17A-005. Definitions for subtitle.

17A-010. Repealed, 1998. [Repealed]

17A-020. Repealed, 1998. [Repealed]

17A-030. Repealed, 1998. [Repealed]

17A-040. Repealed, 1998. [Repealed]

17A-050. Repealed, 1998. [Repealed]

17A-060. Repealed, 1998. [Repealed]

17A-070. Repealed, 1998. [Repealed]

17A-071. Repealed, 2010. [Repealed]

Miscellaneous Provisions

17A-080. Health Insurance Advisory Council -- Powers -- Duties -- Members -- Expenses and supplies.

17A-090. Repealed, 1998 [Repealed]

17A-095. Insurer issuing health benefit plan must file rates and charges -- Commissioner's approval -- Policy forms -- Administrative regulations -- Hearing.

17A-0952. Premium rate guidelines for individual, small group, and association plans.

17A-0954. Definitions for section -- Premium rate guidelines for employer-organized association plans.

17A-096. Basic health benefit plans permitted for individual, small group, and association markets -- Required coverage -- Exclusions from coverage.

17A-097. Disclosure of coverage levels in basic health benefit plan.

17A-098. Rewards or incentives to participate in voluntary wellness or health improvement program.

17A-100. Repealed, 1998. [Repealed]

17A-110. Repealed, 1998. [Repealed]

17A-120. Repealed, 1998. [Repealed]

17A-130. Repealed, 1998. [Repealed]

17A-131. Coverage for cochlear implants.

17A-132. Coverage for hearing aids.

17A-133. Coverage for mammograms.

17A-134. Coverage for medical and surgical benefits with respect to mastectomy, diagnosis and treatment of endometrioses and endometritis, and bone density testing -- Requirements for health benefit plan.

17A-135. Coverage for treatment of breast cancer.

17A-136. Coverage for cancer clinical trials.

17A-137. Repealed, 2002. [Repealed]

17A-138. Prohibition against health benefit plan excluding coverage for telehealth -- Benefits subject to deductible, co-payment, or coinsurance -- Payment subject to provider network arrangements -- Administrative regulations.

17A-139. Family or dependents coverage to apply to newly born child from moment of birth and to include inherited metabolic diseases -- Requirement for notification and payment of premium -- Coverage for milk fortifiers to prevent enterocolitis.

17A-140. Coverage applicable to children to include legally-adopted children.

17A-141. Definitions for KRS 304.17A-141, 304.17A-142, and 304.17A-143.

17A-142. Coverage for autism spectrum disorders -- Limitations on coverage -- Utilization review -- Reimbursement not required.

17A-143. Coverage for treatment of autism in the individual and small group market -- Limitation -- Definitions.

17A-145. Maternity coverage to include specified amounts of inpatient care for mothers and newly-born children -- Exemption.

17A-146. Coverage for registered nurse first assistant.

17A-147. Coverage for surgical first assisting or intraoperative surgical care to include services performed by certified surgical assistant.

17A-1473. Coverage for surgical first assisting or intraoperative surgical care to include services performed by certified surgical assistant or physician assistant.

17A-148. Coverage for diabetes.

17A-149. Coverage for anesthesia and services in connection with dental procedures for certain patients.

17A-150. Unfair trade practices -- Penalties.

17A-155. Prohibition against denial of coverage to victims of domestic violence.

17A-160. Repealed, 1998. [Repealed]

17A-161. Definitions for KRS 304.17A-161 and 304.17A-162.

17A-162. Contract between pharmacy benefit manager and contracted pharmacy -- Contents -- Resolution of disputes over maximum allowable cost pricing -- Duties of pharmacy benefit manager.

17A-163. Override of restrictions on medication sequence in step therapy or fail-first protocol.

17A-165. Prescription drug coverage to include exceptions or override policy for refills of covered drugs -- Limitations and exclusions.

17A-170. Definitions for KRS 304.17A-170 and 304.17A-171.

17A-171. Requirements for health benefit plans that include chiropractic benefits.

17A-173. Payment for coverage of services within scope of practice of optometrists.

17A-175. Limitation on amount of copayment or coinsurance charged for services rendered by chiropractor or optometrist.

17A-177. Limitation on amount of copayment or coinsurance charged for services rendered by occupational or physical therapist -- Insurer to clearly state coverage.

