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AN ACT relating to coverage for health care. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
SECTION 1. A NEW SECTION OF SUBTITLE 17A OF KRS CHAPTER 304 3
IS CREATED TO READ AS FOLLOWS: 4
(1) As used in this section: 5
(a) "Exchange": 6
1. Means a governmental agency or nonprofit entity that makes qualified 7
health plans, as defined in 42 U.S.C. sec. 18021, as amended, 8
available to qualified individuals or qualified employers; and 9
2. Includes: 10
a. An exchange serving the individual market for qualified 11
individuals; and 12
b. A Small Business Health Options Program serving the small 13
group market for qualified employers; and 14
(b) "Health benefit plan" has the same meaning as in KRS 304.17A-005, 15
except that for purposes of this section, the term includes: 16
1. Short-term limited-duration coverage; and 17
2. Student health insurance offered by a Kentucky-licensed insurer 18
under written contract with a university or college whose students it 19
proposes to insure. 20
(2) To the extent permitted by federal law: 21
(a) The following shall provide a special enrollment period to pregnant 22
individuals who are eligible for coverage: 23
1. Any insurer offering a health benefit plan; and 24
2. Any exchange operating in this state; 25
(b) The insurer or exchange shall allow the pregnant individual, and any 26
individual who is eligible for coverage because of a relationship to the 27 UNOFFICIAL COPY 23 RS BR 1142
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pregnant individual, to enroll for coverage under the plan or on the 1
exchange: 2
1. Except as provided in subparagraph 2. of this paragraph, at any time 3
during the pregnancy; or 4
2. If the insurer or exchange is required under federal law to limit the 5
enrollment period, beginning on the date that the pregnant individual 6
reports the pregnancy to the insurer or the exchange; 7
(c) The coverage required under this subsection shall begin not later than the 8
first day of the first calendar month in which a medical professional 9
determines that the pregnancy began, except that a pregnant individual may 10
direct coverage to begin on the first day of any month occurring after that 11
date but during the pregnancy; and 12
(d) If a directive under paragraph (c) of this subsection falls outside of the 13
pregnancy period, the coverage required under this subsection shall begin 14
not later than the first day of the last month that occurred during the 15
pregnancy. 16
(3) For group health plans and insurers offering group health insurance coverage in 17
Kentucky, the plan or insurer shall, at or before the time an individual is initially 18
offered the opportunity to enroll in the plan or coverage, provide the individual 19
with a notice of the special enrollment rights under this section. 20
Section 2. KRS 304.17A-145 is amended to read as follows: 21
(1) A health benefit plan[ issued or renewed on or after July 15, 1996,] that provides 22
maternity coverage shall provide coverage for inpatient care for a mother and her 23
newly-born child for a minimum of forty-eight (48) hours after vaginal delivery and 24
a minimum of ninety-six (96) hours after delivery by Cesarean section. 25
(2) The provisions of subsection (1) of this section shall not apply to a health benefit 26
plan if the health benefit plan authorizes an initial postpartum home visit which 27 UNOFFICIAL COPY 23 RS BR 1142
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would include the collection of an adequate sample for the hereditary and metabolic 1
newborn screening and if the attending physician, with the consent of the mother of 2
the newly-born child, authorizes a shorter length of stay than that required of health 3
benefit plans in subsection (1) of this section upon the physician's determination 4
that the mother and newborn meet the criteria for medical stability in the most 5
current version of "Guidelines for Perinatal Care" prepared by the American 6
Academy of Pediatrics and the American College of Obstetricians and 7
Gynecologists. 8
(3) (a) As used in this subsection, "health benefit plan" has the same meaning as 9
in KRS 304.17A-005, except that for purposes of this section, the term 10
includes: 11
1. Short-term limited-duration coverage; and 12
2. Student health insurance offered by a Kentucky-licensed insurer 13
under written contract with a university or college whose students it 14
proposes to insure. 15
(b) A health benefit plan that provides coverage for dependents shall provide 16
coverage for maternity care associated with pregnancy, childbirth, and 17
postpartum care for all individuals covered under the plan, including 18
dependents. 19
(c) The coverage required under this subsection shall: 20
1. Include coverage for labor and delivery; and 21
2. Be provided to all pregnant dependents regardless of age. 22
Section 3. KRS 304.17A-220 is amended to read as follows: 23
(1) All group health plans and insurers offering group health insurance coverage in the 24
Commonwealth shall comply with Section 1 of this Act and the provisions of this 25
section. 26
(2) Subject to subsection (8) of this section, a group health plan, and a health insurance 27 UNOFFICIAL COPY 23 RS BR 1142
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insurer offering group health insurance coverage, may, with respect to a participant 1
or beneficiary, impose a pre-existing condition exclusion only if: 2
(a) The exclusion relates to a condition, whether physical or mental, regardless of 3
the cause of the condition, for which medical advice, diagnosis, care, or 4
treatment was recommended or received within the six (6) month period 5
ending on the enrollment date. For purposes of this paragraph: 6
1. Medical advice, diagnosis, care, or treatment is taken into account only 7
if it is recommended by, or received from, an individual licensed or 8
similarly authorized to provide such services under state law and 9
operating within the scope of practice authorized by state law; and 10
2. The six (6) month period ending on the enrollment date begins on the 11
six (6) month anniversary date preceding the enrollment date; 12
(b) The exclusion extends for a period of not more than twelve (12) months, or 13
eighteen (18) months in the case of a late enrollee, after the enrollment date; 14
(c) 1. The period of any pre-existing condition exclusion that would otherwise 15
apply to an individual is reduced by the number of days of creditable 16
