RELATES TO:
KRS
304.17A-080,
304.17A-250
NECESSITY, FUNCTION, AND CONFORMITY:
KRS
304.2-110(1) authorizes the
Commissioner of Insurance to promulgate administrative regulations necessary
for or as an aid to the effectuation of any provisions of the Kentucky
Insurance Code as defined in
KRS
304.1-010.
KRS
304.17A-250(1) requires the
Commissioner of Insurance to define by administrative regulation one (1)
standard health benefit plan. This administrative regulation establishes one
(1) standard health benefit plan that may be offered by an insurer in the
individual and small group markets and establishes procedures for modifications
to the standard health benefit plan.
Section
1. Definitions.
(1) "Department"
is defined by
KRS
304.1-050(2).
(2) "Health Insurance Advisory Council" means
the body established in accordance with
KRS
304.17A-080.
(3) "Standard health benefit plan" means the
format, cost-sharing levels, definitions, benefits, exclusions, and
supplemental benefit riders:
(a) Established
by the department in accordance with
KRS
304.17A-250 and any other health insurance
benefit mandated by the General Assembly; and
(b) Included in the Kentucky Standard Health
Benefit Plan, HIPMC-SP1.
Section 2. Modification Process.
(1) The standard health benefit plan shall
remain in effect until the plan or any form is modified in accordance with the
procedures established by this section.
(2) The standard health benefit plan may be
modified each year and each modification shall apply to each policy or
certificate issued or renewed on or after July 15.
(3) A person wishing to make a recommendation
for modification of the standard health benefit plan shall:
(a) Submit the recommendation, in writing, to
the Kentucky Department of Insurance, Health and Life Division, by May 1 of the
year preceding the year in which each modification is recommended for
implementation;
(b) Explain the
need for each recommended modification; and
(c) Provide a statement regarding the cost
effect of each recommended modification.
(4) Prior to July 1 of each year:
(a) The department shall present each
recommendation for modification received pursuant to subsection (3) of this
section to the Health Insurance Advisory Council for consideration;
(b) The Health Insurance Advisory Council
shall review and discuss each recommendation for modification of the standard
health benefit plan in accordance with
KRS
304.17A-080(3);
(c) The Health Insurance Advisory Council
shall make a final recommendation for modification of the standard health
benefit plan based on the recommendations presented by the department pursuant
to paragraph (a) of this subsection; and
(d) After considering the final
recommendation for modification from the Health Insurance Advisory Council, the
department shall either accept or decline, in writing, to modify the standard
health benefit plan.
(5)
Each insurer issuing, delivering, or renewing a standard health benefit plan
shall:
(a) Implement each modification to the
standard health benefit plan prescribed by the department; and
(b) Amend each policy form and rate filing to
include modifications to the standard health benefit plan.
Section 3. Incorporation by
Reference.
(1) "The Kentucky Standard Health
Benefit Plan, HIPMC-SP1", (5/2011) is incorporated by reference.
(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. This material is also available on the department's
Web site at
http://insurance.ky.gov.
