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304.17A-510 Notification by insurer offering managed care plans of
availability of printed document.
(1)
(2)
(3)
In addition to the disclosure requirements provided in KRS 304.17A-505, an
insurer that offers a managed care plan shall notify an enrollee, in writing, of
the availability of a printed document, in a manner consistent with KRS
304.14-420 to 304.14-450, containing the following information at the time of
enrollment and upon request:
(a) A current participating provider directory providing information on a
covered person's access to primary care health care providers, including
available participating health care providers, by provider category or
specialty and by county. The directory shall include the professional office
address of each participating health care provider. The directory shall also
provide information about participating hospitals and other providers. The
insurer shall promptly notify each covered person on the termination or
withdrawal from the insurer's provider network of the covered person's
designated primary care provider;
(b) General information about the type of financial incentives between
participating providers under contract with the insurer and other
participating health care providers and facilities to which the participating
providers refer their managed care patients;
(c) The insurer's managed care plan's standard for customary waiting times
for appointments for urgent and routine care; and
(d) The existence of any hold harmless agreements it has with providers and
their effect on the enrollee.
The insurer shall provide a prospective enrollee with information about the
provider network, including hospital affiliations, and other information specified
in this subsection, upon request. In addition to making the information available
in a printed document, an insurer may also make the information available in
an accessible electronic format.
Upon request of a covered person, an insurer shall promptly inform the person:
(a) Whether a particular network provider is board certified; and
(b) Whether a particular network provider is currently accepting new patients.
Each insurer shall annually make available to its enrollees at its principal office
and place of business:
(a) Its most recent annual statement of financial condition including a
balance sheet and summary of receipts and disbursements; and
(b) A current description of its organizational structure and operation.
Effective:July 14, 2000
History: Amended 2000 Ky. Acts ch. 293, sec. 1, effective July 14, 2000; and
ch. 500, sec. 3, effective July 14, 2000. -- Created 1998 Ky. Acts ch. 496,
sec. 27, effective April 10, 1998.
Legislative Research Commission Note (7/14/2000). This section was amended
by 2000 Ky. Acts chs. 293 and 500, which do not appear to be in conflict and
have been codified together.
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