coverage the individual has as of the enrollment date, as counted under 17
subsection (3) of this section; and 18
2. Except for ineligible individuals who apply for coverage in the 19
individual market, the period of any pre-existing condition exclusion 20
that would otherwise apply to an individual may be reduced by the 21
number of days of creditable coverage the individual has as of the 22
effective date of coverage under the policy; and 23
(d) A written notice of the pre-existing condition exclusion is provided to 24
participants under the plan, and the insurer cannot impose a pre-existing 25
condition exclusion with respect to a participant or a dependent of the 26
participant until such notice is provided. 27 UNOFFICIAL COPY 23 RS BR 1142
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(3) In reducing the pre-existing condition exclusion period that applies to an individual, 1
the amount of creditable coverage is determined by counting all the days on which 2
the individual has one (1) or more types of creditable coverage. For purposes of 3
counting creditable coverage: 4
(a) If on a particular day the individual has creditable coverage from more than 5
one (1) source, all the creditable coverage on that day is counted as one (1) 6
day; 7
(b) Any days in a waiting period for coverage are not creditable coverage; 8
(c) Days of creditable coverage that occur before a significant break in coverage 9
are not required to be counted; and 10
(d) Days in a waiting period and days in an affiliation period are not taken into 11
account in determining whether a significant break in coverage has occurred. 12
(4) An insurer may determine the amount of creditable coverage in another manner 13
than established in subsection (3) of this section that is at least as favorable to the 14
individual as the method established in subsection (3) of this section. 15
(5) If an insurer receives creditable coverage information, the insurer shall make a 16
determination regarding the amount of the individual's creditable coverage and the 17
length of any pre-existing exclusion period that remains. A written notice of the 18
length of the pre-existing condition exclusion period that remains after offsetting 19
for prior creditable coverage shall be issued by the insurer. An insurer may not 20
impose any limit on the amount of time that an individual has to present a 21
certificate or evidence of creditable coverage. 22
(6) For purposes of this section: 23
(a) "Pre-existing condition exclusion" means, with respect to coverage, a 24
limitation or exclusion of benefits relating to a condition based on the fact that 25
the condition was present before the effective date of coverage, whether or not 26
any medical advice, diagnosis, care, or treatment was recommended or 27 UNOFFICIAL COPY 23 RS BR 1142
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received before that day. A pre-existing condition exclusion includes any 1
exclusion applicable to an individual as a result of information relating to an 2
individual's health status before the individual's effective date of coverage 3
under a health benefit plan; 4
(b) "Enrollment date" means, with respect to an individual covered under a group 5
health plan or health insurance coverage, the first day of coverage or, if there 6
is a waiting period, the first day of the waiting period. If an individual 7
receiving benefits under a group health plan changes benefit packages, or if 8
the employer changes its group health insurer, the individual's enrollment date 9
does not change; 10
(c) "First day of coverage" means, in the case of an individual covered for 11
benefits under a group health plan, the first day of coverage under the plan 12
and, in the case of an individual covered by health insurance coverage in the 13
individual market, the first day of coverage under the policy or contract; 14
(d) "Late enrollee" means an individual whose enrollment in a plan is a late 15
enrollment; 16
(e) "Late enrollment" means enrollment of an individual under a group health 17
plan other than: 18
1. On the earliest date on which coverage can become effective for the 19
individual under the terms of the plan; or 20
2. Through special enrollment; 21
(f) "Significant break in coverage" means a period of sixty-three (63) consecutive 22
days during each of which an individual does not have any creditable 23
coverage; and 24
(g) "Waiting period" means the period that must pass before coverage for an 25
employee or dependent who is otherwise eligible to enroll under the terms of 26
a group health plan can become effective. If an employee or dependent enrolls 27 UNOFFICIAL COPY 23 RS BR 1142
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as a late enrollee or special enrollee, any period before such late or special 1
enrollment is not a waiting period. If an individual seeks coverage in the 2
individual market, a waiting period begins on the date the individual submits a 3
substantially complete application for coverage and ends on: 4
1. If the application results in coverage, the date coverage begins; or 5
2. If the application does not result in coverage, the date on which the 6
application is denied by the insurer or the date on which the offer of 7
coverage lapses. 8
(7) (a) 1. Except as otherwise provided under subsection (3) of this section, for 9
purposes of applying subsection (2)(c) of this section, a group health 10
plan, and a health insurance insurer offering group health insurance 11
coverage, shall count a period of creditable coverage without regard to 12
the specific benefits covered during the period. 13
2. A group health plan, or a health insurance insurer offering group health 14
insurance coverage, may elect to apply subsection (2)(c) of this section 15
based on coverage of benefits within each of several classes or 16
categories of benefits specified in federal regulations. This election shall 17
be made on a uniform basis for all participants and beneficiaries. Under 18
this election, a group health plan or insurer shall count a period of 19
creditable coverage with respect to any class or category of benefits if 20
any level of benefits is covered within this class or category. 21
3. In the case of an election with respect to a group health plan under 22
subparagraph 2. of this paragraph, whether or not health insurance 23
coverage is provided in connection with the plan, the plan shall: 24
a. Prominently state in any disclosure statements concerning the 25
