40-22a14.Same; exceptions; review procedure;confidentiality.On and after January 1, 2000:
(a) The provisions of K.S.A. 40-22a13 through 40-22a16 andamendments thereto shall not apply to any policy orcertificate which provides coverage for any specified disease, specifiedaccident or accident only coverage, credit, dental, disability income, hospitalindemnity, long-term care insurance as defined by K.S.A. 40-227, and amendmentsthereto, vision care or any other limited supplemental benefit nor to anymedicare supplement policy of insurance as defined by the commissioner ofinsurance by rule and regulation, coverage under a plan through medicare,medicaid, or the federal employees health benefits program, any coverage issuesas a supplement to liability insurance, workers compensation or similarinsurance, automobile medical-payment insurance or any insurance under whichbenefits are payable with or without regard to fault, whether written on agroup, blanket or individual basis.
(b) The right to external review under K.S.A. 40-22a13 through40-22a16, and amendmentsthereto, shall not beconstrued tochange the terms of coverage under a health insurance plan or insurance policy.
(c) The insurer or health insurance plan shall provide written notice to theinsured of a final adverse decision and the opportunity for requesting anexternal review.
(d) The insured has the right to request an independent external review ofan adverse decision by a health insurance plan or insurer when: (1) The insuredhas exhausted all available internal review procedures provided by the healthinsurance plan or insurer, unless the insured has an emergency medicalcondition, in which case an expedited procedure is used; or (2) the insured hasnot received a final decision from the insurer within 60 days of seeking theinternal review, except to the extent that the delay was requested by theinsured.
(e) Within 90 days of receipt of an adverse decision by a health insuranceplan or an insurer, any request for external review shall be made in writing tothe commissioner from the following persons: (1) The insured; (2) the treatingphysician or health care provider acting on behalf on [of] the insuredwith writtenauthorization from the insured; or (3) a legally authorized designee of theinsured.
(f) The insured shall provide all information in the possession of theinsured pertaining to the adverse decision in order for the commissioner tomake a preliminary determination for an external review. The insured also shallprovide the commissioner with an appeal form, and a fully executed release forthe commissioner and the external review organization to obtain any necessarymedical records from the insurer or health insurance plan and any otherrelevant provider.
(g) In responding to the commissioner, the insurer or health insurance planshall provide a copy of the adverse decision given to the insured and allmedical and other records pertaining to the insured's claim within fivebusiness days of the request of the commissioner.
(h) The confidentiality of any medical information submitted by the insured,on behalf of the insured, insurer or health insurance plan, shall bemaintained pursuant to applicable state and federal laws.
40-22a14.Same; exceptions; review procedure;confidentiality.On and after January 1, 2000:
(a) The provisions of K.S.A. 40-22a13 through 40-22a16 andamendments thereto shall not apply to any policy orcertificate which provides coverage for any specified disease, specifiedaccident or accident only coverage, credit, dental, disability income, hospitalindemnity, long-term care insurance as defined by K.S.A. 40-227, and amendmentsthereto, vision care or any other limited supplemental benefit nor to anymedicare supplement policy of insurance as defined by the commissioner ofinsurance by rule and regulation, coverage under a plan through medicare,medicaid, or the federal employees health benefits program, any coverage issuesas a supplement to liability insurance, workers compensation or similarinsurance, automobile medical-payment insurance or any insurance under whichbenefits are payable with or without regard to fault, whether written on agroup, blanket or individual basis.
(b) The right to external review under K.S.A. 40-22a13 through40-22a16, and amendmentsthereto, shall not beconstrued tochange the terms of coverage under a health insurance plan or insurance policy.
(c) The insurer or health insurance plan shall provide written notice to theinsured of a final adverse decision and the opportunity for requesting anexternal review.
