Kentucky Code — 38715
Browse 227 sections in division 38715 of the Kentucky code. Each section page includes the full statutory text, official source links, and citation guidance.
Sections (showing up to 300)
- § 38715.17A. 005 Definitions for subtitle.
- § 38715.17A. 008 Application of subtitle.
- § 38715.17A. 010 Repealed, 1998.
- § 38715.17A. 020 Repealed, 1998.
- § 38715.17A. 030 Repealed, 1998.
- § 38715.17A. 040 Repealed, 1998.
- § 38715.17A. 050 Repealed, 1998.
- § 38715.17A. 060 Repealed, 1998.
- § 38715.17A. 070 Repealed, 1998.
- § 38715.17A. 071 Repealed, 2010.
- § 38715.17A. 080 Health Insurance Advisory Council -- Powers -- Duties -- Members -- Expenses and supplies.
- § 38715.17A. 090 Repealed, 1998
- § 38715.17A. 095 Insurer issuing health benefit plan must file rates and charges -- Commissioner's approval -- Policy forms -- Administrative regulations -- Hearing.
- § 38715.17A. 0952 Premium rate guidelines for individual, small group, and association plans.
- § 38715.17A. 0954 Premium rate guidelines for employer-organized association plans.
- § 38715.17A. 096 Basic health benefit plans permitted for individual, small group, and association markets -- Required coverage -- Exclusions from coverage.
- § 38715.17A. 097 Disclosure of coverage levels in basic health benefit plan.
- § 38715.17A. 098 Rewards or incentives to participate in voluntary wellness or health improvement program.
- § 38715.17A. 099 Qualified health plans -- Effect of requirement that state make payments under federal law to defray the cost of application of provision of chapter -- Administrative regulations.
- § 38715.17A. 100 Repealed, 1998.
- § 38715.17A. 110 Repealed, 1998.
- § 38715.17A. 120 Repealed, 1998.
- § 38715.17A. 128 Coverage for prostheses and orthoses -- Utilization review decision -- Denial letter -- Network adequacy -- Reports. (Effective January 1, 2027)
- § 38715.17A. 129 Coverage for stuttering.
- § 38715.17A. 130 Repealed, 1998.
- § 38715.17A. 131 Coverage for cochlear implants.
- § 38715.17A. 132 Coverage for hearing aids. (Effective until January 1, 2027)
- § 38715.17A. 132 Coverage for hearing aids. (Effective January 1, 2027)
- § 38715.17A. 133 Coverage for mammograms -- Prohibition on cost-sharing requirements for covered diagnostic breast examinations or supplemental breast examinations.
- § 38715.17A. 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.
- § 38715.17A. 135 Coverage for treatment of breast cancer.
- § 38715.17A. 136 Coverage for cancer clinical trials.
- § 38715.17A. 137 Repealed, 2002.
- § 38715.17A. 138 Telehealth coverage and reimbursement -- Requirements for health benefit plan -- Reimbursement for rural health clinics, federally qualified health centers, and federally qualified health center look-alikes -- Benefits subject to deductible, copayment, or coinsurance -- Payment subject to provider network arrangements -- Audio-only encounters -- Administrative regulations.
- § 38715.17A. 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.
- § 38715.17A. 140 Coverage applicable to children to include legally-adopted children.
- § 38715.17A. 141 Repealed, 2019.
- § 38715.17A. 142 Coverage for autism spectrum disorders -- Limitations on coverage -- Utilization review -- Reimbursement not required.
- § 38715.17A. 143 Repealed, 2019.
- § 38715.17A. 144 Liaison for autism spectrum disorders treatment benefits.
- § 38715.17A. 145 Maternity coverage to include specified services and amounts of inpatient care for mothers and newly born children -- Exemption.
- § 38715.17A. 146 Coverage for registered nurse first assistant.
- § 38715.17A. 147 Coverage for surgical first assisting or intraoperative surgical care to include services performed by certified surgical assistant.
- § 38715.17A. 1473 Coverage for surgical first assisting or intraoperative surgical care to include services performed by certified surgical assistant or physician assistant.
- § 38715.17A. 148 Coverage for diabetes -- Cap on cost-sharing requirements for insulin.
- § 38715.17A. 149 Coverage for anesthesia and services in connection with dental procedures for certain patients.
- § 38715.17A. 150 Unfair trade practices -- Penalties.
- § 38715.17A. 155 Prohibition against denial of coverage to victims of domestic violence.
- § 38715.17A. 160 Repealed, 1998.
- § 38715.17A. 161 Definitions for KRS 304.17A-161, 304.17A-162, 304.17A-163, and 304.17A-165.