plan, and state to each enrollee at the time of enrollment under the 26
plan, that the plan has made this election; and 27 UNOFFICIAL COPY 23 RS BR 1142
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b. Include in these statements a description of the effect of this 1
election. 2
(b) Periods of creditable coverage with respect to an individual shall be 3
established through presentation of certifications described in subsection (9) 4
of this section or in such other manner as may be specified in administrative 5
regulations. 6
(8) (a) Subject to paragraph (e) of this subsection, a group health plan, and a health 7
insurance insurer offering group health insurance coverage, may not impose 8
any pre-existing condition exclusion on a child who, within thirty (30) days 9
after birth, is covered under any creditable coverage. If a child is enrolled in a 10
group health plan or other creditable coverage within thirty (30) days after 11
birth and subsequently enrolls in another group health plan without a 12
significant break in coverage, the other group health plan may not impose any 13
pre-existing condition exclusion on the child. 14
(b) Subject to paragraph (e) of this subsection, a group health plan, and a health 15
insurance insurer offering group health insurance coverage, may not impose 16
any pre-existing condition exclusion on a child who is adopted or placed for 17
adoption before attaining eighteen (18) years of age and who, within thirty 18
(30) days after the adoption or placement for adoption, is covered under any 19
creditable coverage. If a child is enrolled in a group health plan or other 20
creditable coverage within thirty (30) days after adoption or placement for 21
adoption and subsequently enrolls in another group health plan without a 22
significant break in coverage, the other group health plan may not impose any 23
pre-existing condition exclusion on the child. This shall not apply to coverage 24
before the date of the adoption or placement for adoption. 25
(c) A group health plan may not impose any pre-existing condition exclusion 26
relating to pregnancy. 27 UNOFFICIAL COPY 23 RS BR 1142
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(d) A group health plan may not impose a pre-existing condition exclusion 1
relating to a condition based solely on genetic information. If an individual is 2
diagnosed with a condition, even if the condition relates to genetic 3
information, the insurer may impose a pre-existing condition exclusion with 4
respect to the condition, subject to other requirements of this section. 5
(e) Paragraphs (a) and (b) of this subsection shall no longer apply to an individual 6
after the end of the first sixty-three (63) day period during all of which the 7
individual was not covered under any creditable coverage. 8
(9) (a) 1. A group health plan, and a health insurance insurer offering group health 9
insurance coverage, shall provide a certificate of creditable coverage as 10
described in subparagraph 2. of this subsection. A certificate of 11
creditable coverage shall be provided, without charge, for participants or 12
dependents who are or were covered under a group health plan upon the 13
occurrence of any of the following events: 14
a. At the time an individual ceases to be covered under a health 15
benefit plan or otherwise becomes eligible under a COBRA 16
continuation provision; 17
b. In the case of an individual becoming covered under a COBRA 18
continuation provision, at the time the individual ceases to be 19
covered under the COBRA continuation provision; and 20
c. On request on behalf of an individual made not later than twenty-21
four (24) months after the date of cessation of the coverage 22
described in subdivision a. or b. of this subparagraph, whichever is 23
later. 24
The certificate of creditable coverage as described under subdivision a. 25
of this subparagraph may be provided, to the extent practicable, at a time 26
consistent with notices required under any applicable COBRA 27 UNOFFICIAL COPY 23 RS BR 1142
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continuation provision. 1
2. The certification described in this subparagraph is a written certification 2
of: 3
a. The period of creditable coverage of the individual under the 4
health benefit plan and the coverage, if any, under the COBRA 5
continuation provision; and 6
b. The waiting period, if any, and affiliation period, if applicable, 7
imposed with respect to the individual for any coverage under the 8
plan. 9
3. To the extent that medical care under a group health plan consists of 10
group health insurance coverage, the plan is deemed to have satisfied the 11
certification requirement under this paragraph if the health insurance 12
insurer offering the coverage provides for the certification in accordance 13
with this paragraph. 14
(b) In the case of an election described in subsection (7)(a)2. of this section by a 15
group health plan or health insurance insurer, if the plan or insurer enrolls an 16
individual for coverage under the plan and the individual provides a 17
certification of coverage of the individual under paragraph (a) of this 18
subsection: 19
1. Upon request of that plan or insurer, the entity that issued the 20
certification provided by the individual shall promptly disclose to the 21
requesting plan or insurer information on coverage of classes and 22
categories of health benefits available under the entity's plan or 23
coverage; and 24
2. The entity may charge the requesting plan or insurer for the reasonable 25
cost of disclosing this information. 26
(10) (a) A group health plan, and a health insurance insurer offering group health 27 UNOFFICIAL COPY 23 RS BR 1142
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insurance coverage in connection with a group health plan, shall permit an 1
employee who is eligible but not enrolled for coverage under the terms of the 2
plan, or a dependent of that employee if the dependent is eligible but not 3
enrolled for coverage under these terms, to enroll for coverage under the 4
terms of the plan if each of the following conditions is met: 5
1. The employee or dependent was covered under a group health plan or 6
had health insurance coverage at the time coverage was previously 7
offered to the employee or dependent; 8
2. The employee stated in writing at that time that coverage under a group 9
health plan or health insurance coverage was the reason for declining 10
