Kentucky Statutes 304.17B-019 – Types of health benefit plans to be issued under Kentucky Access
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(1) Kentucky Access shall offer at least three (3) health benefit plans to enrollees, which shall be similar to the health benefit plans currently being marketed to individuals in the individual market.
(2) At least one (1) plan shall be offered in a traditional fee-for-service form. At least one (1) plan may be offered in a managed-care form at such time as the Office of Health Data and Analytics can establish an appropriate provider network in available service areas.
(3) The office shall provide for utilization review and case management for all health benefit plans issued under Kentucky Access.
(4) The office shall review and compare health benefit plans provided under Kentucky Access to health benefit plans provided in the individual market. Based on the review, the office may amend or replace the health benefit plans issued under Kentucky Access.
(5) Individuals who apply and are determined eligible for health benefit plans issued under Kentucky Access shall have coverage effective the first day of the month after the application month.
(6) For eligible individuals, health benefit plans issued under Kentucky Access shall not impose any pre-existing condition exclusions. In all other cases, a pre-existing condition exclusion may be imposed in accordance with KRS § 304.17A-230.
(7) Health benefit plans issued under Kentucky Access shall be guaranteed renewable except as otherwise specified in KRS § 304.17B-015 and KRS § 304.17A-240.
(8) All health benefit plans issued under Kentucky Access shall provide that, upon the death or divorce of the individual in whose name the contract was issued, every other person covered in the contract may elect within sixty-three (63) days to continue under the same or a different contract.
(9) Health benefit plans issued under Kentucky Access shall coordinate benefits with other health benefit plans and be the payor of last resort.
(10) Health benefit plans issued under Kentucky Access shall pay covered benefits up to a lifetime limit of two million dollars ($2,000,000) per covered individual. The maximum limit under this subsection may be increased by the office.
Effective: June 27, 2019
History: Amended 2019 Ky. Acts ch. 90, sec. 20, effective June 27, 2019. — Amended
2010 Ky. Acts ch. 24, sec. 1282, effective July 15, 2010; and ch. 126, sec. 2, effective July 15, 2010. — Created 2000 Ky. Acts ch. 476, sec. 10, effective July 14,
2000.
(2) At least one (1) plan shall be offered in a traditional fee-for-service form. At least one (1) plan may be offered in a managed-care form at such time as the Office of Health Data and Analytics can establish an appropriate provider network in available service areas.
Terms Used In Kentucky Statutes 304.17B-019
- 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. See Kentucky Statutes 304.17B-001
- Contract: A legal written agreement that becomes binding when signed.
- Month: means calendar month. See Kentucky Statutes 446.010
- Office: means the Office of Health Data and Analytics in the Cabinet for Health and Family Services. See Kentucky Statutes 304.17B-001
(3) The office shall provide for utilization review and case management for all health benefit plans issued under Kentucky Access.
(4) The office shall review and compare health benefit plans provided under Kentucky Access to health benefit plans provided in the individual market. Based on the review, the office may amend or replace the health benefit plans issued under Kentucky Access.
(5) Individuals who apply and are determined eligible for health benefit plans issued under Kentucky Access shall have coverage effective the first day of the month after the application month.
(6) For eligible individuals, health benefit plans issued under Kentucky Access shall not impose any pre-existing condition exclusions. In all other cases, a pre-existing condition exclusion may be imposed in accordance with KRS § 304.17A-230.
(7) Health benefit plans issued under Kentucky Access shall be guaranteed renewable except as otherwise specified in KRS § 304.17B-015 and KRS § 304.17A-240.
(8) All health benefit plans issued under Kentucky Access shall provide that, upon the death or divorce of the individual in whose name the contract was issued, every other person covered in the contract may elect within sixty-three (63) days to continue under the same or a different contract.
(9) Health benefit plans issued under Kentucky Access shall coordinate benefits with other health benefit plans and be the payor of last resort.
(10) Health benefit plans issued under Kentucky Access shall pay covered benefits up to a lifetime limit of two million dollars ($2,000,000) per covered individual. The maximum limit under this subsection may be increased by the office.
Effective: June 27, 2019
History: Amended 2019 Ky. Acts ch. 90, sec. 20, effective June 27, 2019. — Amended
2010 Ky. Acts ch. 24, sec. 1282, effective July 15, 2010; and ch. 126, sec. 2, effective July 15, 2010. — Created 2000 Ky. Acts ch. 476, sec. 10, effective July 14,
2000.