{"data":{"id":"us-ky/krs-304.17a-410","jurisdiction":"us-ky","citation":"KRS 304.17A-410","heading":"Definitions for KRS 304.17A-400 to 304.17A-480.","body":"As used in KRS 304.17A-400 to 304.17A-480, unless the context requires otherwise:\n(1) \"Actual guaranteed acceptance program plan losses\" means a dollar amount\ncalculated by subtracting an insurer's guaranteed acceptance program plan claims\nfrom that insurer's guaranteed acceptance program plan premiums;\n(2) \"Benefits\" means amounts paid by an insurer to covered lives or to third parties for\nthe benefit of covered lives. \"Benefits\" do not include an insurer's administrative\ncosts, any assessments under the p lan, allocated loss adjustment expenses, reserves,\nor other overhead costs;\n(3) \"Guaranteed acceptance program plan claims\" or \"alternative underwriting\nmechanism losses\" means the dollar amount of benefits actually paid by an insurer\non behalf of a guaran teed acceptance plan enrollee for claims that were incurred\nwhile the individual was a guaranteed acceptance program plan enrollee or another\nclaim measurement formula as the department may establish by administrative\nregulation to measure an insurer's cos ts, other than administrative costs, allocated\nloss adjustment expenses, reserves, or other overhead costs, with respect to a\nprogram plan;\n(4) \"Guaranteed acceptance program plan premiums\" means the dollar amount of\npremiums received by an insurer with respect to program plans;\n(5) \"Guaranteed acceptance risk adjustment process\" means the process of allocating\nguaranteed acceptance program plan losses provided for in KRS 304.17A-460;\n(6) \"Group market\" means the health insurance market under which individu als obtain\nhealth insurance coverage, directly or through any arrangement, on behalf of\nthemselves and their dependents through a group health plan or through any\narrangement other than through the individual market, or through a federal health\nbenefit plan or program;\n(7) \"Health insurance stop -loss policy\" means any policy of insurance that directly or\nindirectly protects, in whole or in part, an employer who self -insures health benefits\ncovering any residents in Kentucky from the risk of paying benefits in excess of any\nspecified amount;\n(8) \"Market share\" means a percentage calculated by dividing an insurer's health\ninsurance coverage premiums in both the individual and group markets by the total\namount of the health insurance coverage premiums in both t he individual and group\nmarkets for all insurers;\n(9) \"Other coverage\" means coverage under any of the following:\n(a) A group plan;\n(b) Part A or Part B of Title XVIII of the Social Security Act, 42 U.S.C. secs.\n1995c et seq.;\n(c) A state plan under Title XIX of the Social Security Act, or any successor\nprogram;\n(d) Continuation coverage under any COBRA continuation provisions as defined\nin 42 U.S.C. sec. 300gg -91(d)(4) or under a similar program under any state\nlaw; or\n(e) Any other health insurance coverage which is not individual health insurance\ncoverage;\n(10) \"Premiums\" means amounts paid to insurers to purchase health insurance coverage\nand includes all amounts paid however denominated, including, but not limited to,\namounts indicated as being charged for administrative costs, allocated loss\nadjustment expenses, reserve or other overhead costs;\n(11) \"Program\" means the Kentucky Guaranteed Acceptance Program;\n(12) \"Refund\" means an amount to be paid to an insurer by the program;\n(13) \"Stop-loss carrier\" means any person providing health insurance stop-loss coverage;\n(14) \"Stop-loss premiums\" means amounts paid to purchase health insurance stop -loss\ncoverage; and\n(15) \"Total actual guaranteed acceptance program plan losses\"  means a dollar amount\nequal to the sum of the actual program plan losses of all insurers participating in the\nprogram.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=17418","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:47Z","sha256":"c8562a2900c81bccbf1d1744d6e16ab3de516993e139c6c06e5cb6a4c3fabb5f","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-400","next":"us-ky/krs-304.17a-420"},"notice":"GroundRules: Original legal text. Not legal advice."}