{"data":{"id":"us-ky/krs-304.17a-250","jurisdiction":"us-ky","citation":"KRS 304.17A-250","heading":"Standard health benefit plan -- Individual or small group markets --","body":"Writing requirement for provider participation -- Time limit for rate quote --\nNotice of denial of coverage.\n(1) The commissioner shall, by administrative regulations promulgated  under KRS\nChapter 13A, define one (1) standard health benefit plan. After July 15, 2004,\ninsurers may offer the standard health benefit plan in the individual or small group\nmarkets. Except as may be necessary to coordinate with changes in federal law, th e\ncommissioner shall not alter, amend, or replace the standard health benefit plan\nmore frequently than annually.\n(2) If offered, the standard health benefit plan may be available in at least one (1) of\nthese four (4) forms of coverage:\n(a) A fee-for-service product type;\n(b) A health maintenance organization type;\n(c) A point-of-service type; and\n(d) A preferred provider organization type.\n(3) The standard health benefit plan shall be defined so that it meets the requirements of\nKRS 304.17B -021 for inclusi on in calculating assessments and refunds under\nKentucky Access.\n(4) Any health insurer who offers the standard health benefit plan may offer the\nstandard health benefit plan in the individual or small group markets in each and\nevery form of coverage that the health insurer offers to sell.\n(5) Nothing in this section shall be construed:\n(a) To require a health insurer to offer a standard health benefit plan in a form of\ncoverage that the health insurer has not selected;\n(b) To prohibit a health insurer from  offering other health benefit plans in the\nindividual or small group markets in addition to the standard health benefit\nplan; or\n(c) To require that a standard health benefit plan have guaranteed issue,\nrenewability, or pre -existing condition exclusion ri ghts or provisions that are\nmore generous to the applicant than the health insurer would be required to\nprovide under KRS 304.17A -200, 304.17A-220, 304.17A.230, and 304.17A -\n240.\n(6) All health benefit plans shall cover hospice care at least equal to the Me dicare\nbenefits.\n(7) All health benefit plans shall coordinate benefits with other health benefit plans in\naccordance with the guidelines for coordination of benefits prescribed by the\ncommissioner as provided in KRS 304.18-085.\n(8) Every health insurer of any kind, nonprofit hospital, medical -surgical, dental and\nhealth service corporation, health maintenance organization, or provider -sponsored\nhealth delivery network that issues or delivers an insurance policy in this state that\ndirects or gives any incentives to insureds to obtain health care services from certain\nhealth care providers shall not imply or otherwise represent that a health care\nprovider is a participant in or an affiliate of an approved or selected provider\nnetwork unless the health care provider has agreed in writing to the representation\nor there is a written contract between the health care provider and the insurer or an\nagreement by the provider to abide by the terms for participation established by the\ninsurer. This requirement to have written contracts shall apply whenever an insurer\nincludes a health care provider as a part of a preferred provider network or\notherwise selects, lists, or approves certain health care providers for use by the\ninsurer's insureds. The  obligation set forth in this section for an insurer to have\nwritten contracts with providers selected for use by the insurer shall not apply to\nemergency or out-of-area services.\n(9) A self -insured plan may select any third party administrator licensed un der KRS\n304.9-052 to adjust or settle claims for persons covered under the self-insured plan.\n(10) Any health insurer that fails to issue a premium rate quote to an individual within\nthirty (30) days of receiving a properly completed application request fo r the quote\nshall be required to issue coverage to that individual and shall not impose any pre -\nexisting conditions exclusion on that individual with respect to the coverage. Each\nhealth insurer offering individual health insurance coverage in the individual market\nin the Commonwealth that refuses to issue a health benefit plan to an applicant or\ninsured with a disclosed high -cost condition as specified in KRS 304.17B -001 or\nfor any reason, shall provide the individual with a denial letter within twenty (20 )\nworking days of the request for coverage. The letter shall include the name and title\nof the person making the decision, a statement setting forth the basis for refusing to\nissue a policy, a description of Kentucky Access, and the telephone number for a\ncontact person who can provide additional information about Kentucky Access.\n(11) If a standard health benefit plan covers services that the plan's insureds lawfully\nobtain from health departments established under KRS Chapter 212, the health\ninsurer shall  pay the plan's established rate for those services to the health\ndepartment.\n(12) No individually insured person shall be required to replace an individual policy with\ngroup coverage on becoming eligible for group coverage that is not provided by an\nemployer. In a situation where a person holding individual coverage is offered or\nbecomes eligible for group coverage not provided by an employer, the person\nholding the individual coverage shall have the option of remaining individually\ninsured, as the policyh older may decide. This shall apply in any such situation that\nmay arise through an association, an affiliated group, the Kentucky state employee\nhealth insurance plan, or any other entity.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=17400","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:46Z","sha256":"a138529cc334b84e910016f5e91788abbb88b37bc9414134d4587b3f258bd4c5","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-245","next":"us-ky/krs-304.17a-252"},"notice":"GroundRules: Original legal text. Not legal advice."}