§ 304.38-010 Title
§ 304.38-020 Purpose
§ 304.38-030 Definitions for subtitle
§ 304.38-035 Certificate required for health maintenance organization
§ 304.38-040 Establishment of health maintenance organizations
§ 304.38-050 Evidence of coverages and charges for health care service — Exception
§ 304.38-060 Issuance of certificate of authority
§ 304.38-070 Requirements for protection against insolvency — Risk-based capital requirements
§ 304.38-073 Deposit of cash or securities for performance of obligations to enrollees
§ 304.38-075 Requirements for transfer of risk to provider — Additional reserves may be required
§ 304.38-080 Information to enrollees
§ 304.38-090 Annual report
§ 304.38-095 Application of KRS 304.2-205
§ 304.38-098 Compliance with KRS 304.18-124 to 304.18-127
§ 304.38-100 Investments
§ 304.38-110 Agent of health maintenance organization — Licensing — Continuing education — Appointment
§ 304.38-120 Financial condition, market conduct, and business practices subject to examination
§ 304.38-130 Revocation or suspension of certificate of authority
§ 304.38-140 Rehabilitation, liquidation, or conservation of health maintenance organization
§ 304.38-150 Rules and regulations
§ 304.38-170 Public documents — Statutory construction
§ 304.38-180 Prohibited practices
§ 304.38-185 Coordination of benefits
§ 304.38-190 Powers of insurers
§ 304.38-191 Conversion and continuation rights upon termination of group coverage
§ 304.38-193 Coverage for treatment for mental illness
§ 304.38-1933 Coverage for services of licensed psychologist or licensed clinical social worker
§ 304.38-1934 Coverage for medical and surgical benefits with respect to mastectomy, diagnosis and treatment of endometrioses and endometritis, and bone density testing — Duties of health maintenance organization
§ 304.38-1935 Coverage for mammograms
§ 304.38-1936 Coverage for treatment of breast cancer
§ 304.38-1937 Coverage for treatment of temporomandibular joint disorders and craniomandibular jaw disorders
§ 304.38-194 Pooling of claims experience required
§ 304.38-195 Policy covering services performed by dentist deemed to cover such services performed by physician
§ 304.38-1955 Construction of provisions for services by licensed optometrist or licensed ophthalmic dispenser to include same services from licensed physician
§ 304.38-196 Indemnity payable for services performed by chiropractors, physicians, osteopaths, or podiatrists
§ 304.38-197 Coverage for treatment of alcoholism
§ 304.38-198 Optional nursery care coverage for a well newly born child
§ 304.38-199 Coverage for newly-born child
§ 304.38-200 Application of other subtitles
§ 304.38-205 Medicare supplement coverage for persons not eligible for Medicare by reason of age
§ 304.38-210 Health maintenance organizations as insurers to offer home health care coverage — Conditions
§ 304.38-220 Long-term health care benefits
§ 304.38-225 Requirements for health maintenance organization that provides hospital benefits coverage and requires utilization review of benefits
§ 304.38-230 Funding of benefits by employer or group contract holder
§ 304.38-240 Solicitation of proposals designating medical necessity criteria for Medicaid managed care organizations — Administrative regulation

Terms Used In Kentucky Statutes > Chapter 304 > Subtitle 38 - Health Maintenance Organizations

  • 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.
  • Amortization: Paying off a loan by regular installments.
  • 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.
  • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
  • Attorney: means attorney-at-law. See Kentucky Statutes 446.010
  • Baseline: Projection of the receipts, outlays, and other budget amounts that would ensue in the future without any change in existing policy. Baseline projections are used to gauge the extent to which proposed legislation, if enacted into law, would alter current spending and revenue levels.
  • 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
  • Building: includes any structure or improvement upon real estate of a permanent nature and additionally includes any sites, structures, equipment, machinery, or devices for the purpose of establishing, developing, or furthering television or related services in aid of education or in aid of any other proper public functions, whether or not the same would otherwise be legally defined as buildings. See Kentucky Statutes 56.440
  • Building project: includes the acquisition of any real estate and the acquisition, construction, reconstruction, and structural maintenance of buildings, the installation of utility services, including roads and sewers, and the purchase and installation of equipment, facilities, and furnishings of a permanent nature for buildings. See Kentucky Statutes 56.440
  • Cabinet: means the Finance and Administration Cabinet. See Kentucky Statutes 56.440
  • City: includes town. See Kentucky Statutes 446.010
  • Commissioner: means the commissioner of the Department of Insurance. See Kentucky Statutes 304.38-030
  • Company: may extend and be applied to any corporation, company, person, partnership, joint stock company, or association. See Kentucky Statutes 446.010
  • Contract: A legal written agreement that becomes binding when signed.
