{"data":{"id":"us-ky/krs-304.17a-505","jurisdiction":"us-ky","citation":"KRS 304.17A-505","heading":"Disclosure of terms and conditions of health benefit plan -- Filing with","body":"department.\nAn insurer shall disclose in writing to a covered person and an insured or enrollee, in a\nmanner consistent with the provisions of KRS 304.14 -420 to 304.14 -450, the terms and\nconditions of its health benefit plan and shall promptly provide the covered person and\nenrollee with written notification of any change in the terms and conditions prior to the\neffective date of the change. The insurer shall provide the required information at the time\nof enrollment and upon request thereafter.\n(1) The information required to be disclosed under this section shall include a\ndescription of:\n(a) Covered services and benefits to which the enrollee or other covered person is\nentitled;\n(b) Restrictions or limitations on covered services and benefits;\n(c) Financial responsibility of the covered person, including copayments and\ndeductibles;\n(d) Prior authorization and any other review requirements with respect to\naccessing covered services;\n(e) Where and in what manner covered services may be obtained;\n(f) Changes in covered services or benefits, including any addition, reduction, or\nelimination of specific services or benefits;\n(g) The covered person's right to the following:\n1. A utilization review and the procedure for initiating a utilization review,\nif an insurer elects to provide utilization review;\n2. An internal appeal of a utilization review made by or on behalf of the\ninsurer with respect to the denial, reduction, or terminatio n of a health\ncare benefit or the denial of payment for a health care service, and the\nprocedure to initiate an internal appeal; and\n3. An external review and the procedure to initiate the external review\nprocess;\n(h) Measures in place to ensure the confidentiality of the relationship between an\nenrollee and a health care provider;\n(i) Other information as the commissioner shall require by administrative\nregulation;\n(j) A summary of the drug formulary, including, but not limited to, a listing of the\nmost commonly used drugs, drugs requiring prior authorization, any\nrestrictions, limitations, and procedures for authorization to obtain drugs not\non the formulary and, upon request of an insured or enrollee, a complete drug\nformulary; and\n(k) A statement informing the insured or enrollee that if the provider meets the\ninsurer's enrollment criteria and is willing to meet the terms and conditions for\nparticipation, the provider has the right to become a provider for the insurer.\n(2) The insurer shall file the information required under this section with the\ndepartment.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=17427","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:47Z","sha256":"564cf43fcafc35e6d72bbeb9b54870546dcc4c21cd3c77805cd350c91c15929a","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-500","next":"us-ky/krs-304.17a-510"},"notice":"GroundRules: Original legal text. Not legal advice."}