2014 Kentucky Revised Statutes CHAPTER 304 - INSURANCE CODE Subtitle 17A - Health Benefit Plans 17A.17A-172 Requirements for health benefit plans that include anticancer medications that are injected or intravenously administered by a health care provider and patient-administered anticancer medications.
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304.17A-172 Requirements for health benefit plans that include anticancer
medications that are injected or intravenously administered by a health
care provider and patient-administered anticancer medications.
(1)
(2)
(3)
(4)
(5)
For purposes of this section:
(a) "Anticancer medications" means drugs and biologics that are used to kill,
slow, or prevent the growth of cancerous cells; and
(b) "Cost sharing" means the cost to an individual insured under an individual
or group health benefit plan according to any coverage limit, copayment,
coinsurance, deductible, or other out-of-pocket expense requirements
imposed by the plan.
A health benefit plan that covers anticancer medications that are injected or
intravenously administered by a health care provider and patient-administered
anticancer medications, including but not limited to those orally administered or
self-injected, shall not require a higher copayment, deductible, or coinsurance
amount for patient-administered anticancer medications than it requires for
injected or intravenously administered anticancer medications, regardless of
the formulation or benefit category determination by the health benefit plan.
A health benefit plan shall not comply with subsection (2) of this section by:
(a) Increasing the copayment, deductible, or coinsurance amount required
for injected or intravenously administered anticancer medications that are
covered under the health benefit plan; or
(b) Reclassifying benefits with respect to anticancer medications.
Notwithstanding any provision of this section to the contrary, an individual or
group health benefit plan shall be deemed to be in compliance with this section
if the cost sharing imposed under such a policy does not exceed one hundred
dollars ($100) per prescription fill for a thirty (30) day period.
For a health benefit plan that meets the definition of a high deductible health
plan as defined by 26 U.S.C. sec. 223(c)(2), to be used in conjunction with a
health savings account as defined by 26 U.S.C. sec. 223(d)(1), the provisions
of subsection (4) of this section shall only apply after an insured's deductible
has been satisfied for the year.
Effective:January 1, 2015
History: Created 2014 Ky. Acts ch. 119, sec. 11, effective January 1, 2015.
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