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304.17B-019 Types of health benefit plans to be issued under Kentucky Access.
(1)
Kentucky Access shall offer at least three (3) health benefit plans to enrollees,
which shall be similar to the health benefit plans currently being marketed to
individuals in the individual market.
(2) At least one (1) plan shall be offered in a traditional fee-for-service form. At least
one (1) plan may be offered in a managed-care form at such time as the department
can establish an appropriate provider network in available service areas.
(3) The department shall provide for utilization review and case management for all
health benefit plans issued under Kentucky Access.
(4) The department shall review and compare health benefit plans provided under
Kentucky Access to health benefit plans provided in the individual market. Based
on the review, the department may amend or replace the health benefit plans issued
under Kentucky Access.
(5) Individuals who apply and are determined eligible for health benefit plans issued
under Kentucky Access shall have coverage effective the first day of the month after
the application month.
(6) For eligible individuals, health benefit plans issued under Kentucky Access shall
not impose any pre-existing condition exclusions. In all other cases, a pre-existing
condition exclusion may be imposed in accordance with KRS 304.17A-230.
(7) Health benefit plans issued under Kentucky Access shall be guaranteed renewable
except as otherwise specified in KRS 304.17B-015 and KRS 304.17A-240.
(8) All health benefit plans issued under Kentucky Access shall provide that, upon the
death or divorce of the individual in whose name the contract was issued, every
other person covered in the contract may elect within sixty-three (63) days to
continue under the same or a different contract.
(9) Health benefit plans issued under Kentucky Access shall coordinate benefits with
other health benefit plans and be the payor of last resort.
(10) Health benefit plans issued under Kentucky Access shall pay covered benefits up to
a lifetime limit of two million dollars ($2,000,000) per covered individual. The
maximum limit under this subsection may be increased by the department.
Effective: July 15, 2010
History: Amended 2010 Ky. Acts ch. 24, sec. 1282, effective July 15, 2010; and ch.
126, sec. 2, effective July 15, 2010. -- Created 2000 Ky. Acts ch. 476, sec. 10,
effective July 14, 2000.
Legislative Research Commission Note (7/15/2010). This section was amended by
2010 Ky. Acts chs. 24 and 126, which do not appear to be in conflict and have been
codified together.
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