(d) The insured has the right to request an independent external review ofan adverse decision by a health insurance plan or insurer when: (1) The insuredhas exhausted all available internal review procedures provided by the healthinsurance plan or insurer, unless the insured has an emergency medicalcondition, in which case an expedited procedure is used; or (2) the insured hasnot received a final decision from the insurer within 60 days of seeking theinternal review, except to the extent that the delay was requested by theinsured.
(e) Within 90 days of receipt of an adverse decision by a health insuranceplan or an insurer, any request for external review shall be made in writing tothe commissioner from the following persons: (1) The insured; (2) the treatingphysician or health care provider acting on behalf on [of] the insuredwith writtenauthorization from the insured; or (3) a legally authorized designee of theinsured.
(f) The insured shall provide all information in the possession of theinsured pertaining to the adverse decision in order for the commissioner tomake a preliminary determination for an external review. The insured also shallprovide the commissioner with an appeal form, and a fully executed release forthe commissioner and the external review organization to obtain any necessarymedical records from the insurer or health insurance plan and any otherrelevant provider.
(g) In responding to the commissioner, the insurer or health insurance planshall provide a copy of the adverse decision given to the insured and allmedical and other records pertaining to the insured's claim within fivebusiness days of the request of the commissioner.
(h) The confidentiality of any medical information submitted by the insured,on behalf of the insured, insurer or health insurance plan, shall bemaintained pursuant to applicable state and federal laws.
40-22a14.Same; exceptions; review procedure;confidentiality.On and after January 1, 2000:
(a) The provisions of K.S.A. 40-22a13 through 40-22a16 andamendments thereto shall not apply to any policy orcertificate which provides coverage for any specified disease, specifiedaccident or accident only coverage, credit, dental, disability income, hospitalindemnity, long-term care insurance as defined by K.S.A. 40-227, and amendmentsthereto, vision care or any other limited supplemental benefit nor to anymedicare supplement policy of insurance as defined by the commissioner ofinsurance by rule and regulation, coverage under a plan through medicare,medicaid, or the federal employees health benefits program, any coverage issuesas a supplement to liability insurance, workers compensation or similarinsurance, automobile medical-payment insurance or any insurance under whichbenefits are payable with or without regard to fault, whether written on agroup, blanket or individual basis.
(b) The right to external review under K.S.A. 40-22a13 through40-22a16, and amendmentsthereto, shall not beconstrued tochange the terms of coverage under a health insurance plan or insurance policy.
(c) The insurer or health insurance plan shall provide written notice to theinsured of a final adverse decision and the opportunity for requesting anexternal review.
(d) The insured has the right to request an independent external review ofan adverse decision by a health insurance plan or insurer when: (1) The insuredhas exhausted all available internal review procedures provided by the healthinsurance plan or insurer, unless the insured has an emergency medicalcondition, in which case an expedited procedure is used; or (2) the insured hasnot received a final decision from the insurer within 60 days of seeking theinternal review, except to the extent that the delay was requested by theinsured.
(e) Within 90 days of receipt of an adverse decision by a health insuranceplan or an insurer, any request for external review shall be made in writing tothe commissioner from the following persons: (1) The insured; (2) the treatingphysician or health care provider acting on behalf on [of] the insuredwith writtenauthorization from the insured; or (3) a legally authorized designee of theinsured.
(f) The insured shall provide all information in the possession of theinsured pertaining to the adverse decision in order for the commissioner tomake a preliminary determination for an external review. The insured also shallprovide the commissioner with an appeal form, and a fully executed release forthe commissioner and the external review organization to obtain any necessarymedical records from the insurer or health insurance plan and any otherrelevant provider.
(g) In responding to the commissioner, the insurer or health insurance planshall provide a copy of the adverse decision given to the insured and allmedical and other records pertaining to the insured's claim within fivebusiness days of the request of the commissioner.
(h) The confidentiality of any medical information submitted by the insured,on behalf of the insured, insurer or health insurance plan, shall bemaintained pursuant to applicable state and federal laws.
