KRS 304.38-050: Evidence of coverages and charges for health care service -- Exception.

(1) No health maintenance organization shall deliver or issue for delivery in this state

any contract describing health benefits available, or any endorsement, rider, or

application which becomes a part thereof, or any amendments thereto or

modifications thereof, or the schedule of fees or other periodic charges to be paid by

enrollees, until a copy of the form has been filed with and approved by the

commissioner. Each form shall contain a complete and clear statement of:

(a) The health care services to which the enrollee is entitled;

(b) Any limitations on the services, kind of services, or benefits to be provided,

including any deductible or copayment feature;

(c) Where and in what manner information is available as to how services may be

obtained; and

(d) Any other provisions pertaining to the delivery of health care services.

Any schedule of fees or other periodic charges to be paid by enrollees submitted to

and filed with the commissioner along with adequate supporting information to

show that the charg es or fees are not excessive, inadequate, or unfairly

discriminatory.

(2) At the expiration of sixty (60) days, the form so filed shall be deemed approved

unless prior thereto it has been affirmatively approved or disapproved by order of

the commissioner, or a hearing has been scheduled by order of the commissioner. In

the event that a hearing is held, the sixty (60) day waiting period shall begin anew

after the close of the hearing. Approval of the form by the commissioner shall

constitute a waiver of any unexpired portion of the waiting period. The

commissioner may extend by not more than an additional thirty (30) day period

within which he or she may affirmatively approve or disapprove the form by giving

notice to the insurer of the extension before expir ation of the initial sixty (60) day

period. At the expiration of the period as so extended, and in the absence of the

prior affirmative approval or disapproval, the form shall be deemed approved. The

commissioner may at any time withdraw the approval.

(3) This section shall not apply to rate filings made under Subtitle 17A of this chapter.