40-2209f.Same; prexisting conditions exclusion,waiver; late enrollee exclusion; underwriting and rating; waiting periods;uniform employer coverage eligibility requirements; minimum participation andcontribution requirements.Health benefit plans covering small employers that are issued or renewed withinthis state or outside this state covering persons residing in this state shallbe subject to the following provisions, as applicable:
(a) Such policy may impose a preexisting conditionsexclusion, not to exceed 90 days following the date of enrollment, forconditions whether physical or mental, regardless ofthe cause of the condition for which medical advice, diagnosis, care ortreatment was recommended or received in the six months prior to theeffective date of enrollment. Any preexisting conditionsexclusion shall runconcurrently with any waiting period.
(b) Such policy shallwaive such a preexisting conditions exclusion tothe extent the employee or member or individual dependent or family member wascovered by (1) a group or individual sickness and accident policy, (2)coverageunder section 607(1) of the employees retirement income security act of1974 (ERISA), (3) agroup specified in K.S.A. 40-2222 and amendments thereto(4) part A or part B of title XVIII of the social security act, (5) titleXIX ofthe social security act, other than coverage consisting solely of benefitsunder section 1928, (6) chapter 55 of title 10 United States code, (7) astate children's health insurance program established pursuant to title XXI ofthe social security act, (8)medical careprogram of the indian health service or of a tribal organization,(9) theKansas uninsurable health plan act pursuant toK.S.A. 40-2217 et seq. and amendments thereto or similar healthbenefits risk pool of another state,(10) a health planoffered under chapter 89 of title 5, United States code, (11) ahealth benefitplan under section 5(e) of the peace corps act (22 U.S.C. 2504 (e) or(12)a group subject toK.S.A. 12-2616 et seq. and amendments thereto whichprovided hospital, medical and surgical expense benefits within 63days priorto the effective date of coverage under a health benefitplan with no gap in coverage.A group policy shall credit the periods of prior coverage specified in thissubsection without regard to the specific benefits covered during the period ofprior coverage. Any period that the employee or member is in a waiting periodfor any coverage under a group health plan or is in an affiliation period shallbe taken into account in determining the continuous period under thissubsection.
(c) A carrier may exclude a late enrollee except during an open enrollmentperiod.
(d) Except as expressly provided by this act, every carrierdoing businessin the small employer market retains the authority to underwrite and rateindividual accident and sickness insurance policies, and to rate small employergroups using generally accepted actuarial practices.
(e) No health benefit plan issued by a carrier may limit orexclude, by useof a rider or amendment applicable to a specific individual, coverage by typeof illness, treatment, medical condition or accident, except forpreexisting conditions as permitted under subsection (a).
(f) In the absence of the small employer's decision to thecontrary, allhealth benefit plans shall make coverage available to all the eligibleemployees of a small employer without a waiting period. Thedecision of whether to impose a waiting period for eligibleemployees of a small employer shall be made by the small employer, who may onlychoose from the waiting periods offered by the carrier. No waiting periodshall be greater than 90 days and shall permitcoverage to become effective no later than the first day of the monthimmediately following completion of the waiting period.
(g) (1) Except as provided in subsection (f),requirements usedby a smallemployer carrier in determining whether to provide coverage to a smallemployer, including requirements for minimum participation of eligibleemployees and minimum employer contributions, shall be applied uniformly amongall small employers with the same number of eligible employees applying forcoverage or receiving coverage from the small employer carrier.
(2) A small employer carrier may vary application of minimum participationrequirements and minimum employer contribution requirements only by the size ofthe small employer group.
(3) (A) Except as provided in provision (B), in applying minimumparticipation requirements with respect to a small employer, a small employercarrier shall not consider employees or dependents who have qualifying existingcoverage in a health benefit plan sponsored by another employer in determiningwhether the applicable percentage of participation ismet.
(B) With respect to a small employer, a small employer carrier may consideremployees or dependents who have coverage under another health benefit plansponsored by such small employer in applying minimum participationrequirements.
(h) For the purposes of this section, the term "preexistingconditionsexclusion" shall mean, with respect to coverage, a limitation or exclusion ofbenefits relating to a condition based on the fact that the condition waspresent before the date of enrollment for such coverage whether or not anymedical advice, diagnosis, care or treatment was recommended or received beforesuch date.
(i) For the purposes of this section, the term "date ofenrollment" meansthe date the individual is enrolled under the group policy or, if earlier, thefirst day of the waiting period for such enrollment.
(j) For the purposes of this section, the term "waitingperiod" means withrespect to a group policy the period which must pass before the individual iseligible to be covered for benefits under the terms of the policy.
