2014 Kentucky Revised Statutes CHAPTER 304 - INSURANCE CODE Subtitle 18 - Group and Blanket Health Insurance 18.18-037 Group or blanket health insurers to offer home health care coverage to master policyholder -- Conditions.
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304.18-037 Group or blanket health insurers to offer home health care
coverage to master policyholder -- Conditions.
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All insurers issuing group or blanket health insurance policies and certificates
issued thereunder in the Commonwealth providing coverage on an expense
incurred basis shall make available and offer to the master policyholder
coverage for home health care. The coverage may contain a limitation on the
number of home health care visits for which benefits are payable, but the
number of such visits shall not be less than sixty (60) in any calendar year or in
any continuous period of twelve (12) months for each person covered under
the policy. Each visit by an authorized representative of a home health agency
shall be considered as one (1) home health care visit except that at least four
(4) hours of home health aide service shall be considered as one (1) home
health visit.
Home health care coverage shall be subject to the same deductible and
coinsurance provisions as are other services covered by insurers issuing group
or blanket health insurance policies in the Commonwealth.
Home health care shall not be reimbursed unless an attending physician
certifies that hospitalization or confinement in a skilled nursing facility as
defined by the Kentucky Health Facilities and Health Services Certificate of
Need and Licensure Board would otherwise be required if home health care
was not provided.
Medicare beneficiaries shall be deemed eligible to receive home health care
benefits under a group or blanket health insurance policy provided that the
policy shall only pay for those home health care services which are not paid for
by Medicare and do not exceed the maximum liability of the policy.
Pursuant to the provisions of this section, all insurers issuing group or blanket
health insurance policies and certificates issued thereunder in the
Commonwealth providing coverage on an expense incurred basis which
include coverage for home health care shall inform the beneficiaries of such
policies, in writing, of the specific home health care benefits which are covered.
Such written notification shall take place at the time of issuance or reissuance
of the policy.
Effective:January 1, 1981
History: Created 1980 Ky. Acts ch. 61, sec. 3, effective January 1, 1981.
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