§ 304.38-010 Title
§ 304.38-020 Purpose
§ 304.38-030 Definitions for subtitle
§ 304.38-035 Certificate required for health maintenance organization
§ 304.38-040 Establishment of health maintenance organizations
§ 304.38-042 Requirements for provider-sponsored integrated health networks to convert to health maintenance organization
§ 304.38-050 Evidence of coverages and charges for health care service — Exception
§ 304.38-060 Issuance of certificate of authority
§ 304.38-070 Requirements for protection against insolvency — Risk-based capital requirements — Requirements for health maintenance organizations
§ 304.38-073 Deposit of cash or securities for performance of obligations to enrollees
§ 304.38-075 Requirements for transfer of risk to provider — Additional reserves may be required
§ 304.38-080 Information to enrollees
§ 304.38-090 Annual report
§ 304.38-095 Application of KRS 304.2-205
§ 304.38-098 Compliance with KRS 304.18-124 to 304.18-127
§ 304.38-100 Investments
§ 304.38-110 Agent of health maintenance organization — Licensing — Continuing education — Appointment
§ 304.38-120 Financial condition, market conduct, and business practices subject to examination
§ 304.38-130 Revocation or suspension of certificate of authority
§ 304.38-140 Rehabilitation, liquidation, or conservation of health maintenance organization
§ 304.38-150 Rules and regulations
§ 304.38-170 Public documents — Statutory construction
§ 304.38-180 Prohibited practices
§ 304.38-185 Coordination of benefits
§ 304.38-190 Powers of insurers
§ 304.38-191 Conversion and continuation rights upon termination of group coverage
§ 304.38-193 Coverage for treatment for mental illness
§ 304.38-1933 Coverage for services of licensed psychologist or licensed clinical social worker
§ 304.38-1934 Coverage for medical and surgical benefits with respect to mastectomy, diagnosis and treatment of endometrioses and endometritis, and bone density testing — Duties of health maintenance organization
§ 304.38-1935 Coverage for mammograms
§ 304.38-1936 Coverage for treatment of breast cancer
§ 304.38-1937 Coverage for treatment of temporomandibular joint disorders and craniomandibular jaw disorders
§ 304.38-194 Pooling of claims experience required
§ 304.38-195 Policy covering services performed by dentist deemed to cover such services performed by physician
§ 304.38-1955 Construction of provisions for services by licensed optometrist or licensed ophthalmic dispenser to include same services from licensed physician
§ 304.38-196 Indemnity payable for services performed by chiropractors, physicians, osteopaths, or podiatrists
§ 304.38-197 Coverage for treatment of alcoholism
§ 304.38-198 Optional nursery care coverage for a well newly born child
§ 304.38-199 Coverage for newly-born child
§ 304.38-200 Application of other subtitles
§ 304.38-205 Medicare supplement coverage for persons not eligible for Medicare by reason of age
§ 304.38-210 Health maintenance organizations as insurers to offer home health care coverage — Conditions
§ 304.38-220 Long-term health care benefits
§ 304.38-225 Requirements for health maintenance organization that provides hospital benefits coverage and requires utilization review of benefits
§ 304.38-230 Funding of benefits by employer or group contract holder
§ 304.38-240 Solicitation of proposals designating medical necessity criteria for Medicaid managed care organizations — Administrative regulation
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Terms Used In Kentucky Statutes > Chapter 304 > Subtitle 38 - Health Maintenance Organizations

  • Action: includes all proceedings in any court of this state. See Kentucky Statutes 446.010
  • agent: includes managing general agent unless the context requires otherwise. See Kentucky Statutes 304.9-085
  • 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.
  • 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.
  • Appraisal: A determination of property value.
  • 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
  • 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
  • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
  • Attorney: means attorney-at-law. See Kentucky Statutes 446.010
  • 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.
  • 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
  • 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
  • Building: includes any structure or improvement upon real estate of a permanent nature and additionally includes any sites, structures, equipment, machinery, or devices for the purpose of establishing, developing, or furthering television or related services in aid of education or in aid of any other proper public functions, whether or not the same would otherwise be legally defined as buildings. See Kentucky Statutes 56.440
  • Business trust: includes , except when utilized in KRS Chapter 386, a "statutory trust" as organized under KRS Chapter 386A. See Kentucky Statutes 446.010
  • Cabinet: means the Finance and Administration Cabinet. See Kentucky Statutes 56.440
  • Commission: means the State Property and Buildings Commission. See Kentucky Statutes 56.440
  • Commissioner: means the commissioner of the Department of Insurance. See Kentucky Statutes 304.38-030
  • Company: may extend and be applied to any corporation, company, person, partnership, joint stock company, or association. See Kentucky Statutes 446.010
  • Contract: A legal written agreement that becomes binding when signed.
  • Corporation: may extend and be applied to any corporation, company, partnership, joint stock company, or association. See Kentucky Statutes 446.010
  • 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.
  • Deed: The legal instrument used to transfer title in real property from one person to another.
  • Dependent: A person dependent for support upon another.
  • Directors: when applied to corporations, includes managers or trustees. See Kentucky Statutes 446.010
  • 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
  • Enrollee: means a person who has been enrolled in a health maintenance organization. See Kentucky Statutes 304.38-030
  • 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.
  • 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.
  • Federal: refers to the United States. See Kentucky Statutes 446.010
  • Fee simple: Absolute title to property with no limitations or restrictions regarding the person who may inherit it.
  • 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.
  • Fixed Rate: Having a "fixed" rate means that the APR doesn't change based on fluctuations of some external rate (such as the "Prime Rate"). In other words, a fixed rate is a rate that is not a variable rate. A fixed APR can change over time, in several circumstances:
    • You are late making a payment or commit some other default, triggering an increase to a penalty rate
    • The bank changes the terms of your account and you do not reject the change.
    • The rate expires (if the rate was fixed for only a certain period of time).
  • 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.
  • Health maintenance organization: means any person who undertakes to provide, directly or through arrangements with others, health care services to individuals enrolled with such an organization on a per capita or a predetermined, fixed prepayment basis. See Kentucky Statutes 304.38-030
  • 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
  • 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.
  • 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.
  • Meeting: means all gatherings of every kind, including video teleconferences. See Kentucky Statutes 56.440
  • Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
  • 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
  • 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
  • Person: includes but is not limited to any individual, partnership, association, trust, or corporation. See Kentucky Statutes 304.38-030
  • Provider: means a person or group of persons licensed to practice medicine, osteopathy, dentistry, podiatry, optometry, or another health profession in a state or licensed to act as a hospital or another health care facility. See Kentucky Statutes 304.38-030
  • Quorum: The number of legislators that must be present to do business.
  • Real estate: includes lands together with improvements thereon and appurtenances thereto. See Kentucky Statutes 56.440
  • Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
  • 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.
  • 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.
  • 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 administrative body, agency, department, or division as defined in KRS §. See Kentucky Statutes 56.440
  • Statute: A law passed by a legislature.
  • 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
  • Variable Rate: Having a "variable" rate means that the APR changes from time to time based on fluctuations in an external rate, normally the Prime Rate. This external rate is known as the "index." If the index changes, the variable rate normally changes. Also see Fixed Rate.
  • written: shall mean 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 56.440
  • Year: means calendar year. See Kentucky Statutes 446.010