Kentucky Statutes 304.32-330 – Requirements for self-insured employer that provides health coverage and requires utilization review of benefits
Current as of: 2024 | Check for updates
|
Other versions
(1) Every employer in this state which provides coverage of hospital benefits on a self- insured basis and requires the utilization review of such benefits by an insurer, its designee, or a private review agent shall:
(a) Be a registered private review agent in accordance with KRS § 304.17A-607 and administrative regulations promulgated under the authority of KRS
304.17A-613; or
(b) Contract with a private review agent that has been registered in accordance with KRS § 304.17A-607 and administrative regulations promulgated under the authority of KRS § 304.17A-613.
(2) Notwithstanding any other provision of KRS § 304.17A-603, 304.17A-605, 304.17A-
607, 304.17A-609, 304.17A-611, 304.17A-613, and 304.17A-615, a self-insured employer shall not deny or reduce payment of health benefits to any person, licensed practitioner, or health facility for covered services which have been rendered to an insured unless:
(a) Notice of denial has been issued; and
(b) The self-insured employer is in compliance with subsection (1) of this section.
Effective: July 14, 2000
History: Amended 2000 Ky. Acts ch. 262, sec. 30, effective July 14, 2000. — Created
1990 Ky. Acts ch. 451, sec. 10, effective July 13, 1990.
(a) Be a registered private review agent in accordance with KRS § 304.17A-607 and administrative regulations promulgated under the authority of KRS
Terms Used In Kentucky Statutes 304.32-330
- agent: includes managing general agent unless the context requires otherwise. See Kentucky Statutes 304.9-085
- Contract: A legal written agreement that becomes binding when signed.
- State: when applied to a part of the United States, includes territories, outlying possessions, and the District of Columbia. See Kentucky Statutes 446.010
304.17A-613; or
(b) Contract with a private review agent that has been registered in accordance with KRS § 304.17A-607 and administrative regulations promulgated under the authority of KRS § 304.17A-613.
(2) Notwithstanding any other provision of KRS § 304.17A-603, 304.17A-605, 304.17A-
607, 304.17A-609, 304.17A-611, 304.17A-613, and 304.17A-615, a self-insured employer shall not deny or reduce payment of health benefits to any person, licensed practitioner, or health facility for covered services which have been rendered to an insured unless:
(a) Notice of denial has been issued; and
(b) The self-insured employer is in compliance with subsection (1) of this section.
Effective: July 14, 2000
History: Amended 2000 Ky. Acts ch. 262, sec. 30, effective July 14, 2000. — Created
1990 Ky. Acts ch. 451, sec. 10, effective July 13, 1990.