40-2122. Same; persons eligible for plan coverage; termination upon cessation of eligibility; notice of availability of coverage.
40-2122
40-2122. Same; persons eligible for plan coverage;termination upon cessation ofeligibility; notice of availability ofcoverage.(a) The following individuals shall be eligible for plan coverage provided theymeet the criteria set forth in subsection (b):
(1) Any person who has been a resident of this state for at least sixmonths;
(2) any person who is a legal domiciliary of this state who previously wascovered under the high risk pool of another state, provided they apply forcoverage under the plan within 63 days of losing such other coverage forreasons other than fraud or nonpayment of premiums;
(3) any federally defined eligible individual who is a legal domiciliary ofthis state; or
(4) any federally defined eligible individual for FTAA.
(b) Those individuals who are eligible for plan coverage undersubsection (a) must provide evidencesatisfactory to the administering carrier that such person meets one of thefollowing criteria:
(1) Such person has had health insurance coverage involuntarily terminatedfor any reason other than nonpayment of premium;
(2) such person has applied for health insurance and been rejected by twocarriers because of health conditions;
(3) such person has applied for health insurance and has been quoted apremium rate which is in excess of the plan rate;
(4) such person has been accepted for health insurance subject to apermanent exclusion of a preexisting disease or medical condition;
(5) such person is a federally defined eligible individual; or
(6) such person is a federally defined eligible individual for FTAA.
(c) Each resident dependent of a person who is eligible for plancoverageshall also be eligible for plan coverage.
(d) The following persons shall not be eligible for coverageunder the plan:
(1) Any person who is eligible for medicare or iseligible for medicaidbenefits;
(2) any person who has had coverage under the plan terminated less than 12months prior to the date of the current application, except that thisprovision shall not apply with respect to an applicant who is a federallydefined eligible individual;
(3) any person who has received accumulated benefits from the plan equal toor in excess of the lifetime maximum benefits under the plan prescribed byK.S.A. 40-2124 and amendments thereto;
(4) any person having access to accident and health insurance through anemployer-sponsored group or self-insured plan, including coverage under theconsolidated omnibus budget reconciliation act (COBRA), except that therequirement for exhaustion of any available COBRA or state continuation iswaived whenever such person:
(A) Is eligible for the credit for health care costs under section 35 of theinternal revenue code of 1986; and
(B) has three months of prior creditable coverage as described in subsection(c) of K.S.A. 40-2124, and amendments thereto; or
(5) any person who is eligible for any other public orprivate program thatprovides or indemnifies for health services.
(e) Any person who ceases to meet the eligibility requirementsof thissection may be terminated at the end of a policy period.
(f) All plan members, insurers and insurance arrangements shallnotifyin writing persons denied health insurance coverage, for any reason, of theavailabilityof coverage through the Kansas health insurance association.
History: L. 1992, ch. 209, § 6;L. 1995, ch. 129, § 1;L. 1997, ch. 190, § 10;L. 1998, ch. 174, § 4;L. 1999, ch. 30, § 1;L. 2004, ch. 159, § 9; May 27.