- § 38715.17A. 162 Identification of sources used to calculate drug product reimbursement -- Process to appeal disputes over maximum allowable cost pricing -- Adjustment of maximum allowable cost and drug product reimbursement -- Duties of pharmacy benefit manager.
- § 38715.17A. 163 Definitions for KRS 304.17A-163 and 304.17A-1631 -- Establishment of clinical review criteria -- Override of restrictions on medication sequence in step therapy or fail-first protocol.
- § 38715.17A. 1631 Administrative regulations -- Requirement of annual report to commissioner.
- § 38715.17A. 164 Limitations on insurers and pharmacy benefit managers regarding cost-sharing for prescription drugs -- Exceptions.
- § 38715.17A. 165 Prescription drug coverage to include exceptions or override policy for refills of covered drugs -- Limitations and exclusions -- Program for synchronization of medications.
- § 38715.17A. 166 Prescription eye drops coverage to include refills and additional bottle if conditions met.
- § 38715.17A. 167 Processes and standards for electronic prior authorizations -- Prior authorization of drugs for ongoing medication therapy -- Requirements -- Time span of authorization -- Exemptions.
- § 38715.17A. 168 Coverage for tobacco cessation medications and services.
- § 38715.17A. 170 Definitions for KRS 304.17A-170 and 304.17A-171.
- § 38715.17A. 171 Requirements for health benefit plans that include chiropractic benefits.
- § 38715.17A. 172 Requirements for health benefit plans that include anticancer medications that are injected or intravenously administered by a health care provider and patient-administered anticancer medications.
- § 38715.17A. 173 Reimbursement for services within scope of practice of optometrists -- Terms and conditions.
- § 38715.17A. 175 Limitation on amount of copayment or coinsurance charged for services rendered by chiropractor or optometrist.
- § 38715.17A. 177 Limitation on amount of copayment or coinsurance charged for services rendered by occupational or physical therapist -- Insurer to clearly state coverage.
- § 38715.17A. 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.
- § 38715.17A. 210 Repealed, 2000.
- § 38715.17A. 220 Pre-existing condition exclusion in group coverage -- Definitions for section.
- § 38715.17A. 230 Pre-existing condition exclusion in individual market -- Prohibition against use of genetic information -- Administrative regulations.
- § 38715.17A. 235 Notice of proposed material change in health benefit plan's agreement with participating provider.
- § 38715.17A. 240 Renewal or continuation -- Ground for nonrenewal, cancellation, or discontinuance.
- § 38715.17A. 243 Grace period for unpaid premiums.
- § 38715.17A. 245 Required notice of cancellation -- Procedure -- Refund of unearned premium.
- § 38715.17A. 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.
- § 38715.17A. 252 Health benefit plan not required to include state-mandated benefits enacted after issuance.
- § 38715.17A. 254 Duties of insurer offering health benefit plan.
- § 38715.17A. 255 Definition of "cost sharing" and "plan year" -- Payments from specified federal programs on behalf of an insured count toward insured's premium and cost-sharing requirement -- Payments made by any person on behalf of insured permissible -- Exceptions -- Insured's responsibility towards premium payments.
- § 38715.17A. 256 Options for dependent coverage under group health benefit plans -- Disclaimer.
- § 38715.17A. 257 Coverage under health benefit plan for colorectal cancer examinations and laboratory tests.
- § 38715.17A. 258 Coverage under health benefit plan for therapeutic food, formulas, supplements, low-protein modified food products, and amino acid-based elemental formula.
- § 38715.17A. 259 Coverage under health benefit plan for genetic test for cancer risk.
- § 38715.17A. 260 Repealed, 2002.
- § 38715.17A. 261 Coverage under health benefit plan for oocyte and sperm preservation services.
- § 38715.17A. 262 Coverage for orchiectomy or orchidectomy as treatment for urological cancers.
- § 38715.17A. 263 Coverage under health benefit plan for biomarker testing.
- § 38715.17A. 264 Coverage under health benefit plan for cancer screening, test, or procedure.
- § 38715.17A. 265 Insurer may not restrict assignment of benefits to substance abuse or mental health facility -- Exceptions -- Requirements for assignment -- Construction.
- § 38715.17A. 270 Nondiscrimination against provider in geographic coverage area.
- § 38715.17A. 275 Health benefit plan not to discriminate against physician on basis of degree in medicine or osteopathy.
- § 38715.17A. 280 Repealed, 2000.
- § 38715.17A. 290 Prohibition against renewal of nonstate employees and small groups under KRS 18A.2251 or 18A.2281.
