2009 Kentucky Revised Statutes Subtitle 17A. Health Benefit Plans 304.17A.510 Notification by insurer offering managed care plans of availability of printed document.
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304.17A-510 Notification by insurer offering managed care plans of availability of
printed document.
(1) In addition to the disclosure requirements provided in KRS 304.17A-505, an insurer
that offers a managed care plan shall notify an enrollee, in writing, of the <br>availability of a printed document, in a manner consistent with KRS 304.14-420 to <br>304.14-450, containing the following information at the time of enrollment and <br>upon request: <br>(a) A current participating provider directory providing information on a covered
person's access to primary care health care providers, including available <br>participating health care providers, by provider category or specialty and by <br>county. The directory shall include the professional office address of each <br>participating health care provider. The directory shall also provide information <br>about participating hospitals and other providers. The insurer shall promptly <br>notify each covered person on the termination or withdrawal from the insurer's <br>provider network of the covered person's designated primary care provider;
(b) General information about the type of financial incentives between
participating providers under contract with the insurer and other participating <br>health care providers and facilities to which the participating providers refer <br>their managed care patients;
(c) The insurer's managed care plan's standard for customary waiting times for
appointments for urgent and routine care; and
(d) The existence of any hold harmless agreements it has with providers and their
effect on the enrollee.
The insurer shall provide a prospective enrollee with information about the provider <br>network, including hospital affiliations, and other information specified in this <br>subsection, upon request. In addition to making the information available in a <br>printed document, an insurer may also make the information available in an <br>accessible electronic format.
(2) Upon request of a covered person, an insurer shall promptly inform the person:
(a) Whether a particular network provider is board certified; and <br>(b) Whether a particular network provider is currently accepting new patients.
(3) Each insurer shall annually make available to its enrollees at its principal office and
place of business: <br>(a) Its most recent annual statement of financial condition including a balance
sheet and summary of receipts and disbursements; and
(b) A current description of its organizational structure and operation.
Effective: July 14, 2000 <br>History: Amended 2000 Ky. Acts ch. 293, sec. 1, effective July 14, 2000; and ch. 500,
sec. 3, effective July 14, 2000. -- Created 1998 Ky. Acts ch. 496, sec. 27, effective <br>April 10, 1998.
Legislative Research Commission Note (7/14/2000). This section was amended by
2000 Ky. Acts chs. 293 and 500, which do not appear to be in conflict and have been <br>codified together.
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