Health Insurance Contracts

KRS tit. XXV, ch. 304, subtit. 17

in effect

KRS 304.17-010 Short title

304.17-010. Short title This subtitle may be cited as the "Uniform Health Policy Provision Law." Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 1, effective June 18, 1970.

KRS 304.17-020 Scope of subtitle

304.17-020. Scope of subtitle Nothing in this subtitle shall apply to or affect: (1) Any policy of liability or workers' compensation insurance with or without supplementary expense coverage therein. (2) Any group or blanket policy. (3) Life insurance, endowment or annuity contracts, or contracts supplemental thereto which contain only such provisions relating to health insurance as: (a) Provide additional benefits in case of death or dismemberment or loss of sight by accident or accidental means, or (b) Operate to safeguard such contracts against lapse, or to give a special surrender value or special benefit or an annuity in the event that the insured or annuitant becomes totally and permanently disabled, as defined by the contract or supplemental contract. (4) Reinsurance. (5) Any contract made or issued prior to June 18, 1970, together with any extensions, renewals, reinstatements or modifications thereof or amendments thereto, whenever made. Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 2, effective June 18, 1970.

KRS 304.17-030 Scope and format of policy

304.17-030. Scope and format of policy No policy of health insurance shall be delivered or issued for delivery to any person in this state unless it otherwise complies with this title, and complies with the following: (1) The entire money and other considerations therefor shall be expressed therein; (2) The time when the insurance takes effect and terminates shall be expressed therein; (3) It shall purport to insure only one (1) person, except that a policy may insure, originally or by subsequent amendment, upon the application of an adult member of a family, who shall be deemed the policyholder, any two (2) or more eligible members of that family, including husband, wife, unmarried dependent children to age nineteen (19), unmarried children from nineteen (19) to twenty-five (25) years of age who are full-time students enrolled in and attending an accredited educational institution and who are primarily dependent on the policyholder for maintenance and support, and any other person dependent upon the policyholder as provided pursuant to KRS 304.17-310; (4) The style, arrangement, and overall appearance of the policy shall give no undue prominence to any portion of the text, and every printed portion of the text of the policy and of any indorsements or attached papers shall be plainly printed in light- faced type of a style in general use, the size of which shall be uniform and not less than ten (10) point with a lower case unspaced alphabet length not less than one hundred and twenty (120) point (the "text" shall include all printed matter except the name and address of the insurer, name on title of the policy, the brief description, if any, and captions and subcaptions); (5) The exceptions and reductions of indemnity shall be set forth in the policy and other than those contained in KRS 304.17-050 to 304.17-290, inclusive, shall be printed, at the insurer's option, either included with the benefit provision to which they apply, or under an appropriate caption such as "Exceptions," or "Exceptions and Reductions," except that if an exception or reduction specifically applies only to a particular benefit of the policy, a statement of the exception or reduction shall be included with the benefit provision to which it applies; (6) Each form, including riders and indorsements, shall be identified by a form number in the lower left-hand corner of the first page thereof; and (7) The policy shall contain no provision purporting to make any portion of the charter, rules, constitution, or bylaws of the insurer a part of the policy unless the portion is set forth in full in the policy, except in the case of the incorporation of, or reference to, a statement of rates or classification of risks, or short-rate table filed with the commissioner. Effective: July 15, 2010 History: Amended 2010 Ky. Acts ch. 24, sec. 1201, effective July 15, 2010. -- Amended 1998 Ky. Acts ch. 483, sec. 18, effective July 15, 1998. -- Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 3, effective June 18, 1970.

KRS 304.17-040 Required provisions -- Captions -- Omissions -- Substitutions

304.17-040. Required provisions -- Captions -- Omissions -- Substitutions (1) Except as provided in subsection (2) of this section, each such policy delivered or issued for delivery to any person in this state shall contain the provisions specified in KRS 304.17-050 to 304.17-160, inclusive, in the words in which the same appear; except, that the insurer may at its option, substitute for one (1) or more of such provisions corresponding provisions of different wording approved by the commissioner which are in each instance not less favorable in any respect to the insured or the beneficiary. Each such provision shall be preceded individually by the applicable caption shown, or, at the option of the insurer, by such appropriate individual or group captions or subcaptions as the commissioner may approve. (2) If any such provision is in whole or in part inapplicable to or inconsistent with the coverage provided by a particular form of policy, the insurer, with the approval of the commissioner, shall omit from such policy any inapplicable provision or part of a provision, and shall modify any inconsistent provision or part of a provision in such manner as to make the provision as contained in the policy consistent with the coverage provided by the policy. Effective: July 15, 2010 History: Amended 2010 Ky. Acts ch. 24, sec. 1202, effective July 15, 2010. -- Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 4, effective June 18, 1970.

KRS 304.17-042 Coverage for newly born children from moment of birth

304.17-042. Coverage for newly born children from moment of birth (1) All individual health insurance policies providing coverage on an expense incurred basis regardless of whether the policies are issued for nonfamily or family coverage, shall, provide that health insurance benefits shall be payable with respect to a newly born child of the insured 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 insurer 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 health insurance policies delivered in this state on and after July 15, 1994. Effective: July 15, 1994 History: Amended 1994 Ky. Acts ch. 93, sec. 11, effective July 15, 1994. -- Created 1976 Ky. Acts ch. 31, sec. 1, effective June 19, 1976.

KRS 304.17-050 Policy as entire contract -- Authority to change

304.17-050. Policy as entire contract -- Authority to change There shall be a provision as follows: "Entire Contract; Changes: This policy, including the indorsements and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall be valid until approved by an executive officer of the insurer and unless such approval be indorsed hereon or attached hereto. No agent has authority to change this policy or to waive any of its provisions." Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 5, effective June 18, 1970.

KRS 304.17-060 Limitation on defenses -- Incontestability

304.17-060. Limitation on defenses -- Incontestability (1) (a) There shall be a provision as follows: "Time Limit on Certain Defenses: After three (3) years from the date of issue of this policy no misstatements, except fraudulent misstatements, made by the applicant in the application for the policy shall be used to void the policy or to deny a claim for loss incurred or disability (as defined in the policy) commencing after the expiration of the three (3) year period." (The foregoing policy provision shall not be so construed as to affect any legal requirement for avoidance of a policy or denial of a claim during the initial three (3) year period, nor to limit the application of KRS 304.17-190 to 304.17-230, inclusive, in the event of misstatement with respect to age or occupation or other insurance.) A policy which the insured has the right to continue in force subject to its terms by the timely payment of premium (a) until at least age fifty (50) or (b) in the case of a policy issued after age forty-four (44) for at least five (5) years from its date of issue, may contain in lieu of the foregoing the following provision, from which the clause in parentheses may be omitted at the insurer's option, under the caption "Incontestable": "After the policy has been in force for a period of three (3) years during the lifetime of the insured (excluding any period during which the insured is disabled), it shall become incontestable as to the statements contained in the application." (b) No claim for loss incurred or disability as defined in the policy commencing after two (2) years from the date of issue of this policy shall be reduced or denied on the ground that a disease or physical condition not excluded from coverage by name or specific description effective on the date of loss had existed prior to the effective date of coverage of this policy. (2) Paragraph (b) of subsection (1) of this section shall not apply to policies subject to KRS Chapter 304, Subtitle 17A. Effective: July 15, 1998 History: Amended 1998 Ky. Acts ch. 483, sec. 19, effective July 15, 1998. -- Amended 1994 Ky. Acts ch. 512, sec. 63, effective July 15, 1994. -- Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 6, effective June 18, 1970.

