2015 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.
Download as PDF
304.18-037 Group or blanket health insurers to offer home health care coverage to
master policyholder -- Conditions.
(1)
(2)
(3)
(4)
(5)
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.
Disclaimer: These codes may not be the most recent version. Kentucky may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.