enrollment, but only if the plan sponsor or insurer, if applicable, 11
required that statement at that time and provided the employee with 12
notice of the requirement, and the consequences of the requirement, at 13
that time; 14
3. The employee's or dependent's coverage described in subparagraph 1. of 15
this paragraph: 16
a. Was under a COBRA continuation provision and the coverage 17
under that provision was exhausted; or 18
b. Was not under such a provision and either the coverage was 19
terminated as a result of loss of eligibility for the coverage, 20
including as a result of legal separation, divorce, cessation of 21
dependent status, such as obtaining the maximum age to be 22
eligible as a dependent child, death of the employee, termination 23
of employment, reduction in the number of hours of employment, 24
employer contributions toward the coverage were terminated, a 25
situation in which an individual incurs a claim that would meet or 26
exceed a lifetime limit on all benefits, or a situation in which a 27 UNOFFICIAL COPY 23 RS BR 1142
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plan no longer offers any benefits to the class of similarly situated 1
individuals that includes the individual; or 2
c. Was offered through a health maintenance organization or other 3
arrangement in the group market that does not provide benefits to 4
individuals who no longer reside, live, or work in a service area 5
and, loss of coverage in the group market occurred because an 6
individual no longer resides, lives, or works in the service area, 7
whether or not within the choice of the individual, and no other 8
benefit package is available to the individual; and 9
4. An insurer shall allow an employee and dependent a period of at least 10
thirty (30) days after an event described in this paragraph has occurred 11
to request enrollment for the employee or the employee's dependent. 12
Coverage shall begin no later than the first day of the first calendar 13
month beginning after the date the insurer receives the request for 14
special enrollment. 15
(b) A dependent of a current employee, including the employee's spouse, and the 16
employee each are eligible for enrollment in the group health plan subject to 17
plan eligibility rules conditioning dependent enrollment on enrollment of the 18
employee if the requirements of paragraph (a) of this subsection are satisfied. 19
(c) 1. If: 20
a. A group health plan makes coverage available with respect to a 21
dependent of an individual; 22
b. The individual is a participant under the plan, or has met any 23
waiting period applicable to becoming a participant under the plan 24
and is eligible to be enrolled under the plan but for a failure to 25
enroll during a previous enrollment period; and 26
c. A person becomes such a dependent of the individual through 27 UNOFFICIAL COPY 23 RS BR 1142
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marriage, birth, or adoption or placement for adoption; 1
the group health plan shall provide for a dependent special enrollment 2
period described in subparagraph 2. of this paragraph during which the 3
person or, if not otherwise enrolled, the individual, may be enrolled 4
under the plan as a dependent of the individual, and in the case of the 5
birth or adoption of a child, the spouse of the individual may be enrolled 6
as a dependent of the individual if the spouse is otherwise eligible for 7
coverage. 8
2. A dependent special enrollment period under this subparagraph shall be 9
a period of at least thirty (30) days and shall begin on the later of: 10
a. The date dependent coverage is made available; or 11
b. The date of the marriage, birth, or adoption or placement for 12
adoption, as the case may be, described in subparagraph 1.c. of 13
this paragraph. 14
3. If an individual seeks to enroll a dependent during the first thirty (30) 15
days of the dependent special enrollment period, the coverage of the 16
dependent shall become effective: 17
a. In the case of marriage, not later than the first day of the first 18
month beginning after the date the completed request for 19
enrollment is received; 20
b. In the case of a dependent's birth, as of the date of the birth; or 21
c. In the case of a dependent's adoption or placement for adoption, 22
the date of the adoption or placement for adoption. 23
(d) At or before the time an employee is initially offered the opportunity to enroll 24
in a group health plan, the employer shall provide the employee with a notice 25
of special enrollment rights. 26
(11) (a) In the case of a group health plan that offers medical care through health 27 UNOFFICIAL COPY 23 RS BR 1142
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insurance coverage offered by a health maintenance organization, the plan 1
may provide for an affiliation period with respect to coverage through the 2
organization only if: 3
1. No pre-existing condition exclusion is imposed with respect to coverage 4
through the organization; 5
2. The period is applied uniformly without regard to any health status-6
related factors; and 7
3. The period does not exceed two (2) months, or three (3) months in the 8
case of a late enrollee. 9
(b) 1. For purposes of this section, the term "affiliation period" means a period 10
which, under the terms of the health insurance coverage offered by the 11
health maintenance organization, must expire before the health 12
insurance coverage becomes effective. The organization is not required 13
to provide health care services or benefits during this period and no 14
premium shall be charged to the participant or beneficiary for any 15
coverage during the period. 16
2. This period shall begin on the enrollment date. 17
3. An affiliation period under a plan shall run concurrently with any 18
waiting period under the plan. 19
(c) A health maintenance organization described in paragraph (a) of this 20
subsection may use alternative methods other than those described in that 21
paragraph to address adverse selection as approved by the commissioner. 22
Section 4. KRS 18A.225 is amended to read as follows: 23
(1) (a) The term "employee" for purposes of this section means: 24
1. Any person, including an elected public official, who is regularly 25
employed by any department, office, board, agency, or branch of state 26
government; or by a public postsecondary educational institution; or by 27 UNOFFICIAL COPY 23 RS BR 1142
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any city, urban-county, charter county, county, or consolidated local 1
