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304.17B-019 Types of health benefit plans to be issued under Kentucky
Access.
(1)
Kentucky Access shall offer at least three (3) health benefit plans to enrollees,
which shall be similar to the health benefit plans currently being marketed to
individuals in the individual market.
(2) At least one (1) plan shall be offered in a traditional fee-for-service form. At
least one (1) plan may be offered in a managed-care form at such time as the
department can establish an appropriate provider network in available service
areas.
(3) The department shall provide for utilization review and case management for
all health benefit plans issued under Kentucky Access.
(4) The department shall review and compare health benefit plans provided under
Kentucky Access to health benefit plans provided in the individual market.
Based on the review, the department may amend or replace the health benefit
plans issued under Kentucky Access.
(5) Individuals who apply and are determined eligible for health benefit plans
issued under Kentucky Access shall have coverage effective the first day of the
month after the application month.
(6) For eligible individuals, health benefit plans issued under Kentucky Access
shall not impose any pre-existing condition exclusions. In all other cases, a
pre-existing condition exclusion may be imposed in accordance with KRS
304.17A-230.
(7) Health benefit plans issued under Kentucky Access shall be guaranteed
renewable except as otherwise specified in KRS 304.17B-015 and KRS
304.17A-240.
(8) All health benefit plans issued under Kentucky Access shall provide that, upon
the death or divorce of the individual in whose name the contract was issued,
every other person covered in the contract may elect within sixty-three (63)
days to continue under the same or a different contract.
(9) Health benefit plans issued under Kentucky Access shall coordinate benefits
with other health benefit plans and be the payor of last resort.
(10) Health benefit plans issued under Kentucky Access shall pay covered benefits
up to a lifetime limit of two million dollars ($2,000,000) per covered individual.
The maximum limit under this subsection may be increased by the department.
Effective:July 15, 2010
History: Amended 2010 Ky. Acts ch. 24, sec. 1282, effective July 15, 2010; and
ch. 126, sec. 2, effective July 15, 2010. -- Created 2000 Ky. Acts ch. 476,
sec. 10, effective July 14, 2000.
Legislative Research Commission Note (7/15/2010). This section was amended
by 2010 Ky. Acts chs. 24 and 126, which do not appear to be in conflict and
have been codified together.
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