UNOFFICIAL COPY 24 RS BR 2046
Page 1 of 7
XXXX 2/15/2024 12:55 PM Jacketed
AN ACT relating to health care trade practices. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
SECTION 1. A NEW SECTION OF KRS 304.17C-130 TO 304.17C-138 IS 3
CREATED TO READ AS FOLLOWS: 4
(1) (a) An insurer providing coverage under a dental benefit plan shall honor a 5
written assignment of payments due under the plan by a covered person to a 6
provider for dental services provided to the covered person. 7
(b) A provider with a valid assignment under paragraph (a) of this subsection: 8
1. May: 9
a. Bill the insurer; and 10
b. Notify the insurer of the assignment; and 11
2. Shall provide a statement to the covered person, prior to performing a 12
dental service associated with the assigned benefits, informing the 13
covered person that the provider, as applicable: 14
a. Is an out-of-network provider; 15
b. May charge the covered person for services not covered under 16
the dental benefit plan; and 17
c. May charge the covered person the balance of any bill for 18
services that are covered under the dental benefit plan; and 19
3. Upon request, shall provide a copy of the assignment to the insurer. 20
(c) 1. Upon notice of an assignment made in accordance with paragraph (a) 21
of this subsection, the insurer shall make payments directly to the 22
provider. 23
2. Payments made to a provider under subparagraph 1. of this paragraph 24
shall be at the same rate as payments made to in-network providers. 25
(2) (a) An assignment made in accordance with subsection (1) of this section may 26
be revoked by the covered person, with or without the consent of the 27 UNOFFICIAL COPY 24 RS BR 2046
Page 2 of 7
XXXX 2/15/2024 12:55 PM Jacketed
provider, by submitting the revocation, in writing, to the insurer. 1
(b) An insurer that receives a revocation referenced in paragraph (a) of this 2
subsection shall send a copy of the revocation to the provider. 3
(c) A revocation made in accordance with this subsection shall: 4
1. Become effective when both the insurer and the provider have received 5
a copy of the revocation; and 6
2. Only be effective for any charges incurred on or after the effective 7
date established under subparagraph 1. of this paragraph. 8
(3) If, under an assignment made in accordance with subsection (1) of this section, a 9
provider collects payment from a covered person and subsequently receives 10
payment from the insurer, the provider shall reimburse the covered person, less 11
any applicable cost sharing, within forty-five (45) days of receiving the payment 12
from the insurer. 13
(4) An entity providing dental services shall provide conspicuous notice to covered 14
persons that: 15
(a) Any assignment of benefits is optional; and 16
(b) Additional payments may be required if the assigned benefits are not 17
sufficient to pay for dental services received by the covered person. 18
(5) Nothing in this section shall be construed to limit an insurer's ability to: 19
(a) Determine the scope of a dental benefit plan's benefits, services, or other 20
terms that are not in conflict with this section; or 21
(b) Negotiate any contract with a health care provider regarding 22
reimbursement rates or any other lawful provisions that are not in conflict 23
with section. 24
SECTION 2. A NEW SECTION OF SUBTITLE 17A OF KRS CHAPTER 304 25
IS CREATED TO READ AS FOLLOWS: 26
(1) As used in this section, the following have the same meaning as in KRS 304.17C-27 UNOFFICIAL COPY 24 RS BR 2046
Page 3 of 7
XXXX 2/15/2024 12:55 PM Jacketed
130: 1
(a) "Dental services"; and 2
(b) "Provider." 3
(2) (a) An insurer providing coverage for dental services under a health insurance 4
policy, certificate, plan, or contract, including but not limited to a health 5
benefit plan, shall: 6
1. Honor assignments of dental benefits due under the policy, certificate, 7
plan, or contract by an insured to a provider in accordance with 8
Section 1 of this Act; and 9
2. Make payments in accordance with subsection (1)(c) of Section 1 of 10
this Act to providers with valid assignments under this section. 11
(b) A provider with a valid assignment under this section shall comply with the 12
requirements for providers under Section 1 of this Act. 13
Section 3. KRS 304.17C-085 is amended to read as follows: 14
(1) As used in this section: 15
(a) "Contractual discount" means a percentage reduction from a provider's usual 16
and customary rate for covered services [and material ]required under a 17
participating provider agreement; and 18
(b) "Covered services": 19
1. Means services and materials for which: 20
a.[1.] Reimbursement from a plan is provided by the enrollee's plan 21
contract; or 22
b.[2.] Reimbursement would be available but for the application of the 23
enrollee's contractual limitations of deductibles, copayments, 24
coinsurance, or frequency limitations; and 25
2. Does not include services and materials for which reimbursement 26
would be available but for the application of the enrollee's contractual 27 UNOFFICIAL COPY 24 RS BR 2046
Page 4 of 7
XXXX 2/15/2024 12:55 PM Jacketed
limitation of an annual maximum benefit. 1
(2) A participating provider agreement shall not require a participating provider to 2
provide services to an enrollee at a fee set by or subject to the approval of the 3
limited health service benefit plan unless the services are covered services under the 4
provider agreement. 5
(3) A provider shall not charge more for services and materials that are noncovered 6
services under a limited health service benefit plan than the provider's rate for the 7
services and materials. 8
(4) The amount of a contractual discount shall not result in a fee that is less than the 9
limited health service benefit plan would pay for covered services but for the 10
application an enrollee's contractual limitations of deductibles, copayments, 11
coinsurance, or frequency limitations. 12
(5) Reimbursement paid by the limited health service benefit plan for covered services: 13
(a) Shall be reasonable; and 14
(b) Shall not provide nominal reimbursement in order to claim that services and 15
materials are covered services. 16
