2009 Kentucky Revised Statutes Subtitle 17A. Health Benefit Plans 304.17A.580 Education of insured about appropriate use of emergency and medical services -- Coverage of emergency medical conditions and emergency department services -- Emergency personnel to contact primary care provider or insurer -- Exclusion of limited-benefit health insurance policies.
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304.17A-580 Education of insured about appropriate use of emergency and
medical services -- Coverage of emergency medical conditions and emergency <br>department services -- Emergency personnel to contact primary care provider <br>or insurer -- Exclusion of limited-benefit health insurance policies.
(1) An insurer offering health benefit plans shall educate its insureds about the
availability, location, and appropriate use of emergency and other medical services, <br>cost-sharing provisions for emergency services, and the availability of care outside <br>an emergency department.
(2) An insurer offering health benefit plans shall cover emergency medical conditions
and shall pay for emergency department screening and stabilization services both in-<br>network and out-of-network without prior authorization for conditions that <br>reasonably appear to a prudent layperson to constitute an emergency medical <br>condition based on the patient's presenting symptoms and condition. An insurer <br>shall be prohibited from denying the emergency room services and altering the level <br>of coverage or cost-sharing requirements for any condition or conditions that <br>constitute an emergency medical condition as defined in KRS 304.17A-500.
(3) Emergency department personnel shall contact a patient's primary care provider or
insurer, as appropriate, as quickly as possible to discuss follow-up and <br>poststabilization care and promote continuity of care.
(4) Nothing in this section shall apply to accident-only, specified disease, hospital
indemnity, Medicare supplement, long-term care, disability income, or other <br>limited-benefit health insurance policies.
Effective: July 14, 2000 <br>History: Amended 2000 Ky. Acts ch. 343, sec. 16, effective July 14, 2000; and ch. 500,
sec. 7, effective July 14, 2000. -- Created 1998 Ky. Acts ch. 496, sec. 59, effective <br>April 10, 1998.
Legislative Research Commission Note (7/14
/2000
). This section was amended by
2000 Ky. Acts chs. 343 and sec. 500. Where these Acts are not in conflict, they have <br>been codified together. Where a conflict exists, Acts ch. 500, which was last enacted <br>by the General Assembly, prevails under KRS 446.250.
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