§ 304.17A-005 Definitions for subtitle
§ 304.17A-080 Health Insurance Advisory Council — Powers — Duties — Members — Expenses and supplies
§ 304.17A-095 Insurer issuing health benefit plan must file rates and charges — Commissioner’s approval — Policy forms — Administrative regulations — Hearing
§ 304.17A-0952 Premium rate guidelines for individual, small group, and association plans
§ 304.17A-0954 Premium rate guidelines for employer-organized association plans
§ 304.17A-096 Basic health benefit plans permitted for individual, small group, and association markets — Required coverage — Exclusions from coverage
§ 304.17A-097 Disclosure of coverage levels in basic health benefit plan
§ 304.17A-098 Rewards or incentives to participate in voluntary wellness or health improvement program
§ 304.17A-131 Coverage for cochlear implants
§ 304.17A-132 Coverage for hearing aids
§ 304.17A-133 Coverage for mammograms
§ 304.17A-134 Coverage for medical and surgical benefits with respect to mastectomy, diagnosis and treatment of endometrioses and endometritis, and bone density testing — Requirements for health benefit plan
§ 304.17A-135 Coverage for treatment of breast cancer
§ 304.17A-136 Coverage for cancer clinical trials
§ 304.17A-138 Telehealth coverage and reimbursement — Requirements for health benefit plan — Reimbursement for rural health clinics, federally qualified health centers, and federally qualified health center look-alikes — Benefits subject to deductible, copayme
§ 304.17A-139 Family or dependents coverage to apply to newly born child from moment of birth and to include inherited metabolic diseases — Requirement for notification and payment of premium — Coverage for milk fortifiers to prevent enterocolitis
§ 304.17A-140 Coverage applicable to children to include legally-adopted children
§ 304.17A-142 Coverage for autism spectrum disorders — Limitations on coverage — Utilization review — Reimbursement not required
§ 304.17A-144 Liaison for autism spectrum disorders treatment benefits
§ 304.17A-145 Maternity coverage to include specified amounts of inpatient care for mothers and newly-born children — Exemption
§ 304.17A-146 Coverage for registered nurse first assistant
§ 304.17A-147 Coverage for surgical first assisting or intraoperative surgical care to include services performed by certified surgical assistant
§ 304.17A-1473 Coverage for surgical first assisting or intraoperative surgical care to include services performed by certified surgical assistant or physician assistant
§ 304.17A-148 Coverage for diabetes — Cap on cost-sharing requirements for insulin
§ 304.17A-149 Coverage for anesthesia and services in connection with dental procedures for certain patients
§ 304.17A-150 Unfair trade practices — Penalties
§ 304.17A-155 Prohibition against denial of coverage to victims of domestic violence
§ 304.17A-161 Definitions for KRS 304.17A-161, 304.17A-162, 304.17A-163, and 304.17A-165
§ 304.17A-162 Identification of sources used to calculate drug product reimbursement — Process to appeal disputes over maximum allowable cost pricing — Adjustment of maximum allowable cost and drug product reimbursement — Duties of pharmacy benefit manager
§ 304.17A-163 Definitions for KRS 304.174-163 and 304.17A-1631 — Establishment of clinical review criteria — Override of restrictions on medication sequence in step therapy or fail-first protocol
§ 304.17A-1631 Administrative regulations — Requirement of annual report to commissioner
§ 304.17A-164 Limitations on insurers and pharmacy benefit managers regarding cost-sharing for prescription drugs — Exceptions
§ 304.17A-165 Prescription drug coverage to include exceptions or override policy for refills of covered drugs — Limitations and exclusions — Program for synchronization of medications
§ 304.17A-166 Prescription eye drops coverage to include refills and additional bottle if conditions met
§ 304.17A-167 Processes and standards for electronic prior authorizations — Prior authorization of drugs for ongoing medication therapy — Requirements — Time span of authorization — Exemptions
§ 304.17A-168 Coverage for tobacco cessation medications and services
§ 304.17A-170 Definitions for KRS 304.17A-170 and 304.17A-171
§ 304.17A-171 Requirements for health benefit plans that include chiropractic benefits
§ 304.17A-172 Requirements for health benefit plans that include anticancer medications that are injected or intravenously administered by a health care provider and patient-administered anticancer medications
§ 304.17A-173 Reimbursement for services within scope of practice of optometrists — Terms and conditions
§ 304.17A-175 Limitation on amount of copayment or coinsurance charged for services rendered by chiropractor or optometrist
§ 304.17A-177 Limitation on amount of copayment or coinsurance charged for services rendered by occupational or physical therapist — Insurer to clearly state coverage
