00RS HB757


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HB 757 (BR 1222) - R. Damron

     AN ACT relating to health insurance.
     Create a new section of KRS 304.17A-500 to 304.17A-590 to require managed care plans to file with the commissioner of insurance sample copies of agreements entered into with health care providers; amend KRS 304.17A-505 to make provision apply to insureds as well as enrollees; require the insurer to disclose to the insured or enrollee a summary of the drug formulary and a statement informing the insured or enrollee that the provider has the right to become a provider for the insurer if the provider meets the insurer's enrollment criteria and meets the terms and conditions required for participation; amend KRS 304.17A-510 to require the insurer at the time of enrollment and upon request to inform the insured or enrollee of any hold harmless agreements with providers that affect the enrollee; amend KRS 304.17A-515 to require a managed care plan to demonstrate it offers a provider network that meets accessibility standards of this Act; amend KRS 304.17A-500 to define terms; define emergency medical condition as one that would cause a prudent layperson to believe the medical condition needs immediate attention; amend KRS 304.17A-540 to clarify the letter of denial; amend 304.17A-580 to clarify coverage of emergency medical conditions; provide that an insurer cannot deny emergency room services and alter the level of coverage or cost-sharing requirements for any condition or conditions that constitute an emergency medical condition; amend KRS 304.17A-590 to clarify the contents of provider directories.


     HCA (1, R. Damron) - Make technical changes; amend KRS 304.17A-535 to require a managed care plan that restricts pharmacy benefits to a drug formulary to have an exceptions policy through which the managed care plan may cover prescription drugs not included on the formulary.
     HFA (1, D. Ford) - Create a new section of Subtitle 17A of KRS Chapter 304 to require an insurer delivering or issuing a health benefit plan or a health insurance policy covering specified disease to provide the policyholder with 45 days notice of cancellation; provide that if cancellation is for nonpayment of premium the notice shall be 14 days; require on and after January 1, 2001, that every insurer offering group coverage to include in the contract with the policyholder or contract holder a provision requiring the policyholder to mail promptly to each person covered under the group policy a copy of the notice of cancellation and to promptly provide proof to the insurer that the covered persons were notified; require prompt return of the unearned premium upon cancellation; provide that if the insurer fails to provide the 45 days notice the coverage shall remain in effect at the existing premium until 45 days after the notice is given or until the effective date of replacement coverage, whichever comes first.
     HFA (2, R. Damron) - Make technical changes; provide that in filing information concerning risk sharing arrangements the insurer is not required to submit the actual financial information agreed to between the insurer and the entity or provider; define "risk sharing agreement."
     HFA (3, R. Damron) - Amend KRS 304.17A-0952 to provide that the section shall not apply to an employer-organized association or a plan providing benefits to an individual, employer, small group, or other person on account of the person's status as a member of an employer-organized association; amend KRS 304.17A- 0954 to change the definition of "index rate"; establish rate restrictions on premium rates for an employer-organized health insurance plan; restrict application of rate restrictions for an employer-organized association that has more than 50 employees within the state in each of 20 or more calendar weeks in the current or preceding calendar year.

     Feb 18-introduced in House
     Feb 22-to Banking and Insurance (H)
     Feb 24-posted in committee
     Mar 2-reported favorably, 1st reading, to Calendar with committee amendment (1) ; floor amendments (1) and (2) filed
     Mar 3-2nd reading, to Rules; posted for passage in the Regular Orders of the Day for Monday, March 6, 2000
     Mar 8-floor amendment (3) filed
     Mar 9-3rd reading; floor amendment (3) defeated ; passed 92-2 with committee amendment (1), floor amendments (1) and (2)
     Mar 10-received in Senate
     Mar 14-to Banking and Insurance (S)
     Mar 21-reported favorably, 1st reading, to Consent Calendar
     Mar 22-2nd reading, to Rules
     Mar 29-posted for passage in the Consent Orders of the Day for Wednesday, March 29, 2000; 3rd reading, passed 37-0; received in House; enrolled, signed by Speaker of the House
     Apr 11-enrolled, signed by President of the Senate; delivered to Governor
     Apr 21-signed by Governor (Acts ch. 500)

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