SB 331--
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Session of 1997
SENATE BILL No. 331
By Committee on Financial Institutions and
Insurance
2-14
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9 AN ACT concerning health care services; accident and sickness insurance;
10 amending K.S.A. 1996 Supp. 40-2,103, 40-1909, 40-19a10, 40-19b10,
11 40-19c09 and 40-19d10 and repealing the existing sections; also re-
12 pealing K.S.A. 40-1909, as amended by section 110 of chapter 229 of
13 the 1996 Session Laws of Kansas and K.S.A. 1995 Supp. 40-19a10, as
14 amended by section 111 of chapter 229 of the 1996 Session Laws of
15 Kansas, 40-19b10, as amended by section 112 of chapter 229 of the
16 1996 Session Laws of Kansas, 40-19c09, as amended by section 113 of
17 chapter 229 of the 1996 Session Laws of Kansas and 40-19d10, as
18 amended by section 114 of chapter 229 of the 1996 Session Laws of
19 Kansas.
20
21 Be it enacted by the Legislature of the State of Kansas:
22 New Section 1. (a) As used in this section:
23 (1) ``Health care consumer'' means a person and any covered de-
24 pendent of such person who is: (A) An insured under any individual health
25 insurance policy; (B) enrolled as a beneficiary of a group health insurance
26 policy; or (C) an enrollee of a health maintenance organization;
27 (2) ``health care products'' means medical equipment, appliances,
28 drugs, medicines and medical supplies;
29 (3) ``health care services'' means basic health care services and other
30 services, which may include, but are not limited to, medical, surgical and
31 dental care; psychological, obstetrical, osteopathic, optometric, optical,
32 podiatric, nursing, physical therapy services, occupational therapy serv-
33 ices, chiropractic services and pharmacy services; health education, pre-
34 ventative medical, rehabilitative and home health services; inpatient and
35 outpatient hospital services, extended care, nursing home care, convales-
36 cent institutional care, laboratory and ambulance services; the dispensing
37 or furnishing of health care products; and any other care, service or treat-
38 ment for the prevention, control or elimination of disease, the correction
39 of defects or the maintenance of the physical or mental well-being of
40 human beings;
41 (4) ``person'' means any natural or artificial person, including but not
42 limited to individuals, partnerships, associations, trusts or corporations;
43 (5) ``network provider'' means a provider which has entered into an
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1 agreement with a third-party payor or an agent thereof to provide health
2 care services to health care consumers;
3 (6) ``provider'' means any physician, hospital or other person which
4 is licensed or otherwise authorized in this state to furnish health care
5 services; and
6 (7) ``third-party payor'' means any insurer or corporation which issues
7 individual and group health insurance policies providing coverage on an
8 expense-incurred basis, individual and group service or indemnity-type
9 contracts issued by a profit or nonprofit corporation and all contracts
10 issued by health maintenance organizations organized or authorized to
11 transact business in this state.
12 (b) Any health care consumer who is authorized to obtain health care
13 services pursuant to health care coverage afforded by any third-party
14 payor which has entered into an agreement with network providers, may
15 obtain such health care services from a network provider or another pro-
16 vider selected by the health care consumer. If such health care services
17 are rendered by a nonnetwork provider, payment by the third-party payor
18 for the health care services so provided shall be in an amount not less
19 than 90% of the amount which would be paid if the services were pro-
20 vided by a network provider, except that, where the agreement between
21 the third-party payor and the network provider specifies separate amounts
22 which will be paid for prescription legend drugs and the corresponding
23 pharmacy services rendered in connection with the dispensing of such
24 drugs, the payment for the prescription legend drugs shall be in an
25 amount equal to the amount allowed by such agreement for the prescrip-
26 tion legend drugs, if dispensed by a network provider, and the amount
27 paid for the corresponding pharmacy services shall be in an amount not
28 less than 90% of the amount which would be paid for such services if
29 rendered by a network provider.
30 Sec. 2. K.S.A. 1996 Supp. 40-2,103 is hereby amended to read as
31 follows: 40-2,103. The requirements of K.S.A. 40-2,100, 40-2,101, 40-
32 2,102, 40-2,104, 40-2,105, 40-2,114 and 40-2250, and amendments
33 thereto and K.S.A. 1996 Supp. 40-2,160 and section 1 and amendments
34 thereto of this act shall apply to all insurance policies, subscriber contracts
35 or certificates of insurance delivered, renewed or issued for delivery
36 within or outside of this state or used within this state by or for an indi-
37 vidual who resides or is employed in this state.