KRS 304.17-070 Grace period -- Cancellation

304.17-070. Grace period -- Cancellation (1) There shall be a provision as follows: "Grace Period: A grace period of .... (insert a number not less than "7" for weekly premium policies, "10" for monthly premium policies, and "31" for all other policies) days will be granted for the payment of each premium falling due after the first premium, during which grace period the policy shall continue in force." (2) A policy in which the insurer reserves the right to refuse any renewal shall have, at the beginning of the above provision: "Unless not less than five (5) days prior to the premium due date the insurer has delivered to the insured, or has mailed to his last address as shown by the records of the insurer, written notice of its intention not to renew this policy beyond the period for which the premium has been accepted." Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 7, effective June 18, 1970.

KRS 304.17-080 Reinstatement

304.17-080. Reinstatement (1) There shall be a provision as follows: "Reinstatement: If any renewal premium be not paid within the time granted the insured for payment, a subsequent acceptance of premium by the insurer or by any agent duly authorized by the insurer to accept such premium, without requiring in connection therewith an application for reinstatement, shall reinstate the policy: provided, however, that if the insurer or such agent requires an application for reinstatement and issues a conditional receipt for the premium tendered, the policy will be reinstated upon approval of such application by the insurer or, lacking such approval, upon the forty-fifth day following the date of such conditional receipt unless the insurer has previously notified the insured in writing of its disapproval of such application. The reinstated policy shall cover only loss resulting from such accidental injury as may be sustained after the date of reinstatement and loss due to such sickness as may begin more than ten (10) days after such date. In all other respects the insured and insurer shall have the same rights thereunder as they had under the policy immediately before the due date of the defaulted premium, subject to any provisions indorsed hereon or attached hereto in connection with the reinstatement. Any premium accepted in connection with a reinstatement shall be applied to a period for which premium has not been previously paid, but not to any period more than sixty (60) days prior to the date of reinstatement." (2) The last sentence of the provision contained in subsection (1) of this section may be omitted from any policy which the insured has the right to continue in force subject to its terms by the timely payment of premiums (a) until at least age fifty (50) or, (b) in the case of a policy issued after age forty-four (44), for at least five (5) years from its date of issue. Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 8, effective June 18, 1970.

KRS 304.17-090 Notice of claim

304.17-090. Notice of claim (1) There shall be a provision as follows: "Notice of Claim: Written notice of claim must be given to the insurer within sixty (60) days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the insured or the beneficiary to the insurer at .... (insert the location of such office as the insurer may designate for the purpose), or to any authorized agent of the insurer, with information sufficient to identify the insured, shall be deemed notice to the insurer." (2) In a policy providing a loss-of-time benefit which may be payable for at least two (2) years, an insurer may at its option insert the following between the first and second sentences of the provision contained in subsection (1) of this section: "Subject to the qualifications set forth below, if the insured suffers loss of time on account of disability for which indemnity may be payable for at least two (2) years, he shall at least once in every six (6) months after having given notice of claim, give to the insurer notice of continuance of said disability, except in the event of legal incapacity. The period of six (6) months following any filing of proof by the insured or any payment by the insurer on account of such claim or any denial of liability in whole or in part by the insurer shall be excluded in applying this provision. Delay in the giving of such notice shall not impair the insured's right to any indemnity which would otherwise have accrued during the period of six (6) months preceding the date on which such notice is actually given." Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 9, effective June 18, 1970.

KRS 304.17-100 Forms for proof of loss

304.17-100. Forms for proof of loss There shall be a provision as follows: "Claim Forms: The insurer, upon receipt of a notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proofs of loss. If such forms are not furnished within fifteen (15) days after the giving of such notice the claimant shall be deemed to have complied with the requirements of this policy as to proof of loss upon submitting, within the time fixed in the policy for filing proofs of loss, written proof covering the occurrence, the character and the extent of the loss for which claim is made." Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 10, effective June 18, 1970.

KRS 304.17-110 Time for filing proof of loss

304.17-110. Time for filing proof of loss There shall be a provision as follows: "Proofs of Loss: Written proof of loss must be furnished to the insurer at its said office in case of claim for loss for which this policy provides any periodic payment contingent upon continuing loss within ninety (90) days after the termination of the period for which the insurer is liable and in case of claim for any other loss within ninety (90) days after the date of such loss. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it was not reasonably possible to give proof within such time, provided such proof is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity, later than one (1) year from the time proof is otherwise required." Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 11, effective June 18, 1970.

KRS 304.17-120 Time of payment of claims

304.17-120. Time of payment of claims There shall be a provision as follows: "Time of Payment of Claims: Indemnities payable under this policy for any loss other than loss for which this policy provides any periodic payment will be paid within thirty (30) days of receipt of due written proof of the loss. Subject to due written proof of loss, all accrued indemnities for loss for which this policy provides periodic payment will be paid .... (insert period for payment which must not be less frequently than monthly) and any balance remaining unpaid upon the termination of liability will be paid within thirty (30) days of receipt of due written proof." Effective: July 15, 1994 History: Amended 1994 Ky. Acts ch. 93, sec. 10, effective July 15, 1994. -- Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 12, effective June 18, 1970.

KRS 304.17-130 Person to whom indemnity payable

304.17-130. Person to whom indemnity payable (1) There shall be a provision as follows: "Payment of Claims: Indemnity for loss of life will be payable in accordance with the beneficiary designation and the provisions respecting payment which may be prescribed herein and effective at the time of payment. If no designation or provision is then effective, any indemnity shall be payable to the estate of the insured. Any other accrued indemnities unpaid at the insured's death may, at the option of the insurer, be paid either to a beneficiary or to the estate. All other indemnities will be payable to the insured." (2) Except as provided in KRS 304.17A-265 and 304.17C-137, the following provisions, or either of them, may be included with the provision required under subsection (1) of this section at the option of the insurer: (a) "If any indemnity of this policy shall be payable to the estate of the insured, or to an insured or beneficiary who is a minor or otherwise not competent to give a valid release, the insurer may pay such indemnity, up to an amount not exceeding $.... (insert an amount which shall not exceed $5,000), to any relative by blood or connection by marriage of the insured or beneficiary who is deemed by the insurer to be equitably entitled thereto. Any payment made by the insurer in good faith pursuant to this provision shall fully discharge the insurer to the extent of the payment."; and (b) "Subject to any written direction of the insured in the application or otherwise, all or a portion of any indemnities provided by this policy on account of hospital, nursing, medical, or surgical services may, at the insurer's option and unless the insured requests otherwise in writing not later than the time of filing proofs of the loss, be paid directly to the hospital or person rendering services, but it is not required that the service be rendered by a particular hospital or person." Effective: January 1, 2026 History: Amended 2025 Ky. Acts ch. 147, sec. 3, effective January 1, 2026. -- Amended 2023 Ky. Acts ch. 86, sec. 3, effective June 29, 2023. -- Amended 1998 Ky. Acts ch. 483, sec. 20, effective July 15, 1998. -- Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 13, effective June 18, 1970. Legislative Research Commission Note (1/1/2026). 2025 Ky. Acts ch. 147, sec. 5, provides that the amendments to this statute in that Act shall apply to policies, plans, and contracts issued or renewed on or after January 1, 2026. Legislative Research Commission Note (6/29/2023). This statute was amended by 2023 Ky. Acts ch. 86, sec. 3. Section 8 of that Act provides that the Act applies to health insurance policies in effect on or after June 29, 2023, and to health insurance policies issued, delivered, or renewed on or after June 29, 2023.