government, whose legislative body has opted to participate in the state-2
sponsored health insurance program pursuant to KRS 79.080; and who 3
is either a contributing member to any one (1) of the retirement systems 4
administered by the state, including but not limited to the Kentucky 5
Retirement Systems, County Employees Retirement System, Kentucky 6
Teachers' Retirement System, the Legislators' Retirement Plan, or the 7
Judicial Retirement Plan; or is receiving a contractual contribution from 8
the state toward a retirement plan; or, in the case of a public 9
postsecondary education institution, is an individual participating in an 10
optional retirement plan authorized by KRS 161.567; or is eligible to 11
participate in a retirement plan established by an employer who ceases 12
participating in the Kentucky Employees Retirement System pursuant to 13
KRS 61.522 whose employees participated in the health insurance plans 14
administered by the Personnel Cabinet prior to the employer's effective 15
cessation date in the Kentucky Employees Retirement System; 16
2. Any certified or classified employee of a local board of education or a 17
public charter school as defined in KRS 160.1590; 18
3. Any elected member of a local board of education; 19
4. Any person who is a present or future recipient of a retirement 20
allowance from the Kentucky Retirement Systems, County Employees 21
Retirement System, Kentucky Teachers' Retirement System, the 22
Legislators' Retirement Plan, the Judicial Retirement Plan, or the 23
Kentucky Community and Technical College System's optional 24
retirement plan authorized by KRS 161.567, except that a person who is 25
receiving a retirement allowance and who is age sixty-five (65) or older 26
shall not be included, with the exception of persons covered under KRS 27 UNOFFICIAL COPY 23 RS BR 1142
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61.702(2)(b)3. and 78.5536(2)(b)3., unless he or she is actively 1
employed pursuant to subparagraph 1. of this paragraph; and 2
5. Any eligible dependents and beneficiaries of participating employees 3
and retirees who are entitled to participate in the state-sponsored health 4
insurance program; 5
(b) The term "health benefit plan" for the purposes of this section means a health 6
benefit plan as defined in KRS 304.17A-005; 7
(c) The term "insurer" for the purposes of this section means an insurer as defined 8
in KRS 304.17A-005; and 9
(d) The term "managed care plan" for the purposes of this section means a 10
managed care plan as defined in KRS 304.17A-500. 11
(2) (a) The secretary of the Finance and Administration Cabinet, upon the 12
recommendation of the secretary of the Personnel Cabinet, shall procure, in 13
compliance with the provisions of KRS 45A.080, 45A.085, and 45A.090, 14
from one (1) or more insurers authorized to do business in this state, a group 15
health benefit plan that may include but not be limited to health maintenance 16
organization (HMO), preferred provider organization (PPO), point of service 17
(POS), and exclusive provider organization (EPO) benefit plans 18
encompassing all or any class or classes of employees. With the exception of 19
employers governed by the provisions of KRS Chapters 16, 18A, and 151B, 20
all employers of any class of employees or former employees shall enter into 21
a contract with the Personnel Cabinet prior to including that group in the state 22
health insurance group. The contracts shall include but not be limited to 23
designating the entity responsible for filing any federal forms, adoption of 24
policies required for proper plan administration, acceptance of the contractual 25
provisions with health insurance carriers or third-party administrators, and 26
adoption of the payment and reimbursement methods necessary for efficient 27 UNOFFICIAL COPY 23 RS BR 1142
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administration of the health insurance program. Health insurance coverage 1
provided to state employees under this section shall, at a minimum, contain 2
the same benefits as provided under Kentucky Kare Standard as of January 1, 3
1994, and shall include a mail-order drug option as provided in subsection 4
(13) of this section. All employees and other persons for whom the health care 5
coverage is provided or made available shall annually be given an option to 6
elect health care coverage through a self-funded plan offered by the 7
Commonwealth or, if a self-funded plan is not available, from a list of 8
coverage options determined by the competitive bid process under the 9
provisions of KRS 45A.080, 45A.085, and 45A.090 and made available 10
during annual open enrollment. 11
(b) The policy or policies shall be approved by the commissioner of insurance 12
and may contain the provisions the commissioner of insurance approves, 13
whether or not otherwise permitted by the insurance laws. 14
(c) Any carrier bidding to offer health care coverage to employees shall agree to 15
provide coverage to all members of the state group, including active 16
employees and retirees and their eligible covered dependents and 17
beneficiaries, within the county or counties specified in its bid. Except as 18
provided in subsection (20) of this section, any carrier bidding to offer health 19
care coverage to employees shall also agree to rate all employees as a single 20
entity, except for those retirees whose former employers insure their active 21
employees outside the state-sponsored health insurance program and as 22
otherwise provided in KRS 61.702(2)(b)3.b. and 78.5536(2)(b)3.b. 23
(d) Any carrier bidding to offer health care coverage to employees shall agree to 24
provide enrollment, claims, and utilization data to the Commonwealth in a 25
format specified by the Personnel Cabinet with the understanding that the data 26
shall be owned by the Commonwealth; to provide data in an electronic form 27 UNOFFICIAL COPY 23 RS BR 1142
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and within a time frame specified by the Personnel Cabinet; and to be subject 1
to penalties for noncompliance with data reporting requirements as specified 2
by the Personnel Cabinet. The Personnel Cabinet shall take strict precautions 3
to protect the confidentiality of each individual employee; however, 4
confidentiality assertions shall not relieve a carrier from the requirement of 5
providing stipulated data to the Commonwealth. 6
(e) The Personnel Cabinet shall develop the necessary techniques and capabilities 7
