Nonprofit Hospital, Medical-Surgical, Dental and Health Service Corporations

KRS tit. XXV, ch. 304, subtit. 32

in effect

KRS 304.32-010 Short title

304.32-010. Short title This subtitle may be cited as the "Nonprofit Hospital, Medical-Surgical, Dental and Health Service Corporation Law." Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 1, effective June 18, 1970.

KRS 304.32-020 Purpose and interpretation

304.32-020. Purpose and interpretation (1) It is the purpose of this subtitle to regulate in the public's interest the formation and operation of prepaid health care service organizations, in order that such services may be made available upon a basis of fair and equitable contracts through state licensed nonprofit organizations meeting reasonable standards as to administration, reserves and financial soundness. (2) The provisions of this subtitle shall be liberally interpreted to effectuate the purpose hereinabove declared. Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 2, effective June 18, 1970.

KRS 304.32-030 Application of subtitle

304.32-030. Application of subtitle (1) Any nonprofit corporation organized under the laws of this state for the purpose of establishing, maintaining, and operating a nonprofit plan, whereby hospital care, medical-surgical care, dental care, and other health services are made available to persons who become subscribers to such plan or plans under a contract with the corporation, shall be subject to and be governed by the provisions of this subtitle, and shall be exempt from all other provisions of this code, except as expressly provided in this subtitle, and no insurance law hereafter enacted shall be deemed to apply to these corporations unless they be specifically referred to therein. (2) Except as provided in KRS 304.32-300 to 304.32-320, the provisions of this subtitle shall not apply to any employer's self-insured health plan or service established and maintained solely for its members and their immediate families, or to any self- insured health plan or service established, maintained, and insured jointly by any employer and any labor organization or organizations. Effective: July 13, 2004 History: Amended 2004 Ky. Acts ch. 24, sec. 37, effective July 13, 2004. -- Amended 1978 Ky. Acts ch. 158, sec. 3, effective June 17, 1978. -- Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 3, effective June 18, 1970.

KRS 304.32-040 Incorporation

304.32-040. Incorporation KRS Chapter 273, as may from time to time be amended, except where inconsistent with the express provisions of this subtitle, shall govern the corporate powers, duties, and relationships of corporations incorporated under the provisions of this subtitle, but such chapter shall not apply to any corporation incorporated and formed under the laws of this state and in existence on June 18, 1970. Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 4, effective June 18, 1970.

KRS 304.32-045 Entities subject to provisions of this subtitle permitted to convert to domestic mutual insurance companies subject to provisions of Subtitle 24

304.32-045. Entities subject to provisions of this subtitle permitted to convert to domestic mutual insurance companies subject to provisions of Subtitle 24 (1) Any nonprofit hospital, medical-surgical, dental, and health service corporation subject to the provisions of this subtitle, possessed of admitted assets in excess of all liabilities at least equal to the original surplus required of a domestic mutual insurance company transacting the same kind or kinds of business may, at its option and without reincorporation, adopt and become subject to the provisions of Subtitle 24 of this chapter governing domestic mutual insurers in lieu of this subtitle; provided, however, that upon becoming subject to the provisions of Subtitle 24 of this chapter, as hereinafter provided, such companies may continue to provide services to their present or like services to future members and subscribers and may make provision for the payment for health care services directly to hospitals or other agencies or institutions or persons rendering such health care service or related services or may make direct payment to the member or subscriber. (2) Any nonprofit hospital, medical-surgical, dental, and health service corporation subject to the provisions of this subtitle may adopt and become subject to the provisions of Subtitle 24 of this chapter by the adoption of a resolution by its board of directors declaring the election of said nonprofit hospital, medical-surgical, dental, and health service corporation to become subject to the provisions of Subtitle 24 of this chapter governing domestic mutual insurers, and after the adoption of such resolution the board of directors shall adopt such amendments to the articles of incorporation and bylaws of the nonprofit hospital, medical-surgical, dental, and health service corporation as shall be necessary and file the same with the commissioner of the Department of Insurance of the Commonwealth of Kentucky. Upon such filing, said nonprofit hospital, medical-surgical, dental, and health service corporation shall no longer be subject to the provisions of this subtitle, but shall be subject to Subtitle 24 of this chapter governing domestic mutual insurers and shall honor all legitimate claims presented by its member policyholders under the terms and conditions of its policy who have incurred claims in any private hospital with acute care in the State of Kentucky as long as the hospital is duly licensed and certified by the State of Kentucky; provided, however, that group certificate holders may also be members of the insurer, if so specified in the bylaws of the insurer; and further provided that the conversion of a nonprofit hospital, medical-surgical, dental, and health service corporation, subject to this subtitle, into a domestic mutual insurance company shall not impair the rights or obligations of the nonprofit hospital, medical-surgical, dental, and health service corporation or its members on any contract heretofore or hereafter made. Effective: July 15, 2010 History: Amended 2010 Ky. Acts ch. 24, sec. 1413, effective July 15, 2010. -- Created 1986 Ky. Acts ch. 320, sec. 1, effective July 15, 1986.

KRS 304.32-050 Certificate of authority

304.32-050. Certificate of authority (1) Whenever any number of persons shall associate to form a corporation for any of the purposes in KRS 304.32-030, they shall submit proposed articles of incorporation in triplicate to the commissioner for examination. After being approved by the commissioner and the Attorney General, the articles shall be filed in the office of the Secretary of State, who shall issue a certificate of incorporation pursuant to the provisions of KRS Chapter 273. (2) When not less than the amount required by KRS 304.32-140 is deposited with the commissioner, he or she shall cause an examination to be made either by the commissioner or some disinterested person, especially appointed by him or her for the purpose, who shall certify that the corporation has complied with the provisions of this subtitle. The certificate shall be filed in the office of the commissioner, who shall issue a certificate of authority to the corporation. (3) Whenever any such corporation shall desire to amend its articles of incorporation, it shall file its articles of amendment with the commissioner before filing them with the Secretary of State. When the commissioner shall find the articles of amendment to have been legally adopted, the articles of amendment shall be filed with the Secretary of State. Effective: July 15, 2010 History: Amended 2010 Ky. Acts ch. 24, sec. 1414, effective July 15, 2010. -- Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 5, effective June 18, 1970.

KRS 304.32-060 Name

304.32-060. Name In addition to the contents required or permitted by KRS Chapter 273, the articles of incorporation of any nonprofit hospital, medical-surgical, dental, and health service corporation shall comply with the following: (1) The name of the corporation shall not include the words "insurance," "casualty," "surety," "mutual," or any other words descriptive of the insurance, casualty, or surety business. The corporate name of any corporation to be formed under this subtitle shall not be the same as, or deceptively similar to, the name of any other corporation authorized to do business in this state; and, (2) The statement of purposes shall be in conformity with the provisions of this subtitle. Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 6, effective June 18, 1970.

