Kansas Administrative Code

Long-term care insurance; pre-existing conditions; requirements; pro- hibitions. (a) If a long-term care insurance pol- icy or certificate contains any limitations with respect to pre-existing conditions, the limitations shall appear as a separate paragraph of the policy or certi…

Long-term care insurance; re- placement; notice; waiver of waiting periods. (a) Long-term care insurance application forms shall request information as to other accident and health insurance coverage in force and whether the insurance to be issued is intended to replace any other…

Long-term care insurance; out- line of coverage; content; format. (a)(1) An outline of coverage shall be delivered to a pro- spective applicant for long-term care insurance at the time of initial solicitation. The outline of cov- erage shall prominently direct the attention of th…

Long-term care insurance; minimum loss ratios. (a) Long-term care insur- ance policies shall return the following to policy- holders 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 policie…

Long-term care insurance; ap- plications. 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 appli…

Long-term care insurance; re- scissions; annual report required. Every insur- er or other entity selling or issuing long-term care insurancebenefitsshallmaintainarecordofallpol- icy or certificate rescissions, both state and coun- trywide, except those which the insured voluntari…

Long-term care insurance; home health or community care services. (a) A long-term care insurance policy or certifi- cate, 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…

Long-term care insurance; in- flation protection; increased benefits; offer required. (a) No insurer may offer a long-term care insurance policy unless the insurer also of- fers to the policyholder, in addition to any oth- er inflation protection, the option to purchase a policy …

Long-term care insurance; advertisements; marketing. (a) Every insurer, health care service plan or other entity provid- ing 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, wheth…

Initial filing requirements. (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 pol- icy as defined in K.S…

Long-term care insurance; non-duplication provisions. A long-term care policy may contain non-duplication of coverage provisions consistent with Kansas insurance stat- utes, administrative regulations or which have been specifically approved by the commissioner. (Authorized by K.…

Long-term care insurance; re- quired disclosure of rating practices to con- sumers. (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 t…

Premium rate schedule in- creases. (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 J…

Contingent-benefit-upon-lapse requirement. (a) This regulation shall not apply to life insurance policies or riders containing ac- celerated long-term care benefits. (b) Each long-term care policy or certificate is- sued in this state shall offer a nonforfeiture bene- fit subject…

Long-term care; agent train- ing. (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 part- nership program policy shall have four hours of initial training in courses certified by the com- miss…

Accident and health insurance policies; limited benefits; notice required. 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 …

Accidentandsicknessinsurance; specified disease policies; replacement; cred- it for waiting periods and other time sensi- tive limitations. (a) This regulation shall apply to individual specified disease policies as defined in K.A.R. 40-4-32 issued by any insurance compa- ny, hea…

Accident and health insurance policies; limitation on the use of the terms “non-cancellable”, “non-cancellable and guaranteed renewable” and “guaranteed renewable”. (a) The terms “non-cancellable”, “non-cancellable and guaranteed renewable”, or “guaranteed renewable” may be used …

Accident and sickness insur- ance; claim forms; acceptance required. (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…

Utilization review organiza- tions; standards. The Kansas insurance depart- ment’s “policy and procedure relating to health utilization management standards,” dated March 22, 2016, is hereby adopted by reference. (Autho- rized by K.S.A. 40-103, 40-22a04, and 40-22a11; implementin…

(Authorized by K.S.A. 40-103 and K.S.A. 1994 Supp. 40-22a01, et seq.; implement- ing K.S.A. 1994 Supp. 40-22a04; effective, T-40- 4-26-95, April 26, 1995; effective June 12, 1995; revoked April 18, 2008.)

(Authorized by K.S.A. 40-103, 40-22a04, and 40-22a11; implementing K.S.A. 40-22a04; effective, T-40-4-26-95, April 26, 1995; effective June 12, 1995; amended June 22, 2001; amended Jan. 12, 2007; revoked April 18, 2008.)

(Authorized by K.S.A. 40-103, 40-22a04, and 40-22a11; implementing K.S.A. 40-22a04; effective, T-40-4-26-95, April 26, 1995; effective June 12, 1995; amended May 16, 1997; amended June 22, 2001; amended Jan. 12, 2007; revoked April 18, 2008.)

(Authorized by K.S.A. 40-103, 40-22a04, and 40-22a11; implementing K.S.A. 40-22a04; effective, T-40-4-26-95, April 26, 1995; effective June 12, 1995; amended June 22, 2001; amended Jan. 12, 2007; revoked April 18, 2008.)

(Authorized by K.S.A. 40-103, 40-22a04, and 40-22a11; implementing K.S.A. 40-22a04; effective, T-40-4-26-95, April 26, 1995; effective June 12, 1995; amended June 22, 2001; amended Jan. 12, 2007; revoked April 18, 2008.)

(Authorized by K.S.A. 40-103, 40- 22a04, and 40-22a11; implementing K.S.A. 40- 22a04; effective, T-40-4-26-95, April 26, 1995; effective June 12, 1995; amended June 22, 2001; amended Jan. 12, 2007; revoked April 18, 2008.)

(Authorized by K.S.A. 40-103, 40-22a04, and 40-22a11; implementing K.S.A. 40-22a04 and 40-22a11; effective, T-40-4-26-95, April 26, 1995; effective June 12, 1995; amended June 22, 2001; revoked April 18, 2008.)

