entity for such medicare
			 supplement insurance policies or contracts."
(e) The provisions entitled "accelerated
			 policy adjustment procedures" included in the drafting note which follows
			 section 6C. are not adopted.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-36 - Accident and sickness insurance; conversion policies; reasonable notice of right to convert

Current through Register Vol. 43, No. 28, July 11, 2024
(a) The
			 requirements for reasonable notice by the insurer of the right to convert
			 specified in
			 K.S.A.
			 40-19c06,
			 K.S.A.
			 40-2209, and
			 K.S.A.
			 40-3209, and amendments thereto, shall be
			 fulfilled if, during the 18-month continuation period, a form meeting the
			 following requirements is transmitted to the person eligible for conversion:
(1) Describes the conversion
			 options;
(2) describes the premiums
			 or subscriber's charges for each option;
(3) provides instructions regarding the
			 action required to effect conversion; and
(4) describes the availability of types of
			 coverage through the Kansas health insurance association.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-37 - Long-term care insurance; application; definitions

Current through Register Vol. 43, No. 28, July 11, 2024
(a) These
			 regulations shall apply to individual or group long-term care insurance
			 policies, subscriber contracts, endorsements, and riders delivered or issued
			 for delivery in this state by the following:
(1) Insurance companies;
(2) fraternal benefit societies;
(3) nonprofit hospital and medical service
			 corporations; and
(4) health
			 maintenance organizations.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-37a - Long-term care insurance; renewal provisions; requirements

Current through Register Vol. 43, No. 28, July 11, 2024
(a) A certificate
			 or individual policy delivered or issued for delivery shall not contain renewal
			 provisions less favorable to the insured than "guaranteed renewable" for life.
			 Any insurer may receive approval of another type of renewal provision if the
			 insurer demonstrates to the satisfaction of the commissioner that the approval
			 would be in recognition of the unique, developing and experimental nature of
			 long-term care insurance.
(b)
			 Individual long-term care insurance policies shall include a renewal provision
			 which complies with subsection (a) of this regulation. The provision shall:
(1) Be appropriately captioned;
(2) appear on the first page of the policy;
			 and
(3) clearly state the terms of
			 renewability.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-37b - Long-term care insurance; marketing practices; prohibitions; limitations

Current through Register Vol. 43, No. 28, July 11, 2024
A policy shall not be advertised, described, solicited,
				delivered or issued for delivery in this state as long-term care insurance if
				the policy, contract or rider limits or excludes coverage by type of illness,
				treatment, medical condition or accident, except for the following:
(a) Mental or nervous disorders without
			 demonstrable organic disease. This provision shall not exclude coverage for
			 loss which results from organic brain disease, including alzheimer's disease or
			 senile dementia;
(b) alcoholism
			 and drug addiction;
(c) illness,
			 treatment, medical condition or accident arising from:
(1) Participation in a felony, riot or
			 insurrection;
(2) suicide,
			 attempted suicide, or intentionally self-inflicted injury, whether sane or
			 insane;
(3) aviation; or
(4) war or act of war, whether
			 declared or undeclared;
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-37c - Long-term care insurance; termination; recurrent confinements; continuation of benefits

Current through Register Vol. 43, No. 28, July 11, 2024
(a) If a long-term
			 care insurance policy is terminated while an insured is confined in a nursing
			 facility, benefits provided as a result of receiving nursing facility services
			 shall continue until discharge from the nursing facility, expiration of the
			 policy benefit period, if any, or payment of the maximum benefits for nursing
			 facility services or maximum aggregate benefits under the policy, whichever
			 comes first. For the purpose of this provision, continuous nursing confinement
			 shall include transfer to another nursing facility or receiving another level
			 of nursing care in a nursing facility. This subsection shall not apply if
			 coverage under the policy terminates because of a lapse as defined in
			 subsection (c) (11) of K.A.R. 40-4-37.
(b) A policy may contain a provision relating
			 to recurrent confinements. However, a provision shall not specify that a
			 recurrent condition be separated by a period greater than six months.
(c) Family coverage shall continue
			 for any child who:
(1) is incapable of
			 self-sustaining employment due to mental retardation or physical handicap on
			 the date that the child's coverage would otherwise terminate under the policy
			 due to the attainment of a specified age limit; and
(2) is chiefly dependent on the insured for
			 support and maintenance. The policy may require that within 31 days of the date
			 that the child's coverage would otherwise terminate, the insured must furnish
			 the company due proof of the child's incapacity and a notice of the insured's
			 election to continue the policy in force with respect to the child, or the
			 policy may require that a separate converted policy be issued at the option of
			 the insured or policyholder.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-37f - Long-term care insurance; notices, limited policy; right to return requirements