40-2209f.Same; prexisting conditions exclusion,waiver; late enrollee exclusion; underwriting and rating; waiting periods;uniform employer coverage eligibility requirements; minimum participation andcontribution requirements.Health benefit plans covering small employers that are issued or renewed withinthis state or outside this state covering persons residing in this state shallbe subject to the following provisions, as applicable:
(a) Such policy may impose a preexisting conditionsexclusion, not to exceed 90 days following the date of enrollment, forconditions whether physical or mental, regardless ofthe cause of the condition for which medical advice, diagnosis, care ortreatment was recommended or received in the six months prior to theeffective date of enrollment. Any preexisting conditionsexclusion shall runconcurrently with any waiting period.
(b) Such policy shallwaive such a preexisting conditions exclusion tothe extent the employee or member or individual dependent or family member wascovered by (1) a group or individual sickness and accident policy, (2)coverageunder section 607(1) of the employees retirement income security act of1974 (ERISA), (3) agroup specified in K.S.A. 40-2222 and amendments thereto(4) part A or part B of title XVIII of the social security act, (5) titleXIX ofthe social security act, other than coverage consisting solely of benefitsunder section 1928, (6) chapter 55 of title 10 United States code, (7) astate children's health insurance program established pursuant to title XXI ofthe social security act, (8)medical careprogram of the indian health service or of a tribal organization,(9) theKansas uninsurable health plan act pursuant toK.S.A. 40-2217 et seq. and amendments thereto or similar healthbenefits risk pool of another state,(10) a health planoffered under chapter 89 of title 5, United States code, (11) ahealth benefitplan under section 5(e) of the peace corps act (22 U.S.C. 2504 (e) or(12)a group subject toK.S.A. 12-2616 et seq. and amendments thereto whichprovided hospital, medical and surgical expense benefits within 63days priorto the effective date of coverage under a health benefitplan with no gap in coverage.A group policy shall credit the periods of prior coverage specified in thissubsection without regard to the specific benefits covered during the period ofprior coverage. Any period that the employee or member is in a waiting periodfor any coverage under a group health plan or is in an affiliation period shallbe taken into account in determining the continuous period under thissubsection.
(c) A carrier may exclude a late enrollee except during an open enrollmentperiod.
(d) Except as expressly provided by this act, every carrierdoing businessin the small employer market retains the authority to underwrite and rateindividual accident and sickness insurance policies, and to rate small employergroups using generally accepted actuarial practices.
(e) No health benefit plan issued by a carrier may limit orexclude, by useof a rider or amendment applicable to a specific individual, coverage by typeof illness, treatment, medical condition or accident, except forpreexisting conditions as permitted under subsection (a).
(f) In the absence of the small employer's decision to thecontrary, allhealth benefit plans shall make coverage available to all the eligibleemployees of a small employer without a waiting period. Thedecision of whether to impose a waiting period for eligibleemployees of a small employer shall be made by the small employer, who may onlychoose from the waiting periods offered by the carrier. No waiting periodshall be greater than 90 days and shall permitcoverage to become effective no later than the first day of the monthimmediately following completion of the waiting period.
(g) (1) Except as provided in subsection (f),requirements usedby a smallemployer carrier in determining whether to provide coverage to a smallemployer, including requirements for minimum participation of eligibleemployees and minimum employer contributions, shall be applied uniformly amongall small employers with the same number of eligible employees applying forcoverage or receiving coverage from the small employer carrier.
(2) A small employer carrier may vary application of minimum participationrequirements and minimum employer contribution requirements only by the size ofthe small employer group.
(3) (A) Except as provided in provision (B), in applying minimumparticipation requirements with respect to a small employer, a small employercarrier shall not consider employees or dependents who have qualifying existingcoverage in a health benefit plan sponsored by another employer in determiningwhether the applicable percentage of participation ismet.
(B) With respect to a small employer, a small employer carrier may consideremployees or dependents who have coverage under another health benefit plansponsored by such small employer in applying minimum participationrequirements.
(h) For the purposes of this section, the term "preexistingconditionsexclusion" shall mean, with respect to coverage, a limitation or exclusion ofbenefits relating to a condition based on the fact that the condition waspresent before the date of enrollment for such coverage whether or not anymedical advice, diagnosis, care or treatment was recommended or received beforesuch date.
(i) For the purposes of this section, the term "date ofenrollment" meansthe date the individual is enrolled under the group policy or, if earlier, thefirst day of the waiting period for such enrollment.
(j) For the purposes of this section, the term "waitingperiod" means withrespect to a group policy the period which must pass before the individual iseligible to be covered for benefits under the terms of the policy.