§ 304.17A-200 Prohibition against establishing certain rules of eligibility in small group, large group, or association markets — Limitation on premium — Participation rules — Effect of denial of coverage — Disclosure
§ 304.17A-220 Pre-existing condition exclusion in group coverage — Definitions for section
§ 304.17A-230 Pre-existing condition exclusion in individual market — Prohibition against use of genetic information — Administrative regulations
§ 304.17A-235 Notice of proposed material change in health benefit plan’s agreement with participating provider
§ 304.17A-240 Renewal or continuation — Ground for nonrenewal, cancellation, or discontinuance
§ 304.17A-243 Grace period for unpaid premiums
§ 304.17A-245 Required notice of cancellation — Procedure — Refund of unearned premium
§ 304.17A-250 Standard health benefit plan — Individual or small group markets — Writing requirement for provider participation — Time limit for rate quote — Notice of denial of coverage
§ 304.17A-252 Health benefit plan not required to include state-mandated benefits enacted after issuance
§ 304.17A-254 Duties of insurer offering health benefit plan
§ 304.17A-255 Definition of “cost sharing” and “plan year” — Payments from specified federal programs on behalf of an insured count toward insured’s premium and cost-sharing requirement — Payments made by any person on behalf of insured permissible — Exception
§ 304.17A-256 Options for dependent coverage under group health benefit plans — Disclaimer
§ 304.17A-257 Coverage under health benefit plan for colorectal cancer examinations and laboratory tests
§ 304.17A-258 Coverage under health benefit plan for therapeutic food, formulas, supplements, low-protein modified food products, and amino acid-based elemental formula
§ 304.17A-259 Coverage under health benefit plan for genetic test for cancer risk
§ 304.17A-261 Coverage under health benefit plan for oocyte and sperm preservation services. (Effective January 1, 2025)
§ 304.17A-262 Coverage for orchiectomy or orchidectomy as treatment for urological cancers. (Effective January 1, 2025)
§ 304.17A-263 Coverage under health benefit plan for biomarker testing
§ 304.17A-265 Insurer may not restrict assignment of benefits to substance abuse or mental health facility — Exceptions — Requirements for assignment — Construction
§ 304.17A-270 Nondiscrimination against provider in geographic coverage area
§ 304.17A-275 Health benefit plan not to discriminate against physician on basis of degree in medicine or osteopathy
§ 304.17A-290 Prohibition against renewal of nonstate employees and small groups under KRS 18A.2251 or 18A.2281
§ 304.17A-300 Provider-sponsored integrated health delivery network — Qualifications — Fees — Network subject to provisions of other subtitles
§ 304.17A-310 Financial solvency requirements for network
§ 304.17A-320 Certificate of filing for employer-organized association — Effect — Revocation
§ 304.17A-330 Health insurance reporting requirements — Exemption
§ 304.17A-340 Restrictions on use of Kentucky Children’s Health Insurance Program allocated funds
§ 304.17A-410 Definitions for KRS 304.17A-400 to 304.17A-480
§ 304.17A-430 Criteria for program plan — Alternative underwriting
§ 304.17A-450 Cost-containment feature requirement for program plans
§ 304.17A-500 Definitions for KRS 304.17A-500 to 304.17A-590
§ 304.17A-505 Disclosure of terms and conditions of health benefit plan — Filing with department
§ 304.17A-510 Notification by insurer offering managed care plans of availability of printed document
§ 304.17A-515 Requirements for managed care plan
§ 304.17A-520 Enrollee choice of primary care providers
§ 304.17A-525 Standards for provider participation — Mechanisms for consideration of provider applications — Policy for removal or withdrawal
§ 304.17A-527 Filing of provider agreements, risk-sharing arrangements, and subcontract agreements with commissioner — Contents — Disclosure of financial information not required
§ 304.17A-530 Prohibition against contract limiting disclosure to patient of patient medical condition or treatment options
§ 304.17A-532 Prohibition against contract requiring mandatory use of hospitalist
§ 304.17A-535 Drug utilization waiver program — Limitations on generic substitution — Application to drug formulary
§ 304.17A-540 Disclosure of limitations on coverage — Denial letter
§ 304.17A-545 Medical director for managed care plan — Duties — Quality assurance or improvement standards — Process to select health care providers — Uniform application form and guidelines for health care provider evaluations
§ 304.17A-550 Out-of-network benefits
§ 304.17A-555 Patient’s right of privacy regarding mental health or chemical dependency — Authorized disclosure
§ 304.17A-560 Most-favored-nation provision
§ 304.17A-565 Commissioner to enforce KRS 304.17A-500 to 304.17A-570 — Administrative regulations
§ 304.17A-570 Applicability of KRS 304.17A-500 to 304.17A-570 for health insurance contracts or certificates
§ 304.17A-575 Definitions for KRS 304.17A-575 to 304.17A-577
§ 304.17A-576 Notice by managed care plan insurer of health care provider’s application for credentialing — Payments to applicant