KRS 304.32-070 Management

304.32-070. Management The property and lawful business of every corporation subject to the provisions of this subtitle shall be held and managed by a governing board of trustees or directors with such powers and authority as shall be necessary or instrumental to the complete execution of purposes of each corporation as limited by its articles of incorporation and bylaws. The number of directors of such corporation shall not be less than ten (10), and subject to such limitation, the number of directors shall be fixed by the bylaws, except as to the number of the first board of directors, which shall be fixed by the articles of incorporation. Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 7, effective June 18, 1970.

KRS 304.32-080 Authorized contracts

304.32-080. Authorized contracts Corporations subject to the provisions of this subtitle may enter into contracts for the rendering of hospital services, medical-surgical services, and other health services on behalf of any of their subscribers with hospitals maintained by the state, or by any of its political subdivisions, or maintained by a nonprofit corporation organized for hospital purposes, or with other corporations, associations, partnerships, or individuals furnishing hospital services, medical-surgical services, or other health services. Nothing contained in this subtitle shall require any corporation to contract or remain under contract with any individual, hospital, physician, or other purveyor of health services; nor shall any employee, agent, officer, director or trustee of any corporation influence or seek to influence any subscriber in the choice or selection of a contracting hospital or contracting physician, or any other contracting purveyor of health service. Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 8, effective, effective June 18, 1970.

KRS 304.32-090 Annual and quarterly statements

304.32-090. Annual and quarterly statements (1) Corporations subject to the provisions of this subtitle doing business in this state on June 18, 1970, or which thereafter do business in this state, shall make and file annually with the commissioner, on or before the first day of March of each year, a statement under oath upon a form to be prescribed by the commissioner, stating the amount of all membership dues, or subscriber fees, collected in this state by the corporation during the year ending the last day of December next preceding; the amounts actually paid during the year for hospital, medical-surgical, dental, and other health services for the subscribers or members of the corporation, and the amounts placed in established reserves for cases billed but not yet paid, unreported and unbilled cases, retroactive cost adjustments, and membership dues or fees paid in advance but not yet earned. (2) The commissioner shall require that domestic companies subject to this subtitle file quarterly statements according to the form and instructions approved by the National Association of Insurance Commissioners. Effective: July 15, 2010 History: Amended 2010 Ky. Acts ch. 24, sec. 1415, effective July 15, 2010. -- Amended 1994 Ky. Acts ch. 496, sec. 8, effective July 15, 1994. -- Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 9, effective June 18, 1970.

KRS 304.32-095 Application of KRS 304.2-205

304.32-095. Application of KRS 304.2-205 Corporations subject to this subtitle shall comply with KRS 304.2-205. Effective: July 15, 1986 History: Created 1986 Ky. Acts ch. 263, sec. 3, effective July 15, 1986.

KRS 304.32-098 Compliance with KRS 304.18-124 to 304.18-127

304.32-098. Compliance with KRS 304.18-124 to 304.18-127 Corporations subject to this subtitle shall comply with KRS 304.18-124 to 304.18-127. Effective: July 13, 1990 History: Created 1990 Ky. Acts ch. 119, sec. 5, effective July 13, 1990.

KRS 304.32-100 Repealed, 1982

304.32-100. Repealed, 1982 Catchline at repeal: Fees. History: Repealed 1982 Ky. Acts ch. 320, sec. 52, effective July 15, 1982. -- Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 10, effective June 18, 1970.

KRS 304.32-110 Certificate of authority -- Renewal date

304.32-110. Certificate of authority -- Renewal date No corporation subject to the provisions of this subtitle shall transact any business in this state unless it shall first procure from the commissioner a certificate of authority stating that the requirements of the laws of this state have been complied with and authorizing it to do business. The certificate of authority shall expire on the last day of February of each year and shall be renewed annually if the corporation has continued to comply with the provisions of this subtitle. Effective: July 15, 2010 History: Amended 2010 Ky. Acts ch. 24, sec. 1416, effective July 15, 2010. -- Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 11, effective June 18, 1970.

KRS 304.32-120 Certificate of authority -- Extension

304.32-120. Certificate of authority -- Extension When the annual statement of a corporation subject to the provisions of this subtitle shall have been filed and all fees due from the corporation shall have been paid, the corporation's certificate of authority to do business in this state shall automatically be extended until such time as the commissioner refuses to relicense the corporation. Effective: July 15, 2010 History: Amended 2010 Ky. Acts ch. 24, sec. 1417, effective July 15, 2010. -- Amended 2002 Ky. Acts ch. 273, sec. 47, effective July 15, 2002. -- Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 12, effective June 18, 1970.

KRS 304.32-130 Schedule of dues and fees

304.32-130. Schedule of dues and fees The commissioner shall not issue or renew a certificate of authority to any corporation operating or proposing to operate a nonprofit hospital, medical-surgical, dental, or other health service plan unless: (1) The subscription or membership certificates which the corporation offers to its subscribers or members, together with a schedule of the dues and fees to be paid by subscribers or members, or the formula for developing dues or fees, has been filed with the commissioner in accordance with KRS 304.32-160. (2) The schedule of the dues and fees to be paid by subscribers or members is one which will: (a) Enable the corporation to meet its current and ongoing obligations to its subscribers or members without impairing the guarantee fund required by KRS 304.32-140; (b) Is established and justified in accordance with those actuarially sound factors deemed relevant by the commissioner; (c) Not be excessive, inadequate, or unfairly discriminatory in relation to the services offered; and (d) Enable the corporation to achieve and maintain the highest insurance industry financial strength ratings. Effective:June 29, 2017 History: Amended 2017 Ky. Acts ch. 127, sec. 1, effective June 29, 2017. -- Amended 2014 Ky. Acts ch. 119, sec. 10, effective July 15, 2014. -- Amended 2010 Ky. Acts ch. 24, sec. 1418, effective July 15, 2010. -- Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 13, effective June 18, 1970.

KRS 304.32-140 Guarantee fund -- Investments -- Risk-based capital requirements

304.32-140. Guarantee fund -- Investments -- Risk-based capital requirements (1) No corporation subject to provisions of this subtitle shall be permitted to do any business in this state unless, in addition to the other requirements of law, it shall have and maintain liquid reserves in an amount not less than five percent (5%) of the corporation's subscription income collected in the preceding year not exceeding two million dollars ($2,000,000), plus two and one-half percent (2.5%) of income exceeding two million dollars ($2,000,000) but not exceeding ten million dollars ($10,000,000), plus one percent (1%) of income exceeding ten million dollars ($10,000,000); but in no event shall reserves be less than five hundred thousand dollars ($500,000). All corporations subject to the provisions of this subtitle shall place on deposit with the commissioner a guarantee fund of cash or approved securities in an amount determined by this formula, but not less than five hundred thousand dollars ($500,000) nor more than one million five hundred thousand dollars ($1,500,000). Any amount of liquid reserves required by this subsection in excess of one million five hundred thousand dollars ($1,500,000) shall be maintained by the corporation at all times, but shall not be required to be placed on deposit, provided that the corporation shall be allowed a period of five (5) years after July 15, 1982, to establish the liquid reserves and deposit the guarantee fund with the commissioner. A corporation subject to the provisions of this subtitle shall at all times comply with the risk-based capital requirements as established in administrative regulations promulgated by the commissioner. (2) The cash or securities representing the guarantee fund required by this section shall be acceptable to the commissioner and the securities shall be negotiable securities. (3) The investments of a corporation subject to the provisions of this subtitle shall be the same kind of investments which life insurance companies are authorized to have. Effective: July 15, 2010 History: Amended 2010 Ky. Acts ch. 24, sec. 1419, effective July 15, 2010. -- Amended 2004 Ky. Acts ch. 24, sec. 38, effective July 13, 2004. -- Amended 2000 Ky. Acts ch. 255, sec. 1, effective July 14, 2000. -- Amended 1982 Ky. Acts ch. 128, sec. 6, effective July 15, 1982. -- Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 14, effective June 18, 1970.

