[As Further Amended by Senate Committee of the Whole]
          
Session of 1999
         
SENATE BILL No. 14
         
By Special Committee on Financial Institutions and Insurance
          
12-16
          
10             AN  ACT relating to accident and health insurance; providing coverage
11             for reconstructive breast surgery; amending K.S.A. 1998 Supp. 40-
12             2,103 and 40-19c09 and repealing the existing sections; also repealing
13             K.S.A. 1998 Supp. 40-1909.
14      
15       Be it enacted by the Legislature of the State of Kansas:
16             New Section  1. (a) Any individual or group health insurance policy,
17       medical service plan, contract, hospital service corporation contract, hos-
18       pital and medical service corporation contract, fraternal benefit society
19       or health maintenance organization which provides coverage for accident
20       and health services and which is delivered, issued for delivery, amended
21       or renewed on or after July 1, 1999, and which provides medical and
22       surgical benefits with respect to a mastectomy shall provide, in a case of
23       a participant or beneficiary who is receiving benefits in connection with
24       a mastectomy and who elects breast reconstruction in connection with
25       such mastectomy, coverage for:
26             (1) Reconstruction of the breast on which the mastectomy has been
27       performed;
28             (2) surgery and reconstruction of the other breast to produce a sym-
29       metrical appearance; and
30             (3) prostheses and physical complications in all stages of mastectomy,
31       including lymphedemas.
32             Such coverage shall be provided in a manner determined in consulta-
33       tion with the attending physician and the patient. Such coverage may be
34       subject to annual deductibles and coinsurance provisions as may be
35       deemed appropriate and as are consistent with those established for other
36       benefits under the plan or coverage.
37             (b) Each individual or group health insurance policy, medical service
38       plan, contract, hospital service corporation contract, hospital and medical
39       service corporation contract, fraternal benefit society or health mainte-
40       nance organization which provides coverage for accident and health serv-
41       ices which provides medical and surgical benefits with respect to a mas-
42       tectomy shall provide written notice, as currently required, to all
43       enrollees, insureds or subscribers regarding the coverage required by this

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  1       section.
  2             (c) No individual or group health insurance policy, medical service
  3       plan, contract, hospital service corporation contract, hospital and medical
  4       service corporation contract, fraternal benefit society or health mainte-
  5       nance organization which provides coverage for accident and health serv-
  6       ices which provides medical and surgical benefits with respect to a mas-
  7       tectomy shall:
  8             (1) Deny to a patient eligibility, or continued eligibility, to enroll or
  9       to renew coverage under the terms of the plan, solely for the purpose of
10       avoiding the requirements of this section; and
11             (2) penalize or otherwise reduce or limit the reimbursement of an
12       attending provider, or provide incentives (monetary or otherwise) to an
13       attending provider, to induce such provider to provide care to an individ-
14       ual participant or beneficiary in a manner inconsistent with this section.
15             (d) The provisions of this section shall not apply to any policy or
16       certificate which provides coverage for any specified disease, specified
17       accident or accident only coverage, credit[,] dental, disability income,
18       hospital indemnity, long-term care insurance as defined by K.S.A. 40-
19       2227 and amendments thereto, vision care or any other limited supple-
20       mental benefit nor to any medicare supplement policy of insurance as
21       defined by the commissioner of insurance by rule and regulation, any
22       coverage issued as a supplement to liability insurance, workers' compen-
23       sation or similar insurance, automobile medical-payment insurance or any
24       insurance under which benefits are payable with or without regard to
25       fault, whether written on a group, blanket or individual basis.
26             Sec.  2. K.S.A. 1998 Supp. 40-2,103 is hereby amended to read as
27       follows: 40-2,103. The requirements of K.S.A. 40-2,100, 40-2,101, 40-
28       2,102, 40-2,104, 40-2,105, 40-2,114 and 40-2250, and amendments
29       thereto, and K.S.A. 1998 Supp. 40-2,160 and section 1, and amendments
30       thereto, shall apply to all insurance policies, subscriber contracts or cer-
31       tificates of insurance delivered, renewed or issued for delivery within or
32       outside of this state or used within this state by or for an individual who
33       resides or is employed in this state.
34             Sec.  3. K.S.A. 1998 Supp. 40-19c09 is hereby amended to read as
35       follows: 40-19c09. (a) Corporations organized under the nonprofit med-
36       ical and hospital service corporation act shall be subject to the provisions
37       of the Kansas general corporation code, articles 60 to 74, inclusive, of
38       chapter 17 of the Kansas Statutes Annotated, applicable to nonprofit cor-
39       porations, to the provisions of K.S.A. 40-214, 40-215, 40-216, 40-218, 40-
40       219, 40-222, 40-223, 40-224, 40-225, 40-226, 40-229, 40-230, 40-231, 40-
41       235, 40-236, 40-237, 40-247, 40-248, 40-249, 40-250, 40-251, 40-252,
42       40-254, 40-2,100, 40-2,101, 40-2,102, 40-2,103, 40-2,104, 40-2,105, 40-
43       2,116, 40-2,117, 40-2a01 et seq., 40-2111 to 40-2116, inclusive, 40-2215

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  1       to 40-2220, inclusive, 40-2221a, 40-2221b, 40-2229, 40-2230, 40-2250,
  2       40-2251, 40-2253, 40-2254, 40-2401 to 40-2421, inclusive, and 40-3301
  3       to 40-3313, inclusive, K.S.A. 1998 Supp. 40-2,153, 40-2,154, 40-2,160,
  4       40-2,161, 40-2,163 and, 40-2,164 and section 1, and amendments thereto,
  5       except as the context otherwise requires, and shall not be subject to any
  6       other provisions of the insurance code except as expressly provided in
  7       this act.
  8             (b) No policy, agreement, contract or certificate issued by a corpo-
  9       ration to which this section applies shall contain a provision which ex-
10       cludes, limits or otherwise restricts coverage because medicaid benefits
11       as permitted by title XIX of the social security act of 1965 are or may be
12       available for the same accident or illness.
13             (c) Violation of subsection (b) shall be subject to the penalties pre-
14       scribed by K.S.A. 40-2407 and 40-2411, and amendments thereto. 
15       Sec.  4. K.S.A. 1998 Supp. 40-2,103, 40-1909 and 40-19c09 are
16       hereby repealed.
17        Sec.  5. This act shall take effect and be in force from and after its
18       publication in the statute book.