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Insurance Laws

Insurance Laws 2017-03-01T11:53:18+00:00
The following statutes govern optometry insurance issues in Kentucky:
Individual Indemnity Insurance

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

 

Group Indemnity Insurance

KRS 304.18-095 – Indemnity 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