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304.17A-550 Out-of-network benefits.
(1) An insurer that offers a managed care plan shall offer a health benefit plan with out-
of-network benefits to every contract holder. The plan with out-of-network benefits <br>shall allow a covered person to receive covered services from out-of-network health <br>care providers without having to obtain a referral. The plan with out-of-network <br>benefits may require that an enrollee pre-certify selected services and pay a higher <br>deductible, copayment, coinsurance, excess charges and higher premium for the <br>out-of-network benefit plan pursuant to limits established by administrative <br>regulations promulgated by the department.
(2) If the contract holder elects the out-of-network offering required under subsection
(1) of this section, the insurer shall provide each enrollee with the opportunity at the <br>time of enrollment and during the annual open enrollment period, to enroll in the <br>out-of-network option. If the contract holder elects the out-of-network offering <br>required under subsection (1) of this section, the insurer and the contract holder <br>shall provide written notice of the benefit plan with out-of-network benefits to each <br>enrollee in a plan and shall include in that notice a detailed explanation of the <br>financial costs to be incurred by an enrollee who selects the plan.
(3) The requirement of this section shall not apply to an insurer contract which offers a
managed care plan that provides health care services solely to Medicaid or Medicare <br>recipients.
(4) Managed care plans currently licensed and doing business in Kentucky that do not
yet offer benefit plans with out-of-network benefits must develop and offer those <br>plans within three hundred sixty-five (365) days of April 10, 1998.
Effective: July 15, 2010 <br>History: Amended 2010 Ky. Acts ch. 24, sec. 1232, effective July 15, 2010. --
Amended 2004 Ky. Acts ch. 59, sec. 10, effective July 13, 2004. -- Created 1998 Ky. <br>Acts ch. 496, sec. 35, effective April 10, 1998.
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