KRS 304.17-140 Physical examination and autopsy

304.17-140. Physical examination and autopsy There shall be a provision as follows: "Physical Examination and Autopsy: The insurer, at its own expense, shall have the right and opportunity to examine the person of the insured when and as often as it may reasonably require during the pendency of a claim hereunder and to make an autopsy in case of death where it is not forbidden by law." Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 14, effective June 18, 1970.

KRS 304.17-150 Time for bringing suit

304.17-150. Time for bringing suit There shall be a provision as follows: "Legal Actions: No action at law or in equity shall be brought to recover on this policy prior to the expiration of sixty (60) days after written proof of loss has been furnished in accordance with the requirements of this policy. No such action shall be brought after the expiration of three (3) years after the time written proof of loss is required to be furnished." Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 15, effective June 18, 1970.

KRS 304.17-160 Change of beneficiary

304.17-160. Change of beneficiary (1) There shall be a provision as follows: "Change of Beneficiary: Unless the insured makes an irrevocable designation of beneficiary, the right to change of beneficiary is reserved to the insured and the consent of the beneficiary or beneficiaries shall not be requisite to surrender or assignment of this policy or to any change of beneficiary or beneficiaries, or to any other changes in this policy." (2) The first clause of the provision contained in subsection (1), of this section, relating to the irrevocable designation of beneficiary, may be omitted at the insurer's option. Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 16, effective June 18, 1970.

KRS 304.17-170 Right to examine and return policy

304.17-170. Right to examine and return policy (1) Except as to nonrenewable accident policies, every individual health insurance policy shall contain a provision therein or in a separate rider attached thereto when delivered, stating in substance that the person to whom the policy is issued shall be permitted to return the policy within ten (10) days of its delivery to such person and have a refund of the premium paid if after examination of the policy the purchaser is not satisfied with it for any reason. If the provision is not printed on the face page or filing back of the policy, notice of the provision should be printed or stamped on the face page or filing back of the policy. (2) The policy may be so returned to the insurer at its principal or branch office or to the agent through whom it was applied for, and thereupon shall be void as from the beginning and as if the policy had not been issued. Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 17, effective June 18, 1970.

KRS 304.17-180 Optional policy provisions

304.17-180. Optional policy provisions Except as provided in subsection (2) of KRS 304.17-040, no such policy delivered or issued for delivery to any person in this state shall contain provisions respecting the matters set forth in KRS 304.17-190 to 304.17-290, inclusive, unless such provisions are in the words in which the same appear in the applicable section, except that the insurer may, at its option, use in lieu of any such provision a corresponding provision of different wording approved by the commissioner which is not less favorable in any respect to the insured or the beneficiary. Any such provision contained in the policy shall be preceded individually by the appropriate caption or, at the option of the insurer, by such appropriate individual or group captions or subcaptions as the commissioner may approve. Effective: July 15, 2010 History: Amended 2010 Ky. Acts ch. 24, sec. 1203, effective July 15, 2010. -- Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 18, effective June 18, 1970.

KRS 304.17-182 Special enrollment period for pregnancy

304.17-182. Special enrollment period for pregnancy (1) As used in this section: (a) "Health benefit plan" has the same meaning as in KRS 304.17A-005, except for purposes of this section, the term includes student health insurance offered by a Kentucky-licensed insurer under written contract with a university or college whose students it proposes to insure; and (b) "Individual Exchange": 1. Means a governmental agency or nonprofit entity that makes qualified health plans, as defined in 42 U.S.C. sec. 18021, as amended, available to qualified individuals; 2. Includes an exchange serving the individual market for qualified individuals; and 3. Does not include a Small Business Health Options Program serving the small group market for qualified employers. (2) To the extent permitted by federal law: (a) The following shall provide a special enrollment period to pregnant women who are eligible for coverage: 1. Any insurer offering a health benefit plan in the individual market, which shall include student health insurance coverage as defined in 45 C.F.R. sec. 147.145, as amended; and 2. Any individual exchange operating in this state; (b) Except as provided in paragraph (c) of this subsection, the insurer or exchange shall allow a pregnant woman, and any individual who is eligible for coverage because of a relationship to a pregnant woman, to enroll for coverage under the plan or on the exchange at any time during the pregnancy; (c) If the insurer or exchange is required by federal law to limit the enrollment period to a period that is less than the period provided in paragraph (b) of this subsection: 1. The enrollment period shall not be less than the maximum period of time permitted by federal law; and 2. The enrollment period shall begin not earlier than the date that the pregnant woman receives confirmation of the pregnancy from a medical professional; (d) The coverage required under this subsection shall begin no later than the first day of the first calendar month in which a medical professional determines that the pregnancy began, except that a pregnant woman may direct coverage to begin on the first day of any month occurring after that date but during the pregnancy; and (e) If a directive under paragraph (d) of this subsection falls outside of the pregnancy period, the coverage required under this subsection shall begin no later than the first day of the last month that occurred during the pregnancy. (3) (a) Nothing in this section shall be construed to imply that the insured is not responsible for the payment of premiums for each month during which coverage is provided. (b) For any coverage provided under this section, the original or first premium shall become due and owing not earlier than thirty (30) days after the date of enrollment. Effective: January 1, 2025 History: Created 2024 Ky. Acts ch. 207, sec. 4, effective January 1, 2025. Legislative Research Commission Note (1/1/2025). 2024 Ky. Acts ch. 207, sec. 16, provides that the amendments to this statute in that Act shall apply to plans issued or renewed on or after January 1, 2025.

KRS 304.17-185 Optional nursery care coverage for a well newly born child

304.17-185. Optional nursery care coverage for a well newly born child (1) All individual health insurance policies providing coverage on an expense incurred basis which provide maternity benefits shall offer the insured the option to purchase coverage to pay for routine nursery care for a well newly born child for up to five (5) full days in a 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 health insurance policies in effect on October 1, 1980, and those policies issued thereafter. Effective: July 15, 1980 History: Created 1980 Ky. Acts ch. 9, sec. 1, effective July 15, 1980.

KRS 304.17-190 Change of occupation

304.17-190. Change of occupation There may be a provision as follows: "Change of Occupation: If the insured be injured or contract sickness after having changed his occupation to one classified by the insurer as more hazardous than that stated in this policy or while doing for compensation anything pertaining to an occupation so classified, the insurer will pay only such portion of the indemnities provided in this policy as the premium paid would have purchased at the rate and within the limits fixed by the insurer for such more hazardous occupation. If the insured changes his occupation to one classified by the insurer as less hazardous than that stated in this policy, the insurer, upon receipt of proof of such change of occupation, will reduce the premium rate accordingly, and will return the excess pro rata unearned premium from the date of change of occupation or from the policy anniversary date immediately preceding receipt of such proof, whichever is the more recent. In applying this provision, the classification of occupational risk and the premium rates shall be such as have been last filed by the insurer prior to the occurrence of the loss for which the insurer is liable or prior to date of proof of change in occupation with the state official having supervision of insurance in the state where the insured resided at the time this policy was issued; but if such filing was not required, then the classification of occupational risk and the premium rates shall be those last made effective by the insurer in such state prior to the occurrence of the loss or prior to the date of proof of change in occupation." Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 19, effective June 18, 1970.

KRS 304.17-200 Misstatement of age

304.17-200. Misstatement of age There may be a provision as follows: "Misstatement of Age: If the age of the insured has been misstated, all amounts payable under this policy shall be such as the premium paid would have purchased at the correct age." Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 20, effective June 18, 1970.

