{"data":{"id":"us-ky/krs-304.17a-550","jurisdiction":"us-ky","citation":"KRS 304.17A-550","heading":"Out-of-network benefits.","body":"(1) An insurer that offers a managed care plan shall offer a health benefit plan with out-\nof-network benefits to every contract holder. The plan with out -of-network benefits\nshall allow a covered person to receive covered services from out-of-network health\ncare providers without having to obtain a referral. The plan with out -of-network\nbenefits may require that an enrollee pre -certify selected services and pay a higher\ndeductible, copayment, coinsurance, excess charges and higher premium for the\nout-of-network benefit plan pursuant to limits established by administrative\nregulations promulgated by the department.\n(2) If the contract holder elects the out -of-network offering required under subsection\n(1) of this section, the insurer shall provide each enrollee with the opportunity at the\ntime of enrollment and during the annual open enrollment period, to enroll in the\nout-of-network option. If the contract holder elects the out -of-network offering\nrequired under subsection (1) of this section, the insurer and the  contract holder\nshall provide written notice of the benefit plan with out -of-network benefits to each\nenrollee in a plan and shall include in that notice a detailed explanation of the\nfinancial costs to be incurred by an enrollee who selects the plan.\n(3) The requirement of this section shall not apply to an insurer contract which offers a\nmanaged care plan that provides health care services solely to Medicaid or Medicare\nrecipients.\n(4) Managed care plans currently licensed and doing business in Kentucky that do not\nyet offer benefit plans with out -of-network benefits must develop and offer those\nplans within three hundred sixty-five (365) days of April 10, 1998.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=17439","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:47Z","sha256":"34f38e92aaace8ab3bf77c8cb6a528be1778829fadafe5f1e5d0dc5a9daeab62","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-545","next":"us-ky/krs-304.17a-555"},"notice":"GroundRules: Original legal text. Not legal advice."}