304.17A-096 Basic health benefit plans permitted for individual,
small group, andassociation markets -- Required coverage --
Exclusions from coverage. (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, 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 12, 2006 History: Amended 2006 Ky.
Acts ch. 253, sec. 4, effective July 12, 2006. -- Created 2005 Ky.
Acts ch. 144, sec. 2, effective June 20, 2005. Page 1 of 1
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