{"data":{"id":"us-ky/krs-304.17b-015","jurisdiction":"us-ky","citation":"KRS 304.17B-015","heading":"Eligibility for coverage under Kentucky Access.","body":"(1) Any individual who is an eligible individual and a resident of Kentucky is eligible\nfor coverage under Kentucky Access, except as specified in paragraphs (a), (b), (d),\nand (e) of subsection (4) of this section.\n(2) Any individual who is not an eligible in dividual who has been a resident of the\nCommonwealth for at least twelve (12) months immediately preceding the\napplication for Kentucky Access coverage is eligible for coverage under Kentucky\nAccess if one (1) of the following conditions is met:\n(a) The individual has been rejected by at least one (1) insurer for coverage of a\nhealth benefit plan that is substantially similar to Kentucky Access coverage;\n(b) The individual has been offered coverage substantially similar to Kentucky\nAccess coverage at a premium rate greater than the Kentucky Access premium\nrate at the time of enrollment or upon renewal; or\n(c) The individual has a high-cost condition listed in KRS 304.17B-001.\n(3) A Kentucky Access enrollee whose premium rates exceed claims for a three (3) year\nperiod shall be issued a notice of insurability. The notice shall indicate that the\nKentucky Access enrollee has not had claims exceed premium rates for a three (3)\nyear period and may be used by the enrollee to obtain insurance in the regular\nindividual market.\n(4) An individual shall not be eligible for coverage under Kentucky Access if:\n(a) 1. The individual has, or is eligible for, on the effective date of coverage\nunder Kentucky Access, substantially similar coverage under another\ncontract or policy , unless the individual was issued coverage from a\nGAP participating insurer as a GAP qualified individual prior to January\n1, 2001. A GAP qualified individual shall be automatically eligible for\ncoverage under Kentucky Access without regard to the require ments of\nsubsection (2) of this section; or\n2. For individuals meeting the requirements of KRS 304.17A -005(11), the\nindividual has, or is eligible for, on the effective date of coverage under\nKentucky Access, coverage under a group health plan.\nAn individual who is ineligible for coverage pursuant to this paragraph shall\nnot preclude the individual's spouse or dependents from being eligible for\nKentucky Access coverage. As used in this paragraph, \"eligible for\" includes\nany individual and an individual's s pouse or dependent who was eligible for\ncoverage but waived that coverage. That individual and the individual's\nspouse or dependent shall be ineligible for Kentucky Access coverage through\nthe period of waived coverage;\n(b) The individual is eligible for coverage under Medicaid or Medicare;\n(c) The individual previously terminated Kentucky Access coverage and twelve\n(12) months have not elapsed since the coverage was terminated, unless the\nindividual demonstrates a good faith reason for the termination;\n(d) Except for covered benefits paid under the standard health benefit plan as\nspecified in KRS 304.17B-019, Kentucky Access has paid two million dollars\n($2,000,000) in covered benefits per individual. The maximum limit under\nthis paragraph may be increased by the office;\n(e) The individual is confined to a public institution or incarcerated in a federal,\nstate, or local penal institution or in the custody of federal, state, or local law\nenforcement authorities, including work release programs; or\n(f) The individual's premium, deductible, coinsurance, or copayment is partially\nor entirely paid or reimbursed by an individual or entity other than the\nindividual or the individual's parent, grandparent, spouse, child, stepchild,\nfather-in-law, mother-in-law, son-in-law, daughter-in-law, sibling, brother -in-\nlaw, sister-in-law, grandchild, guardian, or court-appointed payor.\n(5) The coverage of any person who ceases to meet the requirements of this section or\nthe requirements of any administrative regulation promulga ted under this subtitle\nmay be terminated.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=48818","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:48Z","sha256":"824cb3b7b161a88fb1580dfff7d406217b63b90ff45d1c2c747ff49af8da9984","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17b-013","next":"us-ky/krs-304.17b-017"},"notice":"GroundRules: Original legal text. Not legal advice."}