2013 Kentucky Revised Statutes CHAPTER 304 - INSURANCE CODE Subtitle 18 - Group and Blanket Health Insurance 18.18-110 Continuation of group coverage after termination of membership in group -- Notice of eligibility.
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304.18-110 Continuation of group coverage after termination of membership
in group -- Notice of eligibility.
(1)
(2)
(3)
(4)
(5)
As used in this section:
(a) "Group policy" means group health insurance policies as defined in KRS
304.18-020 and blanket health insurance policies which the
commissioner, in his or her discretion, designates as subject to this
section, which:
1.
Affect the rights of a Kentucky insured and bear a reasonable
relation to Kentucky, regardless of whether delivered or issued for
delivery in Kentucky;
2.
Provide hospital or surgical expenses benefits, other than for a
specific disease or accidental injury only; and
3.
Are delivered, issued for delivery, or renewed after July 15, 2002;
(b) "Medicare" means Title XVIII of the United States Social Security Act as
amended or superseded.
Persons insured under group policies have the right upon termination of group
membership to continue coverage for themselves and their dependents upon
meeting the following conditions:
(a) The group member has been covered by the group policy or any group
policy it replaced for at least three (3) months; and
(b) Notice is given to the insurer and payment of the group rate is made to
the insurer, by the group member, within thirty-one (31) days after notice
pursuant to subsection (7) of this section.
Continued group health insurance coverage shall terminate on the earlier of:
(a) The date eighteen (18) months after the date on which the group
coverage would otherwise have terminated because of termination of
group membership;
(b) If the group member fails to make timely payment of premium to the
insurance company, the end of the period for which premium payment
was made; or
(c) The date the group policy is terminated and is not replaced by another
group policy within thirty-one (31) days.
If a group policy is replaced, by a succeeding insurer, persons under the
continued group health insurance shall remain covered under the prior insurer's
policy until it terminates in accordance with subsection (3) of this section.
The right to continue group health insurance coverage shall also be available:
(a) To the surviving spouse, at the death of the group member, with respect
to the spouse and such children whose coverage under the group policy
would terminate or terminates by reason of the death of the group
member;
(b) To a child solely with respect to himself or herself upon termination of
membership in the group or his or her coverage by reason of operation of
the limiting age of coverage under the group policy while covered as a
dependent thereunder; or
(c)
(6)
(7)
To a former spouse for himself or herself and such children of whom he
or she is awarded custody when coverage under the group policy would
terminate or terminates by reason of termination of dependency as
defined in the group policy and resulting from an order dissolving the
marriage entered by a court of competent jurisdiction.
Continuation of group health insurance coverage need not be granted in the
following situations:
(a) On the effective date of coverage, the applicant is or could be covered by
Medicare;
(b) On the effective date of coverage, the applicant is or could be covered by
another group coverage (insured or uninsured).
Notice of the right to continue group health insurance coverage shall be given
as follows:
(a) For group policies delivered, issued for delivery, or renewed after July 15,
2002, the insurer shall give written notice of the right to continue group
health insurance coverage to any group member entitled to continue
coverage under this section upon notice from the group policyholder that
the group member has terminated membership in the group. The
thirty-one (31) day period of subsection (2)(b) of this section shall not
begin to run until the notice required by this paragraph is mailed or
delivered to the last known address of the group member;
(b) If a group member becomes entitled to obtain continued health insurance
coverage, pursuant to this section, and the insurer fails to give the group
member written notice of the right, pursuant to this subsection, the insurer
shall give written notice to the former group member as soon as
practicable after being notified of the insurer's failure to give written notice
of continuation rights to the group member and such group member shall
have an additional period within which to exercise continuation or
conversion rights. The additional period shall expire sixty (60) days after
written notice is received from the insurer. Written notice delivered or
mailed to the last known address of the group member shall constitute the
giving of notice for the purpose of this paragraph. If a group member
makes application and pays the premium for continued health insurance
coverage within the additional period allowed by this paragraph, the
effective date of continued health insurance coverage shall be the date of
termination from the group. However, nothing in this subsection shall
require an insurer to give notice or provide continuation coverage to a
former group member ninety (90) days after termination of the former
group member's group coverage.
Effective:July 15, 2010
History: Amended 2010 Ky. Acts ch. 24, sec. 1296, effective July 15, 2010. -Amended 2002 Ky. Acts ch. 351, sec. 10, effective July 15, 2002. -- Amended
2001 Ky. Acts ch. 120, sec. 1, effective June 21, 2001. -- Amended 2000 Ky.
Acts ch. 521, sec. 7, effective July 14, 2000. -- Amended 1996 Ky. Acts ch. 371,
sec. 20, effective July 15, 1996. -- Amended 1986 Ky. Acts ch. 153, sec. 1,
effective July 15, 1986; and ch. 163, sec. 1, effective July 15, 1986. -- Amended
1984 Ky. Acts ch. 243, sec. 1, effective July 13, 1984. -- Amended 1982 Ky.
Acts ch. 406, sec. 11, effective July 15, 1982. -- Amended 1980 Ky. Acts
ch. 130, sec. 1, effective July 15, 1980; and ch. 258, sec. 1, effective July 15,
1980. -- Created 1974 Ky. Acts ch. 195, sec. 1, effective January 1, 1975.
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