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304.17B-001 Definitions for subtitle.
As used in this subtitle, unless the context requires otherwise:
(1) "Administrator" is defined in KRS 304.9-051(1);
(2) "Agent" is defined in KRS 304.9-020;
(3) "Assessment process" means the process of assessing and allocating
guaranteed acceptance program losses or Kentucky Access funding as
provided for in KRS 304.17B-021;
(4) "Authority" means the Kentucky Health Care Improvement Authority;
(5) "Case management" means a process for identifying an enrollee with specific
health care needs and interacting with the enrollee and their respective health
care providers in order to facilitate the development and implementation of a
plan that efficiently uses health care resources to achieve optimum health
outcome;
(6) "Commissioner" is defined in KRS 304.1-050(1);
(7) "Department" is defined in KRS 304.1-050(2);
(8) "Earned premium" means the portion of premium paid by an insured that has
been allocated to the insurers loss experience, expenses, and profit year to
date;
(9) "Enrollee" means a person who is enrolled in a health benefit plan offered
under Kentucky Access;
(10) "Eligible individual" is defined in KRS 304.17A-005(11);
(11) "Guaranteed acceptance program" or "GAP" means the Kentucky Guaranteed
Acceptance Program established and operated under KRS 304.17A-400 to
304.17A-480;
(12) "Guaranteed acceptance program participating insurer" means an insurer that
offered health benefit plans through December 31, 2000, in the individual
market to guaranteed acceptance program qualified individuals;
(13) "Health benefit plan" is defined in KRS 304.17A-005(22);
(14) "High-cost condition" means acquired immune deficiency syndrome (AIDS),
angina pectoris, ascites, chemical dependency, cirrhosis of the liver, coronary
insufficiency, coronary occlusion, cystic fibrosis, Friedreich's ataxia,
hemophilia, Hodgkin's disease, Huntington's chorea, juvenile diabetes,
leukemia, metastatic cancer, motor or sensory aphasia, multiple sclerosis,
muscular dystrophy, myasthenia gravis, myotonia, open-heart surgery,
Parkinson's disease, polycystic kidney, psychotic disorders, quadriplegia,
stroke, syringomyelia, Wilson's disease, chronic renal failure, malignant
neoplasm of the trachea, malignant neoplasm of the bronchus, malignant
neoplasm of the lung, malignant neoplasm of the colon, short gestation period
for a newborn child, and low birth weight of a newborn child;
(15) "Incurred losses" means for Kentucky Access the excess of claims paid over
premiums received;
(16) "Insurer" is defined in KRS 304.17A-005(27);
(17) "Kentucky Access" means the program established in accordance with KRS
304.17B-001 to 304.17B-031;
(18) "Kentucky Access Fund" means the fund established in KRS 304.17B-021;
(19) "Kentucky Health Care Improvement Authority" means the board established to
administer the program initiatives listed in KRS 304.17B-003(5);
(20) "Kentucky Health Care Improvement Fund" means the fund established for
receipt of the Kentucky tobacco master settlement moneys for program
initiatives listed in KRS 304.17B-003(5);
(21) "MARS" means the Management Administrative Reporting System
administered by the Commonwealth;
(22) "Medicaid" means coverage in accordance with Title XIX of the Social Security
Act, 42 U.S.C. secs. 1396 et seq., as amended;
(23) "Medicare" means coverage under both Parts A and B of Title XVIII of the
Social Security Act, 42 U.S.C. secs. 1395 et seq., as amended;
(24) "Pre-existing condition exclusion" is defined in KRS 304.17A-220(6);
(25) "Standard health benefit plan" means a health benefit plan that meets the
requirements of KRS 304.17A-250;
(26) "Stop-loss carrier" means any person providing stop-loss health insurance
coverage;
(27) "Supporting insurer" means all insurers, stop-loss carriers, and self-insured
employer-controlled or bona fide associations; and
(28) "Utilization management" is defined in KRS 304.17A-500(12).
Effective:July 15, 2010
History: Amended 2010 Ky. Acts ch. 24, sec. 1273, effective July 15, 2010. -Amended 2006 Ky. Acts ch. 253, sec. 6, effective July 12, 2006. -- Amended
2005 Ky. Acts ch. 144, sec. 10, effective June 20, 2005. -- Amended 2003 Ky.
Acts ch. 150, sec. 4, effective June 24, 2003. -- Created 2000 Ky. Acts ch. 476,
sec. 1, effective July 14, 2000.
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