Kansas Statutes 40-4606. Same; health insurer required to inform in writing current and prospective insureds of availability of certain information
Terms Used In Kansas Statutes 40-4606
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- 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. See Kansas Statutes 40-4602
- 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. See Kansas Statutes 40-4602
- Insured: means a person who is covered by a health benefit plan. See Kansas Statutes 40-4602
- Provider: means a physician, hospital or other person which is licensed, accredited or certified to perform specified health care services. See Kansas Statutes 40-4602
Every health insurer shall inform in writing current and prospective insureds that the following information shall be available upon request:
(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.