reglab/statecodes huggingface dataset:
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 14 - Insurance Contract › Section 806 KAR 14:020 - Binders

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS 304.14-220
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				304.2-110 provides that the Executive
				Director of Insurance may make reasonable rules and administrative regulations
				necessary for or as an aid to the effectuation of any provision of the Kentucky
				Insurance Code. This administrative regulation sets forth certain requirements
				to be met by companies when issuing binders.
Section 1. No binder shall be issued covering
			 any property or casualty risk within the Commonwealth of Kentucky unless a
			 proper premium is charged therefor, and no such coverage shall be cancelled
			 flat. In every case, the agent must charge the proper pro rata or short rate
			 premium for the period of risk.
Section
			 2.
(1) When a policy is issued
			 in the same company, the date of commencement of the policy must be the same as
			 the binder unless a pro rata earned premium is charged for the period of the
			 binder.
(2) Binders in effect less
			 than fifteen (15) days, however, may be cancelled flat as "not taken" without
			 premium charge, subject to the approval of the company; provided the cancelled
			 binder is received by the insuring company within fifteen (15) days of its
			 effective date.
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 14 - Insurance Contract › Section 806 KAR 14:030 - Participating policy dividends not to be guaranteed

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				304.14-290
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				304.2-110 provides that the Executive
				Director of Insurance may make reasonable rules and administrative regulations
				necessary for or as an aid to the effectuation of any provision of the Kentucky
				Insurance Code. This administrative regulation prohibits the guaranteeing of
				payments of dividends under participating policies.
Section 1. Payments of dividends under
			 participating policies shall not be guaranteed and statements or words shall
			 not be used in or in connection with any policy which imply that the payment of
			 dividends is guaranteed or certain to occur.
STATUTORY AUTHORITY:
				  KRS
				  304.2-110
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 14 - Insurance Contract › Section 806 KAR 14:050 - Additional benefits to policyholders

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				304.14-180
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				304.2-110 provides that the Executive
				Director of Insurance may make reasonable rules and administrative regulations
				necessary for or as an aid to the effectuation of any provision of the Kentucky
				Insurance Code. This administrative regulation requires additional benefits
				extended to some policyholders under a policy without additional premium to be
				extended to all policyholders under the same policy.
Section 1. If additional benefits are
			 afforded to property and casualty insurance policyholders of an insurer which
			 do not require increases in premium rates or reductions or restrictions of
			 coverage, such additional benefits shall also be afforded to all prior
			 policyholders paying the same rates and each such policy shall be interpreted
			 by the insurer as if such additional benefits were contained in the prior
			 policies.
STATUTORY AUTHORITY:
				  KRS
				  304.2-110
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 14 - Insurance Contract › Section 806 KAR 14:090 - Grouping for preferential treatment prohibited

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				304.12-080,
				304.13-051,
				304.14-120
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				304.2-110 authorizes the Commissioner of
				Insurance to promulgate administrative regulations necessary for or as an aid
				to the effectuation of any provision of the Kentucky Insurance Code, as defined
				in
				KRS
				304.1-010. This administrative regulation
				prohibits the grouping of persons or risks for preferential treatment in
				insurance rates or forms.
Section 1. A
			 form, plan, or policy of insurance covering any group or combination of persons
			 or risks, other than life or health insurance, shall not be written or
			 delivered within or outside the Commonwealth of Kentucky to cover a Kentucky
			 person or risk at any preferred rate or form other than that offered to the
			 public generally, unless the form, plan, or policy and the rate or premium to
			 be charged have been submitted to and approved by the Commissioner of
			 Insurance.
STATUTORY AUTHORITY:
				  KRS
				  304.2-110
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 14 - Insurance Contract › Section 806 KAR 14:100 - Certificate not to alter contract

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				304.14-120
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				304.2-110 provides that the Executive
				Director of Insurance may make reasonable rules and administrative regulations
				necessary for or as an aid to the effectuation of any provision of the Kentucky
				Insurance Code. This administrative regulation requires that memoranda or
				certificates of insurance, as herein defined, shall not amend, extend or alter
				the coverage of an existing contract.
Section
			 1. Each certificate or memorandum of property or casualty
			 insurance when issued to any person other than the policyholder shall contain
			 the following or similar statement: "This certificate or memorandum of
			 insurance neither affirmatively nor negatively amends, extends, or alters the
			 coverage afforded by policy number ____ issued by ____."
Section 2. Prior to its use, each insurer
			 shall file with the executive director the form of certificate or memorandum of
			 insurance which will be used by such company.
STATUTORY AUTHORITY:
				  KRS
				  304.2-110
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 14 - Insurance Contract › Section 806 KAR 14:121 - Minimum standards for the readability and intelligibility of insurance contracts

