40-2118. Same; definitions.
40-2118
40-2118. Same; definitions.As used in this act, unless the context otherwise requires,the following words and phrases shall have the meanings ascribed to them inthis section:
(a) "Administering carrier" means the insurer or third-party administratordesignated in K.S.A. 40-2120, and amendments thereto.
(b) "Association" means the Kansas health insurance association establishedin K.S.A. 40-2119, and amendments thereto.
(c) "Board" means the board of directors of the association.
(d) "Church plan" means a plan as defined under section 3(33) of theEmployee Retirement Income Security Act of 1974.
(e) "Commissioner" means the commissioner of insurance.
(f) "Creditable coverage" means with respect to an individual, coverage ofthe individual under any of the following:
(1) A group health plan;
(2) health insurance coverage;
(3) part A or part B of Title XVIII of the Social Security Act;
(4) title XIX of the Social Security Act, other than coverage consistingsolely of benefit under Section 1928;
(5) chapter 55 of Title 10, United States Code;
(6) a medical care program of the Indian Health Service or of a tribalorganization;
(7) a state health benefit risk pool;
(8) a health plan offered under Chapter 89 of Title 5, United States Code;
(9) a public health plan as defined under regulations promulgated by thesecretary of health and human services; and
(10) a health benefit plan under section 5(e) of the Peace Corps Act (22U.S.C. 2504(d)).
(g) "Dependent" means a resident spouse or resident unmarried child underthe age of 19 years, a child who is a student under the age of 23 years and whois financially dependent upon the parent, or a child of any age who is disabledand dependent upon the parent.
(h) "Excess loss" means the total dollar amount by which claims expenseincurred for any issuer of a medicare supplement policy or certificatedelivered or issued for delivery to persons in this state eligible for medicareby reason of disability and who are under age 65exceeds 65% of the premiumearned by such issuer during a calendar year.
(i) "Federally defined eligible individual" means an individual:
(1) For whom, as of the date the individual seeks coverage under thissection, the aggregate of the periods of creditable coverage is 18or more months and whose most recent prior coverage was under a group healthplan, government plan or church plan;
(2) who is not eligible for coverage under a group health plan, Part A or Bof Title XVII of the Social Security Act, or a state plan under Title XIX ofthe Social Security Act, or any successor program, and who does not have anyother health insurance coverage;
(3) with respect to whom the most recent coverage was not terminated forfactors relating to nonpayment of premiums or fraud; and
(4) who had been offered the option of continuation coverage under COBRA orunder a similar program, who elected such continuation coverage, and who hasexhausted such continuation coverage.
(j) "Federally defined eligible individuals for FTAA" means an individualwho is:
(1) Legally domiciled in this state; and
(2) eligible for the credit for health insurance costs under section 35 oftheinternal revenue code of 1986.
(k) "FTAA" means federal trade adjustment assistance under thefederal trade adjustment assistance reform act of 2002, public law 107-210.
(l) "Governmental plan" means a plan as defined undersection 3(32) of theEmployee Retirement Income Security Act of 1974 and any plan maintained for itsemployees by the government of the United States or by any agency orinstrumentality of such government.
(m) "Group health plan" means an employee benefit plan asdefined by section3(1) of the Employee Retirement Income Security Act of 1974 to the extent thatthe plan provides any hospital, surgical or medical expense benefits toemployees or their dependents (as defined under the terms of the plan) directlyor through insurance, reimbursement or otherwise.
(n) "Health insurance" meansany hospital ormedical expense policy, health, hospital or medical service corporationcontract, and a plan provided by a municipal group-funded pool, or a healthmaintenance organization contract offered by an employer or any certificateissued under any such policies, contracts or plans. "Health insurance" doesnot include policies or certificates covering only accident, credit, dental,disability income, long-term care, hospital indemnity, medicare supplement,specified disease, vision care, coverage issued as a supplement to liabilityinsurance, insurance arising out of a workers compensation or similar law,automobile medical-payment insurance, or insurance under which benefits arepayable with or without regard to fault and which is statutorily required to becontained in any liability insurance policy or equivalent self-insurance.
(o) "Health maintenance organization" means anyorganizationgranted acertificate of authority under the provisions of the health maintenanceorganization act.
(p) "Insurance arrangement" means any plan, program,contract orany otherarrangement under which one or more employers, unions or other organizationsprovide to their employees or members, either directly or indirectly through agroup-funded pool, trust or third-party administrator, health care services orbenefits other than through an insurer.
(q) "Insurer" means any insurance company, fraternalbenefitsociety, healthmaintenance organization and nonprofit hospital and medical servicecorporation authorized to transact health insurance business in this state.
(r) "Medicaid" means the medical assistance programoperated bythe stateunder title XIX of the federal social security act.
(s) "Medicare" means coverage under both parts A and B oftitleXVIII of thefederal social security act, 42 USC 1395.
(t) "Medicare supplement policy" means a group orindividual policy ofaccident and sickness insurance or a subscriber contract of hospitals andmedical service associations or health maintenance organizations, other than apolicy issued pursuant to a contract under section 1876 of the federal socialsecurity act (42 USC 1395 et seq.) or an issued policy under ademonstration project specified in 42 USC 1395ss(g)(1), which isadvertised, marketed or designed primarily as a supplement to reimbursementsunder medicare for the hospital, medical or surgical expenses of personseligible for medicare.
(u) "Member" means all insurers and insurance arrangementsparticipating inthe association.
(v) "Plan" means the Kansas uninsurable health insuranceplancreatedpursuant to this act.
(w) "Plan of operation" means the plan to create andoperate theKansasuninsurable health insurance plan, including articles, bylaws and operatingrules, adopted by the board pursuant to K.S.A. 40-2119, and amendmentsthereto.
History: L. 1992, ch. 209, § 2;L. 1997, ch. 190, § 7;L. 1999, ch. 106, § 1;L. 2004, ch. 159, § 8; May 27.