KRS 304.17A-550: Out-of-network benefits.

(1) An insurer that offers a managed care plan shall offer a health benefit plan with out-

of-network benefits to every contract holder. The plan with out -of-network benefits

shall allow a covered person to receive covered services from out-of-network health

care providers without having to obtain a referral. The plan with out -of-network

benefits may require that an enrollee pre -certify selected services and pay a higher

deductible, copayment, coinsurance, excess charges and higher premium for the

out-of-network benefit plan pursuant to limits established by administrative

regulations promulgated by the department.

(2) If the contract holder elects the out -of-network offering required under subsection

(1) of this section, the insurer shall provide each enrollee with the opportunity at the

time of enrollment and during the annual open enrollment period, to enroll in the

out-of-network option. If the contract holder elects the out -of-network offering

required under subsection (1) of this section, the insurer and the contract holder

shall provide written notice of the benefit plan with out -of-network benefits to each

enrollee in a plan and shall include in that notice a detailed explanation of the

financial costs to be incurred by an enrollee who selects the plan.

(3) The requirement of this section shall not apply to an insurer contract which offers a

managed care plan that provides health care services solely to Medicaid or Medicare

recipients.

(4) Managed care plans currently licensed and doing business in Kentucky that do not

yet offer benefit plans with out -of-network benefits must develop and offer those

plans within three hundred sixty-five (365) days of April 10, 1998.