Title XXV, Business and Financial Institutions

Catchline at repeal: Other kinds of insurance; requirements for authority to transact.

This subtitle may be cited as the "Uniform Health Policy Provision Law."

Nothing in this subtitle shall apply to or affect: (1) Any policy of liability or workers' compensation insurance with or without supplementary expense coverage therein. (2) Any group or blanket policy. (3) Life insurance, endowment or annuity contracts, or contracts supplemental…

No policy of health insurance shall be delivered or issued for delivery to any person in this state unless it otherwise complies with this title, and complies with the following: (1) The entire money and other considerations therefor shall be expressed therein; (2) The time when …

(1) Except as provided in subsection (2) of this section, each such policy delivered or issued for delivery to any person in this state shall contain the provisions specified in KRS 304.17-050 to 304.17-160, inclusive, in the words in which the same appear; except, that the insur…

(1) All individual health insurance policies providing coverage on an expense incurred basis regardless of whether the policies are issued for nonfamily or family coverage, shall, provide that health insurance benefits shall be payable with respect to a newly born child of the in…

There shall be a provision as follows: "Entire Contract; Changes: This policy, including the indorsements and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall be valid until approved by an executive officer of the insurer a…

(1) (a) There shall be a provision as follows: "Time Limit on Certain Defenses: After three (3) years from the date of issue of this policy no misstatements, except fraudulent misstatements, made by the applicant in the application for the policy shall be used to void the policy …

(1) There shall be a provision as follows: "Grace Period: A grace period of .... (insert a number not less than "7" for weekly premium policies, "10" for monthly premium policies, and "31" for all other policies) days will be granted for the payment of each premium falling due af…

(1) There shall be a provision as follows: "Reinstatement: If any renewal premium be not paid within the time granted the insured for payment, a subsequent acceptance of premium by the insurer or by any agent duly authorized by the insurer to accept such premium, without requirin…

(1) There shall be a provision as follows: "Notice of Claim: Written notice of claim must be given to the insurer within sixty (60) days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Notice given by or on …

There shall be a provision as follows: "Claim Forms: The insurer, upon receipt of a notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proofs of loss. If such forms are not furnished within fifteen (15) days after the giving of such…

There shall be a provision as follows: "Proofs of Loss: Written proof of loss must be furnished to the insurer at its said office in case of claim for loss for which this policy provides any periodic payment contingent upon continuing loss within ninety (90) days after the termin…

There shall be a provision as follows: "Time of Payment of Claims: Indemnities payable under this policy for any loss other than loss for which this policy provides any periodic payment will be paid within thirty (30) days of receipt of due written proof of the loss. Subject to d…

(1) There shall be a provision as follows: "Payment of Claims: Indemnity for loss of life will be payable in accordance with the beneficiary designation and the provisions respecting payment which may be prescribed herein and effective at the time of payment. If no designation or…

There shall be a provision as follows: "Physical Examination and Autopsy: The insurer, at its own expense, shall have the right and opportunity to examine the person of the insured when and as often as it may reasonably require during the pendency of a claim hereunder and to make…

There shall be a provision as follows: "Legal Actions: No action at law or in equity shall be brought to recover on this policy prior to the expiration of sixty (60) days after written proof of loss has been furnished in accordance with the requirements of this policy. No such ac…

(1) There shall be a provision as follows: "Change of Beneficiary: Unless the insured makes an irrevocable designation of beneficiary, the right to change of beneficiary is reserved to the insured and the consent of the beneficiary or beneficiaries shall not be requisite to surre…

(1) Except as to nonrenewable accident policies, every individual health insurance policy shall contain a provision therein or in a separate rider attached thereto when delivered, stating in substance that the person to whom the policy is issued shall be permitted to return the p…

Except as provided in subsection (2) of KRS 304.17-040, no such policy delivered or issued for delivery to any person in this state shall contain provisions respecting the matters set forth in KRS 304.17-190 to 304.17-290, inclusive, unless such provisions are in the words in whi…

(1) As used in this section: (a) "Health benefit plan" has the same meaning as in KRS 304.17A-005, except for purposes of this section, the term includes student health insurance offered by a Kentucky-licensed insurer under written contract with a university or college whose stud…

(1) All individual health insurance policies providing coverage on an expense incurred basis which provide maternity benefits shall offer the insured the option to purchase coverage to pay for routine nursery care for a well newly born child for up to five (5) full days in a hosp…

There may be a provision as follows: "Change of Occupation: If the insured be injured or contract sickness after having changed his occupation to one classified by the insurer as more hazardous than that stated in this policy or while doing for compensation anything pertaining to…

There may be a provision as follows: "Misstatement of Age: If the age of the insured has been misstated, all amounts payable under this policy shall be such as the premium paid would have purchased at the correct age."

