Title XXV, Business and Financial Institutions

The following definitions shall apply to KRS 304.37-500 to 304.37-580: (1) "Interested person" means: (a) Any affiliated person of a company; (b) Any member of the immediate family of any natural person who is an affiliated person of a company; (c) Any person or partner or employ…

mutual insurance holding company -- Hearing -- Approval. (1) A domestic mutual insurance company, upon approval of the commissioner, may reorganize by forming an insurance holding company based upon a mutual plan and continuing the corporate existence of the reorganizing insuranc…

insurance holding company -- Hearing -- Approval. (1) A foreign mutual insurance company may reorganize upon the approval of the commissioner and in compliance with the requirement of any law or regulation which is applicable to the foreign mutual insurance company by merging its…

A mutual insurance holding company resulting from the reorganization of a domestic mutual insurance company organized under KRS Chapter 271B shall be incorporated under KRS Chapter 271B. The articles of incorporation and any amendments to the articles of the mutual insurance hold…

A mutual insurance holding company is deemed to be an insurer subject to Subtitle 33 of this chapter and shall automatically be a party to any proceeding under Subtitle 33 of this chapter involving an insurance company which, as a result of a reorganization under KRS 304.37-505, …

(1) KRS 304.24-600 to 304.24-625 is not applicable to a reorganization or merger under KRS 304.37-505 and 304.37-510. (2) KRS 304.24-600 to 304.24-625 is applicable to demutualization of a mutual insurance holding company which resulted from the reorganization of a domestic mutua…

A membership interest in a domestic mutual insurance holding company shall not constitute a security as defined in KRS 292.310(19).

(1) The majority of the voting shares of the capital stock of the reorganized insurance company, which is required by KRS 304.37-505 to be at all times owned by a mutual insurance holding company, shall not be conveyed, transferred, assigned, pledged, subjected to a security inte…

encumbrances of assets -- Investment of net worth in subsidiaries. (1) In addition to any other items required to be filed with the department under this chapter, each mutual insurance holding company shall supply to the Department of Insurance, by March 1 of each year, an annual…

No policyholder who is a member of a mutual insurance holding company shall receive because of a membership interest any payment of a policy credit, dividend, or other distribution unless the payment has been approved by the commissioner. The commissioner, after a public hearing,…

The reorganizing or merging insurer shall file with the commissioner an application requesting approval of the proposed reorganization or merger. The application shall include the following: (1) A Form A filing as described in KRS 304.37-120 and the administrative regulations pro…

The reorganizing or merging insurer shall file a plan of reorganization, approved by the affirmative vote of a majority of its board of directors, for review and approval by the commissioner. The plan shall provide the following: (1) Establishing a mutual insurance holding compan…

The application and plan of reorganization submitted to the commissioner shall demonstrate that: (1) Policyholder interests are properly preserved and protected; (2) The plan is fair and equitable to policyholders; and (3) The financial condition of the applicant will not be dimi…

and plan review -- Order -- Revocation -- Notice and documentation of completion. (1) A public hearing required by KRS 304.37-505 and 304.37-510 shall be conducted as directed in Subtitle 2 of this chapter and KRS Chapter 13B. (2) In lieu of an administrative hearing, the commiss…

Filing of registration statement with Securities and Exchange Commission. (1) No stock offering by a mutual insurance holding company, an insurance company subsidiary of a mutual insurance holding company, an intermediate holding company subsidiary of a mutual insurance holding c…

The following practices are prohibited: (1) Borrowing funds from the mutual insurance holding company, or its subsidiaries and affiliates, to finance the purchase of any portion of a stock offering; (2) Payment of commissions, "special fees," and any other special payment or extr…

acquire. (1) At no time shall the officers, directors, or insiders of the mutual insurance holding company and its subsidiaries and affiliates beneficially own, in the aggregate, more than eighteen percent (18%) of the voting stock of the insurance company subsidiary of a mutual …

Catchline at repeal: Unearned premium reserve; cargo and transportation.

Catchline at repeal: Reserves, noncancellable disability insurance.

Catchline at repeal: Loss records.

Catchline at repeal: Increased reserves.

Catchline at repeal: Loss reserve for liability insurances.

Catchline at repeal: Unallocated liability loss expense.

Catchline at repeal: Schedule of experience.

Catchline at repeal: Loss reserve for workmen's compensation insurance.

This subtitle may be cited as the Health Maintenance Organization Act.