§ 304.17A-577 Disclosure of payment or fee schedule to managed care plan health care provider — Disclosure of schedule change — Confidentiality of payment information
§ 304.17A-580 Education of insured about appropriate use of emergency and medical services — Coverage of emergency medical conditions and emergency department services — Emergency personnel to contact primary care provider or insurer — Exclusion of limited-ben
§ 304.17A-590 Participating provider directories
§ 304.17A-600 Definitions for KRS 304.17A-600 to 304.17A-633
§ 304.17A-603 Application of KRS 304.17A-600 to 304.17A-633 — Written procedures for coverage and utilization review determinations to be accessible on insurers’ Web sites — Preauthorization review requirements for insurers
§ 304.17A-605 Requirements and procedures for utilization review — Exception for private review agent operating under contract with the federal government
§ 304.17A-607 Duties of insurer or private review agent performing utilization reviews — Requirement for registration — Consequences of insurer’s failure to make timely utilization review determination — Requirement that insurer or private review agent submit
§ 304.17A-609 Emergency administrative regulations governing utilization review and internal appeal to be promulgated by the department
§ 304.17A-611 Prohibition against retrospective denial of coverage for health care services under certain circumstances — Prohibition against prospective or concurrent review of prescription drug for alcohol or opioid use disorder
§ 304.17A-613 Emergency administrative regulations governing registration of insurers and private review agents seeking to conduct utilization reviews — Procedure for handling complaints
§ 304.17A-615 Prohibition against denying or reducing payments under certain circumstances
§ 304.17A-617 Internal appeals process — Procedures — Review of coverage denials
§ 304.17A-619 Duty of covered person, authorized person, or provider to provide insurer with new information regarding internal appeal — Time frame for insurer to render a decision based on new information — Insurer’s failure to make timely determination or pro
§ 304.17A-621 Independent External Review Program established
§ 304.17A-623 External review of adverse determination — Who may request — Criteria for review — Fee — Conditions under which covered person not entitled to review — Resolution of disputes — Confidentiality — Expedited external review
§ 304.17A-625 Factors to be considered by independent review entity conducting external review — Basis for decision — Insurer’s responsibilities — Contents, admissibility, and effect of decision — Consequence of insurer’s failure to provide coverage — Liabil
§ 304.17A-627 Certification as independent review entity — Requirements and restrictions
§ 304.17A-629 Administrative regulations to implement provisions of KRS 304.17A-621, 304.17A-623, 304.17A-625, 304.17A-627, 304.17A-629, and 304.17A-631
§ 304.17A-631 Time for insurers to comply with administrative regulations
§ 304.17A-633 Commissioner to report to Interim Joint Committee on Banking and Insurance and to Governor — Contents of report
§ 304.17A-640 Definitions for KRS 304.17A-640 et seq
§ 304.17A-641 Treatment of a stabilized covered person with an emergency medical condition in a nonparticipating hospital’s emergency room
§ 304.17A-643 Treatment of covered person under special circumstances
§ 304.17A-645 Covered person’s access to participating nonprimary care physician specialist
§ 304.17A-647 Covered person’s access to participating obstetrician or gynecologist — Authorization for annual pap smear without referral
§ 304.17A-649 Administrative regulations for the implementation of KRS 304.17A-640 et seq
§ 304.17A-660 Definitions for KRS 304.17A-660 to 304.17A-669
§ 304.17A-661 Treatment of mental health conditions to be covered under terms or conditions that are no more restrictive than terms or conditions for treatment of physical health conditions — Parity coverage for nonquantitative treatment limitations and medical
§ 304.17A-665 Commissioner to report to Legislative Research Commission on impact of health insurance costs under KRS 304.17A-660 to 304.17A-669
§ 304.17A-669 KRS 304.17A-660 to 304.17A-669 not to be construed as mandating coverage for mental health conditions — Exemption from KRS 304.17A-660 to 304.17A-669
§ 304.17A-700 Definitions for KRS 304.17A-700 to 304.17A-730 and KRS 205.593, 304.14-135, and 304.99-123
§ 304.17A-702 Claims payment time frames — Duties of insurer
§ 304.17A-704 Insurer’s acknowledgment of receipt of claim — Inaccurate or insufficient claim information — Claim status information
§ 304.17A-705 Electronic claims submission
§ 304.17A-706 Contested claims — Delay of payment — Conditions — Procedure
§ 304.17A-708 Resolution of payment errors — Retroactive denial of claims — Conditions
§ 304.17A-710 Disclosure of claims payment information to provider
