2014 Kentucky Revised Statutes CHAPTER 304 - INSURANCE CODE Subtitle 18 - Group and Blanket Health Insurance 18.18-114 Conversion health insurance policy for member terminated under group policy -- Terms -- Situations in which conversion coverage need not be granted.
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304.18-114 Conversion health insurance policy for member terminated under
group policy -- Terms -- Situations in which conversion coverage need
not be granted.
(1)
(2)
(3)
As used in this section:
(a) "Conversion health insurance coverage" means a health benefit plan
meeting the requirements of this section and regulated in accordance with
Subtitles 17 and 17A of this chapter;
(b) "Group policy" has the meaning provided in KRS 304.18-110; and
(c) "Medicare" has the meaning provided in KRS 304.18-110.
An insurer providing group health insurance coverage shall offer a conversion
health insurance policy, by written notice, to any group member terminated
under the group policy for any reason. The insurer shall offer a conversion
health insurance policy substantially similar to the group policy. The former
group member shall meet the following conditions:
(a) The former group member had been a member of the group and covered
under any health insurance policy offered by the group for at least three
(3) months;
(b) The former group member must make written application to the insurer
for conversion health insurance coverage not later than thirty-one (31)
days after notice pursuant to subsection (5) of this section; and
(c) The former group member must pay the monthly, quarterly, semiannual,
or annual premium, at the option of the applicant, to the insurer not later
than thirty-one (31) days after notice pursuant to subsection (5) of this
section.
An insurer shall offer the following terms of conversion health insurance
coverage:
(a) Conversion health insurance coverage shall be available without
evidence of insurability and may contain a pre-existing condition limitation
in accordance with KRS 304.17A-230;
(b) The premium for conversion health insurance coverage shall be
according to the insurer's table of premium rates in effect on the latter of:
1.
The effective date of the conversion policy; or
2.
The date of application when the premium rate applies to the class
of risk to which the covered persons belong, to their ages, and to the
form and amount of insurance provided;
(c) The conversion health insurance policy shall cover the former group
member and eligible dependents covered by the group policy on the date
coverage under the group policy terminated.
(d) The effective date of the conversion health insurance policy shall be the
date of termination of coverage under the group policy; and
(e) The conversion health insurance policy shall provide benefits
substantially similar to those provided by the group policy, but not less
than the minimum standards set forth in KRS 304.18-120 and any
administrative regulations promulgated thereunder.
(4)
(5)
Conversion health insurance coverage need not be granted in the following
situations:
(a) On the effective date of coverage, the applicant is or could be covered by
Medicare;
(b) On the effective date of coverage, the applicant is or could be covered by
another group coverage (insured or uninsured) or, the applicant is
covered by substantially similar benefits by another individual hospital,
surgical, or medical expenses insurance policy; or
(c) The issuance of conversion health insurance coverage would cause the
applicant to be overinsured according to the insurer's standards, taking
into account that the applicant is or could be covered by similar benefits
pursuant to or in accordance with the requirements of any statute and the
individual coverage described in paragraph (b) of this subsection.
Notice of the right to conversion health insurance coverage shall be given as
follows:
(a) For group policies delivered, issued for delivery, or renewed after July 15,
2002, the insurer shall give written notice of the right to conversion health
insurance coverage to any former group member entitled to conversion
coverage under this section upon notice from the group policyholder that
the group member has terminated membership in the group, upon
termination of the former group member's continued group health
insurance coverage pursuant to KRS 304.18-110 or COBRA as defined in
KRS 304.17A-005(7), or upon termination of the group policy for any
reason. The written notice shall clearly explain the former group
member's right to a conversion policy.
(b) The thirty-one (31) day period of subsection (2)(b) of this section shall not
begin to run until the notice required by this subsection is mailed or
delivered to the last known address of the former group member.
(c) If a former group member becomes entitled to obtain conversion health
insurance coverage, pursuant to this section, and the insurer fails to give
the former group member written notice of the right, pursuant to this
subsection, the insurer shall give written notice to the former group
member as soon as practicable after being notified of the insurer's failure
to give written notice of conversion rights to the former group member and
such former group member shall have an additional period within which to
exercise his conversion rights. The additional period shall expire sixty (60)
days after written notice is received from the insurer. Written notice
delivered or mailed to the last known address of the former group
member shall constitute the giving of notice for the purpose of this
paragraph. If a former group member makes application and pays the
premium, for conversion health insurance coverage within the additional
period allowed by this paragraph, the effective date of conversion health
insurance coverage shall be the date of termination of group health
insurance coverage. However, nothing in this subsection shall require an
insurer to give notice or provide conversion coverage to a former group
member ninety (90) days after termination of the former group member's
group coverage.
Effective:June 20, 2005
History: Amended 2005 Ky. Acts ch. 144, sec. 12, effective June 20, 2005. -Created 2002 Ky. Acts ch. 351, sec. 9, effective July 15, 2002.
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