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304.17A-410 Definitions for KRS 304.17A-400 to 304.17A-480.
As used in KRS 304.17A-400 to 304.17A-480, unless the context requires otherwise:
(1) "Actual guaranteed acceptance program plan losses" means a dollar amount
calculated by subtracting an insurer's guaranteed acceptance program plan
claims from that insurer's guaranteed acceptance program plan premiums;
(2) "Benefits" means amounts paid by an insurer to covered lives or to third parties
for the benefit of covered lives. "Benefits" do not include an insurer's
administrative costs, any assessments under the plan, allocated loss
adjustment expenses, reserves, or other overhead costs;
(3) "Guaranteed acceptance program plan claims" or "alternative underwriting
mechanism losses" means the dollar amount of benefits actually paid by an
insurer on behalf of a guaranteed acceptance plan enrollee for claims that were
incurred while the individual was a guaranteed acceptance program plan
enrollee or another claim measurement formula as the department may
establish by administrative regulation to measure an insurer's costs, other than
administrative costs, allocated loss adjustment expenses, reserves, or other
overhead costs, with respect to a program plan;
(4) "Guaranteed acceptance program plan premiums" means the dollar amount of
premiums received by an insurer with respect to program plans;
(5) "Guaranteed acceptance risk adjustment process" means the process of
allocating guaranteed acceptance program plan losses provided for in KRS
304.17A-460;
(6) "Group market" means the health insurance market under which individuals
obtain health insurance coverage, directly or through any arrangement, on
behalf of themselves and their dependents through a group health plan or
through any arrangement other than through the individual market, or through a
federal health benefit plan or program;
(7) "Health insurance stop-loss policy" means any policy of insurance that directly
or indirectly protects, in whole or in part, an employer who self-insures health
benefits covering any residents in Kentucky from the risk of paying benefits in
excess of any specified amount;
(8) "Market share" means a percentage calculated by dividing an insurer's health
insurance coverage premiums in both the individual and group markets by the
total amount of the health insurance coverage premiums in both the individual
and group markets for all insurers;
(9) "Other coverage" means coverage under any of the following:
(a) A group plan;
(b) Part A or Part B of Title XVIII of the Social Security Act, 42 U.S.C. secs.
1995c et seq.;
(c) A state plan under Title XIX of the Social Security Act, or any successor
program;
(d) Continuation coverage under any COBRA continuation provisions as
defined in 42 U.S.C. sec. 300gg-91(d)(4) or under a similar program
under any state law; or
(e) Any other health insurance coverage which is not individual health
(10)
(11)
(12)
(13)
(14)
(15)
insurance coverage;
"Premiums" means amounts paid to insurers to purchase health insurance
coverage and includes all amounts paid however denominated, including, but
not limited to, amounts indicated as being charged for administrative costs,
allocated loss adjustment expenses, reserve or other overhead costs;
"Program" means the Kentucky Guaranteed Acceptance Program;
"Refund" means an amount to be paid to an insurer by the program;
"Stop-loss carrier" means any person providing health insurance stop-loss
coverage;
"Stop-loss premiums" means amounts paid to purchase health insurance
stop-loss coverage; and
"Total actual guaranteed acceptance program plan losses" means a dollar
amount equal to the sum of the actual program plan losses of all insurers
participating in the program.
Effective:July 15, 2010
History: Amended 2010 Ky. Acts ch. 24, sec. 1227, effective July 15, 2010. -Amended 2002 Ky. Acts ch. 128, sec. 1, effective July 15, 2002. -- Created 1998
Ky. Acts ch. 496, sec. 16, effective April 10, 1998.
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