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				304.14-130, 304.14-420-304.14-450
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				304.2-110 authorizes the Commissioner of
				Insurance to promulgate administrative regulations necessary for or as an aid
				to the effectuation of any provision of the Kentucky Insurance Code, as defined
				in
				KRS
				304.1-010.
				KRS
				304.14-420(2) requires the
				Commissioner of Insurance to promulgate administrative regulations to establish
				minimum standards for the readability and intelligibility of insurance
				contracts.
				KRS
				304.14-450(1) requires the
				Commissioner of Insurance to promulgate administrative regulations establishing
				a list of type face styles acceptable for use in insurance contracts. This
				administrative regulation establishes the list of type face styles acceptable
				for use in insurance contracts, and the minimum standards for readability and
				intelligibility of insurance contracts.
Section
			 1. Definitions.
(1) "Amended" or
			 "renewed" does not include changes or an extension of the term that are
			 contractually granted and exercised by the policy owner or insured under the
			 provisions of the policy;
(2)
			 "Commissioner" is defined by
			 KRS
			 304.1-050(1);
(3) "Personal lines insurance" means those
			 personal lines of insurance established in
			 KRS
			 304.14-420(1); and
(4) "Text" means all printed matter, except:
(a)
1. The
			 name and address of the insurer;
2.
			 The name, number, or title of the policy;
3. The table of contents or index;
4. Captions and subcaptions;
5. Specification or declarations
			 pages;
6. Schedules; or
7. Tables; and
(b) Any policy language that is drafted to
			 conform to the requirements of any federal law, administrative regulation, or
			 agency interpretation, any medical terminology, and any policy language
			 required by law or administrative regulation, but the insurer shall certify
			 that the language is entitled to be excepted from the definition of "text" as
			 established in this paragraph.
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 15 - Life Insurance and Annuity Contracts › Section 806 KAR 15:010 - Variable annuity contracts

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				304.7-240,
				304.9-160,
				304.15-390
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				304.2-110 provides that the Commissioner of
				Insurance may make reasonable rules and administrative regulations necessary
				for or as an aid to the effectuation of any provision of the Kentucky Insurance
				Code.
				KRS
				304.15-390 provides that the commissioner may
				promulgate administrative regulations controlling the sale and issuance of
				variable contracts. This administrative regulation sets forth the requirements
				on variable annuity contracts.
Section
			 1. Scope and Definitions.
(1)
			 The term "variable contract," when used in this administrative regulation,
			 shall mean any contract which provides for annuity benefits which vary
			 according to the investment experience of any separate account or accounts
			 maintained by the insurer as to such contract, as provided for in
			 KRS
			 304.15-390.
(2) "Agent," when used in this administrative
			 regulation, shall mean any person, corporation, partnership, or other legal
			 entity which under the laws of this state is licensed as a life insurance
			 agent.
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 15 - Life Insurance and Annuity Contracts › Section 806 KAR 15:020 - Wholesale life insurance; employer's contribution; dividends

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS 304.15-020
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				304.2-110 provides that the Commissioner of
				Insurance may make reasonable rules and administrative regulations necessary
				for or as an aid to the effectuation of any provision of the Kentucky Insurance
				Code. This administrative regulation clarifies the meaning of the phrase "funds
				contributed by the employer" as used in
				KRS 304.15-020. It
				also requires the payment of dividends on such policies to the insured.
Section 1. As used in
			 KRS 304.15-020, the
			 phrase "funds contributed by the employer" shall be deemed to mean those funds
			 contributed by the employer which make an effective contribution to the net
			 cost of the insurance, on the life of the employee.
Section 2. Any dividend returned upon a whole
			 life insurance policy shall be applied for the sole benefit of insured
			 employees.
STATUTORY AUTHORITY:
				  KRS
				  304.2-110
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 15 - Life Insurance and Annuity Contracts › Section 806 KAR 15:050 - Reporting and general requirements for settlement providers and brokers

