Title XXV, Business and Financial Institutions
21 chapters · 2,855 sections in this title.
KRS § 304.17B-023 Duties of GAP participating insurer and department to report and to provide information -- Payment of GAP losses -- Examination of insurers to determine accuracy of information provided
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provide information -- Payment of GAP losses -- Examination of insurers to determine accuracy of information provided. (1) After the end of each calendar year, a GAP participating insurer shall report the following information for the previous calendar year: (a) The total earned …
KRS § 304.17B-025 Enrollee's option to renew health benefit plan -- Guaranteed Acceptance Program to remain in effect with certain exceptions
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Acceptance Program to remain in effect with certain exceptions. (1) Any health benefit plan issued to a GAP qualified individual under the GAP program shall be renewed at the option of the enrollee, except for the reasons set out in KRS 304.17A-240. (2) The Guaranteed Acceptance …
KRS § 304.17B-027 Exemption of Kentucky Access and the Office of Health Data and Analytics from state and local taxes
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Analytics from state and local taxes. Kentucky Access and the Office of Health Data and Analytics shall be exempt from all taxes levied by the state or any of its subdivisions.
KRS § 304.17B-029 Duties of the Office of Health Data and Analytics to report to General Assembly -- State Auditor to audit Kentucky Access and report to the Legislative Research Commission and the Office of Health Data and Analytics
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Assembly -- State Auditor to audit Kentucky Access and report to the Legislative Research Commission and the Office of Health Data and Analytics. (1) Sixty (60) days prior to the regular session of the General Assembly in the year 2002, and sixty (60) days prior to each subsequen…
KRS § 304.17B-031 Administrative regulations to carry out KRS 304.17B-001 to 304.17B-031 -- Kentucky Access subject to other laws
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031 -- Kentucky Access subject to other laws. (1) The Office of Health Data and Analytics shall promulgate administrative regulations necessary to carry out the provisions of KRS 304.17B-001 to 304.17B- 031. (2) Kentucky Access shall be subject to the provisions of this subtitle,…
KRS § 304.17B-033 List of high-cost conditions -- Recommendations and changes -- Administrative regulations
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Administrative regulations. (1) No less than annually, the Health Insurance Advisory Council shall review the list of high-cost conditions established under KRS 304.17B-001(14) and recommend changes to the director of the Division of Health Benefit Exchange. The director may acce…
KRS § 304.17B-035 Payment for coverage of services within scope of practice of optometrists
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optometrists. Any health benefit plan issued or renewed on or after July 12, 2006, by Kentucky Access which provides coverage for services rendered by a physician or osteopath duly licensed under KRS Chapter 311 that are within the scope of practice of an optometrist duly license…
KRS § 304.17B-037 Limitation on amount of copayment or coinsurance charged for services rendered by chiropractor or optometrist
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services rendered by chiropractor or optometrist. Health benefit plans provided under Kentucky Access shall not impose a copayment or coinsurance amount charged to the insured for services rendered by a chiropractor licensed under KRS Chapter 312 or an optometrist licensed under …
KRS § 304.17C-010 Definitions for subtitle
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As used in this subtitle, unless the context requires otherwise: (1) "At the time of enrollment" means the same as defined in KRS 304.17A-005(2); (2) "Enrollee" means an individual who is enrolled in a limited health service benefit plan; (3) "Health care provider" or "provider" …
KRS § 304.17C-020 Discrimination prohibited against willing provider located in area
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A health insurer shall not discriminate against any provider who is located within the geographic coverage area of the limited health benefit plan and who is willing to meet the terms and conditions for participation established by the insurer.
