KRS 304.17A-410: Definitions for KRS 304.17A-400 to 304.17A-480.

As used in KRS 304.17A-400 to 304.17A-480, unless the context requires otherwise:

(1) "Actual guaranteed acceptance program plan losses" means a dollar amount

calculated by subtracting an insurer's guaranteed acceptance program plan claims

from that insurer's guaranteed acceptance program plan premiums;

(2) "Benefits" means amounts paid by an insurer to covered lives or to third parties for

the benefit of covered lives. "Benefits" do not include an insurer's administrative

costs, any assessments under the p lan, allocated loss adjustment expenses, reserves,

or other overhead costs;

(3) "Guaranteed acceptance program plan claims" or "alternative underwriting

mechanism losses" means the dollar amount of benefits actually paid by an insurer

on behalf of a guaran teed acceptance plan enrollee for claims that were incurred

while the individual was a guaranteed acceptance program plan enrollee or another

claim measurement formula as the department may establish by administrative

regulation to measure an insurer's cos ts, other than administrative costs, allocated

loss adjustment expenses, reserves, or other overhead costs, with respect to a

program plan;

(4) "Guaranteed acceptance program plan premiums" means the dollar amount of

premiums received by an insurer with respect to program plans;

(5) "Guaranteed acceptance risk adjustment process" means the process of allocating

guaranteed acceptance program plan losses provided for in KRS 304.17A-460;

(6) "Group market" means the health insurance market under which individu als obtain

health insurance coverage, directly or through any arrangement, on behalf of

themselves and their dependents through a group health plan or through any

arrangement other than through the individual market, or through a federal health

benefit plan or program;

(7) "Health insurance stop -loss policy" means any policy of insurance that directly or

indirectly protects, in whole or in part, an employer who self -insures health benefits

covering any residents in Kentucky from the risk of paying benefits in excess of any

specified amount;

(8) "Market share" means a percentage calculated by dividing an insurer's health

insurance coverage premiums in both the individual and group markets by the total

amount of the health insurance coverage premiums in both t he individual and group

markets for all insurers;

(9) "Other coverage" means coverage under any of the following:

(a) A group plan;

(b) Part A or Part B of Title XVIII of the Social Security Act, 42 U.S.C. secs.

1995c et seq.;

(c) A state plan under Title XIX of the Social Security Act, or any successor

program;

(d) Continuation coverage under any COBRA continuation provisions as defined

in 42 U.S.C. sec. 300gg -91(d)(4) or under a similar program under any state

law; or

(e) Any other health insurance coverage which is not individual health insurance

coverage;

(10) "Premiums" means amounts paid to insurers to purchase health insurance coverage

and includes all amounts paid however denominated, including, but not limited to,

amounts indicated as being charged for administrative costs, allocated loss

adjustment expenses, reserve or other overhead costs;

(11) "Program" means the Kentucky Guaranteed Acceptance Program;

(12) "Refund" means an amount to be paid to an insurer by the program;

(13) "Stop-loss carrier" means any person providing health insurance stop-loss coverage;

(14) "Stop-loss premiums" means amounts paid to purchase health insurance stop -loss

coverage; and

(15) "Total actual guaranteed acceptance program plan losses" means a dollar amount

equal to the sum of the actual program plan losses of all insurers participating in the

program.