for timely analysis of data received from carriers and, to the extent possible, 8
provide in the request-for-proposal specifics relating to data requirements, 9
electronic reporting, and penalties for noncompliance. The Commonwealth 10
shall own the enrollment, claims, and utilization data provided by each carrier 11
and shall develop methods to protect the confidentiality of the individual. The 12
Personnel Cabinet shall include in the October annual report submitted 13
pursuant to the provisions of KRS 18A.226 to the Governor, the General 14
Assembly, and the Chief Justice of the Supreme Court, an analysis of the 15
financial stability of the program, which shall include but not be limited to 16
loss ratios, methods of risk adjustment, measurements of carrier quality of 17
service, prescription coverage and cost management, and statutorily required 18
mandates. If state self-insurance was available as a carrier option, the report 19
also shall provide a detailed financial analysis of the self-insurance fund 20
including but not limited to loss ratios, reserves, and reinsurance agreements. 21
(f) If any agency participating in the state-sponsored employee health insurance 22
program for its active employees terminates participation and there is a state 23
appropriation for the employer's contribution for active employees' health 24
insurance coverage, then neither the agency nor the employees shall receive 25
the state-funded contribution after termination from the state-sponsored 26
employee health insurance program. 27 UNOFFICIAL COPY 23 RS BR 1142
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(g) Any funds in flexible spending accounts that remain after all reimbursements 1
have been processed shall be transferred to the credit of the state-sponsored 2
health insurance plan's appropriation account. 3
(h) Each entity participating in the state-sponsored health insurance program shall 4
provide an amount at least equal to the state contribution rate for the employer 5
portion of the health insurance premium. For any participating entity that used 6
the state payroll system, the employer contribution amount shall be equal to 7
but not greater than the state contribution rate. 8
(3) The premiums may be paid by the policyholder: 9
(a) Wholly from funds contributed by the employee, by payroll deduction or 10
otherwise; 11
(b) Wholly from funds contributed by any department, board, agency, public 12
postsecondary education institution, or branch of state, city, urban-county, 13
charter county, county, or consolidated local government; or 14
(c) Partly from each, except that any premium due for health care coverage or 15
dental coverage, if any, in excess of the premium amount contributed by any 16
department, board, agency, postsecondary education institution, or branch of 17
state, city, urban-county, charter county, county, or consolidated local 18
government for any other health care coverage shall be paid by the employee. 19
(4) If an employee moves his or her place of residence or employment out of the 20
service area of an insurer offering a managed health care plan, under which he or 21
she has elected coverage, into either the service area of another managed health care 22
plan or into an area of the Commonwealth not within a managed health care plan 23
service area, the employee shall be given an option, at the time of the move or 24
transfer, to change his or her coverage to another health benefit plan. 25
(5) No payment of premium by any department, board, agency, public postsecondary 26
educational institution, or branch of state, city, urban-county, charter county, 27 UNOFFICIAL COPY 23 RS BR 1142
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county, or consolidated local government shall constitute compensation to an 1
insured employee for the purposes of any statute fixing or limiting the 2
compensation of such an employee. Any premium or other expense incurred by any 3
department, board, agency, public postsecondary educational institution, or branch 4
of state, city, urban-county, charter county, county, or consolidated local 5
government shall be considered a proper cost of administration. 6
(6) The policy or policies may contain the provisions with respect to the class or classes 7
of employees covered, amounts of insurance or coverage for designated classes or 8
groups of employees, policy options, terms of eligibility, and continuation of 9
insurance or coverage after retirement. 10
(7) Group rates under this section shall be made available to the disabled child of an 11
employee regardless of the child's age if the entire premium for the disabled child's 12
coverage is paid by the state employee. A child shall be considered disabled if he or 13
she has been determined to be eligible for federal Social Security disability benefits. 14
(8) The health care contract or contracts for employees shall be entered into for a 15
period of not less than one (1) year. 16
(9) The secretary shall appoint thirty-two (32) persons to an Advisory Committee of 17
State Health Insurance Subscribers to advise the secretary or the secretary's 18
designee regarding the state-sponsored health insurance program for employees. 19
The secretary shall appoint, from a list of names submitted by appointing 20
authorities, members representing school districts from each of the seven (7) 21
Supreme Court districts, members representing state government from each of the 22
seven (7) Supreme Court districts, two (2) members representing retirees under age 23
sixty-five (65), one (1) member representing local health departments, two (2) 24
members representing the Kentucky Teachers' Retirement System, and three (3) 25
members at large. The secretary shall also appoint two (2) members from a list of 26
five (5) names submitted by the Kentucky Education Association, two (2) members 27 UNOFFICIAL COPY 23 RS BR 1142
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from a list of five (5) names submitted by the largest state employee organization of 1
nonschool state employees, two (2) members from a list of five (5) names submitted 2
by the Kentucky Association of Counties, two (2) members from a list of five (5) 3
names submitted by the Kentucky League of Cities, and two (2) members from a 4
list of names consisting of five (5) names submitted by each state employee 5
organization that has two thousand (2,000) or more members on state payroll 6