KRS 304.32-145 Coordination of benefits

304.32-145. Coordination of benefits Corporations doing business pursuant to this subtitle are subject to coordination of benefits guidelines prescribed pursuant to KRS 304.18-085. Effective: July 15, 1986 History: Created 1986 Ky. Acts ch. 433, sec. 2, effective July 15, 1986.

KRS 304.32-147 Requirements for health service corporation that issues policy or administers program providing for utilization review of benefits

304.32-147. Requirements for health service corporation that issues policy or administers program providing for utilization review of benefits (1) Every nonprofit hospital, medical-surgical, dental, and health service corporation 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 benefits by a private review agent shall: (a) Be a registered private review agent in accordance with KRS 304.17A-607 and administrative regulations promulgated under the authority of KRS 304.17A-613; or (b) Contract with a private review agent that has been registered in accordance with KRS 304.17A-607 and administrative regulations promulgated under the authority of KRS 304.17A-613. (2) Notwithstanding any other provision of KRS 304.17A-603, 304.17A-605, 304.17A- 607, 304.17A-609, 304.17A-611, 304.17A-613, and 304.17A-615, a nonprofit hospital, medical-surgical, dental, and health service corporation shall not deny or reduce payment of health benefits to any person, licensed practitioner, or health facility for covered services which have been rendered to an insured unless: (a) Notice of denial has been issued. The notice shall inform patients, authorized persons, and health-care providers of their right to appeal adverse determinations of a utilization review by the insurer, its designee, or private review agent to the insurer for the internal appeal process established by the insurer in accordance with KRS 304.17A-617 and 304.17A-619. The notice shall also include instructions on filing an appeal to the cabinet; and (b) The nonprofit hospital, medical-surgical, dental, and health service corporation is in compliance with subsection (1) of this section. Effective: July 14, 2000 History: Amended 2000 Ky. Acts ch. 262, sec. 29, effective July 14, 2000. -- Amended 1998 Ky. Acts ch. 426, sec. 527, effective July 15, 1998. -- Amended 1996 Ky. Acts ch. 353, sec. 3, effective July 15, 1996. -- Created 1990 Ky. Acts ch. 451, sec. 9, effective July 13, 1990.

KRS 304.32-150 Benefits

304.32-150. Benefits The benefits or services which a corporation subject to the provisions of this subtitle may contract to make available to its members or subscribers shall include all of the services made available by hospitals, or other licensed health care institutions, doctors of medicine, osteopathy, dentistry, podiatry, licensed optometrists, licensed psychologists, nursing services, appliances, drugs, medicine, ambulance service, and other health services or related items as the governing board of any corporation may approve; but no corporation subject to the provisions of this subtitle may offer to its members or subscribers any certificate or form which would provide for a cash payment or allowance for sickness, accident, disability, or death, other than payments of or toward the charges made by the purveyors of the health services covered by the certificates issued by the corporation; or for any form of casualty or life insurance unless the corporation shall first comply with the statutes of this state applicable to companies offering such forms of insurance. Nothing in this section shall prohibit a corporation from reimbursing its members or subscribers for payments made by them directly to the purveyors of health services covered by certificates for services which members or subscribers have received. Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 15, effective June 18, 1970.

KRS 304.32-151 Conversion and continuation rights upon termination of group coverage

304.32-151. Conversion and continuation rights upon termination of group coverage Any group policy, group plan or group contract issued, delivered or renewed by a nonprofit hospital, medical-surgical, or health service corporation shall include conversion and continuation rights for certificate holders equal to that provided in KRS 304.18-110 subject to the minimum benefits specified in KRS 304.18-120. Effective: July 15, 1986 History: Amended 1986 Ky. Acts ch. 163, sec. 3, effective July 15, 1986. -- Created 1980 Ky. Acts ch. 258, sec. 2, effective July 15, 1980.

KRS 304.32-152 Repealed, 1986

304.32-152. Repealed, 1986 Catchline at repeal: Continuation of group coverage. History: Repealed 1986 Ky. Acts ch. 163, sec. 5, effective July 15, 1986; amended 1986 Ky. Acts ch. 153, sec. 2, effective July 15, 1986. -- Amended 1982 Ky. Acts ch. 406, sec. 12, effective July 15, 1982. -- Created 1980 Ky. Acts ch. 130, sec. 2, effective June 15, 1980. Legislative Research Commission Note. KRS 304.32-152 was amended by Acts 1986, ch. 153, § 2 and repealed by Acts 1986, ch. 163, § 5. Pursuant to KRS 446.260, the repeal prevails.

KRS 304.32-153 Coverage for newly born children from moment of birth

304.32-153. Coverage for newly born children from moment of birth (1) All individual or group service or indemnity type contracts and all certificates thereunder issued by a nonprofit corporation regardless of whether the contracts and certificates 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 member or subscriber from the moment of birth. (2) The coverage for newly born children shall consist of coverage of injury or sickness including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities. (3) If payment of a specific premium or fee is required to provide coverage for a child, the policy or contract may require that notification of birth of a newly born child and payment of the required premium or fees must be furnished to the nonprofit service or indemnity corporation within thirty-one (31) days after the date of birth in order to have the coverage continue beyond such thirty-one (31) day period. (4) The requirements of this section shall apply to all member or subscriber contracts, and all certificates thereunder, delivered or issued for delivery in this state on and after July 15, 1994. Effective: July 15, 1994 History: Amended 1994 Ky. Acts ch. 93, sec. 13, effective July 15, 1994. -- Created 1976 Ky. Acts ch. 31, sec. 3, effective June 19, 1976.

KRS 304.32-154 Optional nursery care coverage for a well newly born child

304.32-154. Optional nursery care coverage for a well newly born child (1) All individual or group service or indemnity type contracts and all certificates thereunder issued by a nonprofit corporation 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) full days in a hospital nursery. (2) The coverage for the well newly born child shall pay the hospital charges for each day in the hospital nursery. (3) The requirements of this section shall apply to all member or subscriber contracts, and all certificates thereunder, in effect on October 1, 1980, and those contracts, and certificates, issued thereafter. Effective: July 15, 1980 History: Created 1980 Ky. Acts ch. 9, sec. 3, effective July 15, 1980.