38 Sec. 3. K.S.A. 1996 Supp. 40-1909 is hereby amended to read as
39 follows: 40-1909. (a) Such corporations shall be subject to the provisions
40 of the Kansas general corporation code, articles 60 to 74, inclusive, of
41 chapter 17 of the Kansas Statutes Annotated, applicable to nonprofit cor-
42 porations, to the provisions of K.S.A. 40-214, 40-215, 40-216, 40-218, 40-
43 219, 40-222, 40-223, 40-224, 40-225, 40-226, 40-229, 40-230, 40-231, 40-
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1 235, 40-236, 40-237, 40-247, 40-248, 40-249, 40-250, 40-251, 40-252,
2 40-254, 40-2,100, 40-2,101, 40-2,102, 40-2,103, 40-2,104, 40-2,105, 40-
3 2,114, 40-2,116, 40-2,117, 40-2a01 to 40-2a19, inclusive, 40-2216 to 40-
4 2221, inclusive, 40-2229, 40-2230, 40-2250, 40-2251, 40-2253, 40-2254,
5 40-2401 to 40-2421, inclusive, 40-3301 to 40-3313, inclusive, and
6 amendments thereto, and to the provisions of K.S.A. 1996 Supp. 40-2,153
7 and, 40-2,154 and 40-2,160, and amendments thereto, and K.S.A. 1996
8 Supp. 40-2,160 to the provisions of section 1 and amendments thereto of
9 this act, except as the context otherwise requires, and shall not be subject
10 to any other provisions of the insurance code except as expressly provided
11 in this act.
12 (b) No policy, agreement, contract or certificate issued by a corpo-
13 ration to which this section applies shall contain a provision which ex-
14 cludes, limits or otherwise restricts coverage because medicaid benefits
15 as permitted by title XIX of the social security act of 1965 are or may be
16 available for the same accident or illness.
17 (c) Violation of subsection (b) shall be subject to the penalties pre-
18 scribed by K.S.A. 40-2407 and 40-2411, and amendments thereto.
19 Sec. 4. K.S.A. 1996 Supp. 40-19a10 is hereby amended to read as
20 follows: 40-19a10. (a) Such corporations shall be subject to the provisions
21 of K.S.A. 40-214, 40-215, 40-216, 40-218, 40-219, 40-222, 40-223, 40-
22 224, 40-225, 40-226, 40-229, 40-230, 40-231, 40-235, 40-236, 40-237, 40-
23 247, 40-248, 40-249, 40-250, 40-251, 40-252, 40-254, 40-2,102, 40-2a01
24 et seq., 40-2215 to 40-2220, inclusive, 40-2253, 40-2401 to 40-2421, in-
25 clusive, 40-3301 to 40-3313, inclusive, and amendments thereto, and to
26 the provisions of K.S.A. 1996 Supp. 40-2,154, and amendments thereto
27 and to the provisions of section 1 and amendments thereto of this act
28 except as the context otherwise requires, and shall not be subject to any
29 other provisions of the insurance code except as expressly provided in
30 this act.
31 (b) No policy, agreement, contract or certificate issued by a corpo-
32 ration to which this section applies shall contain a provision which ex-
33 cludes, limits or otherwise restricts coverage because medicaid benefits
34 as permitted by title XIX of the social security act of 1965 are or may be
35 available for the same accident or illness.
36 (c) Violation of subsection (b) shall be subject to the penalties pre-
37 scribed by K.S.A. 40-2407 and 40-2411, and amendments thereto.
38 Sec. 5. K.S.A. 1996 Supp. 40-19b10 is hereby amended to read as
39 follows: 40-19b10. (a) Such corporations shall be subject to the provisions
40 of K.S.A. 40-214, 40-215, 40-216, 40-218, 40-219, 40-222, 40-223, 40-
41 224, 40-225, 40-226, 40-229, 40-230, 40-231, 40-235, 40-236, 40-237, 40-
42 247, 40-248, 40-249, 40-250, 40-251, 40-252, 40-254, 40-2,102, 40-2a01
43 et seq., 40-2215, 40-2253, 40-2401 to 40-2421, inclusive, and 40-3301 to
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1 40-3312, inclusive, and amendments thereto, and to the provisions of
2 K.S.A. 1996 Supp. 40-2,154, and amendments thereto, and to the provi-
3 sions of section 1 and amendments thereto of this act, except as the context
4 otherwise requires, and shall not be subject to any other provisions of the
5 insurance code except as expressly provided in this act.
6 (b) No policy, agreement, contract or certificate issued by a corpo-
7 ration to which this section applies shall contain a provision which ex-
8 cludes, limits or otherwise restricts coverage because medicaid benefits
9 as permitted by title XIX of the social security act of 1965 are or may be
10 available for the same accident or illness.