deduction. The advisory committee shall be appointed in January of each year and 7
shall meet quarterly. 8
(10) Notwithstanding any other provision of law to the contrary, the policy or policies 9
provided to employees pursuant to this section shall not provide coverage for 10
obtaining or performing an abortion, nor shall any state funds be used for the 11
purpose of obtaining or performing an abortion on behalf of employees or their 12
dependents. 13
(11) Interruption of an established treatment regime with maintenance drugs shall be 14
grounds for an insured to appeal a formulary change through the established appeal 15
procedures approved by the Department of Insurance, if the physician supervising 16
the treatment certifies that the change is not in the best interests of the patient. 17
(12) Any employee who is eligible for and elects to participate in the state health 18
insurance program as a retiree, or the spouse or beneficiary of a retiree, under any 19
one (1) of the state-sponsored retirement systems shall not be eligible to receive the 20
state health insurance contribution toward health care coverage as a result of any 21
other employment for which there is a public employer contribution. This does not 22
preclude a retiree and an active employee spouse from using both contributions to 23
the extent needed for purchase of one (1) state sponsored health insurance policy 24
for that plan year. 25
(13) (a) The policies of health insurance coverage procured under subsection (2) of 26
this section shall include a mail-order drug option for maintenance drugs for 27 UNOFFICIAL COPY 23 RS BR 1142
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state employees. Maintenance drugs may be dispensed by mail order in 1
accordance with Kentucky law. 2
(b) A health insurer shall not discriminate against any retail pharmacy located 3
within the geographic coverage area of the health benefit plan and that meets 4
the terms and conditions for participation established by the insurer, including 5
price, dispensing fee, and copay requirements of a mail-order option. The 6
retail pharmacy shall not be required to dispense by mail. 7
(c) The mail-order option shall not permit the dispensing of a controlled 8
substance classified in Schedule II. 9
(14) The policy or policies provided to state employees or their dependents pursuant to 10
this section shall provide coverage for obtaining a hearing aid and acquiring hearing 11
aid-related services for insured individuals under eighteen (18) years of age, subject 12
to a cap of one thousand four hundred dollars ($1,400) every thirty-six (36) months 13
pursuant to KRS 304.17A-132. 14
(15) Any policy provided to state employees or their dependents pursuant to this section 15
shall provide coverage for the diagnosis and treatment of autism spectrum disorders 16
consistent with KRS 304.17A-142. 17
(16) Any policy provided to state employees or their dependents pursuant to this section 18
shall provide coverage for obtaining amino acid-based elemental formula pursuant 19
to KRS 304.17A-258. 20
(17) If a state employee's residence and place of employment are in the same county, 21
and if the hospital located within that county does not offer surgical services, 22
intensive care services, obstetrical services, level II neonatal services, diagnostic 23
cardiac catheterization services, and magnetic resonance imaging services, the 24
employee may select a plan available in a contiguous county that does provide 25
those services, and the state contribution for the plan shall be the amount available 26
in the county where the plan selected is located. 27 UNOFFICIAL COPY 23 RS BR 1142
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(18) If a state employee's residence and place of employment are each located in 1
counties in which the hospitals do not offer surgical services, intensive care 2
services, obstetrical services, level II neonatal services, diagnostic cardiac 3
catheterization services, and magnetic resonance imaging services, the employee 4
may select a plan available in a county contiguous to the county of residence that 5
does provide those services, and the state contribution for the plan shall be the 6
amount available in the county where the plan selected is located. 7
(19) The Personnel Cabinet is encouraged to study whether it is fair and reasonable and 8
in the best interests of the state group to allow any carrier bidding to offer health 9
care coverage under this section to submit bids that may vary county by county or 10
by larger geographic areas. 11
(20) Notwithstanding any other provision of this section, the bid for proposals for health 12
insurance coverage for calendar year 2004 shall include a bid scenario that reflects 13
the statewide rating structure provided in calendar year 2003 and a bid scenario that 14
allows for a regional rating structure that allows carriers to submit bids that may 15
vary by region for a given product offering as described in this subsection: 16
(a) The regional rating bid scenario shall not include a request for bid on a 17
statewide option; 18
(b) The Personnel Cabinet shall divide the state into geographical regions which 19
shall be the same as the partnership regions designated by the Department for 20
Medicaid Services for purposes of the Kentucky Health Care Partnership 21
Program established pursuant to 907 KAR 1:705; 22
(c) The request for proposal shall require a carrier's bid to include every county 23
within the region or regions for which the bid is submitted and include but not 24
be restricted to a preferred provider organization (PPO) option; 25
(d) If the Personnel Cabinet accepts a carrier's bid, the cabinet shall award the 26
carrier all of the counties included in its bid within the region. If the Personnel 27 UNOFFICIAL COPY 23 RS BR 1142
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Cabinet deems the bids submitted in accordance with this subsection to be in 1
the best interests of state employees in a region, the cabinet may award the 2
contract for that region to no more than two (2) carriers; and 3
(e) Nothing in this subsection shall prohibit the Personnel Cabinet from including 4
other requirements or criteria in the request for proposal. 5
(21) Any fully insured health benefit plan or self-insured plan issued or renewed on or 6
after July 12, 2006, to public employees pursuant to this section which provides 7
coverage for services rendered by a physician or osteopath duly licensed under KRS 8
