Title XXV, Business and Financial Institutions

Pooling of claims experience for groups with fewer than fifty (50) insureds shall be required. No more than twenty-five percent (25%) of the premium for these groups shall be based on their own claims experience. This provision shall not permit competing health insurers or health…

services performed by physician. Any certificate, agreement or contract issued in this state by a health maintenance organization which provides coverage for services which can be lawfully performed within the scope of the license of a duly licensed dentist, shall be deemed to pr…

licensed ophthalmic dispenser to include same services from licensed physician. Any certificate, agreement, or contract issued in this state by a health maintenance organization which provides coverage for services which can be lawfully performed within the statutory scope of pra…

osteopaths, or podiatrists. (1) Any certificate, agreement or contract issued in this state by a health maintenance organization which provides coverage for any service which is within the lawful scope of practice of a chiropractor duly licensed under KRS Chapter 312, shall be de…

Any group policy, group plan, or group contract issued in this state by a health maintenance organization shall offer the master policyholder the option to purchase in new contracts the minimum benefits for treatment of alcoholism as specified in KRS 304.18-130 to 304.18-170.

(1) Any group policy, group plan, or group contract issued in this state by a health maintenance organization which provides maternity benefits shall offer the master policyholder the option to purchase coverage to pay for routine nursery care for a well newly born child for up t…

(1) All health maintenance organization contracts issued by health maintenance organizations, regardless of whether the contracts are for nonfamily or family coverage, shall provide that health insurance benefits shall be payable with respect to a newly-born child of the subscrib…

Except as provided in KRS 304.38-070(5), health maintenance organizations shall be subject to the provisions of this subtitle, and to the following provisions of this chapter, to the extent applicable and not in conflict with the expressed provisions of this subtitle: (1) Subtitl…

reason of age. Health maintenance organizations delivering or issuing for delivery in Kentucky Medicare supplement contracts as defined in KRS 304.14-500 to 304.14-550, or renewing such contracts, shall make available upon request Medicare supplement coverage for persons not elig…

health care coverage -- Conditions. (1) Health maintenance organizations issuing policies in the Commonwealth which provide hospital, medical, or surgical expense benefits shall make available and offer to include benefits for home health care. On group benefits the option for ho…

Health maintenance organizations issuing long-term care coverage shall comply with KRS 304.14-600 to 304.14-625.

hospital benefits coverage and requires utilization review of benefits. (1) Every health maintenance organization in this state which provides coverage of hospital benefits and requires the utilization review of such benefits or administers a health benefit program which provides…

Notwithstanding the definition of health maintenance organization in KRS 304.38-030, an authorized health maintenance organization may issue contracts under which benefits are funded, in whole or in part, by an employer or other group contract holder.

Medicaid managed care organizations -- Administrative regulation. (1) (a) The commissioner shall promulgate an administrative regulation to establish procedures for conducting a competitive process to solicit proposals from publishers of medical necessity criteria to designate fo…

As used in this subtitle, unless the context requires otherwise: (1) "Enrollee" means an individual who is enrolled in a limited health services benefit plan; (2) "Evidence of coverage" means any certificate, agreement, contract, or other document issued to an enrollee stating th…

No person may operate a limited health service organization in this state without obtaining and maintaining a certificate of authority from the commissioner pursuant to this section and KRS 304.38A-030, 304.38A-040, 304.38A-050, 304.38A-060, 304.38A- 070, 304.38A-090, and 304.38A…

An application for a certificate of authority to operate a limited health service organization shall be filed with the commissioner on a form prescribed by the commissioner. The application shall be verified by an officer or authorized representative of the applicant and shall se…

application and of reasons for denial. (1) Following receipt of an application filed pursuant to KRS 304.38A-030, the commissioner shall review the application and notify the applicant of any deficiencies. The commissioner shall issue a certificate of authority to an applicant if…

In order to maintain its eligibility for a certificate of authority, a limited health service organization shall continue to meet all conditions required to be met under this subtitle and the relevant administrative regulations for the initial application for and issuance of its …

Hearing. (1) A limited health service organization may add one (1) or more limited health services by: (a) Filing the relevant information required by KRS 304.38A-030; (b) Demonstrating compliance with KRS 304.38A-030 and 304.38A-080; and (c) Obtaining approval from the commissio…

A limited health service organization shall be subject to the provisions of this subtitle, and to the following provisions of this chapter, to the extent applicable and not in conflict with the expressed provisions of this subtitle: (1) Subtitle 1--Scope--General Definitions and …

(1) Each limited health service organization shall at all times have and maintain a net worth of not less than one hundred twenty-five thousand dollars ($125,000). (2) (a) Each limited health service organization shall deposit with the commissioner or with any organization or tru…

Winding up affairs -- Applicable provisions. (1) The commissioner may suspend or revoke the certificate of authority issued to a limited health service organization pursuant to this subtitle upon determining that any of the following conditions exist: (a) The limited health servi…

(1) Any limited health service organization that contracts with a provider or provider organization for the transfer of risk to the provider shall take reasonable steps to ensure the transferee is able to accept and manage the risk to be transferred. The limited health service or…

requirements. (1) A person issued a single service organization certificate of authority in accordance with KRS 304.38-065 and holding the certificate of authority on July 15, 2002, shall be converted to a limited health service organization as defined in KRS 304.38A- 010. At the…

specified sections of Subtitle 17A of KRS Chapter 304. (Effective until January 1, 2027) Limited health service organizations shall comply with: (1) KRS 304.17A-262; (2) KRS 304.17A-265; and (3) KRS 304.17A-591 to 304.17A-599.

