KRS 304.17A-510: Notification by insurer offering managed care plans of availability of

printed document.

(1) In addition to the disclosure requirements provided in KRS 304.17A-505, an insurer

that offers a managed care plan shall notify an enrollee, in writing, o f the

availability of a printed document, in a manner consistent with KRS 304.14 -420 to

304.14-450, containing the following information at the time of enrollment and

upon request:

(a) A current participating provider directory providing information on a c overed

person's access to primary care health care providers, including available

participating health care providers, by provider category or specialty and by

county. The directory shall include the professional office address of each

participating health care provider. The directory shall also provide information

about participating hospitals and other providers. The insurer shall promptly

notify each covered person on the termination or withdrawal from the insurer's

provider network of the covered person's designated primary care provider;

(b) General information about the type of financial incentives between

participating providers under contract with the insurer and other participating

health care providers and facilities to which the participating prov iders refer

their managed care patients;

(c) The insurer's managed care plan's standard for customary waiting times for

appointments for urgent and routine care; and

(d) The existence of any hold harmless agreements it has with providers and their

effect on the enrollee.

The insurer shall provide a prospective enrollee with information about the provider

network, including hospital affiliations, and other information specified in this

subsection, upon request. In addition to making the information availabl e in a

printed document, an insurer may also make the information available in an

accessible electronic format.

(2) Upon request of a covered person, an insurer shall promptly inform the person:

(a) Whether a particular network provider is board certified; and

(b) Whether a particular network provider is currently accepting new patients.

(3) Each insurer shall annually make available to its enrollees at its principal office and

place of business:

(a) Its most recent annual statement of financial condition i ncluding a balance

sheet and summary of receipts and disbursements; and

(b) A current description of its organizational structure and operation.