KRS 304.32-155 Payment of claims

304.32-155. Payment of claims Corporations subject to this subtitle shall be required to honor all legitimate claims presented by their members and subscribers who have incurred claims in any private hospital with acute care in the State of Kentucky, as long as the hospital is duly licensed and certified by the State of Kentucky. Effective: July 1, 1973 History: Created 1972 Ky. Acts ch. 288, sec. 1, effective July 1, 1973.

KRS 304.32-156 Ambulatory surgical centers, coverage

304.32-156. Ambulatory surgical centers, coverage (1) All individual or group service or indemnity type contracts and all certificates thereunder issued by a nonprofit corporation 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 Licensure Board. The coverage for health care treatment or services rendered by an ambulatory surgical center shall be on the same basis as coverage provided for the same health care treatment or services rendered by a hospital. (2) The requirements of this section shall apply to all member or subscriber contracts and all certificates thereunder, delivered or issued for delivery in this state on or after October 1, 1978. Effective: June 17, 1978 History: Created 1978 Ky. Acts ch. 245, sec. 3, effective June 17, 1978.

KRS 304.32-157 Indemnity payable for services performed by optometrists, osteopaths, podiatrists, physicians or chiropractors

304.32-157. Indemnity payable for services performed by optometrists, osteopaths, podiatrists, physicians or chiropractors (1) When any contract, plan or policy issued in this state by any corporation subject to the provisions of this subtitle 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 person entitled to benefits under such contract, plan or policy shall be entitled to reimbursement for such services, whether such services are performed by a duly licensed physician, osteopath, podiatrist, or optometrist, notwithstanding any provision contained in such policy, or if the policy so provides, payment may be made directly to the provider of the services. (2) When any contract, plan or policy issued in this state by any corporation subject to the provisions of this subtitle provides for reimbursement for any service which is within the lawful scope of practice of a chiropractor duly licensed under KRS Chapter 312, the insured or other person entitled to reimbursement for such services, whether such services are performed by a duly licensed physician, osteopath, podiatrist or chiropractor, notwithstanding any provision contained in such policy; or if the policy so provides, payment may be made directly to the provider of the services. Effective: July 15, 1986 History: Amended 1986 Ky. Acts ch. 399, sec. 3, effective July 15, 1986. -- Amended 1980 Ky. Acts ch. 345, sec. 3, effective July 15, 1980. -- Amended 1974 Ky. Acts ch. 225, sec. 6, effective June 21, 1974. -- Created 1972 Ky. Acts ch. 72, sec. 3, effective June 16, 1972.

KRS 304.32-158 Coverage for treatment of alcoholism

304.32-158. Coverage for treatment of alcoholism Any group policy, group plan or group contract issued in this state by a nonprofit hospital, medical-surgical, or health service corporation 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. Effective: January 1, 1979 History: Created 1978 Ky. Acts ch. 131, sec. 7, effective January 1, 1979.

KRS 304.32-159 Policy covering services performed by dentist deemed to cover such services performed by physician

304.32-159. Policy covering services performed by dentist deemed to cover such services performed by physician Any policy, contract or plan issued in this state by a nonprofit hospital, medical-surgical, dental and health service corporation 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 whether performed by a duly licensed physician or a duly licensed dentist. Effective: June 19, 1976 History: Created 1976 Ky. Acts ch. 112, sec. 4, effective June 19, 1976.

KRS 304.32-160 Forms and schedules of charges -- Filing and approval

304.32-160. Forms and schedules of charges -- Filing and approval (1) On or after June 18, 1970, no corporation subject to the provisions of this subtitle shall deliver or issue for delivery in this state any subscription certificate or membership certificate describing health benefits available, or any indorsement, rider, or application which becomes a part thereof, or the schedule of rates, dues, fees, or other periodic charges, to be paid by subscribers or members, until a copy of such form has been filed with and approved by the commissioner. (2) At the expiration of thirty (30) days the form so filed shall be deemed approved unless prior thereto it has been affirmatively approved or disapproved by order of the commissioner, or a hearing has been scheduled by order of the commissioner. In the event that a hearing is held, the thirty (30) day waiting period shall begin anew after the close of such hearing. Approval of any such form by the commissioner shall constitute a waiver of any unexpired portion of such waiting period. The commissioner may extend by not more than an additional thirty (30) day period within which the commissioner may so affirmatively approve or disapprove any such form, by giving notice to the insurer of such extension before expiration of the initial thirty (30) day period. At the expiration of any such period as so extended, and in the absence of such prior affirmative approval or disapproval, any such form shall be deemed approved. The commissioner may at any time withdraw any such approval. Any notice of the commissioner withdrawing a previous approval shall state the grounds therefor and the particulars thereof in such detail as reasonable to inform the insurer thereof. Any such withdrawal of a previously approved form shall be effective at the expiration of such period, not less than thirty (30) days after the giving of the notice of withdrawal, as the commissioner shall in such notice prescribe. (3) The commissioner's order disapproving any form or withdrawing previous approval shall state the grounds for disapproval or withdrawal. (4) The commissioner may, by order, exempt from the requirements of this section for so long as he or she deems proper, any document or form specified in the order, to which in his or her opinion this section may not practicably be applied, or the filing and approval of which are, in his or her opinion, not desirable or necessary for the protection of the public. Effective: July 15, 2010 History: Amended 2010 Ky. Acts ch. 24, sec. 1420, effective July 15, 2010. -- Amended 1982 Ky. Acts ch. 320, sec. 35, effective July 15, 1982. -- Amended 1980 Ky. Acts ch. 187, sec. 22, effective July 15, 1980. -- Amended 1978 Ky. Acts ch. 155, sec. 147, effective June 17, 1978. -- Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 16, effective June 18, 1970.

KRS 304.32-165 Coverage for treatment for mental illness

304.32-165. Coverage for treatment for mental illness (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 by a nonprofit hospital, medical- surgical, or health service corporation after January 1, 1987, shall include an offer of coverage for the inpatient and outpatient treatment of mental illness, at least to the same extent and degree as coverage provided by the policy or contract for the treatment of physical illnesses. (3) Nothing in this section shall be construed to prohibit an insurer from issuing or continuing to issue a health insurance policy or contract which provides benefits greater than the minimum benefits required by this section or from issuing such policies or contracts providing benefits which are generally more favorable to the insured than those required by this section. Effective: July 15, 1986 History: Created 1986 Ky. Acts ch. 482, sec. 3, effective July 15, 1986.

KRS 304.32-166 Coverage for services of licensed psychologist or licensed clinical social worker

304.32-166. Coverage for services of licensed psychologist or licensed clinical social worker Every policy, contract, or plan issued, delivered, or renewed in this state by a nonprofit hospital, medical-surgical, dental, or health service corporation which provides coverage for services performed by a licensed psychologist pursuant to KRS Chapter 319, or a licensed clinical social worker pursuant to KRS Chapter 335, shall be deemed to provide benefits for those services regardless of provider profession. If the policy, contract, or plan permits, payment may be made directly to the provider of the services. If the policy, contract, or plan does not permit, the person entitled to these benefits shall be entitled to reimbursement for the cost of services received. Nothing in this section shall require a policy issued by a nonprofit hospital, medical-surgical, dental or health service corporation which places the insured within a preferred or exclusive provider arrangement to cover services by a provider with whom the insurer does not have a contract, or to make payment of or reimbursement for the cost of any services which exceeds the limits of the policy. Effective: July 15, 1994 History: Created 1994 Ky. Acts ch. 218, sec. 3, effective July 15, 1994.

