Terms Used In Kansas Statutes 40-2122

  • Administering carrier: means the insurer or third-party administrator designated in Kan. See Kansas Statutes 40-2118
  • Association: means the Kansas health insurance association established in Kan. See Kansas Statutes 40-2118
  • Creditable coverage: means with respect to an individual, coverage of the individual under any of the following:

    (1) A group health plan;

    (2) health insurance coverage;

    (3) part A or part B of title XVIII of the social security act;

    (4) title XIX of the social security act, other than coverage consisting solely of benefit under section 1928;

    (5) chapter 55 of title 10, United States code;

    (6) a medical care program of the Indian health service or of a tribal organization;

    (7) a state health benefit risk pool;

    (8) a health plan offered under chapter 89 of title 5, United States code;

    (9) a public health plan as defined under regulations promulgated by the secretary of health and human services;

    (10) a health benefit plan under section 5(e) of the peace corps act (22 U. See Kansas Statutes 40-2118

  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Federally defined eligible individual: means an individual:

    (1) For whom, as of the date the individual seeks coverage under this section, the aggregate of the periods of creditable coverage is 18 or more months and whose most recent prior coverage was under a group health plan, government plan or church plan;

    (2) who is not eligible for coverage under a group health plan, part A or B of title XVII of the social security act, or a state plan under title XIX of the social security act, or any successor program, and who does not have any other health insurance coverage;

    (3) with respect to whom the most recent coverage was not terminated for factors relating to nonpayment of premiums or fraud; and

    (4) who if offered the option of continuation coverage under COBRA or under a similar program, elected such continuation coverage, and has exhausted such continuation coverage. See Kansas Statutes 40-2118

  • Fraud: Intentional deception resulting in injury to another.
  • FTAA: means federal trade adjustment assistance under the federal trade adjustment assistance reform act of 2002, public law 107-210. See Kansas Statutes 40-2118
  • Health insurance: means any hospital or medical expense policy, health, hospital or medical service corporation contract, and a plan provided by a municipal group-funded pool, or a health maintenance organization contract offered by an employer or any certificate issued under any such policies, contracts or plans. See Kansas Statutes 40-2118
  • Medicaid: means the medical assistance program operated by the state under title XIX of the federal social security act. See Kansas Statutes 40-2118
  • Medicare: means coverage under both parts A and B of title XVIII of the federal social security act, 42 U. See Kansas Statutes 40-2118
  • Plan: means the Kansas uninsurable health insurance plan created pursuant to this act. See Kansas Statutes 40-2118
  • State: when applied to the different parts of the United States, includes the District of Columbia and the territories. See Kansas Statutes 77-201

(a) The following individuals shall be eligible for plan coverage provided they meet the criteria set forth in subsection (b):

(1) Any person who has been a resident of this state for at least six months;

(2) any person who is a legal domiciliary of this state who previously was covered under the high risk pool of another state, provided they apply for coverage under the plan within 63 days of losing such other coverage for reasons other than fraud or nonpayment of premiums;

(3) any federally defined eligible individual who is a legal domiciliary of this state; or

(4) any federally defined eligible individual for FTAA.

(b) Those individuals who are eligible for plan coverage under subsection (a) must provide evidence satisfactory to the administering carrier that such person meets one of the following criteria:

(1) Such person has had health insurance coverage involuntarily terminated for any reason other than nonpayment of premium;

(2) such person has applied for health insurance and been rejected by two carriers because of health conditions;

(3) such person is a child under the age of 19 years and has been unable to purchase or obtain coverage under an individual health insurance policy providing health insurance coverage, because such coverage is not available for sale in the county in which the child resides;

(4) such person has applied for health insurance and has been quoted a premium rate which is in excess of the plan rate;

(5) such person has been accepted for health insurance subject to a permanent exclusion of a preexisting disease or medical condition;

(6) such person is a federally defined eligible individual; or

(7) such person is a federally defined eligible individual for FTAA.

(c) Each resident dependent of a person who is eligible for plan coverage shall also be eligible for plan coverage.

(d) The following persons shall not be eligible for coverage under the plan:

(1) Any person who is eligible for medicare or is eligible for medicaid benefits;

(2) any person who has had coverage under the plan terminated less than 12 months prior to the date of the current application, except that this provision shall not apply with respect to an applicant who is a federally defined eligible individual;

(3) any person who has received accumulated benefits from the plan equal to or in excess of the lifetime maximum benefits under the plan prescribed by Kan. Stat. Ann. § 40-2124, and amendments thereto;

(4) any person having access to accident and health insurance through an employer-sponsored group or self-insured plan, including coverage under the consolidated omnibus budget reconciliation act (COBRA), except that the requirement for exhaustion of any available COBRA or state continuation is waived whenever such person:

(A) Is eligible for the credit for health care costs under section 35 of the internal revenue code of 1986; and

(B) has three months of prior creditable coverage as described in subsection (c) of Kan. Stat. Ann. § 40-2124, and amendments thereto; or

(5) any person who is eligible for any other public or private program that provides or indemnifies for health services.

(e) Any person who ceases to meet the eligibility requirements of this section may be terminated at the end of a policy period.

(f) All plan members, insurers and insurance arrangements shall notify in writing persons denied health insurance coverage, for any reason, of the availability of coverage through the Kansas health insurance association.

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