2014 Kentucky Revised Statutes CHAPTER 304 - INSURANCE CODE Subtitle 17A - Health Benefit Plans 17A.17A-846 Providing of requested information on insureds by group health benefit plan insurers -- Confidentiality -- Additional information to be provided to large groups.
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304.17A-846 Providing of requested information on insureds by group health
benefit plan insurers -- Confidentiality -- Additional information to be
provided to large groups.
(1)
(2)
(3)
Any insurer issuing or delivering group health benefit plans in the
Commonwealth shall provide to an employer-organized association health
benefit plan, within thirty (30) calendar days after a written request, the
information relating to its health benefit plan that has been requested, including
but not limited to the following information for the previous three (3) years or for
the entire period of coverage, whichever is shorter:
(a) Aggregate claims experience by month, including claims experience for
pharmacy benefits;
(b) Total premiums paid by month;
(c) Total number of insureds on a monthly basis by coverage tier; and
(d) Sufficient detailed claims information to permit the employer-organized
association to verify eligibility and participation of the groups and
individuals participating in the employer-organized association program.
The department shall, by July 15, 2005, promulgate administrative regulations
to implement the provisions of this section and define the extent that individual
information shall be provided.
This section shall not require the insurer to disclose any nonpublic personal
health information without the written consent of the individual who is the
subject of the information, as required by administrative regulations
promulgated by the commissioner. However, nonpublic personal health
information may be provided to the employer-organized association health
benefit plan and large group health benefit plan with fifty-one (51) or more
enrolled employees as a covered entity to cover entity transfer under the
Federal Health Insurance Portability and Accountability Act of 1996 (HIPAA),
42 U.S.C. sec. 300gg et seq., provided that the health benefit plan certifies to
the insurer that it has adopted HIPAA-required safeguards and will treat the
nonpublic personal health information in accordance with HIPAA standards.
Any insurer issuing or delivering group health benefit plans in the
Commonwealth shall provide to a large group health benefit plan with fifty-one
(51) or more enrolled employees, within thirty (30) calendar days after receipt
of a written request, the following information relating to its health benefit plan:
(a) Total premiums paid by month;
(b) Total number of insureds on a monthly basis by coverage tier; and
(c) Additional utilization data to help the employer measure costs in the
following areas:
1.
Detailed prescription drug utilization information, including generic
versus brand utilization;
2.
Number of office visits to primary care providers and specialists;
3.
Number of emergency room visits;
4.
Number of inpatient and outpatient hospitalizations;
5.
Number of members utilizing deductible and out-of-pocket expenses
by cost level; and
(4)
6.
A list of the most prevalent disease categories.
Insurers shall not be required to produce reports requested pursuant to
subsection (3) of this section more than twice annually.
Effective:July 15, 2010
History: Amended 2010 Ky. Acts ch. 24, sec. 1272, effective July 15, 2010. -Amended 2007 Ky. Acts ch. 87, sec. 1, effective June 26, 2007. -- Created 2005
Ky. Acts ch. 144, sec. 1, effective June 20, 2005.
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