2013 Kentucky Revised Statutes CHAPTER 304 - INSURANCE CODE Subtitle 18 - Group and Blanket Health Insurance 18.18-126 Policies to provide reasonable extension of benefits during disability -- Extensions to be described in group policies and certificates.
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304.18-126 Policies to provide reasonable extension of benefits during
disability -- Extensions to be described in group policies and certificates.
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As used in this section, "disability" means the state of being hospitalized on the
date of replacement coverage or coverage under an extension of benefits
provision.
An insurer offering group health insurance, as defined in KRS 304.18-020,
shall provide for an extension of benefits in the event of a member's total
disability at the date of discontinuance of the group policy or contract in
accordance with this section.
Benefits payable under an extension of benefits shall be limited to the
member's hospital confinement or period of total disability for a specific
condition, injury, or illness that resulted in the member's total disability.
In the case of hospital or medical expense coverages, a reasonable extension
of benefits or accrued liability shall be required. A provision shall be considered
reasonable if:
(a) Under major medical coverages for hospital confinement, it provides an
extension until the earlier of one (1) of the following:
1.
Discharge from the hospital confinement;
2.
Until maximum benefits under the policy are received; or
3.
At least twelve (12) months.
(b) Under major medical coverage for a period of total disability, it provides
an extension of benefits until the earlier of one (1) of the following:
1.
Until coverage for the total disability has been obtained under
another group policy;
2.
Until the total disability ceases;
3.
Until maximum benefits under the policy are received; or
4.
At least twelve (12) months.
(c) Under other types of hospital or medical expense coverages, it provides
an extension of at least ninety (90) days for expenses incurred during the
period of total disability or hospital confinement or incurred within a period
of at least ninety (90) days starting with a specific event which occurred
while coverage was in force, such as an accident.
Coverage for a total disability shall not be considered to have been obtained
under a succeeding plan, whether it be fully insured or self-insured, if the
succeeding plan excludes coverage for the total disability covered under the
prior plan's extension of benefits provision.
Any applicable extension of benefits or accrued liability shall be described in
the group policy as well as in group insurance certificates.
Effective:July 15, 2002
History: Amended 2002 Ky. Acts ch. 351, sec. 11, effective July 15, 2002. -Created 1990, Ky. Acts ch. 119, sec. 3, effective July 13, 1990.
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