KRS 304.17-210 Other insurance in same insurer

304.17-210. Other insurance in same insurer (1) There may be a provision as follows: "Other Insurance in This Insurer: If an accident or sickness or accident and sickness policy or policies previously issued by the insurer to the insured be in force concurrently herewith, making the aggregate indemnity for .... (insert type of coverage or coverages) in excess of $.... (insert maximum limit of indemnity or indemnities) the excess insurance shall be void and all premiums paid for such excess shall be returned to the insured or to his estate." (2) Or, in lieu of the provision contained in subsection (1) of this section, there may be a provision as follows: "Insurance effective at any one time on the insured under this policy and a like policy or policies in this insurer is limited to the one such policy elected by the insured, his beneficiary or his estate, as the case may be, and the insurer will return all premiums paid for all other such policies." Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 21, effective June 18, 1970.

KRS 304.17-220 Insurance with other insurers -- Expense incurred benefits -- "Other valid coverage."

304.17-220. Insurance with other insurers -- Expense incurred benefits -- "Other valid coverage." (1) There may be a provision as follows: "Insurance with Other Insurers: If there be other valid coverage, not with this insurer, providing benefits for the same loss on a provision of service basis or on an expense incurred basis and of which this insurer has not been given written notice prior to the occurrence or commencement of loss, the only liability under any expense incurred coverage of this policy shall be for such proportion of the loss as the amount which would otherwise have been payable hereunder plus the total of the like amounts under all such other valid coverages for the same loss of which this insurer had notice bears to the total like amounts under all valid coverages for such loss, and for the return of such portion of the premiums paid as shall exceed the pro rata portion for the amount so determined. For the purpose of applying this provision when other coverage is on a provision of service basis, the like amount of such other coverage shall be taken as the amount which the services rendered would have cost in the absence of such coverage." (2) If the foregoing policy provision is included in a policy which also contains the policy provision set out in subsection (1) of KRS 304.17-230, there shall be added to the caption of the foregoing provision the phrase "... Expense Incurred Benefits." (3) The insurer may, at its option, include in the provision provided in subsection (1) of this section, a definition of "other valid coverage" approved as to form by the commissioner, which definition shall be limited in subject matter to coverage provided by organizations subject to regulation by insurance law or by insurance authorities of this or any other state of the United States or any province of Canada, and by hospital or medical service organizations, and to any other coverage the inclusion of which may be approved by the commissioner. In the absence of such definition such term shall not include group insurance, automobile medical payments insurance, or coverage provided by hospital or medical service organizations or by union welfare plans or employer or employee benefit organizations. For the purpose of applying such policy provision no third-party liability coverage amount of benefit provided for such insured pursuant to any compulsory benefit statute, including any workers' compensation or employer's liability statute, whether provided by a governmental agency or otherwise, shall in all cases be deemed to be "other valid coverage" of which the insurer has had notice. In applying such policy provision no third-party liability coverage shall be included as "other valid coverage." Effective: July 15, 2010 History: Amended 2010 Ky. Acts ch. 24, sec. 1204, effective July 15, 2010. -- Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 22, effective June 18, 1970.

KRS 304.17-230 Insurance with other insurers -- Other benefits -- "Other valid coverage."

304.17-230. Insurance with other insurers -- Other benefits -- "Other valid coverage." (1) There may be a provision as follows: "Insurance with Other Insurers: If there be other valid coverage, not with this insurer, providing benefits for the same loss on other than an expense incurred basis and of which this insurer has not been given written notice prior to the occurrence or commencement of loss, the only liability for such benefits under this policy shall be for such proportion of the indemnities otherwise provided hereunder for such loss as the like indemnities of which the insurer had notice (including the indemnities under this policy) bear to the total amount of all like indemnities for such loss, and for the return of such portion of the premium paid as shall exceed the pro rata portion for the indemnities thus determined." (2) If the policy provision set out in subsection (1) of this section is included in a policy which also contains the policy provision set out in subsection (1) of KRS 304.17- 220, there shall be added to the caption of the foregoing provisions the phrase "... Other Benefits." (3) The insurer may, at its option, include in the provision set out in subsection (1) of this section, a definition of "other valid coverage" approved as to form by the commissioner, which definition shall be limited in subject matter to coverage provided by organizations subject to regulation by insurance laws or by insurance authorities of this or any other state of the United States or any province of Canada, and to any other coverage the inclusion of which may be approved by the commissioner. In the absence of such definition such term shall not include group insurance, or benefits provided by union welfare plans or by employer or employee benefit organizations. For the purpose of applying the foregoing policy provision with respect to any insured, any amount of benefit provided for such insured pursuant to any compulsory benefit statute, including any workers' compensation or employer's liability statute, whether provided by a governmental agency or otherwise, shall in all cases be deemed to be "other valid coverage" of which the insurer has had notice. In applying such policy provision no third-party liability coverage shall be included as "other valid coverage." Effective: July 15, 2010 History: Amended 2010 Ky. Acts ch. 24, sec. 1205, effective July 15, 2010. -- Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 23, effective June 18, 1970.

KRS 304.17-240 Relation of earnings to insurance

304.17-240. Relation of earnings to insurance (1) There may be a provision as follows: "After the loss-of-time benefit of this policy has been payable for ninety (90) days, such benefit will be adjusted, as provided below, if the total amount of unadjusted loss-of-time benefits provided in all valid loss-of-time coverage upon the insured should exceed -- % of the insured's earned income; provided, however, that if the information contained in the application discloses that the total amount of loss-of- time benefits under this policy and under all other valid loss-of-time coverage expected to be effective upon the insured in accordance with the application for this policy exceeded -- % of the insured's earned income at the time of such application, such higher percentage will be used in the place of -- %. Such adjusted loss-of-time benefit under this policy for any month shall be only such proportion of the loss-of- time benefit otherwise payable under this policy as: (a) The product of the insured's earned income and -- % (or, if higher, the alternative percentage described at the end of the first sentence of this provision) bears to (b) The total amount of loss-of-time benefits payable for such month under this policy and all other valid loss-of-time coverage on the insured (without giving effect of the overinsurance provision in this or any other coverage) less in both paragraphs (a) and (b) of this subsection any amount of loss-of-time benefits payable under other valid loss-of-time coverage which does not contain an 'overinsurance provision.' In making such computation, all benefits and earnings shall be converted to a consistent (insert 'weekly' if the loss-of-time benefit of this policy is payable weekly, 'monthly' if such benefit is payable monthly, etc.) basis. If the numerator of the foregoing ratio is zero (0) or is negative, no benefit shall be payable under this policy. In no event shall this provision 1. Operate to reduce the total combined amount of loss-of-time benefits for such month payable under this policy and all other valid loss-of-time coverage below the lesser of three hundred dollars ($300) and the total combined amount of loss-of-time benefits determined without giving effect to any 'overinsurance provision' nor 2. Operate to increase the amount of benefits payable under this policy above the amount which would have been paid in the absence of this provision, nor 3. Take into account or operate to reduce any benefit other than the loss-of- time benefit. (c) For purposes of this provision: 1. 'Earned income,' except where otherwise specified, means the greater of the monthly earnings of the insured at the time disability commences and his or her average monthly earnings for a period of two (2) years immediately preceding the commencement of such disability, and shall not include any investment income or any other income not derived from the insured's vocational activities. 2. 'Overinsurance provision' shall include this provision and any other provision with respect to any loss-of-time coverage which may have the effect of reducing an insurer's liability if the total amount of loss-of-time benefits under all coverage exceeds a stated relationship to the insured's earnings." (2) The foregoing provision may be included only in a policy which provides a loss-of- time benefit which may be payable for at least fifty-two (52) weeks, which is issued on the basis of selective underwriting of each individual application, and for which the application includes a question designed to elicit information necessary either to determine the ratio of the total loss-of-time benefits of the insured to the insured's earned income or to determine that such ratio does not exceed the percentage of earnings, not less than sixty percent (60%), selected by the insurer and inserted in lieu of the blank factor above. The insurer may require, as part of the proof of claim, the information necessary to administer this provision. If the application indicates that other loss-of-time coverage is to be discontinued, the amount of such other coverage shall be excluded in computing the alternative percentage in the first sentence of the overinsurance provision. The policy shall include a definition of "valid loss-of-time coverage," approved as to form by the commissioner, which definition may include coverage provided by governmental agencies and by organizations subject to regulations by insurance law and by insurance authorities of this or any other state of the United States or any other country or subdivision thereof, coverage provided for such insured pursuant to any disability benefits statute or any workers' compensation or employer's liability statute, benefits provided by labor-management trusteed plans or union welfare plans or by employer or employee benefit organizations, or by salary continuance or pension programs, and any other coverage the inclusion of which may be approved by the commissioner. (3) If by application of any of the foregoing provisions the insurer effects a material reduction of benefits otherwise payable under the policy, the insurer shall refund to the insured any premium unearned on the policy by reason of such reduction of coverage during the policy year current and that next preceding at the time the loss commenced, subject to the insurer's right to provide in the policy that no such reduction of benefits or refund will be made unless the unearned premium to be so refunded amounts to five dollars ($5) or such larger sum as the insurer may so specify. Effective: July 15, 2010 History: Amended 2010 Ky. Acts ch. 24, sec. 1206, effective July 15, 2010. -- Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 24, effective June 18, 1970.