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				304.12-020,
				304.14-120,
				304.14-440,
				304.14-450,
				304.15-020,
				304.15-035,
				304.15-700-304.15-725,
				304.99-020
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				304.15-715 requires a request for
				verification of coverage to be made on a form approved by the commissioner.
				KRS
				304.15-720 authorizes the commissioner to
				promulgate administrative regulations implementing the provisions of
				KRS
				304.15-700 to
				304.15-720.
				This administrative regulation establishes the standards for life settlement
				contracts and other forms, the information to be included in disclosures and
				reports, advertising standards, and general rules and prohibited practices with
				respect to life settlement contracts, life settlement providers, and life
				settlement brokers.
Section 1.
			 Definitions.
(1) "Commissioner" is defined by
			 KRS
			 304.1-050(1).
(2) "Department" is defined by
			 KRS
			 304.1-050(2).
(3) "Individual identification data" means an
			 insured's address, telephone number, facsimile number, electronic mail address,
			 photograph or likeness, employer, employment status, Social Security number, or
			 other information that is likely to lead to the identification of the
			 insured.
(4) "Insured" means the
			 person covered under the policy being considered for settlement.
(5) "Insurer" is defined by
			 KRS
			 304.1-040.
(6) "Life expectancy" means the mean of the
			 number of months the individual insured under the life insurance policy to be
			 settled can be expected to live as utilized by the life settlement provider
			 pursuant to the life settlement contract considering medical records and
			 appropriate experiential data.
(7)
			 "Net death benefit" means the amount of the life insurance policy or
			 certificate to be settled less any outstanding debts or liens.
(8) "Owner" is defined by
			 KRS
			 304.15-020(19).
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 15 - Life Insurance and Annuity Contracts › Section 806 KAR 15:060 - Universal life insurance

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS 304.6-120,
				304.6-130,
				304.6-140,
				304.6-143,
				304.6-145,
				304.6-150,
				304.14-120,
				304.15-010,
				304.15-040,
				304.15-300,
				304.15-310,
				304.15-340,
				304.15-342
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 provision of the Kentucky Insurance
				Code. This administrative regulation establishes requirements to accommodate
				the development and issuance of universal life insurance policies.
Section 1. Definitions.
(1) "Cash surrender value" means the net cash
			 surrender value plus any amounts outstanding as policy loans.
(2) "Commissioner" is defined by
			 KRS
			 304.1-050(1).
(3) "Fixed premium universal life insurance
			 policy" means a universal life insurance policy other than a flexible premium
			 universal life insurance policy.
(4) "Flexible premium universal life
			 insurance policy" means a universal life insurance policy that permits the
			 policyowner to vary, independently of each other, the amount or timing of one
			 (1) or more premium payments or the amount of insurance.
(5) "Guaranteed maturity premium for fixed
			 premium universal life insurance policies" means the premium defined in the
			 policy that at the time of issue, provides the minimum policy
			 guarantees.
(6) "Guaranteed
			 maturity premium" means the level gross premium, that is paid at issue and
			 periodically thereafter over the period which premiums are allowed to be paid,
			 that will mature the policy on the latest maturity date, if any, permitted
			 under the policy, or at the highest age in the valuation mortality table, for
			 an amount which is in accordance with the policy structure.
(7) "Interest-indexed universal life
			 insurance policy" means any universal life insurance policy in which the
			 interest credits are linked to an external reference.
(8) "Net cash surrender value" means the
			 maximum amount payable to the policyowner upon surrender.
(9) "Policy value" means the amount that
			 shall separately identify interest credits and mortality, expense, or other
			 charges made under a universal life insurance policy.
(10) "Universal life insurance policy" means
			 a life insurance policy:
(a) That shall
			 separately identify interest credits, other than in connection with dividend
			 accumulations, premium deposit funds, or other supplementary accounts, and
			 mortality and expense charges made to the policy; and
(b) That may provide for other credits and
			 charges, such as charges for the cost of benefits provided by the
			 rider.
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 15 - Life Insurance and Annuity Contracts › Section 806 KAR 15:070 - Annuity nonforfeiture

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				304.14-120,
				304.15-365
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				304.2-110 authorizes the Commissioner of
				Insurance to promulgate administrative regulations necessary for or as an aid
				to the effectuation of any provision of the Kentucky Insurance Code.
				KRS
				304.15-365(7) authorizes the
				commissioner to promulgate administrative regulations to implement
				KRS
				304.15-365(6) and to
				establish further adjustments to the calculation of minimum nonforfeiture
				amounts for contracts that provide substantive participation in an equity index
				benefit and for other contracts that the commissioner shall determine if
				adjustments are justified. This administrative regulation establishes the
				requirement to implement the annuity nonforfeiture provisions established in
				KRS
				304.15-365(4).
Section 1. Definitions.
(1) "Basis" means:
(a) If used in the context of an initial or
			 redetermination method, the specified period over which an average is computed
			 that shall produce the value of the five-year Constant Maturity Treasury (CMT)
			 Rate; or
(b) If used in the context
			 of the equity-indexed benefit, the point in time used for establishing the
			 parameters that:
1. Are incorporated into the
			 calculation of the value of the equity-indexed options; and
2. Include the risk free rate, dividend
			 yield, index volatility, and prior index values if the option is path
			 dependent.
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 15 - Life Insurance and Annuity Contracts › Section 806 KAR 15:090 - Notice of rights as an owner of a life insurance policy

