The national Group Health Insurance guide covers how group coverage works: the master policy and certificates, eligible groups, contributory and noncontributory plans, experience and community rating, coordination of benefits, and federal COBRA and HIPAA rules. Kansas adds its own rules on eligible groups, enrollment, state continuation and conversion (K.S.A. 40-2209), blanket coverage (40-2210), and small employer rating (the Small Employer Health Insurance Availability Act, 40-2209b to 40-2209p).

Eligible groups (K.S.A. 40-2209)

• Employer groups must insure at least two employees, for the benefit of people other than the employer.
• Labor union groups must insure at least 25 members.

Enrollment periods:

• The initial open enrollment opportunity must run at least from the employee's date of first eligibility until 31 days later (40-2209(a)(1)).
• A special enrollment period for dependents after a marriage, birth or adoption must last at least 30 days (40-2209(a)(3)).

State continuation (K.S.A. 40-2209(i), (j))

Kansas has its own continuation right, separate from federal COBRA.

• Who qualifies. An employee or dependent whose group coverage ends may continue it if they were continuously insured under the group plan, or the plan it replaced, for at least three months before termination.
• How long. Coverage continues for up to 18 months.
• Cost. The person pays the same premium charged to active group members.
• Not available to someone who:
  • is or could be covered by Medicare
  • failed to pay required contributions
  • is replaced by similar group coverage
  • was terminated for cause

Conversion (K.S.A. 40-2209(j))

At the end of continuation, the person may buy an individual converted policy:

• The written application and first premium are due within 31 days after group coverage ends, or after the required notice.
• The converted policy is issued without evidence of insurability and may cover dependents who were covered on the termination date.
• It takes effect the day after group coverage ends, so there is no gap.

Continuation keeps the same group coverage for a limited time. Conversion replaces it with an individual policy.

Blanket accident and sickness (K.S.A. 40-2210)

Blanket policies cover a changing group without naming individuals. Examples:

• all passengers of a common carrier
• students of a school
• volunteer firefighters
• a sports team, camp or sponsor, which must cover at least 10 members, campers or officials

Small employer coverage (K.S.A. 40-2209b to 40-2209p)

• A small employer has at least 2 and no more than 50 eligible employees on at least half of its working days in the prior year.
• An eligible employee works full time, with a normal work week of 30 hours or more. Part-time, temporary and substitute workers are excluded.
• The act's purpose is to make coverage available to small employers regardless of health status or claims experience and to prevent abusive rating practices (40-2209b).
• Rating case characteristics may include geography, age and sex, industry and group size. They may not include claim experience, health status or duration of coverage (40-2209d).

The Kansas mental health and substance use mandates (K.S.A. 40-2,105) apply to small employer group policies. They are covered in the Kansas Medical Plans guide.

Common exam traps

• An employer group needs at least 2 employees. A union group needs at least 25 members.
• Initial enrollment lasts 31 days. Special enrollment for dependents lasts at least 30 days.
• State continuation requires 3 months of prior coverage, lasts 18 months, and costs the active-member premium.
• Medicare eligibility or a for-cause termination bars continuation.
• A conversion application is due within 31 days. The converted policy needs no evidence of insurability and starts the next day.
• A small employer has 2–50 employees, and "full time" means 30 hours a week.