{"data":{"id":"us-ky/krs-304.17b-021","jurisdiction":"us-ky","citation":"KRS 304.17B-021","heading":"Assessment of insurers -- Kentucky Access fund -- Reimbursement of","body":"GAP losses -- Examination of insurers and stop -loss carriers to determine\naccuracy of information provided.\n(1) In addition to the other powers enumerated in KRS 304.17B -001 to 304.17B-031,\nthe Office of Health Data and Analytics shall assess insurers in the amounts\nspecified in this section. The assessment shall be used for the purpose of funding\nGAP losses and Kentucky Access.\n(a) The amount of the assessment for each calendar year shall be as follows:\n1. From each stop -loss carrier, an amount that is equal to two dollars ($2)\nupon each one hundred dollars ($100) of health insurance stop -loss\npremiums;\n2. From all insurers, an amount based on the total amount of all health\nbenefit plan premiums earned during the prior assessment period and\npaid by all insurers who received any of the health benefit plan\npremiums on which the annual assessment is based. The percentage rate\nused for the annual assessment shall be the same perce ntage rate as\ncalculated in the GAP risk adjustment process for the six (6) month\nperiod of July 1, 1998, through December 31, 1998;\n3. If determined necessary by the office, a second assessment may be\nassessed in the same manner as the annual assessment i n subparagraph\n2. of this paragraph; and\n4. In no event shall the sum of the first assessment provided for in\nsubparagraph 2. of this paragraph and the second assessment provided\nfor in subparagraph 3. of this paragraph be greater than one percent\n(1%) of the total amount of all assessable health benefit plan premiums\nearned during the prior assessment period.\n(b) The first assessment shall be for the period from January 1, 2000, through\nDecember 31, 2000, and shall be paid on or before March 31, 2001.\nSubsequent annual assessments shall be paid on or before March 31 of the\nyear following the assessment period.\n(2) Every supporting insurer shall report to the office, in a form and at the time as the\noffice may specify, the following information for the specified period:\n(a) The insurer's total stop-loss premiums and health benefit plan premiums in the\nindividual, small group, large group, and association markets; and\n(b) Other information as the office may require.\n(3) As part of the assessment process, the office shall establish and maintain the\nKentucky Access fund. All funds shall be held at interest, in a single depository\ndesignated in accordance with KRS 304.8-090(1) under a written trust agreement in\naccordance with KRS 304.8 -095. All expense and revenue transactions of the fund\nshall be posted to the Management Administrative Reporting System (MARS) and\nits successors.\n(4) The Kentucky Access fund shall be funded from the following sources:\n(a) Premiums paid by Kentucky Access enrollees;\n(b) The funds designated for Kentucky Access in the Kentucky Health Care\nImprovement fund;\n(c) Appropriations from the General Assembly;\n(d) Annual assessments from supporting insurers;\n(e) A second assessment from supporting insurers;\n(f) Gifts, grants, or other voluntary contributions;\n(g) Interest or other earnings on the investment of the moneys held in the account;\nand\n(h) Any funds remaining on January 1, 2001, in the guaranteed acceptance\nprogram account may be transferred to the Kentucky Access fund.\n(5) The office shall determine on behalf of Kentucky Access the premiums, the\nexpenses for administration, the incurred losses, taking into account investment\nincome and other amounts needed to satisfy reserves, estimated claim l iabilities,\nand other obligations for each calendar year. The office shall also determine the\namount of the actual guaranteed acceptance program plan losses for each calendar\nyear. The office shall assess insurers as follows:\n(a) On or before March 31 of e ach year, the amount set forth in subsection\n(1)(a)1. and (1)(a)2. of this section.