Current through Register Vol. 43, No. 28, July 11, 2024
(a) A long-term
			 care insurance policy shall have the words "this is a limited policy read it
			 carefully" printed on or attached to the face of the policy in not less than 18
			 point bold face type or in some other manner that distinguishes it from the
			 print otherwise appearing in the policy.
(b) Right to return free look provision.
			 Long-term care insurance policies or certificates shall have a notice printed
			 on or attached to the first page of the policy stating that the policyholder
			 shall have the right to return the policy within 30 days of its delivery and to
			 have the premium refunded if, after examination of the policy, the insured
			 person is not satisfied for any reason. Any refund made pursuant to this
			 section shall be paid directly to the applicant or named insured by the insurer
			 within 10 business days following receipt of the returned policy by the insurer
			 or its agent. The notice required by this section shall be printed in bold face
			 type or in some other manner which distinguishes it from the print otherwise
			 appearing in the policy.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-37g - Long-term care insurance; benefit standards; definitions; explanations

Current through Register Vol. 43, No. 28, July 11, 2024
(a) A long-term
			 care insurance policy that provides for the payment of benefits based on
			 standards described as "usual and customary," "reasonable and customary" or
			 words of similar import shall include a definition and an explanation of these
			 terms in its accompanying outline of coverage.
(b) Definitions or provisions of the words
			 "accident," "accidental injury," or "accidental means" shall not:
(1) Include words which establish an
			 accidental means test or use words such as "external, violent, visible wounds"
			 or similar words of description or characterization;
(2) be more restrictive than the following:
			 "Injury or injuries for which benefits are provided means accidental bodily
			 injury sustained by the insured person which is the direct result of an
			 accident, independent of disease or bodily infirmity or any other cause, and
			 occurs while insurance coverage is in force."
(3) Such definitions may provide that
			 injuries shall not include injuries for which benefits are provided under
			 workers' compensation, employer's liability or any similar law.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-37h - Long-term care insurance; pre-existing conditions; requirements; prohibitions

Current through Register Vol. 43, No. 28, July 11, 2024
(a) If a long-term
			 care insurance policy or certificate contains any limitations with respect to
			 pre-existing conditions, the limitations shall appear as a separate paragraph
			 of the policy or certificate and be labeled as "pre-existing condition
			 limitations."
(b) The definition
			 of preexisting condition shall not prohibit an insurer from using an
			 application form designed to elicit the complete health history of an
			 applicant, and, on the basis of the answers on that application, from
			 underwriting in accordance with that insurer's established underwriting
			 standards. Unless otherwise provided in the policy or certificate, a
			 preexisting condition, regardless of whether it is disclosed on the
			 application, need not be covered until the waiting period described in K.S.A.
			 1991 Supp.
			 40-2228(e) (1)
			 expires. No long-term care insurance policy or certificate may exclude or use
			 waivers or riders of any kind to exclude, limit or reduce coverage or benefits
			 for specifically named or described preexisting diseases or physical conditions
			 beyond the waiting period of the policy or certificate.
(c) No long-term care insurance policy or
			 certificate shall exclude coverage for a loss or confinement which is the
			 result of a preexisting condition unless such loss or confinement begins within
			 the preexisting waiting period following the effective date of coverage of an
			 insured person.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-37j - Long-term care insurance; outline of coverage; content; format

