Kan. Admin. Regs. § 40-4-43 - Hospital, medical, and surgical expense insurance policies and certificates; prohibiting certain types of discrimination
(a) A hospital, medical, or surgical expense
policy or certificate issued by an insurance company, nonprofit health service
corporation, nonprofit medical and hospital service corporation, or health
maintenance organization shall not be delivered or issued for delivery in this
state on an individual, group, blanket, franchise, or association basis if the
amount of benefits payable or a term, condition, or type of coverage is or
could be restricted, modified, excluded, or reduced onthe basis of whether both
of the following conditions are met:
(1) The
insured or prospective insured has been diagnosed with cancer and accepted into
a phase I, phase II, phase III, or phase IV clinical trial for
cancer.
(2) The treating physician
who is providing covered health care services to the insured recommends
participation in the clinical trial after determining that participation in the
clinical trial has a meaningful potential to benefit the insured.
(b) Each policy or certificate
covered by this regulation shall provide coverage for all routine patient care
costs associated with the provision of health care services, including drugs,
items, devices, treatments, diagnostics, and services that would otherwise be
covered under the insurance policy or certificate if those drugs, items,
devices, treatments, diagnostics, and services were not provided in connection
with an approved clinical trial program, including health care services
typically provided to patients not participating in a clinical trial.
(c) For purposes of this regulation, "routine
patient care costs" shall not include the costs associated with the provision
of any of the following:
(1) Drugs or devices
that have not been approved by the federal food and drug administration and
that are associated with the clinical trial;
(2) services other than health care services,
including travel, housing, companion expenses, and other nonclin-ical expenses,
that an insured could require as a result of the treatment being provided for
purposes of the clinical trial;
(3)
any item or service that is provided solely to satisfy data collection and
analysis needs and that is not used in the clinical management of the
patient;
(4) health care services
that, except for the fact that they are being provided in a clinical trial, are
otherwise specifically excluded from coverage under the insured's hospital,
medical, or surgical expense policy or certificate; or
(5) health care services customarily provided
by the research sponsors of a trial free of charge for any insured in the
trial.
(d) This
regulation shall not apply if the amount of benefits, the terms, the
conditions, or the type of coverage varies as a result of the application of
permissible rate differentials or as a result of negotiations between the
insurer and insured.
Notes
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