- § 38715.17A. 300 Provider-sponsored integrated health delivery network -- Qualifications -- Fees -- Network subject to provisions of other subtitles.
- § 38715.17A. 310 Financial solvency requirements for network.
- § 38715.17A. 320 Certificate of filing for employer-organized association -- Effect -- Revocation.
- § 38715.17A. 330 Health insurance reporting requirements -- Exemption.
- § 38715.17A. 340 Restrictions on use of Kentucky Children's Health Insurance Program allocated funds.
- § 38715.17A. 350 Repealed, 2002.
- § 38715.17A. 400 Repealed, 2000.
- § 38715.17A. 410 Definitions for KRS 304.17A-400 to 304.17A-480.
- § 38715.17A. 420 Repealed, 2000.
- § 38715.17A. 430 Criteria for program plan -- Alternative underwriting.
- § 38715.17A. 440 Repealed, 2000.
- § 38715.17A. 450 Cost-containment feature requirement for program plans.
- § 38715.17A. 460 Repealed, 2000.
- § 38715.17A. 470 Repealed, 2000.
- § 38715.17A. 480 Repealed, 2000.
- § 38715.17A. 500 Definitions for KRS 304.17A-500 to 304.17A-590.
- § 38715.17A. 505 Disclosure of terms and conditions of health benefit plan -- Filing with department.
- § 38715.17A. 510 Notification by insurer offering managed care plans of availability of printed document.
- § 38715.17A. 515 Requirements for managed care plan.
- § 38715.17A. 520 Enrollee choice of primary care providers.
- § 38715.17A. 525 Standards for provider participation -- Mechanisms for consideration of provider applications -- Policy for removal or withdrawal.
- § 38715.17A. 527 Filing of provider agreements, risk-sharing arrangements, and subcontract agreements with commissioner -- Contents -- Disclosure of financial information not required.
- § 38715.17A. 530 Prohibition against contract limiting disclosure to patient of patient medical condition or treatment options.
- § 38715.17A. 532 Prohibition against contract requiring mandatory use of hospitalist.
- § 38715.17A. 533 Repealed, 2004.
- § 38715.17A. 535 Drug utilization waiver program -- Limitations on generic substitution -- Application to drug formulary.
- § 38715.17A. 540 Disclosure of limitations on coverage -- Denial letter.
- § 38715.17A. 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.
- § 38715.17A. 550 Out-of-network benefits.
- § 38715.17A. 555 Patient's right of privacy regarding mental health or chemical dependency -- Authorized disclosure.
- § 38715.17A. 560 Most-favored-nation provision.
- § 38715.17A. 565 Commissioner to enforce KRS 304.17A-500 to 304.17A-570 -- Administrative regulations.
- § 38715.17A. 570 Applicability of KRS 304.17A-500 to 304.17A-570 for health insurance contracts or certificates.
- § 38715.17A. 575 Definitions for KRS 304.17A-575 to 304.17A-577.
- § 38715.17A. 576 Notice by managed care plan insurer of health care provider's application for credentialing -- Payments to applicant.
- § 38715.17A. 577 Disclosure of payment or fee schedule to managed care plan health care provider -- Disclosure of schedule change -- Confidentiality of payment information.
- § 38715.17A. 578 Renumbered as KRS 304.17A-235.
- § 38715.17A. 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.
- § 38715.17A. 590 Participating provider directories.
- § 38715.17A. 591 Definitions for KRS 304.17A-591 to 304.17A-599.
- § 38715.17A. 593 Requirement to provide reasonably adequate and accessible pharmacy networks -- Annual report to commissioner -- Confidential information not subject to disclosure.
- § 38715.17A. 595 Definitions for section -- Requirements for contract for provision of pharmacy services -- Minimum reimbursements -- Administrative regulations.
- § 38715.17A. 597 Prohibition against certain actions of administrator of pharmacy benefits against pharmacy -- Right of pharmacist to provide information about lower cost alternatives to insured.
- § 38715.17A. 599 Commissioner review of alleged violations of KRS 304.17A-593, 304.17A-595, or 304.17A-597.
- § 38715.17A. 600 Definitions for KRS 304.17A-600 to 304.17A-633.
- § 38715.17A. 603 Application of KRS 304.17A-600 to 304.17A-633 -- Written procedures for coverage and utilization review determinations to be accessible on insurers' Web sites -- Preauthorization review requirements for insurers.
