{"data":{"id":"us-ky/krs-304.17a-255","jurisdiction":"us-ky","citation":"KRS 304.17A-255","heading":"Definition of \"cost sharing\" and \"plan year\" -- Payments from","body":"specified federal programs on behalf of an insured count toward insured's\npremium and cost -sharing requirement -- Payments made by any person on\nbehalf of insured permissible -- Exceptions -- Insured's responsibility towards\npremium payments.\n(1) As used in this section:\n(a) \"Cost sharing\" means the cost to an individual insured under a health benefit\nplan according to any coverage limit, copayment, coinsurance, deductible, or\nother out-of-pocket expense requirements imposed by the plan; and\n(b) \"Plan year\" means the year that is designated as the plan year in the plan\ndocument of a health benefit plan, except that if the plan document does not\ndesignate a plan year or if there is no plan document, the plan year is:\n1. The deductible or limit year used under the plan;\n2. If the plan does not impose deductibles or limits on a yearly basis, the\npolicy year;\n3. If the plan does not impose deductibles or limits on a yearly basis a nd\neither the plan is not insured or the insurance policy is not renewed on\nan annual basis, the employer or sponsor's taxable year; or\n4. If none of the preceding subparagraphs apply, the calendar year.\n(2) Except as provided in subsection (4) of this sec tion, all health benefit plans shall\naccept, and count towards the insured's contributions to any applicable premium or\ncost-sharing requirement, premium and cost-sharing payments made on behalf of an\ninsured from the following:\n(a) A state or federal government program, including payments made by\nprograms operating in accordance with Title XXVI of the federal Public\nHealth Service Act, 42 U.S.C. secs. 300ff et seq., as amended;\n(b) An Indian tribe, tribal organization, or urban Indian organization; and\n(c) A program conducted by an organization that certifies that the organization:\n1. Is exempt from taxation under 26 U.S.C. sec. 501(a), as amended;\n2. Is described in 26 U.S.C. sec. 170(b)(1)(A)(i) or (vi);\n3. Is operating in complian ce with applicable federal laws, including the\nFalse Claims Act, 31 U.S.C. secs. 3729 to 3733; and\n4. If the organization is not a church or a convention or association of\nchurches, as described in 26 U.S.C. sec. 170(b)(1)(A)(i), is in\ncompliance with at least one (1) of the following:\na. The organization does not receive funding in any form from a\nhealth care provider, as defined in KRS 304.17A-005;\nb. Any premium assistance offered by the organization to an insured\nis sufficient to cover the insured's pre miums payments for a full\nplan year; or\nc. The organization has been issued an advisory opinion under 42\nU.S.C. sec. 1320a-7d(b), as amended, determining that the:\ni. Program conducted by the organization is not prohibited\nremuneration in violation of federal law;\nii. Program conducted by the organization would not constitute\ngrounds for the imposition of civil monetary penalties under\n42 U.S.C. sec. 1320a-7a(a)(5), as amended; or\niii. Issuing agency would not impose sanctions in connection\nwith the program conducted by the organization.\n(3) To the extent permitted under federal law, all health benefit plans may accept, and\ncount towards the insured's contributions to any applicable premium or cost -sharing\nrequirement, premium and cost -sharing payments made on behalf of an insured by\nany person not referenced in subsection (2) of this section.\n(4) If the application of any requirement of subsection (2) of this section would be the\nsole cause of a health benefit plan's failure to qualify as a Health Savings Ac count-\nqualified High Deductible Health Plan under 26 U.S.C. sec. 223, as amended, then\nthe requirement shall not apply to that health benefit plan until the minimum\ndeductible under 26 U.S.C. sec. 223, as amended, is satisfied.\n(5) Nothing in this section shall be construed to imply that the insured is not\nresponsible for the timely payment of premiums in accordance with the terms of the\nhealth benefit plan contract between the insurer and the insured, even if the\npayment is made on behalf of the insured by  a person referenced in subsection (2)\nof this section.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=52594","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:46Z","sha256":"79b40ab28de08bbffa3b7580cdabefe855de95ada8df8fff90151c4bad8edafd","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-254","next":"us-ky/krs-304.17a-256"},"notice":"GroundRules: Original legal text. Not legal advice."}