{"data":{"id":"us-ky/krs-304.17a-254","jurisdiction":"us-ky","citation":"KRS 304.17A-254","heading":"Duties of insurer offering health benefit plan.","body":"An insurer that offers a health benefit plan that is not a managed care plan but provides\nfinancial incentives for a covered person to access a network of providers shall:\n(1) Notify the covered person, in writing, of the availability of a printed document , in a\nmanner consistent with KRS 304.14 -420 to 304.14 -450, containing the following\ninformation at the time of enrollment and upon request:\n(a) A current directory of the in -network providers from which the covered\nperson may access covered services at a financially beneficial rate. The\ndirectory shall, at a minimum, provide the name, type of provider,\nprofessional office address, telephone number, and specialty designations of\nthe network provider, if any; and\n(b) In addition to making the information ava ilable in a printed document, an\ninsurer may also make the information available in an accessible electronic\nformat;\n(2) Assure that contracts with the providers in the network contain a hold harmless\nagreement under which the covered person will not be ba lanced billed by the in -\nnetwork provider except for deductibles, co -pays, coinsurance amounts, and\nnoncovered benefits;\n(3) File with the department a copy of the directory required under subsection (1) of\nthis section;\n(4) Have a process for the selection of health care providers who will be on the insurer's\nlist of participating providers, with written policies and procedures for review and\napproval used by the insurer. The insurer shall establish minimum professional\nrequirements for participating health  care providers. An insurer may not\ndiscriminate against a provider solely on the basis of the provider's license by the\nstate;\n(5) Not contract with a health care provider to limit the provider's disclosure to a\ncovered person, or to another person on beh alf of a covered person, of any\ninformation relating to the covered person's medical condition or treatment options;\n(6) Not penalize a health care provider, or terminate a health care provider's contract\nwith the insurer, because the provider discusses me dically necessary or appropriate\ncare with a covered person or another person on behalf of a covered person. The\nhealth care provider may:\n(a) Not be prohibited by the insurer from discussing all treatment options with the\ncovered person; and\n(b) Disclose to the covered person or to another person on behalf of a covered\nperson other information determined by the health care provider to be in the\nbest interests of the covered person;\n(7) Include in any agreements it enters into with providers for the provisi on of health\ncare services a clause stating that the insurer will, upon request of a health care\nprovider, provide or make available to a health care provider, when contracting or\nrenewing an existing contract with such provider, the payment or fee schedul es or\nother information sufficient to enable the health care provider to determine the\nmanner and amount of payments under the contract for the health care provider's\nservices prior to the final execution or renewal of the contract and shall provide any\nchange in such schedules at least ninety (90) days prior to the effective date of the\namendment pursuant to KRS 304.17A-577;\n(8) Establish a policy governing the removal of and withdrawal by health care providers\nfrom the provider network that includes the following:\n(a) The insurer shall inform a participating health care provider of the insurer's\nremoval and withdrawal policy at the time the insurer contracts with the health\ncare provider to participate in the provider network, and when changed\nthereafter;\n(b) If a participating health care provider's participation will be terminated or\nwithdrawn prior to the date of the termination of the contract as a result of a\nprofessional review action, the insurer and participating health care provider\nshall comply with the standards in 42 U.S.C. sec. 11112; and\n(c) If the insurer finds that a health care provider represents an imminent danger\nto an individual patient or to the public health, safety, or welfare, the medical\ndirector shall promptly notify the appropriat e professional state licensing\nboard; and\n(9) Meet all requirements provided under KRS 304.17A -600 to 304.17A-633 and KRS\n304.17A-700 to 304.17A-730.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=17402","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:46Z","sha256":"55ebb3ee78ac3846948ed3aa941384b420678ca1d90361cce487ea0d816eca6d","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-252","next":"us-ky/krs-304.17a-255"},"notice":"GroundRules: Original legal text. Not legal advice."}