2015 Kentucky Revised Statutes CHAPTER 304 - INSURANCE CODE Subtitle 38 - Health Maintenance Organizations 38.38-050 Evidence of coverages and charges for health care service -- Exception.
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304.38-050 Evidence of coverages and charges for health care service -- Exception.
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No health maintenance organization shall deliver or issue for delivery in this state
any contract describing health benefits available, or any endorsement, rider, or
application which becomes a part thereof, or any amendments thereto or
modifications thereof, or the schedule of fees or other periodic charges to be paid by
enrollees, until a copy of the form has been filed with and approved by the
commissioner. Each form shall contain a complete and clear statement of:
(a) The health care services to which the enrollee is entitled;
(b) Any limitations on the services, kind of services, or benefits to be provided,
including any deductible or copayment feature;
(c) Where and in what manner information is available as to how services may be
obtained; and
(d) Any other provisions pertaining to the delivery of health care services.
Any schedule of fees or other periodic charges to be paid by enrollees submitted to
and filed with the commissioner along with adequate supporting information to
show that the charges or fees are not excessive, inadequate, or unfairly
discriminatory.
At the expiration of sixty (60) days, the form so filed shall be deemed approved
unless prior thereto it has been affirmatively approved or disapproved by order of
the commissioner, or a hearing has been scheduled by order of the commissioner. In
the event that a hearing is held, the sixty (60) day waiting period shall begin anew
after the close of the hearing. Approval of the form by the commissioner shall
constitute a waiver of any unexpired portion of the waiting period. The
commissioner may extend by not more than an additional thirty (30) day period
within which he or she may affirmatively approve or disapprove the form by giving
notice to the insurer of the extension before expiration of the initial sixty (60) day
period. At the expiration of the period as so extended, and in the absence of the
prior affirmative approval or disapproval, the form shall be deemed approved. The
commissioner may at any time withdraw the approval.
This section shall not apply to rate filings made under Subtitle 17A of this chapter.
Effective: July 15, 2010
History: Amended 2010 Ky. Acts ch. 24, sec. 1501, effective July 15, 2010. -Amended 1998 Ky. Acts ch. 496, sec. 52, effective April 10, 1998. -- Amended 1994
Ky. Acts ch. 93, sec. 18, effective July 15, 1994. -- Amended 1982 Ky. Acts ch. 320,
sec. 39, effective July 15, 1982. -- Created 1974 Ky. Acts ch. 357, subtit. 38, sec. 5,
effective June 21, 1974.
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