KRS 304.32-170 Authorized contracts

304.32-170. Authorized contracts Any corporation subject to the provisions of this subtitle may contract with any agency, instrumentality, or political subdivision of the United States, or of this state for making available hospital, medical-surgical, dental and other health care services, and in aid or furtherance of such contract may accept, receive, and administer in trust, funds directly or indirectly made available by any agency, instrumentality, or political subdivision. Any corporation may also subcontract with any organization which has contracted with any agency, instrumentality, or political subdivision of the United States, or of this state, for the furnishing of hospital, medical-surgical, dental, or other health services by which subcontract the corporation undertakes to furnish the services specified by the basic contract. Any corporation subject to the provisions of this subtitle may also enter into agreements or contracts with other similar organizations or corporations licensed to do business in this state or any other state for the transfer of subscribers or members, for the reciprocal or joint provision of benefits to the subscribers or members of the corporation and organizations or such other joint undertakings as the corporation's governing board may approve. Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 17, effective June 18, 1970.

KRS 304.32-180 Agent of corporation -- Licensing -- Continuing education -- Appointment

304.32-180. Agent of corporation -- Licensing -- Continuing education -- Appointment (1) An agent of the corporation shall be licensed as an agent with a health line of authority in accordance with the provisions of Subtitle 9 of this chapter regulating all aspects of agent licenses. (2) Subsection (1) of this section includes the requirement that the agent shall satisfactorily complete the continuing education requirements in accordance with KRS 304.9-295. (3) An agent of the corporation shall be appointed by the corporation in accordance with the provisions of Subtitle 9 of this chapter regulating all aspects of agent appointments. Effective: July 15, 2002 History: Repealed and reenacted 2002 Ky. Acts ch. 273, sec. 48, effective July 15, 2002. -- Amended 1998 Ky. Acts ch. 378, sec. 3, effective July 15, 1998. -- Amended 1982 Ky. Acts ch. 320, sec. 36, effective July 15, 1982. -- Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 18, effective June 18, 1970.

KRS 304.32-190 Repealed, 2002

304.32-190. Repealed, 2002 Catchline at repeal: Agents: appointment. History: Repealed 2002 Ky. Acts ch. 273, sec. 55, effective July 15, 2002. -- Amended 1982 Ky. Acts ch. 320, sec. 37, effective July 15, 1982. -- Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 19, effective June 18, 1970.

KRS 304.32-200 Repealed, 2002

304.32-200. Repealed, 2002 Catchline at repeal: Revocation of agent's license. History: Repealed 2002 Ky. Acts ch. 273, sec. 55, effective July 15, 2002. -- Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 20, effective June 18, 1970.

KRS 304.32-210 Application of Subtitle 2 to nonprofit hospital, medical-surgical, dental, and health service corporations

304.32-210. Application of Subtitle 2 to nonprofit hospital, medical-surgical, dental, and health service corporations (1) Nonprofit hospital, medical-surgical, dental, and health service corporations shall be subject to the provisions of KRS 304.2-210, 304.2-220, 304.2-230, 304.2-240, 304.2-250, 304.2-260, 304.2-270, 304.2-280, 304.2-290, 304.2-300, and Subtitle 2 of this chapter for determining financial condition, market conduct, and business practice. (2) Each corporation subject to the provisions of this subtitle may own and invest or have invested any of its funds in its principal office building not to exceed an amount which would reduce its surplus, exclusive of the investment, below fifty thousand dollars ($50,000), unless approved by the commissioner. Effective: July 15, 2010 History: Amended 2010 Ky. Acts ch. 24, sec. 1421, effective July 15, 2010. -- Amended 2004 Ky. Acts ch. 24, sec. 39, effective July 13, 2004. -- Amended 1976 Ky. Acts ch. 138, sec. 1, effective June 19, 1976. -- Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 21, effective June 18, 1970.

KRS 304.32-220 Repealed, 2004

304.32-220. Repealed, 2004 Catchline at repeal: Examination expense. History: Repealed 2004 Ky. Acts ch. 24, sec. 48, effective July 13, 2004. -- Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 22, effective June 18, 1970.

KRS 304.32-230 Repealed, 2004

304.32-230. Repealed, 2004 Catchline at repeal: Hearings -- Appeal. History: Repealed 2004 Ky. Acts ch. 24, sec. 48, effective July 13, 2004. -- Amended 1996 Ky. Acts ch. 318, sec. 242, effective July 15, 1996. -- Amended 1976 Ky. Acts ch. 62, sec. 113, effective June 19, 1976. -- Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 23, effective June 18, 1970.

KRS 304.32-235 Suspension or revocation of certificate of authority

304.32-235. Suspension or revocation of certificate of authority (1) If the certificate of authority of a corporation is suspended, the corporation shall not, during the period of suspension, enroll any additional subscribers or members except newborn children or other newly acquired dependents of existing subscribers or members, and shall not engage in any advertising or solicitation whatsoever. (2) If the certificate of authority of a corporation is revoked, the corporation shall proceed, immediately following the effective date of the order of revocation, to wind up its affairs, and shall conduct no further business except as may be essential to the orderly conclusion of the affairs of the corporation. It shall engage in no further advertising or solicitation whatsoever. The commissioner may, by written order, permit further operation of the corporation as the commissioner may find to be in the best interest of subscribers or members, to the end that subscribers or members will be afforded the greatest practical opportunity to obtain continuing coverage. If the commissioner permits further operation, the corporation shall continue to collect the dues and fees required of subscribers or members. Effective: July 13, 2004 History: Created 2004 Ky. Acts ch. 24, sec. 36, effective July 13, 2004.

KRS 304.32-240 Grievances

304.32-240. Grievances Any individual subscriber or member of a corporation subject to the provisions of this subtitle who believes himself or herself to be aggrieved by any act or omission of a corporation or its officers, trustees, directors, agents, or representatives, may file a statement in writing of his or her grievance in the office of the commissioner, and the commissioner in his or her discretion may make an investigation of the grievance. Investigation by the commissioner shall not act as a bar to any suit in a court of competent jurisdiction instituted by any member or subscriber, or as a bar to any defense by the corporation. Effective: July 15, 2010 History: Amended 2010 Ky. Acts ch. 24, sec. 1422, effective July 15, 2010. -- Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 24, effective June 18, 1970.

KRS 304.32-250 Rules and regulations

304.32-250. Rules and regulations The commissioner may promulgate reasonable rules and regulations not inconsistent with the provisions of this subtitle that the commissioner deems necessary for the proper administration of this subtitle. Effective: July 15, 2010 History: Amended 2010 Ky. Acts ch. 24, sec. 1423, effective July 15, 2010. -- Amended 1986 Ky. Acts ch. 437, sec. 22, effective July 15, 1986. -- Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 25, effective June 18, 1970.

