KRS 304.17B-001: Definitions for subtitle.

As used in this subtitle, unless the context requires otherwise:

(1) "Administrator" is defined in KRS 304.9-051(1);

(2) "Agent" is defined in KRS 304.9-020;

(3) "Assessment process" means the process of assessing and allocating guaranteed

acceptance progr am losses or Kentucky Access funding as provided for in KRS

304.17B-021;

(4) "Authority" means the Kentucky Health Care Improvement Authority;

(5) "Case management" means a process for identifying an enrollee with specific health

care needs and interacting with the enrollee and their respective health care

providers in order to facilitate the development and implementation of a plan that

efficiently uses health care resources to achieve optimum health outcome;

(6) "Commissioner" is defined in KRS 304.1-050(1);

(7) "Department" is defined in KRS 304.1-050(2);

(8) "Earned premium" means the portion of premium paid by an insured that has been

allocated to the insurer's loss experience, expenses, and profit year to date;

(9) "Enrollee" means a person who is enro lled in a health benefit plan offered under

Kentucky Access;

(10) "Eligible individual" is defined in KRS 304.17A-005(11);

(11) "Guaranteed acceptance program" or "GAP" means the Kentucky Guaranteed

Acceptance Program established and operated under KRS 304 .17A-400 to

304.17A-480;

(12) "Guaranteed acceptance program participating insurer" means an insurer that

offered health benefit plans through December 31, 2000, in the individual market to

guaranteed acceptance program qualified individuals;

(13) "Health benefit plan" is defined in KRS 304.17A-005(22);

(14) "High-cost condition" means acquired immune deficiency syndrome (AIDS), angina

pectoris, ascites, chemical dependency, cirrhosis of the liver, coronary insufficiency,

coronary occlusion, cystic fibrosis, Friedreich's ataxia, hemophilia, Hodgkin's

disease, Huntington's chorea, juvenile diabetes, leukemia, metastatic cancer, motor

or sensory aphasia, multiple sclerosis, muscular dystrophy, myasthenia gravis,

myotonia, open -heart surgery, Parkinson's disease, polycystic kidney, psychotic

disorders, quadriplegi a, stroke, syringomyelia, Wilson's disease, chronic renal

failure, malignant neoplasm of the trachea, malignant neoplasm of the bronchus,

malignant neoplasm of the lung, malignant neoplasm of the colon, short gestation

period for a newborn child, and low birth weight of a newborn child;

(15) "Incurred losses" means for Kentucky Access the excess of claims paid over

premiums received;

(16) "Insurer" is defined in KRS 304.17A-005(29);

(17) "Kentucky Access" means the program established in accordance with KRS

304.17B-001 to 304.17B-031;

(18) "Kentucky Access Fund" means the fund established in KRS 304.17B-021;

(19) "Kentucky Health Care Improvement Authority" means the board established to

administer the program initiatives listed in KRS 304.17B-003(5);

(20) "Kentucky Health Care Improvement Fund" means the fund established for receipt

of the Kentucky tobacco master settlement moneys for program initiatives listed in

KRS 304.17B-003(5);

(21) "MARS" means the Management Administrative Reporting System administered by

the Commonwealth;

(22) "Medicaid" means coverage in accordance with Title XIX of the Social Security

Act, 42 U.S.C. secs. 1396 et seq., as amended;

(23) "Medicare" means coverage under both Parts A and B of Title XVIII of the Social

Security Act, 42 U.S.C. secs. 1395 et seq., as amended;

(24) "Office" means the Office of Health Data and Analytics in the Cabinet for Health

and Family Services;

(25) "Pre-existing condition exclusion" is defined in KRS 304.17A-220(6);

(26) "Standard health benefit plan" means a health benefit plan that meets the

requirements of KRS 304.17A-250;

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

(28) "Supporting insurer" means all insurers, stop -loss carriers, and self -insured

employer-controlled or bona fide associations; and

(29) "Utilization management" is defined in KRS 304.17A-500(12).