2014 Kentucky Revised Statutes CHAPTER 304 - INSURANCE CODE Subtitle 32 - Nonprofit Hospital, Medical-Surgical, Dental and Health Service Corporations 32.32-280 Nonprofit hospital, medical-surgical, dental and health service corporations as insurers to offer home health care coverage -- Conditions.
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304.32-280 Nonprofit hospital, medical-surgical, dental and health service
corporations as insurers to offer home health care coverage -Conditions.
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All nonprofit hospital, medical-surgical, dental and health service corporations
issuing policies in the Commonwealth which provide hospital, medical, or
surgical expense benefits shall make available and offer to include benefits for
home health care. On group benefits the option for home health care benefits
shall be made available and offered to the master policyholder. 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 nonprofit hospital,
medical-surgical, dental and health service corporations which issue policies in
the Commonwealth that provide hospital, medical, or surgical expense
benefits.
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 policy, contract, plan entered into, issued, delivered or
amended in this state by a nonprofit hospital, medical-surgical, dental and
health service corporation which provides hospital, medical or surgical expense
benefits provided that the policy, contract or plan 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, contract or plan.
Pursuant to the provisions of this section, all nonprofit hospital,
medical-surgical, dental and health service corporations issuing policies in the
Commonwealth which provide hospital, medical, or surgical expense benefits
or 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. 4, effective January 1, 1981.
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