Title XXV, Business and Financial Institutions

When an audit of the records of a pharmacy is conducted by an auditing entity, it shall be subject to the following conditions: (1) The auditing entity shall give at least thirty (30) days' written notice to the pharmacy prior to conducting the audit for each audit to be conducte…

(1) The auditing entity conducting an audit shall establish an appeals process under which a pharmacy may appeal a final audit report. The auditing entity shall provide to the pharmacy, prior to or at the time of the delivery of the preliminary audit report, a written explanation…

by state agency pursuant to KRS Chapter 205. KRS 304.17A-740 to 304.17A-743 shall not apply to any audit conducted by or on behalf of a state agency pursuant to KRS Chapter 205.

misrepresentation, or abuse alleged. KRS 304.17A-740 to 304.17A-743 shall not apply to any audit conducted in which an allegation of fraud, willful misrepresentation, or abuse is made by the auditing entity regarding the audited pharmacy.

As used in KRS 304.17A-750 to 304.17A-770 and 304.47-020, unless the context requires otherwise: (1) "Eligible employee" means any full time or part time employee who is actively engaged in the conduct of business of the employer, who has satisfied any employer waiting period req…

Administrative regulations. (1) No individual or business entity shall act or hold themselves out as an insurance purchasing outlet without first being registered as an insurance purchasing outlet by the commissioner of the Kentucky Department of Insurance in accordance with KRS …

be filed -- Administrative regulations. (1) A business entity seeking to obtain a certificate of registration to act as an insurance purchasing outlet shall complete and file with the commissioner of the Kentucky Department of Insurance an application prescribed by the commission…

penalty. An application for or an existing certificate of registration of an insurance purchasing outlet may be denied, suspended, or revoked for any reason a penalty could be imposed upon an administrator's license in accordance with KRS 304.9-440. In addition to denial, suspens…

-- Books and records -- Renewal of certificate -- Nontransferability -- Fees. (1) The insurance purchasing outlet may collect premiums and the value of vouchers from or on behalf of insurance purchasing outlet members under its administrator license. (2) The insurance purchasing …

(1) An insurance purchasing outlet shall: (a) Set and collect fees to finance necessary costs incurred in marketing, selling, servicing, and administering its services; (b) Offer health benefit plans to eligible persons; (c) Provide premium and voucher collection services for par…

each member -- Disclosure to members. (1) For administrative purposes, an insurance purchasing outlet shall be the policyholder or contract holder of the health benefit plan on behalf of an insurance purchasing outlet member. (2) The participating insurer shall issue a certificat…

(1) Notwithstanding any other provision of this chapter, the amount or rate of premiums for an insurance purchasing outlet health benefit plan may be determined, subject to the restrictions of subsection (2) of this section, based upon the experience or projected experience of th…

benefit plans -- Member who no longer meets participation requirements. (1) Health benefit plan coverage obtained through an insurance purchasing outlet shall be deemed group health insurance in accordance with KRS 304.18-020. (2) Health benefit plans obtained through an insuranc…

process voucher -- Administrative regulations. (1) A voucher issued by an employer shall only be redeemable at an insurance purchasing outlet. A voucher shall be nonassignable and nontransferable. (2) An insurance purchasing outlet shall redeem the value of the voucher with the e…

Insurance purchasing outlets 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; (2) Subtitle 2; (3) Subtitle 3; (4) Subt…

The purpose of KRS 304.17A-800 to 304.17A-844 is to establish minimum standards for self-insured employer-organized association groups to assure that such groups are providing adequate coverage for health benefit liability risks.

(1) "Administrator" means an individual, partnership, corporation, association, or other legal entity engaged by a self-insured employer-organized association group's board of trustees to carry out the policies established by the group's board of trustees and to provide day-to-da…

employer-organized association groups. KRS 304.17A-800 to 304.17A-844 apply to the members of a self-insured employer- organized association group as authorized by KRS 304.17A-320. A self-insured employer-organized association group may be composed of any number of members, who j…

No person or entity in this state shall be, act as, or hold itself out as a self-insured employer-organized association group unless it holds a certificate of filing from the commissioner. All certificates of filing shall be issued by the commissioner.

A proposed self-insured employer-organized association group shall file with the commissioner an application for a certificate of filing accompanied by a nonrefundable filing fee of five hundred dollars ($500). Each application for a certificate of filing shall be submitted to th…

Upon receipt of an application for a certificate of filing, the commissioner shall issue or deny the same. A certificate of filing shall be issued only if the commissioner finds that the applicant has complied with KRS 304.17A-808, has paid the application fee, and the commission…

(1) This section applies to a group applying for and holding a certificate of filing as a self-insured employer-organized association group. (2) To obtain and to maintain its certificate of filing, a self-insured employer-organized association group shall have sufficient financia…

A self-insured employer-organized association group shall notify the commissioner immediately of any change in the information required to be filed under KRS 304.17A- 808 or 304.17A-812.

The funds of a self-insured employer-organized association group shall be invested only in securities or other investments permitted by Subtitle 7 of this chapter, or such other securities or investments as the commissioner may permit by administrative regulation.