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				304.14-120,
				304.15-075
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.
				KRS
				304.15-075(1) requires the
				commissioner to develop a notice to inform the owner of a life insurance policy
				issued in this state of his or her rights as an owner of a life insurance
				policy.
				KRS
				304.15-075(4) authorizes the
				commissioner to promulgate administrative regulations that establish that
				notice shall only be required with respect to policies with a net death benefit
				that is $100,000 or greater. This administrative regulation establishes the
				notice that shall be provided to owners of life insurance policies at times
				specified in
				KRS
				304.15-075(3) and exempts
				insurers from providing notice to owners whose life insurance policy has a net
				death benefit that is less than $100,000.
Section
			 1. When required by
			 KRS
			 304.15-075(3), an insurer
			 shall provide the owner of an individual life insurance policy with a net death
			 benefit of $100,000 or greater with either of the following:
(1) Important Information About Your Life
			 Insurance Policy, Notice 126; or
(2) A notice developed by the insurer that:
(a) Meets the requirements of
			 KRS
			 304.15-075(2); and
(b) Has been approved by the
			 commissioner.
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 17 - Health Insurance Contracts › Section 806 KAR 17:020 - Disclosure of other coverage in application

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				304.14-120
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				304.2-110 authorizes the insurance
				commissioner to promulgate reasonable rules and administrative regulations
				necessary for or as an aid to the effectuation of any provision of the Kentucky
				Insurance Code. This administrative regulation requires an applicant for health
				insurance to disclose any health insurance policy currently in force in the
				name of the applicant.
Section 1.
			 Application Requirements.
(1) Every
			 application form used by an insurer, electronically or otherwise, to solicit
			 individually underwritten health insurance, except group or accident insurance
			 only, shall require the applicant to disclose all health insurance currently
			 covering the applicant and any proposed insured. The applicant shall identify
			 the name of the insurer and the amount of insurance, if known.
(2) Every application, described in
			 subsection (1), solicited personally by an agent shall have the applicant's
			 signature and the agent shall certify that each question on the application was
			 asked of the applicant and that the applicant's answers have been accurately
			 recorded.
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 17 - Health Insurance Contracts › Section 806 KAR 17:030 - Surgical schedule

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				304.17-030
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				304.2-110 provides that the Commissioner of
				Insurance may make reasonable rules and administrative regulations necessary
				for or as an aid to the effectuation of any provision of the Kentucky Insurance
				Code. This administrative regulation provides certain inclusions in health
				insurance contracts where surgical care and indemnification is provided.
Section 1. A health policy, or rider
			 attached, or to be attached thereto, providing identification for surgical care
			 through the means of an operation or surgical schedule will not be approved for
			 use in Kentucky unless it complies with the following:
(1) Where the indemnity is limited to the
			 listed operation(s), the policy or rider shall indicate in unequivocal language
			 that indemnity will be paid only for listed operations; and
(2) If the company is to determine the amount
			 to be paid for any unlisted operation, the policy must provide that the amount
			 will be determined:
(a) On a basis of
			 comparative severity or original difficulty with operations listed in the
			 schedule of operations;
(b) On the
			 basis of usual and customary charges in the community by accredited physicians
			 for comparable services; or
(c) On
			 some other basis as may be approved by the commissioner.
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 17 - Health Insurance Contracts › Section 806 KAR 17:050 - Inclusion of Medicaid as first payor prohibited

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				304.12-080,
				304.17-220,
				304.17-230,
				304.18-020,
				304.18-070,
				304.32-150,
				304.32-160,
				304.38-050,
				304.38-180
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				304.2-110 provides that the Commissioner of
				Insurance may make reasonable rules and administrative regulations for or as an
				aid to the effectuation of any provision of the Kentucky Insurance Code. This
				administrative regulation prohibits the inclusion in insurance contracts and
				health care provider agreements of provisions making Medicaid first
				payor.
Section 1. No insurer or health
			 care provider shall write or issue any policy or certificate of coverage
			 provision which has the effect of limiting or excluding its obligation to pay
			 on a claim because the insured is eligible for or is provided medical
			 assistance under the provisions of title XIX of the Social Security Act
			 (Medicaid).
Section 2. No insurer
			 or health care provider shall deny or cancel a policy of insurance or
			 certificate of coverage on the basis that the insured or enrollee is a
			 recipient of medical assistance benefits under title XIX of the Social Security
			 Act (Medicaid).
STATUTORY AUTHORITY:
				  KRS
				  304.2-110
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 17 - Health Insurance Contracts › Section 806 KAR 17:070 - Filing procedures for health insurance rates