§ 304.17A-712 Claim refunds and overpayments
§ 304.17A-714 Collection of claim overpayments — Dispute resolution
§ 304.17A-716 Prohibition against denial or reduction of payment for covered health benefit — Conditions
§ 304.17A-718 Disclosure of claims payment information to covered person
§ 304.17A-720 Administrative regulations for standardized health claim attachments — Conformity with federal standards
§ 304.17A-722 Administrative regulations on claims payment practices
§ 304.17A-724 Applicability of KRS 304.17A-700 to 304.17A-730 and KRS 205.593, 304.14-135, and 304.99-123
§ 304.17A-726 Exclusive application of KRS 304.17A-700 to 304.17A-730 and KRS 205.593, 304.14-135, and 304.99-123 to claims incurred and contracts made after July 14, 2000
§ 304.17A-728 Contract disclosures of discounted fees — Violation is unfair claims settlement practice
§ 304.17A-730 Payment of interest for failing to pay, denying, or settling a clean claim as required
§ 304.17A-732 Annual reports on providers prescribing medication for addiction treatment
§ 304.17A-740 Definitions for KRS 304.17A-740 to 304.17A-743
§ 304.17A-741 Audit of pharmacy records — Conditions
§ 304.17A-743 Pharmacy audit appeals process
§ 304.17A-745 KRS 304.17A-740 to 304.17A-743 not applicable to audits conducted by state agency pursuant to KRS Chapter 205
§ 304.17A-747 KRS 304.17A-740 to 304.17A-743 not applicable when fraud, willful misrepresentation, or abuse alleged
§ 304.17A-750 Definitions for KRS 304.17A-750 to 304.17A-770 and 304.47-020
§ 304.17A-752 Registration of insurance purchasing outlets — Licensed agents — Administrative regulations
§ 304.17A-754 Application — Approval and issuance of certificate — Information to be filed — Administrative regulations
§ 304.17A-756 Denial, suspension, and revocation of application or license — Civil penalty
§ 304.17A-758 Activities allowed under administrator license — Financial statements — Books and records — Renewal of certificate — Nontransferability — Fees
§ 304.17A-760 Duties and powers of insurance purchasing outlet
§ 304.17A-762 Outlet to act as policyholder for member — Certificate of coverage for each member — Disclosure to members
§ 304.17A-764 Determination of premiums — Restrictions in calculation
§ 304.17A-766 Coverage deemed group health insurance — Requirements for health benefit plans — Member who no longer meets participation requirements
§ 304.17A-768 Voucher — Redemption — Payment of premium amount — Fee to process voucher — Administrative regulations
§ 304.17A-770 Provisions applicable to insurance purchasing outlets
§ 304.17A-800 Purpose of KRS 304.17A-800 to 304.17A-844
§ 304.17A-802 Definitions for KRS 304.17A-800 to 304.17A-844
§ 304.17A-804 Applicability of KRS 304.17A-800 to 304.17A-844 — Self-insured employer-organized association groups
§ 304.17A-806 Certificate of filing required
§ 304.17A-808 Application for certificate of filing — Fee
§ 304.17A-810 Conditions for issuance of certificate of filing
§ 304.17A-812 Initial and continuing financial solvency requirements
§ 304.17A-814 Notification of change in information
§ 304.17A-816 Investment of funds
§ 304.17A-818 Agent of self-insured employer-organized association group — Licensing — Continuing education
§ 304.17A-820 Examination of financial condition, affairs, and management by commissioner
§ 304.17A-822 Appointment of Secretary of State as attorney to receive legal process
§ 304.17A-824 Continuing effectiveness of certificate — Termination of certificate at request of group — Merger with another group
§ 304.17A-826 Operation of group by board of trustees — Powers and duties — Prohibited acts
§ 304.17A-828 Membership — Liability on termination of membership, insolvency, or bankruptcy
§ 304.17A-830 Trustees, officers, directors, or employees not to have interest in administrator or group
§ 304.17A-832 Statement of financial condition — Authority for administrative regulations
§ 304.17A-834 Filing of rates, underwriting guidelines, evidence of coverage, and changes — Filing fee
§ 304.17A-836 Contribution plans to be established
§ 304.17A-838 Members to receive evidences of coverage — Contents
§ 304.17A-840 Suspension or revocation of certificate of filing
§ 304.17A-842 Authority for administrative regulations
§ 304.17A-844 Prohibited activities — Penalties
§ 304.17A-846 Providing of requested information on insureds by group health benefit plan insurers — Confidentiality — Additional information to be provided to large groups
lawyer at desk

Ask an insurance law question, get an answer ASAP!
Click here to chat with a lawyer about your rights.

Terms Used In Kentucky Statutes > Chapter 304 > Subtitle 17A - Health Benefit Plans

  • Action: includes all proceedings in any court of this state. See Kentucky Statutes 446.010
  • Administrator: means the adjutant general of the Commonwealth. See Kentucky Statutes 40.010
  • Affidavit: A written statement of facts confirmed by the oath of the party making it, before a notary or officer having authority to administer oaths.