KRS 304.32-260 Limitations of subtitle

304.32-260. Limitations of subtitle Nothing contained in this subtitle shall be construed to affect or apply to hospitals, or other licensed health care institutions, nor to any individuals, partnerships, associations, or corporations which are the direct purveyors of health services; nor shall it be construed to limit in any way the rights of hospitals, or other licensed health care institutions or purveyors of health services to establish methods of payment directly with purchasers of their services; but the commissioner may require from any institution or purveyor of medical services information that will enable him or her to determine whether arrangements for payment of medical services are subject to the provisions of this subtitle. Effective: July 15, 2010 History: Amended 2010 Ky. Acts ch. 24, sec. 1424, effective July 15, 2010. -- Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 26, effective June 18, 1970.

KRS 304.32-270 Application of other subtitles

304.32-270. Application of other subtitles Nonprofit hospital, medical-surgical, dental, and health service corporations shall be subject to the provisions of this subtitle, and to the following provisions of this code, to the extent applicable and not in conflict with the express provisions of this subtitle: (1) Subtitle 1 -- Scope -- General Definitions and Provisions; (2) Subtitle 2 -- Commissioner of the Department of Insurance; (3) Subtitle 7 -- Investments; (4) Subtitle 8 -- Administration of Deposits; (5) Subtitle 12 -- Trade Practices and Frauds; (6) Subtitle 25 -- Continuity of Management; (7) Subtitle 33 -- Insurers Rehabilitation and Liquidation; (8) Subtitle 18 -- KRS 304.18-110, 304.18-120 -- Group Conversion and KRS 304.18- 045; (9) Subtitle 4 -- Fees and Taxes; (10) Subtitle 99 -- Penalties; (11) Subtitle 14 -- KRS 304.14-500 to 304.14-560; (12) Subtitle 17A -- Health Benefit Plans; (13) Subtitle 17B -- Kentucky Access; (14) Subtitle 9 -- Agents, Consultants, Solicitors and Adjusters; and (15) Subtitle 3 -- Authorization of Insurers and General Requirements. Effective: July 15, 2010 History: Amended 2010 Ky. Acts ch. 24, sec. 1425, effective July 15, 2010. -- Amended 2004 Ky. Acts ch. 24, sec. 40, effective July 13, 2004. -- Amended 2002 Ky. Acts ch. 273, sec. 49, effective July 15, 2002. -- Amended 2000 Ky. Acts ch. 476, sec. 28, effective July 14, 2000. -- Amended 1994 Ky. Acts ch. 512, sec. 62, effective July 15, 1994. -- Amended 1990 Ky. Acts ch. 178, sec. 2, effective July 13, 1990; and ch. 451, sec. 12, effective July 13, 1990. -- Amended 1982 Ky. Acts ch. 37, sec. 6, effective February 26, 1982; and ch. 320, sec. 38, effective July 15, 1982. -- Amended 1974 Ky. Acts ch. 195, sec. 3, effective January 1, 1975. -- Created 1970 Ky. Acts ch. 301, subtit. 32, sec. 27, effective June 18, 1970.

KRS 304.32-275 Medicare supplement coverage for persons not eligible for Medicare by reason of age

304.32-275. Medicare supplement coverage for persons not eligible for Medicare by reason of age Nonprofit hospital, medical-surgical, dental, and health service corporations delivering or issuing for delivery 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 eligible for Medicare by reason of age. In the case of group contracts, the request shall be made by the group contract holder. Effective: July 15, 1988 History: Created 1988 Ky. Acts ch. 354, sec. 3, effective July 15, 1988.

KRS 304.32-280 Nonprofit hospital, medical-surgical, dental and health service corporations as insurers to offer home health care coverage -- Conditions

304.32-280. Nonprofit hospital, medical-surgical, dental and health service corporations as insurers to offer home health care coverage -- Conditions (1) All nonprofit hospital, medical-surgical, dental and health service corporations 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 home health care benefits shall be made available and offered to the master policyholder. The coverage may contain a limitation on the number of home health care visits for which benefits are payable, but the number of such visits shall not be less than sixty (60) in any calendar year or in any continuous period of twelve (12) months for each person covered under the policy. Each visit by an authorized representative of a home health agency shall be considered as one (1) home health care visit except that at least four (4) hours of home health aide service shall be considered as one (1) home health visit. (2) Home health care coverage shall be subject to the same deductible and coinsurance provisions as are other services covered by nonprofit hospital, medical-surgical, dental and health service corporations which issue policies in the Commonwealth that provide hospital, medical, or surgical expense benefits. (3) Home health care shall not be reimbursed unless an attending physician certifies that hospitalization or confinement in a skilled nursing facility as defined by the Kentucky Health Facilities and Health Services Certificate of Need and Licensure Board would otherwise be required if home health care was not provided. (4) Medicare beneficiaries shall be deemed eligible to receive home health care benefits under a policy, contract, plan entered into, issued, delivered or amended in this state by a nonprofit hospital, medical-surgical, dental and health service corporation which provides hospital, medical or surgical expense benefits provided that the policy, contract or plan shall only pay for those home health care services which are not paid for by Medicare and do not exceed the maximum liability of the policy, contract or plan. (5) Pursuant to the provisions of this section, all nonprofit hospital, medical-surgical, dental and health service corporations issuing policies in the Commonwealth which provide hospital, medical, or surgical expense benefits or coverage for home health care shall inform the beneficiaries of such policies, in writing, of the specific home health care benefits which are covered. Such written notification shall take place at the time of issuance or reissuance of the policy. Effective: January 1, 1981 History: Created 1980 Ky. Acts ch. 61, sec. 4, effective January 1, 1981.

KRS 304.32-290 Long-term health care benefits

304.32-290. Long-term health care benefits All nonprofit, medical-surgical, dental, and health service corporations issuing long-term care coverage shall comply with KRS 304.14-600 to 304.14-625. Effective: July 14, 1992 History: Amended 1992 Ky. Acts ch. 423, sec. 8, effective July 14, 1992. -- Created 1986 Ky. Acts ch. 409, sec. 3, effective July 1, 1987.

