Kansas Administrative Regulations

Agency 40.  Insurance Department

Article 4.  Accident and Health Insurance

 

 40-4-34 Accident and health insurance; coordination of benefits; guidelines.

 

Sections 3 through 9, including appendices A and B of the national association of insurance commissioners' “group coordination of benefits model regulation,'' January 1996 edition, are hereby adopted by reference subject to the following exceptions:

(a)  Section 3(A)(1)(c) is not adopted and shall be replaced with the following language: “If a person is covered by two (2) or more plans that provide benefits or services on the basis of negotiated fees, or if one plan calculates its benefits or services on the basis of usual and customary fees and another plan provides its benefits or services on the basis of negotiated fees, any amount in excess of the highest of the fees is not an allowable expense.''

(b)  Section 3(A)(1)(d) is not adopted.

(c)  Section (H)(3)(g) is not adopted.

(d)  Section 3(H)(4)(k) is new and shall read as follows: “Plan shall not include group or grouptype accident-only coverages.''

(e)  Section 3(H)(4)(f) is not adopted.

(f)  Sections 8(B)(2) and (3) and (C) are not adopted and shall be replaced with the following language: ``If the Noncomplying Plan reduces its benefits so that the employee, subscriber, or member receives less in benefits than he or she would have received had the Complying Plan paid or provided its benefits as the Secondary Plan and the Noncomplying Plan paid or provided its benefits as the Primary Plan, then the Complying Plan shall advance to or on behalf of the employee, subscriber, or member an amount equal to such difference. However, in no event shall the Complying Plan advance more than the Complying Plan would have paid had it been the Primary Plan less any amount it previously paid.''

(g)  Appendix A. Model COB contract provisions, sections (C)(3) and (4) are not adopted.

 

(Authorized by K.S.A. 40-103, 40-2404a; implementing K.S.A. 1997 Supp. 40-2404; effective May 1, 1981; amended May 1, 1982; amended May 1, 1984; amended May 1, 1985; amended, T-86-13, May 9, 1985; amended May 1, 1986; amended May 1, 1987; amended Feb. 19, 1999.)