Kentucky Health Insurance Policy Requirements

Kentucky has comprehensive health insurance regulations that work alongside federal requirements. The Kentucky Department of Insurance regulates health coverage in the state under KRS Chapter 304.

Regulatory Structure

Kentucky health coverage is regulated by a single agency:

HMO Regulation in Kentucky

Kentucky regulates Health Maintenance Organizations (HMOs):

• HMOs must be licensed by the Department of Insurance
• Must meet net worth requirements
• Required to have quality assurance programs
• Must have grievance and appeals processes
• Must maintain adequate provider networks

Free Look Period

Kentucky provides free look periods for health insurance:

• Individual health insurance policies typically have a 10-day free look
• Policyholder can return for full premium refund
• Begins when policy is delivered
• No penalty for exercising this right

Kynect Health Coverage

Kynect is Kentucky's state-based health insurance marketplace:

• Kentucky operates its own state-based exchange
• Offers qualified health plans (QHPs)
• Open enrollment and special enrollment periods
• Premium subsidies available based on income
• Website: kynect.ky.gov

Exam Tip: Kentucky is one of the states that operates its own state-based health insurance marketplace, called Kynect.

Required Coverage

Kentucky mandates coverage for numerous benefits in accordance with ACA requirements:

Essential Health Benefits

All individual and small group ACA-compliant plans must cover:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorders
6. Prescription drugs
7. Rehabilitative services
8. Laboratory services
9. Preventive and wellness services
10. Pediatric services (including dental and vision)

Mental Health Parity

Kentucky requires mental health parity in health insurance:

• Mental health benefits must be equal to medical benefits
• Same copays, deductibles, and limits apply
• Covers mental illness and substance use disorders
• Applies to group and individual plans

Pre-Existing Condition Protections

Kentucky prohibits pre-existing condition exclusions in ACA-compliant plans:

Guaranteed Issue and Renewal

Kentucky requires for ACA-compliant plans:

Guaranteed Issue

• Insurers must accept all applicants during open enrollment
• Cannot deny coverage based on health status
• Applies to individual and small group markets

Guaranteed Renewal

• Insurers cannot cancel coverage except for:
  • Non-payment of premium
  • Fraud or misrepresentation
  • Plan discontinuation (with notice)