['Employee Benefits']
['Health Plans']
06/11/2024
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Summary of differences between federal and state regulations
Employee health plans are generally covered under the federal jurisdiction of the Employee Retirement Income Security Act (ERISA).
Federal ERISA plans generally do not have to comply with state laws. ERISA rules preempt or block state laws that relate to ERISA plans. State insurance laws, however, do apply. The following are some of the state’s requirements:
- Insurance coverage to include reimbursement or indemnity for services performed by optometrist, dentist, or podiatrist. (§40-2, 100)
- Coverage for newly born (covered from moment of birth) and adopted children as of the date of the petition for adoption was filed, or when the child was placed in the home. (§40-2, 102)
- Coverage for immunizations for children from birth to 72 months of age. (§40-2, 102)
- Optional coverage for delivery and obstetrical expenses at birth of the birth mother of a child adopted within 90 days of the birth. (§40-2, 102)
- Children are covered even if they
(1)were born out of wedlock;
(2) are not claimed as a dependent on the parent's federal income tax return;
(3) do not reside with the parent or in the plan's service area; or
(4) are receiving, is eligible for or may become eligible for medical assistance. (§40-2256) - Coverage to include reimbursement for services performed by licensed psychologist. (§40-2, 104)
- Coverage for at least 30 days per year for treatment of alcoholism, drug abuse, or nervous or mental conditions in a licensed medical care facility. (§40-2, 105)
- Kansas Mental Health Parity Act covers services rendered in the treatment of certain mental illnesses on the same basis as other diseases. (§40-2, 405a)
- The Kansas Mental Health Parity Act also covers psychotherapeutic drugs used for treatment of mental illness. (§40-2, 105b)
- Rate discrimination on the basis of mental or physical handicaps is prohibited. (§40-2, 109)
- Coverage to include reimbursement for services performed by licensed specialist social worker. (§40-2, 114)
- Coverage to allow choice of pharmacy providers. Plans may not permit or mandate any difference in coverage for or impose any different conditions, including copayment fees, whether the prescription benefits are provided through direct contact with a pharmacy or by use of an out-of-state mail order pharmacy so long as the provider selected is a participant in the plan involved. (§40-2, 153)
- Plan must include coverage for services related to diagnosis, treatment, and management of osteoporosis. (§40-2, 166a)
- Coverage of general anesthesia in conjunction with dental care for certain individuals such as children five years old and under, severely disabled people, or a person has a medical or behavioral condition which requires hospitalization or general anesthesia when dental care is provided. (§40-2, 165)
- Exclusion from coverage of off-label prescriptions for cancer treatment is prohibited. (§40-2, 168)
- Group plans that provide hospital, medical, or surgical benefits that include mental health benefits, must provide parity for the mental health benefits. (§40-2258 per Senate Bill 441, effective July 1, 2008)
- No contract issued or renewed after July 1, 2010 between a health insurer and a dentist who is a participating provider with respect to the health insurer's health benefit plan must contain any provision which requires the dentist who provides any service to an insured under the health benefit plan at a fee set or prescribed by the health insurer unless such service is a covered service (2009 Kansas SB 389)
- Entities offering group coverage may not require individuals, as a condition of enrollment or continued enrollment, to pay a premium or contribution which is greater than premiums or contributions for similarly situated individuals on the basis of whether individuals or a member of the individuals' family has obtained a genetic test or the results of such test. Such entities may not adjust premium or contribution amounts on the basis of whether the individual or a member of the individual's family has obtained a genetic test or the result of such test. (§40-2259)
- Plans that cover prescription drugs and are delivered, issued for delivery, amended or renewed on and after July 1, 2011, must cover a prescribed, orally administered anticancer medication used to kill or slow the growth of cancerous cells on a basis no less favorable than intravenously administered or injected cancer medications that are covered as medical benefits. (2009 Kansas HB 2160)
- Large group health plans that cover accident and health services must provide coverage for the diagnosis and treatment of autism spectrum disorder for children under 12 years old. A large employer is one with an average of at least 51 employees. Effective January 1, 2016, a large employer is one with an average of at least 101 employees, while a small employer is one with up to 100 employees. (§40-2,194)
Federal
Contact
Employee Benefits Security Administration (EBSA)
Regulations
29 CFR chapter XXV (Parts 2509 – 2590)
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