{"data":{"id":"us-ky/krs-304.38-050","jurisdiction":"us-ky","citation":"KRS 304.38-050","heading":"Evidence of coverages and charges for health care service -- Exception.","body":"(1) No health maintenance organization shall deliver or issue for delivery in this state\nany contract describing health benefits available, or any endorsement, rider, or\napplication which becomes a part thereof, or any amendments thereto or\nmodifications thereof, or the schedule of fees or other periodic charges to be paid by\nenrollees, until a copy of the form has been filed with and approved by the\ncommissioner. Each form shall contain a complete and clear statement of:\n(a) The health care services to which the enrollee is entitled;\n(b) Any limitations on the services, kind of services, or benefits to be provided,\nincluding any deductible or copayment feature;\n(c) Where and in what manner information is available as to how services may be\nobtained; and\n(d) Any other provisions pertaining to the delivery of health care services.\nAny schedule of fees or other periodic charges to be paid by enrollees submitted to\nand filed with the commissioner along with adequate supporting information to\nshow that the charg es or fees are not excessive, inadequate, or unfairly\ndiscriminatory.\n(2) At the expiration of sixty (60) days, the form so filed shall be deemed approved\nunless prior thereto it has been affirmatively approved or disapproved by order of\nthe commissioner, or a hearing has been scheduled by order of the commissioner. In\nthe event that a hearing is held, the sixty (60) day waiting period shall begin anew\nafter the close of the hearing. Approval of the form by the commissioner shall\nconstitute a waiver of any unexpired portion of the waiting period. The\ncommissioner may extend by not more than an additional thirty (30) day period\nwithin which he or she may affirmatively approve or disapprove the form by giving\nnotice to the insurer of the extension before expir ation of the initial sixty (60) day\nperiod. At the expiration of the period as so extended, and in the absence of the\nprior affirmative approval or disapproval, the form shall be deemed approved. The\ncommissioner may at any time withdraw the approval.\n(3) This section shall not apply to rate filings made under Subtitle 17A of this chapter.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=29967","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:56Z","sha256":"e49a7e4c9488b6c7032078688e8edc27e0f0647939e38723e86b634d3e993ab1","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.38-042","next":"us-ky/krs-304.38-060"},"notice":"GroundRules: Original legal text. Not legal advice."}