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				304.14-120,
				304.14-130,
				304.17-380,
				304.17A-005(22)
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 provision of the Kentucky Insurance
				Code as defined in
				KRS
				304.1-010. This administrative regulation
				establishes additional filing procedures for health insurance rates.
Section 1. Definitions.
(1) "Accumulated value" means the amount of
			 which a sum of money would have increased as of the valuation date, if invested
			 at a specific date in the past, subject to the investment earnings attributable
			 to the policies.
(2) Insurer is
			 defined by
			 KRS
			 304.1-040.
(3) "Loss ratio" means the ratio of the sum
			 of incurred losses divided by the earned premiums.
(4) "Present value" means the amount of money
			 needed as of the valuation date to produce, when accumulated at interest, a
			 specified amount on a specific future date. The "present value of future
			 benefits" and "present value of future premiums" are the sums of those values
			 that take into account not only the interest assumption, but the assumed
			 persistency and mortality of the business.
(5) "Qualified actuary" means a member of the
			 American Academy of Actuaries, a fellow or associate of the Society of
			 Actuaries, the Institute of Actuaries, the Faculty of Actuaries, the Casualty
			 Actuarial Society, or a fellow or member of the Conference of Actuaries in
			 Public Practice that is compliant with continuing professional development in
			 the area of health insurance.
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 17 - Health Insurance Contracts › Section 806 KAR 17:083 - Kentucky long-term care partnership insurance program

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.619,
				304.14-120,
				304.14-600
				- 304.14-644, 42 C.F.R. sec. 1396p(b), 73 F.R. 30030, 51302
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 provision of the Kentucky Insurance
				Code, as defined in
				KRS
				304.1-010.
				KRS
				304.14-642(5) requires the
				Department of Insurance to promulgate an administrative regulation to implement
				the Kentucky Long-Term Care Partnership Insurance Program and to establish the
				manner and content of a disclosure, in coordination with the Cabinet for Health
				and Family Services. EO 2008-507, effective June 16, 2008, established the
				Department of Insurance and the Commissioner of Insurance as the head of the
				department. This administrative regulation defines terms and establishes
				requirements for long-term care partnership insurance, including a life
				insurance policy with a long-term care partnership insurance rider, notice,
				disclosure, policy exchange, training of an agent, reciprocity of a long-term
				care partnership insurance policy, and reporting long-term care benefits under
				a long-term care partnership insurance policy.
Section 1. Definitions.
(1) "Agent" is defined by
			 KRS
			 304.9-020(1).
(2) "Asset disregard" is defined by
			 KRS
			 304.14-640(1).
(3) "Commissioner" means the Commissioner of
			 Insurance.
(4) "Department" means
			 the Department of Insurance.
(5)
			 "Eligible policyholder" means a policyholder of a long-term care insurance
			 policy, which:
(a) Was issued by the insurer
			 on or after:
1. January 16, 2003, for a
			 policyholder in the individual market; or
2. July 16, 2003, for a policyholder in the
			 group market; and
(b)
			 Meets the requirements of long-term care partnership insurance as established
			 in:
1.
											KRS
			 304.14-642(2)(a) through
			 (c); and
2. Section 2(2)(d) of this administrative
			 regulation.
(6) "Federally tax-qualified" is defined by
			 806
			 KAR 17:081, Section 1(27).
(7) "Kentucky Long-Term Care Partnership
			 Insurance Program" or "Partnership Insurance Program" is defined by
			 KRS
			 304.14-640(2).
(8) "Long-term care insurance" is defined by
			 KRS
			 304.14-600(2).
(9) "Long-term care partnership insurance" is
			 defined by
			 KRS
			 304.14-640(4).
(10) "Medicaid" means coverage in accordance
			 with Title XIX of the Social Security Act,
			 42 U.S.C. secs.
			 1396 et seq., as amended.
(11) "Partnership exchange" means an exchange
			 between an insurer and the insurer's eligible policyholder of an existing
			 long-term care insurance policy, certificate, or rider for a long-term care
			 partnership insurance policy, certificate, rider, or endorsement with
			 substantially similar benefits.
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 17 - Health Insurance Contracts › Section 806 KAR 17:085 - Minimum standards for short-term nursing home insurance policies