  • Agency: means any state administrative body, program cabinet, office, department, or division. See Kentucky Statutes 41.010
  • agent: includes managing general agent unless the context requires otherwise. See Kentucky Statutes 304.9-085
  • Allegation: something that someone says happened.
  • Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
  • Amortization: Paying off a loan by regular installments.
  • Answer: The formal written statement by a defendant responding to a civil complaint and setting forth the grounds for defense.
  • any other state: includes any state, territory, outlying possession, the District of Columbia, and any foreign government or country. See Kentucky Statutes 446.010
  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Appropriation: The provision of funds, through an annual appropriations act or a permanent law, for federal agencies to make payments out of the Treasury for specified purposes. The formal federal spending process consists of two sequential steps: authorization
  • Appropriation: means an authorization by the General Assembly to expend, from public funds, a sum of money not in excess of the sum specified, for the purposes specified in the authorization and under the procedure prescribed in KRS Chapter 48. See Kentucky Statutes 446.010
  • Armed Forces: means the United States Army, Navy, Marine Corps, Air Force, and Coast Guard, including the reserve components thereof on active duty. See Kentucky Statutes 40.010
  • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
  • Assistant: means assistant treasurer. See Kentucky Statutes 41.010
  • Association: means an entity, other than an employer-organized association, that has been organized and is maintained in good faith for purposes other than that of obtaining insurance for its members and that has a constitution and bylaws. See Kentucky Statutes 304.17A-005
  • At the time of enrollment: means :
    (a) At the time of application for an individual, an association that actively markets to individual members, and an employer-organized association that actively markets to individual members. See Kentucky Statutes 304.17A-005
  • Attachment: A procedure by which a person's property is seized to pay judgments levied by the court.
  • Attorney: means attorney-at-law. See Kentucky Statutes 446.010
  • Auditor: means the Auditor of Public Accounts. See Kentucky Statutes 43.010
  • Bail: Security given for the release of a criminal defendant or witness from legal custody (usually in the form of money) to secure his/her appearance on the day and time appointed.
  • Bank: includes any bank or savings and loan association chartered by the State of Kentucky or the United States government designated to take custody of state funds on deposit, for periods greater than overnight, with the intent to honor presentments against those deposits. See Kentucky Statutes 41.010
  • Bankruptcy: Refers to statutes and judicial proceedings involving persons or businesses that cannot pay their debts and seek the assistance of the court in getting a fresh start. Under the protection of the bankruptcy court, debtors may discharge their debts, perhaps by paying a portion of each debt. Bankruptcy judges preside over these proceedings.
  • Base premium rate: means , for each class of business as to a rating period, the lowest premium rate charged or that could have been charged under the rating system for that class of business by the insurer to the individual or small group, or employer as defined in KRS §. See Kentucky Statutes 304.17A-005
  • Baseline: Projection of the receipts, outlays, and other budget amounts that would ensue in the future without any change in existing policy. Baseline projections are used to gauge the extent to which proposed legislation, if enacted into law, would alter current spending and revenue levels.
  • Basic health benefit plan: means any plan offered to an individual, a small group, or employer-organized association that limits coverage to physician, pharmacy, home health, preventive, emergency, and inpatient and outpatient hospital services in accordance with the requirements of this subtitle. See Kentucky Statutes 304.17A-005
  • Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
  • Beneficiary: means , in this order, widow, child or children (sharing equally), mother, father, and no other. See Kentucky Statutes 40.010
  • Bequest: Property gifted by will.
  • Biennium: means the two (2) year period commencing on July 1 in each even- numbered year and ending on June 30 in the ensuing even-numbered year. See Kentucky Statutes 446.010
  • Bonus claim: means a claim or potential claim for a veterans' bonus. See Kentucky Statutes 40.010
  • branch budget: means an enactment by the General Assembly which provides appropriations and establishes fiscal policies and conditions for the biennial financial plan for the judicial branch, the legislative branch, and the executive branch, which shall include a separate budget bill for the Transportation Cabinet. See Kentucky Statutes 446.010
  • Certified mail: means any method of governmental, commercial, or electronic delivery that allows a document or package to have proof of:
    (a) Sending the document or package. See Kentucky Statutes 446.010
  • Child: means a person:
    (a) Who is under the age of eighteen (18). See Kentucky Statutes 40.010
  • Church plan: means a church plan as defined in 29 U. See Kentucky Statutes 304.17A-005
  • City: includes town. See Kentucky Statutes 446.010
  • Claimant: means one who seeks to obtain payment of a bonus claim. See Kentucky Statutes 40.010
  • COBRA: means any of the following:
    (a) 26 U. See Kentucky Statutes 304.17A-005
  • Committee substitute: Short for committee amendment in the nature of a substitute.