- § 38715.17A. 605 Requirements and procedures for utilization review -- Exception for private review agent operating under contract with the federal government. (Effective January 1, 2028)
- § 38715.17A. 605 Requirements and procedures for utilization review -- Exception for private review agent operating under contract with the federal government. (Effective until January 1, 2028)
- § 38715.17A. 606 Definitions for section -- Prior authorization exemption program -- Program requirements and options. (Effective January 1, 2028)
- § 38715.17A. 6061 Commissioner to report to the Legislative Research Commission on prior authorization exemption program -- Contents of report. (Effective January 1, 2028)
- § 38715.17A. 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.
- § 38715.17A. 609 Emergency administrative regulations governing utilization review and internal appeal to be promulgated by the department.
- § 38715.17A. 611 Prohibition against retrospective denial of coverage for health care services under certain circumstances -- Prohibition against prospective or concurrent review of prescription drug for alcohol or opioid use disorder. (Effective until January 1, 2028)
- § 38715.17A. 611 Prohibition against retrospective denial of coverage for health care services under certain circumstances -- Prohibition against prospective or concurrent review of prescription drug for alcohol or opioid use disorder -- Prohibition against retrospective review based solely on participation in prior authorization exemption program. (Effective January 1, 2028)
- § 38715.17A. 613 Emergency administrative regulations governing registration of insurers and private review agents seeking to conduct utilization reviews -- Procedure for handling complaints.
- § 38715.17A. 615 Prohibition against denying or reducing payments under certain circumstances.
- § 38715.17A. 617 Internal appeals process -- Procedures -- Review of coverage denials.
- § 38715.17A. 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.
- § 38715.17A. 621 Independent External Review Program.
- § 38715.17A. 623 External review of adverse benefit determination -- Who may request -- Criteria for review -- Fee -- Conditions under which covered person not entitled to review -- Resolution of disputes -- Confidentiality -- Expedited external review.
- § 38715.17A. 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.
- § 38715.17A. 627 Certification as independent review entity -- Requirements and restrictions.
- § 38715.17A. 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.
- § 38715.17A. 631 Time for insurers to comply with administrative regulations.
- § 38715.17A. 633 Commissioner to report to Interim Joint Committee on Banking and Insurance and to Governor -- Contents of report.
- § 38715.17A. 640 Definitions for KRS 304.17A-640 et seq.
- § 38715.17A. 641 Treatment of a stabilized covered person with an emergency medical condition in a nonparticipating hospital's emergency room.
- § 38715.17A. 643 Treatment of covered person under special circumstances.
- § 38715.17A. 645 Covered person's access to participating nonprimary care physician specialist.
- § 38715.17A. 647 Covered person's access to participating obstetrician or gynecologist -- Authorization for annual pap smear without referral.
- § 38715.17A. 649 Administrative regulations.
- § 38715.17A. 655 Definitions for KRS 304.17A-655 to 304.17A-659. (Effective January 1, 2027)
- § 38715.17A. 657 Coverage for feeding or eating disorders. (Effective January 1, 2027)
- § 38715.17A. 659 Prohibited standards and permitted factors for coverage of feeding or eating disorder treatments. (Effective January 1, 2027)
- § 38715.17A. 660 Definitions for KRS 304.17A-660 to 304.17A-669.
- § 38715.17A. 661 Treatment of mental health conditions to be covered under terms or conditions that are no more restrictive than terms or conditions for treatment of physical health conditions -- Parity coverage for nonquantitative treatment limitations and medical necessity criteria.
- § 38715.17A. 662 Reimbursement for health benefits delivered through psychiatric collaborative care model -- Exception.
- § 38715.17A. 665 Commissioner to report to Legislative Research Commission on impact of health insurance costs under KRS 304.17A-660 to 304.17A-669.
- § 38715.17A. 669 KRS 304.17A-660 to 304.17A-669 not to be construed as mandating coverage for mental health conditions -- Exemption from KRS 304.17A-660 to 304.17A-669.
- § 38715.17A. 700 Definitions for KRS 304.17A-700 to 304.17A-730 and KRS 205.593, 304.14-135, and 304.99-123.
- § 38715.17A. 702 Claims payment time frames -- Duties of insurer.
- § 38715.17A. 704 Insurer's acknowledgment of receipt of claim -- Inaccurate or insufficient claim information -- Claim status information.
- § 38715.17A. 705 Electronic claims submission.
- § 38715.17A. 706 Contested claims -- Delay of payment -- Conditions -- Procedure.
- § 38715.17A. 708 Resolution of payment errors -- Retroactive denial of claims -- Conditions.
- § 38715.17A. 710 Disclosure of claims payment information to provider.
- § 38715.17A. 712 Claim refunds and overpayments.
- § 38715.17A. 714 Collection of claim overpayments -- Dispute resolution.
- § 38715.17A. 716 Prohibition against denial or reduction of payment for covered health benefit -- Conditions.
