SB 146 (BR 1777) - R. Roeding
AN ACT relating to health insurance.
Establish Subtitle 17C of KRS Chapter 304 regarding limited health service benefit plans and create new sections thereof to establish definitions for the subtitle; prohibit health insurers from discriminating against providers based on geographic coverage area; require insurers to disclose in writing to covered persons and insureds or enrollees the terms and conditions of its limited health service benefit plan and any changes in the plan; require insurers offering a limited health service benefit plan that uses a provider network to have a provider network that is available within 50 minutes or 50 miles of each enrollee's place of residence or work; require insurers to establish standards for initial consideration of providers and also for providers continuing to participate in the plan; require insurers to establish mechanisms for soliciting and acting upon applications for provider participation in the plan; require insurers offering a limited health service benefit plan to establish a policy governing the removal of and withdrawal by health care providers from the provider network; require insurers to file with the commissioner sample copies of any agreements it enters into with providers and direct the commissioner to promulgate administrative regulations prescribing the manner and form of filings required; set forth the elements the agreements shall include; require insurers entering into any risk-sharing arrangement or subcontract to file a copy of the arrangement along with other enumerated items with the commissioner; prohibit an insurer from contracting with a provider to limit the provider's disclosure to an enrollee of any information regarding the enrollee's medical condition or treatment options; prohibit penalizing a provider for discussing medically necessary care or for discussing financial arrangements between the provider and the insurer with an enrollee; require insurers to have a process for the selection of health care providers who will be on the plan's list of participating providers; establish Subtitle 38A of KRS Chapter 304 and create new sections thereof to establish definitions for the subtitle; prohibit a person from operating a limited health service organization without obtaining a certificate of authority; require an application of authority to be filed with the commissioner and be accompanied by enumerated items; require the commissioner to review the application and issue a certificate of authority if certain enumerated conditions are met; require limited health service organizations to maintain a net worth of not less than $125,000; allow the commissioner to suspend or revoke the certificate of authority issued to a limited health service organization upon determining that any of certain conditions exist; require a limited health service organization to wind up its affairs immediately following the effective date of an order of revocation; require a limited health service organization that contracts with a provider for the transfer of risk to the provider to take reasonable steps to ensure the transferee is able to accept and manage the risk to be transferred; state that a person holding a single service organization certificate of authority on the effective date of this Act will be converted to a limited health service organization; amend various other sections to conform.
SB 146 - AMENDMENTS
SCS - Maintain original provisions, except require insurers offering limited health service benefit plans to have a provider network that is available within 30 minutes or 30 miles of each enrollee's place of residence or work rather than within 50 miles; create a new section of KRS Chapter 367, regarding consumer protection, to define "health discount plan", and to prohibit persons from selling, marketing, promoting, advertising, or otherwise distributing such a plan unless the plan materials clearly state that the plan is not insurance, the discounts are authorized by separate contracts with each health care provider listed in conjunction with the plan, and the discounts offered by the plan are disclosed to the consumer; deem a violation of this section an unfair act or practice in the conduct of trade or commerce in violation of KRS 367.170; amend KRS 304.1-120 to state that no provision of the insurance code shall apply to a public or private ambulance service meeting outlined conditions; repeal KRS 304.43-010, 304.43-020, 304,43-030, 304.43-040, 304.43-050, 304.43-060, 304.43-070, 304.43-080, 304.43-085, 304.43-090, 304.43-100, 304.43-110, 304.43-120, 304.43-130, 304.43-140, 304.43-150, 304.38-065, 304.38-077, 304.38-500, 304.38-505, and 304.38-510; amend 304.12-013, 304.33-020, and 304.38-040 to conform.
Jan 29-introduced in Senate
Feb 1-to Banking and Insurance (S)
Feb 21-reported favorably, 1st reading, to Consent Calendar with Committee Substitute
Feb 22-2nd reading, to Rules
Feb 26-posted for passage in the Consent Orders of the Day for Thursday, February 28, 2002
Feb 28-3rd reading, passed 38-0 with Committee Substitute
Mar 1-received in House
Mar 4-to Banking and Insurance (H)
Mar 7-posted in committee
Mar 13-reported favorably, 1st reading, to Calendar
Mar 14-2nd reading, to Rules
Mar 21-posted for passage in the Regular Orders of the Day for Friday, March 22, 2002
Mar 22-3rd reading, passed 90-0; received in Senate
Mar 25-enrolled, signed by each presiding officer; delivered to Governor
Mar 28-signed by Governor (Acts ch. 105)