  • Company: may extend and be applied to any corporation, company, person, partnership, joint stock company, or association. See Kentucky Statutes 446.010
  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Contract: A legal written agreement that becomes binding when signed.
  • Conviction: A judgement of guilt against a criminal defendant.
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Corporation: may extend and be applied to any corporation, company, partnership, joint stock company, or association. See Kentucky Statutes 446.010
  • Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
  • Dependent: A person dependent for support upon another.
  • Dependent: means any individual who is or may become eligible for coverage under the terms of an individual or group health benefit plan because of a relationship to a participant. See Kentucky Statutes 304.17A-005
  • Deposition: An oral statement made before an officer authorized by law to administer oaths. Such statements are often taken to examine potential witnesses, to obtain discovery, or to be used later in trial.
  • Directors: when applied to corporations, includes managers or trustees. See Kentucky Statutes 446.010
  • Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
  • Domestic: when applied to a corporation, partnership, business trust, or limited liability company, means all those incorporated or formed by authority of this state. See Kentucky Statutes 446.010
  • Donor: The person who makes a gift.
  • Electronic funds transfer: The transfer of money between accounts by consumer electronic systems-such as automated teller machines (ATMs) and electronic payment of bills-rather than by check or cash. (Wire transfers, checks, drafts, and paper instruments do not fall into this category.) Source: OCC
  • Eligible individual: means an individual:
    (a) For whom, as of the date on which the individual seeks coverage, the aggregate of the periods of creditable coverage is eighteen (18) or more months and whose most recent prior creditable coverage was under a group health plan, governmental plan, or church plan. See Kentucky Statutes 304.17A-005
  • Employee benefit plan: means an employee welfare benefit plan or an employee pension benefit plan or a plan which is both an employee welfare benefit plan and an employee pension benefit plan as defined by ERISA. See Kentucky Statutes 304.17A-005
  • Employer-organized association: means any of the following:
    (a) Any entity that was qualified by the commissioner as an eligible association prior to April 10, 1998, and that has actively marketed a health insurance program to its members since September 8, 1996, and which is not insurer- controlled. See Kentucky Statutes 304.17A-005
  • Entitlement: A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs.
  • Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. Source: U.S. Courts
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Ex officio: Literally, by virtue of one's office.
  • Excepted benefits: means benefits under one (1) or more, or any combination of the following:
    (a) Coverage only for accident, including accidental death and dismemberment, or disability income insurance, or any combination thereof. See Kentucky Statutes 304.17A-005
  • Fair market value: The price at which an asset would change hands in a transaction between a willing, informed buyer and a willing, informed seller.
  • Father: means a father, a father through adoption, or a man who for a period of not less than one (1) year stood in the relationship of a father to a qualified veteran before his or her entry into active service in the Armed Forces, or if two (2) persons stood in such relationship for one (1) year or more, the person who last stood in such relationship before the veteran's last entry into active service in the Armed Forces. See Kentucky Statutes 40.010
  • Federal: refers to the United States. See Kentucky Statutes 446.010
  • Federal Deposit Insurance Corporation: A government corporation that insures the deposits of all national and state banks that are members of the Federal Reserve System. Source: OCC
  • Fiduciary: A trustee, executor, or administrator.
  • Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
  • Foreign: when applied to a corporation, partnership, limited partnership, business trust, statutory trust, or limited liability company, includes all those incorporated or formed by authority of any other state. See Kentucky Statutes 446.010
  • Fraud: Intentional deception resulting in injury to another.
  • Garnishment: Generally, garnishment is a court proceeding in which a creditor asks a court to order a third party who owes money to the debtor or otherwise holds assets belonging to the debtor to turn over to the creditor any of the debtor
  • Germane: On the subject of the pending bill or other business; a strict standard of relevance.
  • Gift: A voluntary transfer or conveyance of property without consideration, or for less than full and adequate consideration based on fair market value.