KRS 304.32-300 Conversion health insurance policy -- Rights of employee's surviving spouse

304.32-300. Conversion health insurance policy -- Rights of employee's surviving spouse (1) Any private employer doing business in this state who provides for his employees on a self-insured basis, hospital or surgical benefits, other than for specific diseases or accidental injury only, shall purchase a conversion health insurance policy. Upon the termination of the employment of any employee who has been continuously employed for not less than six (6) months immediately preceding the termination, the employee shall be entitled to have issued to him by the insurer, without evidence of insurability, a health insurance policy on a form then available for conversion from the health benefit plan provided by the employer by making written application therefor, accompanied by the first quarterly, semiannual or annual premium, at the option of the employee to the employer not later than thirty-one (31) days after such termination. (2) The individual health insurance policy available as provided in subsection (1) shall cover the employee and his dependents for whom the employer provided health or surgical benefits on the date the employment was terminated. The effective date of any such individual policy shall be the date of the termination of the employment. (3) The employee shall not be entitled to be issued a converted policy upon termination of employment if he is or could be covered by Medicare (Title XVIII of the United States Social Security Act as added by the social security amendments of 1965 or as later amended or superseded). Furthermore, the employee shall not be entitled to be issued a converted policy if (a) such person is covered for similar benefits by another hospital or surgical or medical expense insurance policy or hospital or medical service subscriber contract or medical practice or other prepayment plan or by any other plan or program or (b) similar benefits are provided for, or are available to, such person pursuant to, or in accordance with the requirements of any statute, and the benefits provided or available under any of the sources referred to in (a) and (b) above for such employee, together with the converted policy, would result in over insurance according to the employer's standards relating to policies converted from the hospital or surgical benefits provided by the employer. (4) The surviving spouse, at the death of an employee, shall be entitled to be issued a converted policy with respect to the spouse and such children whose coverage under the employer's hospital or surgical benefits terminates by reason of the death of an employee. (5) If an employee or employee's spouse becomes entitled to obtain a converted policy pursuant to the foregoing provisions, and if such person has not been given written notice of the existence of the conversion privilege stated above, within thirty-one (31) days of termination of the group coverage, then in such event the person shall have an additional period within which to exercise the conversion privilege. This additional period shall expire fifteen (15) days after the person shall have been given said notice but in no event shall the additional period extend beyond sixty (60) days after the expiration of the thirty-one (31) day conversion period stated above. Written notice presented to the person or mailed by the employer to the last known address of the person or mailed by the insurer to the last known address of the person as furnished by the employer shall constitute the giving of notice for the purpose of this paragraph. If an additional period is allowed the person for exercise of the conversion privilege as provided herein, and if written application for the converted policy, accompanied by the first quarterly or semiannual or annual premium, is made after the expiration of the thirty-one (31) day conversion period stated above, but within the additional period allowed an employee or spouse in accordance with this paragraph, the effective date of the converted policy shall be the date of termination of employment. Effective: June 17, 1978 History: Created 1978 Ky. Acts ch. 158, sec. 1, effective June 17, 1978.

KRS 304.32-310 Benefits

304.32-310. Benefits (1) A converted policy issued pursuant to the conversion privilege provided in KRS 304.32-300 providing hospital or surgical expense insurance shall provide on an expense incurred basis, the following minimum benefits: (a) Hospital room and board benefits of twenty-five dollars ($25) per day, for a minimum duration of seventy (70) days for any one period of hospital confinement as defined in the converted policy. (b) Miscellaneous hospital expense benefits for any one (1) period of hospital confinement in a minimum amount up to twenty (20) times the hospital room and board daily benefit provided under the converted policy. (c) Surgical operation expense benefits according to a relative value schedule, or a minimum of two hundred fifty dollars ($250). (d) The option to continue any existing benefits on account of pregnancy, childbirth, or miscarriage. (2) The relative values in the surgical schedule shall be consistent with the schedule of operations generally offered by the insurer under group or individual health insurance policies. In the event that the insurer and the employer agree upon one (1) or more additional plans of benefits to be available for converted policies, the applicant for the converted policy may, at his option, elect such a plan in lieu of a converted policy providing the benefits of paragraphs (a), (b), and (c) of subsection (1) of this section. In no event shall the benefits be less than the minimums set forth in subsection (1) of this section. (3) In no event need the insurer provide under the converted policy: (a) Benefits on account of abortion or complications thereof, (b) The benefits of paragraphs (a) and (b) of subsection (1) of this section, unless the group policy from which conversion is made provided hospital expense insurance benefits, or (c) The benefits of paragraph (c) of subsection (1) of this section, unless the group policy provided surgical expense insurance benefits. Furthermore, the converted policy may contain any exclusion, reduction, or limitation contained in the group policy and any exclusion, reduction, or limitation customarily used in individual policies issued by the insurer. With respect to any person who was covered by the group policy, the period specified in the time limit on certain defenses of the incontestable provision of the converted policy shall commence with the date the insurance on such person or member became effective under the group policy. (4) The converted policy may provide that any hospital, surgical, or medical expense benefits otherwise payable thereunder with respect to any person covered thereunder may be reduced by the amount of any such benefits payable under the group policy for the same loss with respect to such person after termination of such person's coverage thereunder. The insurer shall not be entitled to use deterioration of health as the basis for refusing to renew a converted policy. The converted policy may provide for termination of coverage thereunder on any person when he is or could be covered by Medicare (Title XVIII of the United States Social Security Act as added by the Social Security Amendments of 1965 or as later amended or superseded). (5) A converted policy may include a provision whereby the insurer may request information in advance of any premium due date of such policy of any person covered thereunder as to whether: (a) He is covered for similar benefits by another hospital, surgical, or medical expense insurance policy or hospital or medical service subscriber contract or medical practice or other prepayment plan or by any other plan or program; or (b) Similar benefits are provided for, or available to, such person pursuant to, or in accordance with the requirements of, any statute. If any such person is so covered or such statutory benefits are provided or available, and such person fails to furnish the insurer the details of such coverage within thirty-one (31) days after the date of such request, the benefits payable under the converted policy may be based on the hospital or surgical or medical expenses actually incurred after excluding expenses to the extent of the amount of benefits provided or available therefor from any of the sources referred to in paragraphs (a) and (b) of this subsection. A converted policy may contain any provisions permitted herein and may also include any other provisions not expressly prohibited by law; and any provision required to be permitted herein may be made a part of any such policy by means of an endorsement or rider. Effective: July 13, 1984 History: Amended 1984 Ky. Acts ch. 322, sec. 13, effective July 13, 1984. -- Created 1978 Ky. Acts ch. 158, sec. 2, effective June 17, 1978.

KRS 304.32-315 Self-insured private employer subject to KRS 304.14-135

304.32-315. Self-insured private employer subject to KRS 304.14-135 Any private employer doing business in this state who provides for his employees, on a self-insured basis, hospital or surgical benefits shall be subject to KRS 304.14-135. Failure to accept forms prescribed by the commissioner shall be punishable pursuant to KRS 304.99-010. Effective: July 15, 2010 History: Amended 2010 Ky. Acts ch. 24, sec. 1426, effective July 15, 2010. -- Created 1984 Ky. Acts ch. 322, sec. 14, effective July 13, 1984.

KRS 304.32-320 Notification of department

304.32-320. Notification of department Any private employer doing business in this state who provides for his or her employees on a self-insured basis hospital or surgical benefits shall notify the Department of Insurance of the existence of the program within sixty (60) days of June 17, 1978. Any employer doing business in this state who implements for his or her employees on a self- insured basis a plan for providing hospital or surgical benefits shall notify the Department of Insurance not less than thirty (30) days prior to implementing such plan, and shall include in the notice the name of any outside third-party administrator. Any change in third-party administrators shall be reported to the Department of Insurance within thirty (30) days of the change. The Department of Insurance shall make this information available upon request. Effective: July 15, 2010 History: Amended 2010 Ky. Acts ch. 24, sec. 1427, effective July 15, 2010. -- Amended 2002 Ky. Acts ch. 181, sec. 22, effective July 15, 2002. -- Created 1978 Ky. Acts ch. 158, sec. 4, effective June 17, 1978.