KRS 304.17-250 Deduction of unpaid premium

304.17-250. Deduction of unpaid premium There may be a provision as follows: "Unpaid Premium: Upon the payment of a claim under this policy, any premium then due and unpaid or covered by any note or written order may be deducted therefrom." Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 25, effective June 18, 1970.

KRS 304.17-260 Conformity with state statutes

304.17-260. Conformity with state statutes There may be a provision as follows: "Conformity with State Statutes: Any provision of this policy which, on its effective date, is in conflict with the statutes of the state in which the insured resides on such date is hereby amended to conform to the minimum requirements of such statutes." Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 26, effective June 18, 1970.

KRS 304.17-270 Renewability

304.17-270. Renewability Health insurance policies, other than accident insurance only policies, in which the insurer reserves the right to refuse renewal on an individual basis, shall provide in substance in a provision thereof or in an indorsement thereon or rider attached thereto that subject to the right to terminate the policy upon nonpayment of premium when due, such right to refuse renewal may not be exercised so as to take effect before the renewal date occurring on, or after and nearest, each policy anniversary (or in the case of lapse and reinstatement, at the renewal date occurring on, or after and nearest, each anniversary of the last reinstatement), and that any refusal of renewal shall be without prejudice to any claim originating while the policy is in force. (The parenthetic reference to lapse and reinstatement may be omitted at the insurer's option.) Effective: July 15, 1994 History: Amended 1994 Ky. Acts ch. 512, sec. 64, effective July 15, 1994. -- Amended 1976 Ky. Acts ch. 52, sec. 2, effective June 19, 1976. -- Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 27, effective June 18, 1970.

KRS 304.17-275 Repealed, 1994

304.17-275. Repealed, 1994 Catchline at repeal: Renewal of hospital or surgical or medical expense insurance. History: Repealed 1994 Ky. Acts ch. 512, sec. 119, effective July 15, 1994. -- Amended 1982 Ky. Acts ch. 320, sec. 23, effective July 15, 1982. -- Created 1976 Ky. Acts ch. 52, sec. 1, effective June 19, 1976.

KRS 304.17-280 Illegal occupation

304.17-280. Illegal occupation There may be a provision as follows: "Illegal Occupation: The insurer shall not be liable for any loss to which a contributing cause was the insured's commission of or attempt to commit a felony or to which a contributing cause was the insured's being engaged in an illegal occupation." Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 28, effective June 18, 1970.

KRS 304.17-290 Use of intoxicants, narcotics and hallucinogenics

304.17-290. Use of intoxicants, narcotics and hallucinogenics There may be a provision as follows: "Intoxicants, Narcotics and Hallucinogenics: The insurer shall not be liable for any loss sustained or contracted in consequence of the insured's being intoxicated or under the influence of any narcotic or any hallucinogenic unless administered on the advice of a physician." Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 29, effective June 18, 1970.

KRS 304.17-300 Method of printing provisions

304.17-300. Method of printing provisions The provisions which are the subject of KRS 304.17-050 to 304.17-160, inclusive, and KRS 304.17-190 to 304.17-290, inclusive, or any corresponding provisions which are used in lieu thereof in accordance with such sections, shall be printed in the consecutive order of the provisions in such sections, or, at the insurer's option, any such provision may appear as a unit in any part of the policy, with other provisions to which it may be logically related; provided, the resulting policy shall not be in whole or in part unintelligible, uncertain, ambiguous, abstruse, or likely to mislead a person to whom the policy is offered, delivered or issued. Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 30, effective June 18, 1970.

KRS 304.17-305 Indemnity payable for services performed by optometrists, osteopaths, physicians, chiropractors, or podiatrists

304.17-305. Indemnity payable for services performed by optometrists, osteopaths, physicians, chiropractors, or podiatrists (1) When any policy of health insurance issued in this state provides for reimbursement for any service which is within the lawful scope of practice of an optometrist duly licensed as provided in KRS Chapter 320, the insured or other person entitled to benefits under such policy shall be entitled to reimbursement for such services, whether such services are performed by a duly licensed physician, osteopath, 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 policy of health insurance issued in this state 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 benefits under such policy shall be entitled to reimbursement for such services, whether such services are performed by a duly licensed physician, osteopath 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. (3) When any policy of health insurance issued in this state provides for reimbursement for any service which is within the lawful scope of practice of a podiatrist duly licensed under KRS Chapter 311, the insured or other person entitled to benefits under that policy shall be entitled to reimbursement for those services, whether those services are performed by a duly licensed physician, osteopath, chiropractor, or podiatrist, notwithstanding any provision contained in the policy, or if the policy so provides, payment may be made directly to the provider of the services. Effective: July 15, 1994 History: Amended 1994 Ky. Acts ch. 466, sec. 1, effective July 15, 1994. -- Amended 1986 Ky. Acts ch. 399, sec. 1, effective July 15, 1986. -- Amended 1980 Ky. Acts ch. 345, sec. 1, effective July 15, 1980. -- Created 1972 Ky. Acts ch. 72, sec. 1, effective June 16, 1970.

KRS 304.17-310 Family expense health insurance

304.17-310. Family expense health insurance (1) Family expense health insurance is that provided under a policy issued to one (1) of the family members insured, who shall be deemed the policyholder, covering any two (2) or more eligible members of a family, including husband, wife, unmarried dependent children, to age nineteen (19), unmarried children from nineteen (19) to twenty-five (25) years of age who are full-time students enrolled in and attending an accredited educational institution and who are primarily dependent on the policyholder for maintenance and support, and any other person dependent upon the policyholder. Any authorized health insurer may issue the insurance. (2) An individual hospital or medical expense insurance policy or hospital or medical service plan contract delivered or issued for delivery in this state more than 120 days after June 13, 1968, which provides that coverage of a dependent child shall terminate upon attainment of the limiting age for dependent children specified in the policy or contract shall also provide in substance that attainment of the limiting age shall not operate to terminate the coverage of the child while the child is and continues to be both (a) incapable of self-sustaining employment by reason of an intellectual or physical disability and (b) chiefly dependent upon the policyholder or subscriber for support and maintenance, provided proof of the incapacity and dependency is furnished to the insurer or corporation by the policyholder or subscriber within thirty-one (31) days of the child's attainment of the limiting age and subsequently as may be required by the insurer or corporation but not more frequently than annually after the two (2) year period following the child's attainment of the limiting age. (3) Insurers offering family expense health insurance shall offer the applicant the option to purchase coverage for unmarried dependent children until age twenty-five (25). Effective: July 15, 2010 History: Amended 2010 Ky. Acts ch. 141, sec. 27, effective July 15, 2010. -- Amended 2008 Ky. Acts ch. 169, sec. 9, effective July 15, 2008. -- Amended 1998 Ky. Acts ch. 483, sec. 21, effective July 15, 1998. -- Amended 1994 Ky. Acts ch. 405, sec. 82, effective July 15, 1994. -- Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 31, effective June 18, 1970.