(Authorized by K.S.A. 40-103 and K.S.A. 1999 Supp. 40-22a04 and 40-22a11; im- plementing K.S.A. 1999 Supp. 40-22a04 and 40- 22a11; effective June 22, 2001; revoked April 18, 2008.)

(Authorized by K.S.A. 40-103, 40- 22a04, and 40-22a11; implementing K.S.A. 40- 350 INSURANCE DEPARTMENT 40-4-41j 22a04; effective June 22, 2001; amended Jan. 12, 2007; revoked April 18, 2008.)

(Authorized by K.S.A. 40-103, 40-22a04, and 40-22a11; implementing K.S.A. 40-22a04 and 40-22a09; effective June 22, 2001; amended Jan. 12, 2007; revoked April 18, 2008.)

Definitions; external review. (a) “Authorized representative” means any of the following: (1) A person to whom the insured has given ex- press written consent to represent the insured in an external review, unless the request for external review involves either of the following c…

Notice requirements of ad- verse decisions. (a) Each written notification of an adverse decision shall be printed in clear, legi- ble 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 eas…

Preliminary determination by commissioner. (a) Within 10 business days after receiving the written request for external review andallnecessaryinformation,apreliminarydeter- mination shall be completed by the commission- er. The insured, the treating physician or insured’s authori…

Standard external review pro- cedures. (a) At the time a request for external review is accepted pursuant to K.A.R. 40-4-42b, an external review organization that has been ap- proved pursuant to K.S.A. 40-22a15, and amend- ments thereto, shall be assigned by the commis- sioner to…

Expedited external review. (a) If the insured has an emergency medical condi- tion, as defined in L. 1999, Ch. 162, Sec. 6, and amendments thereto, and receives an adverse decision involving that medical condition, the insured or the insured’s authorized representa- tive may make…

Minimum qualifications for ex- ternal review organizations. (a) To be approved under K.A.R. 40-4-42e and L. 1999, Ch. 162, Secs. 6 through 9, and amendments thereto, to conduct external reviews, an external review organization shall have and maintain written policies and proce- d…

External review reporting re- quirements. (a) An external review organization assigned pursuant to K.A.R. 40-4-42c and 40-4- 42d to conduct an external review shall maintain written records in the aggregate and by health car- rier on all requests for external review for which it …

(b) All clinical peer reviewers assigned by an external review organization to conduct external reviews shall be physicians or other appropriate health care providers who meet the following minimum qualifications: (1) Are qualified and credentialed in the treat- ment of the insur…

Hospital, medical, and surgical expense insurance policies and certificates; prohibiting certain types of discrimination. (a) A hospital, medical, or surgical expense pol- icy or certificate issued by an insurance compa- ny, nonprofit health service corporation, non- profit medic…

(Authorized by K.S.A. 40-103, 40-216, 40-2203(G), 40-2215(C); effective Jan. 1, 1966; amended Jan. 1, 1967; revoked May 1, 1979.) 40-4-6 to 40-4-11. (Authorized by K.S.A. 40-103, 40-216, 40-2203(G), 40-2215(C), 40- 2403, 40-2404; effective Jan. 1, 1966; revoked May 1, 1979.)

Credit insurance; fire and ex- tended coverage; issuance for single indi- visible premium; requirements. Fire and ex- tended coverage insurance permitted by Kansas administrative regulation 40-5-6 may be issued for a single indivisible premium subject to the follow- ing requireme…

(Authorized by K.S.A. 16a-4-112; effective Jan. 1, 1974; revoked May 1, 1979.)

Consumer credit insurance; definitions. (a) “Credit life insurance” means in- surance on the life of a consumer pursuant to or in connection with a consumer credit transaction. (b) “Credit accident and health insurance” means insurance, written in connection with a consumer credi…

Same; rights and treatment of consumers. (a) Multiple plans of insurance. If a creditor makes available to consumers more than one plan of credit life insurance, or more than one plan of credit accident and health insurance, all appropriate consumers shall be informed of all avai…

Same; coverage without sepa- rate charge. (a) If no separate charge is made to the consumer for consumer credit insurance, the consumer shall be charged a specific amount for insurance if an identifiable charge for insur- ance is disclosed in the credit or other instrument furnis…

Same; filing requirements. (a) Each policy form, certificate of insurance, notice of proposed insurance, application for insurance, endorsement, and rider to be delivered or issued for delivery in this state and the schedule of pre- mium rates or charges pertaining thereto shall …

(Authorized by K.S.A. 40-103, 16a-4-112; implementing K.S.A. 16a-4-101 through 16a-4-203; effective Jan. 1, 1974; amend- ed May 1, 1979; amended May 1, 1986; revoked Aug. 3, 2001.)

Same; credit insurance rates and forms. (a) The basic test of the reasonable- ness of the relation of benefits to the premium charges shall be an anticipated loss ratio of “claims incurred” to “premiums earned” of not less than 50 percent. Due consideration shall be given to a re…

Same; refunds. (a) Formulas for computing refunds of credit insurance premiums shall be acceptable to the commissioner for cover- age as follows: (1) Pro rata method. The pro rata unearned gross premium method for level term credit life insurance, credit accident and health insur…

Same; experience reports. Each insurer doing consumer credit insurance business in this state shall annually file with the insurance department a report of credit life and credit accident and health business written on a calendar year basis. This report shall utilize the credit i…