Accident & Health and Life Insurance
Accident & Health and Life Insurance
2023 SERFF Health Filings
2022 SERFF Health Filings
Filing Requirements
- Compliance Reference for Group Accident and Health Coverages
- Compliance Reference for Individual Accident and Health Coverages
Standardized Credentialing Application
Health Maintenance Organizations
- Explanatory Letter
- Official List
- Application for Certificate of Authority
- Quality of Care Assessment Guidelines
- HMO Estimated Privilege Fee Statement
Pharmacy Benefits Manager
Effective January 1, 2023, all Pharmacy Benefits Managers operating in Kansas are required to be licensed with the Department. See 2022 House Substitute for SB 28.
- Pharmacy Benefit Manager Licensing and Renewal Information and Instructions
- Network Adequacy Report
- Contacts Form
- PBM Licensing Frequently Asked Questions
- PBM Initial Licensing Application Checklist
Professional Employer Organizations
- Information on registration of Professional Employer Organizations
- Online payment form for ESAC-accredited PEOs
- Criminal History Form
Third Party Administrators
Note: New TPA applications will be accepted through NIPR beginning June 12, 2023.
- New TPA Licensing, Renewal and Annual Report Instructions – Effective June 12, 2023.
- Business Entity Name Change Application
- Annual Report
- Hardship Exemption
- Bond of Administrator
- Bulletin 1991-21
- Bulletin 2017-2
- Voluntary Surrender of Kansas TPA Certificate
Utilization Review Organizations
- Bulletin 1995-4
- Bulletin 1995-6
- K.A.R. 40-4-41
- Explanatory Letter
- Application for New Utilization Review Certificate – URO Standard
- Application for New Utilization Review Certificate – URO URAC Accreditation
- Renewal Process – URO Standard
- Renewal Process – URO URAC Accreditation
Viatical Settlement Companies
- Viatical Settlement Provider License Renewal Form
- Viatical Settlement Provider Annual Statement Form
- Viatical Admission Application
- Viatical Explanatory Letter
- Viatical Instruction Packet
Prepaid Service Plans
- New Application for Dental or Legal Prepaid Service Plan
- Renewal Process for Dental or Legal Prepaid Service Plan
- Prepaid Plans Representatives List – to be submitted by January 1 and July 1 each year
- Qualifying Bond Application
Continuing Care Providers
- Application for New Continuing Care Provider
- Application for Renewal of a Continuing Care Provider
- Continuing Care Provider Annual Disclosure
- Continuing Care Provider Pre-Operational Addendum