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Corporation: may extend and be applied to any corporation, company, partnership, joint stock company, or association. See Kentucky Statutes 446.010
  • Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
  • Directors: when applied to corporations, includes managers or trustees. See Kentucky Statutes 446.010
  • Domestic: when applied to a corporation, partnership, business trust, or limited liability company, means all those incorporated or formed by authority of this state. See Kentucky Statutes 446.010
  • Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. Source: U.S. Courts
  • 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.
  • Federal: refers to the United States. See Kentucky Statutes 446.010
  • Fee simple: Absolute title to property with no limitations or restrictions regarding the person who may inherit it.
  • 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.
  • Headquarters: means the principal office where the principal executives of the entity are located and from which other personnel, branches, affiliates, offices, or entities are controlled. See Kentucky Statutes 56.440
  • 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
  • Incremental taxes: means , for any fiscal year of the Commonwealth, that amount of money which is equal to all tax revenues received by the Commonwealth, as taxing entity, during such fiscal year in respect of an industrial development project and improvements and equipment thereon and the products thereof, and activities carried out by the occupants and users of such industrial development project, minus an amount equal to all tax revenues received by the Commonwealth, as taxing entity, in respect of the site of the industrial development project and the same type of taxable properties and activities during the fiscal year immediately preceding the fiscal year during which construction of the improvements undertaken by an industrial entity as a result of the financing of such industrial development project commenced. See Kentucky Statutes 56.440
  • 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
  • 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.
  • Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). Source: OCC
  • Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
  • Lien: A claim against real or personal property in satisfaction of a debt.
  • Meeting: means all gatherings of every kind, including video teleconferences. See Kentucky Statutes 56.440
  • Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
  • Nonretail service and technology project: means and includes the acquisition of any real estate and the construction, acquisition, equipping, and installation thereon
    and with respect thereto of improvements and facilities necessary and useful for the improvement of that real estate for conveyance to or lease to nonretail service and technology entities to be used for call centers, centralized administrative or processing centers, telephone or Internet sales order or processing centers, distribution or fulfillment centers, data processing centers, research and development facilities, or other similar activities. See Kentucky Statutes 56.440
  • 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.
  • Owner: when applied to any animal, means any person having a property interest in such animal. See Kentucky Statutes 446.010
  • Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
  • Partnership: includes both general and limited partnerships. See Kentucky Statutes 446.010
  • Person: includes but is not limited to any individual, partnership, association, trust, or corporation. See Kentucky Statutes 304.38-030
  • Provider: means a person or group of persons licensed to practice medicine, osteopathy, dentistry, podiatry, optometry, or another health profession in a state or licensed to act as a hospital or another health care facility. See Kentucky Statutes 304.38-030
  • public funds: means sums actually received in cash or negotiable instruments from all sources unless otherwise described by any state agency, state- owned corporation, university, department, cabinet, fiduciary for the benefit of any form of state organization, authority, board, bureau, interstate compact, commission, committee, conference, council, office, or any other form of organization whether or not the money has ever been paid into the Treasury and whether or not the money is still in the Treasury if the money is controlled by any form of state organization, except for those funds the management of which is to be reported to the Legislative Research Commission pursuant to KRS 42. See Kentucky Statutes 446.010
  • Quorum: The number of legislators that must be present to do business.
  • Real estate: includes lands together with improvements thereon and appurtenances thereto. See Kentucky Statutes 56.440
  • Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
  • Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
  • Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
  • State: when applied to a part of the United States, includes territories, outlying possessions, and the District of Columbia. See Kentucky Statutes 446.010
  • State agency: means any state administrative body, agency, department, or division as defined in KRS 42. See Kentucky Statutes 56.440
  • Statute: A law passed by a legislature.
  • 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
  • Trustee: A person or institution holding and administering property in trust.
  • United States: includes territories, outlying possessions, and the District of
    Columbia. See Kentucky Statutes 446.010
  • Variable Rate: Having a "variable" rate means that the APR changes from time to time based on fluctuations in an external rate, normally the Prime Rate. This external rate is known as the "index." If the index changes, the variable rate normally changes. Also see Fixed Rate.
  • written: shall mean 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 56.440
  • Year: means calendar year. See Kentucky Statutes 446.010