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				304.6-070,
				304.6-130,
				304.6-180,
				304.12-010,
				304.12-020,
				304.14-650-304.14-675,
				304.17-080
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 provision of the Kentucky Insurance
				Code as defined in
				KRS
				304.1-010.
				KRS
				304.14-660 requires the Commissioner of
				Insurance to promulgate administrative regulations to establish the
				requirements for short-term nursing home insurance policies. This
				administrative regulation establishes the minimum standards for short-term
				nursing home insurance policies.
Section
			 1. Definitions.
(1) "Applicant"
			 means:
(a) For an individual short-term
			 nursing home insurance policy, the person who seeks to contract for benefits;
			 and
(b) For a group short-term
			 nursing home insurance policy, the proposed certificate holder.
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 17 - Health Insurance Contracts › Section 806 KAR 17:095 - Reimbursement for general anesthesia and facility charges for dental procedures (Repealed)

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				304.17A-149
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 in
				KRS
				304.1-010. This administrative regulation
				establishes definitions and guidelines for an insurer's reimbursement of
				general anesthesia and facility charges associated with dental
				procedures.
Section 1. Definitions.
(1) "Health benefit plan" is defined in
			 KRS
			 304.17A-005(22).
(2) "Insurer" is defined in
			 KRS
			 304.17A-005(27).
(3) "Serious mental condition" or
			 "significant behavioral problem" means a condition:
(a) Identified by a diagnostic code from the
			 most recent edition of the:
1. International
			 Classification of Diseases-Clinical Modification, ICD-9-CM, including only
			 diagnosis codes ranging from 290 through 299.9, 300 through 316, and 317
			 through 319; or
2. Diagnostic and
			 Statistical Manual of Mental Disorders, DSM-IV; and
(b) In a person whose:
1. Inability to cooperate during dental care
			 by a dentist performed in a location other than a hospital or ambulatory
			 surgical facility can reasonably be inferred from the person's diagnosis and
			 medical history; or
2. Airway,
			 breathing, or circulation of blood may be compromised during dental care by a
			 dentist performed in a location other than a hospital or ambulatory surgical
			 facility.
(4)
			 "Serious physical condition" means a disease or condition requiring on-going
			 medical care that may cause compromise of the airway, breathing, or circulation
			 of blood during dental care by a dentist performed in a location other than a
			 hospital or ambulatory surgical facility.
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 17 - Health Insurance Contracts › Section 806 KAR 17:150 - Health benefit plan rate filing requirements

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				304.1-050,
				304.3-270,
				304.4-010,
				304.17A-005,
				304.17A-095,
				304.17A-0952,
				304.17A-0954,
				304.17A-750,
				304.17A-764,
				304.17A-834,
				304.17B-021,
				304.17B-023(3)
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 provision of the Kentucky Insurance
				Code, as defined in
				KRS
				304.1-010.
				KRS
				304.17A-095(7) authorizes
				the commissioner to promulgate an administrative regulation to obtain relevant
				information for health benefit plan rate filings and establish the format of
				the filing. This administrative regulation establishes the format and procedure
				for the submission of a health benefit plan rate filing.
Section 1. Definitions.
(1) "Base premium rate" is defined by
			 KRS
			 304.17A-005(3).
(2) "Class of business" means all or a
			 distinct grouping of small employers or individuals as shown on the records of
			 the small employer or individual insurance carrier.
(3) "Commissioner" is defined by
			 KRS
			 304.1-050(1).
(4) "Date of filing" means the date the
			 department confirms that the appropriate filing fee and all information
			 required by this administrative regulation have been received by the
			 department.
(5) "Department" is
			 defined by
			 KRS
			 304.1-050(2).
(6) "Duration" means a policy year of twelve
			 (12) months, measured from the date of issuance of a policy, with each
			 succeeding twelve (12) month period being a new duration.
(7) "Employer-organized association" is
			 defined by 304.17A-005(12).
(8)
			 "FFS" means a fee for service product type.
(9) "Health benefit plan" is defined by
			 KRS
			 304.17A-005(22).
(10) "Health benefit plan region" or
			 "geographic region" means each one (1) of the eight (8) allowable rating
			 regions for health benefit plans identified in HIPMC-R33, Health Benefit Plan
			 Regions.
(11) "HMO" means a health
			 maintenance organization product type.
(12) "Index rate" is defined by
			 KRS
			 304.17A-005(27).
(13) "Large group" is defined by
			 KRS
			 304.17A-005(32).
(14) "Material change" means any change to a
			 rate filing, except that a change in value of an existing rate factor other
			 than trend is not be considered a material change.
(15) "POS" means a point of service product
			 type.
(16) "PPO" means a preferred
			 provider organization product type.
(17) "Small group" is defined by
			 KRS
			 304.17A-005(45).
(18) "Target loss ratio" means a loss ratio
			 that an insurer files, that projects and guarantees a loss ratio on an annual
			 basis.
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 17 - Health Insurance Contracts › Section 806 KAR 17:160 - Creditable coverage for health insurance

