2016 Kentucky Revised Statutes CHAPTER 304 - INSURANCE CODE Subtitle 17A - Health Benefit Plans 304.17A-846 Providing of requested information on insureds by group health benefit plan insurers -- Confidentiality -- Additional information to be provided to large groups.
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304.17A-846 Providing of requested information on insureds by group health
benefit plan insurers -- Confidentiality -- Additional information to be
provided to large groups.
(1)
(2)
(3)
Any insurer issuing or delivering group health benefit plans in the Commonwealth
shall provide to an employer-organized association health benefit plan, within thirty
(30) calendar days after a written request, the information relating to its health
benefit plan that has been requested, including but not limited to the following
information for the previous three (3) years or for the entire period of coverage,
whichever is shorter:
(a) Aggregate claims experience by month, including claims experience for
pharmacy benefits;
(b) Total premiums paid by month;
(c) Total number of insureds on a monthly basis by coverage tier; and
(d) Sufficient detailed claims information to permit the employer-organized
association to verify eligibility and participation of the groups and individuals
participating in the employer-organized association program.
The department shall, by July 15, 2005, promulgate administrative regulations to
implement the provisions of this section and define the extent that individual
information shall be provided.
This section shall not require the insurer to disclose any nonpublic personal health
information without the written consent of the individual who is the subject of the
information, as required by administrative regulations promulgated by the
commissioner. However, nonpublic personal health information may be provided to
the employer-organized association health benefit plan and large group health
benefit plan with fifty-one (51) or more enrolled employees as a covered entity to
cover entity transfer under the Federal Health Insurance Portability and
Accountability Act of 1996 (HIPAA), 42 U.S.C. sec. 300gg et seq., provided that
the health benefit plan certifies to the insurer that it has adopted HIPAA-required
safeguards and will treat the nonpublic personal health information in accordance
with HIPAA standards.
Any insurer issuing or delivering group health benefit plans in the Commonwealth
shall provide to a large group health benefit plan with fifty-one (51) or more
enrolled employees, within thirty (30) calendar days after receipt of a written
request, the following information relating to its health benefit plan:
(a) Total premiums paid by month;
(b) Total number of insureds on a monthly basis by coverage tier; and
(c) Additional utilization data to help the employer measure costs in the following
areas:
1.
Detailed prescription drug utilization information, including generic
versus brand utilization;
2.
Number of office visits to primary care providers and specialists;
3.
Number of emergency room visits;
4.
5.
(4)
Number of inpatient and outpatient hospitalizations;
Number of members utilizing deductible and out-of-pocket expenses by
cost level; and
6.
A list of the most prevalent disease categories.
Insurers shall not be required to produce reports requested pursuant to subsection
(3) of this section more than twice annually.
Effective: July 15, 2010
History: Amended 2010 Ky. Acts ch. 24, sec. 1272, effective July 15, 2010. -Amended 2007 Ky. Acts ch. 87, sec. 1, effective June 26, 2007. -- Created 2005 Ky.
Acts ch. 144, sec. 1, effective June 20, 2005.
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