(1) The purpose of this subtitle is to encourage and guarantee the development of health maintenance organizations by licensing and regulating their operation to insure that they provide high quality health care services through state licensed organizations meeting reasonable sta…

As used in this subtitle, unless the context otherwise requires: (1) "Commissioner" means the commissioner of the Department of Insurance; (2) "Enrollee" means a person who has been enrolled in a health maintenance organization; (3) "Evidence of coverage" means any certificate, a…

No person shall in this state be, act as, or hold himself or herself out as a health maintenance organization unless he or she holds a certificate of authority as a health maintenance organization from the commissioner.

(1) A corporation, limited liability company, or partnership may apply to the commissioner for and obtain a certificate of authority to establish and operate a health maintenance organization in compliance with this subtitle. (2) Health maintenance organizations which are corpora…

convert to health maintenance organization. (1) As used in this section, "provider-sponsored integrated health delivery network" has the same meaning as in KRS 304.17A-005. (2) A provider-sponsored integrated health delivery network may elect to convert to a health maintenance or…

(1) No health maintenance organization shall deliver or issue for delivery in this state any contract describing health benefits available, or any endorsement, rider, or application which becomes a part thereof, or any amendments thereto or modifications thereof, or the schedule …

Upon receipt of an application for issuance of a certificate of authority, the commissioner shall issue or deny the same. Issuance of a certificate of authority shall be granted only if the commissioner finds that the applicant has complied with KRS 304.38-040 and has paid the ap…

requirements -- Requirements for health maintenance organizations. (1) Except as provided in subsection (5) of this section, the following applies to a corporation or limited liability company applying for and holding a certificate of authority as a health maintenance organizatio…

Each health maintenance organization shall furnish to the commissioner a deposit of cash or securities approved by the commissioner in an amount not less than five hundred thousand dollars ($500,000) so that the obligations to the enrollees shall be performed. A health maintenanc…

may be required. (1) Any health maintenance 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 health maint…

(1) Each enrollee residing in this state shall be entitled to evidence of health care services provided and the same shall be issued and delivered to him by the health maintenance organization, be it in the form of a contract, certificate, or other comparable document. Such evide…

Organizations subject to the provisions of this subtitle shall make and file with the commissioner and the Kentucky Certificate of Need and Licensure Board annually before March 1 of each year, a statement under oath upon a form to be prescribed by the commissioner covering the p…

In his or her discretion, the commissioner may require organizations subject to the provisions of this subtitle to comply with KRS 304.2-205.

Health maintenance organizations shall comply with KRS 304.18-124 to 304.18-127.

The funds of a health maintenance organization shall be invested only in securities or other investments permitted by Subtitle 7 of Chapter 304 of the Kentucky Revised Statutes, or such other securities or investments as the commissioner may permit.

education -- Appointment. (1) An agent of a health maintenance organization shall be licensed as an agent with a health line of authority in accordance with the provisions of Subtitle 9 of this chapter regulating all aspects of agent licenses. (2) Subsection (1) of this section i…

examination. Health maintenance organizations shall be subject to the provisions of KRS 304.2-210, 304.2-220, 304.2-230, 304.2-240, 304.2-250, 304.2-260, 304.2-270, 304.2-280, 304.2- 290, 304.2-300, and Subtitle 2 of this chapter for determining financial condition, market conduc…

(1) The commissioner may suspend or revoke any certificate of authority issued to a health maintenance organization under this subtitle if the commissioner finds that any of the conditions exist for which the commissioner could suspend or revoke a certificate of authority as prov…

organization. Any rehabilitation or liquidation of a health maintenance organization shall be conducted under the supervision of the commissioner pursuant to and in accordance with Subtitle 33 of Chapter 304 of the Kentucky Revised Statutes.

The commissioner may promulgate reasonable rules and regulations not inconsistent with the provisions of this subtitle that he or she deems necessary for the proper administration of this subtitle.

(1) All applications, filings, and reports required under this subtitle shall be treated as public documents, except as otherwise provided for herein. (2) The nonprofit hospital, medical-surgical, dental, and health service corporation law of this state shall not be applicable to…

(1) No health maintenance organization, or representative thereof, may cause or knowingly permit the use of advertising or solicitation which is untrue or misleading, or any form of evidence of coverage which is deceptive. (2) No health maintenance organization shall cancel an en…

In his or her discretion, the commissioner may include health maintenance organizations or designated types of health maintenance organizations doing business pursuant to this subtitle in coordination of benefits guidelines prescribed pursuant to KRS 304.18-085.

(1) Any domestic stock and mutual insurance company licensed in this state, or any nonprofit hospital, medical-surgical, dental, and health service corporation authorized to do business in this state, may either directly or indirectly through a subsidiary, organize and operate a …