17A-200. Prohibition against establishing certain rules of eligibility in small group, large group, or association markets -- Limitation on premium -- Participation rules -- Effect of denial of coverage -- Disclosure.

17A-210. Repealed, 2000. [Repealed]

17A-220. Pre-existing condition exclusion in group coverage -- Definitions for section.

17A-230. Pre-existing condition exclusion in individual market -- Prohibition against use of genetic information -- Administrative regulations.

17A-240. Renewal or continuation -- Ground for nonrenewal, cancellation, or discontinuance.

17A-243. Grace period for unpaid premiums.

17A-245. Required notice of cancellation -- Procedure -- Refund of unearned premium.

17A-250. Standard health benefit plan -- Individual or small group markets -- Writing requirement for provider participation -- Time limit for rate quote -- Notice of denial of coverage.

17A-252. Health benefit plan not required to include state-mandated benefits enacted after issuance.

17A-254. Duties of insurer offering health benefit plan.

17A-256. Options for dependent coverage under group health benefit plans -- Disclaimer.

17A-257. Coverage under health benefit plan for colorectal cancer examinations and laboratory tests.

17A-258. Coverage under health benefit plan for therapeutic food, formulas, supplements, and low-protein modified food products.

17A-260. Repealed, 2002. [Repealed]

17A-270. Nondiscrimination against provider in geographic coverage area.

17A-275. Health benefit plan not to discriminate against physician on basis of degree in medicine or osteopathy.

17A-280. Repealed, 2000. [Repealed]

17A-290. Prohibition against renewal of nonstate employees and small groups under KRS 18A.2251 or 18A.2281.

17A-300. Provider-sponsored integrated health delivery network -- Qualifications -- Fees -- Network subject to provisions of other subtitles.

17A-310. Financial solvency requirements for network.

17A-320. Certificate of filing for employer-organized association -- Effect -- Revocation.

17A-330. Self-insurance reporting requirements -- Exemption.

17A-340. Restrictions on use of Kentucky Children's Health Insurance Program allocated funds.

17A-350. Repealed, 2002. [Repealed]

Kentucky Guaranteed Acceptance Program

17A-400. Repealed, 2000. [Repealed]

17A-410. Definitions for KRS 304.17A-400 to 304.17A-480.

17A-420. Repealed, 2000. [Repealed]

17A-430. Criteria for program plan -- Alternative underwriting.

17A-440. Repealed, 2000. [Repealed]

17A-450. Cost-containment feature requirement for program plans.

17A-460. Repealed, 2000. [Repealed]

17A-470. Repealed, 2000. [Repealed]

17A-480. Repealed, 2000. [Repealed]

Managed Care Plans

17A-500. Definitions for KRS 304.17A-500 to 304.17A-590.

17A-505. Disclosure of terms and conditions of health benefit plan -- Filing with department.

17A-510. Notification by insurer offering managed care plans of availability of printed document.

17A-515. Requirements for managed care plan.

17A-520. Enrollee choice of primary care providers.

17A-525. Standards for provider participation -- Mechanisms for consideration of provider applications -- Policy for removal or withdrawal.

17A-527. Filing of provider agreements, risk-sharing arrangements, and subcontract agreements with commissioner -- Contents -- Disclosure of financial information not required.

17A-530. Prohibition against contract limiting disclosure to patient of patient medical condition or treatment options.

17A-532. Prohibition against contract requiring mandatory use of hospitalist.

17A-533. Repealed, 2004. [Repealed]

17A-535. Drug utilization waiver program -- Limitations on generic substitution -- Application to drug formulary.

17A-540. Disclosure of limitations on coverage -- Denial letter.

17A-545. Medical director for managed care plan -- Duties -- Quality assurance or improvement standards -- Process to select health care providers -- Uniform application form and guidelines for health care provider evaluations.

17A-550. Out-of-network benefits.

17A-555. Patient's right of privacy regarding mental health or chemical dependency -- Authorized disclosure.

17A-560. Most-favored-nation provision.

17A-565. Commissioner to enforce KRS 304.17A-500 to 304.17A-570 -- Administrative regulations.

17A-570. Applicability of KRS 304.17A-500 to 304.17A-570 for health insurance contracts or certificates.

17A-575. Definitions for KRS 304.17A-575 to 304.17A-578.