40-2209f.Same; prexisting conditions exclusion,waiver; late enrollee exclusion; underwriting and rating; waiting periods;uniform employer coverage eligibility requirements; minimum participation andcontribution requirements.Health benefit plans covering small employers that are issued or renewed withinthis state or outside this state covering persons residing in this state shallbe subject to the following provisions, as applicable:
(a) Such policy may impose a preexisting conditionsexclusion, not to exceed 90 days following the date of enrollment, forconditions whether physical or mental, regardless ofthe cause of the condition for which medical advice, diagnosis, care ortreatment was recommended or received in the six months prior to theeffective date of enrollment. Any preexisting conditionsexclusion shall runconcurrently with any waiting period.
(b) Such policy shallwaive such a preexisting conditions exclusion tothe extent the employee or member or individual dependent or family member wascovered by (1) a group or individual sickness and accident policy, (2)coverageunder section 607(1) of the employees retirement income security act of1974 (ERISA), (3) agroup specified in K.S.A. 40-2222 and amendments thereto(4) part A or part B of title XVIII of the social security act, (5) titleXIX ofthe social security act, other than coverage consisting solely of benefitsunder section 1928, (6) chapter 55 of title 10 United States code, (7) astate children's health insurance program established pursuant to title XXI ofthe social security act, (8)medical careprogram of the indian health service or of a tribal organization,(9) theKansas uninsurable health plan act pursuant toK.S.A. 40-2217 et seq. and amendments thereto or similar healthbenefits risk pool of another state,(10) a health planoffered under chapter 89 of title 5, United States code, (11) ahealth benefitplan under section 5(e) of the peace corps act (22 U.S.C. 2504 (e) or(12)a group subject toK.S.A. 12-2616 et seq. and amendments thereto whichprovided hospital, medical and surgical expense benefits within 63days priorto the effective date of coverage under a health benefitplan with no gap in coverage.A group policy shall credit the periods of prior coverage specified in thissubsection without regard to the specific benefits covered during the period ofprior coverage. Any period that the employee or member is in a waiting periodfor any coverage under a group health plan or is in an affiliation period shallbe taken into account in determining the continuous period under thissubsection.
(c) A carrier may exclude a late enrollee except during an open enrollmentperiod.
(d) Except as expressly provided by this act, every carrierdoing businessin the small employer market retains the authority to underwrite and rateindividual accident and sickness insurance policies, and to rate small employergroups using generally accepted actuarial practices.
(e) No health benefit plan issued by a carrier may limit orexclude, by useof a rider or amendment applicable to a specific individual, coverage by typeof illness, treatment, medical condition or accident, except forpreexisting conditions as permitted under subsection (a).
(f) In the absence of the small employer's decision to thecontrary, allhealth benefit plans shall make coverage available to all the eligibleemployees of a small employer without a waiting period. Thedecision of whether to impose a waiting period for eligibleemployees of a small employer shall be made by the small employer, who may onlychoose from the waiting periods offered by the carrier. No waiting periodshall be greater than 90 days and shall permitcoverage to become effective no later than the first day of the monthimmediately following completion of the waiting period.
(g) (1) Except as provided in subsection (f),requirements usedby a smallemployer carrier in determining whether to provide coverage to a smallemployer, including requirements for minimum participation of eligibleemployees and minimum employer contributions, shall be applied uniformly amongall small employers with the same number of eligible employees applying forcoverage or receiving coverage from the small employer carrier.
(2) A small employer carrier may vary application of minimum participationrequirements and minimum employer contribution requirements only by the size ofthe small employer group.
(3) (A) Except as provided in provision (B), in applying minimumparticipation requirements with respect to a small employer, a small employercarrier shall not consider employees or dependents who have qualifying existingcoverage in a health benefit plan sponsored by another employer in determiningwhether the applicable percentage of participation ismet.
(B) With respect to a small employer, a small employer carrier may consideremployees or dependents who have coverage under another health benefit plansponsored by such small employer in applying minimum participationrequirements.
(h) For the purposes of this section, the term "preexistingconditionsexclusion" shall mean, with respect to coverage, a limitation or exclusion ofbenefits relating to a condition based on the fact that the condition waspresent before the date of enrollment for such coverage whether or not anymedical advice, diagnosis, care or treatment was recommended or received beforesuch date.
(i) For the purposes of this section, the term "date ofenrollment" meansthe date the individual is enrolled under the group policy or, if earlier, thefirst day of the waiting period for such enrollment.
(j) For the purposes of this section, the term "waitingperiod" means withrespect to a group policy the period which must pass before the individual iseligible to be covered for benefits under the terms of the policy.
