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304.17A-590 Participating provider directories.
(1) An insurer that offers a managed care plan or a risk-bearing managed care plan shall
notify an enrollee, in writing, of the availability, in a manner consistent with KRS <br>304.14-420 to 304.14-450, in writing, at the time of enrollment and thereafter upon <br>request, and as new providers are contracted with by the plans, or as the directory <br>may change, of a current participating provider directory providing information on a <br>covered person's access to primary care physicians and specialists, optometrists, <br>chiropractors, and hospitals, including available participating physicians, <br>optometrists, chiropractors, and hospitals, by provider category or specialty and by <br>county. The directory shall include the following: <br>(a) Professional office addresses and telephone numbers for all participating
providers;
(b) The benefits for each provider type; <br>(c) 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; and
(d) Grievance procedures available under the plans for complaint resolutions.
In addition to making the information available in a printed document, an insurer <br>may also make the information available in an accessible electronic format.
(2) The insurer shall promptly notify each covered person on the termination or
withdrawal from the insurer's provider network of the covered person's designated <br>primary care provider.
(3) The provisions of this section shall be implemented prior to any open enrollment
period for which the effective date of coverage will be January 1, 1999, or for which <br>the effective date shall commence after an open enrollment period, and shall <br>continue for each open enrollment period thereafter.
Effective: July 14, 2000 <br>History: Amended 2000 Ky. Acts ch. 293, sec. 2, effective July 14, 2000; and ch. 500,
sec. 8, effective July 14, 2000. -- Created 1998 Ky. Acts ch. 281, sec. 1, effective <br>July 15, 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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