KRS § 304.17C-030 Disclosure
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(1) An insurer shall disclose in writing to a covered person and an insured or enrollee, in a manner consistent with the provisions of KRS 304.14-420 to 304.14-450, the terms and conditions of its limited health service benefit plan and shall promptly provide the covered person a…
KRS § 304.17C-040 Availability of provider network
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An insurer that offers a limited health service benefit plan that utilizes a provider network shall have a provider network that is available to all persons enrolled in the plan within thirty (30) minutes or thirty (30) miles of each enrollee's place of residence or work, to the …
KRS § 304.17C-050 Standards for providers -- Mechanism for acting upon applications -- Policy governing removal of providers from network
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Policy governing removal of providers from network. (1) Insurers shall establish relevant, objective standards for initial consideration of providers and for providers to continue as a participating provider in the plan. Standards shall be reasonably related to services provided.…
KRS § 304.17C-060 Filing of agreements -- Provisions of agreements -- Procedures for changing agreement -- Filing of risk-sharing arrangements and subcontracts -- Availability of information
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changing agreement -- Filing of risk-sharing arrangements and subcontracts -- Availability of information. (1) An insurer shall file with the commissioner sample copies of any agreements it enters into with providers for the provision of health care services. The commissioner sha…
KRS § 304.17C-070 Prohibition of contract to limit disclosure to enrollee -- Actions for which provider may not be penalized -- Disclosure of arrangements between plan and providers
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which provider may not be penalized -- Disclosure of arrangements between plan and providers. (1) An insurer may not contract with a health care provider to limit the provider's disclosure to an enrollee, or to another person on behalf of an enrollee, of any information relating …
KRS § 304.17C-080 Plan for selection and reevaluation of providers
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(1) Each insurer shall have a process for the selection of health care providers who will be on the plan's list of participating providers, with written policies and procedures for review and approval used by the plan. (2) The plan shall establish minimum professional requirement…
KRS § 304.17C-085 Definitions for section -- Set fees for noncovered services in participating provider agreement prohibited -- Provider charges limited to provider's rate for services and materials -- Contractual discount for covered services -- Reimbursement -- Provisions cannot be waived by contract
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participating provider agreement prohibited -- Provider charges limited to provider's rate for services and materials -- Contractual discount for covered services -- Reimbursement -- Provisions cannot be waived by contract. (1) As used in this section: (a) "Contractual discount" …
KRS § 304.17C-090 Payment of claims of dental-only benefits -- Reports -- Interest
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The provisions of KRS 304.17A-700 to 304.17A-730, relating to payment of claims, shall apply to limited health service benefit plans for the provision of dental-only benefits, except as follows: (1) A limited health service plan for the provision of dental-only benefits, its agen…
KRS § 304.17C-100 Payment for coverage of services within scope of practice of optometrists
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optometrists. Any limited health service benefit plan issued or renewed on or after July 12, 2006, which provides coverage for services rendered by a physician or osteopath duly licensed under KRS Chapter 311 that are within the scope of practice of an optometrist duly licensed u…
KRS § 304.17C-110 Limitation on amount of copayment or coinsurance charged for services rendered by chiropractor or optometrist
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services rendered by chiropractor or optometrist. An insurer shall not impose a copayment or coinsurance amount charged to the insured for services rendered by a chiropractor licensed under KRS Chapter 312 or an optometrist licensed under KRS Chapter 320 that is greater than the …
KRS § 304.17C-120 Prescription eye drops coverage to include refills and additional bottle if conditions met
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if conditions met. (1) As used in this section, "practitioner" has the same meaning as in KRS 217.015. (2) Any limited health service benefit plan issued or renewed on or after January 1, 2015, that provides coverage for prescription eye drops shall not deny coverage for a refill…
KRS § 304.17C-125 Application of specified sections of Subtitle 17A of KRS Chapter 304 to limited health service benefit plans. (Effective until January 1, 2027)
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to limited health service benefit plans. (Effective until January 1, 2027) The following shall apply to limited health service benefit plans, including any limited health service contract, as defined in KRS 304.38A-010: (1) KRS 304.17A-129; (2) KRS 304.17A-262; and (3) KRS 304.17…
KRS § 304.17C-130 Definitions for KRS 304.17C-130 to 304.17C-138
