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14  AN ACT concerning insurance health benefits coverage; policies and
15    contracts therefor; coverage for certain children; [health benefit
16    coverage; policies and contracts therefor; coverage for certain
17    children;] [insurance] coverage for immunizations; amending K.S.A.
18    1996 Supp. 40-2,102 and repealing the existing section.
19
20  Be it enacted by the Legislature of the State of Kansas:
21    Section 1.  K.S.A. 1996 Supp. 40-2,102 is hereby amended to read as
22  follows: 40-2,102. (a) (1) All individual and group health insurance policies
23  providing coverage on an expense incurred basis, individual and group
24  service or indemnity type contracts issued by a profit or nonprofit cor-
25  poration and all contracts issued by health maintenance organizations
26  organized or authorized to transact business in this state which provides
27  coverage for a family member of the enrollee, insured or subscriber shall,
28  as to such family members' coverage, also provide that the health insur-
29  ance benefits applicable for children shall be payable with respect to a:
30  (A) Newly born child of the enrollee, insured or subscriber from the
31  moment of birth; (B) newly born child adopted by the enrollee, insured
32  or subscriber from the moment of birth if a petition for adoption as pro-
33  vided in K.S.A. 59-2128 and amendments thereto was filed within 31 days
34  of the birth of the child; or (C) child adopted by the enrollee, insured or
35  subscriber from the date the petition for adoption as provided in K.S.A.
36  59-2128 and amendments thereto was filed or (D) child placed in en-
37  rollee, insured or subscriber's home for the purpose of adoption
38  from the date of placement as certified by the enrollee, insured or
39  subscriber [or (D) child placed in enrollee, insured or subscriber's
40  home by a child placement agency as defined by K.S.A. 65-503 and
41  amendments thereto, for the purpose of adoption from the date of
42  placement as certified by the enrollee, insured or subscriber. In no
43  case shall the time from the date of placement to the date the peti-
HB 2137--Am. by SCW
                                     

 1  tion for adoption as provided in K.S.A. 59-2128 and amendments
 2  thereto was filed exceed 280 days].
 3    (2)  The coverage for newly born children shall consist of: (A) Cov-
 4  erage of injury or sickness including the necessary care and treatment of
 5  medically diagnosed congenital defects and birth abnormalities; and (B)
 6  routine and necessary immunizations for all newly born children of the
 7  insured or subscriber. For purposes of this paragraph ``routine and nec-
 8  essary immunizations'' shall consist of at least three five doses of vaccine
 9  against diptheria, pertussis, tetanus,; at least four doses of vaccine against
10  polio, and Haemophilus B (Hib) and ; and three doses of vaccine against
11  Hepatitis B; one dose two doses of vaccine against measles, mumps and
12  rubella; one dose of vaccine against varicella and such other vaccines and
13  dosages as may be prescribed by the secretary of health and environment.
14  The required benefits shall apply to immunizations administered to each
15  newly born child from birth to 36 72 months of age and shall not be
16  subject to any deductible, copayment or coinsurance requirements.
17    (3)  If payment of a specific premium or subscription fee is required
18  to provide coverage for a child, the policy or contract may require that
19  notification of birth of a newly born child or the filing of the petition for
20  adoption or certification that a child has been placed in the home
21  for adoption [or certification that a child has been placed in the
22  home for adoption as defined by subsection (a)(1)(D)] and payment
23  of the required premium or fees must be furnished to the health main-
24  tenance organization, insurer or nonprofit service or indemnity corpora-
25  tion within 31 days after the date of birth or the filing of the petition for
26  adoption or the placement of the child in the home [or certification
27  that a child has been placed in the home for adoption as defined by
28  subsection (a)(1)(D)] in order to have the coverage continue beyond
29  such 31-day period.
30    (4)  The contract issued by a health maintenance organization may
31  provide that the benefits required pursuant to this subsection shall be
32  covered benefits only if the services are rendered by a provider who is
33  designated by and affiliated with the health maintenance organization.
34    (b) (1)  All individual and group health insurance policies providing
35  coverage on an expense incurred basis, individual and group service or
36  indemnity type contracts issued by a profit or nonprofit corporation and
37  all contracts issued by health maintenance organizations organized or au-
38  thorized to transact business in this state which provides coverage for a
39  family member of the enrollee, insured or subscriber, as to such family
40  members' coverage, shall also offer an option whereby the health insur-
41  ance benefits shall include delivery [and obstetrical] expenses at birth
42  of the birth mother of a child adopted within 90 days of birth of such
43  child by the enrollee, insured or subscriber subject to the same limitations
HB 2137--Am. by SCW
                                     

 1  contained in such policy or contract applicable to the enrollee, insured
 2  or subscriber. Such offer of an option regarding such delivery [and ob-
 3  stetrical] expense shall be made to the enrollee of a health maintenance
 4  organization and to the insured and, to the individual subscribers in the
 5  case of a group health insurance policy.
 6    (2)  Contracts issued by a health maintenance organization may pro-
 7  vide that the benefits required pursuant to paragraph (1) of this subsec-
 8  tion, shall be covered benefits only if the services are rendered by a pro-
 9  vider who is designated by and affiliated with the health maintenance
10  organization.
11    Sec. 2.  K.S.A. 1996 Supp. 40-2,102 is hereby repealed.
12    Sec. 3.  This act shall take effect and be in force from and after its
13  publication in the statute book.