  • Governmental plan: means a governmental plan as defined in 29 U. See Kentucky Statutes 304.17A-005
  • Grace period: The number of days you'll have to pay your bill for purchases in full without triggering a finance charge. Source: Federal Reserve
  • Group health plan: means a plan, including a self-insured plan, of or contributed to by an employer, including a self-employed person, or employee organization, to provide health care directly or otherwise to the employees, former employees, the employer, or others associated or formerly associated with the employer in a business relationship, or their families. See Kentucky Statutes 304.17A-005
  • Guaranteed acceptance plan supporting insurer: means either an insurer, on or before December 31, 2000, that is not a guaranteed acceptance plan participating insurer or is a stop loss carrier, on or before December 31, 2000, provided that a guaranteed acceptance plan supporting insurer shall not include an employer- sponsored self-insured health benefit plan exempted by ERISA. See Kentucky Statutes 304.17A-005
  • Guaranteed acceptance program plan: means a health benefit plan in the individual market issued by an insurer that provides health benefits to a guaranteed acceptance program qualified individual and is eligible for assessment and refunds under the guaranteed acceptance program under KRS §. See Kentucky Statutes 304.17A-005
  • Guaranteed acceptance program qualified individual: means an individual who, on or before December 31, 2000:
    (a) Is not an eligible individual. See Kentucky Statutes 304.17A-005
  • Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
  • Health care service: means health care procedures, treatments, or services
    rendered by a provider within the scope of practice for which the provider is licensed. See Kentucky Statutes 304.17A-005
  • Indemnification: In general, a collateral contract or assurance under which one person agrees to secure another person against either anticipated financial losses or potential adverse legal consequences. Source: FDIC
  • Index rate: means , for each class of business as to a rating period, the arithmetic average of the applicable base premium rate and the corresponding highest premium rate. See Kentucky Statutes 304.17A-005
  • Indictment: The formal charge issued by a grand jury stating that there is enough evidence that the defendant committed the crime to justify having a trial; it is used primarily for felonies.
  • Individual market: means the market for the health insurance coverage offered to individuals other than in connection with a group health plan. See Kentucky Statutes 304.17A-005
  • Insurer: means any insurance company. See Kentucky Statutes 304.17A-005
  • Insurer-controlled: means that the commissioner has found, in an administrative hearing called specifically for that purpose, that an insurer has or had a substantial involvement in the organization or day-to-day operation of the entity for the principal purpose of creating a device, arrangement, or scheme by which the insurer segments employer groups according to their actual or anticipated health status or actual or projected health insurance premiums. See Kentucky Statutes 304.17A-005
  • Interest rate: The amount paid by a borrower to a lender in exchange for the use of the lender's money for a certain period of time. Interest is paid on loans or on debt instruments, such as notes or bonds, either at regular intervals or as part of a lump sum payment when the issue matures. Source: OCC
  • Joint committee: Committees including membership from both houses of teh legislature. Joint committees are usually established with narrow jurisdictions and normally lack authority to report legislation.
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • Large group: means :
    (a) An employer with fifty-one (51) or more employees. See Kentucky Statutes 304.17A-005
  • Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). Source: OCC
  • Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
  • Lien: A claim against real or personal property in satisfaction of a debt.
  • Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
  • 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
  • Month: means calendar month. See Kentucky Statutes 446.010
  • Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
  • Mortgagee: The person to whom property is mortgaged and who has loaned the money.
  • Mother: means a mother, a mother through adoption, or a woman who for a period of not less than one (1) year stood in the relationship of a mother to a qualified veteran before his or her entry into active service in the Armed Forces, or if two (2) persons stood in such relationship for one (1) year or more, the person who last stood in such relationship before the veteran's last entry into active service in the Armed Forces. See Kentucky Statutes 40.010
  • Oath: A promise to tell the truth.
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
  • Oversight: Committee review of the activities of a Federal agency or program.
  • Owner: when applied to any animal, means any person having a property interest in such animal. See Kentucky Statutes 446.010
  • Participant: means any employee or former employee of an employer, or any member or former member of an employee organization, who is or may become eligible to receive a benefit of any type from an employee benefit plan which covers employees of the employer or members of the organization, or whose beneficiaries may be eligible to receive any benefit as established in Section 3(7) of ERISA. See Kentucky Statutes 304.17A-005
  • Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
  • Partnership: includes both general and limited partnerships. See Kentucky Statutes 446.010
  • Personal property: All property that is not real property.
  • Precedent: A court decision in an earlier case with facts and law similar to a dispute currently before a court. Precedent will ordinarily govern the decision of a later similar case, unless a party can show that it was wrongly decided or that it differed in some significant way.
  • Preventive services: means medical services for the early detection of disease that are associated with substantial reduction in morbidity and mortality. 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
  • Provider network: means an affiliated group of varied health care providers that is established to provide a continuum of health care services to individuals. See Kentucky Statutes 304.17A-005
  • Provider-sponsored integrated health delivery network: means any provider- sponsored integrated health delivery network created and qualified under KRS
    304. See Kentucky Statutes 304.17A-005
  • public funds: means sums actually received in cash or negotiable instruments from all sources unless otherwise described by any state agency, state- owned corporation, university, department, cabinet, fiduciary for the benefit of any form of state organization, authority, board, bureau, interstate compact, commission, committee, conference, council, office, or any other form of organization whether or not the money has ever been paid into the Treasury and whether or not the money is still in the Treasury if the money is controlled by any form of state organization, except for those funds the management of which is to be reported to the Legislative Research Commission pursuant to KRS §. See Kentucky Statutes 446.010
  • Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide.
