§ 304.17C-010 Definitions for subtitle
§ 304.17C-020 Discrimination prohibited against willing provider located in area
§ 304.17C-030 Disclosure
§ 304.17C-040 Availability of provider network
§ 304.17C-050 Standards for providers — Mechanism for acting upon applications — Policy governing removal of providers from network
§ 304.17C-060 Filing of agreements — Provisions of agreements — Procedures for changing agreement — Filing of risk-sharing arrangements and subcontracts — Availability of information
§ 304.17C-070 Prohibition of contract to limit disclosure to enrollee — Actions for which provider may not be penalized — Disclosure of arrangements between plan and providers
§ 304.17C-080 Plan for selection and reevaluation of providers
§ 304.17C-085 Definitions for section — Set fees for noncovered services in participating provider agreement prohibited — Provider charges limited to provider’s rate for services and materials — Contractual discount for covered services — Reimbursement
§ 304.17C-090 Payment of claims of dental-only benefits — Reports — Interest
§ 304.17C-100 Payment for coverage of services within scope of practice of optometrists
§ 304.17C-110 Limitation on amount of copayment or coinsurance charged for services rendered by chiropractor or optometrist
§ 304.17C-120 Prescription eye drops coverage to include refills and additional bottle if conditions met
§ 304.17C-125 Coverage for orchiectomy or orchidectomy. (Effective January 1, 2025)
§ 304.17C-130 Definitions for KRS 304.17C-130 to 304.17C-138
§ 304.17C-132 Definitions for section — Third party access to provider network contract — Prohibition against dental carrier contract cancellation
§ 304.17C-134 Conditions for dental benefit plan denial of claims requiring prior authorization
§ 304.17C-136 Definitions for section — Prohibition against payment method restrictions for dental benefit plan — Electronic fund transfer payments
§ 304.17C-138 Prohibition of contractual waiver of KRS 304.17C-130 to 304.17C-138

Terms Used In Kentucky Statutes > Chapter 304 > Subtitle 17C - Limited Health Service Benefit Plans

  • Action: includes all proceedings in any court of this state. See Kentucky Statutes 446.010
  • agent: includes managing general agent unless the context requires otherwise. See Kentucky Statutes 304.9-085
  • Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Appropriation: The provision of funds, through an annual appropriations act or a permanent law, for federal agencies to make payments out of the Treasury for specified purposes. The formal federal spending process consists of two sequential steps: authorization
  • Appropriation: means an authorization by the General Assembly to expend, from public funds, a sum of money not in excess of the sum specified, for the purposes specified in the authorization and under the procedure prescribed in KRS Chapter 48. See Kentucky Statutes 446.010
  • At the time of enrollment: means the same as defined in KRS §. See Kentucky Statutes 304.17C-010
  • Attorney: means attorney-at-law. See Kentucky Statutes 446.010
  • Biennium: means the two (2) year period commencing on July 1 in each even- numbered year and ending on June 30 in the ensuing even-numbered year. See Kentucky Statutes 446.010
  • branch budget: means an enactment by the General Assembly which provides appropriations and establishes fiscal policies and conditions for the biennial financial plan for the judicial branch, the legislative branch, and the executive branch, which shall include a separate budget bill for the Transportation Cabinet. See Kentucky Statutes 446.010
  • City: includes town. See Kentucky Statutes 446.010
  • Company: may extend and be applied to any corporation, company, person, partnership, joint stock company, or association. See Kentucky Statutes 446.010
  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Contract: A legal written agreement that becomes binding when signed.
  • Dependent: A person dependent for support upon another.
  • Electronic funds transfer: The transfer of money between accounts by consumer electronic systems-such as automated teller machines (ATMs) and electronic payment of bills-rather than by check or cash. (Wire transfers, checks, drafts, and paper instruments do not fall into this category.) Source: OCC
  • Enrollee: means an individual who is enrolled in a limited health service benefit plan. See Kentucky Statutes 304.17C-010
  • Federal: refers to the United States. See Kentucky Statutes 446.010
  • Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
  • Fraud: Intentional deception resulting in injury to another.
  • Insurer: means any insurance company, health maintenance organization, self- insurer or multiple employer welfare arrangement not exempt from state regulation by ERISA, provider-sponsored integrated health delivery network, self-insured employer-organized association, nonprofit hospital, medical-surgical, dental, health service corporation, or limited health service organization authorized to transact health insurance business in Kentucky who offers a limited health service benefit plan. See Kentucky Statutes 304.17C-010
  • Interest rate: The amount paid by a borrower to a lender in exchange for the use of the lender's money for a certain period of time. Interest is paid on loans or on debt instruments, such as notes or bonds, either at regular intervals or as part of a lump sum payment when the issue matures. Source: OCC
  • Joint committee: Committees including membership from both houses of teh legislature. Joint committees are usually established with narrow jurisdictions and normally lack authority to report legislation.
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • Limited health service benefit plan: means any policy or certificate that provides services for dental, vision, mental health, substance abuse, chiropractic, pharmaceutical, podiatric, or other such services as may be determined by the commissioner to be offered under a limited health service benefit plan. See Kentucky Statutes 304.17C-010
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
  • Outlays: Outlays are payments made (generally through the issuance of checks or disbursement of cash) to liquidate obligations. Outlays during a fiscal year may be for payment of obligations incurred in prior years or in the same year.
  • Oversight: Committee review of the activities of a Federal agency or program.
  • Personal property: All property that is not real property.
  • provider: means the same as defined in KRS §. See Kentucky Statutes 304.17C-010
  • Recourse: An arrangement in which a bank retains, in form or in substance, any credit risk directly or indirectly associated with an asset it has sold (in accordance with generally accepted accounting principles) that exceeds a pro rata share of the bank's claim on the asset. If a bank has no claim on an asset it has sold, then the retention of any credit risk is recourse. Source: FDIC
  • Restitution: The court-ordered payment of money by the defendant to the victim for damages caused by the criminal action.
  • State: when applied to a part of the United States, includes territories, outlying possessions, and the District of Columbia. See Kentucky Statutes 446.010
  • Statute: A law passed by a legislature.
  • Subpoena: A command to a witness to appear and give testimony.
  • Testify: Answer questions in court.
  • Testimony: Evidence presented orally by witnesses during trials or before grand juries.
  • Treatment: when used in a criminal justice context, means targeted interventions
    that focus on criminal risk factors in order to reduce the likelihood of criminal behavior. See Kentucky Statutes 446.010
  • Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
  • written: means letters, words, or numbers, or their equivalent, set down by handwriting, typewriting, printing, photostating, photographing, magnetic impulse, mechanical or electronic recording, or other form of data compilation. See Kentucky Statutes 45.0005
  • Year: means calendar year. See Kentucky Statutes 446.010