KRS 304.17-311 Medicare supplement insurance for persons not eligible for Medicare by reason of age

304.17-311. Medicare supplement insurance for persons not eligible for Medicare by reason of age Insurers delivering or issuing for delivery in Kentucky Medicare supplement insurance policies as defined in KRS 304.14-500 to 304.14-550, or renewing such policies, shall make available upon request Medicare supplement insurance for persons not eligible for Medicare by reason of age. Effective: July 15, 1988 History: Created 1988 Ky. Acts ch. 354, sec. 1, effective July 15, 1988.

KRS 304.17-312 Definitions for KRS 304.17-313, 304.18-037, 304.32-280, and 304.38-210

304.17-312. Definitions for KRS 304.17-313, 304.18-037, 304.32-280, and 304.38-210 As used in KRS 304.17-313, 304.18-037, 304.32-280, and 304.38-210: (1) "Home health agency" means a public agency or private organization, or a subdivision of such an agency or organization which is licensed as a home health agency by the Kentucky Health Facilities and Health Services Certificate of Need and Licensure Board and is certified to participate as a home health agency under Title XVIII of the Social Security Act; (2) "Home health care" means the care and treatment provided by a home health agency which is prescribed and supervised by a physician, an advanced practice registered nurse, or a physician assistant. The care and treatment shall include but not be limited to one (1) or more of the following: (a) Part-time or intermittent skilled nursing services provided by an advanced practice registered nurse, registered nurse, or licensed practical nurse; (b) Physical, respiratory, occupational, or speech therapy; (c) Home health aide services; (d) Medical appliances and equipment, drugs and medication, and laboratory services, to the extent that such items and services would have been covered under the policy if the covered person had been in a hospital; and (3) "Home health aide services" means those services provided by a home health aide and supervised by a registered nurse which are directed towards the personal care of the patient. Such services shall include but not be limited to the following: (a) Helping the patient with bath, care of mouth, skin, and hair; (b) Helping the patient to the bathroom or in using a bedpan; (c) Helping the patient in and out of bed and assisting with ambulation; (d) Helping the patient with prescribed exercises which the patient and home health aide have been taught by appropriate professional personnel; (e) Assisting with medication ordinarily self-administered that has been specifically ordered by a physician, an advanced practice registered nurse, or a physician assistant; (f) Performing incidental household services as are essential to the patient's health care at home provided that such services would have been performed if the patient was in a hospital or skilled nursing facility; and (g) Reporting to the professional nurse supervisor changes in the patient's condition or family situation. Effective:March 22, 2021 History: Amended 2021 Ky. Acts ch. 59, sec. 2, effective March 22, 2021. -- Amended 2010 Ky. Acts ch. 85, sec. 45, effective July 15, 2010. -- Amended 2000 Ky. Acts ch. 521, sec. 11, effective July 14, 2000. -- Created 1980 Ky. Acts ch. 61, sec. 1, effective January 1, 1981.

KRS 304.17-313 Individual health insurers to offer home health care coverage -- Conditions

304.17-313. Individual health insurers to offer home health care coverage -- Conditions (1) All insurers issuing individual health insurance policies in the Commonwealth providing coverage on an expense incurred basis shall make available and offer to the purchaser coverage for home health care. The coverage may contain a limitation on the number of home 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 insurers issuing individual health insurance policies in the Commonwealth. (3) Home health care shall not be reimbursed unless an attending physician, an advanced practice registered nurse, or a physician assistant 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 an individual health insurance policy providing coverage on an expense incurred basis provided that the policy 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. (5) Pursuant to the provisions of this section, all insurers issuing individual health insurance policies in the Commonwealth on an expense incurred basis 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:March 22, 2021 History: Amended 2021 Ky. Acts ch. 59, sec. 3, effective March 22, 2021. -- Created 1980 Ky. Acts ch. 61, sec. 2, effective January 1, 1981.

KRS 304.17-314 Repealed, 1992

304.17-314. Repealed, 1992 Catchline at repeal: Long-term health care coverage. History: Repealed 1992 Ky. Acts ch. 423, sec. 10, effective July 14, 1992. -- Created 1986 Ky. Acts ch. 409, sec. 1, effective July 1, 1987.

KRS 304.17-315 Policy covering services performed by dentist deemed to cover such services performed by physician

304.17-315. Policy covering services performed by dentist deemed to cover such services performed by physician Any policy or contract of health insurance issued in this state which provides coverage for services which can be lawfully performed within the scope of the license of a duly licensed dentist, shall be deemed to provide benefits for such services whether performed by a duly licensed physician or a duly licensed dentist. Effective: June 19, 1976 History: Created 1976 Ky. Acts ch. 112, sec. 2, effective June 19, 1976.

KRS 304.17-316 Coverage for mammograms -- Prohibition on cost-sharing requirements for covered diagnostic breast examinations or supplemental breast examinations

