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304.17A-510 Notification by insurer offering managed care plans of availability of
printed document.
(1)
(2)
(3)
In addition to the disclosure requirements provided in KRS 304.17A-505, an insurer
that offers a managed care plan shall notify an enrollee, in writing, of the
availability of a printed document, in a manner consistent with KRS 304.14-420 to
304.14-450, containing the following information at the time of enrollment and
upon request:
(a) A current participating provider directory providing information on a covered
person's access to primary care health care providers, including available
participating health care providers, by provider category or specialty and by
county. The directory shall include the professional office address of each
participating health care provider. The directory shall also provide information
about participating hospitals and other providers. The insurer shall promptly
notify each covered person on the termination or withdrawal from the insurer's
provider network of the covered person's designated primary care provider;
(b) General information about the type of financial incentives between
participating providers under contract with the insurer and other participating
health care providers and facilities to which the participating providers refer
their managed care patients;
(c) The insurer's managed care plan's standard for customary waiting times for
appointments for urgent and routine care; and
(d) The existence of any hold harmless agreements it has with providers and their
effect on the enrollee.
The insurer shall provide a prospective enrollee with information about the provider
network, including hospital affiliations, and other information specified in this
subsection, upon request. In addition to making the information available in a
printed document, an insurer may also make the information available in an
accessible electronic format.
Upon request of a covered person, an insurer shall promptly inform the person:
(a) Whether a particular network provider is board certified; and
(b) Whether a particular network provider is currently accepting new patients.
Each insurer shall annually make available to its enrollees at its principal office and
place of business:
(a) Its most recent annual statement of financial condition including a balance
sheet and summary of receipts and disbursements; and
(b) A current description of its organizational structure and operation.
Effective: July 14, 2000
History: Amended 2000 Ky. Acts ch. 293, sec. 1, effective July 14, 2000; and ch. 500,
sec. 3, effective July 14, 2000. -- Created 1998 Ky. Acts ch. 496, sec. 27, effective
April 10, 1998.
Legislative Research Commission Note (7/14/2000). This section was amended by
2000 Ky. Acts chs. 293 and 500, which do not appear to be in conflict and have been
codified together.
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