Chapter 311 that are within the scope of practice of an optometrist duly licensed 9
under the provisions of KRS Chapter 320 shall provide the same payment of 10
coverage to optometrists as allowed for those services rendered by physicians or 11
osteopaths. 12
(22) Any fully insured health benefit plan or self-insured plan issued or renewed to 13
public employees pursuant to this section shall comply with: 14
(a) KRS 304.12-237; 15
(b) KRS 304.17A-270 and 304.17A-525; 16
(c) KRS 304.17A-600 to 304.17A-633; 17
(d) KRS 205.593; 18
(e) KRS 304.17A-700 to 304.17A-730; 19
(f) KRS 304.14-135; 20
(g) KRS 304.17A-580 and 304.17A-641; 21
(h) KRS 304.99-123; 22
(i) KRS 304.17A-138; 23
(j) KRS 304.17A-148; 24
(k) KRS 304.17A-163 and 304.17A-1631; 25
(l) Section 1 of this Act; 26
(m) Section 2 of this Act; and 27 UNOFFICIAL COPY 23 RS BR 1142
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(n)[(l)] Administrative regulations promulgated pursuant to statutes listed in this 1
subsection. 2
Section 5. KRS 164.2871 is amended to read as follows: 3
(1) The governing board of each state postsecondary educational institution is 4
authorized to purchase liability insurance for the protection of the individual 5
members of the governing board, faculty, and staff of such institutions from liability 6
for acts and omissions committed in the course and scope of the individual's 7
employment or service. Each institution may purchase the type and amount of 8
liability coverage deemed to best serve the interest of such institution. 9
(2) All retirement annuity allowances accrued or accruing to any employee of a state 10
postsecondary educational institution through a retirement program sponsored by 11
the state postsecondary educational institution are hereby exempt from any state, 12
county, or municipal tax, and shall not be subject to execution, attachment, 13
garnishment, or any other process whatsoever, nor shall any assignment thereof be 14
enforceable in any court. Except retirement benefits accrued or accruing to any 15
employee of a state postsecondary educational institution through a retirement 16
program sponsored by the state postsecondary educational institution on or after 17
January 1, 1998, shall be subject to the tax imposed by KRS 141.020, to the extent 18
provided in KRS 141.010 and 141.0215. 19
(3) Except as provided in KRS Chapter 44, the purchase of liability insurance for 20
members of governing boards, faculty and staff of institutions of higher education 21
in this state shall not be construed to be a waiver of sovereign immunity or any 22
other immunity or privilege. 23
(4) The governing board of each state postsecondary education institution is authorized 24
to provide a self-insured employer group health plan to its employees, which plan 25
shall: 26
(a) Conform to the requirements of Subtitle 32 of KRS Chapter 304; and 27 UNOFFICIAL COPY 23 RS BR 1142
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(b) Except as provided in subsection (5) of this section, be exempt from 1
conformity with Subtitle 17A of KRS Chapter 304. 2
(5) A self-insured employer group health plan provided by the governing board of a 3
state postsecondary education institution to its employees shall comply with: 4
(a) KRS 304.17A-163 and 304.17A-1631; 5
(b) Section 1 of this Act; and 6
(c) Section 2 of this Act. 7
Section 6. KRS 194A.099 is amended to read as follows: 8
(1) The Division of Health Benefit Exchange shall administer the provisions of the 9
Patient Protection and Affordable Care Act of 2010, Pub. L. No. 111-148. 10
(2) The Division of Health Benefit Exchange shall: 11
(a) Facilitate enrollment in health coverage and the purchase and sale of qualified 12
health plans in the individual market; 13
(b) Facilitate the ability of eligible individuals to receive premium tax credits and 14
cost-sharing reductions and enable eligible small businesses to receive tax 15
credits, in compliance with all applicable federal and state laws and 16
regulations; 17
(c) Oversee the consumer assistance programs of navigators, in-person assisters, 18
certified application counselors, and insurance agents as appropriate; 19
(d) At a minimum, carry out the functions and responsibilities required pursuant 20
to 42 U.S.C. sec. 18031 to implement and comply with federal regulations in 21
accordance with 42 U.S.C. sec. 18041;[ and] 22
(e) Regularly consult with stakeholders in accordance with 45 C.F.R. sec. 23
155.130; and 24
(f) Comply with Section 1 of this Act. 25
(3) The office may enter into contracts and other agreements with appropriate entities, 26
including but not limited to federal, state, and local agencies, as permitted under 45 27 UNOFFICIAL COPY 23 RS BR 1142
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C.F.R. sec. 155.110, to the extent necessary to carry out the duties and 1
responsibilities of the office, provided that the agreements incorporate adequate 2
protections with respect to the confidentiality of any information to be shared. 3
(4) The office shall pursue all available federal funding for the further development and 4
operation of the Division of Health Benefit Exchange. 5
(5) The Office of[ Health] Data[ and] Analytics shall promulgate administrative 6
regulations in accordance with KRS Chapter 13A to implement this section. 7
(6) The office shall not establish procedures and rules that conflict with or prevent the 8
application of the Patient Protection and Affordable Care Act of 2010, Pub. L. No. 9
111-148. 10
Section 7. KRS 205.592 is amended to read as follows: 11
(1) Except as provided in subsection (2) of this section, pregnant women, new mothers 12
up to twelve (12) months postpartum, and children up to age one (1) shall be 13
eligible for participation in the Kentucky Medical Assistance Program if: 14
(a)[(1)] They have family income up to but not exceeding one hundred and 15
eighty-five percent (185%) of the nonfarm income official poverty guidelines 16
as promulgated by the Department of Health and Human Services of the 17
United States as revised annually; and 18
(b)[(2)] They are otherwise eligible for the program. 19
(2) The percentage established in subsection (1)(a) of this section may be increased 20
to the extent: 21
(a) Permitted under federal law; and 22
(b) Funding is available. 23
Section 8. Sections 1 to 6 of this Act apply to health benefit plans issued or 24
renewed on or after January 1, 2024. 25
Section 9. Sections 1, 2, 3, 4, 5, 6, and 8 of this Act take effect on January 1, 26
2024. 27