304.17-316. Coverage for mammograms -- Prohibition on cost-sharing requirements for covered diagnostic breast examinations or supplemental breast examinations (1) As used in this section: (a) "Cost-sharing requirements" means any: 1. Deductible, coinsurance, or copayment; or 2. Out-of-pocket expense imposed upon an insured that is similar to an expense referenced in subparagraph 1. of this paragraph; (b) 1. "Diagnostic breast examination" means a medically necessary and appropriate examination of the breast that is used to evaluate an abnormality seen or suspected from, or detected by, a screening examination for breast cancer or another means of examination. 2. As used in subparagraph 1. of this paragraph, "examination of the breast" includes but is not limited to an examination using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound; (c) 1. "Mammogram" means an X-ray examination of the breast, with at least two (2) views of each breast and with an average radiation exposure at the current recommended level as set forth in guidelines of the American College of Radiology, using equipment dedicated specifically for mammography, including but not limited to: a. The X-ray tube, filter, compression device, screens, film, and cassettes; b. Digital mammography; and c. Breast tomosynthesis. 2. As used in subparagraph 1. of this paragraph, "breast tomosynthesis" means a radiologic procedure that involves the acquisitio n of projection images over the stationary breast to produce cross -sectional digital three-dimensional images of the breast; and (d) 1. "Supplemental breast examination" means a medically necessary and appropriate examination of the breast that is: a. Used to screen for breast cancer when there is no abnormality seen or suspected; and b. Based on personal or family medical history, or additional factors, that may increase the individual's risk of breast cancer. 2. As used in subparagraph 1. of this paragrap h, "examination of the breast" includes but is not limited to: a. A mammogram; and b. An examination using breast magnetic resonance imaging or breast ultrasound. (2) Subject to subsection (3) of this section and except as otherwise provided in subsection (4) of this section, a health insurance policy, plan, certificate, or contract issued, renewed, or delivered in this Commonwealth: (a) That provides coverage on an expense-incurred basis for surgical services for a mastectomy shall also provide coverage for: 1. a. Low-dose mammography screening for persons who have no sign or symptom of breast cancer upon self -referral or referral by a health care practitioner acting within the scope of the practitioner's licensure. b. The coverage required under this subpa ragraph may be limited to the following: i. One (1) mammogram for persons ages thirty-five (35) years through thirty-nine (39) years; ii. One (1) mammogram every two (2) years for persons ages forty (40) years through forty-nine (49) years; iii. One (1) mammogram per year for persons ages fifty (50) years and over; and iv. A benefit of fifty dollars ($50) per screening mammogram. c. The coverage required under this subparagraph shall be subject to deductibles and coinsurance that are no less favorable than the deductibles and coinsurance for coverage for physical illness generally; and 2. a. Mammograms for any insured, regardless of age, who has been diagnosed with breast disease upon referral by a health care practitioner acting within the scope of the prac titioner's licensure. b. The coverage required under this subparagraph shall be subject to the same annual deductibles or coinsurance established for other coverages within the policy; (b) Shall not impose any cost-sharing requirements for any diagnostic b reast examination or supplemental breast examination that is covered under the policy, plan, certificate, or contract; and (c) Shall provide any coverage not otherwise required under this section, including coverage with respect to restrictions on cost -sharing requirements, for breast examinations, including mammograms, that is required for that policy, plan, certificate, or contract under federal law. (3) The coverage required under subsection (2)(a) of this section shall be limited to mammograms: (a) Performed by a radiographer: 1. Licensed under KRS Chapter 311B; or 2. Certified by the American Registry of Radiologic Technologists; (b) Interpreted by a qualified radiologist; (c) Performed under the direction of a person licensed to practice medicine and certified by the American Board of Radiology; (d) Performed by a facility and ordered by a health care practitioner that follow federal laws relating to the notification of mammography exam results and maintaining medical records; (e) Performed by a facility that meets current criteria of the American College of Radiology Mammography Accreditation Program; and (f) Performed on dedicated equipment that meets the guidelines established by the American College of Radiology. (4) If the application of any requirement of subsection (2) of this section would be the sole cause of a health insurance policy's, plan's, certificate's, or contract's failure to qualify as a Health Savings Account-qualified High Deductible Health Plan under 26 U.S.C. sec. 223, as amended, then the requirement shall not apply to that policy, plan, certificate, or contract until the minimum deductible under 26 U.S.C. sec. 223, as amended, is satisfied. Effective: January 1, 2025 History: Amended 2024 Ky. Acts ch. 97, sec. 1, effective January 1, 2025. -- Amended 2017 Ky. Acts ch. 183, sec. 2, effective June 29, 2017. -- Amended 2000 Ky. Acts ch. 18, sec. 1, effective July 14, 2000. -- Created 1990 Ky. Acts ch. 46, sec. 1, 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 304.17-317 Ambulatory surgical centers, coverage

304.17-317. Ambulatory surgical centers, coverage (1) All individual health insurance policies providing coverage on an expense incurred basis shall provide coverage for health care treatment or services rendered by ambulatory surgical centers approved by the Kentucky Health Facilities and Health Services Certificate of Need and Licensure Board. The health 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 health insurance policies delivered or issued for delivery in this state on and after October 1, 1978. Effective: June 17, 1978 History: Created 1978 Ky. Acts ch. 245, sec. 1, effective June 17, 1978.

KRS 304.17-318 Coverage for treatment for mental illness

304.17-318. 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 in this state 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. 1, effective July 15, 1986.

KRS 304.17-319 Coverage for treatment of temporomandibular joint disorders and craniomandibular jaw disorders

304.17-319. Coverage for treatment of temporomandibular joint disorders and craniomandibular jaw disorders (1) All individual policies of health insurance which provide coverage on an expense- incurred basis for surgical or nonsurgical treatment of skeletal disorders shall provide coverage for medically necessary procedures relating to temporomandibular 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) Nothing in this section shall 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. 1, effective July 13, 1990.

KRS 304.17-320 Third party ownership

304.17-320. Third party ownership The word "insured," as used in this subtitle, shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under such a policy to any indemnities, benefits, and rights provided therein. Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 32, effective June 18, 1970.

KRS 304.17-330 Requirement of other jurisdictions

304.17-330. Requirement of other jurisdictions (1) Any policy of a foreign or alien insurer, when delivered or issued for delivery to any person in this state, may contain any provision which is not less favorable to the insured or the beneficiary than the provisions of this subtitle and which is prescribed or required by the laws of the state under which the insurer is organized. (2) Any policy of a domestic insurer may, when issued for delivery in any other state or country, contain any provision permitted or required by the laws of such other state or country. Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 33, effective June 18, 1970.

KRS 304.17-340 Conforming to statute

304.17-340. Conforming to statute A policy delivered or issued for delivery to any person in this state in violation of this subtitle shall be held valid but shall be construed as provided in this subtitle. When any provision in a policy subject to this subtitle is in conflict with any provision of this subtitle, the rights, duties, and obligations of the insurer, the insured and the beneficiary shall be governed by the provisions of this subtitle. Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 34, effective June 18, 1970.

KRS 304.17-350 Age limit

304.17-350. Age limit If any policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if such date falls within a period for which premium is accepted by the insurer or if the insurer accepts a premium after such date, the coverage provided by the policy will continue in force subject to any right of cancellation until the end of the period for which premium has been accepted. In the event the age of the insured has been misstated and if, according to the correct age of the insured, the coverage provided by the policy would not have become effective, or would have ceased prior to the acceptance of such premium or premiums, then the liability of the insurer shall be limited to the refund, upon request, of all premiums paid for the period not covered by the policy. Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 35, effective June 18, 1970.

KRS 304.17-360 Prohibited policy plans -- Provisions

304.17-360. Prohibited policy plans -- Provisions No insurer shall deliver or issue for delivery in this state any policy providing benefits or values for surviving or continuing policyholders contingent upon the lapse or termination of the policies of other policyholders whether by death or otherwise. Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 36, effective June 18, 1970.

KRS 304.17-370 Incontestability after reinstatement

304.17-370. Incontestability after reinstatement The reinstatement of any policy of noncancellable health insurance, or of any health policy containing a provision for incontestability, or a provision of similar nature, delivered or issued for delivery in this state subsequent to September 1, 1950, shall be contestable only on account of fraud or misrepresentation of facts material to the reinstatement and only for the same period following reinstatement as is provided in the policy with respect to the contestability thereof after the original issuance of the policy. Effective: June 18, 1970 History: Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 37, effective June 18, 1970.

KRS 304.17-380 Filing of rates

304.17-380. Filing of rates Each insurer issuing health insurance policies for delivery in this state shall, before use thereof, file with the commissioner its premium rates and classification of risks pertaining to such policies. The insurer shall adhere to its rates and classifications as filed with the commissioner. The insurer may change such filings from time to time as it deems proper. Effective: July 15, 2010 History: Amended 2010 Ky. Acts ch. 24, sec. 1207, effective July 15, 2010. -- Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 38, effective June 18, 1970.