Licensing -- Continuing education. (1) An agent of a self-insured employer-organized association group shall be licensed as an agent with the life and health lines of authority in accordance with Subtitle 9 of this chapter regulating all aspects of agent licenses. (2) Subsection …

commissioner. The commissioner or any person authorized by him or her shall have the power to examine the financial condition, affairs, and management of any self-insured employer- organized association group subject to the provisions of KRS 304.17A-800 to 304.17A- 844. The commi…

Any self-insured employer-organized association group holding a certificate of filing pursuant to KRS 304.17A-800 to 304.17A-844 is deemed to have appointed the Secretary of State as its attorney to receive service of legal process issued against it in Kentucky. This appointment …

request of group -- Merger with another group. (1) A certificate of filing remains in effect until terminated at the request of the group or suspended or revoked by the commissioner pursuant to KRS 304.17A-840. (2) The commissioner shall not grant the request of the self-insured …

Prohibited acts. (1) Each group shall be operated by a board of trustees which shall consist of not less than two (2) persons selected in the manner prescribed by the self-insured employer-organized association or by other laws of the Commonwealth. The trustees shall not be offic…

bankruptcy. (1) An employer joining a self-insured employer-organized association group after the group has been issued a certificate of filing shall submit an application for membership to the board of trustees or its administrator. Membership shall take effect no earlier than e…

administrator or group. No trustee of a self-insured employer-organized association group nor any of its employees, officers, or directors shall be an employee, officer, or director of, or have either a direct or indirect interest in, an administrator. No administrator nor any of…

regulations. (1) All self-insured employer-organized association groups shall file with the commissioner a statement of financial condition audited by an independent certified public accountant on or before one hundred twenty (120) days from the end of the group's fiscal year for…

changes -- Filing fee. Self-insured employer-organized association groups shall file with the commissioner their forms, rates, underwriting guidelines, evidence of coverage, and any changes therein. The filing shall be accompanied by a filing fee of five dollars ($5) per form fil…

Self-insured employer-organized association groups shall establish contribution plans.

(1) Every member of a self-insured employer-organized association group shall receive written evidence of coverage by the group. (2) All evidences of coverage issued pursuant to this section shall contain coverage terms, conditions, and exclusions. (3) All evidences of coverage i…

(1) The commissioner may suspend or revoke any certificate of filing issued to a self- insured employer-organized association group if the commissioner finds that any of the following conditions exist: (a) The self-insured employer-organized association group is operating signifi…

The commissioner may promulgate reasonable administrative regulations not inconsistent with the provisions of KRS 304.17A-800 to 304.17A-844 that he or she deems necessary for the proper administration of these sections. Nothing in KRS 304.17A-800 to 304.17A- 844 or 304.17A-320 o…

(1) After a hearing or upon agreement by the self-insured employer-organized association group, the commissioner may suspend or revoke the certificate of filing of a self-insured employer-organized association group, impose a civil penalty of up to five thousand dollars ($5,000) …

benefit plan insurers -- Confidentiality -- Additional information to be provided to large groups. (1) Any insurer issuing or delivering group health benefit plans in the Commonwealth shall provide to an employer-organized association health benefit plan, within thirty (30) calen…

As used in this subtitle, unless the context requires otherwise: (1) "Administrator" is defined in KRS 304.9-051(1); (2) "Agent" is defined in KRS 304.9-020; (3) "Assessment process" means the process of assessing and allocating guaranteed acceptance program losses or Kentucky Ac…

Members and meetings -- Programs and expenditure of funds -- Public hearings -- Annual report to the Governor and the General Assembly -- Liabilities. (1) There is hereby established the Kentucky Health Care Improvement Authority as an agency, instrumentality, and political subdi…

Purpose -- Liabilities. (1) There is hereby created Kentucky Access, which shall ensure that health coverage is made available to each Kentucky individual resident applying and qualifying for coverage. Any health coverage provided under this section shall begin no sooner than Jan…

administration of Kentucky Access. In its duties to operate and administer Kentucky Access, the Office of Health Data and Analytics shall, through itself or designated agents: (1) Establish administrative and accounting procedures for the operation of Kentucky Access; (2) Enter i…

administration of Kentucky Access. In its duties to operate and administer Kentucky Access, the Office of Health Data and Analytics may, through itself or third parties: (1) Exercise any and all powers granted to insurers under this chapter; and (2) Sue or be sued.

and duties -- Reimbursement for expenses. (1) The Office of Health Data and Analytics shall select a third-party administrator, through the state competitive bidding process, to administer Kentucky Access. The third-party administrator shall be an administrator licensed by the de…

(1) The schedule of rates, premium rates charged to enrollees, deductible amounts, copayment amounts, coinsurance amounts, and other cost-sharing amounts shall be established by the Office of Health Data and Analytics. Premium rates charged to enrollees are not intended to fully …

(1) Any individual who is an eligible individual and a resident of Kentucky is eligible for coverage under Kentucky Access, except as specified in paragraphs (a), (b), (d), and (e) of subsection (4) of this section. (2) Any individual who is not an eligible individual who has bee…

evaluation and revision of rates and plans offered to Kentucky Access enrollees. (1) At least annually, the Office of Health Data and Analytics shall evaluate and revise as necessary rates to be charged to Kentucky Access enrollees. (2) Except as provided in KRS 304.17B-019, the …

(1) Kentucky Access shall offer at least three (3) health benefit plans to enrollees, which shall be similar to the health benefit plans currently being marketed to individuals in the individual market. (2) At least one (1) plan shall be offered in a traditional fee-for-service f…

GAP losses -- Examination of insurers and stop-loss carriers to determine accuracy of information provided. (1) In addition to the other powers enumerated in KRS 304.17B-001 to 304.17B-031, the Office of Health Data and Analytics shall assess insurers in the amounts specified in …