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As used in KRS 304.17C-130 to 304.17C-138: (1) "Covered person" means an individual who is covered by a dental benefit plan; (2) "Dental benefit plan" means a limited health service benefit plan that provides coverage for dental services; (3) "Dental carrier" means a health insur…
KRS § 304.17C-132 Definitions for section -- Third party access to provider network contract -- Prohibition against dental carrier contract cancellation
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contract -- Prohibition against dental carrier contract cancellation. (1) As used in this section: (a) "Contracting entity" means a dental carrier, a third-party administrator, or any other person that enters into direct contracts with providers for the delivery of dental service…
KRS § 304.17C-134 Conditions for dental benefit plan denial of claims requiring prior authorization
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authorization. (1) As used in this section, "prior authorization" means any written communication that: (a) Indicates that a specific procedure is, or multiple procedures are, covered under the covered person's dental benefit plan and reimbursable at a specific amount, subject to…
KRS § 304.17C-136 Definitions for section -- Prohibition against payment method restrictions for dental benefit plan -- Electronic fund transfer payments
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restrictions for dental benefit plan -- Electronic fund transfer payments. (1) As used in this section: (a) "Credit card payment": 1. Means a type of electronic funds transfer in which a dental benefit plan or its contracted vendor issues a single-use series of numbers associated…
KRS § 304.17C-137 Assignment of benefits under a dental insurance plan -- Procedures -- Revocation -- Construction
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Revocation -- Construction. (1) (a) An insurer providing coverage under a dental benefit plan shall honor a written assignment of benefits due under the plan that is: 1. Made: a. By a covered person to a provider for dental services provided to the covered person; and b. On a for…
KRS § 304.17C-138 Prohibition of contractual waiver of KRS 304.17C-130 to 304.17C-138
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138. The provisions of KRS 304.17C-130 to 304.17C-138 shall not be waived by contract. Any contractual arrangement in conflict with this section or that purports to waive any requirement of this section of shall be null and void.
KRS § 304.18-010 Scope of subtitle -- Short title
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(1) This subtitle may be cited as the Group or Blanket Health Insurance Law. (2) This subtitle applies only to group health insurance contracts and to blanket health insurance contracts, except: (a) Disability income insurance; and (b) Paid family leave insurance.
KRS § 304.18-020 "Group health insurance" defined -- Eligible groups and benefits
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(1) "Group health insurance" is hereby declared to be that form of health insurance covering groups of persons as defined in this section, with or without one (1) or more members of their families or one (1) or more of their dependents, or covering one (1) or more members of the …
KRS § 304.18-030 Required provisions in group policies
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Each such group health insurance policy shall contain in substance the following provisions: (1) A provision that, in the absence of fraud, all statements made by applicants or the policyholders or by an insured person shall be deemed representations and not warranties, and that …
KRS § 304.18-032 Coverage for newly born children from moment of birth
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(1) All group or blanket health insurance policies and certificates issued thereunder providing coverage on an expense incurred basis, regardless of whether the policies and certificates are issued for nonfamily or family coverage, shall, provide that health insurance benefits sh…
KRS § 304.18-033 Optional nursery care coverage for a well newly born child
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(1) All group or blanket health insurance policies providing coverage on an expense incurred basis which provide 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 to five (5) f…
KRS § 304.18-034 Medicare supplement insurance for persons not eligible for Medicare by reason of age
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by reason of age. Insurers delivering or issuing for delivery in Kentucky group Medicare supplement insurance policies as defined in KRS 304.14-500 to 304.14-550, or renewing such policies, shall make available upon request of the group policyholder Medicare supplement insurance …
KRS § 304.18-035 Ambulatory surgical centers, coverage
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(1) All group or blanket health insurance policies and certificates issued thereunder 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 an…
KRS § 304.18-036 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 group policy or contract of general health insurance to be issued, delivered, issued for delivery, amended or renewed in this state after January 1, 1987…
KRS § 304.18-0363 Coverage for services of licensed psychologist or licensed clinical social worker