KRS 304.17-383 Procedure for approval of rate filing containing increase

304.17-383. Procedure for approval of rate filing containing increase (1) No filing under KRS 304.17-380 that contains an increase in premium rates shall become effective until the commissioner has issued an order approving the filing. The commissioner may hold a hearing within thirty (30) days after receiving a filing under this subtitle containing a rate increase, and after the hearing shall issue a final order approving or disapproving the filing. (2) In approving or disapproving a filing under subsection (1) of this section, the commissioner shall consider: (a) Whether the benefits provided are reasonable in relation to the premium charged; (b) Previous premium rates for the policies to which the filing applies; and (c) The effect of the increase on policyholders. (3) The commissioner shall notify the Attorney General in writing of the hearing and of the premium increase to be considered. The Attorney General shall be considered a party to the hearing if he or she chooses to participate. (4) No insurer receiving the commissioner's approval of a filing under this section shall submit a new filing containing a rate increase for any of the same policies until at least six (6) months have elapsed following the effective date of the approved increase. (5) At any time, the commissioner, after an administrative hearing may withdraw approval of rates previously approved under this section if he or she determines that the benefits are no longer reasonable in relation to the premium charged. Administrative hearings conducted under authority of this section shall be conducted in accordance with KRS Chapter 13B. Effective: July 15, 2010 History: Amended 2010 Ky. Acts ch. 24, sec. 1208, effective July 15, 2010. -- Amended 1996 Ky. Acts ch. 318, sec. 237, effective July 15, 1996. -- Amended 1994 Ky. Acts ch. 512, sec. 61, effective July 15, 1994. -- Created 1990 Ky. Acts ch. 69, sec. 1, effective July 13, 1990.

KRS 304.17-390 Franchise plan health insurance -- Franchise plan disability insurance

304.17-390. Franchise plan health insurance -- Franchise plan disability insurance (1) Health insurance on a franchise plan is that issued to: (a) Five (5) or more employees of a common employer; or (b) Ten (10) or more members of any bona fide association or labor union, which association or union was formed and exists for purposes other than that of obtaining insurance, and under which such employees or members, with or without their dependents, are issued individual policies which may vary as to amounts and kinds of coverage as applied for, under an arrangement whereby the premiums on the policies are to be paid to the insurer periodically by the employer, with or without payroll deductions, or by the association, or by some designated employee or officer of the association acting on behalf of the employer or association members. (2) Disability insurance on a franchise plan is that issued for: (a) Three (3) or more employees of a common employer; or (b) Ten (10) or more members of any bona fide association or labor union, which association or union was formed and exists for purposes other than that of obtaining insurance, and under which the employees or members, with or without their dependents, are issued individual policies which may vary as to amounts and kinds of coverage as applied for, under an arrangement whereby the premiums on the policies are to be paid to the insurer periodically by the employer, with or without payroll deductions, or by the association, or by some designated employee or officer of the association acting on behalf of the employer or association members. (3) The term "employees" includes also the employer's officers, and the employer or partners if the employer is an individual or a partnership. (4) An insurer may charge different rates, provide different benefits, or employ different underwriting procedure for individuals insured under a franchise plan, if such rates, benefits, or procedures as used do not unfairly discriminate as between individuals insured under franchise plans and individuals otherwise insured under similar policies, taking into consideration the insuring, risk and exposure factors, and expense elements. Effective: July 15, 1998 History: Amended 1998 Ky. Acts ch. 326, sec. 1, effective July 15, 1998. -- Created 1970 Ky. Acts ch. 301, subtit. 17, sec. 39, effective June 18, 1970.

KRS 304.17-400 Repealed, 1982

304.17-400. Repealed, 1982 Catchline at repeal: Authority to make rules or regulations. History: Repealed 1982 Ky. Acts ch. 37, sec. 8, effective February 26, 1982. -- Created 1980 Ky. Acts ch. 37, sec. 1, effective July 15, 1980.

KRS 304.17-410 Repealed, 2000

304.17-410. Repealed, 2000 Catchline at repeal: Department to collect data concerning cost of health insurance -- Report to General Assembly. History: Repealed 2000 Ky. Acts ch. 521, sec. 30, effective July 14, 2000. -- Created 1980 Ky. Acts ch. 61, sec. 6, effective January 1, 1981.

KRS 304.17-412 Requirements for insurer that issues policy or administers program providing for utilization review of benefits

304.17-412. Requirements for insurer that issues policy or administers program providing for utilization review of benefits (1) Every health insurer proposing to issue or deliver in this state a health insurance policy or contract or administer a health benefit program which provides for the coverage of hospital benefits and the utilization review of those benefits by an insurer, its designee, or a private review agent shall: (a) Be registered 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, an insurer or its designee 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 review 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 internal appeal; and (b) The insurer is in compliance with subsection (1) of this section. Effective: July 14, 2000 History: Amended 2000 Ky. Acts ch. 262, sec. 26, effective July 14, 2000. -- Amended 1998 Ky. Acts ch. 426, sec. 523, effective July 15, 1998. -- Amended 1996 Ky. Acts ch. 353, sec. 1, effective July 15, 1996. -- Created 1990 Ky. Acts ch. 451, sec. 7, effective July 13, 1990.

KRS 304.17-415 Cancellation of health insurance policy -- Return of unearned premium

304.17-415. Cancellation of health insurance policy -- Return of unearned premium If an individually marketed health insurance policy is canceled, the insurer shall return promptly the unearned portion of any premium paid beyond the month in which the cancellation is effective. Effective: July 15, 2010 History: Amended 2010 Ky. Acts ch. 166, sec. 9, effective July 15, 2010. -- Created 2006 Ky. Acts ch. 121, sec. 3, effective July 12, 2006.

KRS 304.17-3163 Coverage for medical and surgical benefits with respect to mastectomy, diagnosis and treatment of endometrioses and endometritis, and bone density testing -- Duties of insurer

304.17-3163. 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 insurers issuing individual health insurance policies in this Commonwealth providing coverage on an expense-incurred basis shall make available and offer to the purchaser coverage for: (a) The following, if an insurer provides medical and surgical benefits with respect to mastectomy, 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 a 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 to 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. sec. 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. sec. 300gg-52. Effective: July 15, 2002 History: Amended 2002 Ky. Acts ch. 181, sec. 1, effective July 15, 2002. -- Created 1998 Ky. Acts ch. 427, sec. 1, effective July 15, 1998.

KRS 304.17-3165 Coverage for treatment of breast cancer

304.17-3165. Coverage for treatment of breast cancer (1) All insurers issuing individual health insurance policies in this Commonwealth which provide coverage for treatment of breast cancer by chemotherapy on an expense-incurred basis shall also provide coverage for treatment of breast cancer by high-dose chemotherapy with 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. 1, effective March 28, 1996.

KRS 304.17-3185 Coverage for services of licensed psychologist or licensed clinical social worker

304.17-3185. Coverage for services of licensed psychologist or licensed clinical social worker Every individual health insurance policy issued, delivered, or renewed in this state which provides coverage on an expense-incurred basis for any services performed by a licensed psychologist pursuant to KRS Chapter 319, or by a licensed clinical social worker pursuant to KRS Chapter 335, shall entitle the policyholder, or other person entitled to these benefits under the policy, to payment of or reimbursement for the cost of the service, not in excess of the coverage limits, regardless of provider profession. If the policy, contract, or plan permits, payment may be made directly to the provider of the services. If the plan does not permit direct provider reimbursement, the person entitled to these benefits shall be entitled to reimbursement for the cost of services received. Nothing in this section shall require an individual health insurance policy 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 service which exceeds the limits of the policy. Effective: July 15, 1994 History: Created 1994 Ky. Acts ch. 218, sec. 1, effective July 15, 1994.

Source: Kentucky Legislative Research Commission (legislature.ky.gov)URL: https://apps.legislature.ky.gov/law/statutes/chapter.aspx?id=38714Fetched: 10/20/2026