\n(b) If the amount of actual guaranteed acceptance program plan losses exceeds\nthe assessment provided for in paragraph (a) of this subsection, a second\nassessment shall be authorized under subsection (1)(a)3. of this section. If the\namount of GAP losses exceeds the assessments provided under subsection\n(1)(a)1., subsection (1)(a)2., and subsection (1)(a)3. of this section, moneys\nreceived and available from the Kentucky Heal th Care Improvement Fund\nafter the office determines available funding for Kentucky Access for the\ncurrent calendar year pursuant to subsection (6) of this section, shall be used\nto reimburse GAP participating insurers for any actual guaranteed acceptance\nprogram losses. If the amount of GAP losses exceeds the amount in the\nKentucky Health Care Improvement Fund after reserving sufficient funds for\nKentucky Access for the current year, each GAP participating insurer shall be\nreimbursed up to the amount of it s proportional share of actual guaranteed\nacceptance program plan losses from the fund. Effective for any assessment\non or after January 1, 2001, in calculating GAP losses, total premiums and\ntotal claims of the GAP participating insurer shall be used. Act ual guaranteed\nacceptance program losses shall be calculated as the difference between the\ntotal GAP claims and the total GAP premiums on an aggregate basis.\n(c) If GAP losses are fully covered by the assessment process provided for in\nsubsection (1)(a)1. and (1)(a)2. of this section and the second assessment\nprovided for in subsection (1)(a)3. of this section is not necessary to cover\nGAP losses, and as determined by the office using reasonable actuarial\nprinciples Kentucky Access funding is needed, a seco nd assessment provided\nfor in subsection (1)(a)3. of this section shall be completed.\n(6) After the end of each calendar year, GAP losses shall be reimbursed only after the\noffice determines that appropriate funding is available for Kentucky Access for the\ncurrent calendar year. GAP losses shall be reimbursed after reserving sufficient\nfunds for Kentucky Access.\n(7) With respect to a GAP participating insurer who reasonably will be expected both\nto pay assessments and to receive payments from the assessment  fund, the office\nshall calculate the net amount owed to or to be received from the fund, and the\noffice shall only collect assessments for or make payments from the fund based\nupon net amounts.\n(8) Insurers paying an assessment may include in any health i nsurance rate filing the\namount of these assessments as provided for in Subtitle 17A of this chapter.\n(9) Insurers shall pay any assessment amounts authorized in KRS 304.17B -001 to\n304.17B-031 within thirty (30) days of receiving notice from the office of the\nassessment amount.\n(10) Any surpluses remaining in the Kentucky Access fund after completion of the\nassessment process for a calendar year shall be maintained for use in the assessment\nprocess for future calendar years and such funds shall not lapse. T he general fund\nappropriations to the Kentucky Access fund shall not lapse.\n(11) Assessments on health benefit plan premiums that are required under KRS\n304.17B-001 to 304.17B -031 shall not be applied to premiums received by an\ninsurer for state employees,  Medicaid recipients, Medicare beneficiaries, and\nCHAMPUS insureds.\n(12) The office shall direct that receipts of Kentucky Access be held at interest, and may\nbe used to offset future losses or to reduce plan premiums in accordance with the\nterms of KRS 30 4.17B-001 to 304.17B -031. As used in this subsection, \"future\nlosses\" may include reserves for incurred but not reported claims.\n(13) The office shall conduct examinations of insurers and stop -loss carriers reasonably\nnecessary to determine if the informat ion provided by the insurers or stop -loss\ncarriers is accurate.\n(14) The insurer, as a condition of conducting health insurance business in Kentucky,\nshall pay the assessments specified in KRS 304.17B-001 to 304.17B-031.\n(15) The stop-loss carrier, as a condition of doing health insurance business in Kentucky,\nshall pay the assessments specified in KRS 304.17B-001 to 304.17B-031.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=56947","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:48Z","sha256":"f1e29a091b46fb255e895c520f3de6b61c740252cf92bb53a9c03478d3b8c3b5","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17b-019","next":"us-ky/krs-304.17b-023"},"notice":"GroundRules: Original legal text. Not legal advice."}