  • Purchaser: means an individual, organization, employer, association, or the Commonwealth that makes health benefit purchasing decisions on behalf of a group of individuals. See Kentucky Statutes 304.17A-005
  • Qualified veteran: means a person answering to the specifications set forth in subsections (2) and (3), and who
    (a) Was a resident of the Commonwealth at the time of entry into active service in the Armed Forces and for at least six (6) months prior thereto. See Kentucky Statutes 40.010
  • Quorum: The number of legislators that must be present to do business.
  • Rating period: means the calendar period for which premium rates are in effect. See Kentucky Statutes 304.17A-005
  • real estate: includes lands, tenements, and hereditaments and all rights thereto and interest therein, other than a chattel interest. See Kentucky Statutes 446.010
  • Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
  • Recourse: An arrangement in which a bank retains, in form or in substance, any credit risk directly or indirectly associated with an asset it has sold (in accordance with generally accepted accounting principles) that exceeds a pro rata share of the bank's claim on the asset. If a bank has no claim on an asset it has sold, then the retention of any credit risk is recourse. Source: FDIC
  • Registered mail: means any governmental, commercial, or electronic method of delivery that allows a document or package to have:
    (a) Its chain of custody recorded in a register to enable its location to be tracked. See Kentucky Statutes 446.010
  • Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
  • report: means any written method of transporting data. See Kentucky Statutes 41.010
  • Restitution: The court-ordered payment of money by the defendant to the victim for damages caused by the criminal action.
  • Secretary: means the secretary of the Finance and Administration Cabinet. See Kentucky Statutes 41.010
  • Self-insured plan: means a group health insurance plan in which the sponsoring organization assumes the financial risk of paying for covered services provided to its enrollees. See Kentucky Statutes 304.17A-005
  • Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
  • Small employer: means , in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least two (2) but not more than fifty (50) employees on business days during the preceding calendar year and who employs at least two (2) employees on the first day of the plan year. See Kentucky Statutes 304.17A-005
  • Small group: means :
    (a) A small employer with two (2) to fifty (50) employees. See Kentucky Statutes 304.17A-005
  • State: when applied to a part of the United States, includes territories, outlying possessions, and the District of Columbia. See Kentucky Statutes 446.010
  • State agency: means any state officer, department, board, commission, institution, division, or other person or functional group that is authorized to exercise or does exercise any executive or administrative jurisdiction, powers, duties, rights or obligations of the state government conferred or imposed by law or exercised, performed, or discharged by legal authority in compliance with law. See Kentucky Statutes 43.010
  • State depository: means any bank designated to take custody of state funds on deposit pursuant to KRS §. See Kentucky Statutes 41.010
  • Statute: A law passed by a legislature.
  • Subpoena: A command to a witness to appear and give testimony.
  • Subpoena duces tecum: A command to a witness to produce documents.
  • Sworn: includes "affirmed" in all cases in which an affirmation may be substituted for an oath. See Kentucky Statutes 446.010
  • Testimony: Evidence presented orally by witnesses during trials or before grand juries.
  • Tort: A civil wrong or breach of a duty to another person, as outlined by law. A very common tort is negligent operation of a motor vehicle that results in property damage and personal injury in an automobile accident.
  • Treatment: when used in a criminal justice context, means targeted interventions
    that focus on criminal risk factors in order to reduce the likelihood of criminal behavior. See Kentucky Statutes 446.010
  • Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
  • Trustee: A person or institution holding and administering property in trust.
  • uniformed services: means the Armed Forces and the Commissioned Corps of the National Oceanic and Atmospheric Administration and of the Public Health Service. See Kentucky Statutes 304.17A-005
  • Veteran: means a person who served in the active Armed Forces of the United States, during the Spanish American War, World War I, World War II, or the Korean conflict, for a period of ninety (90) days or more (exclusive of time spent AWOL. See Kentucky Statutes 40.010
  • Violate: includes failure to comply with. See Kentucky Statutes 446.010
  • Warrant: means a printed or electronic authorization from the Finance and
    Administration Cabinet for the Treasurer to issue a check. See Kentucky Statutes 41.010
  • Widow: means a woman who was the wife of a veteran at the time of his death, and who had not deserted him (except where there was a separation which was due to the misconduct of, or procured by, the veteran without the fault of the wife), and who had not remarried, (unless the purported remarriage was void or had been annulled). See Kentucky Statutes 40.010
  • written: means letters, words, or numbers, or their equivalent, set down by handwriting, typewriting, printing, photostating, photographing, magnetic impulse, mechanical or electronic recording, or other form of data compilation. See Kentucky Statutes 41.010
  • written: means letters, words, or numbers, or their equivalent, set down by handwriting, typewriting, printing, photostating, photographing, magnetic impulse, mechanical or electronic recording, or other form of data compilation. See Kentucky Statutes 42.001
  • Year: means calendar year. See Kentucky Statutes 446.010