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304.17A-410 Definitions for KRS 304.17A-400 to 304.17A-480.
As used in KRS 304.17A-400 to 304.17A-480, unless the context requires otherwise: <br>(1) "Actual guaranteed acceptance program plan losses" means a dollar amount
calculated by subtracting an insurer's guaranteed acceptance program plan claims <br>from that insurer's guaranteed acceptance program plan premiums;
(2) "Benefits" means amounts paid by an insurer to covered lives or to third parties for
the benefit of covered lives. "Benefits" do not include an insurer's administrative <br>costs, any assessments under the plan, allocated loss adjustment expenses, reserves, <br>or other overhead costs;
(3) "Guaranteed acceptance program plan claims" or "alternative underwriting
mechanism losses" means the dollar amount of benefits actually paid by an insurer <br>on behalf of a guaranteed acceptance plan enrollee for claims that were incurred <br>while the individual was a guaranteed acceptance program plan enrollee or another <br>claim measurement formula as the department may establish by administrative <br>regulation to measure an insurer's costs, other than administrative costs, allocated <br>loss adjustment expenses, reserves, or other overhead costs, with respect to a <br>program plan;
(4) "Guaranteed acceptance program plan premiums" means the dollar amount of
premiums received by an insurer with respect to program plans;
(5) "Guaranteed acceptance risk adjustment process" means the process of allocating
guaranteed acceptance program plan losses provided for in KRS 304.17A-460;
(6) "Group market" means the health insurance market under which individuals obtain
health insurance coverage, directly or through any arrangement, on behalf of <br>themselves and their dependents through a group health plan or through any <br>arrangement other than through the individual market, or through a federal health <br>benefit plan or program;
(7) "Health insurance stop-loss policy" means any policy of insurance that directly or
indirectly protects, in whole or in part, an employer who self-insures health benefits <br>covering any residents in Kentucky from the risk of paying benefits in excess of any <br>specified amount;
(8) "Market share" means a percentage calculated by dividing an insurer's health
insurance coverage premiums in both the individual and group markets by the total <br>amount of the health insurance coverage premiums in both the individual and group <br>markets for all insurers;
(9) "Other coverage" means coverage under any of the following:
(a) A group plan; <br>(b) Part A or Part B of Title XVIII of the Social Security Act, 42 U.S.C. secs.
1995c et seq.;
(c) A state plan under Title XIX of the Social Security Act, or any successor
program;
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(d) Continuation coverage under any COBRA continuation provisions as defined
in 42 U.S.C. sec. 300gg-91(d)(4) or under a similar program under any state <br>law; or
(e) Any other health insurance coverage which is not individual health insurance
coverage;
(10) "Premiums" means amounts paid to insurers to purchase health insurance coverage
and includes all amounts paid however denominated, including, but not limited to, <br>amounts indicated as being charged for administrative costs, allocated loss <br>adjustment expenses, reserve or other overhead costs;
(11) "Program" means the Kentucky Guaranteed Acceptance Program; <br>(12) "Refund" means an amount to be paid to an insurer by the program; <br>(13) "Stop-loss carrier" means any person providing health insurance stop-loss coverage; <br>(14) "Stop-loss premiums" means amounts paid to purchase health insurance stop-loss
coverage; and
(15) "Total actual guaranteed acceptance program plan losses" means a dollar amount
equal to the sum of the actual program plan losses of all insurers participating in the <br>program.
Effective: July 15, 2010 <br>History: Amended 2010 Ky. Acts ch. 24, sec. 1227, effective July 15, 2010. --
Amended 2002 Ky. Acts ch. 128, sec. 1, effective July 15, 2002. -- Created 1998 Ky. <br>Acts ch. 496, sec. 16, effective April 10, 1998.
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