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worker. Every policy of group or blanket health insurance issued, delivered, or renewed in this state which provides coverage on an expense-incurred basis for any services by a licensed psychologist pursuant to KRS Chapter 319, or a licensed clinical social worker pursuant to KRS…
KRS § 304.18-0365 Coverage for treatment of temporomandibular joint disorders and craniomandibular jaw disorders
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craniomandibular jaw disorders. (1) All groups or blanket policies of health insurance, and certificates issued thereunder, which provide coverage on an expense-incurred basis for surgical or nonsurgical treatment of skeletal disorders shall provide coverage for medically necessa…
KRS § 304.18-037 Group or blanket health insurers to offer home health care coverage to master policyholder -- Conditions
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coverage to master policyholder -- Conditions. (1) All insurers issuing group or blanket health insurance policies and certificates issued thereunder in the Commonwealth providing coverage on an expense incurred basis shall make available and offer to the master policyholder cove…
KRS § 304.18-040 Direct payment of hospital, medical services
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Any group health policy may provide that all or any portion of any indemnities provided by any such policy on account of hospital, nursing, medical or surgical services may, at the insurer's option, be paid directly to the hospital or person rendering such services; but the polic…
KRS § 304.18-045 Requirements for insurer that issues policy or administers program providing for utilization review of benefits
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providing for utilization review of benefits. (1) Every health insurer proposing to issue or deliver in this state a group or blanket health insurance policy or contract or administer a health benefit program which provides for the coverage of hospital benefits and the utilizatio…
KRS § 304.18-050 Readjustment of premiums -- Dividends
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Any contract of group health insurance may provide for the readjustment of the rate of premium based upon the experience thereunder. If a policy dividend is declared or a reduction in rate is made or continued for the first or any subsequent year of insurance under any policy of …
KRS § 304.18-060 "Blanket health insurance" defined
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"Blanket health insurance" is that form of health insurance covering groups of persons as enumerated in one (1) of the following subsections under a policy or contract issued to: (1) Any common carrier or to any operator, owner, or lessee of a means of transportation, who or whic…
KRS § 304.18-070 Filing and required provisions in blanket policies
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Any insurer authorized to write health insurance in this state shall have the power to issue blanket health insurance. No such blanket policy, except as provided in subsection (4) of KRS 304.14-120, may be issued or delivered in this state unless a copy of the form thereof has be…
KRS § 304.18-080 Application and certificates
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(1) An individual application need not be required from a person covered under a blanket health policy or contract, nor shall it be necessary for the insurer to furnish each person a certificate, if such person does not pay all or part of the premium for such insurance. (2) A per…
KRS § 304.18-082 Delivery of communications relating to insurance policy, certificate, plan, or contract by electronic means -- Employer consent -- Compliance requirements
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plan, or contract by electronic means -- Employer consent -- Compliance requirements. (1) As used in this section: (a) "Communications" includes health insurance identification cards and other documents; (b) "Covered person" means an individual that: 1. Is an employer-sponsored g…
KRS § 304.18-085 Commissioner to prescribe guidelines for coordination of benefits by group health insurance policies
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group health insurance policies. The commissioner shall prescribe guidelines for coordination of benefits by group health insurance policies. All group health insurance policies delivered, issued for delivery, or renewed in Kentucky after July 15, 1986, shall comply with the guid…
KRS § 304.18-090 Payment of benefits under blanket health insurance policy or contract
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Except as provided in KRS 304.17A-265 and 304.17C-137: (1) Subject to subsection (2) of this section, all benefits under any blanket health insurance policy or contract shall be payable to the person insured, or to the person's designated beneficiary or beneficiaries, or to the p…
KRS § 304.18-095 Indemnity payable for services performed by optometrists, osteopaths, physicians, chiropractors, or podiatrists
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physicians, chiropractors, or podiatrists. (1) When any policy or group insurance or blanket 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 32…
KRS § 304.18-097 Policy covering services performed by dentist deemed to cover such services performed by physician
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services performed by physician. Any group insurance or blanket health insurance policy or contract 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 ben…