Kan. Admin. Regs. § 40-4-42a - Notice requirements of adverse decisions
(a) Each written notification of an adverse
decision shall be printed in clear, legible type and in at least 12-point
type.
(b) The notice of adverse
decision shall explain the principal reason for the adverse decision in
language easily understood by a person with an eighth-grade reading level. An
insurer may meet this requirement by omitting medical terminology that
describes an insured's medical condition. The notice shall include the legal
names of all impacted parties and their telephone numbers and
addresses.
(c) The notice of
adverse decision shall explain how an insured, as defined in
K.S.A.
40-22a13, and amendments thereto, can
initiate an external review with the commissioner. If an insured is eligible
for an expedited review due to an emergency medical condition as defined in
K.S.A.
40-22a13, and amendments thereto, then the
notice shall explain how an insured can initiate an expedited review.
(d) The notice shall explain that an insured
may file for an external review with the commissioner within 120 days of
receipt of a final adverse decision. The notice shall also list the Kansas
insurance department's toll-free number.
(e) The notice of adverse decision shall
describe how the insured can request a writen statement of the clinical
rationale and clinical review criteria used to make the adverse
decision.
Notes
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