17A-576. Notice by managed care plan insurer of health care provider's application for credentialing -- Payments to applicant.

17A-577. Disclosure of payment or fee schedule to managed care plan health care provider -- Disclosure of schedule change -- Confidentiality of payment information.

17A-578. Notice to health care provider of material change to managed care plan.

17A-580. Education of insured about appropriate use of emergency and medical services -- Coverage of emergency medical conditions and emergency department services -- Emergency personnel to contact primary care provider or insurer -- Exclusion of limited-benefit health insurance policies.

17A-590. Participating provider directories.

Utilization Reviews

17A-600. Definitions for KRS 304.17A-600 to 304.17A-633.

17A-603. Application of KRS 304.17A-600 to 304.17A-633.

17A-605. Requirements and procedures for utilization review -- Exception for private review agent operating under contract with the federal government.

17A-607. Duties of insurer or private review agent performing utilization reviews -- Requirement for registration -- Consequences of insurer's failure to make timely utilization review determination -- Requirement that insurer or private review agent submit changes to the department -- Requirement that private review agent provide timely notice of entities for whom it is providing review.

17A-609. Emergency administrative regulations governing utilization review and internal appeal to be promulgated by the department.

17A-611. Prohibition against retrospective denial of coverage for health care services under certain circumstances.

17A-613. Emergency administrative regulations governing registration of insurers and private review agents seeking to conduct utilization reviews -- Procedure for handling complaints.

17A-615. Prohibition against denying or reducing payments under certain circumstances.

17A-617. Internal appeals process -- Procedures -- Review of coverage denials.

17A-619. Duty of covered person, authorized person, or provider to provide insurer with new information regarding internal appeal -- Time frame for insurer to render a decision based on new information -- Insurer's failure to make timely determination or provide written notice.

17A-621. Independent External Review Program established.

17A-623. External review of adverse determination -- Who may request -- Criteria for review -- Fee -- Conditions under which covered person not entitled to review -- Resolution of disputes -- Confidentiality -- Expedited external review.

17A-625. Factors to be considered by independent review entity conducting external review -- Basis for decision -- Insurer's responsibilities -- Contents, admissibility, and effect of decision -- Consequence of insurer's failure to provide coverage -- Liability -- Written complaints.

17A-627. Certification as independent review entity -- Requirements and restrictions.

17A-629. Administrative regulations to implement provisions of KRS 304.17A-621, 304.17A-623, 304.17A-625, 304.17A-627, 304.17A-629, and 304.17A-631.

17A-631. Time for insurers to comply with administrative regulations.

17A-633. Commissioner to report to Interim Joint Committee on Banking and Insurance and to Governor -- Contents of report.

Emergency Medical Conditions

17A-640. Definitions for KRS 304.17A-640 et seq.

17A-641. Treatment of a stabilized covered person with an emergency medical condition in a nonparticipating hospital's emergency room.

17A-643. Treatment of covered person under special circumstances.

17A-645. Covered person's access to participating nonprimary care physician specialist.

17A-647. Covered person's access to participating obstetrician or gynecologist -- Authorization for annual pap smear without referral.

17A-649. Administrative regulations for the implementation of KRS 304.17A-640 et seq.

Mental Health Conditions

17A-660. Definitions for KRS 304.17A-660 to 304.17A-669.

17A-661. Treatment of mental health conditions to be covered under same terms and conditions as treatment of physical health conditions.

17A-665. Commissioner to report to Legislative Research Commission on impact of health insurance costs under KRS 304.17A-660 to 304.17A-669.

17A-669. KRS 304.17A-660 to 304.17A-669 not to be construed as mandating coverage for mental health conditions -- Exemptions from KRS 304.17A-660 to 304.17A-669.

KRS 304.17A-700 to 304.17A-730 Payment of Claims

17A-700. Definitions for KRS 304.17A-700 to 304.17A-730 and KRS 205.593, 304.14-135, and 304.99-123.

17A-702. Claims payment time frames -- Duties of insurer.

17A-704. Insurer's acknowledgment of receipt of claim -- Inaccurate or insufficient claim information -- Claim status information.

17A-705. Electronic claims submission.

17A-706. Contested claims -- Delay of payment -- Conditions -- Procedure.

