KRS 304.18-110: Continuation of group coverage after termination of membership in

group -- Notice of eligibility.

(1) As used in this section:

(a) "Group policy" means group health insurance policies as defined in KRS

304.18-020 and blanket health insurance polici es which the commissioner, in

his or her discretion, designates as subject to this section, which:

1. Affect the rights of a Kentucky insured and bear a reasonable relation to

Kentucky, regardless of whether delivered or issued for delivery in

Kentucky;

2. Provide hospital or surgical expenses benefits, other than for a specific

disease or accidental injury only; and

3. Are delivered, issued for delivery, or renewed after July 15, 2002;

(b) "Medicare" means Title XVIII of the United States Social Security A ct as

amended or superseded.

(2) Persons insured under group policies have the right upon termination of group

membership to continue coverage for themselves and their dependents upon

meeting the following conditions:

(a) The group member has been covered by the group policy or any group policy

it replaced for at least three (3) months; and

(b) Notice is given to the insurer and payment of the group rate is made to the

insurer, by the group member, within thirty-one (31) days after notice pursuant

to subsection (7) of this section.

(3) Continued group health insurance coverage shall terminate on the earlier of:

(a) The date eighteen (18) months after the date on which the group coverage

would otherwise have terminated because of termination of group

membership;

(b) If the group member fails to make timely payment of premium to the

insurance company, the end of the period for which premium payment was

made; or

(c) The date the group policy is terminated and is not replaced by another group

policy within thirty-one (31) days.

(4) If a group policy is replaced, by a succeeding insurer, persons under the continued

group health insurance shall remain covered under the p rior insurer's policy until it

terminates in accordance with subsection (3) of this section.

(5) The right to continue group health insurance coverage shall also be available:

(a) To the surviving spouse, at the death of the group member, with respect to t he

spouse and such children whose coverage under the group policy would

terminate or terminates by reason of the death of the group member;

(b) To a child solely with respect to himself or herself upon termination of

membership in the group or his or her c overage by reason of operation of the

limiting age of coverage under the group policy while covered as a dependent

thereunder; or

(c) To a former spouse for himself or herself and such children of whom he or she

is awarded custody when coverage under the g roup policy would terminate or

terminates by reason of termination of dependency as defined in the group

policy and resulting from an order dissolving the marriage entered by a court

of competent jurisdiction.

(6) Continuation of group health insurance cov erage need not be granted in the

following situations:

(a) On the effective date of coverage, the applicant is or could be covered by

Medicare;

(b) On the effective date of coverage, the applicant is or could be covered by

another group coverage (insured or uninsured).

(7) Notice of the right to continue group health insurance coverage shall be given as

follows:

(a) For group policies delivered, issued for delivery, or renewed after July 15,

2002, the insurer shall give written notice of the right to continue group health

insurance coverage to any group member entitled to continue coverage under

this section upon notice from the group policyholder that the group member

has terminated membership in the group. The thirty -one (31) day period of

subsection (2)(b) of this section shall not begin to run until the notice required

by this paragraph is mailed or delivered to the last known address of the group

member;

(b) If a group member becomes entitled to obtain continued health insurance

coverage, pursuant to thi s section, and the insurer fails to give the group

member written notice of the right, pursuant to this subsection, the insurer

shall give written notice to the former group member as soon as practicable

after being notified of the insurer's failure to giv e written notice of

continuation rights to the group member and such group member shall have an

additional period within which to exercise continuation or conversion rights.

The additional period shall expire sixty (60) days after written notice is

received from the insurer. Written notice delivered or mailed to the last known

address of the group member shall constitute the giving of notice for the

purpose of this paragraph. If a group member makes application and pays the

premium for continued health insu rance coverage within the additional period

allowed by this paragraph, the effective date of continued health insurance

coverage shall be the date of termination from the group. However, nothing in

this subsection shall require an insurer to give notice or provide continuation

coverage to a former group member ninety (90) days after termination of the

former group member's group coverage.