- § 38715.17A. 718 Disclosure of claims payment information to covered person.
- § 38715.17A. 720 Administrative regulations for standardized health claim attachments -- Conformity with federal standards.
- § 38715.17A. 722 Administrative regulations on claims payment practices.
- § 38715.17A. 724 Applicability of KRS 304.17A-700 to 304.17A-730 and KRS 205.593, 304.14-135, and 304.99-123.
- § 38715.17A. 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.
- § 38715.17A. 728 Contract disclosures of discounted fees -- Violation is unfair claims settlement practice.
- § 38715.17A. 730 Payment of interest for failing to pay, denying, or settling a clean claim as required.
- § 38715.17A. 732 Annual reports on providers prescribing medication for addiction treatment.
- § 38715.17A. 740 Definitions for KRS 304.17A-740 to 304.17A-743.
- § 38715.17A. 741 Audit of pharmacy records -- Conditions.
- § 38715.17A. 743 Pharmacy audit appeals process.
- § 38715.17A. 745 KRS 304.17A-740 to 304.17A-743 not applicable to audits conducted by state agency pursuant to KRS Chapter 205.
- § 38715.17A. 747 KRS 304.17A-740 to 304.17A-743 not applicable when fraud, willful misrepresentation, or abuse alleged.
- § 38715.17A. 750 Definitions for KRS 304.17A-750 to 304.17A-770 and 304.47-020.
- § 38715.17A. 752 Registration of insurance purchasing outlets -- Licensed agents -- Administrative regulations.
- § 38715.17A. 754 Application -- Approval and issuance of certificate -- Information to be filed -- Administrative regulations.
- § 38715.17A. 756 Denial, suspension, and revocation of application or license -- Civil penalty.
- § 38715.17A. 758 Activities allowed under administrator license -- Financial statements -- Books and records -- Renewal of certificate -- Nontransferability -- Fees.
- § 38715.17A. 760 Duties and powers of insurance purchasing outlet.
- § 38715.17A. 762 Outlet to act as policyholder for member -- Certificate of coverage for each member -- Disclosure to members.
- § 38715.17A. 764 Determination of premiums -- Restrictions in calculation.
- § 38715.17A. 766 Coverage deemed group health insurance -- Requirements for health benefit plans -- Member who no longer meets participation requirements.
- § 38715.17A. 768 Voucher -- Redemption -- Payment of premium amount -- Fee to process voucher -- Administrative regulations.
- § 38715.17A. 770 Provisions applicable to insurance purchasing outlets.
- § 38715.17A. 800 Purpose of KRS 304.17A-800 to 304.17A-844.
- § 38715.17A. 802 Definitions for KRS 304.17A-800 to 304.17A-844.
- § 38715.17A. 804 Applicability of KRS 304.17A-800 to 304.17A-844 -- Self-insured employer-organized association groups.
- § 38715.17A. 806 Certificate of filing required.
- § 38715.17A. 808 Application for certificate of filing -- Fee.
- § 38715.17A. 810 Conditions for issuance of certificate of filing.
- § 38715.17A. 812 Initial and continuing financial solvency requirements.
- § 38715.17A. 814 Notification of change in information.
- § 38715.17A. 816 Investment of funds.
- § 38715.17A. 818 Agent of self-insured employer-organized association group -- Licensing -- Continuing education.
- § 38715.17A. 820 Examination of financial condition, affairs, and management by commissioner.
- § 38715.17A. 822 Appointment of Secretary of State as attorney to receive legal process.
- § 38715.17A. 824 Continuing effectiveness of certificate -- Termination of certificate at request of group -- Merger with another group.
- § 38715.17A. 826 Operation of group by board of trustees -- Powers and duties -- Prohibited acts.
- § 38715.17A. 828 Membership -- Liability on termination of membership, insolvency, or bankruptcy.
- § 38715.17A. 830 Trustees, officers, directors, or employees not to have interest in administrator or group.
- § 38715.17A. 832 Statement of financial condition -- Authority for administrative regulations.
- § 38715.17A. 834 Filing of rates, underwriting guidelines, evidence of coverage, and changes -- Filing fee.
- § 38715.17A. 836 Contribution plans to be established.
- § 38715.17A. 838 Members to receive evidences of coverage -- Contents.
- § 38715.17A. 840 Suspension or revocation of certificate of filing.
- § 38715.17A. 842 Authority for administrative regulations.
- § 38715.17A. 844 Prohibited activities -- Penalties.
- § 38715.17A. 846 Providing of requested information on insureds by group health benefit plan insurers -- Confidentiality -- Additional information to be provided to large groups.