2015 Kentucky Revised Statutes CHAPTER 304 - INSURANCE CODE Subtitle 11 - Unauthorized Insurers -- Prohibitions and Process 11.11-045 Jurisdiction over providers of health care benefits.
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304.11-045 Jurisdiction over providers of health care benefits.
(1)
(2)
(3)
(4)
(5)
(6)
The purpose of this section is to give Kentucky jurisdiction over providers of health
care benefits; to indicate how each provider of health care benefits may show under
what jurisdiction it falls; to allow for examination by Kentucky if the provider of
health care benefits is unable to show it is subject to another jurisdiction; to make
such a provider of health care benefits subject to the laws of Kentucky if it cannot
show that it is subject to another jurisdiction; and to disclose to purchasers of such
health care benefits whether or not the plans are fully insured.
Notwithstanding any other provision of law, and except as provided herein, any
person or other entity which provides coverage in this state for medical, surgical,
chiropractic, physical therapy, speech pathology, audiology, professional mental
health, dental, hospital, or optometric expenses, whether such coverage is by direct
payment, reimbursement, or otherwise, shall be presumed to be subject to the
jurisdiction of the department, unless the person or other entity shows that while
providing such services it is subject to the jurisdiction of another agency of this
state, any subdivision thereof, or the federal government.
If a person or entity wishes to show that it is subject to the jurisdiction of another
agency of this state, any subdivision thereof, or the federal government, such
showing shall be made by providing to the commissioner the appropriate certificate,
license, or other document issued by other governmental agency which permits or
qualifies it to provide those services.
Any person or entity which is unable to show under subsection (3) that it is subject
to the jurisdiction of another agency of this state, any subdivision thereof, or the
federal government, shall submit to an examination by the commissioner to
determine the organization and solvency of the person or the entity, and to
determine whether or not such person or entity complies with the applicable
provisions of this chapter.
Any person or entity unable to show that it is subject to the jurisdiction of another
agency of this state, any subdivision thereof, or the federal government, shall be
subject to all appropriate provisions of this code regarding the conduct of its
business.
Any production agency or administrator which advertises, sells, transacts, or
administers the coverage in this state described in subsection (2) of this section and
which is required to submit to an examination by the commissioner under
subsection (4) of this section shall, if said coverage is not fully insured or otherwise
fully covered by an authorized life or health insurer, nonprofit hospital, medicalsurgical, dental, and health service corporation, health maintenance organization, or
prepaid dental plan organization, advise every purchaser, prospective purchaser, and
covered person of such lack of insurance or other coverage. Any administrator
which advertises or administers the coverage in this state described in subsection (2)
of this section which is required to submit to an examination by the commissioner
under subsection (4) of this section shall advise any production agency of the
elements of the coverage, including the amount of "stop loss" insurance in effect.
Effective: July 15, 2010
History: Amended 2010 Ky. Acts ch. 24, sec. 1104, effective July 15, 2010. -- Created
1986 Ky. Acts ch. 437, sec. 16, effective July 15, 1986.
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