Kentucky Statutes 304.17A-520 – Enrollee choice of primary care providers
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(1) An enrollee shall have adequate choice among participating primary care providers in a managed care plan who are accessible and qualified.
(2) A managed care plan shall permit enrollees to choose their own primary care provider from a list of health care providers within the plan. This list shall be updated as health care providers are added or removed and shall include a sufficient number of primary care providers who are accepting new enrollees.
(3) Women shall be able to choose a qualified health care provider offered by a plan for the provision of covered care necessary to provide routine and preventive women’s health care services.
(4) An insurer shall provide a covered person with access to a consultation with a participating health care provider for a second opinion. Obtaining the second opinion shall not cost a covered person more than the covered person’s normal copay or coinsurance amounts.
Effective: July 13, 2004
History: Amended 2004 Ky. Acts ch. 59, sec. 7, effective July 13, 2004. — Amended
2000 Ky. Acts ch. 262, sec. 25, effective July 14, 2000. — Created 1998 Ky. Acts ch.
496, sec. 29, effective April 10, 1998.
(2) A managed care plan shall permit enrollees to choose their own primary care provider from a list of health care providers within the plan. This list shall be updated as health care providers are added or removed and shall include a sufficient number of primary care providers who are accepting new enrollees.
Terms Used In Kentucky Statutes 304.17A-520
- Insurer: means any insurance company. See Kentucky Statutes 304.17A-005
- Managed care: means systems or techniques generally used by third-party payors or their agents to affect access to and control payment for health care services and that integrate the financing and delivery of appropriate health care services to covered persons by arrangements with participating providers who are selected to participate on the basis of explicit standards for furnishing a comprehensive set of health care services and financial incentives for covered persons using the participating providers and procedures provided for in the plan. See Kentucky Statutes 304.17A-005
- provider: means any:
(a) Advanced practice registered nurse licensed under KRS Chapter 314. See Kentucky Statutes 304.17A-005
(3) Women shall be able to choose a qualified health care provider offered by a plan for the provision of covered care necessary to provide routine and preventive women’s health care services.
(4) An insurer shall provide a covered person with access to a consultation with a participating health care provider for a second opinion. Obtaining the second opinion shall not cost a covered person more than the covered person’s normal copay or coinsurance amounts.
Effective: July 13, 2004
History: Amended 2004 Ky. Acts ch. 59, sec. 7, effective July 13, 2004. — Amended
2000 Ky. Acts ch. 262, sec. 25, effective July 14, 2000. — Created 1998 Ky. Acts ch.
496, sec. 29, effective April 10, 1998.