2013 Kentucky Revised Statutes CHAPTER 304 - INSURANCE CODE Subtitle 18 - Group and Blanket Health Insurance 18.18-127 Transfer of liability when policy replaced by that of succeeding insurer.
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304.18-127 Transfer of liability when policy replaced by that of succeeding
insurer.
(1)
(2)
(3)
This section shall indicate the insurer responsible for liability in those instances
in which one (1) insurer's group policy replaces the group policy of another
insurer.
The prior insurer shall remain liable only to the extent of its accrued liabilities,
extension of benefits, and for persons who are under continued group health
insurance coverage pursuant to KRS 304.18-110 at the time the group policy
terminates. The position of the prior insurer shall be the same whether the
group policyholder secures replacement coverage from a new insurer, self
insures, or forgoes the provision of a group policy, except that termination of
continued group health insurance coverage shall occur in accordance with
KRS 304.18-110 and 304.18-114.
The liability of a succeeding insurer shall be as follows:
(a) Each person who is eligible for coverage shall be covered by that
insurer's plan on the effective date of coverage and in accordance with
KRS 304.17A-200.
(b) If a person, who is eligible for coverage, is confined as of the effective
date of coverage under the succeeding insurer's plan and the succeeding
insurer has a nonconfinement rule, the succeeding insurer is not
responsible for the cost of the person's confinement to the extent that the
confinement is covered by a prior insurer's extension of benefits
provision, in accordance with KRS 304.18-126.
(c) The succeeding insurer, in applying any deductibles or waiting periods in
its plan, shall give credit for the satisfaction or partial satisfaction of the
same or similar provisions under a prior group policy. In the case of
deductible provisions, the credit shall apply for the same or overlapping
benefit periods and shall be given for expenses actually incurred and
applied against the deductible provisions of the prior insurer's group
policy during the ninety (90) days preceding the effective date of the
succeeding insurer's group policy, but only to the extent these expenses
are recognized under the terms of the succeeding insurer's group policy
and are subject to similar deductible provisions.
(d) If a determination of the prior insurer's benefit is required by the
succeeding insurer, at the succeeding insurer's request the prior insurer
shall furnish a statement of the benefits available or pertinent information
sufficient to permit verification of the benefit determination or the
determination itself by the succeeding insurer. For purposes of this
section, benefits of the prior insurer's group policy shall be determined in
accordance with all of the definitions, conditions, and covered expense
provisions of the prior insurer's group policy rather than those of the
succeeding insurer's group policy. The benefit determination shall be
made as if coverage had not been replaced by the succeeding insurer.
Effective:July 15, 2002
History: Amended 2002 Ky. Acts ch. 351, sec. 12, effective July 15, 2002. -Amended 1998 Ky. Acts ch. 483, sec. 22, effective July 15, 1998. -- Created
1990 Ky. Acts ch. 119, sec. 4, effective July 13, 1990.
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