Title XXV, Business and Financial Institutions

If any policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if such date falls within a period for which premium is accepted by the insurer or if the insurer accepts a premium aft…

No insurer shall deliver or issue for delivery in this state any policy providing benefits or values for surviving or continuing policyholders contingent upon the lapse or termination of the policies of other policyholders whether by death or otherwise.

The reinstatement of any policy of noncancellable health insurance, or of any health policy containing a provision for incontestability, or a provision of similar nature, delivered or issued for delivery in this state subsequent to September 1, 1950, shall be contestable only on …

Each insurer issuing health insurance policies for delivery in this state shall, before use thereof, file with the commissioner its premium rates and classification of risks pertaining to such policies. The insurer shall adhere to its rates and classifications as filed with the c…

(1) No filing under KRS 304.17-380 that contains an increase in premium rates shall become effective until the commissioner has issued an order approving the filing. The commissioner may hold a hearing within thirty (30) days after receiving a filing under this subtitle containin…

(1) Health insurance on a franchise plan is that issued to: (a) Five (5) or more employees of a common employer; or (b) Ten (10) or more members of any bona fide association or labor union, which association or union was formed and exists for purposes other than that of obtaining…

providing for utilization review of benefits. (1) Every health insurer proposing to issue or deliver in this state a health insurance policy or contract or administer a health benefit program which provides for the coverage of hospital benefits and the utilization review of those…

If an individually marketed health insurance policy is canceled, the insurer shall return promptly the unearned portion of any premium paid beyond the month in which the cancellation is effective.

Catchline at repeal: Minimum surplus.

Catchline at repeal: Membership.

Catchline at repeal: Rights of members.

Catchline at repeal: Bylaws.

Catchline at repeal: Annual meeting; voting.

Catchline at repeal: Contingent liability of members.

Catchline at repeal: Accrual of liability; amount and collection of assessment.

As used in this subtitle, unless the context requires otherwise: (1) "Association" means an entity, other than an employer-organized association, that has been organized and is maintained in good faith for purposes other than that of obtaining insurance for its members and that h…

(1) As used in this section, "otherwise specifically indicated or provided" means that the section or another section of the Kentucky Revised Statutes: (a) Expressly states that the section is applicable to; and (b) Specifically refers to; a type of insurance, coverage, or benefi…

Catchline at repeal: Definitions for KRS 304.17A-010 to 304.17A-070.

Catchline at repeal: Kentucky Health Purchasing Alliance -- Regional advisory boards.

Catchline at repeal: Duties of the Kentucky Health Purchasing Alliance.

Catchline at repeal: Conditions of participation in the alliance.

Catchline at repeal: Duties of the Department of Insurance with respect to the alliance.

Catchline at repeal: Supervision of alliance by department relative to antitrust laws.

Catchline at repeal: Creation of accountable health plans -- Certification.

Catchline at repeal: Discontinuance of operation of Kentucky Health Purchasing Alliance -- Executive director to terminate alliance activities by June 30, 1999.

Expenses and supplies. (1) There is hereby created and established a Health Insurance Advisory Council whose duties shall be to review and discuss with the commissioner any issues which impact the provision of health insurance in the state. The advisory council shall consist of t…

Catchline at repeal: Commissioner's review of rates and charges filed between July 15, 1995, and July 15, 1996 -- Refunds -- Suspension of certificate of authority -- Notification of review.

Commissioner's approval -- Policy forms -- Administrative regulations -- Hearing. (1) (a) Notwithstanding any other provisions of this chapter to the contrary, each insurer that issues, delivers, or renews any health benefit plan to any market segment other than a large group sha…

plans. Premium rates for a health benefit plan issued or renewed to an individual, a small group, or an association on or after April 10, 1998, shall be subject to the following provisions: (1) The premium rates charged during a rating period to an individual with similar case ch…

(1) Notwithstanding any other provision of this chapter, the amount or rate of premiums for an employer-organized association health plan may be determined, subject to the restrictions of subsection (2) of this section, based upon the experience or projected experience of the emp…

association markets -- Required coverage -- Exclusions from coverage. (1) An insurer authorized to engage in the business of insurance in the Commonwealth of Kentucky may offer one (1) or more basic health benefit plans in the individual, small group, and employer-organized assoc…

An insurer that offers a basic health benefit plan shall disclose to all individuals, small employer groups and employer-organized associations prior to the issuance of a policy that the basic health benefit plan: (1) Provides limited coverage; (2) Includes federally mandated ben…

improvement program. (1) An insurer issuing a group or individual health benefit plan may offer a voluntary wellness or health improvement program that allows for rewards or incentives to encourage participation or to reward members for participation, including but not limited to…

payments under federal law to defray the cost of application of provision of chapter -- Administrative regulations. (1) As used in this section, "qualified health plan" has the same meaning as in 42 U.S.C. sec. 18021(a)(1), as amended. (2) Notwithstanding any other provision of t…

Catchline at repeal: Definitions for KRS 304.17A-100 to 304.17A-160 and KRS 304.18-023.

Catchline at repeal: Requirement of compliance with specified conditions regarding renewability and pre-existing conditions.

Catchline at repeal: Use of approved modified rating methodology required for issuance or renewal of plans -- Geographic rating areas -- Exemption -- Permitted deviation from index community rates.

Denial letter -- Network adequacy -- Reports. (Effective January 1, 2027) (1) As used in this section, "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 …

(1) As used in this section: (a) "Habilitative services" means health care services that help a person keep, learn, or improve skills and functioning for daily living; (b) "Habilitative speech therapy" means speech therapy that helps a person keep, learn, or improve skills and fu…

Catchline at repeal: Risk adjustment process -- Authority for administrative regulations.

All health benefit plans shall provide coverage for cochlear implants for persons diagnosed with profound hearing impairment.

(1) As used in this section: (a) "Hearing aid" means any wearable, nondisposable instrument or device designed to aid or compensate for impaired human hearing and any parts, attachments, or accessories, including earmolds, but excluding batteries and cords; and (b) "Related servi…

requirements for covered diagnostic breast examinations or supplemental breast examinations. Health benefit plans shall comply with KRS 304.17-316.

mastectomy, diagnosis and treatment of endometrioses and endometritis, and bone density testing -- Requirements for health benefit plan. (1) A health benefit plan shall make available and offer to the purchaser coverage for: (a) The following, if a health benefit plan provides me…

(1) Health benefit plans which provide benefits for treatment of breast cancer by chemotherapy shall also provide coverage for treatment of breast cancer by high- dose chemotherapy with autologous bone marrow transplantation or stem cell transplantation. (2) The administration of…

(1) As used in this section, unless the context requires otherwise: (a) "Cancer clinical trial" means a clinical trial that: 1. Is approved by: a. The National Institutes of Health, or any institutional review board recognized by the National Institutes of Health; b. The United S…

Catchline at repeal: Coverage for prescribed cancer drugs not approved by the Federal Food and Drug Administration for cancer treatment -- Review panel for off-label uses.

benefit plan -- Reimbursement for rural health clinics, federally qualified health centers, and federally qualified health center look-alikes -- Benefits subject to deductible, copayment, or coinsurance -- Payment subject to provider network arrangements -- Audio-only encounters …

moment of birth and to include inherited metabolic diseases -- Requirement for notification and payment of premium -- Coverage for milk fortifiers to prevent enterocolitis. (1) A health benefit plan that provides coverage for a family or dependent shall provide coverage of a newl…

All health benefit plans issued or renewed on or after July 15, 1995, which provide coverage for a family member of the insured shall provide that the health plan benefits applicable for children shall be payable with respect to legally-adopted children of the insured or any chil…