RELATES TO:
KRS
304.1-010,
304.4-010,
304.14-120,
304.14-190,
304.17A-095,
304.17A-096,
304.17A-600-304.17A-629
NECESSITY, FUNCTION, AND CONFORMITY:
KRS
304.2-110(1) authorizes the
executive director of insurance to promulgate reasonable administrative rules
and administrative regulations necessary for or as an aid to the effectuation
of any provision of the Kentucky Insurance Code, as defined by
KRS
304.1-010. EO 2008-507, effective June 16,
2008, established the Department of Insurance and the Commissioner of Insurance
as head of the department. This administrative regulation establishes forms and
reports to be submitted to the Department of Insurance by a health insurer or
independent review entity.
Section 1.
Forms and Reports.
(1) Form HIPMC-RF-25, Basic
Health Benefit Plan Summary Sheet-Form and Rate Filings, shall be filed by an
insurer with a form or rate for a basic health benefit plan.
(2) Form HIPMC-BHP-1, Basic Health Benefit
Plan Annual Report, shall be filed annually by an insurer offering a basic
health benefit plan.
(3) Form
HIPMC-R32, Health Benefit Plan Rate Filing Information Form, shall be filed
with a rate for a health benefit plan.
(4) Form HIPMC-F1, Face Sheet and
Verification Form, shall be filed as the coversheet of a rate or form filing
for a health benefit plan.
(5) An
Income and Expense Worksheet shall be filed with a rate for a health benefit
plan.
(6) Form HIPMC-R33, Health
Benefit Plan Regions, which includes eight (8) identified health benefit plan
regions in Kentucky, may be filed for a geographic region factor adjustment in
a rate for a health benefit plan.
(7) Form HIPMC-R34, Certification Form, shall
be filed with a rate for a health benefit plan for an individual, association,
or small group.
(8) Form
HIPMC-IRE-1, Application for Certification of an Independent Review Entity,
shall be filed by an independent review entity applying for certification to
perform external reviews in Kentucky.
(9) Form HIPMC-IRE-2, Assignment of
Independent Review Entity Form, shall be filed by an insurer if an external
review is assigned to an independent review entity.
(10) Form HIPMC-IRE-3, External Review
Decision Notification Form, shall be used by an independent review entity to
notify the Department of Insurance of an external review decision.
(11) Form HIPMC-IRE-4, Annual Independent
Review Entity Report Form, shall be filed by an independent review entity
annually with the Department of Insurance.
(12) Form HIPMC-IRE-5, Approval of an
External Review Fee in excess of $800, shall be used by the Department of
Insurance to approve excess fees of an independent review entity in unusual or
complicated circumstances.
(13)
Form HIPMC-IRE-6, External Review Information Face Sheet, shall be used by an
insurer to provide information and documentation relating to an external review
to an independent review entity.
(14) Form HIPMC-UR-1, Utilization Review
Registration Application, shall be filed by an insurer or private review agent
applying for registration to perform utilization review in Kentucky.
(15) Form HIPMC-UR-2, Annual Utilization
Review Report Form, shall be filed by an insurer or private review agent
annually to the Department of Insurance.
(16) Form HIPMC-R1, Risk-sharing Arrangement
Information Sheet, shall be filed by an insurer for each risk-sharing
arrangement in force.
Section
2. Incorporation by Reference.
(1) The following material is incorporated by
reference:
(a) "HIPMC-RF-25, Basic Health
Benefit Plan Summary Sheet-Form and Rate Filings", 07/2008;
(b) "HIPMC-BHP-1, Basic Health Benefit Plan
Annual Report", 07/2008;
(c)
"HIPMC-R32, Health Benefit Plan Rate Filing Information Form",
07/2008;
(d) "HIPMC-F1, Face Sheet
and Verification Form", 07/2008;
(e) "Income and Expense Worksheet",
1998;
(f) "HIPMC-R33, Health
Benefit Plan Regions", 12/00;
(g)
"HIPMC-R34, Certification Form", 07/2008;
(h) "HIPMC-IRE-1, Application for
Certification of an Independent Review Entity", 07/2008;
(i) "HIPMC-IRE-2, Assignment of Independent
Review Entity Form", 7/2008;
(j)
"HIPMC-IRE-3, External Review Decision Notification Form", 07/2008;
(k) "HIPMC-IRE-4, Annual Independent Review
Entity Report Form", 07/2008;
(l)
"HIPMC-IRE-5, Approval of an External Review Fee in excess of $800",
07/2008;
(m) "HIPMC-IRE-6, External
Review Information Face Sheet", 07/2008;
(n) "HIPMC-UR-1, Utilization Review
Registration Application", 07/2008;
(o) "HIPMC-UR-2, Annual Utilization Review
Report Form", 07/2008; and
(p)
"HIPMC-R1, Risk-sharing Arrangement Information Sheet", 07/00.
(2) This material may be
inspected, copied, or obtained, subject to applicable copyright law, at the
Kentucky Department of Insurance, 215 West Main Street, Frankfort, Kentucky
40601, Monday through Friday, 8 a.m. to 4:30 p.m.