(6) The provisions of this section shall not be waived by contract. Any contractual 17
arrangement in conflict with this section or that purports to waive any 18
requirement of this section shall be null and void. 19
Section 4. KRS 304.14-250 is amended to read as follows: 20
Except as provided in Sections 1 and 2 of this Act and KRS 304.17A-265: 21
(1) A policy may be assignable or not assignable, as provided by its terms; 22
(2) Subject to its terms relating to assignability, a life or health insurance policy, 23
regardless of when it was issued, under the terms of which the beneficiary may be 24
changed upon the sole request of the insured or owner, may be assigned either by 25
pledge or transfer of title, by an assignment executed by the insured or owner alone 26
and delivered to the insurer, whether or not the pledgee or assignee is the insurer; 27 UNOFFICIAL COPY 24 RS BR 2046
Page 5 of 7
XXXX 2/15/2024 12:55 PM Jacketed
(3) Any assignment of a policy which is otherwise lawful and of which the insurer has 1
received notice shall entitle the insurer to deal with the assignee as the owner or 2
pledgee of the policy in accordance with the terms of the assignment, until the 3
insurer has received at its principal office written notice of the termination of the 4
assignment or pledge or written notice by or on behalf of some interest in the policy 5
in conflict with the assignment; and 6
(4) (a) Any individual insured under a group insurance policy or group annuity 7
contract shall have the right, unless expressly prohibited under the terms of 8
the policy or contract, to assign to any other person his rights and benefits 9
under the policy or contract, including but not limited to the right to designate 10
the beneficiary or beneficiaries and the rights as to conversion provided for in 11
KRS 304.16-180 to 304.16-200, inclusive. 12
(b) While the assignment is in effect, and regardless of when it was made, the 13
insurer shall be entitled to deal with the assignee as the owner of the rights 14
and benefits in accordance with the terms of the assignment and without 15
prejudice to the insurer on account of any lawful action taken or payment 16
made by the insurer prior to receipt by the insurer at its principal office of 17
written notice of the assignment or of the termination thereof. 18
(c) This subsection acknowledges, confirms, and codifies the existing right of 19
assignment of interests under group life insurance policies. 20
Section 5. KRS 304.17-130 is amended to read as follows: 21
(1) There shall be a provision as follows: 22
"Payment of Claims: Indemnity for loss of life will be payable in accordance with 23
the beneficiary designation and the provisions respecting payment which may be 24
prescribed herein and effective at the time of payment. If no designation or 25
provision is then effective, any indemnity shall be payable to the estate of the 26
insured. Any other accrued indemnities unpaid at the insured's death may, at the 27 UNOFFICIAL COPY 24 RS BR 2046
Page 6 of 7
XXXX 2/15/2024 12:55 PM Jacketed
option of the insurer, be paid either to a beneficiary or to the estate. All other 1
indemnities will be payable to the insured." 2
(2) Except as provided in Sections 1 and 2 of this Act and KRS 304.17A-265, the 3
following provisions, or either of them, may be included with the provision required 4
under subsection (1) of this section at the option of the insurer: 5
(a) "If any indemnity of this policy shall be payable to the estate of the insured, or 6
to an insured or beneficiary who is a minor or otherwise not competent to give 7
a valid release, the insurer may pay such indemnity, up to an amount not 8
exceeding $.... (insert an amount which shall not exceed $5,000), to any 9
relative by blood or connection by marriage of the insured or beneficiary who 10
is deemed by the insurer to be equitably entitled thereto. Any payment made 11
by the insurer in good faith pursuant to this provision shall fully discharge the 12
insurer to the extent of the payment."; and 13
(b) "Subject to any written direction of the insured in the application or otherwise, 14
all or a portion of any indemnities provided by this policy on account of 15
hospital, nursing, medical, or surgical services may, at the insurer's option and 16
unless the insured requests otherwise in writing not later than the time of 17
filing proofs of the loss, be paid directly to the hospital or person rendering 18
services, but it is not required that the service be rendered by a particular 19
hospital or person." 20
Section 6. KRS 304.18-090 is amended to read as follows: 21
Except as provided in Sections 1 and 2 of this Act and KRS 304.17A-265: 22
(1) Subject to subsection (2) of this section, all benefits under any blanket health 23
insurance policy or contract shall be payable to the person insured, or to the 24
person's designated beneficiary or beneficiaries, or to the person's estate, except that 25
if the person insured is a minor or otherwise not competent to give a valid release, 26
the benefits may be made payable to the person's parent, guardian, conservator, or 27 UNOFFICIAL COPY 24 RS BR 2046
Page 7 of 7
XXXX 2/15/2024 12:55 PM Jacketed
other person actually supporting the minor or person not competent to give a valid 1
release; and 2
(2) (a) A blanket health insurance policy or contract may provide that all or a portion 3
of any indemnities provided by the policy or contract on account of hospital, 4
nursing, medical, or surgical services may, at the option of the insurer and 5
unless the insured requests otherwise in writing not later than the time of 6
filing proofs of such loss, be paid directly to the hospital or person rendering 7
such services, but the policy or contract may not require that the service be 8
rendered by a particular hospital or person. 9
(b) Payment made directly to a hospital or other person for all or a portion of any 10
indemnities provided by a blanket health insurance policy or contract shall 11
discharge the obligation of the insurer with respect to the amount of insurance 12
so paid. 13
Section 7. This Act shall apply to policies, plans, and contracts issued or 14
renewed on or after the effective date of this Act. 15