17A-708. Resolution of payment errors -- Retroactive denial of claims -- Conditions.

17A-710. Disclosure of claims payment information to provider.

17A-712. Claim refunds and overpayments.

17A-714. Collection of claim overpayments -- Dispute resolution.

17A-716. Prohibition against denial or reduction of payment for covered health benefit -- Conditions.

17A-718. Disclosure of claims payment information to covered person.

17A-720. Administrative regulations for standardized health claim attachments -- Conformity with federal standards.

17A-722. Administrative regulations on claims payment practices.

17A-724. Applicability of KRS 304.17A-700 to 304.17A-730 and KRS 205.593, 304.14-135, and 304.99-123.

17A-726. Exclusive application of KRS 304.17A-700 to 304.17A-730 and KRS 205.593, 304.14-135, and 304.99-123 to claims incurred and contracts made after July 14, 2000.

17A-728. Contract disclosures of discounted fees -- Violation is unfair claims settlement practice.

17A-730. Payment of interest for failing to pay, denying, or settling a clean claim as required.

Audits of Pharmacy Records

17A-740. Definitions for KRS 304.17A-740 to 304.17A-743.

17A-741. Audit of pharmacy records -- Conditions.

17A-743. Pharmacy audit appeals process.

17A-745. KRS 304.17A-740 to 304.17A-743 not applicable to audits conducted by state agency pursuant to KRS Chapter 205.

17A-747. KRS 304.17A-740 to 304.17A-743 not applicable when fraud, willful misrepresentation, or abuse alleged.

Insurance Purchasing Outlets

17A-750. Definitions for KRS 304.17A-750 to 304.17A-770 and 304.47-020.

17A-752. Registration of insurance purchasing outlets -- Licensed agents -- Administrative regulations.

17A-754. Application -- Approval and issuance of certificate -- Information to be filed -- Administrative regulations.

17A-756. Denial, suspension, and revocation of application or license -- Civil penalty.

17A-758. Activities allowed under administrator license -- Financial statements -- Books and records -- Renewal of certificate -- Nontransferability -- Fees.

17A-760. Duties and powers of insurance purchasing outlet.

17A-762. Outlet to act as policyholder for member -- Certificate of coverage for each member -- Disclosure to members.

17A-764. Determination of premiums -- Restrictions in calculation.

17A-766. Coverage deemed group health insurance -- Requirements for health benefit plans -- Member who no longer meets participation requirements.

17A-768. Voucher -- Redemption -- Payment of premium amount -- Fee to process voucher -- Administrative regulations.

17A-770. Provisions applicable to insurance purchasing outlets.

Self-Insured Employer-Organized Association Groups

17A-800. Purpose of KRS 304.17A-800 to 304.17A-844.

17A-802. Definitions for KRS 304.17A-800 to 304.17A-844.

17A-804. Applicability of KRS 304.17A-800 to 304.17A-844 -- Self-insured employer-organized association groups.

17A-806. Certificate of filing required.

17A-808. Application for certificate of filing - Fee.

17A-810. Conditions for issuance of certificate of filing.

17A-812. Initial and continuing financial solvency requirements.

17A-814. Notification of change in information.

17A-816. Investment of funds.

17A-818. Agent of self-insured employer-organized association group -- Licensing -- Continuing education.

17A-820. Examination of financial condition, affairs, and management by commissioner.

17A-822. Appointment of Secretary of State as attorney to receive legal process.

17A-824. Continuing effectiveness of certificate -- Termination of certificate at request of group -- Merger with another group.

17A-826. Operation of group by board of trustees -- Powers and duties -- Prohibited acts.

17A-828. Membership -- Liability on termination of membership, insolvency, or bankruptcy.

17A-830. Trustees, officers, directors, or employees not to have interest in administrator or group.

17A-832. Statement of financial condition -- Authority for administrative regulations.

17A-834. Filing of rates, underwriting guidelines, evidence of coverage, and changes -- Filing fee.

17A-836. Contribution plans to be established.

17A-838. Members to receive evidences of coverage -- Contents.

17A-840. Suspension or revocation of certificate of filing.

17A-842. Authority for administrative regulations.

17A-844. Prohibited activities -- Penalties.

17A-846. Providing of requested information on insureds by group health benefit plan insurers -- Confidentiality -- Additional information to be provided to large groups.