04RS SB258


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SB 258 (BR 2079) - J. Denton

     AN ACT relating to health benefit plans.
     Create new sections of Subtitle 17A of KRS Chapter 304 to require that a health benefit plan provided to individuals through an association not related to employment be considered coverage in the individual market; provide that an insurer issuing or renewing a health benefit plan on or after January 1, 2005 until December 31, 2007, not be required to include any additional mandated state benefits; require an insurer that is not a managed care plan but provides financial incentives for a person to access a network of providers must notify the covered person that certain information is available at the time of enrollment and upon request; amend KRS 304.17A-095 to restrict retroactive reduction of rates to filings containing misrepresentations or based on fraudulent information; amend KRS 304.17A-250 to permit, rather than require, insurers in the individual and small group market to offer the standard plan after July 15, 2004; delete the benefits comparison; amend KRS 304.17A-330 to exempt from the annual data reporting requirement insurers, employer-organized associations that self-insure, and health purchasing outlets that insure less than 500 persons; amend KRS 304.17A-500 to change the definition of "enrollee" and other terms; amend KRS 304.17A-527, 304.17A-550, 304.17A-520, and 304.17A-532 to make technical changes to eliminate certain requirements for non-HMO insurers; amend KRS 304.17A-545 to provide that the medical director of a managed care plan may be licensed in the state where the insurer is domiciled or in any state in which the insurer is licensed to do business; amend KRS 304.17A-600 to define "urgent care"; amend KRS 304.17A-607 to delete requirement of rendering written notice of utilization review decision within one (1) day of decision and delete other time requirements for preadmission review of hospital admission, preauthorization for a treatment, procedure, drug, or device, and receipt of requested information when a retrospective review is initiated; amend KRS 304.17A-617 as to the internal appeal determination letter to delete requirement that letter contain a description of alternative benefits, services, or supplies in cases retrospective review; amend KRS 304.17A-623 to provide that external reviews which are not expedited must be conducted by the review entity and a determination made within 21 days from the receipt of all information required from the insurer rather than from the receipt of the request for external review; amend KRS 304.17A-627 to delete requirement that the independent review entity annually submit certain information to the department in a form acceptable to the department; amend KRS 304.17A-722 to exempt, with approval of the commissioner, an insurer from the data reporting requirements if the total number of insureds is less than 500; amend KRS 304.17A-700 to conform; repeal KRS 304.17A-533.

     Mar 2-introduced in Senate
     Mar 5-to Banking and Insurance (S)

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