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Insurance Laws

Insurance Laws2018-10-30T15:48:33+00:00
The following statutes govern optometry insurance issues in Kentucky:
Individual Indemnity Insurance

KRS 304.17-305Indemnity payable for services performed by optometrists, osteopaths or physicians [FREEDOM OF CHOICE]

 

Group Indemnity Insurance

KRS 304.18-095Indemnity payable for services performed by optometrists, osteopaths or physicians [FREEDOM OF CHOICE]

 

Blanket Indemnity Coverage

KRS 304.32-157: Indemnity payable for services performed by optometrists, osteopaths or physicians [FREEDOM OF CHOICE]

 

HMO Freedom of Choice

KRS 304.38-1955: Provisions for services by licensed optometrist or ophthalmic dispenser to include same services as licensed physician.

 

Medicaid

KRS 205.510: Definitions for medical assistance law

KRS 205.560: Reimbursements mandated or prohibited [MEDICAID PARITY]

KRS 304.17A-270: Nondiscrimination against provider in geographic coverage area [ANY WILLING PROVIDER]

 

KCHIP

KRS 205.6485 : Access [DIRECT ACCESS]

 

Health Insurance

KRS 304.17A-005(23): Definition of Health Care Provider

KRS 304.17A-150(4): Unfair Trade Practices [ALL PRODUCTS]

KRS 304.17A-166: Prescription eye drops coverage to include refills and additional bottle if conditions met [EARLY REFILL OF EYE DROPS]

KRS 304.17A-170(9): Definition of Covered Service

KRS 304.17A-173: Optometry Reimbursement, Terms and Conditions [REIMBURSEMENT PARITY, PROHIBITION ON TYPING TO VISION PLANS]

KRS 304.17A-175: Limitation on amount of copayment charged for services [PRIMARY CARE CO-PAYMENT]

KRS 304.17A-235: Notice of proposed material change in health benefit plan [NOTIFICATION OF MATERIAL CONTRACT CHANGES]

KRS 304.17A-250: Writing requirement for provider participation [REQUIREMENT FOR WRITTEN CONTRACT WITH INSURER]

KRS 304.17A-254: Duties of insurer offering health benefit plan [NO CLASS DISCRIMINATION, RIGHT TO FEE SCHEDULE, DUE PROCESS IN TERMINATION FROM NETWORK]

KRS 304.17A-270: Nondiscrimination against provider in geographic coverage area [ANY WILLING PROVIDER]

 

Managed Care

KRS 304.17A-515: Requirements for managed care plan [NETWORK ADEQUACY REQUIREMENT]

KRS 304.17A-525: Standards for provider participation, consideration of provider applications [REASONABLE STANDARDS, CRITERIA MADE PUBLIC]

KRS 304.17A-527: Filing of provider agreements, risk-sharing arrangements, contents [HOLD HARMLESS, DOWNSTREAMING]

KRS 304.17A-545: Medical director for managed care plans, quality assurance/improvement standards [UTILIZATION REVIEW BY KY OD, PROHIBITION OF CLASS DISCRIMINATION]

KRS 304.17A-560: Most-Favored- Nation provision

KRS 304.17A-575: Definition of applicant for credentialing [CREDENTIALING]

KRS 304.17A-576: Notice by managed care plan insurer of health care provider’s application for credentialing [TIME RESTRICTIONS ON CREDENTIALING]

KRS 304.17A-577: Disclosure of payment or fee schedule to managed care health provider [PROVIDER RIGHT TO FEES]

KRS 304.17A-590: Participating provider directories

 

Utilization Review

KRS 304.17A-607: Utilization reviews [UTILIZATION REVIEW REQUIRED BY KY OD]

KRS 304.17A-611: Prohibition against retrospective denial of coverage for health care services under certain circumstances

 

Payment of Claims

KRS 304.17A-700: Definitions

KRS 304.17A-702: Claims payment time frames [PROMPT PAY]

KRS 304.17A-704: Insurer’s acknowledgment of receipt of claim

KRS 304.17A-706: Contested claims, delay of payment, procedure

KRS 304.17A-708: Resolution of payment errors, retroactive denial of claims

KRS 304.17A-712: Claim refunds and overpayments

KRS 304.17A-714: Collection of claim overpayments, dispute resolution

KRS 304.17A-724: Applicability

KRS 304.17A-728: Contract disclosures of discounted fees, violations

KRS 304.17A-730: Payment of interest for failing to pay, denying or settling a claim

 

Limited Health Service Plans – Vision Care Plans

KRS 304.17C-010(3): Definitions

KRS 304.17C-020: Discrimination prohibited against any willing provider located in area [ANY WILLING PROVIDER]

KRS 304.17C-030: Disclosure

KRS 304.17C-040: Availability of provider network [NETWORK ADEQUACY]

KRS 304.17C-050: Standards for providers [REASONABLE STANDARDS]

KRS 304.17C-060: Filing of agreements, provisions of agreements [DOWNSTREAMING]

KRS 304.17C-070: Prohibition of contract to limit disclosure to enrollee, when provider cannot be penalized, disclosure of arrangements

KRS 304.17C-080: Plan for selection and reevaluation of providers [CLASS DISCRIMINATION PROHIBITED]

KRS 304.17C-085: Set fees for noncovered services in provider agreement prohibited [NONCOVERED SERVICES FEES PROHIBITED]

KRS 304.17C-100: Payment for coverage of services within scope of practice of optometrists [FEE PARITY WITH PHYSICIANS]

KRS 304.17C-110: Limitation on amount of copayment or coinsurance charged for services rendered by optometrists

KRS 304.17C-120: Prescription eye drops coverage to include refills and additional bottle if conditions met

 

Food, Drugs and Poisons

KRS 217.015(35): Definitions – Optometrists included in this chapter which covers administering or prescribing pharmaceutical agents

 

State Employee Health Insurance

KRS 18A.225: Plan must pay optometrists the same as physicians

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