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				304.17A-005(8),
				304.17A-220(4),
				26 C.F.R.
				54.9801-1,
				26
				C.F.R. 54.9801-2,
				26 C.F.R.
				54.9801-5,
				45 C.F.R.
				146.113,
				45 C.F.R.
				146.113,
				42 U.S.C.
				300gg
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				304.2-110(1) authorizes the
				commissioner to promulgate administrative regulations necessary for or as an
				aid to the effectuation of any provision of the Kentucky Insurance Code as
				defined in
				KRS
				304.1-010.
				KRS
				304.17A-220(7)(b) authorizes
				the commissioner to specify how periods of creditable coverage shall be
				certified. This administrative regulation establishes the form that shall be
				used by insurers for certification of periods of creditable coverage.
Section 1. Definitions.
(1) "Creditable coverage" is defined in
			 KRS
			 304.17A-005(8).
(2) "Health benefit plan" is defined in
			 KRS
			 304.17A-005(22).
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 17 - Health Insurance Contracts › Section 806 KAR 17:180 - Standard health benefit plan

Current through Register Vol. 51, No. 1, July 1, 2024
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.
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 17 - Health Insurance Contracts › Section 806 KAR 17:190 - Guaranteed Acceptance Program requirements

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				304.17A-210(5)(b),
				304.17A-420,
				304.17A-430
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				304.2-110 authorizes the commissioner to
				promulgate administrative regulations to implement the Insurance Code.
				KRS
				304.17A-210(5)(b) requires
				the commissioner to promulgate administrative regulations establishing
				equitable enrollment limits for new market insurers for the first twelve (12)
				months and a remaining portion of the calendar year after expiration of a
				twelve (12) month period. This administrative regulation establishes the limits
				and requirements of a new market insurer.
Section
			 1. Definitions.
(1) "Alternative
			 underwriting mechanism" or "AUM" is defined in
			 KRS
			 304.17A-430(3).
(2) "Commissioner" is defined by
			 KRS
			 304.1-050
(3) "GAP health benefit plan" means a health
			 benefit plan issued to an individual with a high-cost condition or to an
			 individual meeting the AUM criteria.
(4) "GAP participant" means a GAP qualified
			 individual defined in
			 KRS
			 304.17A-005(15) who has been
			 issued a GAP health benefit plan.
(5) "GAP participating insurer" is defined by
			 KRS
			 304.17A-005(12).
(6) "GAP qualified individual" is defined by
			 KRS
			 304.17A-005(15).
(7) "Guaranteed Acceptance Program" or "GAP"
			 is defined in
			 KRS
			 304.17A-005(14).
(8) "High-cost condition" is defined by
			 KRS
			 304.17A-005(19).
(9) "Mandatory GAP participating insurer"
			 means a health insurer in Kentucky that has twenty-five (25) percent or more of
			 the market share and is required to be a GAP participating insurer.
(10) "New market insurer" means an insurer
			 that enters the individual health market as a voluntary GAP participating
			 insurer in Kentucky on or after July 1, 1998.
(11) "New market period" means a period
			 extending twelve (12) months from the date a new market insurer enters the
			 individual health insurance market in Kentucky, and includes the remainder of
			 the calendar year after the twelve (12) month period expires.
(12) "Voluntary GAP participating insurer"
			 means a health insurer that has less than twenty-five (25) percent of the
			 market share and elects to be a GAP participating insurer.
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 17 - Health Insurance Contracts › Section 806 KAR 17:230 - Requirements regarding medical director's signature on health care benefit denials

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				304.17A-540,
				304.17A-545,
				304.17A-600
				- 304.17A-619
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				304.2-110(1) authorizes the
				Commissioner to promulgate reasonable administrative regulations necessary for,
				or as an aid to, the effectuation of any provision of the Kentucky Insurance
				Code, as defined in
				KRS
				304.1-010. This administrative regulation
				establishes the procedure to be followed when a medical director's signature is
				required on health care benefit denials.
Section
			 1. Definitions.
(1) "Adverse
			 determination" is defined by
			 KRS
			 304.17A-600(1).
(2) "Coverage denial" is defined by
			 KRS
			 304.17A-617(1).
(3) "Electronic signature" is defined by
			 KRS
			 369.102(8).
(4) "Enrollee" is defined by
			 KRS
			 304.17A-500(5).
(5) "Managed care plan" is defined by
			 KRS
			 304.17A-500(9).
(6) "Medical director" means a person meeting
			 the requirements of
			 KRS
			 304.17A-545(1), and includes
			 a medical director of an entity under contract and delegated to perform
			 utilization review on behalf of a managed care plan.
(7) "Notice of coverage denial" means a
			 letter, a notice, or an Explanation of Benefits statement advising of a
			 coverage denial as defined by
			 KRS
			 304.17A-617(1).
(8) "Signature" means name, title, state of
			 licensure and license number.
(9)
			 "Utilization review" is defined by
			 KRS
			 304.17A-600(17).
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 17 - Health Insurance Contracts › Section 806 KAR 17:240 - Data reporting requirements