11 (c) Violation of subsection (b) shall be subject to the penalties pre-
12 scribed by K.S.A. 40-2407 and 40-2411, and amendments thereto.
13 Sec. 6. K.S.A. 1996 Supp. 40-19c09 is hereby amended to read as
14 follows: 40-19c09. (a) Corporations organized under the nonprofit med-
15 ical and hospital service corporation act shall be subject to the provisions
16 of the Kansas general corporation code, articles 60 to 74, inclusive, of
17 chapter 17 of the Kansas Statutes Annotated, applicable to nonprofit cor-
18 porations, to the provisions of K.S.A. 40-214, 40-215, 40-216, 40-218, 40-
19 219, 40-222, 40-223, 40-224, 40-225, 40-226, 40-229, 40-230, 40-231, 40-
20 235, 40-236, 40-237, 40-247, 40-248, 40-249, 40-250, 40-251, 40-252,
21 40-254, 40-2,100, 40-2,101, 40-2,102, 40-2,103, 40-2,104, 40-2,105, 40-
22 2,116, 40-2,117, 40-2a01 et seq., 40-2111 to 40-2116, inclusive, 40-2215
23 to 40-2220, inclusive, 40-2221a, 40-2221b, 40-2229, 40-2230, 40-2250,
24 40-2251, 40-2253, 40-2254, 40-2401 to 40-2421, inclusive, and 40-3301
25 to 40-3313, inclusive, and amendments thereto, and to the provisions of
26 K.S.A. 1996 Supp. 40-2,153 and, 40-2,154 and 40-2,160, and amendments
27 thereto, and K.S.A. 1996 Supp. 40-2,160 to the provisions of section 1
28 and amendments thereto of this act, except as the context otherwise re-
29 quires, and shall not be subject to any other provisions of the insurance
30 code except as expressly provided in this act.
31 (b) No policy, agreement, contract or certificate issued by a corpo-
32 ration to which this section applies shall contain a provision which ex-
33 cludes, limits or otherwise restricts coverage because medicaid benefits
34 as permitted by title XIX of the social security act of 1965 are or may be
35 available for the same accident or illness.
36 (c) Violation of subsection (b) shall be subject to the penalties pre-
37 scribed by K.S.A. 40-2407 and 40-2411, and amendments thereto.
38 Sec. 7. K.S.A. 1996 Supp. 40-19d10 is hereby amended to read as
39 follows: 40-19d10. (a) Such corporations shall be subject to the provisions
40 of K.S.A. 40-214, 40-215, 40-216, 40-218, 40-219, 40-222, 40-223, 40-
41 224, 40-225, 40-226, 40-229, 40-230, 40-231, 40-235, 40-236, 40-237, 40-
42 247, 40-248, 40-249, 40-250, 40-251, 40-252, 40-254, 40-2,102, 40-2a01
43 et seq., 40-2215 to 40-2220, inclusive, 40-2253, 40-2401 to 40-2421, in-
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1 clusive, 40-3301 to 40-3313, inclusive, and amendments thereto, and to
2 the provisions of K.S.A. 1996 Supp. 40-2,154 and amendments thereto to
3 the provisions of section 1 and amendments thereto of this act, except as
4 the context otherwise requires, and shall not be subject to any other pro-
5 visions of the insurance code except as expressly provided in this act.
6 (b) No policy, agreement, contract or certificate issued by a corpo-
7 ration to which this section applies shall contain a provision which ex-
8 cludes, limits or otherwise restricts coverage because medicaid benefits
9 as permitted by title XIX of the social security act of 1965 are or may be
10 available for the same accident or illness.
11 (c) Violation of subsection (b) shall be subject to the penalties pre-
12 scribed by K.S.A. 40-2407 and 40-2411, and amendments thereto.
13 Sec. 8. K.S.A. 1996 Supp. 40-2,103, 40-1909, 40-19a10, 40-19b10,
14 40-19c09 and 40-19d10 and K.S.A. 40-1909, as amended by section 110
15 of chapter 229 of the 1996 Session Laws of Kansas, and K.S.A. 1995 Supp.
16 40-19a10, as amended by section 111 of chapter 229 of the 1996 Session
17 Laws of Kansas, 40-19b10, as amended by section 112 of chapter 229 of
18 the 1996 Session Laws of Kansas, 40-19c09, as amended by section 113
19 of chapter 229 of the 1996 Session Laws of Kansas and 40-19d10, as
20 amended by section 114 of chapter 229 of the 1996 Session Laws of
21 Kansas are hereby repealed.
22 Sec. 9. This act shall take effect and be in force from and after its
23 publication in the statute book.