Issued by the Kansas Insurance Department, Kathleen Sebelius, Commissioner

June 27, 1997

TO:All Insurance Companies, Nonprofit Medical and Hospital Service Corporations, Municipal Group-funded Pools, Fraternal Benefit Societies, Health Maintenance Organizations or any other entity which is Authorized to Transact Accident & Health Insurance Business in Kansas

SUBJECT: Patient Protection Act, Section 16 through 23 of 1997 Kansas Senate Bill No. 204

The Patient Protection Act shall apply to a Health Benefit plan which includes any hospital or medical expense policy, health, hospital or medical service corporation contract, a plan provided by a municipal group-funded pool, a policy or agreement entered into by a health insurer or a health maintenance organization contract offered by an employer or any certificate issued under such policies contracts or plans. The Act shall become effective on July 1, 1997.

This act establishes standards for payment of "Emergency Services" which includes ambulance services and health care items and services furnished or required to evaluate and treat an emergency medical condition, as directed or ordered by a physician. Pursuant to Section 18(a), of the Act, a health plan shall not deny coverage for emergency services if the symptoms presented by an insured and recorded by the attending provider indicate that an emergency medical condition exists, or for emergency services necessary to provide an insured with a medical examination and stabilizing treatment, regardless of whether prior authorization was obtained to provide those services. It is important to note that these services shall be provided both in and out-of-network.

The Patient Protection Act also stipulates the following important requisites:

Other provisions of the Act that are noteworthy include the following:

If you have any questions and would like to speak with someone, please contact the Accident & Health Division of this department at (785) 296-7850.

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