Article 38.--REGULATION AND REGISTRATION OF ADMINISTRATORS
40-3822.Same; definitions.For purposes of this act: (a) "Commissioner" means thecommissioner of insurance asdefined by K.S.A. 40-102 and amendments thereto.
(b) (1) "Covered entity" means:
(A) A nonprofit hospital or medical service corporation, health insurer,health benefitplan or health maintenance organization;
(B) a health program administered by a department or the state in thecapacity of providerof health coverage; or
(C) an employer, labor union or other group of persons organized in thestate thatprovides health coverage to covered individuals who are employed or reside inthe state.
(2) Covered entity shall not include any:
(A) Self-funded plan that is exempt from state regulation pursuant to ERISA;
(B) plan issued for coverage for federal employees; or
(C) health plan that provides coverage only for accidental injury, specifieddisease,hospital indemnity, medicare supplement, disability income, long-term care orotherlimited benefit health insurance policies and contracts.
(c) "Covered person" means a member, policyholder, subscriber, enrollee,beneficiary,dependent or other individual participating in a health benefit plan.
(d) "Pharmacy benefits management" means:
(1) Any of the following services provided with regard to the administrationof thefollowing pharmacy benefits:
(A) Mail service pharmacy;
(B) claims processing, retail network management and payment of claims topharmaciesfor prescription drugs dispensed to covered individuals;
(C) clinical formulary development and management services;
(D) rebate contracting and administration;
(E) certain patient compliance, therapeutic intervention and genericsubstitution programs;or
(F) disease management programs involving prescription drug utilization; and
(2) (A) the procurement of prescription drugs by a prescription benefitsmanager at a negotiated rate for dispensation to covered individuals withinthis state; or
(B) the administration or management of prescription drug benefits providedby a covered insurance entity for the benefit of covered individuals.
(e) "Pharmacy benefits manager" means a person, business or other entity thatperformspharmacy benefits management. Pharmacy benefits manager includesany person or entity acting in a contractual or employment relationshipfor apharmacy benefits manager in the performance of pharmacy benefits managementfor acovered entity.
The term "pharmacy benefits manager"shall not include a covered insurance entity.
(f) "Person" means an individual, partnership, corporation, organization orother business entity.
Article 38.--REGULATION AND REGISTRATION OF ADMINISTRATORS
40-3822.Same; definitions.For purposes of this act: (a) "Commissioner" means thecommissioner of insurance asdefined by K.S.A. 40-102 and amendments thereto.
(b) (1) "Covered entity" means:
(A) A nonprofit hospital or medical service corporation, health insurer,health benefitplan or health maintenance organization;
(B) a health program administered by a department or the state in thecapacity of providerof health coverage; or
(C) an employer, labor union or other group of persons organized in thestate thatprovides health coverage to covered individuals who are employed or reside inthe state.
(2) Covered entity shall not include any:
(A) Self-funded plan that is exempt from state regulation pursuant to ERISA;
(B) plan issued for coverage for federal employees; or
(C) health plan that provides coverage only for accidental injury, specifieddisease,hospital indemnity, medicare supplement, disability income, long-term care orotherlimited benefit health insurance policies and contracts.
(c) "Covered person" means a member, policyholder, subscriber, enrollee,beneficiary,dependent or other individual participating in a health benefit plan.
(d) "Pharmacy benefits management" means:
(1) Any of the following services provided with regard to the administrationof thefollowing pharmacy benefits:
(A) Mail service pharmacy;
(B) claims processing, retail network management and payment of claims topharmaciesfor prescription drugs dispensed to covered individuals;
(C) clinical formulary development and management services;
(D) rebate contracting and administration;
(E) certain patient compliance, therapeutic intervention and genericsubstitution programs;or
(F) disease management programs involving prescription drug utilization; and
(2) (A) the procurement of prescription drugs by a prescription benefitsmanager at a negotiated rate for dispensation to covered individuals withinthis state; or
(B) the administration or management of prescription drug benefits providedby a covered insurance entity for the benefit of covered individuals.
(e) "Pharmacy benefits manager" means a person, business or other entity thatperformspharmacy benefits management. Pharmacy benefits manager includesany person or entity acting in a contractual or employment relationshipfor apharmacy benefits manager in the performance of pharmacy benefits managementfor acovered entity.
The term "pharmacy benefits manager"shall not include a covered insurance entity.
(f) "Person" means an individual, partnership, corporation, organization orother business entity.
Article 38.--REGULATION AND REGISTRATION OF ADMINISTRATORS
40-3822.Same; definitions.For purposes of this act: (a) "Commissioner" means thecommissioner of insurance asdefined by K.S.A. 40-102 and amendments thereto.
(b) (1) "Covered entity" means:
(A) A nonprofit hospital or medical service corporation, health insurer,health benefitplan or health maintenance organization;
(B) a health program administered by a department or the state in thecapacity of providerof health coverage; or
(C) an employer, labor union or other group of persons organized in thestate thatprovides health coverage to covered individuals who are employed or reside inthe state.
(2) Covered entity shall not include any:
(A) Self-funded plan that is exempt from state regulation pursuant to ERISA;
(B) plan issued for coverage for federal employees; or
(C) health plan that provides coverage only for accidental injury, specifieddisease,hospital indemnity, medicare supplement, disability income, long-term care orotherlimited benefit health insurance policies and contracts.
(c) "Covered person" means a member, policyholder, subscriber, enrollee,beneficiary,dependent or other individual participating in a health benefit plan.
(d) "Pharmacy benefits management" means:
(1) Any of the following services provided with regard to the administrationof thefollowing pharmacy benefits:
(A) Mail service pharmacy;
(B) claims processing, retail network management and payment of claims topharmaciesfor prescription drugs dispensed to covered individuals;
(C) clinical formulary development and management services;
(D) rebate contracting and administration;
(E) certain patient compliance, therapeutic intervention and genericsubstitution programs;or
(F) disease management programs involving prescription drug utilization; and
(2) (A) the procurement of prescription drugs by a prescription benefitsmanager at a negotiated rate for dispensation to covered individuals withinthis state; or
(B) the administration or management of prescription drug benefits providedby a covered insurance entity for the benefit of covered individuals.
(e) "Pharmacy benefits manager" means a person, business or other entity thatperformspharmacy benefits management. Pharmacy benefits manager includesany person or entity acting in a contractual or employment relationshipfor apharmacy benefits manager in the performance of pharmacy benefits managementfor acovered entity.
The term "pharmacy benefits manager"shall not include a covered insurance entity.
(f) "Person" means an individual, partnership, corporation, organization orother business entity.
