Kentucky Statutes 304.17A-096 – Basic health benefit plans permitted for individual, small group, and association markets — Required coverage — Exclusions from coverage
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(1) An insurer authorized to engage in the business of insurance in the Commonwealth of Kentucky may offer one (1) or more basic health benefit plans in the individual, small group, and employer-organized association markets. A basic health benefit plan shall cover physician, pharmacy, home health, preventive, emergency, and inpatient and outpatient hospital services in accordance with the requirements of this subtitle. If vision or eye services are offered, these services may be provided by an ophthalmologist or optometrist.
(2) An insurer that offers a basic health benefit plan shall be required to offer health benefit plans as defined in KRS § 304.17A-005(22).
(3) An insurer in the individual, small group, or employer-organized association markets that offers a basic health benefit plan may offer a basic health benefit plan that excludes from coverage any state-mandated health insurance benefit, except that the basic health benefit plan shall include coverage for diabetes as provided in KRS § 304.17A-148, hospice as provided in KRS § 304.17A-250(6), chiropractic benefits as provided in KRS § 304.17A-171, mammograms as provided in KRS
304.17A-133, and those mandated benefits specified under federal law.
(4) Notwithstanding any other provisions of this section, mandated benefits excluded from coverage shall not be deemed to include the payment, indemnity, or reimbursement of specified health care providers for specific health care services.
Effective: July 15, 2008
History: Amended 2008 Ky. Acts ch. 147, sec. 1, effective July 15, 2008. — Amended
2006 Ky. Acts ch. 253, sec. 4, effective July 12, 2006. — Created 2005 Ky. Acts ch.
144, sec. 2, effective June 20, 2005.
(2) An insurer that offers a basic health benefit plan shall be required to offer health benefit plans as defined in KRS § 304.17A-005(22).
Terms Used In Kentucky Statutes 304.17A-096
- 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
- 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
- Federal: refers to the United States. See Kentucky Statutes 446.010
- Insurer: means any insurance company. 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
(3) An insurer in the individual, small group, or employer-organized association markets that offers a basic health benefit plan may offer a basic health benefit plan that excludes from coverage any state-mandated health insurance benefit, except that the basic health benefit plan shall include coverage for diabetes as provided in KRS § 304.17A-148, hospice as provided in KRS § 304.17A-250(6), chiropractic benefits as provided in KRS § 304.17A-171, mammograms as provided in KRS
304.17A-133, and those mandated benefits specified under federal law.
(4) Notwithstanding any other provisions of this section, mandated benefits excluded from coverage shall not be deemed to include the payment, indemnity, or reimbursement of specified health care providers for specific health care services.
Effective: July 15, 2008
History: Amended 2008 Ky. Acts ch. 147, sec. 1, effective July 15, 2008. — Amended
2006 Ky. Acts ch. 253, sec. 4, effective July 12, 2006. — Created 2005 Ky. Acts ch.
144, sec. 2, effective June 20, 2005.