{"data":{"id":"us-ky/krs-304.17a-0954","jurisdiction":"us-ky","citation":"KRS 304.17A-0954","heading":"Premium rate guidelines for employer-organized association plans.","body":"(1) Notwithstanding any other provision of this chapter, the amount or rate of\npremiums for an employer -organized association health plan may be determined,\nsubject to the restrictions of subsection (2) of this section, based upon the\nexperience or project ed experience of the employer -organized associations whose\nemployers obtain group coverage under the plan.\n(2) The following restrictions shall be applied in calculating the permissible amount or\nrate of premiums for an employer -organized association healt h insurance plan\nissued to an employer-organized association as defined in KRS 304.17A-005(12)(a)\nto (c):\n(a) The premium rates charged during a rating period to members of the\nemployer-organized association with similar characteristics for the same or\nsimilar coverage, or the premium rates that could be charged to a member of\nthe employer-organized association under the rating system for that class of\nbusiness, shall not vary from its own index rate by more than fifty percent\n(50%) of its own index rate;\n(b) The percentage increase in the premium rate charged to an employer member\nof an employer-organized association for a new rating period shall not exceed\nthe sum of the following:\n1. The percentage change in the new business premium rate for the\nemployer-organized association measured from the first day of the prior\nrating period to the first day of the new rating period;\n2. Any adjustment, not to exceed twenty percent (20%) annually and\nadjusted pro rata for rating period of less than one (1) year, due to  the\nclaims experience, mental and physical condition, including medical\ncondition, medical history, and health service utilization, or duration of\ncoverage of the member as determined from the insurer's rate manual;\nand\n3. Any adjustment due to change in coverage or change in the case\ncharacteristics of the member as determined by the insurer's rate manual;\n(c) In utilizing case characteristics, the ratio of the highest rate factor to the\nlowest rate factor within a class of business shall not exceed five to one (5:1).\nFor purpose of this limitation, case characteristics include age, gender,\noccupation or industry, and geographic area; and\n(d) Unless the written consent of the employer -organized association is filed with\nthe department, the index rate for t he employer-organized association shall be\ncalculated solely with respect to that employer-organized association and shall\nnot be tied to, linked to, or otherwise adversely affected by any other index\nrate used by the issuing insurer.\n(3) For the purpose o f this section, a health insurance contract that utilizes a restricted\nprovider network shall not be considered similar coverage to a health insurance\ncontract that does not utilize a restricted provider network if utilization of the\nrestricted provider network results in measurable differences in claims costs.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=49280","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:46Z","sha256":"c86902e8a7a882e058aa627a914d826b6a9524643b27eee535e1f534d9e04cb3","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-0952","next":"us-ky/krs-304.17a-096"},"notice":"GroundRules: Original legal text. Not legal advice."}