40-2,153.Insurance coverage to allow choice of pharmacy providers.(a) Every policy, contract, plan or agreement delivered toany group in this state which provides benefits or services, or both, forhospital and medical services that is offered by an accident and healthinsurance companyor bya health maintenance organization as defined in K.S.A. 40-3202 and amendmentsthereto, except when the health maintenance organization owns and operates itsown pharmacies and such health maintenance organization is in operation on theeffective date of this act, by a preferred provider organization or by anindividual practice association or by a similar mechanism shall provide forwritten notice to the commissioner of insurance of thecreation of a pharmacy network not less than 90 days prior to the effectivedate of any contract for pharmacy services. All notices shall identify acontact person or office of such plan, the address of such person or office andthe geographic area to be served by such contract. The commissioner ofinsurance shall cause to be published in the Kansas register on a weekly basisa copy of all notices received by the commissioner in the preceding week.
(b) If such policy, contract, plan or agreement provides or contracts forthe services of a pharmacy network, such policy, contract, plan or agreementshall permit participation of at least one pharmacy for each Kansas county inwhich that plan has participating employers or physicians. In no event shall aplan have less than one pharmacy within 30 miles of a plan physician oremployer in a Kansas county designated pursuant to K.S.A. 76-375 and amendmentsthereto as an underserved area and within 10 miles in any other county. Theprovisions of this subsection shall apply only if the plan has a written offertoparticipate in the pharmacy network from a registered pharmacy locatedin such Kansas county under the same terms and conditions of the policy,contract, plan or agreement as those offered to any other provider of pharmacyservices.
(c) No such policy, contract, plan or agreement, except as permitted in thissubsection, shall permit or mandate any difference in coverage for or imposeany different conditions, including copayment fees, whether the prescriptionbenefits are provided through direct contact with a pharmacy or by use of anout-of-state mail order pharmacy so long as the provider selected is aparticipant in the plan involved.The limitations of this subsection shall not apply to any pharmacyservices owned and operated by an accident and health insurance company,its commonly owned affiliate or subsidiary,health maintenanceorganization,individual practice association or other similar mechanism.
(d) Any provision in an accident and health insurance policy, contract, planor agreement offered in this state which violates the provisions of thissection is void.
(e) Nothing in this section shall apply to any policy, plan, contract oragreement operating pursuant to the federal employee retirement income securityact of 1974 (ERISA).
(f) The department of insurance shall enforce the provisions of thissection with regard to any policy, contract, plan or agreement issued underauthority of chapter 40 of the Kansas Statutes Annotated.
History: L. 1994, ch. 253, § 1;L. 1997, ch. 8, § 7; July 1.
40-2,153.Insurance coverage to allow choice of pharmacy providers.(a) Every policy, contract, plan or agreement delivered toany group in this state which provides benefits or services, or both, forhospital and medical services that is offered by an accident and healthinsurance companyor bya health maintenance organization as defined in K.S.A. 40-3202 and amendmentsthereto, except when the health maintenance organization owns and operates itsown pharmacies and such health maintenance organization is in operation on theeffective date of this act, by a preferred provider organization or by anindividual practice association or by a similar mechanism shall provide forwritten notice to the commissioner of insurance of thecreation of a pharmacy network not less than 90 days prior to the effectivedate of any contract for pharmacy services. All notices shall identify acontact person or office of such plan, the address of such person or office andthe geographic area to be served by such contract. The commissioner ofinsurance shall cause to be published in the Kansas register on a weekly basisa copy of all notices received by the commissioner in the preceding week.
(b) If such policy, contract, plan or agreement provides or contracts forthe services of a pharmacy network, such policy, contract, plan or agreementshall permit participation of at least one pharmacy for each Kansas county inwhich that plan has participating employers or physicians. In no event shall aplan have less than one pharmacy within 30 miles of a plan physician oremployer in a Kansas county designated pursuant to K.S.A. 76-375 and amendmentsthereto as an underserved area and within 10 miles in any other county. Theprovisions of this subsection shall apply only if the plan has a written offertoparticipate in the pharmacy network from a registered pharmacy locatedin such Kansas county under the same terms and conditions of the policy,contract, plan or agreement as those offered to any other provider of pharmacyservices.