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				304.17A-005,
				304.17A-320,
				304.17A-330,
				304.17A-750
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				304.2-110(1) authorizes the
				commissioner to promulgate reasonable administrative regulations necessary for,
				or as an aid to, the effectuation of any provision of the Kentucky Insurance
				Code as defined in
				KRS
				304.1-010.
				KRS
				304.17A-330 authorizes the commissioner to
				prescribe the format for reporting the information required by
				KRS
				304.17A-330. This administrative regulation
				establishes the data elements and the format for submitting annual reports to
				the Department of Insurance.
Section
			 1. Definitions.
(1)
			 "Association" is defined by
			 KRS
			 304.17A-005(1).
(2) "Electronic format" means an electronic
			 copy of a Microsoft Excel Spreadsheet.
(3) "Health benefit plan" means a health
			 benefit plan as defined by
			 KRS
			 304.17A-005(22) and issued
			 within Kentucky to a Kentucky resident.
(4) "Insurance purchasing outlet" is defined
			 by
			 KRS
			 304.17A-750(4).
(5) "Insurer" is defined by
			 KRS
			 304.17A-005(29).
(6) "Market segment" means the portion of the
			 market covering one (1) of the following:
(a)
			 Individual;
(b) Small
			 group;
(c) Large group;
(d) Group association;
(e) Individual association;
(f) Self-insured employer-organized
			 association; or
(g) Insurance
			 purchasing outlet.
(7)
			 "Medical service" means the service that was provided by a health care provider
			 to a member of a health benefit plan.
(8) "Member" means a covered person, as
			 defined by
			 KRS
			 304.17A-500(3).
(9) "Member month" means a period of time
			 that represents each month that a member or subscriber, depending upon the data
			 request, is enrolled in a health benefit plan.
(10) "Self-insured employer-organized
			 association" means an association that holds a certificate of filing pursuant
			 to
			 KRS
			 304.17A-320.
(11) "Subscriber" means the following:
(a) In the individual market, the number of
			 health benefit plan policyholders; or
(b) In the small group, large group,
			 individual association, group association, self-insured employer-organized
			 association, or insurance purchasing outlet market, the number of health
			 benefit plan certificate holders.
(12) "Total unduplicated covered persons"
			 means the total number of subscribers and their dependents covered by a health
			 benefit plan at any time during the reporting year.
Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 17 - Health Insurance Contracts › Section 806 KAR 17:250 - Notification requirements for drug benefits

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				304.17A-505,
				304.17A-535
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				304.2-110(1) authorizes the
				commissioner to promulgate administrative regulations necessary for or as an
				aid to the effectuation of any provision of the Kentucky Insurance Code, as
				defined in
				KRS
				304.1-010.
				KRS
				304.17A-565 requires the commissioner to
				enforce and carry out the provisions of
				KRS
				304.17A-500 to
				304.17A-570
				by promulgating necessary administrative regulations. This administrative
				regulation establishes notification requirements of a managed care plan if a
				prescription medication is removed from its drug formulary, a supply amount of
				a prescription is changed, or prior authorization is added for a prescription
				medication.
Section 1. Definitions.
(1) "Drug formulary" means a list of
			 prescription medications preferred for use by a managed care plan and dispensed
			 through a participating pharmacy to an enrollee.
(2) "Enrollee" is defined in
			 KRS
			 304.17A-500(5).
(3) "Maintenance prescription medication"
			 means a prescription drug
(a) For which a
			 managed care plan receives no less than:
1.
			 Three (3) claims for a thirty (30) day supply within a four (4) month period of
			 time; or
2. One (1) claim for a
			 ninety (90) day supply within a six (6) month period of time, including a mail
			 order prescription; and
(b) That is required for maintenance therapy
			 as determined by the prescribing provider.
(4) "Managed care plan" is defined in
			 KRS
			 304.17A-500(9).