The toll of about 20,000,000 motor vehicle accidents nationally and comparable experience in Kentucky upon the interests of victims, the public, policyholders and others require that improvements in the reparations provided for herein be adopted to effect the following purposes: …

As used in this subtitle: (1) "Added reparation benefits" mean benefits provided by optional added reparation insurance; (2) "Basic reparation benefits" mean benefits providing reimbursement for net loss suffered through injury arising out of the operation, maintenance, or use of…

(1) If the accident causing injury occurs in this Commonwealth every person suffering loss from injury arising out of maintenance or use of a motor vehicle has a right to basic reparation benefits, unless he has rejected the limitation upon his tort rights as provided in KRS 304.…

motorcycle coverage in liability contracts -- Exclusion of motorcycle operator or passenger who has not purchased optional coverage. (1) Basic reparation benefits shall be paid without regard to fault. (2) Basic reparation obligors and the assigned claims plan shall pay basic rep…

In an automobile liability insurance policy, the insurer and the named insured may agree to exclude any member of the household not a spouse or dependent from coverage as the operator of an insured vehicle. The names of persons excluded shall be set forth in the policy or in an e…

car sharing -- Right of recovery. (1) As used in this section, the following have the same meaning as in KRS 365.520: (a) "Car sharing period"; (b) "Peer-to-peer car sharing program"; (c) "Shared vehicle"; (d) "Shared vehicle driver"; and (e) "Shared vehicle owner." (2) An author…

(1) As used in this section, the following have the same meaning as in KRS 365.530: (a) "Delivery available period"; (b) "Delivery network driver"; and (c) "Delivery service period." (2) An authorized insurer that writes motor vehicle liability insurance in this state may exclude…

benefits. (1) The basic reparation insurance applicable to bodily injury to which this subtitle applies is the security covering the vehicle occupied by the injured person at the time of the accident or, if the injured person is a pedestrian, the security covering the vehicle whi…

Exceptions. (1) Any person who registers, operates, maintains or uses a motor vehicle on the public roadways of this Commonwealth shall, as a condition of such registration, operation, maintenance or use of such motor vehicle and use of the public roadways, be deemed to have acce…

(1) "Secured person" means the owner, operator or occupant of a secured motor vehicle, and any other person or organization legally responsible for the acts or omissions of such owner, operator or occupant. (2) A reparation obligor which has paid or may become obligated to pay ba…

(1) "Security covering the vehicle" is the insurance or other security so provided. The vehicle for which the security is so provided is the "secured vehicle." (2) "Basic reparation insurance" includes a contract, self-insurance, or other legal means under which the obligation to…

(1) If the owner of a motor vehicle has been issued a binder, or other contract for temporary insurance, for motor vehicle security and subsequently contacts the agent who issued the binder or other contract for temporary insurance to cancel the motor vehicle security before the …

insured whose policy was terminated -- Exception. (1) As used in this section, the following have the same meaning as in KRS 186A.040: (a) "Commercial motor vehicle"; (b) "Commercial motor vehicle insurance"; and (c) "Insurer." (2) Every insurer that does not provide access to in…

policyholders to Department of Vehicle Regulation -- Limitation of liability. (1) (a) As used in this subsection, "personal motor vehicle" means: 1. A private passenger motor vehicle that is not used as a public or livery conveyance for passengers, nor rented to others; and 2. An…

An owner of a motor vehicle registered in this Commonwealth who ceases to maintain security as required by the provisions on security may not operate or permit operation of the vehicle in this Commonwealth until security has again been provided as required by this subtitle. An ow…

(1) An insurance contract which purports to provide coverage for basic reparation benefits or is sold with representation that it provides security covering a motor vehicle has the legal effect of including all coverages required by this subtitle. (2) An insurer authorized to tra…

(1) The requirement of security for payment of tort liabilities is fulfilled by providing: (a) Either: 1. Split limits liability coverage of not less than twenty-five thousand dollars ($25,000) for all damages arising out of bodily injury sustained by any one (1) person, and not …

Loss of use of a motor vehicle, regardless of the type of use, shall be recognized as an element of damage in any property damage liability claim. Such a claim for loss of use of a motor vehicle shall be limited to reasonable and necessary expenses for the time necessary to repai…

Presentation of electronic insurance card to peace officer. (Effective until January 1, 2027) (1) Each insurer issuing an insurance contract which provides security covering a motor vehicle shall provide to the insured, in compliance with administrative regulations promulgated by…

(1) All benefits or advantages a person receives or is entitled to receive because of the injury from workers' compensation are subtracted in calculating net loss. (2) If a benefit or advantage received to compensate for loss of income because of injury, whether from basic repara…