Current through Register Vol. 43, No. 28, July 11, 2024
(a)
(1) An outline of coverage shall be delivered
			 to a prospective applicant for long-term care insurance at the time of initial
			 solicitation. The outline of coverage shall prominently direct the attention of
			 the recipient to such outline of coverage and explain its purpose.
(A) The commissioner shall prescribe a
			 standard format, including style, arrangement, and overall appearance, and the
			 content of the outline of coverage.
(B) In the case of agent solicitations, the
			 agent shall deliver the outline of coverage prior to the presentation of an
			 application or enrollment form.
(C) In the case of direct response
			 solicitations, the outline of coverage shall be presented in conjunction with
			 any application or enrollment form.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-37k - Long-term care insurance; minimum loss ratios

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Long-term care
			 insurance policies shall return the following to policyholders in the form of
			 aggregate benefits under the policy:
(1) At
			 least 65 percent of the aggregate amount of premiums earned in the case of
			 group policies; and
(2) at least
			 60 percent of the aggregate amount of premiums earned in the case of individual
			 policies.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-37l - Long-term care insurance; applications

Current through Register Vol. 43, No. 28, July 11, 2024
All applications for long-term care insurance policies or
				certificates, except those which are guaranteed issue, shall contain clear and
				unambiguous questions designed to ascertain the health condition of the
				applicant.
(a)
(1) If an application for long-term care
			 insurance contains a question which asks whether the applicant has had
			 medication prescribed by a physician, it must also ask the applicant to list
			 the medication that has been prescribed.
(2) If the medications listed in such
			 application were known by the insurer, or should have been known at the time of
			 application, to be directly related to a medical condition for which coverage
			 would otherwise be denied, then the policy or certificate shall not be
			 rescinded for that condition.
(3)
			 Application forms shall include the following questions designed to elicit
			 information as to whether, as of the date of the application, the applicant has
			 another long-term care insurance policy or certificate in force or whether a
			 long-term care policy or certificate is intended to replace any other accident
			 and sickness or long-term care policy or certificate presently in force. A
			 supplementary application or other form to be signed by the applicant and
			 agent, except where the coverage is sold without an agent, containing such
			 questions may be used. With regard to a replacement policy issued to a group
			 defined by K.S.A. 1991 Supp.
			 40-2209(3), if
			 the certificateholder has been notified of the replacement, the following
			 questions may be modified only to the extent necessary to elicit information
			 about health or long-term care insurance policies other than the group policy
			 being replaced.
(A) Do you have another
			 long-term care insurance policy or certificate in force (including health care
			 service contract, health maintenance organization contract)?
(B) Did you have another long-term care
			 insurance policy or certificate in force during the last 12 months?
(i) If so, with which company?
(ii) If that policy lapsed, when did it
			 lapse?
(C) Are you
			 covered by medicaid?
(D) Do you
			 intend to replace any of your medical or health insurance coverage with this
			 policy (certificate)?
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-37m - Long-term care insurance; rescissions; annual report required

Current through Register Vol. 43, No. 28, July 11, 2024
Every insurer or other entity selling or issuing long-term care
				insurance benefits shall maintain a record of all policy or certificate
				rescissions, both state and countrywide, except those which the insured
				voluntarily effectuated and shall annually furnish this information to the
				insurance department in the format prescribed by the commissioner. This
				information shall be provided for each rescission no later than March 1 of the
				calendar year following the date of rescission. This information shall include:
(a) Policy form number;
(b) policy and certificate number;
(c) name of insured;
(d) date of policy issuance;
(e) date each claim is submitted;
(f) date of rescission; and
(g) detailed reason for rescission.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-37n - Long-term care insurance; home health or community care services

Current through Register Vol. 43, No. 28, July 11, 2024
(a) A long-term
			 care insurance policy or certificate, if it provides for home health or
			 community care services, shall provide total home health or community care
			 coverage that is a dollar amount equivalent to at least one-half of one year's
			 coverage available for nursing home benefits under the policy or certificate at
			 the time covered home health or community care services are being received.
			 This requirement shall not apply to policies or certificates issued to
			 residents of continuing care retirement communities.
(b) Home health care coverage may be applied
			 to the non-home health care benefits provided in the policy or certificate when
			 determining maximum coverage under the terms of the policy or certificate.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-37o - Long-term care insurance; inflation protection; increased benefits; offer required

