As used in this subtitle, unless the context requires otherwise: (1) “Administrator” is defined in KRS § 304.9-051(1);
(2) “Agent” is defined in KRS § 304.9-020;
(3) “Assessment process” means the process of assessing and allocating guaranteed acceptance program losses or Kentucky Access funding as provided for in KRS
304.17B-021;
(4) “Authority” means the Kentucky Health Care Improvement Authority;
(5) “Case management” means a process for identifying an enrollee with specific health care needs and interacting with the enrollee and their respective health care providers in order to facilitate the development and implementation of a plan that efficiently uses health care resources to achieve optimum health outcome;
(6) “Commissioner” is defined in KRS § 304.1-050(1); (7) “Department” is defined in KRS § 304.1-050(2);
(8) “Earned premium” means the portion of premium paid by an insured that has been allocated to the insurer’s loss experience, expenses, and profit year to date;
(9) “Enrollee” means a person who is enrolled in a health benefit plan offered under
Kentucky Access;
(10) “Eligible individual” is defined in KRS § 304.17A-005(11);
(11) “Guaranteed acceptance program” or “GAP” means the Kentucky Guaranteed
Acceptance Program established and operated under KRS § 304.17A-400 to
304.17A-480;
(12) “Guaranteed acceptance program participating insurer” means an insurer that offered health benefit plans through December 31, 2000, in the individual market to guaranteed acceptance program qualified individuals;
(13) “Health benefit plan” is defined in KRS § 304.17A-005(22);
(14) “High-cost condition” means acquired immune deficiency syndrome (AIDS), angina pectoris, ascites, chemical dependency, cirrhosis of the liver, coronary insufficiency, coronary occlusion, cystic fibrosis, Friedreich’s ataxia, hemophilia, Hodgkin’s disease, Huntington’s chorea, juvenile diabetes, leukemia, metastatic cancer, motor or sensory aphasia, multiple sclerosis, muscular dystrophy, myasthenia gravis, myotonia, open-heart surgery, Parkinson’s disease, polycystic kidney, psychotic disorders, quadriplegia, stroke, syringomyelia, Wilson’s disease, chronic renal failure, malignant neoplasm of the trachea, malignant neoplasm of the bronchus, malignant neoplasm of the lung, malignant neoplasm of the colon, short gestation period for a newborn child, and low birth weight of a newborn child;
(15) “Incurred losses” means for Kentucky Access the excess of claims paid over premiums received;
(16) “Insurer” is defined in KRS § 304.17A-005(29);
(17) “Kentucky Access” means the program established in accordance with KRS
304.17B-001 to 304.17B-031;
(18) “Kentucky Access Fund” means the fund established in KRS § 304.17B-021;
(19) “Kentucky Health Care Improvement Authority” means the board established to administer the program initiatives listed in KRS § 304.17B-003(5);
(20) “Kentucky Health Care Improvement Fund” means the fund established for receipt of the Kentucky tobacco master settlement moneys for program initiatives listed in KRS § 304.17B-003(5);
(21) “MARS” means the Management Administrative Reporting System administered by the Commonwealth;
(22) “Medicaid” means coverage in accordance with Title XIX of the Social Security
Act, 42 U.S.C. secs. 1396 et seq., as amended;
(23) “Medicare” means coverage under both Parts A and B of Title XVIII of the Social
Security Act, 42 U.S.C. secs. 1395 et seq., as amended;
(24) “Office” means the Office of Health Data and Analytics in the Cabinet for Health and Family Services;
(25) “Pre-existing condition exclusion” is defined in KRS § 304.17A-220(6);
(26) “Standard health benefit plan” means a health benefit plan that meets the requirements of KRS § 304.17A-250;
(27) “Stop-loss carrier” means any person providing stop-loss health insurance coverage; (28) “Supporting insurer” means all insurers, stop-loss carriers, and self-insured
employer-controlled or bona fide associations; and
(29) “Utilization management” is defined in KRS § 304.17A-500(12).
Effective: June 27, 2019
History: Amended 2019 Ky. Acts ch. 90, sec. 11, effective June 27, 2019. — Amended
2010 Ky. Acts ch. 24, sec. 1273, effective July 15, 2010. — Amended 2006 Ky. Acts ch. 253, sec. 6, effective July 12, 2006. — Amended 2005 Ky. Acts ch. 144, sec. 10, effective June 20, 2005. — Amended 2003 Ky. Acts ch. 150, sec. 4, effective June 24,
2003. — Created 2000 Ky. Acts ch. 476, sec. 1, effective July 14, 2000.
Legislative Research Commission Note (1/1/2020). Under the authority of KRS
7.136(1), a reference to “KRS § 304.17A-005(27)” in subsection (16) of this statute has been changed to “KRS § 304.17A-005(29)” by the Reviser of Statutes following the enactment of 2019 Ky. Acts ch. 190, sec. 5, which inserted new subsections into KRS § 304.17A-005 and renumbered the subsequent subsections, but did not amend this statute to conform.