KRS 304.32-330 Requirements for self-insured employer that provides health coverage and requires utilization review of benefits

304.32-330. Requirements for self-insured employer that provides health coverage and requires utilization review of benefits (1) Every employer in this state which provides coverage of hospital benefits on a self- insured basis and requires the utilization review of such benefits by an insurer, its designee, or a private review agent shall: (a) Be a registered private review agent in accordance with KRS 304.17A-607 and administrative regulations promulgated under the authority of KRS 304.17A-613; or (b) Contract with a private review agent that has been registered in accordance with KRS 304.17A-607 and administrative regulations promulgated under the authority of KRS 304.17A-613. (2) Notwithstanding any other provision of KRS 304.17A-603, 304.17A-605, 304.17A- 607, 304.17A-609, 304.17A-611, 304.17A-613, and 304.17A-615, a self-insured employer shall not deny or reduce payment of health benefits to any person, licensed practitioner, or health facility for covered services which have been rendered to an insured unless: (a) Notice of denial has been issued; and (b) The self-insured employer is in compliance with subsection (1) of this section. Effective: July 14, 2000 History: Amended 2000 Ky. Acts ch. 262, sec. 30, effective July 14, 2000. -- Created 1990 Ky. Acts ch. 451, sec. 10, effective July 13, 1990.

KRS 304.32-1551 Use by corporation of itemized statement furnished to paying patient prohibited

304.32-1551. Use by corporation of itemized statement furnished to paying patient prohibited No corporation subject to the provisions of this subtitle shall use an itemized statement furnished pursuant to KRS 216B.250 for insurance payment purposes where benefits have been assigned. Effective: July 15, 1986 History: Created 1986 Ky. Acts ch. 288, sec. 4, effective July 15, 1986.

KRS 304.32-1585 Coverage for treatment of temporomandibular joint disorders or craniomandibular jaw disorders

304.32-1585. Coverage for treatment of temporomandibular joint disorders or craniomandibular jaw disorders (1) All policies, contracts, or plans issued in this state, including subscription or membership certificates thereunder, which provide for surgical or nonsurgical treatment of skeletal disorders shall provide coverage for medically necessary procedures relating to temporomandibular joint disorders and craniomandibular jaw disorders. (2) The requirements of this section shall apply to all policies issued, delivered, or renewed in this state on or after January 1, 1991. (3) This section does not require a health insurance policy to provide dental services if dental services are not otherwise scheduled or provided as a part of policy benefits. Effective: July 13, 1990 History: Created 1990 Ky. Acts ch. 438, sec. 3, effective July 13, 1990.

KRS 304.32-1591 Coverage for mammograms -- Prohibition on cost-sharing requirements for covered diagnostic breast examinations or supplemental breast examinations

304.32-1591. Coverage for mammograms -- Prohibition on cost-sharing requirements for covered diagnostic breast examinations or supplemental breast examinations Nonprofit hospital, medical-surgical, dental, and health service corporation contrac ts in this Commonwealth shall comply with KRS 304.17 -316. Effective: January 1, 2025 History: Amended 2024 Ky. Acts ch. 97, sec. 5, effective January 1, 2025. -- Amended 2000 Ky. Acts ch. 18, sec. 4, effective July 14, 2000. -- Created 1990 Ky. Acts ch. 46, sec. 3, effective July 13, 1990. Legislative Research Commission Note (1/1/2025). 2024 Ky. Acts ch. 97, sec. 9, provides that the amendments to this statute in that Act shall apply to policies, plans, certificates, and contracts issued or renewed on or after January 1, 2025.

KRS 304.32-1593 Coverage for medical and surgical benefits with respect to mastectomy, diagnosis and treatment of endometrioses and endometritis, and bone density testing -- Duties of insurer

304.32-1593. Coverage for medical and surgical benefits with respect to mastectomy, diagnosis and treatment of endometrioses and endometritis, and bone density testing -- Duties of insurer (1) All nonprofit hospital, medical-surgical, dental, and health service corporations issuing contracts in this Commonwealth providing hospital, medical, or surgical expense benefits shall make available and offer to the purchaser coverage for: (a) The following, if medical and surgical benefits with respect to a mastectomy are covered, in a manner determined in consultation with the attending physician and the covered person, and subject to annual deductibles and coinsurance provisions as may be deemed appropriate and as are consistent with those established for other benefits under the coverage: 1. All stages of breast reconstruction surgery of the breast on which the mastectomy has been performed; 2. Surgery and reconstruction of the other breast to produce a symmetrical appearance; and 3. Prostheses and physical complications of all stages of mastectomy, including lymphedemas; (b) Diagnosis and treatment of endometriosis and endometritis if the insurer also covers hysterectomies; and (c) Bone density testing for women age thirty-five (35) years and older, as indicated by the health-care provider, in accordance with standard medical practice, to obtain baseline data for the purpose of early detection of osteoporosis. (2) No insurer under this section shall offer medical and surgical benefits with respect to a mastectomy that requires the procedure be performed on an outpatient basis. (3) An insurer shall provide written notice to a covered person of the availability of medical and surgical benefits with respect to a mastectomy upon enrollment and annually thereafter. (4) An insurer shall not: (a) Deny eligibility, or continued eligibility, to an individual to enroll or to renew coverage under the terms of the plan, solely for the purpose of avoiding the requirements of 42 U.S.C. secs. 300gg-6 and 300gg-52; and (b) Penalize or otherwise reduce or limit the reimbursement of an attending provider or provide incentives to an attending provider, to induce the provider to provide care to an individual in a manner inconsistent with 42 U.S.C. secs. 300gg-6 and 300gg-52. Effective: July 15, 2002 History: Amended 2002 Ky. Acts ch. 181, sec. 20, effective July 15, 2002. -- Created 1998 Ky. Acts ch. 427, sec. 4, effective July 15, 1998.

KRS 304.32-1595 Coverage for treatment of breast cancer

304.32-1595. Coverage for treatment of breast cancer (1) All nonprofit hospital, medical-surgical, dental, and health service corporations 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 autologous bone marrow transplantation or stem cell transplantation. (2) The administration of high-dose chemotherapy with autologous bone marrow transplantation or stem cell transplantation shall only be covered when performed in institutions that comply with the guidelines of the American Society for Blood and Marrow Transplantation or the International Society of Hematotherapy and Graft Engineering, whichever has the higher standard. (3) Treatment of breast cancer by high-dose chemotherapy with autologous bone marrow transplantation or stem cell transplantation shall not be considered experimental or investigational. Coverage for transplantation under this section shall not be subject to any greater coinsurance or copayment than that applicable to any other coverage provided by the health plan. Effective: March 28, 1996 History: Created 1996 Ky. Acts ch. 114, sec. 3, effective March 28, 1996.

Source: Kentucky Legislative Research Commission (legislature.ky.gov)URL: https://apps.legislature.ky.gov/law/statutes/chapter.aspx?id=38746Fetched: 10/20/2026