Kentucky Administrative Regulations › Title 806 - PUBLIC PROTECTION CABINET - DEPARTMENT OF INSURANCE › Chapter 17 - Health Insurance Contracts › Section 806 KAR 17:005 - Health insurance forms and reports

Current through Register Vol. 51, No. 1, July 1, 2024
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.