Health Insurance in Kansas

Health Insurance in Kansas
Having a suitable health insurance is the key to all your financial worries arising from the occurrence of illness or an injury. A good evaluation of all future risks and its impact on your finances is compulsory. In the U.S., approximately 47 million people are uninsured, among whom a majority of families are threatened by the unexpected medical expenses due to the lack of proper health coverage. For those families who are not covered by their employers’ group plan, there are low-cost state sponsored health insurance programs that provide insurance to the medically-uninsurable individuals.

In 2008, Kansas was ranked 22nd healthiest state to live in according to the United Health Foundation’s Health Rankings. The state was on the 23rd and 17th position in 2007 and 2006 respectively. Several factors contributed to the recovering healthcare system of Kansas including poor public health funding and low percentage of residents without health coverage. The state of Kansas, with more than two million people, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide low-cost coverage to the uninsurable citizens of Kansas who meet specific eligibility requirements of age and income.

The Kansas Insurance Department manages and administers all kinds of insurance sold through private-market health insurers as well as public health coverage programs. However, approximately 12.6% of the state’s population is still uninsured. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, roughly 38.4 of Kansas’s uninsured citizens come under the above 200% FPL category.

Buying health coverage is not quite easy. However, with the guidance of a licensed health insurance agent/broker, you can select a proper health insurance plan with benefits ideal for your family.

Individual/Family Health Insurance

Below is the guidelines for applying for and obtaining individual health insurance in the state of Kansas. These regulations apply to all insurance companies offering individual or family health insurance in Kansas:

Medical Underwriting
Yes
Pre-Existing Condition Exclusion Period
24 months
Look Back Period
No Limit
Look Back Standard
No Definition
Mandatory Benefits
Cancer screening for women including breast cancer screening, cervical cancer screening, reconstructive surgery after mastectomy, osteoporosis screening, direct access to OB/GYNs
Market Rate Restrictions
None
Guaranteed Issue Options
None
Small Group Health Insurance

Below is the guidelines for small group health insurance in the state of Kansas. These regulations apply to all insurance companies offering small group health insurance in Kansas:

Small Group Size
2-50
Employee Qualifications
Two employees must work for at least 6 months out of the year, and work 20 hours per week
Guaranteed Issue
Yes
Premium Rating Factors
Rate Bands
Rate Adjustment Factors
25%
Look-Back Period
3 months
Pre-existing condition exclusionary period
3 months
Mandatory Benefits
Same as individual
State Cobra Variations for Small Groups

Below are the COBRA guidelines for small groups in the state of Kansas. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:

Mini-Cobra Option
Yes
Eligible Group Sizes
2-19
Extension of Benefits Period – Standard
18 months
Extension of Benefits Period – Disabled
18 months
Maximum Premium Increase
100%
State Legislation Reference
Kansas Continuation Law, K.S.A 40-2209
Additional Notes
The burden of continuation is placed on the insurance com­pany. Kansas mini-cobra applies to terminated group policies and exempts new carriers when the employer switches insurance plans,
State Sponsored Health Insurance Programs

There are several state sponsored health insurance programs in the State of Kansas to assist those without insurance in obtaining adequate coverage.

High-Risk Pools

Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of Kansas is summarized in the chart below:

Plan Name
Kansas Health Insurance Association (5KHIA)
Website
https://www.khiastatepool.com/
Phone Number
800-362-9290
HIPPA Eligibility Required?
Yes
Available Carriers
First Health, Preferred Health Care
Pre-Existing Condition Waiting Period
3 months
Enrollment Periods
Open to new enrollment
Premium Limits
No more than 125% of standard risk
Lifetime Maximum Benefit
$2 million
Special Notes
You would be eligible for this risk pool, provided you are not eligible for COBRA; or Medicaid/Medicare; most recent coverage was not terminated due to nonpayment of premiums or fraud and you do not have other health insurance coverage.
Children’s Health Insurance Program

Through shared funding from the federal government, the State of Kansas provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:

Program Name
Kansas Health Wave
Website
https://www.kansashealthwave.org/
Phone Number
800-792-4884
Apply Online
Yes
Age Limits
Under 19
Insurance Carrier
Unicare, KHS, Children’s Mercy, Cenpatico
Length of Coverage
Annual eligibility review
Residency Requirements
Kansas residents
Other Eligibility Requirements
Children living in households with income levels at or below 200% of FPL qualify for this program
Pre-Existing Condition Exclusions
None
Cost
HealthWave 21: $0 for most families; $20-$30 for others (5premiums are subject to change at anytime); no co-pays, deductibles, or exclusions for pre-existing health conditions.
HealthWave19: $0 or small share of cost (5There are minor co-pays for adults)
Medicaid

Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Kansas:

Governing Agency
Kansas Medical Assistance Program
Website
https://www.kmap-state-ks.us/
Phone Number
800-766-9012
Residency Requirements
Kansas resident and U.S. citizen
Federal Poverty Line Income Limits
Children ages 1-5: 133% FPL;
Ages 6-19: 100% FPL;
Pregnant Women and Infants ages 0-1:150% FPL;
Supplemental Security Income Recipients: 74% FPL;
Medically Needy Individual: 66% FPL;
Medically Needy Couple: 59% FPL;
Working Parents: 38% FPL;
Non-Working Parents: 31% FPL
Additional Resources

Kansas Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Kansas’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Kansas: At-A-Glance
Provides exclusive health data of Kansas. Statehealthfacts.org is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.