Current through Register Vol. 43, No. 28, July 11, 2024
(a) No insurer may
			 offer a long-term care insurance policy unless the insurer also offers to the
			 policyholder, in addition to any other inflation protection, the option to
			 purchase a policy that provides for benefit levels to increase with benefit
			 maximums or reasonable durations which are meaningful to account for reasonably
			 anticipated increases in the costs of long-term care services covered by the
			 policy. Insurers shall offer to each policyholder, at the time of purchase, the
			 option to purchase a policy with an inflation protection feature no less
			 favorable than one of the following:
(1)
			 Benefit levels increase annually in a manner so that the increases are
			 compounded annually at a rate not less than five percent;
(2) the insured individual is guaranteed the
			 right to periodically increase benefit levels, without providing evidence of
			 insurability or health status, so long as the option for the previous period
			 has not been declined. The amount of the additional benefit shall be no less
			 than the difference between the existing policy benefit and that benefit
			 compounded annually at a rate of at least five percent for the period beginning
			 with the purchase of the existing benefit and extending until the year in which
			 the offer is made; or
(3) a
			 specified percentage of actual or reasonable charges are covered and a maximum
			 specified indemnity amount or limit is not included.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-37p - Long-term care insurance; advertisements; marketing

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Every insurer,
			 health care service plan or other entity providing long-term care insurance or
			 benefits in this state shall provide a copy of any long-term care insurance
			 advertisement intended for use in this state, whether through written, radio or
			 television medium, to the commissioner of insurance of this state for review or
			 approval by the commissioner to the extent it may be required under state law.
			 In addition, all advertisements shall be retained by the insurer, health care
			 service plan or other entity for at least three years from the date the
			 advertisement was first used.
(b)
			 The commissioner may exempt from these requirements any advertising form or
			 material, when in the commissioner's opinion, this requirement may not be
			 reasonably applied.
(c)
(1) Every insurer, health care service plan
			 or other entity marketing long-term care insurance coverage in this state,
			 directly or through its producers, shall:
(A)
			 Establish marketing procedures to assure that any comparison of policies by its
			 agents or other producers will be fair and accurate;
(B) establish marketing procedures to assure
			 excessive insurance is not sold or issued;
(C) inquire and otherwise make every
			 reasonable effort to identify whether a prospective applicant or enrollee for
			 long-term care insurance already has accident and sickness or long-term care
			 insurance and the types and amounts of any such insurance;
(D) establish auditable procedures for
			 verifying compliance with this subsection (1); and
(E) provide written notice to the prospective
			 policyholder and certificateholder at solicitation that a senior insurance
			 counselling, senior citizen seminars and other information services programs
			 are available through the Kansas Department on Aging and Kansas Insurance
			 Department and the address and telephone number of such agencies.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-37q - Initial filing requirements

Current through Register Vol. 43, No. 28, July 11, 2024
(a) This regulation
			 shall apply as follows:
(1) To any long-term
			 care policy issued in this state on or after January 1, 2003; or
(2) for certificates issued on or after
			 January 1, 2003 under a group long-term care insurance policy as defined in
			 K.S.A.
			 40-2227(e), and amendments
			 thereto, which policy was in force at the time this regulation became
			 effective, on the policy anniversary following 12 months after January 1, 2003.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-37r - Long-term care insurance; non-duplication provisions

Current through Register Vol. 43, No. 28, July 11, 2024
A long-term care policy may contain non-duplication of coverage
				provisions consistent with Kansas insurance statutes, administrative
				regulations or which have been specifically approved by the commissioner.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-37s - Long-term care insurance; required disclosure of rating practices to consumers

