{"data":{"id":"us-ky/krs-304.17a-764","jurisdiction":"us-ky","citation":"KRS 304.17A-764","heading":"Determination of premiums -- Restrictions in calculation.","body":"(1) Notwithstanding any other provision of this chapter, the amount or rate of\npremiums for an insurance purchasing outlet health benefit plan may be determined,\nsubject to the restrictions of subsection (2) of this section, based upon the\nexperience or projec ted experience of the insurance purchasing outlets whose\nmembers obtain coverage under the plan. The index rate for the insurance\npurchasing outlet shall be calculated solely with respect to that insurance purchasing\noutlet and shall not be tied to, linked  to, or otherwise adversely affected by any\nother index rate used by the participating insurer.\n(2) The following restrictions shall be applied in calculating the permissible amount or\nrate of premiums for an insurance purchasing outlet health benefit plan:\n(a) The premium rates charged during a rating period to members of the insurance\npurchasing outlet with similar characteristics for the same or similar coverage,\nor the premium rates that could be charged to a member of the insurance\npurchasing outlet un der the rating system for that class of business, shall not\nvary from its own index rate by more than twenty -five percent (25%), except\nthat the premium rates charged to an insurance purchasing outlet member\nshall not vary from the index rate by more than fifty percent (50%) through\nDecember 31, 2002. However, upon any policy issuance or renewal, on or\nafter January 1, 2003, the maximum variation shall revert to twenty -five\npercent (25%) of the index rate.\n(b) The percentage increase in the premium rate cha rged to a member of an\ninsurance purchasing outlet for a new rating period shall not exceed the sum\nof the following:\n1. The percentage change in the new business premium rate for the\ninsurance purchasing outlet measured from the first day of the prior\nrating period to the first day of the new rating period;\n2. Any adjustment, not to exceed twenty percent (20%) annually and\nadjusted pro rata for rating periods of less than one (1) year, due to the\nclaims experience, mental and physical condition, including medical\ncondition, medical history, and health service utilization, or duration of\ncoverage of the member as determined from the insurer's rate manual;\nand\n3. Any adjustment due to change in coverage or change in the case\ncharacteristics of the member as determined by the insurer's rate manual.\n(3) In utilizing case characteristics the ratio of the highest rate factor to the lowest rate\nfactor within a class of business shall not exceed five to one (5:1). For purposes of\nthis limitation, case characteristic s include age, gender, occupation or industry, and\ngeographic area.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=29357","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:48Z","sha256":"89779aecc2f6f35ac7978bddd32ed56e137119b2c686818a1a53374d29eb37b4","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-762","next":"us-ky/krs-304.17a-766"},"notice":"GroundRules: Original legal text. Not legal advice."}