Terms Used In Kansas Statutes > Chapter 40 > Article 38 - Regulation and Registration of Administrators

• Act: means the pharmacy benefits manager licensure act. See Kansas Statutes 40-3822
• affiliated: means an entity or person who, directly or indirectly through one or more intermediaries, controls or is controlled by, or is under common control with, a specified entity or person. See Kansas Statutes 40-3801
• Annuity: A periodic (usually annual) payment of a fixed sum of money for either the life of the recipient or for a fixed number of years. A series of payments under a contract from an insurance company, a trust company, or an individual. Annuity payments are made at regular intervals over a period of more than one full year.
• Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
• Appropriation: The provision of funds, through an annual appropriations act or a permanent law, for federal agencies to make payments out of the Treasury for specified purposes. The formal federal spending process consists of two sequential steps: authorization
• Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. ^{Source: OCC}
• Business entity: means a corporation, association, partnership, limited liability company or other legal entity. See Kansas Statutes 40-3801
• Collateral: means funds, letters of credit or any item with economic value owned by the payor but held by an insurer or TPA in case it needs to be used to fulfill premium or loss reimbursement obligations in accordance with a contract between the insurer or TPA and the payor. See Kansas Statutes 40-3801
• Commissioner: means the commissioner of insurance of the state of Kansas. See Kansas Statutes 40-3801
• Contract: A legal written agreement that becomes binding when signed.
• Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
• Covered entity: means :

  (A) A nonprofit hospital or medical service corporation, health insurer, health benefit plan or health maintenance organization;

  (B) a health program administered by a department or the state in the capacity of provider of health coverage; or

  (C) an employer, labor union or other group of persons organized in the state that provides health coverage to covered individuals who are employed or reside in the state. See Kansas Statutes 40-3822

• Covered person: means a member, policyholder, subscriber, enrollee, beneficiary, dependent or other individual participating in a health benefit plan. See Kansas Statutes 40-3822
• Department: means the insurance department. See Kansas Statutes 40-3822
• Dependent: A person dependent for support upon another.
• Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
• ERISA: means the federal employee retirement income security act of 1974. See Kansas Statutes 40-3822
• Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
• Fiduciary: A trustee, executor, or administrator.
• Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
• Fraud: Intentional deception resulting in injury to another.
• GAAP: means United States generally accepted accounting principles consistently applied. See Kansas Statutes 40-3801
• Health benefit plan: means the same as defined in Kan. See Kansas Statutes 40-3822
• Home state: means the United States jurisdiction that has adopted this act or a substantially similar law governing TPAs and that has granted the TPA a home state TPA license. See Kansas Statutes 40-3801
• Insurance producer: means a person required to be licensed under the laws of this state to sell, solicit or negotiate insurance, and also includes a business entity whose primary activities are the sales, solicitation and negotiation of insurance. See Kansas Statutes 40-3801
• insurer: means a licensed insurance company, hospital or professional service corporation or a managed care organization. See Kansas Statutes 40-3801
• Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
• MAC: means any term or methodology that a pharmacy benefits manager or a healthcare insurer may use to establish the maximum amount that a pharmacy benefits manager will reimburse a pharmacy or a pharmacist for generic drugs. See Kansas Statutes 40-3822
• Month: means a calendar month, unless otherwise expressed. See Kansas Statutes 77-201
• Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
• NAIC: means the national association of insurance commissioners. See Kansas Statutes 40-3801
• Nolo contendere: No contest-has the same effect as a plea of guilty, as far as the criminal sentence is concerned, but may not be considered as an admission of guilt for any other purpose.
• Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• Payor: means an insurer or an employer administering its employee benefit plan or the employee benefit plan of an affiliated employer under common management or control. See Kansas Statutes 40-3801
• Person: means an individual or a business entity. See Kansas Statutes 40-3801
• Pharmacy benefits management: means :

  (1) Any of the following services provided with regard to the administration of the following pharmacy benefits:

  (A) Mail service pharmacy;

  (B) claims processing, retail network management and payment of claims to pharmacies for prescription drugs dispensed to covered individuals;

  (C) clinical formulary development and management services;

  (D) rebate contracting and administration;

  (E) certain patient compliance, therapeutic intervention and generic substitution programs; or

  (F) disease management programs involving prescription drug utilization; and

  (2) (A) the procurement of prescription drugs by a prescription benefits manager at a negotiated rate for dispensation to covered individuals within this state; or

  (B) the administration or management of prescription drug benefits provided by a covered insurance entity for the benefit of covered individuals. See Kansas Statutes 40-3822

• Pharmacy benefits manager: includes any person or entity acting in a contractual or employment relationship for a pharmacy benefits manager in the performance of pharmacy benefits management for a covered entity. See Kansas Statutes 40-3822
• Plea: In a criminal case, the defendant's statement pleading "guilty" or "not guilty" in answer to the charges, a declaration made in open court.
• Service of process: The service of writs or summonses to the appropriate party.
• Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
• State: when applied to the different parts of the United States, includes the District of Columbia and the territories. See Kansas Statutes 77-201
• Stop-loss insurance: means insurance protecting an employer or other person responsible for an otherwise self-insured health or life benefit plan against obligations under the plan, but "stop-loss insurance" does not include reinsurance written for an insurance company. See Kansas Statutes 40-3801
• Subpoena: A command to a witness to appear and give testimony.
• Testify: Answer questions in court.
• TPA: means any person who directly or indirectly underwrites, collects charges or premiums from, or who adjusts or settles claims on, residents of this state in connection with life, annuity or health insurance coverage offered or provided by a payor, except any of the following:

  (1) An employer, or a wholly owned direct or indirect subsidiary of an employer, on behalf of its employees or the employees of one or more subsidiaries or affiliated corporations of such employer. See Kansas Statutes 40-3801

• under common control with: means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, by contract other than a commercial contract for goods or nonmanagement services, or otherwise, unless the power is the result of an official position with or corporate office held by the person. See Kansas Statutes 40-3801
• Undertaking: means a promise or security in any form where required by law. See Kansas Statutes 77-201
• underwriting: means , but is not limited to, the acceptance of employer or individual applications for coverage of individuals in accordance with the written rules of the insurer or self-funded plan, or the overall planning and coordinating of a benefits program. See Kansas Statutes 40-3801
• Uniform application: means the current version of the NAIC uniform application for third party administrators. See Kansas Statutes 40-3801