History: L. 1997, ch. 190, § 16; July 1.
(a) "Emergency medical condition" means the sudden and, at the time, unexpected onset of a health condition that requires immediate medical attention, where failure to provide medical attention would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or would place the person's health in serious jeopardy.
(b) "Emergency services" means ambulance services and health care items and services furnished or required to evaluate and treat an emergency medical condition, as directed or ordered by a physician.
(c) "Health benefit plan" means any hospital or medical expense policy, health, hospital or medical service corporation contract, a plan provided by a municipal group-funded pool, a policy or agreement entered into by a health insurer or a health maintenance organization contract offered by an employer or any certificate issued under any such policies, contracts or plans. "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.
(d) "Health insurer" means any insurance company, nonprofit medical and hospital service corporation, municipal group-funded pool, fraternal benefit society, health maintenance organization, or any other entity which offers a health benefit plan subject to the Kansas Statutes Annotated.
(e) "Insured" means a person who is covered by a health benefit plan.
(f) "Participating provider" means a provider who, under a contract with the health insurer or with its contractor or subcontractor, has agreed to provide one or more health care services to insureds with an expectation of receiving payment, other than coinsurance, copayments or deductibles, directly or indirectly from the health insurer.
(g) "Provider" means a physician, hospital or other person which is licensed, accredited or certified to perform specified health care services.
(h) "Provider network" means those participating providers who have entered into a contract or agreement with a health insurer to provide items or health care services to individuals covered by a health benefit plan offered by such health insurer.
(i) "Physician" means a person licensed by the state board of healing arts to practice medicine and surgery.
History: L. 1997, ch. 190, § 17; July 1.
(b) If a participating provider or other authorized representative of a health insurer authorizes emergency services, the health insurer shall not subsequently rescind or modify that authorization after the provider renders the authorized care in good faith and pursuant to the authorization except for:
(1) Payments made as a result of misrepresentation, fraud, omission or clerical error; and
(2) copayment, coinsurance or deductible amounts that are the responsibility of the insured.
(c) Once an insured is stabilized pursuant to subsection (a), a health benefit plan may require as a condition of further coverage that a hospital emergency facility shall promptly contact the health insurer for prior authorization for continuing treatment, specialty consultations, transfer arrangements or other medically necessary and appropriate care for an insured.
(d) Coverage of emergency services shall be subject to applicable copayments, coinsurance and deductibles.
(e) For required post evaluation or post stabilization services immediately following treatment of an emergency medical condition, a health insurer shall provide access to an authorized representative 24 hours a day, seven days a week.
History: L. 1997, ch. 190, § 18; July 1.
History: L. 1997, ch. 190, § 19; July 1.
History: L. 1997, ch. 190, § 20; July 1.
(a) A complete description of the health care services, items and other benefits to which the insured is entitled in the particular health benefit plan which is covering or being offered to such person;
(b) a description of any limitations, exceptions or exclusions to coverage in the health benefit plan, including prior authorization policies, restricted drug formularies or other provisions which restrict access to covered services or items by the insured;
(c) a listing of the health benefit plan's participating providers, their business addresses and telephone numbers, the availability of those providers, and any limitations on an insured's choice of provider;
(d) notification in advance of any changes in the health benefit plan which either reduces the coverage or benefits, or increases the cost, to such person; and
(e) a description of the grievance and appeal procedures available under the health benefit plan and an insured's rights regarding termination, disenrollment, nonrenewal or cancelation of coverage.
History: L. 1997, ch. 190, § 21; July 1.
(b) A health insurer shall have a plan by which an insured with a life-threatening, chronic, degenerative or disabling condition or disease, which requires specialized medical care over a prolonged period of time, may receive a referral to a specialist with expertise in treating such disease or condition who shall be responsible for and capable of providing and coordinating the insured's specialty care.
(c) Nothing in this section shall require a health insurer to provide benefits not otherwise covered by the terms of the health benefits plan.
(d) A provider network shall not be determined to be insufficient for failure to contract with any provider unwilling to contract under the same terms and conditions, including reimbursement levels, as such health insurer offers to other similarly situated health care providers.
History: L. 1997, ch. 190, § 22; July 1.
History: L. 1997, ch. 190, § 23; July 1.
(b) This section shall be part of and supplemental to the patient protection act, cited at K.S.A. 40-4601 et seq., and amendments thereto.
History: L. 2001, ch. 198, § 1; July 1.
History: L. 2003, ch. 89, § 1; July 1.
(a) "Commissioner" means the Kansas commissioner of insurance;
(b) "department" means the Kansas department of insurance; and
(c) "health benefit plan" shall have the meaning ascribed to such term by subsection (1) of K.S.A. 40-2209d, and amendments thereto.
History: L. 2003, ch. 89, § 2; July 1.
(1) ANSI-BIN number;
(2) processor control number or group number or both;
(3) card issuer identifier;
(4) prescription claims processor, if different from card issuer;
(5) cardholder identification number;
(6) cardholder or insured name;
(7) claims submission names and addresses; and
(8) help desk telephone numbers.
(b) A uniform prescription drug information card shall be issued by a health benefit plan to each person entitled to such card under the health benefit plan upon enrollment and reissued upon any change in such person's coverage that affects one or more mandatory data elements contained on the card.
(c) Notwithstanding the foregoing provision, any health benefit plan or administrator of such plan may utilize, in lieu of such card, electronic technology which contains all of the information required for claims adjudication, as long as such electronic technology is provided by the health benefit plan or administrator of such plan to the pharmacies which will adjudicate the prescription drug claims.
(d) On and after July 1, 2006: (1) No cardholder's social security number shall be printed or encoded on or into any card issued under this section.
(2) Any cardholder identification number or other distinguishing identifier assigned to the card issued to a cardholder shall be a combination of numbers or letters or both, which is unique to the cardholder.
(3) A cardholder's identification number or other distinguishing identifier assigned to such insured's policy card shall not, in any way, be based on or depend on the cardholder's social security number.
History: L. 2003, ch. 89, § 3; L. 2004, ch. 157, § 6; July 1.
History: L. 2003, ch. 89, § 4; July 1.
(b) The commissioner may adopt rules and regulations that are necessary to implement the provisions of this act.
History: L. 2003, ch. 89, § 5; July 1.
History: L. 2003, ch. 89, § 6; July 1.