Title XXV, Business and Financial Institutions
21 chapters · 2,855 sections in this title.
KRS § 304.38-191 Conversion and continuation rights upon termination of group coverage
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coverage. Any group policy, group plan, or group contract issued, delivered, or renewed by a health maintenance organization shall include continuation rights for certificate holders, pursuant to KRS 304.18-110, and conversion rights for certificate holders equal to that provided…
KRS § 304.38-193 Coverage for treatment for mental illness
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(1) For purposes of this section, "mental illness" means psychosis, neurosis or an emotional disorder. (2) Any offer to sell a policy of general health insurance or health maintenance organization coverage issued, delivered, issued for delivery, amended or renewed by a health mai…
KRS § 304.38-1933 Coverage for services of licensed psychologist or licensed clinical social worker
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worker. Every policy, contract, agreement, or certificate entered into, issued or delivered by a health maintenance organization which provides coverage for services performed by a licensed psychologist pursuant to KRS Chapter 319, or a licensed clinical social worker pursuant to…
KRS § 304.38-1934 Coverage for medical and surgical benefits with respect to mastectomy, diagnosis and treatment of endometrioses and endometritis, and bone density testing -- Duties of health maintenance organization
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mastectomy, diagnosis and treatment of endometrioses and endometritis, and bone density testing -- Duties of health maintenance organization. (1) Health maintenance organizations issuing contracts in this Commonwealth that provide hospital, medical, or surgical expense benefits s…
KRS § 304.38-1935 Coverage for mammograms -- Prohibition on cost-sharing requirements for covered diagnostic breast examinations or supplemental breast examinations
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requirements for covered diagnostic breast examinations or supplemental breast examinations. Health maintenance organization contracts in this Commonwealth shall comply with KRS 304.17-316.
KRS § 304.38-1936 Coverage for treatment of breast cancer
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(1) Health maintenance organizations issuing contracts in this Commonwealth which provide hospital, medical, or surgical expense benefits for treatment of breast cancer by chemotherapy shall also provide coverage for treatment of breast cancer by high- dose chemotherapy with auto…
KRS § 304.38-1937 Coverage for treatment of temporomandibular joint disorders and craniomandibular jaw disorders
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craniomandibular jaw disorders. (1) All contracts, agreements, certificates, or other comparable documents of health care services provided which provide coverage for surgical or nonsurgical treatment of skeletal disorders shall provide coverage for medically necessary procedures…
KRS § 304.38-194 Pooling of claims experience required
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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…
KRS § 304.38-195 Policy covering services performed by dentist deemed to cover such services performed by physician
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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…
KRS § 304.38-1955 Construction of provisions for services by licensed optometrist or licensed ophthalmic dispenser to include same services from licensed physician
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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…
KRS § 304.38-196 Indemnity payable for services performed by chiropractors, physicians, osteopaths, or podiatrists
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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…
KRS § 304.38-197 Coverage for treatment of alcoholism
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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.
KRS § 304.38-198 Optional nursery care coverage for a well newly born child
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(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…
KRS § 304.38-199 Coverage for newly-born child
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(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…
KRS § 304.38-200 Application of other subtitles
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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…
KRS § 304.38-205 Medicare supplement coverage for persons not eligible for Medicare by reason of age
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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…
KRS § 304.38-210 Health maintenance organizations as insurers to offer home health care coverage -- Conditions
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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…
KRS § 304.38-220 Long-term health care benefits
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Health maintenance organizations issuing long-term care coverage shall comply with KRS 304.14-600 to 304.14-625.
KRS § 304.38-225 Requirements for health maintenance organization that provides hospital benefits coverage and requires utilization review of benefits
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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…
KRS § 304.38-230 Funding of benefits by employer or group contract holder
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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.
KRS § 304.38-240 Solicitation of proposals designating medical necessity criteria for Medicaid managed care organizations -- Administrative regulation
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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…
KRS § 304.380 Repealed, 1970
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Catchline at repeal: Unallocated workmen's compensation loss expense.
KRS § 304.381 Repealed, 1970
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Catchline at repeal: "Loss payments" and "Loss expense payments" defined.
KRS § 304.383 Repealed, 1970
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Catchline at repeal: Standard valuation law for life policies.
KRS § 304.385 Repealed, 1970
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Catchline at repeal: Reserve credit for reinsurance; insolvent ceding insurers; assuming insurers.
KRS § 304.387 Repealed, 1970
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Catchline at repeal: Valuation of bonds or other like evidences of debt.
KRS § 304.388 Repealed, 1970
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Catchline at repeal: Valuation of other securities.
KRS § 304.389 Repealed, 1970
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Catchline at repeal: Valuation of property.
KRS § 304.38A-010 Definitions for subtitle
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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…
KRS § 304.38A-020 Certificate of authority
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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…
KRS § 304.38A-030 Application for certificate of authority
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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…
KRS § 304.38A-040 Issuance of certificate of authority -- Notification of deficiencies in application and of reasons for denial
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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…
KRS § 304.38A-050 Conditions for maintaining eligibility for certificate of authority
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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 …
KRS § 304.38A-060 Addition of limited health services -- Notification of disapproval -- Hearing
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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…
KRS § 304.38A-070 Application of provisions of chapter
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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 …
KRS § 304.38A-080 Net worth -- Deposit -- Risk-based capital requirements
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(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…
KRS § 304.38A-090 Suspension or revocation of certificate of authority -- Notification -- Winding up affairs -- Applicable provisions
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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…
KRS § 304.38A-100 Transfer of risk -- Plan for evaluating provider -- Additional reserves
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(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…
KRS § 304.38A-110 Conversion of single service organization -- Net worth and capital requirements
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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…
KRS § 304.38A-115 Requirement for limited health service organizations to comply with specified sections of Subtitle 17A of KRS Chapter 304. (Effective until January 1, 2027)
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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.
KRS § 304.39-010 Policy and purpose
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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: …
KRS § 304.39-020 Definitions for subtitle
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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…
KRS § 304.39-030 Right to basic reparation benefits
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(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.…
KRS § 304.39-040 Obligation to pay basic reparation benefits -- Requirement of option for motorcycle coverage in liability contracts -- Exclusion of motorcycle operator or passenger who has not purchased optional coverage
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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…
KRS § 304.39-045 Exclusion from coverage as operator by agreement
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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…
KRS § 304.39-047 Definitions for section -- Authority to exclude coverage for peer-to-peer car sharing -- Right of recovery
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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…
KRS § 304.39-048 Authorized insurers -- Exclusions -- Defense of claims
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(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…
KRS § 304.39-050 Priority of applicability of security for payment of basic reparation benefits
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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…
KRS § 304.39-060 Acceptance or rejection of partial abolition of tort liability -- Exceptions
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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…
KRS § 304.39-070 "Secured person" -- Obligor's rights to recovery
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(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…