40-2228h. Same; claims; procedures; rules and regulations. (a) Within 30 days after receipt of any claim, and amendments thereto, any insurer issuing a policy of long-term care insurance shall pay a clean claim for reimbursement in accordance with this section or send a written or electronic notice acknowledging receipt of and the status of the claim. Such notice shall include the date such claim was received by the insurer and state that:
(1) The insurer refuses to reimburse all or part of the claim and specify each reason for denial; or
(2) additional information is necessary to determine if all or any part of the claim will be reimbursed and what specific additional information is necessary.
(b) If any insurer issuing a policy of long-term care insurance fails to comply with subsection (a), such insurer shall pay interest at the rate of 1% per month on the amount of the claim that remains unpaid 30 days after the receipt of the claim. The interest paid pursuant to this subsection shall be included in any late reimbursement without requiring the person who filed the original claim to make any additional claim for such interest.
(c) After receiving a request for additional information, the person claiming reimbursement shall submit all additional information requested by the insurer within 30 days after receipt of the request for additional information. Failure to furnish such additional information within the time required shall not invalidate nor reduce the claim if it was not reasonably possible to give such information within such time, provided such proof is furnished as soon as possible as defined (within the time prescribed) in paragraph (7) of subsection (A) of K.S.A. 40-2203, and amendments thereto.
(d) Within 30 days after receipt of all the requested additional information, an insurer issuing a policy of long-term care insurance shall pay a clean claim in accordance with this section or send a written or electronic notice that states:
(1) Such insurer refuses to reimburse all or part of the claim; and
(2) specifies each reason for denial. Any insurer issuing a policy of long-term care insurance that fails to comply with this subsection shall pay interest on any amount of the claim that remains unpaid at the rate of 1% per month.
(e) The provisions of subsection (b) shall not apply when there is a good faith dispute about the legitimacy of the claim, or when there is a reasonable basis supported by specific information that such claim was submitted fraudulently.
(f) Any violation of this act by an insurer issuing a policy of long-term care insurance with flagrant and conscious disregard of the provisions of this act or with such frequency as to constitute a general business practice shall be considered a violation of the unfair trade practices act in K.S.A. 40-2401 et seq., and amendments thereto.
(g) The commissioner of insurance shall adopt rules and regulations necessary to carry out the provisions of the Kansas long-term care insurance prompt payment act.
History: L. 2007, ch. 150, ยง 7; July 1.
Structure Kansas Statutes
Article 22 - Uniform Policy Provisions
40-2201 Accident and sickness policy; definition.
40-2202 Same; form of policy; policies issued to nonresidents.
40-2203 Uniform policy provisions; rules and regulations for filing or submission of policies.
40-2204 Conforming to statute; construction of policies in conflict.
40-2205 Statements made in application for policy; effect.
40-2206 Notice acknowledged by insurer not waiver of rights.
40-2207 Age; limit; misstatement by insured.
40-2208 Nonapplication to certain policies.
40-2209a Applicability of 1978 amendments to K.S.A. 40-1805, 40-1905 and 40-2209.
40-2209b Small employer healthcare plans; citation; purpose of act.
40-2209c Same; application of act; construction of 40-2209.
40-2209g Same; establishment of business classes by carrier; limitation.
40-2209i Same; carrier sales solicitations, disclosures required.
40-2209j Same; actuarial certification of underwriting and rating compliance.
40-2209n Same; rules and regulations.
40-2209o Same; violations, penalties.
40-2211 Workmen's compensation; insolvency of insured.
40-2213 Prior policy, rider or endorsement.
40-2220 Coverage of loss from pre-existing conditions required, when.
40-2221a Same; notice required prior to termination; reinstatement.
40-2221b Same; when provisions of 40-2221a not applicable.
40-2222 Health coverage; jurisdiction of commissioner; exceptions.
40-2222b Same; premium tax, rate, computation, return and payment.
40-2223 Same; examination; subject to insurance laws.
40-2224 Same; disclosure to purchaser required.
40-2225 Long-term care insurance; name and citation of act.
40-2226 Same; application and construction of act.
40-2228d Same; lapse or termination of policy or certificate; requirements; notice.
40-2228e Same; reinstatement, conditions.
40-2228f Long-term care insurance prompt payment act; effective date.
40-2228h Same; claims; procedures; rules and regulations.
40-2229 Mammogram and pap smear coverage; policies to which mandated coverage applicable.
40-2231 Continuing care contracts; definitions.
40-2232 Same; provider's annual disclosure statement; contents; requirement to furnish.
40-2233 Same; annual disclosure statement, contract and annual audit; filing with commissioner.
40-2234 Same; providing form to commissioner; contents and attachments.
40-2235 Same; certificate of registration, application, fee, renewal.
40-2237 Same; change of ownership or management of provider or home.
40-2238 Same; rules and regulations.
40-2239 Small employer health benefit plans; definitions.
40-2240 Same; establishment; assistance by commissioner.
40-2241 Same; contracts with carriers; coverage options; application of 40-2209 and 40-2215.
40-2242 Same; qualification for employer participation.
40-2247 Same; exemption from insurance premium tax.
40-2248 Mandated health benefits; impact report to be submitted prior to legislative consideration.
40-2249a Same; state employee group pilot project for new mandated health benefits.
40-2252 Same; rules and regulations.
40-2254 Group accident and sickness insurance; extension of payment of benefits.
40-2255 Accident and sickness insurance; closing block of business, when.
40-2259 Genetic screening or testing; prohibiting the use of; exceptions; restrictions.
40-2260 Group health benefit plan option to establish premium only cafeteria plan.