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Except as
			 provided in subsection (b) of this regulation, this regulation shall apply to
			 any long-term care policy or certificate issued in this state six or more
			 months after the adoption of this regulation.
(b) For certificates issued on and after the
			 effective date of this regulation under a group long-term care insurance policy
			 as defined in
			 K.S.A.
			 40-2227(e) and amendments
			 thereto, which policy was in force at the time this regulation became
			 effective, the provisions of this regulation shall apply on the policy
			 anniversary following the date that is 12 months after the adoption of this
			 regulation.
(c) Other than for
			 policies for which no applicable premium rate or rate schedule increases can be
			 made or for which the method of application does not allow for delivery at the
			 time of application or enrollment, each insurer shall provide all the following
			 information to the applicant at the time of application or enrollment.
(1) A statement that the policy may be
			 subject to rate increases in the future;
(2) an explanation of potential future
			 premium rate revisions, and the policyholder's or certificate holder's option
			 in the event of a premium rate revision;
(3) the premium rate or rate schedules
			 applicable to the applicant that will be in effect until a request is made for
			 an increase;
(4) a general
			 explanation for applying premium rate or rate schedule adjustments that shall
			 include the following:
(A) A description of
			 when premium rate or rate schedule adjustments will be effective, including the
			 next anniversary date, next billing date; and
(B) the right to a revised premium rate or
			 rate schedule as specified in paragraph (c)(2) of this regulation if the
			 premium rate or rate schedule is changed;
(5) information regarding each premium rate
			 increase on this policy form or similar policy forms over the past 10 years for
			 this state or any other state that, at a minimum, identifies the following:
(A) The policy forms for which premium rates
			 have been increased;
(B) the
			 calendar years when the form was available for purchase; and
(C) the amount or percent of each increase.
			 The percentage may be expressed as a percentage of the premium rate before the
			 increase, and may also be expressed as minimum and maximum percentages if the
			 rate increase is variable by rating characteristics.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-37t - Premium rate schedule increases

Current through Register Vol. 43, No. 28, July 11, 2024
(a) This regulation
			 shall apply as follows:
(1) Except as
			 provided in paragraph (a)(2) of this regulation, to any long-term care policy
			 or certificate issued in this state on or after January 1, 2003; or
(2) for certificates issued on or after
			 January 1, 2003 under a group long-term care insurance policy as defined in
			 K.S.A.
			 40-2227(e) and amendments
			 thereto, which policy was in force when this regulation became effective, on
			 the policy anniversary following 12 months after January 1, 2003.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-37u - Contingent-benefit-upon-lapse requirement

Current through Register Vol. 43, No. 28, July 11, 2024
(a) This regulation
			 shall not apply to life insurance policies or riders containing accelerated
			 long-term care benefits.
(b) Each
			 long-term care policy or certificate issued in this state shall offer a
			 nonforfeiture benefit subject to the following requirements:
(1) A policy or certificate offered with
			 nonforfeiture benefits shall have coverage elements, eligibility, benefit
			 triggers, and benefit lengths that are the same as coverage to be issued
			 without nonforfeiture benefits. The nonforfeiture benefit included in the offer
			 shall be the benefits described in subsection (f) of this regulation; and
(2) the offer shall be in writing
			 if the nonforfeiture benefit is not otherwise described in the outline of
			 coverage or other materials given to the prospective policyholder.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-37v - Long-term care; agent training

Current through Register Vol. 43, No. 28, July 11, 2024
(a)
			 On and after July 1, 2010, each licensed insurance agent who is an individual
			 and who sells, solicits, or negotiates a long-term care partnership program
			 policy shall have four hours of initial training in courses certified by the
			 commissioner of insurance as long-term care partnership program training. For
			 each biennium after obtaining the initial training, each licensed insurance
			 agent who is an individual and who sells, solicits, or negotiates a long-term
			 care partnership program policy shall obtain at least one hour of training in
			 any course certified by the commissioner of insurance as long-term care
			 partnership program training.
(b)
			 The number of hours required by this regulation may be used to meet the
			 requirements of
			 K.S.A.
			 40-4903, and amendments thereto, if the
			 training is submitted to and approved by the commissioner of insurance for
			 continuing education credit.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-38 - Accident and health insurance policies; limited benefits; notice required

