Kathleen Sebelius, Commissioner of Insurance

BULLETIN No. 1998-9, May 29, 1998

TO: All Companies Authorized to Transact Accident and Health Insurance Business in the State of Kansas

SUBJECT: 1998 House Substitute for Senate Bill 439

The purpose of this bulletin is to advise all companies authorized to transact Accident and Health Insurance in Kansas of the requirements of the captioned legislation. Failure to comply with the requirements of the legislation could result in mandatory fines and/or other penalty provisions in accordance with Kansas law.

Insurers are hereby advised to notify all of their marketing and claims personnel of 1998 House Substitute for Senate Bill 439. Any policy or certificate containing a provision or provisions not in compliance with this legislation must be amended and all necessary amendments must be filed and approved by this department prior to issuance.

1998 Kansas HOUSE Substitute for SENATE BILL No. 439

Increased Health Insurance Coverage for the Treatment of Diabetes. The captioned legislation would require individual and group health insurance policies, medical service plans, contracts, nonprofit medical and hospital service corporations, fraternal benefit societies, or health maintenance organizations to provide coverage for certain equipment and supplies used in the treatment of diabetes.

• Coverage for equipment and supplies would be limited to hypodermic needles and supplies used exclusively with diabetes management and outpatient self-management training and education; including medical nutrition therapy, for the treatment of insulin dependent diabetes, insulin-using diabetes, gestational diabetes, and non insulin using diabetes if prescribed by a health care professional legally authorized to prescribe such services and supplies.
• Coverage for insulin is only required when there is coverage of prescription drugs.
• Coverage for diabetes outpatient self-management training and education is only required when provided by a certified, registered, or licensed healthcare professional with expertise in diabetes. The coverage required by this act will only be covered when ordered by a healthcare professional legally authorized to prescribe such services and the diabetic (1) is treated at an approved program, (2) is treated by a person certified by the National Certification Board for Diabetes Educators, or (3) is, as to nutritional education, treated by a licensed dietitian pursuant to an approved treatment plan.
• Benefits for the treatment of diabetes shall be subject to copayments, deductibles, and medical necessity that is applicable to all other covered benefits.
• The mandate for covering diabetes equipment, supplies, and education and training would not apply to any Medicare supplemental policy of insurance, any policy of any long-term care insurance, specific disease, or specified accident coverage or any accident only coverage whether written on a group, blanket, or individual basis.

This mandate shall apply to all contracts and certificates issued to residents of this state on or after January 1, 1999. Contracts and certificates which were in existence prior to January 1, 1999, must be brought into compliance no later than the first renewal date or the first policy annual anniversary date on or after January 1, 1999.

Mandated Health Insurance Coverage for the Screening of Prostate Cancer. The captioned legislation would require individual and group health insurance policies, medical service plans, contracts, hospital service corporations, fraternal benefit societies, or health maintenance organizations to provide coverage for prostate cancer screening.

• Benefits shall include coverage for prostate cancer screening for men 40 years of age or over who are symptomatic or in a high risk category, and for all men 50 years of age or older.
• Minimum screening requirements shall consist of a prostate-specific antigen blood test and a digital rectal examination.
• Benefits for prostate screening shall be subject to the same deductibles, coinsurance and other limitations that apply to other covered services.
• The provisions of this mandate shall not apply to any medicare supplement policy of insurance, any policy of long-term care insurance, any specified disease, specified accident coverage, or any accident only coverage whether written on a group, blanket or individual basis.

This mandate shall apply to all contracts and certificates issued to residents of this state on or after July 1, 1998. Contracts and certificates which were in existence prior to July 1, 1998, must be brought into compliance no later than the first renewal date or the first policy annual anniversary date on or after July 1, 1998.

Amendment to K.S.A. 40-2,105, in reference to Medical Savings Accounts.

• High deductible comprehensive health policies issued in connection with a Medical Savings Account (MSAs) in Kansas shall provide coverage for the outpatient costs of treatment of the insured for alcoholism, drug abuse and nervous or mental conditions on the same level they are provided for a medical condition, after the amount of eligible deductible expenses have been paid by the insured, subject to the yearly and lifetime maximums provided in K.S.A. 40-2,105(a). The outpatient maximums are $1,000 in any year and $7,500 in such person's lifetime.

This amendment becomes effective July 1, 1998.

Amendments to Kansas Health Insurance Association. K.S.A. 1997 Supp. 40-2122.

• In addition to the existing eligibility requirements this amendment allows persons who were previously covered under a high risk pool of another state, provided they apply for coverage under the plan within 63 days of losing such other coverage for reasons other than fraud or nonpayment of premiums, to be covered under the Kansas Health Insurance Association (high risk pool).

This amendment become effective July 1, 1998.

Amendments to Small/Large Group definitions of "Preexisting Conditions".

• The definition of "preexisting conditions exclusion", found in small and large group health insurance laws, has been clarified to state that the exclusion period does not exceed 90 days following the date of enrollment for conditions identified as preexisting conditions. This clarification is consistent with the provisions of the Health Insurance Portability and Accountability Act of 1996 ("HIPPA").
• The time a child has spent in a state health insurance program for children established pursuant to federal law (Title XXI) will be considered as creditable coverage and the time frame will count towards any preexisting waiting period of a group health insurance plan subject to Kansas insurance laws.

These amendments apply to all contracts and certificates issued to residents of this state issued on or after July 1, 1998. Contracts and certificates which were in existence prior to July 1, 1998, must be brought into compliance no later than July 1, 1998.

Amendments to abolish the Small Employer Health Reinsurance Program.

• The Kansas Small Employer Health Reinsurance Program is abolished as July 1, 1998. Basic and standard Kansas Small Employer Health Care Plans (SEHC plans) will not be required to be offered by small employer group insurers on and after July 1, 1998. Other provisions of Kansas insurance laws relating to small employer health insurance coverage remain unchanged.

These amendments become effective July 1, 1998.

If you have any questions or comments regarding this Bulletin, please contact the Accident and Health Division of the Kansas Insurance Department, 420 SW 9th Street, Topeka, Kansas 66612, (785)296-7850.