(1) There may be a provision as follows: "Other Insurance in This Insurer: If an accident or sickness or accident and sickness policy or policies previously issued by the insurer to the insured be in force concurrently herewith, making the aggregate indemnity for .... (insert typ…

valid coverage." (1) There may be a provision as follows: "Insurance with Other Insurers: If there be other valid coverage, not with this insurer, providing benefits for the same loss on a provision of service basis or on an expense incurred basis and of which this insurer has no…

coverage." (1) There may be a provision as follows: "Insurance with Other Insurers: If there be other valid coverage, not with this insurer, providing benefits for the same loss on other than an expense incurred basis and of which this insurer has not been given written notice pr…

(1) There may be a provision as follows: "After the loss-of-time benefit of this policy has been payable for ninety (90) days, such benefit will be adjusted, as provided below, if the total amount of unadjusted loss-of-time benefits provided in all valid loss-of-time coverage upo…

There may be a provision as follows: "Unpaid Premium: Upon the payment of a claim under this policy, any premium then due and unpaid or covered by any note or written order may be deducted therefrom."

There may be a provision as follows: "Conformity with State Statutes: Any provision of this policy which, on its effective date, is in conflict with the statutes of the state in which the insured resides on such date is hereby amended to conform to the minimum requirements of suc…

Health insurance policies, other than accident insurance only policies, in which the insurer reserves the right to refuse renewal on an individual basis, shall provide in substance in a provision thereof or in an indorsement thereon or rider attached thereto that subject to the r…

There may be a provision as follows: "Illegal Occupation: The insurer shall not be liable for any loss to which a contributing cause was the insured's commission of or attempt to commit a felony or to which a contributing cause was the insured's being engaged in an illegal occupa…

There may be a provision as follows: "Intoxicants, Narcotics and Hallucinogenics: The insurer shall not be liable for any loss sustained or contracted in consequence of the insured's being intoxicated or under the influence of any narcotic or any hallucinogenic unless administere…

The provisions which are the subject of KRS 304.17-050 to 304.17-160, inclusive, and KRS 304.17-190 to 304.17-290, inclusive, or any corresponding provisions which are used in lieu thereof in accordance with such sections, shall be printed in the consecutive order of the provisio…

physicians, chiropractors, or podiatrists. (1) When any policy of health insurance issued in this state provides for reimbursement for any service which is within the lawful scope of practice of an optometrist duly licensed as provided in KRS Chapter 320, the insured or other per…

(1) Family expense health insurance is that provided under a policy issued to one (1) of the family members insured, who shall be deemed the policyholder, covering any two (2) or more eligible members of a family, including husband, wife, unmarried dependent children, to age nine…

by reason of age. Insurers delivering or issuing for delivery in Kentucky Medicare supplement insurance policies as defined in KRS 304.14-500 to 304.14-550, or renewing such policies, shall make available upon request Medicare supplement insurance for persons not eligible for Med…

304.38-210. As used in KRS 304.17-313, 304.18-037, 304.32-280, and 304.38-210: (1) "Home health agency" means a public agency or private organization, or a subdivision of such an agency or organization which is licensed as a home health agency by the Kentucky Health Facilities an…

Conditions. (1) All insurers issuing individual health insurance policies in the Commonwealth providing coverage on an expense incurred basis shall make available and offer to the purchaser coverage for home health care. The coverage may contain a limitation on the number of home…

services performed by physician. Any policy or contract of health insurance issued in this state 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 provide benefits for such services …

requirements for covered diagnostic breast examinations or supplemental breast examinations. (1) As used in this section: (a) "Cost-sharing requirements" means any: 1. Deductible, coinsurance, or copayment; or 2. Out-of-pocket expense imposed upon an insured that is similar to an…

mastectomy, diagnosis and treatment of endometrioses and endometritis, and bone density testing -- Duties of insurer. (1) All insurers issuing individual health insurance policies in this Commonwealth providing coverage on an expense-incurred basis shall make available and offer …

(1) All insurers issuing individual health insurance policies in this Commonwealth which provide coverage for treatment of breast cancer by chemotherapy on an expense-incurred basis shall also provide coverage for treatment of breast cancer by high-dose chemotherapy with autologo…

(1) All individual health insurance policies providing coverage on an expense incurred basis shall provide coverage for health care treatment or services rendered by ambulatory surgical centers approved by the Kentucky Health Facilities and Health Services Certificate of Need and…

(1) For purposes of this section, "mental illness" means psychosis, neurosis or an emotional disorder. (2) Any offer to sell a policy or contract of general health insurance to be issued, delivered, issued for delivery, amended or renewed in this state after January 1, 1987, shal…

worker. Every individual health insurance policy issued, delivered, or renewed in this state which provides coverage on an expense-incurred basis for any services performed by a licensed psychologist pursuant to KRS Chapter 319, or by a licensed clinical social worker pursuant to…

craniomandibular jaw disorders. (1) All individual policies of health insurance which provide coverage on an expense- incurred basis for surgical or nonsurgical treatment of skeletal disorders shall provide coverage for medically necessary procedures relating to temporomandibular…

The word "insured," as used in this subtitle, shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under such a policy to any indemnities, …

(1) Any policy of a foreign or alien insurer, when delivered or issued for delivery to any person in this state, may contain any provision which is not less favorable to the insured or the beneficiary than the provisions of this subtitle and which is prescribed or required by the…

A policy delivered or issued for delivery to any person in this state in violation of this subtitle shall be held valid but shall be construed as provided in this subtitle. When any provision in a policy subject to this subtitle is in conflict with any provision of this subtitle,…