(1) Each enrollee residing in this state shall be entitled to evidence of health care services provided and the same shall be issued and delivered to him by the health maintenance organization, be it in the form of a contract, certificate, or other comparable document. Such evidence shall state clearly the total amount of payment for health care services and any indemnity or service benefits which the enrollee is obligated to pay with respect to such health care services.
(2) Each health maintenance organization shall annually make available to its enrollees at its principal office and place of business:

Terms Used In Kentucky Statutes 304.38-080

  • Contract: A legal written agreement that becomes binding when signed.
  • Enrollee: means a person who has been enrolled in a health maintenance organization. See Kentucky Statutes 304.38-030
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Health maintenance organization: means any person who undertakes to provide, directly or through arrangements with others, health care services to individuals enrolled with such an organization on a per capita or a predetermined, fixed prepayment basis. See Kentucky Statutes 304.38-030
  • State: when applied to a part of the United States, includes territories, outlying possessions, and the District of Columbia. See Kentucky Statutes 446.010

(a) Its most recent annual statement of financial condition including a balance sheet and summary of receipts and disbursement; and
(b) A current description of its organizational structure and operation.
Effective: April 10, 1998
History: Amended 1998 Ky. Acts ch. 496, sec. 56, effective April 10, 1998. — Created
1974 Ky. Acts ch. 357, subtit. 38, sec. 8, effective June 21, 1974.

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