{"data":{"id":"us-ky/krs-304.17a-0952","jurisdiction":"us-ky","citation":"KRS 304.17A-0952","heading":"Premium rate guidelines for individual, small group, and association","body":"plans.\nPremium rates for a health benefit plan issued or renewed to an individual, a small group,\nor an association on or after April 10, 1998, shall be subject to the following provisions:\n(1) The premium rates charged during a rating period to an individual with similar case\ncharacteristics for the same coverage, or the rates that could be charged to that\nindividual under the rating system for that class of business, shall not vary from the\nindex rate by more than thirty -five percent (35%) of the index rate upon any policy\nissuance or renewal, on or after January 1, 2003.\n(2) Notwithstanding the thirty -five percent (35%) variance limitation in subsection (1)\nof this section, ins urers offering an individual health benefit plan that is state -\nelected under sec. 35(e)(1)F of the Trade Act of 2002, Pub. L. No. 107 -210 sec.\n201, may vary from the index rate by more than thirty -five percent (35%) for\nindividuals who are eligible for the  health coverage tax credit under the following\nconditions:\n(a) The insurer certifies that the individual does not meet the insurer's\nunderwriting guidelines for issuance of an individual policy;\n(b) The policy meets the requirements for state -elected coverage under the Trade\nAct of 2002; and\n(c) The premium rate is actuarially justified and has been approved by the\nDepartment of Insurance pursuant to KRS 304.17A-095.\n(3) The percentage increase in the premium rate charged to an individual for a new\nrating period shall not exceed the sum of the following:\n(a) The percentage change in the new business premium rate measured from the\nfirst day of the prior rating period to the first day of the new rating period. In\nthe case of a class of business for which the insurer is not issuing new\npolicies, the insurer shall use the percentage change in the base premium rate;\n(b) Any adjustment, not to exceed twenty percent (20%) annually and adjusted\npro rata for rating periods of less than one (1) year, due to the claim\nexperience, mental and physical condition, including medical condition,\nmedical history, and health service utilization, or duration of coverage of the\nindividual and dependents as determined from the insurer's rate manual for the\nclass of business; and\n(c) Any adjustment due to change in coverage or change in the case\ncharacteristics of the individual as determined from the insurer's rate manual\nfor the class of business.\n(4) The premium rates charged during a rating period to a small group or to an\nassociation member with similar case characteristics for the same coverage, or the\nrates that could be charged to that small group or that association member under the\nrating system for that class of business, shall not vary from the index rate by more\nthan fifty percent (50%) of the index rate.\n(5) The percentage increase in the premium rate charged to a small group or to an\nassociation member for a new rating period shall not exceed the sum of the\nfollowing:\n(a) The percentage change in the new business premium  rate measured from the\nfirst day of the prior rating period to the first day of the new rating period. In\nthe case of a class of business for which the insurer is not issuing new\npolicies, the insurer shall use the percentage change in the base premium rate;\n(b) Any adjustment, not to exceed twenty percent (20%) annually and adjusted\npro rata for rating periods of less than one (1) year, due to the claims\nexperience, mental and physical condition, including medical condition,\nmedical history, and health service ut ilization, or duration of coverage of the\nemployee, association member, or dependents as determined from the insurer's\nrate manual for the class of business; and\n(c) Any adjustment due to change in coverage or change in the case\ncharacteristics of the smal l group or association member as determined from\nthe insurer's rate manual for the class of business.\n(6) In utilizing case characteristics, the ratio of the highest rate factor to the lowest rate\nfactor within a class of business shall not exceed five to one (5:1). For purpose of\nthis limitation, case characteristics include age, gender, occupation or industry, and\ngeographic area.\n(7) Adjustments in rates for claims experience, mental and physical condition,\nincluding medical condition, medical history, a nd health service utilization, health\nstatus, and duration of coverage shall not be charged to an individual group member\nor the member's dependents. Any adjustment shall be applied uniformly to the rates\ncharged for all individuals and dependents of the small group.\n(8) The commissioner may approve establishment of additional classes of business\nupon application to the commissioner and a finding by the commissioner that the\nadditional class would enhance the efficiency and fairness for the applicable marke t\nsegment.\n(a) The index rate for a rating period for any class of business shall not exceed the\nindex rate for any other class of business in that market segment by more than\nten percent (10%).\n(b) An insurer may establish a separate class of business only to reflect substantial\ndifferences in expected claims experience or administrative cost related to the\nfollowing reasons:\n1. The insurer uses more than one (1) type of system for the marketing and\nsale of the health benefit plans;\n2. The insurer has acquired a class of business from another insurer; or\n3. The insurer is offering a state -elected plan under the provisions of the\nTrade Act of 2002, Pub. L. No. 107-210 sec. 201.\n(c) Notwithstanding any other provision of this subsection, beginning January 1,\n2001, a GAP participating insurer may establish a separate class of business\nfor the purpose of separating guaranteed acceptance program qualified\nindividuals from other individuals enrolled in their plan prior to January 1,\n2001. The index rate for the se parate class created under this paragraph shall\nbe established taking into consideration expected claims experience and\nadministrative costs of the new class of business and the previous class of\nbusiness.\n(9) For the purpose of this section, a health bene fit plan that utilizes a restricted\nprovider network shall not be considered similar coverage to a health benefit plan\nthat does not utilize a restricted provider network if utilization of the restricted\nprovider network results in substantial differences in claims costs.\n(10) Notwithstanding any other provision of this section, an insurer shall not be required\nto utilize the experience of those individuals with high-cost conditions who enrolled\nin its plans between July 15, 1995, and April 10, 1998, to dev elop the insurer's\nindex rate for its individual policies.\n(11) Nothing in this section shall be construed to prevent an insurer from offering\nincentives to participate in a program of disease prevention or health improvement.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=17358","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:46Z","sha256":"0488bb3020152981c71e5b7859df1a129f68a43f82d0364b7d73a94fff563fae","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-095","next":"us-ky/krs-304.17a-0954"},"notice":"GroundRules: Original legal text. Not legal advice."}