(c) No such policy, contract, plan or agreement, except as permitted in thissubsection, shall permit or mandate any difference in coverage for or imposeany different conditions, including copayment fees, whether the prescriptionbenefits are provided through direct contact with a pharmacy or by use of anout-of-state mail order pharmacy so long as the provider selected is aparticipant in the plan involved.The limitations of this subsection shall not apply to any pharmacyservices owned and operated by an accident and health insurance company,its commonly owned affiliate or subsidiary,health maintenanceorganization,individual practice association or other similar mechanism.
(d) Any provision in an accident and health insurance policy, contract, planor agreement offered in this state which violates the provisions of thissection is void.
(e) Nothing in this section shall apply to any policy, plan, contract oragreement operating pursuant to the federal employee retirement income securityact of 1974 (ERISA).
(f) The department of insurance shall enforce the provisions of thissection with regard to any policy, contract, plan or agreement issued underauthority of chapter 40 of the Kansas Statutes Annotated.
History: L. 1994, ch. 253, § 1;L. 1997, ch. 8, § 7; July 1.
40-2,153.Insurance coverage to allow choice of pharmacy providers.(a) Every policy, contract, plan or agreement delivered toany group in this state which provides benefits or services, or both, forhospital and medical services that is offered by an accident and healthinsurance companyor bya health maintenance organization as defined in K.S.A. 40-3202 and amendmentsthereto, except when the health maintenance organization owns and operates itsown pharmacies and such health maintenance organization is in operation on theeffective date of this act, by a preferred provider organization or by anindividual practice association or by a similar mechanism shall provide forwritten notice to the commissioner of insurance of thecreation of a pharmacy network not less than 90 days prior to the effectivedate of any contract for pharmacy services. All notices shall identify acontact person or office of such plan, the address of such person or office andthe geographic area to be served by such contract. The commissioner ofinsurance shall cause to be published in the Kansas register on a weekly basisa copy of all notices received by the commissioner in the preceding week.
(b) If such policy, contract, plan or agreement provides or contracts forthe services of a pharmacy network, such policy, contract, plan or agreementshall permit participation of at least one pharmacy for each Kansas county inwhich that plan has participating employers or physicians. In no event shall aplan have less than one pharmacy within 30 miles of a plan physician oremployer in a Kansas county designated pursuant to K.S.A. 76-375 and amendmentsthereto as an underserved area and within 10 miles in any other county. Theprovisions of this subsection shall apply only if the plan has a written offertoparticipate in the pharmacy network from a registered pharmacy locatedin such Kansas county under the same terms and conditions of the policy,contract, plan or agreement as those offered to any other provider of pharmacyservices.
(c) No such policy, contract, plan or agreement, except as permitted in thissubsection, shall permit or mandate any difference in coverage for or imposeany different conditions, including copayment fees, whether the prescriptionbenefits are provided through direct contact with a pharmacy or by use of anout-of-state mail order pharmacy so long as the provider selected is aparticipant in the plan involved.The limitations of this subsection shall not apply to any pharmacyservices owned and operated by an accident and health insurance company,its commonly owned affiliate or subsidiary,health maintenanceorganization,individual practice association or other similar mechanism.
(d) Any provision in an accident and health insurance policy, contract, planor agreement offered in this state which violates the provisions of thissection is void.
(e) Nothing in this section shall apply to any policy, plan, contract oragreement operating pursuant to the federal employee retirement income securityact of 1974 (ERISA).
(f) The department of insurance shall enforce the provisions of thissection with regard to any policy, contract, plan or agreement issued underauthority of chapter 40 of the Kansas Statutes Annotated.
History: L. 1994, ch. 253, § 1;L. 1997, ch. 8, § 7; July 1.