Current through Register Vol. 43, No. 28, July 11, 2024
Each limited individual policy of accident and health insurance
				shall have the words "this is a limited policy read it carefully" printed on or
				attached to the face of the policy in not less than 18 point bold face type or
				in some other manner that distinguishes it from the print otherwise appearing
				in the policy. For the purposes of this regulation, a limited policy is one
				that provides long-term care coverage, accident only coverage, specified
				disease coverage, specific accident coverage, or one that contains unusual
				exclusions, limitations, reductions or conditions of such a restrictive nature
				that the benefits under the policy are limited in frequency or in amounts.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-39 - Accident and sickness insurance; specified disease policies; replacement; credit for waiting periods and other time sensitive limitations

Current through Register Vol. 43, No. 28, July 11, 2024
(a) This regulation
			 shall apply to individual specified disease policies as defined in K.A.R.
			 40-4-32 issued by any insurance company, health maintenance organization, or
			 nonprofit hospital and medical service corporation.
(b) Whenever a specified disease policy
			 issued or issued for delivery in this state replaces or is in addition to an
			 existing specified disease policy, the issuing entity shall give credit for the
			 expired portion of any waiting period, elimination period, probationary period
			 or any similar provision.
(c) The
			 credit required by section (b) shall not exceed that earned by the insured
			 under the replaced or previously existing policy and need not be used to place
			 the insured in a more favorable position than would have been the case had a
			 replacement or additional policy not been issued.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-40 - Accident and sickness insurance; claim forms; acceptance required

Current through Register Vol. 43, No. 28, July 11, 2024
(a) As used in this
			 regulation:
(1) "Commissioner" means the
			 commissioner of insurance, state of Kansas.
(2) "Claim form" shall mean any of the forms
			 devised and promulgated by the commissioner pursuant to K.S.A. 1991 Supp.
			 40-2253.
(3) "Insurer" means insurance companies,
			 health maintenance organizations, mutual nonprofit medical and hospital service
			 corporations, nonprofit dental service corporations, nonprofit optometric
			 service corporations and nonprofit pharmacy service corporations.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-41 - Utilization review organizations; standards

Current through Register Vol. 43, No. 28, July 11, 2024
The Kansas insurance department's "policy and procedure
				relating to health utilization management standards," dated March 22, 2016, is
				hereby adopted by reference.
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-42 - Definitions; external review

Current through Register Vol. 43, No. 28, July 11, 2024
(a) "Authorized
			 representative" means any of the following:
(1) A person to whom the insured has given
			 express written consent to represent the insured in an external review, unless
			 the request for external review involves either of the following conditions:
(A) A situation exists in which the insured
			 has an emergency medical condition and the time frame for standard external
			 review pursuant to K.A.R. 40-4-42d would result in a serious impairment to
			 bodily functions, serious dysfunction of a bodily organ or part, or would place
			 a person's health in serious jeopardy; or
(B) express written consent cannot be
			 obtained in a timely manner or is impracticable;
Kansas Administrative Regulations › Agency 40 - INSURANCE DEPARTMENT › Article 4 - ACCIDENT AND HEALTH INSURANCE › Section 40-4-42a - Notice requirements of adverse decisions

Current through Register Vol. 43, No. 28, July 11, 2024
(a) Each written notification of an adverse
			 decision shall be printed in clear, legible type and in at least 12-point
			 type.
(b) The notice of adverse
			 decision shall explain the principal reason for the adverse decision in
			 language easily understood by a person with an eighth-grade reading level. An
			 insurer may meet this requirement by omitting medical terminology that
			 describes an insured's medical condition. The notice shall include the legal
			 names of all impacted parties and their telephone numbers and
			 addresses.
(c) The notice of
			 adverse decision shall explain how an insured, as defined in
			 K.S.A.
			 40-22a13, and amendments thereto, can
			 initiate an external review with the commissioner. If an insured is eligible
			 for an expedited review due to an emergency medical condition as defined in
			 K.S.A.
			 40-22a13, and amendments thereto, then the
			 notice shall explain how an insured can initiate an expedited review.
(d) The notice shall explain that an insured
			 may file for an external review with the commissioner within 120 days of
			 receipt of a final adverse decision. The notice shall also list the Kansas
			 insurance department's toll-free number.
(e) The notice of adverse decision shall
			 describe how the insured can request a writen statement of the clinical
			 rationale and clinical review criteria used to make the adverse
			 decision.